NoCVA HENCLABSI Collaborative

“Sharing Success Stories”

December 6, 2012

1

NoCVA

• This activity is part of the North Carolina Virginia Hospital Engagement Network(NoCVA)

• NoCVA is led by the NC Quality Center in partnership with the VA Hospital and Health Association

• NoCVA exists to support the goals of the CMS national effort - The Partnership for Patients

2

Partnership for Patients Goals

• By the end of 2013, preventable hospital acquired conditions would be reduced by 40%, compared to 2010

• By the end of 2013, 30-day hospital readmissions would be reduced by 20%, compared to 2010

• The CLABSI Collaborative is designed to impact the goal if reducing CLABSI’s.

3

CLABSI Rates

4

Webinar Objectives

1. Name 3 strategies that have helped other hospitals achieve and maintain success in preventing central line associated blood stream infections

2. Understand the importance that staff knowledge and leadership commitment related to patient safety have in achieving and sustaining improvement

3. List 2 ways an EMR can help with nursing compliance in central line care

5

Guest Presenters• Augusta Health, Fishersville, VA

Carolyn Palmer, BSN, RN Infection Control Stefanie Bartley, BSN, RN, Information Technology Tracy Sansossio, MSN, CMSRN, Clinical Education

• Sentara CarePlex, Hampton, VA Gail J. Rudder RN, CRNI, CIC

Infection Preventionist

• MCV-VCU, Richmond, VA Lauren R. Goodloe, PhD, RN, NEA-BC

Director of Medical & Geriatric Nursing,Administrative Director - Nursing Research andAssistant Dean for Clinical Operations, VCU School of Nursing

Darci Bowles, MS RN RRT CNML Nurse Manager North 9 Progressive Care Medicine UnitAdjunct Faculty, VCU School of Nursing

6

Getting to Zero at Sentara CarePlex Hospital

Gail J. Rudder RN, CRNI, CIC

Infection Preventionist

7

Sentara CarePlex HospitalWho We Are

•One of ten acute care hospitals within the Sentara Healthcare system,

•Located in Hampton, an independent city, in southeastern Virginia.

•A not-for-profit organization, advanced 224 bed hospital which serves a very complex and diverse community comprising urban, suburban, rural, military and transient groups.

8

Sentara CarePlex HospitalWho We Are

• Main campus includes: the Orthopedic Hospital at SCP, an Outpatient Diagnostic Imaging center , a comprehensive Cancer Institute and one of the state’s largest emergency

departments, comprising of 52 treatment beds.

9

Our History“History is the narrative of great actions with praise or blame”….Cotton Mather

• According to the Centers for Disease Prevention & Control, an estimated 41,000 Central Line Associated Blood Stream Infections (CLABSI) occur in US hospitals each year.

• Sentara CarePlex Hospital has focused on National Patient Safety Goal 7, reduction of Hospital Acquired Infections (HAIs), including CLABSI prevention.

• By April 2010, there were 4 CLABSI’s already reported in the Intensive Care Unit at Sentara CarePlex Hospital.

10

Our Journey to ZeroThe journey of a thousand miles begins with a single step”…Lao Tzu

GOAL: Reduce CLABSI within ICU to CDC/NHSN benchmark and Sentara goal of 0.28/1000 catheter days.

Hitting the Road and Getting Started Enrolled in “On The Cusp: StopBSI” initiative – April 2010 Focused on improving Safety Culture Identified responsible team Identified key areas of focus for prevention of CLABSIs -

1. Educate staff on evidence-based practices

2. Empower nurses to ensure compliance with best practice

3. Provide feedback on infection rates at the unit level

4. Assess monthly progress

11

Our Journey to ZeroWhat We Did; What We Found Out

• Identified CLABSI rate for SCPH• Assigned staff surveys on culture of safety

- “How we do things around here”

- “How will the next patient be harmed”• Assigned Preventing Errors through Safety Habits video

(CUSP) • Developed Sentara-specific “Science of Safety” video • Conducted monthly team meetings

12

Our Journey to ZeroChange is Possible!

Areas of Focus for Prevention of CLABSI

Change the culture Ensure best practice during Selection, Insertion &

MaintenanceEducate staff on best practice Improve Hand Hygiene Reduce device days Revise daily goals

13

Our Journey to Zero Has Spread

• Expanded prevention measures to Medical-Surgical Units outside of ICU

• Developed CLABSI Prevention & Performance Improvement Committee

• Reports provided to Administrative and Unit leadership on monthly basis.

• Zero CLABSI in ICU since April 2010• 18 CLABSIs were identified outside of the ICU,

CYE 2008; 7 CLABSIs identified YTD 2012

14

Our Journey to ZeroWe’ve Arrived and the Goal is Sweet!

15

Questions?

16

VCUHS CLABSI Prevention Story

Lauren Goodloe, PhD RN NEA-BC

Darci Bowles, MS RN RRT CNML

Janis Ober BSN RN CIC

17

Background

• 28 bed medicine progressive care unit• Unit is covered by 8 MD teams• MD rounds are not consistent or at set time• Attending MD’s rotate every 2 weeks• Patient safety initiative started more than 2 years

ago mandated for all employees

18

Issues

• Attending preference followed – lack consistency • Discharges are not scheduled• Admissions are not predictable based on discharge

variability• Nursing staff may not be available for rounds• Lack of engaged unit medical director

19

Interventions

• Face to face bedside nursing handoff (after listening to recorded report) at shift change When was IV access inserted? If PICC line, is it still needed? What is condition of dressing and site? Are IV fluids correct and running at correct rate?\ Is the tubing and bag within date? What is the pts. biggest safety risk? What can be done to reduce the risk? Brief overview of plan of care for next 24 hours Does the pt. have any questions?

20

Safety Huddles

• Take place after each 12 hour shift change• Conducted by the Charge RN• Review staffing levels for next 24 hours• Identify any safety issues:

Falls, high risk pts., inmates, psych pts., etc.

• Identify the most unstable or highest acuity pts.• Identify any pts. or family members requiring extra

attention

21

Results

• Concurrent Central Line related blood stream infection (CLBSI) data collection

• Each identified CLABSI is reviewed by Infection Preventionist and reported to Nurse Manager and Nurse Clinician

• Rates of infection and device utilization are monitored and reported on quarterly basis

• Incidence of CLABSI went from 1/month to less than 1/quarter applying same definition

22

Questions?

23

Augusta HealthCarolyn Palmer, BSN, RN Infection Control

Stefanie Bartley, BSN, RN, Information Technology

Tracy Sansossio, MSN, CMSRN, Clinical Education

24

Augusta Health

• 12,000+ annual admissions equally 52,000 days of care

• 60,000 + emergency visits annually• 2,300 staff members• 225 + active full time physicians• Eight bed ICU considered a Medical ICU

25

How We Made a Difference

• Physician Involvement: Physician Champion, Chair of CLABSI Prevention Team.

• Education: Physicians, LIPs, NP, PA and Nursing in new hire orientation and annually.

• Implementation of Central Line Insertion Check List/Bundle• Facility wide Daily Central Line Rounds and documentation

improvements initiative daily and quick review Status Board Dressing occlusive Dressing dated Dressing changed per protocol Daily necessary of line Increased awareness of line type, care and maintenance

26

Nursing Dashboard for Central Lines

27

EMR Documentation for CL’s

28

Nursing Documentation in EMR

29

EMR List of Patients with CL’s

30

Challenges and Monitoring

• Challenges Check list completed Follow up with compliance and education

• Monitoring IC and Directors monitor central lines Feedback given to staff at unit staff meetings and

also addressed at point of care with daily rounding

31

Lessons Learned

• Work remains Critical check list that can be incorporated into daily

rounding that includes central line awareness Hospitalists to begin intentional rounding with nursing

staff on all units January 1, 2013

• Measures of Success In 2011, CLABSI rate of 1.29 for our ICU, DU=0.7 In 2012, CLABSI rate =0, DU = 0.56

32

Questions?

33

Polling Question #1

How well did this Learning activity meet the stated objectives?

1.Excellent

2.Good

3.Fair

4.Poor

5.N/A

1. Name 3 strategies that have helped other hospitals achieve and maintain success in preventing central line associated blood stream infections

2. Understand the importance that staff knowledge and leadership commitment related to patient safety have in achieving and sustaining improvement

3. List 2 ways an EMR can help with nursing compliance in central line care

34

Polling Question #2

Amount of useful information and ideas provided:

1.Excellent

2.Good

3.Fair

4.Poor

5.N/A

35

Polling Question #3

Usefulness to my hospital of the information and ideas provided:

1. Excellent

2. Good

3. Fair

4. Poor

5. N/A

36

Polling Question #4

Chance that the information and ideas provided will improve my effectiveness and results:

1.Excellent

2.Good

3.Fair

4.Poor

5.N/A

37

Announcements

• Scheduling of Coaching Calls Review progress, barriers, issues Review Culture of Safety Survey results and Action

Plan development• Health Literacy through Teach Back Webinar

December 20th, 130-230pm• VHHA Annual Patient Safety Summit

January 31-February 1 • Pre-Summit Hospital Engagement Learning

Session January 30

38

Contact Information

Jan Mangun, MT(ASCP), MSA, CPHRM

Executive Directive, Quality & Patient Safety

jmangun@vhha.org

804-965-1202

Debbie Roddenberry

Assistant Director

droddenberry@vhha.com

804-965-5714