NICU CLABSI Affinity Group Meeting September 12, 2012

NICU CLABSI Affinity Group MeetingSeptember 12, 2012

Denise Flook, RN, MPH, CIC HAI Collaborative Lead

Vice President, Infection Prevention/Staff Engagement

Learn. Act. Improve. Spread.Learn. Act. Improve. Spread. Keep the Drum Beat Keep the Drum Beat Going.Going.

Learning Objectives

1. Identify what barriers have been encountered to effectively reduce CLABSI in NICU.

2. Discuss how these barriers have been overcome in other hospitals.

3. Outline what specific actions you will do in the next week based on this information.

4. Identify the action steps your team should complete before the October meeting.


Framing Our Meeting

• Putting Patients First: Preventing All Cause Harm

• Think of what has worked to remove barriers to achieving the CLABSI goal.

• What could you add/adapt to identify and address the real barriers in your hospital

• Think about what insights you gained


Refocus Our Goals

• Reduce Hospital Acquired Conditions by 40%– CLABSI HAC Rate 0.67 per 1000 discharges

• CLABSI: <1/1000 central line days

• HHS HAI Action Plan 2013 Goals

– CLABSI: Standardized Infection Ratio (SIR) less than 0.5

– CAUTI: 25% reduction in rates


Standardized Infection Ratio (SIR)


OUR PROGRESS SO FAR


NICU CLABSI Affinity Group

2010 Y 34 32.150 13172 2.59 1.058 0.3951 0.732, 1.478

2011Q1 6 7.527 3236 1.85 0.797 0.3745 0.293, 1.735

2011Q2 5 6.763 2818 1.77 0.739 0.3320 0.240, 1.725

2011Q3 5 8.052 3561 1.41 0.621 0.1865 0.202, 1.449

2011Q4 8 9.303 4005 2.00 0.860 0.4165 0.371, 1.694

2012Q1 7 7.042 2893 2.42 0.994 0.5925 0.400, 2.048

2012Q2 8 6.344 2765 2.89 1.261 0.3046 0.544, 2.485

summaryYQ

InfCount

numExp numCLDays

CLABSI Rate/1000 central

line days

SIR SIR_pval SIR95CI


NICU CLABSI SIR

* 2012Q2 Incomplete data


What Did You Learn

• When you asked 5 staff what the process is to insert a central line did they know the who, what, where, how, when and with what of the process?

• Did you identify any barriers to compliance to the process?


Types of Barriers

• Provider– Knowledge, attitude – Current practice habits

• Guideline-related– Applicability to patient population– Evidence supporting guideline– Ease of compliance

• System– Supplies/equipment unavailable– Inadequate or poorly designed tools and technologies– Poor organizational structure (e.g., staffing, policies)– Inadequate leadership support– Unit/hospital culture– Inadequate feedback mechanisms– System ambiguities

• Other


Steps of Barrier Identification and Mitigation Tool (BIM)*

• Step 1: Assemble the interdisciplinary team

• Step 2: Identify barriers

– Observe the process

– Walk the process

– Ask about the process

• Step 3: Summarize barriers in a table

• Step 4: Prioritize barriers

• Step 5: Develop an action plan for each prioritized barrier

.* Gurses et al. (2009) A practical tool to identify and eliminate barriers to evidence-based guideline compliance. Joint Commission Journal on Quality and Patient Safety 35(10):526-532


Barrier Identification Form


Barrier Summary and Prioritization

Barrier Relation to Guideline

Source Likelihood Score*

SeverityScore†

Barrier Priority Score‡

Target for this QI cycle?

Central line cart missing items (especially late in the afternoon)

Hand washing ObserveAsk

4 3 12 Yes

Full barrier precautions and clean skin with chlorhexidine

ObserveWalk

3 3 9 Yes

*Likelihood score: How likely will a clinician experience this barrier?1.Remote 2. Occasional 3. Probable 4. Frequent

†Severity score: How likely will experiencing a particular barrier lead to non-compliance with guideline?1.Remote 2. Occasional 3. Probable 4. Frequent

‡Barrier priority score = Likelihood score X Severity score


Development of Your Action Plan

*Potential impact score: What is the potential impact of the intervention on improving guideline compliance?0. No impact 1. Low 2. Moderate 3. High 4. Very high †Feasibility score: How feasible is it to take the suggested action?0. Not feasible 1. Low 2. Moderate 3. High 4. Very high ‡Action priority core = Potential impact score X Feasibility score

Prioritized barriers

Potential Actions

Source Potential Impact Score*

Feasibility Score†

Action Priority Score‡

This QI cycle?

Action Leader

Performance Measure(Method)

Follow-up Date

Difficult for providers to cleanse their hands prior to performing central line insertion

Install sinks in rooms Observe 3 0 0 No

Place alcohol-based hand sanitizer in rooms

ObserveAsk

Walk4 4 16 Yes KM

Compliance with hand cleaning(observation)

2 months


All Teach – All Learn: Barriers?? What Barriers?

• Name one barrier you have experienced in your journey

• How did your hospital overcome this?

• What is one small step you can make in the next week to identify and address a barrier?

• What help do you need?


Reliable Systems Process Design Education

• Join the HAI collaborative meeting on October 10 from 11 am – 12:30 pm.

• Dr. Resar will walk through an HAI example of how to have front line staff create and test the process needed to keep patients safe.

• If you missed the RSPD Overview presentation you can listen to the recording and download materials at the HAI meetings page. Look under July 17 meeting.

• We will have an open mic meeting from 10 -11 for those who want to call in and network but no formal presentation.


Next Steps: To be completed by October 10 Meeting

1. Meet with your team to assess barriers.

2. Prioritize barriers.

3. Determine a course to improve

4. Listen to the Reliable System Process Design webinar recording. Go to the link below and go to the July 17 HAI meeting information. The link to the recording and presentation is under this.

5. Complete the meeting evaluation by September 18

6. Submitted August Process Measure Data collection by September 26


Action Step

What is one action you will take in the next week to prevent CLABSI in your unit?


CONTACT INFORMATION

Denise Flook

[email protected].

770-249-4518

NICU CLABSI Affinity Group Meeting September 12, 2012

Documents

Transcript of NICU CLABSI Affinity Group Meeting September 12, 2012