U & I Preventing UTIs Post-surgical Units at Surrey Memorial Hospital (Orthopedics and General Surgery) Team Members: Alana Cohen Margaret Dyka Dareena Malli Pawan Sindhar Brenda Smith Lorraine Prysunka Susann Camus Filda Grado Jas Sidhu Melanie Skidmore Leah Tennant Angela Wilson SQAN Presentation: November 16, 2012

Team Goal Apply National Surgical Quality Improvement Program (NSQIP) data and methods to reduce Urinary Tract Infection rates in SMH Postsurgical Patients from 1.6% on February 29, 2012 to 0.8% by June 30, 2012

Improvement Strategies Use NSQIP risk and non-risk adjusted data to drive improvement Apply NSQIP best practices

Quality Improvement Strategies Team Goals Use Positive Deviance and TRIZ Carry out Plan-Do-Study-Act (PDSA) cycles to test improvements and small changes Staff and patient education Regular facilitated meetings Team meets q 2-3 weeks for 90-120 mins to keep involved and up to date with education and improvements

What we have done to date Developed Foley plan of care sticker for Kardexes PDSA Cycles performed on positioning of catheter bag, integrity of loops, catheter care and documentation of Foley plan of care on Kardex Chart reviews Chart reviews completed on patients who have had an UTI to understand the path and see where improvements could have been made.

What we have done to date con’t Pioneered use of physician reminder sticker Staff huddles and contests Posters, factoids and spot checks Patient education Staff huddles performed, also had a contest on the units: Asked questions of which answers were given previously in huddles, all correct answers thrown in a draw and 5 winners awarded a Starbucks gift Certificate Posters/Factoids posted in walls, staff room. Spot checks performed regularly to remind staff to look out for the best practices (ie. Catheter care performed, drainage containers rinsed/changed, catheter size appropriate, etc) Education provided to patients to inform risks of catheter and promoting them to answer why they have catheters.

Results

Results

Lessons learned No quick fixes Important to master the basics Essential to remind people and to ensure new staff and casual staff are included in education Key challenge: getting the word out and getting people to change practice Be persistent

Hints for new teams 6-8 staff members is optimal Every team member is actively involved Facilitated meetings keep us on track Build in time during meetings to do PDSA cycles Have fun Celebrate successes Meetings are fun (snacks, jokes, etc)

Wavin’ the Cath (apologies to K’naan) When we get data, we will drill down Call us high flyers High flyers wearing the crown Chorus: Call us high flyers. High flyers wearing the crown. We will cut back, We will cut back. First Verse: From Surrey downtown, Surgical Floor These are my patients, couldn’t ask fo’ more This is our way, I am a nurse Caring is first, knowledge we thirst Our patients come first, they’ll be the best, PDSA we always test Patient will heal, this is for real This is our way, that’s all we can say Times struggling, Getting the word out We’re wondering, what’s that about now We actively wait for zero point eight It’s not far away, For now we say Chorus Second Verse: Two person insertion is less exertion, Use the best practice, tell everyone Hold all our contests, we’ve just begun No easy way, Work is the way Let’s do this together, make all believers NSQIP best practice, strive to improve We’re making our way to zero point eight We’ll not give up, Our team is great! We’re reminding, all the physicians We’re stickering, all our Kardexes We’ll actively wait for zero point eight It’s not far away but for now we say. Chorus (repeat twice)