Countdown to ZERO

ETCH CLABSI Project for ETCH CLABSI Project for Tennessee Initiative for Tennessee Initiative for

Perinatal Quality Care (TIPQC) Perinatal Quality Care (TIPQC) and the THA Patient Safety and the THA Patient Safety

CenterCenter

“Above all, do no harm.”

Purpose your life to live Purpose your life to live your passionyour passion

Let that passion drive all Let that passion drive all that you do, every that you do, every

decision, every patient, decision, every patient, every timeevery time

We Provide GOOD CARE!……..Don’t We?

THA Patient Safety Center Kick-offTHA Patient Safety Center Kick-offIntroduction to Peter Pronovost Introduction to Peter Pronovost and the Josie King storyand the Josie King story

SEARCHING for a NICU modelSEARCHING for a NICU model THA Regional MeetingsTHA Regional Meetings

Staff ExposureStaff ExposurePassion IgnitedPassion Ignited

Our House

Freestanding 152 bed not-for-profit Freestanding 152 bed not-for-profit pediatric facilitypediatric facility

44 bed NICU employing around 180 44 bed NICU employing around 180 staff membersstaff members

600 pts/ year ADC 36, all patients out 600 pts/ year ADC 36, all patients out bornborn

58-60% of patients on TennCare58-60% of patients on TennCare Large number high risk mothers, Large number high risk mothers,

teens,substance abuse, little prenatal teens,substance abuse, little prenatal care, limited resourcescare, limited resources

Fumbling Around for a Map….. CPQCC and CPQCC and

NACHRINACHRI Search for a state Search for a state

collaborativecollaborative Team engagementTeam engagement Educational Educational

meetingsmeetings Identifying key Identifying key

stakeholdersstakeholders CDC and NHSNCDC and NHSN

Where are we starting?CLABSI NICU 2008 by Quarter

0

2

4

6

8

10

12

Q1 Q2 Q3 Q4

Infections Rate

Q1 Q2 Q3 Q4Infections 11 6 4Rate 10.7

Who is driving?

Drive culture Drive culture changechange

Engage the staffEngage the staff FOCUS GroupsFOCUS Groups Engage the parentsEngage the parents Get OUT of the Get OUT of the

way!way! Celebrate Celebrate

SUCCESSSUCCESS!!

We are LOST!!!

TIPQC!!!!!TIPQC!!!!! Like minded people with PASSIONLike minded people with PASSION CLABSI Pilot ProjectCLABSI Pilot Project

CLABSI Rate Per 1000 Central Line Days by Month, 2008-2009 East Tennessee Children's Hospital

Weight Group: All Birith WeightsUnit Type: All

7.92

8.85

3.47

11.15

0.00

2.99

9.52

4.63

3.11

4.99

9.62

0.00

3.47

0.00 0.00

4.07

0.00 0.00

3.73

0.00 0.00

2.44

3.64

2.79

4.67

1.29

2.38

3.69

3.122.83

4.87

3.06

1.16

1.93 1.76

2.83

2.171.60 1.61

1.34

0.74

0.00

-2.00

0.00

2.00

4.00

6.00

8.00

10.00

12.00

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP

Month

Rate

per

100

0 Ce

ntra

l Lin

e Da

ys

CLABSI Rate

TN Benchmark

NHSN Benchmark

Linear (CLABSI Rate)

Linear (TN Benchmark)

CLABSI Rate Per 1000 Central Line Days by Month, 2008 East Tennessee Children's Hospital

PMSCC - Pediatric Medical/Surgical Critical Care

0.00 0.00 0.00

19.23

0.00

8.26

10.00

7.52

0.00 0.00

13.16

10.10

0.00 0.00 0.00 0.00

8.62

0.00 0.00 0.00 0.000.88

3.873.15

4.55

3.214.08

6.70

2.96

1.202.22

5.46

3.63

1.68 1.74

5.75

2.463.18 3.09

2.042.78

2.02

0.00

5.00

10.00

15.00

20.00

25.00

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP

Month

Rate

per

100

0 Ce

ntra

l Lin

e Da

ys

Rate Per 1000 Central Line Days

TN Benchmark

NHSN Benchmark

Linear (Rate Per 1000 Central Line Days)

Linear (TN Benchmark)

Lessons Learned…..

Never Never underestimate the underestimate the POWER of POWER of HUMILITY and HUMILITY and TRANSPARENCYTRANSPARENCY

Follow your Follow your PASSIONPASSION

UNLEASH the UNLEASH the power of your power of your staffstaff and and parentsparents

TIPQCEast Tennessee Regional Advisory Committee (ETRAC)

Saving Lives…..Saving Lives…..Improving Improving OutcomesOutcomes