1. Checklist overlap: Prevention of Surgical Site Infection and Venous Thromboembolism Marlies van Dijk, Western Node Leader Safer Healthcare Now! Safe Surgery Saves Lives – March 4, 2009

2. Safer Healthcare Now! Started in 2005 Provide support to healthcare teams to implement evidence based practice (10 interventions) Getting Started Kits, Tools, Measurement worksheets Web platform: Communities of Practice Over 1000 National Clinical Teams working on various interventions 177 SSI teams (229 surgical procedures) – since 2005 13 VTE teams (New intervention in 2008)

3. Supports the Checklist Systematic way of looking at the problems Establishing communication Breaking Silos Checklist opens the door : -Universal framework for surgical care -To build stronger teams -To speak up! -Bringing patient safety culture into the OR

4.  Medications - Antibiotic prophylaxis: double dose? - Glycemic control - Anticoagulant therapy (e.g., Warfarin)? -Antibiotic Prophylaxis: Repeat dose? -Normothermia? Postoperative glucose and temperature  ASA Class  Patient positioning and support / Warming devices  Expected procedure time

5.  VTE Prophylaxis - Anticoagulant - Mechanical

6. Perceptions vs. Reality

7. Current Status? Antibiotic Admininstration within 60 minutes of incision ~ 50% (Bratzler) Antibiotic Discontinuation within 24 hrs of surgery end time ~ 40% (Bratzler) Normothermia; one dedicated team; taken it from 30-70% over a 2 year period

8. 100% 75% 50% 25% 0 86%94%30%32% 11% 36%33% Hip / knee replacement Hip fracture surgery Major gynecology General surgery (cancer) General surgery (benign) Major trauma General Internal Medicine Appropriate use The care gap W. Geerts Routine Use of Recommended Prophylaxis in Canadian Hospitals

9. Interested in Quick and Sustainable Results 40-60% of SSI are preventable Antibiotics within 60 minutes of incision is essential Maintain normothermia during surgery Easy wins and affordable Implementing preprinted order sets for DVT

10. Tips for Implementation Time to consolidate our efforts! Quick cycles of the improvement model have worked for SSI Solutions to match local environment Present your business case to leadership Pockets of excellence – but now what … Time sensitive ….

11. saferhealthcarenow.ca Surgical Site Infection Lead Dr. Claude Laflamme, Director of Cardiac Anesthesia/TEE, Sunnybrook Health Sciences Centre Venous Thromboembolism Lead Dr. William Geerts, Senior Scientist, Sunnybrook Health Sciences Center Marlies van Dijk Western Node Leader Safer Healthcare Now! Marlies.vandijk@hqca.ca