Teams: Getting Together for Change

Baystate Medical Center Adult Intensive Care

Mary Ellen Scales RN MSN CIC

Baystate Medical Center

653 beds Adult Med Surg Trauma ICU, Med Surg CICU Pediatric NICU, PICU

41,000 admissions/year and 27,000 surgeries/year

Members of UHC, Premier, IHI IMPACT and a Stand-up for Patient Safety NPSF Organization SCIP mentor hospital IHI mentor hospital NNIS member since 1994, NHSN charter member

2005 Performance improvement model: PDSA

Intensive Care HAI Patient

Safety Inspiration Teamwork and communication Engaging front line staff and unit

leaders Developing and supporting

multidisciplinary clinical champions Hand hygiene; Environmental

cleaning and disinfection Feedback and motivation

Teamwork for Patient Safety

Adult Intensive Care Facilitated by Infection Control and

Performance Improvement staff Meeting twice a month since February

2008 Walking rounds

Patients with HAI or Risk of HAI Issues with care delivery Best practice Suggestions/ Questions from staff caring

for patients

www.funinstitute.com

Performance Improvement Concepts:

IHI ‘Some is not a Number’ APIC ‘Pay it Forward’ Small tests of Change: PDSA Positive Deviance Lean Engineering

Murphy, D. Pay it forward. APIC News Fall 2007.29-33

ICU Infection Prevention Rounds

All staff including Physicians, Residents, RNs, TAs, RTs, Dietary, Pharmacy:

are invited to participate in Infection Control Rounds every second and third Friday at 11 AM starting in POD A.

Let’s work as a team to eliminate Hospital Acquired Infections.Bring your ideas!!!

CONTACT PRECAUTI ONSVI SI TORS/ VI SI ANTES:

report to the Nurses stat ion before enter ing t he room . Favor de Reportarse a la Estación de Enferm eras Antes de Entrar al Cuarto

____________________________________________________________________• PRI VATE ROOM OR COHORT; room with patient with same microorganism.___________________________________________________________________________• GLOVES: to be worn by healthcare workers entering the room.• HAND HYGI ENE: to be performed after

glove removal and before leaving the room.• Lavarse las m anos inmediatamente con detergente

ant imicrobico ante de salir del cuarto del paciente____________________________________________________________________________• GOW N: To be worn for contact with patient,

laundry, trash, patient care equipment or room surfaces.• Remove gown, then gloves, before leaving the room.• Usa una bata si anticipa que su ropa tendré contacto

con el paciente, medio ambiente, o art ículos en el cuarto del paciente.____________________________________________________________________________• CLEAN AND DI SI NFECT all equipment between patients and when leaving this

room. Remember to clean stethoscopes.An alcohol wipe or hospital disinfectant can be used.

____________________________________________________________________________• TRANSPORT: Out of room for essential

purposes only. Maintain precautions during transport. ___________________________________________________________________________

ICU

ICU CLABSI rate 2004-2008

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2

4

6

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12

14

16

BS

I/100

0 L

ine

day

s

CVL BUNDLE

Antimicrobial CVC

CHG Prep

CHG Dressing

ICU VAP Rate 2004-2008

0

2

4

6

8

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14

16

VA

P/1

000

Ven

t day

s

VAP Bundle

CPOE Vent care set

IC-PI Rounds

ICU

Unit PI Board record to break

Motivation!

CICU

CICU Combined Medical and Surgical CLABSI 2006-2008

0

1

2

3

4

5

6

7

Q1-06 Q2-06 Q3-06 Q4-06 Q1-07 Q2-07 Q3-07 Q4-07 Q1-08

CL

AB

SI/1

000

line

day

s

IC PI teamCHG prep

CICU Combined Medical and Surgical VAP 2006-2008

0

1

2

3

4

5

6

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9

10

VA

P/1

000

Ven

t D

ays

IC PI Team

CPOE Vent Care set

VAP Bundles

CICU Unit PI

Board Record to Break

Measurement Tools

NHSN Criteria for CLABSI and VAP IHI Days between HAI IHI Bundle Compliance measurement

Real Tools:

Positive Deviance

Massachusetts Coalition program Focus on MRSA

Western Massachusetts regional program this Spring Sharing implementation BMC: Expanded to include all infections with

prevention as the key

Positive Deviance

Identified issues with increased rates of HAI

Brought to CICU and ICU CICU CPC team ICU PI team

Rounds concept developed Engagement of bedside and support staff Empowerment for improvement Personalization of each HAI

‘Some is not a number’

A person is not a number…Goal is to personalize each HAI

Do you know Do you know

who your numbers are?who your numbers are?

Each one unique,

A loved one, A family member, friend or someone you have just met

PDSA: Our PI model

LEAN Engineering concepts

Simplification Standardization Automation Redundancy Recovery methods and Strategies Visual Cues Right sources, roles and

responsibilities Autonomy, empowerment Supportive Culture

Feedback from Rounds: Bedside staffIssues identified, Areas to follow up on:

VAP: HOB:

Bed elevation and sliding down….. Elevate HOB for those w/ trach as well as ETT Guesstimating HOB height

Oral Care: Availability of Oral care supplies, visual cues Toothbrush too big, or No teeth. Still need oral care? Patients that cannot be elevated to 300 need more

aggressive mouth care and suctioning ETT holders changed, ETT tubes keeps sliding Enteral feed residuals and ventilated patients

CLABSI: Attire for assistants as well as monitoring

staff IV team does not support critical care

sites Turn off portable fans when inserting

CVL Dedicated ports/lines for TPN? Specifics regarding changing IV tubing

and time

Feedback from Rounds: Bedside staffIssues identified, Areas to follow up on:

Feedback from Rounds: Bedside staffIssues identified, Areas to follow up on:

Cleaning and Disinfection: New beds in the ICU ? About cleaning How can staff tell items have been cleaned? What are staff responsibility regarding

cleaning and disinfection of patient care supplies?

What about C dif rooms? Who is cleaning

WOW units? Request for keyboard cover Dopplers? Request for Wipes to be placed in rooms Monitoring devices (thermometers) between uses Bedside tables

Feedback from Rounds: Bedside staffIssues identified, Areas to follow up on:

Hand Hygiene: Request for more AHR products, increased

availability Request for hand lotion Want dispensers highlighted for increased

visibility Dispenser issues with tab not removed Resident HH education, Glitterbug tool HH Observations done during rounds Request for feedback mechanism for those

non-compliant with HH All visitors should wash their hands upon

entering and leaving the room

Paying it Forward

Stories: ICU HOB compliance support CICU supply management

challenges

The Future of our Teams

Continue to meet Share ideas and outcomes Engage those who can offer support Learn from other teams Celebrate successes and continue to

work on areas for improvement

 "...a Hospital...should do the sick no harm."Florence Nightingale, Notes on Hospitals, 1859

Teamwork, Targeting Zero………….

Thank you.

For more information; contact Mary.ellen.scales@bhs.org