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June 9, 2016 11:00 a.m. – 12:00 p.m. CT AHA/HRET HEN 2.0 SOAP UP WEBINAR: TIME TO SOAP UP YOUR HAND HYGIENE GAME! 1
June 9, 201611:00 a.m. – 12:00 p.m. CT
AHA/HRET HEN 2.0 SOAP UP WEBINAR: TIME TO SOAP UP YOUR HAND HYGIENE GAME!
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WELCOME AND INTRODUCTIONSMarina Levin, Program Manager, HRET | 11:00 – 11:05a.m.
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WEBINAR PLATFORM QUICK REFERENCEMute your computer
audio
Download today’s slides and resources
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AGENDA FOR TODAY
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THE “UP” Campaign: SOAP UP!Maryanne Whitney, RN, CNS, MSN & Pat Teske, RNImprovement Advisors, Cynosure Health 11:05– 11:20a.m.
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Topic Fatigue?Rejuvenate with the UP Campaign!
“UP” the Targets
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• Increases impact on harm reduction• Generates momentum in your organization • Focuses support from leadership• Engages front line staff
– Connects the dots – Creates a vision
• Applies throughout organization• Simplifies patient safety implementation• Help patients recover faster and with less
complications
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WHY THE “UP” CAMPAIGN?
ADE FTR Delirium Falls AS VTE VAE
# 1 OPIOID & SEDATION MANAGEMENT
W A K E - U P
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W Warn Yourself: this is high risk.
A Assess: use tools (STOP BANG, POSS, RASS, PA-PSA).
K Know: Your drugs, Your patient.
E Engage: Patients and Families to set realistic pain expectations, use of non-sedating analgesics, risks of opioids.
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U Utilize: dose limits, layering limits, soft and hard stops.
P Protect: The Patient…our ultimate job.
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Falls PrU Delirium CAUTI VAE VTE Readmissions
# 2 EARLY PROGRESSIVE MOBILITY
G E T - U P
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G Go: determine the resources in your institution and how you will implement a mobility program.
E Evaluate: (patient capabilities):Which scale/tool/evaluation method will you standardize on?
T Team up for progressive mobility: rehab, nursing, and respiratory join to implement the mobility plan.
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U Unite: Engage patients, families and friends in mobility progression.
PPromote progress: Measure and report unit mobility performance.
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CDI CAUTI SSI VAE CLABSI Sepsis
# 3 HAND HYGIENE
S O A P - U P
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S Scrub: for 20 seconds with the right product. Remember soap for C.diff.
O Own: your role in preventing HAIs.
A Address: immediately intervene if breach is observed.
P Place: hand hygiene products in strategic locations.
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U Update: hand hygiene products and policies as needed to promote adherence.
P Protect: patient and families, get them involved.
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TIME TO “SOAP UP” YOUR HAND HYGIENE GAME!
• Since 1847, we have understood that hand hygiene (HH) makes a difference in the spread of infections – Dr. Ignaz Semmelweis in Vienna – Childbed fever – Dr. Lister – OR – 1980’s concepts of hand hygiene in health care emerged– 2002 alcohol based hand rub adopted– 2007-2008 WHO Global clean hands initiative
• Yet the average HH compliance is 48%
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HAND-WASHING AN OLD INTERVENTION WITH A NEW TWIST
• Scrub: for 20 seconds with the right product.– Remember soap for C.diff.
• Scrub hands with appropriate agents, length of timeand with proper technique.
• Use soap and water for C.diff, minimum 15 seconds,with friction on all surfaces of the hands.
• Use alcohol-based gel, rub until dry on all surfaces ofthe hands.
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SCRUB
http://www.cdc.gov/handhygiene/
• Recognize the five moments for HH: – Before patient contact.– Before aseptic task.– After body fluid exposure
risk.– After patient contact.– After contact with patient
surroundings.
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SCRUB
http://www.who.int/gpsc/5may/background/5moments/en/
Your 5 Moments for Hand Hygiene
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• Own your role in preventing hospital acquired infections, develop automaticity in HH performance.
• Surveillance of yourself and others is a must.
• Share observation data and establish personal accountability with the health care worker.
OWN: Your Role in Prevention
• Observation and surveillance of hand hygiene is the best way to ensure appropriate compliance.
• Schedule an unscheduled observation by trained observers.• Intervene immediately if a breach in HH is observed.• Provide scripts for reminding peers to perform HH.• Promote culture of safety.
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ADDRESS
• Thoughtful and strategic placement of HH products for:– Health care workers– Visitors– Patients
• Place signage as reminders • Place gloves inside patient
rooms – Implement a “no glove
zone” outside patient rooms
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PRODUCT PLACEMENT
• Update products, equipment and policies with staff input.
• Update equipment and displays of HH product frequently.
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UPDATE
• Protect our patients from HAI by performing HH.
• Promote patient and family engagement- give them permission to “speak up for clean hands.”
• Promote patient HH for patients.
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PROTECT PATIENT
http://www.cdc.gov/handhygiene/patients/index.html
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Case Study: Hospital UPR- Dr. Federico TrillaMiriam Cotto, RN, CIC & Deborah Acevedo, MHSA | 11:20 – 11:30a.m.
HOSPITAL UPR- DR. FEDERICO TRILLA
Diraida Maldonado, MHSAChief Executive Officer [email protected]
Deborah Acevedo, MHSAQuality Director
Speaker: Miriam Cotto, RN, CICInfection Control [email protected]
Carlos Fernández, MDMedical [email protected]
• Teaching and community hospital• Board-certified physicians• Located in Carolina Puerto Rico and serves the NE Region• Capacity:
– 250 bed hospital; includes 20 mental health beds and 8 critical care unit beds – Services:
• General surgery• Bariatric surgery center• Internal medicine and sub-specialties • Pediatric and neonatal ICU• Obstetrics and gynecology• Urology• Orthopedics
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ABOUT US
In 2012 an outbreak of a multi-resistant bacteria A. baummanniwas identified in the ICU.Recommendations from the CDC and the Department of Health:
– Epidemiological Surveillance Committee : Continuous monitoring, daily meetings and reporting of
findings1. Rectal culture screening/detection of MDR-AB, with high risk ER
admissions. 2. Hand Washing3. Contact Precaution 4. General and terminal cleaning of patient rooms5. Cohort of patients with MDR-AB6. Cleaning and disinfection of Medical Equipment7. Staff Education
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IMPORTANCE OF HAND HYGIENE AT HOSPITAL UPR
• The program is directed by the Infection Control Practitioner, who reports directly to CEO.
• Our program focuses on strict compliance with Infection Control Protocols as per our institution.
• Emphasizes on evidence-based literature and guidelines by the CDC that demonstrate that handwashing is an effective universal precaution used to prevent the spread of infections.
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IMPORTANCE OF HAND HYGIENE AT HOSPITAL UPR
• Concept of infection prevention and control officers (observers) was developed
• The program is composed of:• Team of six infection prevention and control officers • Primary role is for continuous rounding to ensure compliance
with protocols:• Hand hygiene• Glo-germ technique - handwashing competency • Environmental monitoring to identify possible sources of infection• Compliance with the use of Personal Protective Equipment (PPE)• Proper handling and disposal biomedical waste• Patient room certification
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INFECTION CONTROL PROGRAM
• Strategies for handwashing compliance:– Educational workshops for the multidisciplinary team– Infection prevention and control officers (observers)– Increase availability of hand sanitizers throughout the
hospital– Hospital created an institutional policy to measure
competency and compliance of handwashing: Every 3 months clinical staff Every 6 months nonclinical staff
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OUR HAND HYGIENE OBSERVATION PROGRAM
• Progressive disciplinary action with noncompliance of protocols – Card Concept
• Yellow card: Verbal and/or written warning after discussion and re-orientation of established protocols
• Red Card: Suspension after third warning • Black Card: Dismissal after more than three cards have
been issued
The Director of Human Resources is responsible for issuing and reporting cards issued to clinical staff related to noncompliance.
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HAND HYGIENE OBSERVATION PROGRAM
• Significant reduction in hospital-acquired infections
• No cases of any new outbreaks have been reported
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IMPACT ON HOSPITAL ACQUIRED INFECTIONS
• Change with the processes with hand hygiene within the multidisciplinary staff.
• Created an awareness of the importance of handwashing as a way of preventing hospital-acquired infections.
• Factors impacting institution : – Increase in staffing– Increase in costs (cleaning agents)– Medical supplies
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ORGANIZATIONAL IMPACT
• Identify your colonized patients at risk of acquiring a multi-drug resistant organism (MDRO).
• Compose an infection prevention and control program that include observers (preferably experienced clinical personnel)
• Extend this surveillance practice to your more complex clinical practice areas.
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ADVICE FOR OTHERS
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Is it time to adjust your “Just Culture”? Maryanne Whitney, RN, MSN, CNS & Pat Teske, RN Improvement Advisors, Cynosure Health | 11:30– 11:45a.m.
• Learning, not blaming but NOT blame free
• Individuals are accountable for themselves
• The system is accountable for itself– Openness
• The outcome is irrelevant
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CULTURE OF SAFETY CHARACTERISTICS
PATIENT SAFETY AND JUST CULTURE• Individual blame is still dominant despite the literature.• No blame for system-related errors.
But what about reckless behavior or intentional acts that lead to harm?
• Just Culture theory is that balance– Certain errors do demand accountability – Establishes zero tolerance for reckless behavior
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The Right Balance
Personmodel
Systemmodel
Important to get the balance right. Both extremes have their pitfalls.
JUST CULTURE• Just Culture recognizes the difference between:
– Human error (such as slips)– At-risk behavior (such as taking shortcuts)– Reckless behavior (such as ignoring required safety steps like bar
coding and having second person double check high risk drugs), in contrast to an over reaching "no-blame" approach
• It is important to note that the response is not based on the severity of the event or the outcome.– Reckless behavior such as refusing to do a time out would merit
punitive action EVEN IF the patient was not harmed.
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• A mental slip, lapse, or mistake
• Doing other than what should have been done
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HUMAN ERROR
An unintentional act.Not a BEHAVIORAL CHOICE.
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RESPONSE TO HUMAN ERROR: CONSOLE
Refers to intentional acts that are undertaken by the free exercise of one’s judgment.
BEHAVIORAL CHOICE represents the purposeful behavior we intentionally employ while engaging in our day-to-day activities.
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BEHAVIORAL CHOICE
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AT RISK BEHAVIOR
Behavior that increases risk where risk is not recognized or is mistakenly believed to be justified
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RESPONSE TO AT RISK BEHAVIOR: COACH
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RECKLESS BEHAVIOR
A BEHAVIORAL CHOICE to consciously disregard a substantial and unjustifiable risk.
• The person engaging in RECKLESS BEHAVIOR: 1) always perceives the risk he/she is taking.2) understands that the risk is substantial.3) does not mistakenly believe the risk is justified.4) behaves intentionally.5) knows others are not engaging in the same behavior.
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RECKLESS BEHAVIOR
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RESPONSE TO RECKLESS BEHAVIOR: DISCIPLINE
JUST CULTURE ACCOUNTABILITY
• Human errors: slips, lapse or mistakes– Manage through processes, procedures, training and design– CONSOLE
• At-risk behavior: a choice-risk not recognized or believe justified– Manage through removing incentives for at risk behavior and
creating incentives for healthy behaviors and increasing situation awareness
– COACH• Reckless behavior: conscious disregard of unreasonable risk
– Manage through remedial action or punitive action– PUNISH
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• Appoint HH an Institutional priority• Promote a culture of safety• Institute consistent rules for compliance• Apply rewards and sanctions to all disciplines of health
care providers
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SUCCESS IN SOAP UP
• http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/index.html
• http://www.ismp.org/selfassessments/Hospital/2011/Default.asp
• http://www.hsl.gov.uk/products/safety-climate-tool.aspx
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RESOURCES FOR SAFETY CULTURE ASSESSMENTS
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Reflection and Discussion: Freshen UP! Pat Posa, RN, BSN, MSA, FAAN| 11:40 – 11:55a.m.
• Are you a quality lead in your organization? Share the hand hygiene statistics and the gaps in compliance within the hospital.
• Are you a unit-based clinical lead in your organization? Assemble a team to assess and develop strategies for accountability for HH. Share the message that HH protects patients from all six HAI’s.
• Are you a physician champion in your organization? Role model accountability in HH with peers.
• Are you a patient and family advocate in your organization? Interview a patient and understand the barriers for “speaking up” for clean
hands. Create patient education including recommendations for in-hospital hand
hygiene for patients.• Are you senior leadership or a board member for your organization?
Allocate necessary products, personnel, and intense strategic priority for HH compliance promoting patient recovery without secondary infections.
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NEXT STEPS
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BRING IT HOMEMarina Levin, Program Manager, HRET| 11:55– 12:00p.m.
Find more information on our website: www.hret-hen.org
Questions/Comments: [email protected]
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THANK YOU!
