Essentials in quality improvement interventions concepts appraised Patient Safety Programs in Intensive Care Units – Zero Projects Ministry of Health, Social Services, and Equality, Madrid, 12 Dec. 2017 Essentials in quality improvement interventions concepts appraised by the example of CAUTI prevention Stijn BLOT Dept. of Internal Medicine Faculty of Medicine & Health Science Ghent University, Ghent, Flanders (Belgium) ～ Burns, Trauma and Critical Care Research Centre The University of Queensland, Brisbane, Queensland (Australia)

Crash Introduction on HAI Prevention Healthcare-associated infections ➔ morbidity ➔ healthcare costs ➔ mortality Evidence-based prevention guidelines ➔ broad spectrum of measures ➔ nurses / clinicians’ knowledge is poor ➔ adherence is low Quality improvement interventions = solution? Blot S, et al. Clin Infect Dis 2005 Labeau S, et al. Crit Care Med 2009 Cabana MD, et al. JAMA 1999

Quality Improvement (QI) Interventions Crash Introduction on Quality Improvement (QI) Interventions Definition of QI interventions Versatile method Clustering a variety of interventions; the most important: personnel education care bundles checklists

Intermezzo on Essentials of Quality Improvement (QI) Interventions Education Cornerstone of QI Insights in… “Why it is important” Rational behind a preventive approach Repetition ➔ awareness (!) ➔ attitude

Intermezzo on Essentials of Quality Improvement (QI) Interventions Education Cornerstone of QI Insights in… E-learning Published guidelines do not work Flexible and student centered Benefits the organization

Intermezzo on Essentials of Quality Improvement (QI) Interventions Care bundles Set of 3 to 5 EB-interventions Executed: always (daily, per shift,…) together by everyone Better impact on patient outcomes (compared with separated application) Monitoring of the adherence!

Intermezzo on Essentials of Quality Improvement (QI) Interventions Checklists Simple business process improvement tool Control of routine tasks to be executed No “all or nothing” philosophy Not necessarily based on scientific evidence Awareness!

CAUTI reduction Essential steps in a Quality Improvement Project 1 2 5 3 4

CAUTI reduction Essential steps in a Quality Improvement Project Awareness … CAUTI reduction … … …

I - Awareness (!) Absolute condition to motivate the team CAUTI = important Frequent Morbidity ➔ costly Mortality…

I - Awareness (!) Absolute condition to motivate the team Pathogenic mechanisms & risk factors Rational for prevention Understanding “why” and “how” prevention works

I - Awareness (!) Absolute condition to motivate the team Preventable! (=key message) Average 17 – 69% can be avoided How much you can avoid… that depends on the local situation, and therefore you need the following essential step.

CAUTI reduction Essential steps in a Quality Improvement Project Awareness CAUTI detection CAUTI reduction … … …

II – CAUTI detection (!) Essential to convince the team Set up a surveillance system CAUTI definitions, aim for… Objective criteria Reproducible Universally used Methods of surveillance Pro-active screening!

CAUTI reduction Essential steps in a Quality Improvement Project Awareness CAUTI detection CAUTI reduction … Selection of prevention measures …

III – Selection of preventive measures (!) Build your team: participation ➔ consensus Select relevant prevention measures, based on… Evidence / pathogenic mechanism Reduction of exposure time Insertion: sterile equipment & aseptic technique Maintenance: closed system & unobstructed flow Local situation Consensus among all stakeholders Local situation: step away from nation-wide initiative… if one item is already going very good (and its practice has been completely embrased by the team), it has little use to put it in a care bundle. Consensus: example: local quality champion… with lots of knowledge BUT without diplomatic or educational skills… there will be only marginal support for this team member…

CAUTI reduction Essential steps in a Quality Improvement Project Awareness CAUTI detection CAUTI reduction … Selection of prevention measures Implementation & Monitoring

IV - Implementation (!) Support the team in it’s efforts Educate Invest in the teams insights Practice monitoring Bedside instruction c c c Let them feel you care

Performance measurement Essential steps in a Quality Improvement Project Awareness CAUTI detection CAUTI reduction Performance measurement Selection of prevention measures Implementation & Monitoring

V – Performance measurement (!) Control & guide the team Process ➔ compliance rates Outcome ➔ CAUTI rates c c Feedback! c

CAUTI reduction Essential steps in a Quality Improvement Project Awareness CAUTI detection CAUTI reduction Performance measures Selection of prevention measures Implementation & Monitoring

Conclusion 5 essential steps to optimize the outcomes of a quality improvement initiatives All about… team building aspects: create awareness, reach consensus, educate, instruct, monitor, feedback, …

Thank you Dept. of Internal Medicine, Faculty of Medicine & Health Science, Ghent University, Ghent, Flanders (Belgium) Burns, Trauma & Critical Care Research Centre, The University of Queensland, Brisbane, QLD (Australia) stijn.blot@UGent.be