Developing Education, Training and Competence on the Wards

Transcription

1 Developing Education, Training and Competence on the Wards Janet Shepherd Deputy Chief Nurse, NHS London & Pat Cattini Head Infection Prevention and Control Nurse Royal Brompton and Harefield NHS Trust

2 If you cannot measure it, you cannot improve it Lord Kelvin

3 Define the problem Data information Production of KPI scorecard Feedback to wards Ensuring staff recognise that reduction of infection is a trust priority Decide how to further cascade information

4 The score card The score card Use of SPC provides clarity Define in or out of control Know when and where to target Can demonstrate results Clostridium Difficile Toxin From April 2006 Over 65 yr old +ve Patients from KHT requests Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08

5 Weekly SPC Weekly SPC Clostridium Difficile by Week (hospial cases only all ages) 04/09/ /09/ /10/ /10/ /10/ /11/ /11/ /12/ /12/ /01/ /01/ /02/ /02/ /03/ /03/ /04/ /04/ /04/ /05/ /05/ /06/ /06/ /07/2007 C Diff Positive Cases Average Control Limit U Li i Week beginning Number of cases

6 Tackling the problem Cleanliness Antibiotic Management Isolation Education Education Education!

7 Educational Opportunities Mandatory Infection Control Update Corporate Induction Junior Doctor Training Medical Staff Committee Audit/ Governance Meetings Divisional Board Meetings Sisters/ Senior Nurse Meetings Infection Control Committee Support Services Training Ward Based Training Hospital Management Committee

8 Overall aim Education + Information = Individual s recognition of their responsibilities in reducing HCAI

9 Responsibilities reflected in Job descriptions KSF e-tool gateway for career progression

10 Recognise the problem Alert Infection Prevention and Control Team Understand what to do Conformity use of BSC

11 Training Ward visits by Infection Prevention and Control Team, - provide on the spot guidance, and re-enforcement DNS / Matrons walk rounds, - heighten awareness on wards

12 Changing Culture and Practice Unconscious incompetence Unconscious competence

13 Developing the Standards Hand Hygiene policy reviewed and expectations made explicit Increased ward based training HCAI Project Team Weekly hand hygiene audits Feedback of results

14 Hand Hygiene Results by Ward/ Hand Hygiene Results by Ward/ Department Hand Hygiene Audit by Ward, week commencing: 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% A&E Blyth Bronte Derwent Hamble Hardy Keats Kennet MAC Winter Cambridge Canbury Claremont Alex Astor Sycamore DSU ITU Isabella Sunshine Maple Maternity NNU Worcestor Coombe Main OPD Orthopaedic Physio OPD Radiology REU Theatre 22-Mar-07 Medical OrthopaedicSurgeryCritical Care Ward Women & Child Health Ward Target (Aug 06) Other Score

15 Hand Hygiene Results by Staff Group Hand Hygiene Audit by Staff Group, Week Commencing: 22-Mar-07 Score 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Nurses Doctors AHPs Contract Staff Other Trust Staff Staff Group 22-Mar-07 Target (Aug 06)

16 Hand Hygiene Trend Hand Hygiene Trend Hand Hygiene Audits 100% 95% 90% 85% 80% 75% 70% 65% 60% 55% 50% 03/07/ /07/ /07/ /08/ /08/ /09/ /09/ /10/ /10/ /11/ /11/ /12/ /12/2006 Score 01/01/ /01/ /01/ /02/ /02/ /03/ /03/2007 Date Hand Hygiene Audit Result Target

17 Other initiatives Audit of Isolation Practice Feedback to staff Re-iterate good practice Staff knowledge questionnaire Use of HII CDT tool

18 Competency assessment Observations of care Question staff knowledge Use HII tool Use E-Tool as part of KSF Staff JDs Performance appraisal Not easy!!

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20 Impact on CDT rates 2006 CDT all requests ve Hospital Requests +ve Community Requests All +ve Jan-06 Mar-06 May-06 Jul-06 Sep-06 Nov-06

21 Impact 2007 Clostridium Difficile Toxin From April 2006 Over 65 yr old +ve Patients from KHT requests Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08

22 Lessons CDT is a diagnosis in its own right and requires specific management Implementation of BMA e-tool CDT Further use of High Impact Intervention Tool

23 Recommendations Ensure clear management directives Strong leadership Personal accountability Zero-tolerance poor practice Do everything

24 If you get caught on the way home