C2 Michael Arget - Improving Care Using Frontline Action Teams: Reducing UTI at Langley Memorial...
12
Improving Care Using Frontline Action Teams: Reducing UTI at Langley Memorial Hospital Sherman Bastarache Amanda Bordt February 28 th , 2013
Transcript of C2 Michael Arget - Improving Care Using Frontline Action Teams: Reducing UTI at Langley Memorial...
Improving Care Using
Frontline Action Teams:
Reducing UTI at Langley
Memorial Hospital
Sherman Bastarache
Amanda Bordt
February 28th, 2013
LMH and NSQIP
Joined NSQIP in July 2011
NSQIP module: procedure targeted 33 surgical beds 4.5 Operating Rooms
Team recruitment started in January 2012. Team Action started April 2012
Goal and the Stats Team Goal To 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 Prep
Stopped Routine Catheterization of
Total Joint Patients
Total Joint Foley insertion
Guideline Criteria to insert Indwelling Foley Catheter in Total Joint Patients
Procedures expected to last longer than 5 hours
Total Hip replacements patients who meet 1 (one) of the following criteria:
-Over the age of 80
-Obesity (BMI > 40)
-urinary incontinence or history of urological issues / medications
-Determined necessity by the surgeon
Total Knee replacement patients who meet 1 (one) of the following criteria
-Over the age of 75
-ASA III or greater
-Obesity (BMI >40)
-Urinary incontinence or history of urological issues / medications
-Determined necessity by the surgeon
Audits and Huddles
Physician Reminder Sticker
This patient has an indwelling urinary catheter
Remove indwelling urinary catheter
Maintain indwelling urinary catheter
Signature: __________________
What we have done so far: Practice Change Status
Re-prep perineum in gyne OR Adopted
Elimination of routine catheters
for total joint patients
Adopted
Catheterization guidelines for
total joint patients
Adopted
Change in catheterization kit in
OR and on inpatient unit
Adopted
Physician reminder sticker for
patients with foley catheters
In Progress
Team Goal
To reduce the catheter-associated urinary tract infection rate to 2% (from 3.4%) by October 1, 2012 in surgical patients at Langley Memorial Hospital
Result as of October 1st: A reduction in our overall rate of 0.5%, or, a savings of 8 UTI’s.
Since our goal date…..
Overall UTI rate 2011 – 3.2% Overall UTI rate 2012 – 2.3%
A decrease of 0.9% so far, which translates to 19 UTI’s
prevented!!!!!
Postoperative UTI with Control Limits Trend over Time
0%
2%
4%
6%
Jul-
11
Aug-
11
Sep-
11
Oct-
11
N
ov-
11
Dec-
11
Jan-
12
Feb-
12
M
ar-
12
Apr-
12
M
ay-
12
Jun-
12
Jul-
12
Aug-
12
Sep-
12
Oct-
12
N
ov-
12
Dec-
12
LMH
NSQIP Overall mean
Upper Limit (+3 Sigma)
Lower Limit (-3 Sigma)
Overall Rate = 2.6%
(1.3%)non risk-adjusted for 2745
28%
reduction
Contact Information
Sherman Bastarache [email protected] Amanda Bordt [email protected] Veronica Mills [email protected]
SCR: Lila Gottenbos [email protected]
Denise Sherban [email protected]
QI: Michael Arget [email protected]
Manager: Kendall Korda: [email protected]
Surgeon Dr. Mitra Maharaj [email protected]
Champion
FHA: [email protected]
