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Colorectal Bundle: A Multi-disciplinary Teamwork Approach to ...
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Colorectal Bundle: A Multi-disciplinary Teamwork Approach to Reduce Surgical Site Infections Rena Thompson, APN, MSN, CNS-BC, Rachel Marrs, RN, MSN, Sandra Schulz, RN, BSN , Konstantin Umanskiy, MD, and Vivek Prachand, MD, FACS Background Aims The Intervention Lessons Learned The Surgical Quality and Pa3ent Safety Improvement Commi;ee implemented the colorectal bundles to reduce the SSI rates by 20% to improve pa3ent safety in the periopera3ve phase of care. The Surgical Quality and Pa3ent Safety Improvement Commi;ee proposed the Colorectal Bundle. The colorectal surgeons met collec3vely to develop and implement a cohesive Colorectal Bundle. • The surgical providers in the clinic should prescribe mechanical bowel prep, An3bio3c Prophylaxis (if indicated), Clear liquid diet, Preopera3ve bathing, and Educa3on. • In the preopera3ve phase of care, the RN should ensure the pa3ent had taken oral an3bio3cs, mechanical bowel prepara3on and pre opera3ve bathing. • In the intraopera3ve phase of care, the surgical team should provide consistent applica3on of the skin prepara3on to the surgical incision area. The scrub nurse/technician should ensure a set of closing instruments and an addi3onal protec3on of ioban drape was used for open and laparoscopic cases. During the surgical procedure, the surgical team should not cross contaminate instruments and/or supplies. At the closure of the surgical procedure, the surgical team should change gloves and gowns depending on a cleancontaminated versus contaminated case. The implemen3ng of the colorectal bundle provided an opportunity for mul3disciplinary teams to work. • Interdisciplinary team work is important in implemen3ng an ini3a3ve that crosses mul3ple departments and surgical providers. • Communica3on is necessary when implemen3ng a quality project across the surgical and nursing service. • The use of consistent audits provided the surgical providers and nursing a benchmark of the necessary steps to improve the ini3a3ve. Next Steps Results The Infec3on Control (IC) department facilitated audits to ensure the Colorectal bundle was being appropriately followed in the periopera3ve seRngs. The IC personnel performed chart reviews to monitor the clinic implementa3on of the colorectal bundle. ASer the full implementa3on of the colorectal bundles, the SSI rates have decreased. The impact of the colorectal bundle has decreased colorectal pa3ent complica3ons. The SSI rate has reduced to 2.2% from 21.8%. The goal of the surgical quality commi;ee is to reduce the current rate from 10% . The colorectal bundle provided a consistent prac3ce of colorectal pa3ents and ul3mately reduced the SSI rate. The Surgical Services annual Surgical Site Infec3ons (SSI) rate was increasing in colorectal cases at the UCM. In the first month of the 2014 fiscal year the SSI rate was at 21.8%. The 2014 goal of the Surgical Quality and Pa3ent Safety Improvement Commi;ee was to have a 20% reduc3on in SSI rates. Before implementa3on of the colorectal bundle, the colorectal pa3ent did not receive the following consistent prac3ce: Clinic visit: prescribe mechanical bowel preps and oral an3bio3cs Intraopera3ve phase of care: • Pa3ent’s surgical skin prepara3on was not applied in a consistent manner. Draping and isola3ng of contaminated supplies was not a consistent prac3ce across surgical providers and surgical team members. This inconsistency created a poten3al for SSI rates to increase. The Surgical Quality and Pa3ent Safety Improvement Commi;ee will con3nue to monitor and audit SSI rates for colorectal cases. • Promote Pa3ent teaching in the clinics regarding the Colorectal interven3ons. • Create consistent colorectal pa3ent care workflow among the residents and preopera3ve nursing Contact: Rena Thompson, APN, MSN, CNS-BC; [email protected]
Transcript of Colorectal Bundle: A Multi-disciplinary Teamwork Approach to ...
Colorectal Bundle: A Multi-disciplinary Teamwork Approach to Reduce Surgical Site Infections
Rena Thompson, APN, MSN, CNS-BC, Rachel Marrs, RN, MSN, Sandra Schulz, RN, BSN , Konstantin Umanskiy, MD, and Vivek Prachand, MD, FACS
Background Aims
The Intervention
Lessons Learned
The Surgical Quality and Pa3ent Safety Improvement Commi;ee implemented the colorectal bundles to reduce the SSI rates by 20% to improve pa3ent safety in the periopera3ve phase of care.
The Surgical Quality and Pa3ent Safety Improvement Commi;ee proposed the Colorectal Bundle. The colorectal surgeons met collec3vely to develop and implement a cohesive Colorectal Bundle. • The surgical providers in the clinic should prescribe mechanical
bowel prep, An3bio3c Prophylaxis (if indicated), Clear liquid diet, Pre-‐opera3ve bathing, and Educa3on.
• In the preopera3ve phase of care, the RN should ensure the pa3ent had taken oral an3bio3cs, mechanical bowel prepara3on and pre-‐opera3ve bathing.
• In the intraopera3ve phase of care, the surgical team should provide consistent applica3on of the skin prepara3on to the surgical incision area. The scrub nurse/technician should ensure a set of closing instruments and an addi3onal protec3on of ioban drape was used for open and laparoscopic cases. During the surgical procedure, the surgical team should not cross contaminate instruments and/or supplies. At the closure of the surgical procedure, the surgical team should change gloves and gowns depending on a clean-‐contaminated versus contaminated case.
The implemen3ng of the colorectal bundle provided an opportunity for mul3disciplinary teams to work. • Interdisciplinary team work is important in implemen3ng an
ini3a3ve that crosses mul3ple departments and surgical providers. • Communica3on is necessary when implemen3ng a quality project
across the surgical and nursing service. • The use of consistent audits provided the surgical providers and
nursing a benchmark of the necessary steps to improve the ini3a3ve.
Next Steps
Results
The Infec3on Control (IC) department facilitated audits to ensure the Colorectal bundle was being appropriately followed in the periopera3ve seRngs. The IC personnel performed chart reviews to monitor the clinic implementa3on of the colorectal bundle. ASer the full implementa3on of the colorectal bundles, the SSI rates have decreased. The impact of the colorectal bundle has decreased colorectal pa3ent complica3ons. The SSI rate has reduced to 2.2% from 21.8%. The goal of the surgical quality commi;ee is to reduce the current rate from 10% . The colorectal bundle provided a consistent prac3ce of colorectal pa3ents and ul3mately reduced the SSI rate.
The Surgical Services annual Surgical Site Infec3ons (SSI) rate was increasing in colorectal cases at the UCM. In the first month of the 2014 fiscal year the SSI rate was at 21.8%. The 2014 goal of the Surgical Quality and Pa3ent Safety Improvement Commi;ee was to have a 20% reduc3on in SSI rates. Before implementa3on of the colorectal bundle, the colorectal pa3ent did not receive the following consistent prac3ce: Clinic visit: prescribe mechanical bowel preps and oral an3bio3cs Intraopera3ve phase of care: • Pa3ent’s surgical skin prepara3on was not applied in a consistent
manner. Draping and isola3ng of contaminated supplies was not a consistent prac3ce across surgical providers and surgical team members.
This inconsistency created a poten3al for SSI rates to increase.
The Surgical Quality and Pa3ent Safety Improvement Commi;ee will con3nue to monitor and audit SSI rates for colorectal cases. • Promote Pa3ent teaching in the clinics regarding the Colorectal
interven3ons. • Create consistent colorectal pa3ent care workflow among the
residents and pre-‐opera3ve nursing
Contact: Rena Thompson, APN, MSN, CNS-BC; [email protected]
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Baseline: 58.0% Standard HH Campaign: 72.3%, p<0.001 Giving for Performance: 83.9%, p=0.003
