Improving Care Using Improving Care Using Frontline Action Teams: Frontline Action Teams: Reducing UTI at Langley Reducing UTI at Langley

Memorial HospitalMemorial HospitalSherman BastaracheSherman Bastarache

Amanda BordtAmanda Bordt

November 16, 2012November 16, 2012

LMH and NSQIP

Joined NSQIP in July 2011NSQIP module: procedure targeted 33 surgical beds

Team recruitment started in January 2012. Team Action started April 2012

Goal and the StatsGoal and the StatsTeam GoalTo reduce the catheter-associated urinary tract infection rate to 2% (from 3.4%) by October 1, 2012 in surgical patients at Langley Memorial Hospital

Postoperative UTI with Control Limits Trend over Time

0%

2%

4%

6%

Jun/Jul Aug Sept Oct Nov Dec Jan

LMH

NSQIP Overall mean

Upper Limit (+3 Sigma)

Lower Limit (-3 Sigma)

Overall Rate = 3.4% NSQIP - 1.4%

Gyne perineal PrepGyne perineal Prep

Stopped Routine Catheterization of Stopped Routine Catheterization of Total Joint PatientsTotal Joint Patients

Total Joint Foley insertion Total Joint Foley insertion Guideline Guideline

Criteria to insert Indwelling Foley Catheter in Total Joint PatientsCriteria to insert Indwelling Foley Catheter in Total Joint Patients

Procedures expected to last longer than Procedures expected to last longer than 5 hours5 hours

Total Hip replacements patients who meet Total Hip replacements patients who meet 1 (one)1 (one) of the following of the following criteria:criteria:

-Over the age of 80-Over the age of 80 -Obesity (BMI > 40)-Obesity (BMI > 40) -urinary incontinence or -urinary incontinence or history of urological issues / medicationshistory of urological issues / medications -Determined necessity by the surgeon-Determined necessity by the surgeon

Total Knee replacement patients who meet Total Knee replacement patients who meet 1 (one)1 (one) of the following of the following criteriacriteria

-Over the age of 75-Over the age of 75 -ASA III or greater-ASA III or greater -Obesity (BMI >40)-Obesity (BMI >40) -Urinary incontinence or -Urinary incontinence or history of urological issues / medicationshistory of urological issues / medications --Determined necessity by the surgeonDetermined necessity by the surgeon

Audits and HuddlesAudits and Huddles

New Catheter KitNew Catheter Kit

Physician Reminder StickerPhysician Reminder Sticker

This patient has an indwelling urinary catheterThis patient has an indwelling urinary catheter

Remove indwelling urinary catheterRemove indwelling urinary catheter Maintain indwelling urinary catheterMaintain indwelling urinary catheter

Signature: __________________Signature: __________________

Goal and the StatsGoal and the StatsTeam GoalTo reduce the catheter-associated urinary tract infection rate to 2% (from 3.4%) by October 1, 2012 in surgical patients at Langley Memorial Hospital

Postoperative UTI with Control Limits Trend over Time

0%

2%

4%

6%

Jun/Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May June July August

LMH

NSQIP Overall mean

Upper Limit (+3 Sigma)

Lower Limit (-3 Sigma)

Overall Rate = 2.8% NSQIP - 1.3%

A decrease of 0.6% so far, which translates to 17 UTI’s prevented!!!!!

Contact Information Contact Information Sherman Bastarache sherman.bastarache@fraserhealth.caAmanda Bordt amanda.bordt@fraserhealth.caVeronica Mills veronicamills@fraserhealth.caMohammad Khaligh-Razavi mohammad.khaligh-razavi@fraserhealth.caAmanda Crowe amanda.crowe@fraserhealth.ca

SCR: Lila Gottenbos lila.gottenbos@fraserhealth.ca Denise Sherban denise.sherban@fraserhealth.ca

QI: Michael Arget michael.arget@fraserhealth.ca

Manager: Kendalll Korda: kendall.korda@fraserhealth.ca

Surgeon Dr. Mitra Maharaj mitra.maharaj@fraserhealth.caChampion

FHA: ACS.NSQIP@fraserhealth.ca