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U & I Preventing UTIsPost-surgical Units at Surrey Memorial
Hospital (Orthopedics and General Surgery)
Alana CohenMargaret DykaDareena MalliPawan SindharBrenda SmithLorraine Prysunka
Susann CamusFilda GradoJas SidhuMelanie SkidmoreLeah TennantAngela Wilson
Team Members:
Quality Forum: February 28, 2013
2
Team Goal
Apply National Surgical Quality Improvement Program (NSQIP) data and methods to reduceUrinary Tract Infection rates in SMHPostsurgical Patients from 1.6% on February 29, 2012 to 0.8% by June 30, 2012
3
Improvement Strategies
Driven by front line staff
Use NSQIP risk and non-risk adjusted data to drive improvement
Apply NSQIP best practices
4
Quality Improvement Strategies Team Goals
Use Positive Deviance and TRIZ Carry out Plan-Do-Study-Act (PDSA)
cycles to test improvements and small changes
Staff and patient education Regular facilitated meetings
5
What we have done to date Developed Foley plan of care sticker for
Kardexes
PDSA Cycles performed on positioning of catheter bag, integrity of loops, catheter care and documentation of Foley plan of care on Kardex
Chart reviews
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What we have done to date con’t
Pioneered use of physician reminder sticker
Staff huddles and contests
Posters, factoids and spot checks
Patient education
7
New Initiatives
UTI Prevention Video targeting patients and staff (Collaborating with Kwantlen Polytechnic University)
Quality Dashboards to provide a visual representation of PDSA Cycle results
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PDSA cycle: Knowing why patients have a catheter, knowing the plan for removal: Orthopedics Unit
Knowing why:Orthopedics PODs 3&4: 100%
Knowing removal plan, Orthopedics PODs 3&4: 83.5%
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PDSA cycle: Knowing why patients have a catheter, knowing the plan for removal: General Surgery Unit
Knowing why, Surgical PODs 1&2: 73%
Knowing removal plan, Surgical PODs 1&2: 73%
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ResultsOverall UTI occurrence rate at Surrey Memorial Hospital from August, 2011
to December, 2012 with control limits (non-risk adjusted NSQIP data)
UCL
LCL0%
1%
2%
3%
4%
5%
6%
7%
8%
Aug
, 201
1
Sep
, 201
1
Oct
, 201
1
Nov
, 201
1
Dec
, 201
1
Jan,
201
2
Feb,
201
2
Mar
, 201
2
Apr
, 201
2
May
, 201
2
Jun,
201
2
Jul,
2012
Aug
, 201
2
Sep
, 201
2
Oct
, 201
2
Nov
, 201
2
Dec
, 201
2
Subgroup Center UCL LCLPercent
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ResultsOverall UTI occurrence rate at Surrey Memorial Hospital from August, 2011 to
December, 2012 compared to NSQIP rate (non-risk adjusted NSQIP data)
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
4.5%
Aug,2011
Sep,2011
Oct,2011
Nov,2011
Dec,2011
Jan,2012
Feb,2012
Mar,2012
Apr,2012
May,2012
Jun,2012
Jul,2012
Aug,2012
Sep,2012
Oct,2012
Nov,2012
Dec,2012
% SMH UTI % NSQIP UTI
"U & I preventing UTI" team action started
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ResultsUTI occurrence rate on the Orthopedic Unit at Surrey Memorial Hospital, August,
2011 to December, 2012 with control limits (non-risk adjusted NSQIP data)
UCL
LCL0%
2%
4%
6%
8%
10%
12%
14%
16%
Aug
, 201
1
Sep
, 201
1
Oct
, 201
1
Nov
, 201
1
Dec
, 201
1
Jan,
201
2
Feb,
201
2
Mar
, 201
2
Apr
, 201
2
May
, 201
2
Jun,
201
2
Jul,
2012
Aug
, 201
2
Sep
, 201
2
Oct
, 201
2
Nov
, 201
2
Dec
, 201
2
Subgroup Center UCL LCLPercent
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ResultsUTI occurrence rate on the Orthopedic Unit at Surrey Memorial Hospital,
August, 2011 to December, 2012 compared to NSQIP rate (non-risk adjusted NSQIP data)
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
Aug,2011
Sep,2011
Oct,2011
Nov,2011
Dec,2011
Jan,2012
Feb,2012
Mar,2012
Apr,2012
May,2012
Jun,2012
Jul,2012
Aug,2012
Sep,2012
Oct,2012
Nov,2012
Dec,2012
% SMH UTI % NSQIP UTI
"U & I preventing UTI" team action started
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Lessons learned No quick fixes Important to master the basics Essential to remind the unit and to
ensure new and casual staff are included in education
Key challenge: getting the word out and getting staff to change practice
Be persistent
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Hints for new teams 6-8 staff members is optimal Every team member is actively involved Facilitated meetings keep us on track Build in time during meetings to do PDSA
cycles Have fun Celebrate successes
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Where we are now Clear improvement in Ortho based on
data Unit Practices changing Persistence is paying off Physicians are listening to nurses’
recommendations
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Song Lyrics When we get data, we will drill down Call us high fliers, high fliers wearing
the crown Chorus: When we get data, we will drill
down Call us high flyers. High fliers
wearing the crown We will cut back, We will cut back We will cut back CAUTI rates First Verse From Surrey Downtown, Surgical Floor These are my patients, Couldn’t ask fo’
more And this is our way, I am a nurse Caring is first, knowledge we thirst Our patients come first, They’ll be the
best PDSA, we always test Patients will heal, This is for real This is our way, that’s all we can say
Sometimes we’re struggling, Getting the word out
We’re wondering, what’s that about now
We actively wait for zero point eight It’s not far away, but for now we will say
Chorus Second Verse Two person insertion is less exertion, Use the best practice, tell everyone Hold our contests, we’ve just begun There’s no easy answer, Work is the
way Let’s do this together, To make all
believers Use NSQIP best practice, To drive our
improvement We’re making our way to zero point
eight We’ll not give up, Our team is great! And we’re reminding, all the physicians We’re stickering, all our kardexes We’ll actively wait for zero point eight It’s not far away but for now we will say.
Chorus
