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
If you cannot measure it, you cannot improve it Lord Kelvin 1824 1907
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
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 50 45 40 35 30 25 20 15 10 5 0 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
18 16 14 12 10 8 6 4 2 0 Weekly SPC Weekly SPC Clostridium Difficile by Week (hospial cases only all ages) 04/09/2006 18/09/2006 02/10/2006 16/10/2006 30/10/2006 13/11/2006 27/11/2006 11/12/2006 25/12/2006 08/01/2007 22/01/2007 05/02/2007 19/02/2007 05/03/2007 19/03/2007 02/04/2007 16/04/2007 30/04/2007 14/05/2007 28/05/2007 11/06/2007 25/06/2007 09/07/2007 C Diff Positive Cases Average Control Limit U Li i Week beginning Number of cases
Tackling the problem Cleanliness Antibiotic Management Isolation Education Education Education!
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
Overall aim Education + Information = Individual s recognition of their responsibilities in reducing HCAI
Responsibilities reflected in Job descriptions KSF e-tool gateway for career progression
Recognise the problem Alert Infection Prevention and Control Team Understand what to do Conformity use of BSC
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
Changing Culture and Practice Unconscious incompetence Unconscious competence
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
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
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)
Hand Hygiene Trend Hand Hygiene Trend Hand Hygiene Audits 100% 95% 90% 85% 80% 75% 70% 65% 60% 55% 50% 03/07/2006 17/07/2006 31/07/2006 14/08/2006 28/08/2006 11/09/2006 25/09/2006 09/10/2006 23/10/2006 06/11/2006 20/11/2006 04/12/2006 18/12/2006 Score 01/01/2007 15/01/2007 29/01/2007 12/02/2007 26/02/2007 12/03/2007 26/03/2007 Date Hand Hygiene Audit Result Target
Other initiatives Audit of Isolation Practice Feedback to staff Re-iterate good practice Staff knowledge questionnaire Use of HII CDT tool
Competency assessment Observations of care Question staff knowledge Use HII tool Use E-Tool as part of KSF Staff JDs Performance appraisal Not easy!!
Impact on CDT rates 2006 CDT all requests 2006 50 45 40 35 30 25 20 15 10 5 0 +ve Hospital Requests +ve Community Requests All +ve Jan-06 Mar-06 May-06 Jul-06 Sep-06 Nov-06
50 45 40 35 30 25 20 15 10 5 0 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
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
Recommendations Ensure clear management directives Strong leadership Personal accountability Zero-tolerance poor practice Do everything
If you get caught on the way home