Healthcare Associated Infections (HAI) Quality Improvement Activity: Reducing Bloodstream Infections

Transcription

1 Healthcare Associated Infections (HAI) Quality Improvement Activity: Reducing Bloodstream Infections Jeannette Shrift RN, MSN Quality Improvement Coordinator Presentation to Focus Facility Managers and Leadership

2 Aim 1: Better Care for the Individual through Patient and Family Centered Care Quality Insights Renal Network 4 (QIRN 4), under the direction of the Centers for Medicare & Medicaid Services (CMS), shall conduct at least 1 quality Improvement activity (QIA) to reduce dialysis events, specifically BSI rates.

3 Goal of the HAI QIA: Reducing BSIs Overarching Goals Reduce mortality associated with septicemia Better quality of life for patients; less burden of illness Reduction of healthcare cost associated with septicemia Facility Goal At least a 5% reduction in the pooled mean BSI rate of the selected facilities when comparing the January-June 2016 rate with the January-June 2017 rate. NOTE: project interventions continue through December 31 st

4 Quality Improvement Activity Design Patient Subject Matter Experts recommendations are incorporated CMS requirement Patient Engagement at the facility level highly recommended CMS is committed to including the patient in all areas of the care they receive Research shows patient engagement leads to better patient outcomes HOW you include the patient voice in this project is up to each facility

5 Design (cont d) Facility Selection - Inclusion criteria: At least 20% of the facilities in the Network with the highest NHSN BSI rate for 2016 Q1 & Q2 Exclusions criteria: Facilities who participated in the 2016 HAI QIA whose BSI rate was at or below the NHSN national rate of 0.64 by the end of 2016 Q3 Facilities with < or = 4 LTCs Interventions 2 types Required Optional

6 Overview Of Interventions CDC Infection Prevention Protocol Plan-Do-Study-Act quality improvement process Patient education Patient Survey

7 Required Interventions Implement & document results of CDC Protocols Hand Hygiene: minimum of 30 observations/month Catheter Connection/Disconnection: minimum of 10 observations/month Scrub the Hub Data collection begins immediately Perform the Institute for Healthcare Improvement s (IHI s) Plan-Do-Study-Act (PDSA) cycle each month for each protocol with a compliance rate < 100% Educate patients with LTCs on the catheter connection and disconnection procedure & on catheter care at home Distribute BSI Patient Surveys to patients who experienced a BSI between January 1 st 2017 and March 31 st 2017

8 Due Dates for Required Interventions PDSA Reporting tool for hand hygiene and catheter connection/disconnection protocols is due by: COB on the last business day of the month LTC Patient Education Tracker is due by: COB Friday 6/16/17 Patient BSI survey Summary Tool is due by: COB Friday 8/25/16 Please all completed documents to

9 Interventions in Detail Protocols Tools and Patient Education

10 Required Intervention: 3 CDC Protocols Implement 3 CDC Protocols Hand Hygiene: at least 30 opportunities/month Catheter Connection/Disconnection: (any combination) at least 10 observations/month Scrub the Hub Note: DaVita facilities may use their own internal audit tools for data collection as these align with CDC audit tools. All other facilities must use the CDC tools provided by the Network

11 Required Intervention: 3 CDC Protocols Document Results of Protocol Audits Use CDC audit tools provided in the toolkit or DaVita internal tools Network Recommendations include at least 1 staff member in the audit process Include at least 1 patient/family/caregiver in the audit process The Network will contact the patient representative and/or member of the Patient Advisory Committee to inform them of your facility s participation in this project. They will be directed to speak to the Facility Administrator of Clinic Manager if they are interested in participating in this audit

12 Additional WebEx for Audit Training The Network will hold a WebEx for anyone (staff, patients, family members or caregivers) who are interested in assisting with the data collection or audit process The content will be focused on: CDC tools and how to use them How patients/family/caregivers can participate with or without performing data collection

13 Guide to Hand Hygiene Opportunities in Hemodialysis 1. Prior to touching a patient Prior to entering station to provide care to patient Prior to contact with vascular access site Prior to adjusting or removing cannulation needles 2. Prior to aseptic procedures Prior to cannulation or accessing catheter Prior to performing catheter site care Prior to parenteral medication preparation Prior to administering IV medications or infusions 3. After body fluid exposure risk After exposure to any blood or body fluids After contact with other contaminated fluids (e.g., spent dialysate) After handling used dialyzers, blood tubing, or prime buckets After performing wound care or dressing changes 4. After touching a patient When leaving station after performing patient care After removing gloves 5. After touching patient surroundings After touching dialysis machine After touching other items within dialysis station After using chairside computers for charting When leaving station After removing gloves

14 Hand Hygiene Tool- Minimum of 30 Observations/Month Example of Baseline data Collection Did not perform HH after a dressing change Did not perform HH prior to contact with vascular access site Completion of Duration of observation period is not necessary Only dialysis staff should complete numerator and denominator section 1 3

15 2016 QIA Facility Patient Engagement Strategies with CDC Audits Hand Hygiene Patients completed the form Patients verbally reminded the staff to wash/glove if they felt a reminder was needed Patients tapped a bell to remind the staff to wash/glove if they felt a reminder was needed no one was called out. The staff was directed to stop and check themselves for a break or near miss when they heard the bell. Catheter patients followed along with the CDC Checklist as staff performed the procedure

16 3 Polling Questions 2017 Patient Engagement with Hand Hygiene Audits POLL

17 Catheter Connection/ Disconnection Tool Minimum of 10 Observations/Month

18 How to Use the Catheter Tool -Example Each audit includes multiple observations. If each step of a procedure is observed and correctly performed, the observation is marked as 1 success

19 How to Tally Results Once the observations have been completed, calculate the number of successful observations (Numerator) and note the total number of observations performed (Denominator)

20 Record Retention Retain completed monthly audit tools, the Network may request them for data validation purposes

21 Required Intervention: PDSA Cycle Perform the Institute for Healthcare Improvement s (IHI s) Plan-Do-Study-Act (PDSA) cycle each month for each protocol compliance which falls below 100% Begin by documenting your observations on the BASELINE Reporting Tool

22 PDSA Cycle (cont d) Once the baseline data tool is complete, use the MONTHLY reporting tool for the remainder of the project For the Hand Hygiene audit ONLY Once you have achieved 3 consecutive months of 100 % compliance in a focus area, begin a new PDSA cycle, using the BASELINE tool to identify a new focus area Use the BASELINE Reporting tool for each NEW focus area

23 Data Collection/PDSA Tools

24 Educate All Patients With Long Term Catheters (LTCs) Catheter Care at Home - Educate or re-educate all patients with LTCs. You may use your organization s education resources or the ones provided in the QIA toolkit. Patient Subject Matter Expert defined intervention CDC Catheter Connection and Disconnection Protocols using the CDC checklist (toolkit) The checklist can serve as both a patient education tool and a staff visual aide Document the education on the Vascular Access Patient Education Tracking tool

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26 Due by COB 6/15/17

27 Optional Intervention Minor Bleeding *Provide a home care kit for minor bleeding to all patients with an AVG or AVF along with education for treating the bleeding at home. *Patient Subject Matter Expert defined intervention

28 BSI Patient Surveys: Population & Design The survey cards, envelopes, trackers and reporting tool will be sent to facilities in JULY Target Population - Patients who experienced a BSI between January 1 st 2017 and March 31 st 2017 (Patient Subject Matter Expert defined intervention) Use NHSN Summary menu or internal reports/records to identify patients Design A two question, postcard size, anonymous survey of patients 1) What do you think caused your bloodstream infection? 2) What do you think could have been done to prevent your bloodstream infection? The back of the card will have the definition of a BSI in simple language Facilities can set up their own process for conducting this survey Facilities are responsible for determining appropriate feedback/education to the patients based on responses received

29 BSI Patient Surveys: Rationale for Intervention To provide feedback to the facility leadership & staff about your patients understanding of how BSI s occur and how they can be prevented To allow patient feedback to directly impact their health To provide an opportunity to tailor patient education to address the specific needs of your patients

30 BSI Survey: Logistics The Network will use NHSN to identify the number of patients in the target group and send the appropriate number of surveys and envelopes to the facility The survey cards, envelopes, trackers and reporting tool will be sent to facilities in JULY

31 Steps to Identify Target Patients for BSI Survey Step 1 Locate Line Listing Steps 2 Select Format

32 Step 3 Select Time Period & Export

33 Optional Intervention *Assess knowledge of patients returning to the facility post hospitalization for a BSI that he/she was treated for a BSI. Educate as needed. 12 out of 28 patients from 2016 QIA were unaware that they had been treated for a BSI while hospitalized * Educational opportunity identified in 2016 BSI QIA

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36 Q & A Thank you!