Willamette Valley Medical Center Carla Galbraith RN, BSN, CIC Manager Patient Safety/Infection Control November 1, 2013

Transcription

1 Willamette Valley Medical Center Carla Galbraith RN, BSN, CIC Manager Patient Safety/Infection Control November 1, 2013

2 About Us Willamette Valley Medical Center McMinnville, Oregon Acute Care Facility 88 beds Services: General Med/Surg Unit ICU/CCU Birthing Center Joint Replacement Program Senior Behavioral Health Unit Trauma Level 4 ED Affiliated Cancer Center Affiliated Wound Care Center 2

3 CAUTI REDUCTION in the ED Willamette Valley Medical Center Identified Issues We stopped making Progress in the ICU & on Med/Surg in reduction of Foley Use With the implementation of Meditech 6 No reports, Unable to put paper daily order sheet on chart CPOE allowed the Hospitalists to write inappropriate orders for foley use on Med/Surg Med/Surg unit was having the most trouble with appropriate indication for use 3

4 How We Got Started Recognized that we were unable to make changes in the computer system until corporate wide implementation was completed. Multi-departmental Team of Nursing, Quality, Infection Prevention staff felt that eliminating inappropriate foley use up front in the ED would impact the inpatient units. Identified Education Needs Rolled out to the ED staff 4

5 Barriers and Solutions Barriers Implementation of New Computer System Loss of established reports to generate daily order sheet for the chart Not all physicians documented in the Medical Record the same way (Hospitalist s use CPOE while everyone else uses paper documentation) CPOE ordering in M6 allowed the choice of inappropriate uses on Med/Surg (e.g., Intake and Output) Difficult to change habits on a larger nursing unit (think herding cats) Solutions This is still a work in progress. Basically, intensified daily rounding by the IP and discussions with staff on FC use. Months of working with corporate report writers have FINALLY brought us to a useable report on pts with foleys. This remains an issue. Daily rounding by IP, utilizing digital pages to MDs Corporate Focus group of IPs working on the edit of options in M6 as acceptable indications for use with a foley order. Eliminate inserting foleys in ED as much as possible. 5

6 Advice for Others & Lessons Learned Don t give up! Just when you have things working well you can be blind sided Seek out nursing champions on each unit. Reports and Order Forms help, but getting out and rounding on staff and having daily discussions on foley use can t be replaced. Reward your Stars 6

7 CAUTI REDUCTION in the ED Willamette Valley Medical Center Foley Utilization Rates Meditech 6 Implementation 4th Qtr 2011st Qtr 20122nd Qtr rd Qtr 20124th Qtr 20121st Qtr 20132nd Qtr rd Qtr 2013 Med/Surg ICU/CCU Reduction of F/C Insertions in the ED 40% 35% 30% 25% 20% 15% ED insertions 10% 5% 0% 4th Qtr st Qtr nd Qtr rd Qtr th Qtr st Qtr nd Qtr rd Qtr

8 Next Steps Work towards getting all physicians on CPOE Finish Foley Order indication for use edits Try to get CPOE Foley Order to come up with a daily reminder for re-order or discontinue. Provide ongoing feedback to ED Staff on performance Have the ED Staff take ownership for looking at each ED patient, each month that is admitted with a foley for appropriateness of use. 8

9 Colo-Rectal Surgical Site Infection Reduction Willamette Valley Medical Center Colo-Rectal SSI Rate Comparison 2011 Barriers 1. Recognition of a problem 2. Voodoo Medicine Solution 1. Face-to Face Discussions with General Surgeons 2. Surgeons given homework to check literature and OHSU 2 0 WVMC Peers State National 3. 15% is Good Enough 3. Re-educate on target-zero philosophy 4. Antibiotic Formulary 4. State Antibiotic Collaborative feedback, literature search, WVMC Antibiotic Stewardship taskforce buy-in. 9

10 Contact Info Carla Galbraith RN, BSN, CIC Willamette Valley Medical Center