Implementing Surgical Surveillance with icnet ng. Optimising Patient Safety Through Effective Information Technology Implementing Surgical Surveillance with icnet ng. Anne Smith- Nurse Consultant Infection Prevention & Control Dorset County Hospital NHS Foundation Trust

Dorset County Hospital Acute Hospital Trust situated in Dorchester in the West of Dorset Main provider of acute hospital services for those living within Dorchester, Weymouth, Portland, West Dorset, North Dorset and Purbeck. Serves a population of approximately 215,000 Renal provider for patients throughout Dorset and South Somerset Approx 400 beds

icnet ng live since October 2013 Good working relationship with ICNet, working jointly on projects to improve patient care: Implementing surgical site surveillance Piloted upload of SSI data to PHE Risk assessment of patients with infections for isolation Developed reports directing cleaning

How ICNet is used ‘on the move’ Integrated programme for use as part of daily Trust-wide clinical ward round by IPCT App on mobile device and functionality remains good Enhanced ability to access information with clinical staff in the clinical setting Facilitates prioritising patient placement and cleaning Ability to access patient ‘alerts’ and ‘organisms’ at the bedside Outbreak Management tool Undertake surgical surveillance Review patients on SSI readmission alert

Surgical Site Surveillance SSI’s account for up to 20% of HAI At lease 5% of patients undergoing surgery develop SSI Associated with significant morbidity and mortality Ref: NICE 2008 Study on Efficacy of Nosocomial Infection Control

Human Factors “Enhancing clinical performance through an understanding of the effects of teamwork, tasks, equipment, workspace, culture and organisation on human behaviour and abilities; and the application of that knowledge in clinical settings”. Ref: Catchpole (2010)

Relevance of Human factors and Surgical Site Surveillance Human factors applied to identification, assessment and management of patient safety risks. Human factors not a separate agenda but a way of thinking that should be incorporated as part of the design processes, jobs and training. The NHS needs to create the conditions where the safety of those accessing NHS-funded health services is the primary concern. Ref:(Human factors in Healthcare- A Concordat from the National Quality Board)

The Challenges Engaging surgical teams! Meeting Mandatory SSI requirements Improving data input Ensuring interfaces with icnet NG collect data required Patient engagement Uploading data to Public Health England SSI

Rich Data Sources Patient Pathology PAS Pac Vital Pharmacy Theatre icnet

Scoping the project Patient pathway of care OPCS codes Link to current information system for theatre data Identifying relevant microbiology results Validation of the above with clinicians on test site Establishing direct upload to PHE SSI site Reporting readmission

Orthopaedic Surveillance PDSA SSI cycle Orthopaedic Surveillance Plan Knee SSI module Do Results Study Implement change Act

An Automated Approach to Surgical Site Surveillance     An Automated Approach to Surgical Site Surveillance Before Paper data collection Upload on an individual basis case by case to PHE site then final submission

Preliminary Work Dual systems carried out as initial upload to PHE not tested

Was all of the information available?

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Additional Information Added

Surgery Reports Data selection: Time series- (live feed, weekly, monthly, quarterly) Line listing Custom grouping Denominators (Patient days, number of surgical procedures, number of admissions/ readmissions) Category of procedure Wound class

Developing bespoke Consultant Reports Individualising data feeds Pathology results, Antibiotics, vital signs etc

Surgeons data

Creating ownership

Developed SOPs to instruct users Then took the plunge and submitted data via ICNet process directly onto PHE site Data ratified then completed X2 SSI audits (Knee replacement and C. Section)October 2014 Resource not required to develop surveillance as in place through ICNet

Process Engagement-surgical team, patients Utilising Information systems Checking accuracy of data sets Piloting data upload Follow up of patients Clinicians- reviewing real time data Infections-microbiology, readmission data Location of operation (theatre) Reviewing results Identifying improvements

Surveillance results SSI’s reported by 30 day feedback from patients and readmission data; Antibiotics prescribed frequently by variety of healthcare professionals influenced by patient perception of infection; Infection data not represented by microbiology samples to qualify findings.

ACTION New patient information leaflet Presentation of surveillance results to GP’s Implemented next day clinic/ ward review of patients with suspected SSI Readmission within 365 days reviewed via alert Reduction in inappropriate antibiotic prescribing. Rate of reported SSI reduced.

What we have achieved Surgeons describe icnet as potential “one stop shop” Improved patient experience Reviewed surgical pathway Evaluated patient impression of post operative wound infection in knee implants Engaged with Primary Care staff to improve patient outcomes Reduced unnecessary antibiotics

Next steps Upgrade icnet ng Review coding input Increase uptake of surveillance Review patient experience Benchmark Device management

In a Nutshell! Isolation reports Admission alerts (pre and post) Trends e.g. biochemistry Outbreak management Theatre data Bespoke reports Work lists for ICNs Linked case alerts SSI data upload to PHE Device management Live data feeds- lab and PAS

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