SCIP Surgical Care Improvement Project Making Surgeries Safer By: Roshini Mathew, RN
Importance Hospitals could prevent 13,000 patient deaths and 271,000 surgical complications each year 4 measures are publicly reported and compliance with these measures ensures MVH ranks high in the nation for providing quality care To prevent withholding reimbursement from CMS through Value Based Purchasing, MVH must remain in top decile in SCIP initiatives Goal: reduction in the incidence of surgical complications 2
Implications of Surgical Site Infections (SSI) CDC estimates 500,000 SSIs occur annually Each infection increases average hospital stay by 1 week SSIs costs from $3,000 - >$100,000 Patients developing SSIs are 60% more likely to stay in ICU and 5 times more likely to be readmitted Account for 14-16% of all hospital acquired infections are common complication of care 3
4 SCIP Measures 1. Administration of antibiotics 2. Venous Thromboembolism Prophylaxis Pharmacological & Mechanical 3. Indwelling Urinary Catheter 4. Blood Glucose Management 4
4 SCIP Measures 5
Antibiotic Prophylaxis Duration Most studies have confirmed efficacy of 12 hrs Many studies have shown efficacy of a single dose Whenever compared, the shorter course has been as effective as the longer course 6
Venous Thromboembolism Prophylaxis DVT developed in 10% -40% of general surgical patients who had no prophylaxis treatment American College of Chest Physicians (ACCP) performed autopsies of surgical patients who died within 30 days postoperatively 32% percent had PE and it was cause of death for most 7
Urinary Catheter Bacteriuria developed in 26% of patients after 2 to 10 days of catheterization Post-Op patients transferred to a subacute care with urinary catheters were more likely to be readmitted to the hospital with a UTI compared with those who had catheters removed prior to the transfer Patients with catheters > 2 days post-op were 21% more likely to develop UTI, less likely to be discharged to home, and had an increase in mortality at 30 days 8
Glucose Control Control BG <200, obtain 6 a.m. serum glucose POD 1 & POD 2 Poor Glucose control is a risk factor for surgical site infection Degree of hyperglycemia correlates with the SSI rate Current measure is for cardiac surgery patients 9
Role Descriptions: Surgeons Role Owner Role Description Surgeons: Order antibiotics and discontinue within 24 hours after surgery If no antibiotic is indicated for surgery, document reason in patient s chart Order VTE prophylaxis pharmacological and mechanical (if none ordered, document contraindication) Order POC glucose checks for cardiac surgeries 10
Role Descriptions: Pre-op RN Role Owner Role Description Pre-op RN: Check if pre-op antibiotic is ordered, if not call MD Send antibiotic with patient to OR Check if VTE prophylaxis is ordered, if not call MD 11
Role Descriptions: PACU RN Role Owner Role Description PACU RN Review post-op orders for antibiotic and administer as needed Document in PACU report form and communicate to unit RN name of antibiotic and administration time Check blood sugar level for cardiac surgeries 12
Role Descriptions: Unit RN Role Owner Role Description Unit RN: Check if antibiotic was administered in OR/PACU. Verify documentation of antibiotic and administration time Look for anesthesia end time Ensure entire course of post-op antibiotics are administered within 24 hours from end surgery /anesthesia Communicate with other RNs to discontinue urinary catheter within 48 hrs (or remind MD to make note for reason of continuation) Control blood sugar levels per MD orders (for cardiac surgeries) Place SCDs for mechanical VTE prophylaxis 13
Conclusion 30 million inpatient surgeries in the U.S. every year and a significant percentage result in preventable, often life-threatening complications 2.5-3.5 million patients per year experience unintended harm resulting from or contributed to by surgical care 14
Conclusion Reducing complications can be achieved applying evidence-based practices standardizing and simplifying core processes Success has been achieved by many facilities across the nation Ongoing communication, education and collaboration with a multidisciplinary team is imperative for success 15
References Institute for Healthcare Improvement Prevent Surgical Site Infections, Retrieved from http://www.ihi.org/ihi/programs/campaign/ssi.htm Institute for Healthcare Improvement Reduce Surgical Complications, Retrieved from http://www.ihi.org/ihi/programs/campaign/surgicalcomplications.htm Institute for Healthcare Improvement Surgical Site Infections, Retrieved from http://www.ihi.org/ihi/topics/patientsafety/surgicalsiteinfections/ MedQIC Surgical Care Improvement Project, Retrieved from http://www.qualitynet.org/dcs/contentserver?cid=1137346750659&pag ename=medqic/content/parentshelltemplate&parentname=topiccat&c=m QParents Stulberg, J.J., Delaney, C.P., Neuhauser, D.V., Aron, D.C., Fu, P., & Koroukian, S. (2010). Adherence to surgical care improvement project measures and the association with postoperative infections. The Journal of the American Medical Association, 303 (24), 2479-2485. Surgical Care Improvement Project, Retrieved from http://scalpel.stanford.edu/20072008/scipeducationaltool2007v4.pdf 16