sepsis prevention: three part series part three...share your sepsis prevention improvement work...

© 2020, Telligen, Inc.© 2020, Telligen, Inc.

This material was prepared by Telligen, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. This material is for informational purposes only and does not constitute medical advice; it is not intended to be a substitute for professional medical advice, diagnosis or treatment. 12SOW-QIN-QIN-01/30/20-3575

Sepsis Prevention: Three Part Series – Part Three

Gina Anderson, RN, BSN

Senior Quality Improvement Facilitator

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Be sure to enter your name, title, and organization into the

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Sepsis Prevention Series: Part Three

In chat, type in the following:Organization name and state

Who is in the group with you?

Be engaged

Limit multitasking

Come prepared

Be ready to share – use chat or press *6 to speak verbally

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Agenda

Topic Who Time

Introduction Gina 5 minutes

Discussion of Action Period Everyone 15 minutes

Presentation – Infection

Prevention and Putting It All

Together As A Team

Gina 25 minutes

Discussion/Questions Everyone 10 minutes

Next Steps Moving Forward Gina 5 minutes

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▪ Recognize the importance of preventing infections to prevent sepsis

▪ Review key strategies to support your infection prevention program

▪ Describe the role of the Infection Preventionist

▪ Provide tools to help your team move forward

Objectives

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▪ Have you seen challenges with meeting as a team?

▪ Staff communication tool – Who is using a communication tool for change in condition?

▪ Goal: SBAR - 4 nurses to use over the action period

▪ Change in condition tool – Who is using a tool that helps front line staff with their communication of a change in condition?

– Goal: Stop and Watch - implement on one unit

▪ What other tools and resources did you find useful?

– Who uses INTERACT® tools?

Discussion of Action Period

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Series Part One

▪ Sepsis is…

▪ Sepsis Prevention

▪ Hand Hygiene – iScrub App

Series Part Two

▪ Early Identification

▪ Staff Communication Tools

▪ Change in Condition Tools

Quick Review

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Among adults with Sepsis:

▪ 35 percent had pneumonia or respiratory infection

▪ 25 percent had a urinary tract infection

▪ 11 percent had a GI infection

▪ 11 percent had a skin infection

Sepsis Facts:

http://www.cdc.gov/vitalsigns/sepsis/index.html

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Top Infections Causing Harm

OIG report: Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare Beneficiaries (OEI-06-11-00370), February 2014 https://oig.hhs.gov/oei/reports/oei-06-11-00370.pdf

https://www.ahcancal.org/quality_improvement/qualityinitiative/Documents/September%202014%20CMS%20Call%20to%20Action.pdf

Type of Infection Events (All harm) Preventable Events

Pneumonia and respiratory tract

15 (includes 2 cases of sepsis)

5 (33%)

Surgical site (superficial only) 14 9 (64%)

Urinary tract 14 (includes 3 cases of sepsis)

10 (71%)

C. difficile 7 5(71%)

Soft tissue and other 6 1(17%)

Vascular device associated 3 2(67%)

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Steps for Prevention of all Types of Infections

▪ Foundational and education topics

▪ Pre-Admission Practices

▪ Admission Practices

▪ Ongoing Care Practices and Monitoring

▪ Resources

All Cause Harm Prevention Change Package

https://www.telligenqinqio.com/resource/our-work/nursing-home-care/nursing-home-care-resources/2018-all-cause-harm-prevention-in-nursing-homes-change-package/

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▪ Approximately 75% of UTIs that occur in the hospital are associated with a

▪ Between of hospitalized patients receive urinary catheters during their hospital stay

▪ Estimated 93,300 UTIs in acute care hospitals –

results in discomfort, prolonged hospital

stay, increased cost, mortality

Urinary Tract Infection (UTI)

https://www.cdc.gov/nhsn/pdfs/training/2018/uti-508.pdf

▪ Yearly mortality rates estimated more than

deaths are associated with UTIs

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▪ Hydration and nutrition

▪ Provide good perineal hygiene

▪ Encourage good voiding habits

▪ Functional status

▪ Limit indwelling catheter use

UTI Prevention Strategies

Epidemiology & Prevention of UTIhttps://www.cdc.gov/nhsn/pdfs/training/2018/ltcf/epidemiology-prevention-uti-508.pdf

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Training and Competency

Remember C.A.U.T.I. to prevent CAUTI https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/resources/tools/prevent/infographic.html

Indwelling Catheter Audit Toolshttp://patientsafety.pa.gov/pst/Pages/CAUTI/hm.aspx#http://patientsafety.pa.gov/pst/Pages/CAUTI/qi_audit.aspx

AHRQ Training Tools

▪ C – Catheter removal

▪ A – Aseptic insertion

▪ U – Use regular assessments

▪ T – Training for catheter care

▪ I – Incontinence care planning

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Clostridioides difficile (C. diff)

https://www.cdc.gov/cdiff/index.htmlhttps://www.cdc.gov/cdiff/pdf/Cdiff-Factsheet-508.pdf

▪ People on antibiotics are times more likely to get C. diff while on the drugs or during the month after

▪ Within a month of diagnosis, 1 in 11 people died of a healthcare-associated C. diff infection

▪ More than of C. diff deaths occur in people 65 and older

▪ It’s estimated to cause almost illnesses in the United States each year

▪ About 1 in 5 patients who get C. diff will get it

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Prevention Strategies: C. diff

▪ Improve prescribing - Antibiotics

▪ Use standard precautions during all resident cares

▪ Report any s/s of C. diff immediately

▪ Rapidly identify and isolate

– Wear PPE – gloves and gown

– Use C. diff spore killing cleansers

– Wash hands with soap and water

– Designate equipment to only be used on the infected patient/ resident Clinical Practice Guidelines for C-diff infection - IDSA and SHEA

https://www.idsociety.org/practice-guideline/clostridium-difficile/

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Antibiotic Resistance

▪ Each year in the US at least people get an antibiotic resistant infection

▪ At least 23,000 people every year as result

▪ Up to 70% of NH residents receive courses of systemic antibiotics in a year

▪ of antibiotics prescribed in NHs may be unnecessary or inappropriate

CDC Antibiotic/Antimicrobial Threat Report https://www.cdc.gov/drugresistance/biggest_threats.html

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Prevention Strategies: Antibiotic Stewardship

▪ Every resident/patient gets optimal antibiotic treatment

▪ Communication - transfer forms

▪ Preventing infections - vaccinations

▪ Antibiotics given only when they are needed

- Right antibiotic - Right dose - Right duration

▪ Commit now to ensure antibiotic stewardship polices and practices are in place to protect residents/patients and improve clinical care

NH Antimicrobial Stewardship Guide https://www.ahrq.gov/nhguide/index.html

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https://www.train.org/cdctrain/course/1075730/compilation

https://www.train.org/cdctrain/course/1078384/

Core Elements of ABS https://www.cdc.gov/longtermcare/prevention/antibi

otic-stewardship.htmlhttps://www.telligenqinqio.com/resource/our-work/antibiotic-stewardship-in-long-term-care/antibiotic-stewardship-in-long-term-care-resources/antibiotic-time-out-checklist/

Training and Competency

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▪ Collaborates with all departments

▪ Teamwork across all departments

▪ Barriers are investigated and mitigation plans are explored – using QAPI

▪ Family and Resident/Patient education on infection prevention strategies

Infection Preventionist (IP) Role as a Facilitator

CDC NH Infection Preventionist Traininghttps://www.train.org/cdctrain/training_plan/3814

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Establish a surveillance system

▪ Includes:

– Data collection tool(s)

– Whom to report to

– Documentation for follow-up on activity

– Documentation for early detection and management

– Communication at time of a transfer

Infection Preventionist (IP) as a Detective

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Infection Risk Assessment

APIC Risk Assessment for the Infection Surveillance Programhttps://apic.org/Resource_/TinyMceFileManager/Education/ASC_Intensive/Resources_Page/ASC_Risk_Assessment_Template.docx

▪ Performed annually, updated as needed and with new risks and hazard

▪ Purpose

– Provide safe sanitary environment

– Prevent development and transmission

– Helps to identify potential hazards

– Set priorities

– Helps determine resources to prevent

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CMS LTC Infection Control Worksheet

CMS Memo Ref: QSO-20-03-NHhttps://www.cms.gov/files/document/qso-20-03-nh.pdf

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Staff, volunteers, contracting services, residents, patients, families should be aware of infection prevention practices

These include:▪ Washing hands

▪ Observing isolation protocols

▪ Vaccinations

▪ When and what signs to report for an infection

▪ Refraining from the facility when ill

▪ Practicing all infection prevention strategies

Infection Prevention – Takes A Team

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…to practice all infection prevention skills!

▪ Pledge to keep hands clean

▪ Pledge to practice standard precautions

▪ Pledge to keep the environment and equipment clean

▪ Pledge to understand and teach others

Take the Pledge…

https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/resources/tools/practice/pledge.pdf

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Questions

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Next Steps Moving Forward

▪ Continue to meet as a team – study data reports surrounding sepsis,

infection prevention practices, and readmission occurrences

▪ Create a PIP team – Use QAPI fundamentals to guide process

improvements centered around your sepsis prevention program

▪ Review the tools and resources – use the slides in the three parts

of the sepsis series to identify tools and resources you can implement for training, auditing, monitoring and tracking

▪ Commitment to sustain your efforts - ensure safe care for each

resident/patient remains to improve their quality of life

▪ Share your sepsis prevention improvement work – display for

everyone to see how their efforts are a part of this improvement process. Share with Telligen your improvement success!

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States Targeting Reduction in Infections via Engagement

▪ Includes over forty individual training modules grouped into 11 courses

CDC STRIVE Training Course

Foundational Infection Prevention Strategies

Targeted Infection Prevention Strategies

Competency-Based Training Catheter-Associated Urinary Tract Infection

Hand Hygiene Methicillin-Resistant Staphylococcus aureusBacteremia

Strategies for Preventing HAIs Central Line-Associated Bloodstream Infection

Environmental Cleaning Clostridioides difficile Infection

Personal Protective Equipment

Patient and Family Engagement

Business Case

https://www.cdc.gov/infectioncontrol/training/strive.html?deliveryName=USCDC_425-DHQP-DM9328

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▪ Infection Prevention https://www.telligenqinqio.com/?s=infection+

▪ Hand Hygiene https://www.telligenqinqio.com/?s=hand+hygiene

▪ UTIs https://www.telligenqinqio.com/?s=urinary+tract+infection+UTI

▪ Antibiotic Stewardship in Nursing Homes Toolkit https://www.telligenqinqio.com/resource/our-work/improve-your-quality-measures-do-it-yourself-toolkit/improve-your-quality-measures-do-it-yourself-toolkit-resources/antibiotic-stewardship-in-nursing-homes-toolkit/

▪ Clostridioides difficile (CDI) Prevention for Nursing Homes Toolkit https://www.telligenqinqio.com/download/24139/

▪ Environmental https://www.telligenqinqio.com/?s=environmental

▪ All Cause Harm Prevention for Nursing Homes https://www.telligenqinqio.com/resource/our-work/nursing-home-care/nursing-home-care-resources/2018-all-cause-harm-prevention-in-nursing-homes-change-package/

Telligen’s Resources

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▪ CDC Infection Control https://www.cdc.gov/infectioncontrol/index.html

▪ AHRQ – Toolkit To Reduce CAUTI and Other HAIs in LTC Facilities https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/index.html

▪ AHRQ – Toolkit To Educate and Engage Residents and Family Members https://www.ahrq.gov/nhguide/toolkits/educate-and-engage/index.html

• OSHA, Quick Reference Guide to Bloodborne Pathogen Standard https://www.osha.gov/SLTC/bloodbornepathogens/bloodborne_quickref.html

• AHFSA-CMS IP & C Resources, Including Focus on CDI Prevention https://www.telligenqinqio.com/resource/our-work/link/link-resources/c-diff-toolkit-from-ashfsacdccms/

▪ National Healthcare Safety Network https://www.cdc.gov/nhsn/index.html

▪ Agency for Toolkit to Engage Family and Residents https://www.ahrq.gov/nhguide/toolkits/educate-and-engage/index.html

▪ Patient Safety Educational Resources http://www.rochesterpatientsafety.com/index.cfm?Page=Home

Infection Control Resources

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▪ Sepsis Among the Elderly Toolkit https://www.telligenqinqio.com/resource/our-work/sepsis/sepsis-resources/sepsis-among-the-elderly-toolkit/

▪ Telligen Sepsis Resources https://www.telligenqinqio.com/?s=sepsis

▪ Test Your Knowledge: Sepsis Quiz https://www.telligenqinqio.com/our-work/care-

coordination/sepsis-quiz/

▪ CHA Sepsis Training Suite https://cha.com/quality-patient-safety/sepsis/cha-sepsis-training-suite/

▪ Stop Sepsis Now https://atlanticquality.org/initiatives/sepsis-initiative/

▪ The Rory Staunton Foundation for Sepsis Prevention https://rorystauntonfoundationforsepsis.org/

▪ Sepsis Alliance https://www.sepsis.org/itsabouttime/

▪ Agency for Healthcare Research and Quality https://www.ahrq.gov

Sepsis Resources

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Parts One, Two and Three Recordingshttps://www.telligenqinqio.com/resource/our-work/nursing-home-quality/nursing-home-quality-resources/sepsis-series-part-one/

Don’t Miss Out

https://www.telligenqinqio.com/events/

Sepsis Prevention: Three Part Series

Telligen Events

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http://www.euro.who.int/en/health-topics/Health-systems/health-workforce/news/news/2018/5/hand-hygiene-day-its-in-your-hands-prevent-sepsis-in-health-care

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Telligen QI Connect™ Team

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Thank You!

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Please complete the evaluation coming to you by email!

Gina AndersonSenior Quality Improvement Facilitator

gina.anderson@telligen.com515-223-2127