1. Using Data to Improve Practice
HCAI Information for Action 2009
Using Data to Improve Practice
Dr. Eleri Davies,
Director WHAIP
Public Health Wales NHS Trust
With thanks to Dawn Hill, Nurse Consultant WHAIP

2. Directorate / Divisional / Specialty level At Ward level
Organisational level
Information for the Board
Data for the community??
Directorate / Divisional / Specialty level
At Ward level
Business cases

3. My suggestions & thoughts……….
Interactive session – please “butt in” with your own experiences and thoughts

4. HCAI Strategies – Achieving the cultural shift required
Board Responsibilities
Directorate accountability for HCAI
Ownership by front line Clinical Teams
Zero Tolerance
Infection Reduction Targets

5. Assuring the Board Board Agenda – Patient Safety - HCAI
Do CEOs and executives know what data they require?
Content - all HCAI or specific high profile organisms?
Presentations by ICT?
How frequently should reports be tabled and presentations be made?
Annually, Quarterly, Monthly

6. Reporting Outcome Measures
HCAI Information for Action 2009
Reporting Outcome Measures
MRSA rates and Financial Targets only?
It is an unfortunate reality that often true improvements are driven by incidents which get the attention of organisations
Two such examples are the Healthcare commission reports on the c difficle outbreaks we are all so aware of.
These documents had an impact on organisational management ensuring that patient safety and quality was addressed as part of Board agendas as well as at clinical levels.
With health commission stsing that safety of Patients is not to be compromised in any circumstances at a time when the challenges faced in reconciling financial and other targets against the need to ensure safe and quality care was not a moment too soon.
If we compare this to flying, it would be completely unacceptable for airlines to wait for crashes to occur before putting systems and processes in place to ensure the safety of airline passengers.

7. To Paint the full picture

8. Assuring the Board Competence
Demonstrating reliable practices are in place – measurement of process compliance
Outcome measures

9. HCAI Board Reports Competence
Training e-learning engagement, total staff trained, training attendance issues
Risks -incidents/outbreaks/increase in infection rates
Actions being taken
Compliance with national surveillance programmes
Mandatory surveillance, compliance rates for C section, ITU central line surveillance etc
Process measures – compliance
Hand hygiene compliance by Directorate
Care bundle compliance in critical care and other areas
Outcome Measures
Progress against the Infection Reduction Target
Trends for common HCAI infections by Trust and Directorate

10. Governance reports Risk registers
Are Governance/Risk groups filtering HCAI information for the Board?
Using Governance and Risk Groups to influence prioritisation of IC issues
Current NHS re-organisation provides opportunities & threats

11. Community Data
New organisations encompass the whole healthcare community
Data will be required on HCAI derived in the community and managed in the community
Challenges:
Collecting data for baseline
Agreeing definitions
Staffing / Resources
Understanding the data

12. Board Engagement & Reporting
Your views & experiences?

13. Directorate/Speciality Level
Directorate/Speciality accountability
Reporting to Infection Control Committees
Directorates presenting their own data with support from IC
Process data
Numbers of staff trained in IP&C (e-learning)
Hand hygiene compliance
Environmental and practice audit compliance
Care bundle compliance

14. Directorate Reports
Feedback of data to key individuals within directorates
Directorate Leads
Clinical Directors & Senior Nurses (clinical management)
Directorate Managers
Key performance indicators for Directorates
Reducing C.difficile in specific units
Root cause analysis data - themes

15. Evidence for using data to inform practice
Cohort wards opened
Weekly hand hygiene audits trustwide
Actimel
Deep clean programme started
Matrons walk rounds
New antibiotic policy
IC core competency training
cohort ward closed
Decant ward
Antibiotic duration policy

16. Directorate level data
Your views & Thoughts
What about Community & Mental Health Directorate / Division??

17. Ward Level
Historically totally dependant on information from Infection Control teams
Patient safety campaigns (SPI & 1000 lives) are changing that
Infection Control still need to support & advise & drive

18. Reducing Healthcare Associated Infections (HCAI)
Reducing HCAI

19. At Ward Level Ownership of own data Taking actions in response to data
Culture change

20. Collecting Local Data? Data store downloads Excel spread sheets
Access databases
Providing wards/depts with their local data initially
Over time supporting the wards themselves to collect data to influence improvements

21. Ward/departmental data
Organism specific data e.g. C. difficile
Use of SPC charts to monitor progress
Time between events
Additional data:
Audits e.g. hand hygiene
Use of antimicrobials
Environment

22. SPC charts

23. Time between events

24. New Role of Infection Control Teams?!
To support ward staff with data analysis
Provide data to start
Develop skills on the ward to do simple run charts, time between event charting for themselves
Over time ICTs to provide more overview and support

25. Your Views & Experiences
Ward Level Data
Your Views & Experiences

26. Business Cases Financial constraints at present
Saving money by improving practice may be key point in success of current business cases

27. Demonstration of Improvement
Hugues Hallot MSc data personal communication

28. HCAI Information for Action 2009
Demonstrating Savings
Reduction of 0.34 infection per 100 patients.
Reduction of 3.66 infections for 2008.
Bed days available for other patients in 2008 : 64 days.
Savings 2008 : £79,038.
Decreasing use of Central line.
Bed days available : ICU bed free for other patients thank to the avoided infections.
Overall savings : counting the cost of the program in 2006 and 2007.
Because : Lag in the reduction?
Savings 2008 : number of infection avoided with the number of ICU patients in 2008.
Decreasing use of Central line : cost not evaluated.
Hugues Hallot MSc data personal communication 28

29. Information for Action
Using HCAI data at all levels of the organisation can lead to actions:
Improved awareness and risk assessment at Board level
Managerial accountability and actions to improve outcomes at directorate level
Immediate ownership of problem at ward level
Successful business cases based on good evidence

30. Thank You Emma Thomas for organising the course
The WHAIP team for all the input into organising and delivering the course
Susan Harris, Mari Morgan, Wendy Harrison, Dafydd Williams, Victoria McClure
Sue Broadfield for the Excel teaching
All our speakers:
Meirion Evans, Mike Davidge

31. A big Thank You to You
Diolch yn Fawr!!