c. difficile prevention collaborative: principles and practice in massachusetts cdc call september...
TRANSCRIPT
C. Difficile Prevention Collaborative:Principles and Practice in Massachusetts
CDC call
September 28, 2010
www.macoalition.org
1
2
Susanne Salem-Schatz, Sc.D. , principal of Health Care Quality Initiatives, is Program Director for the Massachusetts C. difficile Prevention Collaborative. She partners with Paula Griswold in the development and management of the Collaborative, and also serves the role of improvement advisor to the Collaborative. Dr. Salem-Schatz’s practice is split into the areas of quality improvement and healthcare improvement program evaluation.
Paula Griswold, MS is Executive Director of the Massachusetts Coalition for the Prevention of Medical Errors. The Coalition was established to improve patient safety and reduce medical errors. It is a statewide public-private partnership of state and federal government officials, professional associations representing hospitals, physicians, nurses, and long-term care institutions, professional liability organizations, researchers, consumers, purchasers. [email protected]
Who is on today’s call
3
Eileen McHale, BSN, RN, is an experienced registered nurse with a background in clinical care, patient safety, public policy and infectious disease. A member of the Massachusetts Department of Public Health staff since 2001, Eileen currently serves as the American Recovery and Reinvestment Act Healthcare Associated Infection Coordinator. She received her BSN from Boston College, Chestnut Hill, MA . [email protected]
Sharon Benjamin, Ph.D. principal of Alchemy, specializes in organizational behavior and leadership development. She divides her time between consulting and teaching, and is a co-author of a new book on Positive Deviance in healthcare. Dr. Benjamin worked with Plexus Institute on early groundbreaking applications of the Positive Deviance approach to the prevention of hospital acquired infections. [email protected]
Who is on today’s call
Plan for Today
Infection prevention in Massachusetts Structure of our HAI working group Core principals guiding our learning
collaborative Theory and examples from LS1
Preview some of the CDI prevention activities
4
Handouts Agenda Practice Opportunities for CDI Prevention Pulling it together WHAT- HOW-WHO-WHEN
5
Infection Prevention: a MA Priority
Massachusetts Department of Public Health (MDPH)
Mandate: 2006 legislation directed MDPH to develop a Statewide Infection Prevention and Control Program
Development: Program was guided by recommendations of an HAI Expert Panel
Structure: Program includes state regulatory and survey agency, bureau of infectious diseases and the Betsy Lehman Center for Patient Safety
Leadership: Senior bureau directors accountable for program progress and advancement
Focus: Meaningful data for public reporting, provision of support for collaborative learning and promotion of preventive best practices
Ongoing Guidance: Multidisciplinary Technical Advisory Group (TAG)
6
Infection Prevention: a MA Priority
Massachusetts Coalition for the Prevention of Medical Errors1
Partnership with MA Hospital Association History of Learning Collaboratives
Medication Reconciliation and Critical Test Results History in Infection Prevention (2007-2010)
Leadership series Improvement Collaborative for hospitals teams CUSP
1www.macoalition.org 7
Infection Prevention: a MA Priority
Masspro: QIO 9th Scope of Work: MRSA project with 5 hospitals
Institute for Healthcare Improvement Sit on Coalition Board Infection prevention Breakthrough Series CDI Prevention Expedition
Centers for Disease Control Resources and experts
8
Building & Maintaining Relationships
Coalition participation in DPH Leadership meetings
Coalition membership on TAG Respectful collaboration
Review plans, agendas materials with DPH partners
Engage experts across the State
9
Collaborative Advisors Representation from
Infection Prevention Infectious Disease Hospital Quality Pharmacy
Collaborative & program planning Combination of formal calls and informal
contact.
10
Guiding Collaborative Principles
1. Relationship – centered approach
2. Importance of engaging leadership and the front lines
3. Create opportunities for active learning Face to face meetings Expert and peer support conference calls
4. Combine existing evidence with opportunities for discovery and reinvention
11
Relationship-Centered Approach Began with needs assessment calls to identify
priorities: participants set the agenda Keep attention and focus on the work
Jumpstart conversation on the list serve Periodic phone calls to follow up on activities,
reports and measures Create opportunities for teams to get to know
each other
12
Engaging Leadership and the Frontline
Kickoff conference call for leaders Presentations by hospital CMO and CNO about
leadership approaches they use to support infection prevention.
Require multidisciplinary teams for collaborative participation
13
Engaging Leadership and the Frontline
Infection Preventionist*
CMO / CNO / Other executive
sponsor Physician champion
*Preferably not the team leader
Nurse champion Environmental
Services Laboratory Pharmacy Front line staff
from pilot units
14
Teams may include:
Engaging Leadership and the Frontline
Keeping engagement strong Communications with executive sponsors Monthly conference calls for the whole team
Expert calls Coaching and sharing calls
Stay on the radar Promote listserve conversation Periodic calls to individual team leaders
15
Create Opportunities for Active Learning
Incorporate principles of adult learning into face-to-face meetings Begin meeting with active conversation across
teams Opportunities and tools to encourage reflection
and discussion between speakers Some tools
Presentations on process as well as content Practice new behaviors
16
Create Opportunities for Active Learning
Purposeful pursuit of participation and conversation on coaching calls Be familiar with team progress before the call Recruit team leaders to jumpstart the conversation Observe: what questions lead to conversation?
What’s up this month? What could we do that would be helpful?
17
Balance Evidence with Opportunities for Discovery and Reinvention
Offer opportunities to learn and share Encourage self discovery and re-invention
People own the ideas that they create or adapt to their setting. Combine ‘best practices’ with self organizing approaches
Encourage reflective learning small tests of change – PDSA cycles multiple roles for data and measurement
18
Balance Evidence with Opportunities for Discovery and Reinvention
Informed by principles of Positive Deviance1
Staff ownership NOT buy-in therefore nothing about me without me
Focus on existing & latent solutions using available resources
Shift from telling to asking Emphasize local innovation and small changes Solution-centric
19
1Singhal, A., Buscell, P., & Lindberg, C. (2010) Inviting Everyone: Healing Healthcare through Positive Deviance, Bordentonwn, NJ: Plexus Press
Putting Learning & Discovery into Action
Practice Opportunities for CDI Prevention Combined guidance from multiple sources
Pulling it together What do we do now? What keeps us from doing it all the time?
What else could we try?
WHAT- HOW-WHO-WHEN Practice Recommendation Changes we can try Who needs to be in the room? (Think beyond the usual suspects) How will we know it’s working? (Measures) What will we do next week?
20
MA CDI Prevention Collaborative Kickoff: June 2010
Some things teams are doing
Screening guidelines Lab processing protocols Cleaning assessment, process and products Contact precautions Cohorting policy Hand hygiene Antibiotic stewardship
22
How are teams doing it
Conducting small tests of change We will be testing our new policy changes on 3 pilot units.
Creating efficiencies Testing for C. difficile is now being done 24/7 using Cepheid GeneXpert.
The test is so specific and sensitive that the presence of the organism can be confirmed by testing one specimen. Staff no longer need to test three specimins from the same patient.
Communicating with leadership This work is reported through the Infection Control Committee, Quality &
Pt. Safety Council, Medical Executive Committee, and ultimately to the Board of Trustees. We have received full support for the initiative from these bodies.
23
How are teams doing it Engaging front line staff
I was delighted that utilizing the front line staff increased staff participation and was encouraged by the honest responses.
Changing the culture We are bringing human resource to the table to address staff accountability
relative to Infection Prevention Practices
Strengthening relationships and having fun The Infection Prevention Department and the Environment of Care Department
are sponsoring a fair, with a competition among EOC teams to clean rooms that have been marked with a substance that is revealed with ultra-violet light. There will be prizes!
24
Still Learning
Stay tuned…….
25