1. DRAFT – final pending AHRQ approval Join SUSP Affinity Groups! Learn from experts and other SUSP hospital teams who are working on what you’re working on Early recovery protocol (ERP) Preop care coordination SCIP measuresEnvironmental management Pain management, fluid management, postop mobility Glucose control, bowel prep, oral antibiotics Antibiotic prophylaxis, normothermia, skin prep OR traffic, sterile technique, surface contamination Traci Hedrick, MD University of Virginia Melanie Morris, MD University of Alabama Skandan Shanmugan, MD University of Pennsylvania Mariana Pehar Johns Hopkins Hospital Coaching calls every other month Quarterly Coaching Calls Click this link SUSP Affinity Group Registration Link to register for an affinity group by Tuesday, May 20 th !SUSP Affinity Group Registration Link Click this link SUSP Affinity Group Registration Link to register for an affinity group by Tuesday, May 20 th !SUSP Affinity Group Registration Link

2. Hospital Team Experiences Noble Hospital Molly Carlin MSN, RN

4. Noble Hospital  93 Bed Hospital  Noble Hospital is in a 40,000+ community in Westfield, MA  We provide service to seven surrounding towns

5. SUSP Team Kristen Kroll CST Michael Cromwell CST Kathie Keleher CST Nadya Guseva CST Karen Raymaakers OR RN Lida Powell OR RN Pamela Kislus OR RN Rhonda Partyka OR RN Deb Daniels OR RN

6. SUSP Leadership Team Ann Reichert- Director of Risk Management Mary Jane Lamb- Infection Control Dr. Schonholz- Surgeon Champion Dr. Desai- Chief of Anesthesiology Kim Samele- Director of Perioperative Services Molly Carlin- Perioperative Clinical Coordinator; SUSP Coordinator

7. Noble Hospital Describe how you developed and implemented your SUSP project  SUSP team formation- Development of your SUSP plan  HSOPS administration  Technical and adaptive work that you addressed How and why did you make these choices?  Challenges and successes that you experienced during this process

8. Noble Hospital SUSP Team Formation  The SUSP leadership team has gone through some transitions. At one month into the SUSP journey we had a change in nursing leadership. The SUSP leadership team was chosen by the previous nursing manager.

9. Noble Hospital SUSP Team Formation  Being part of the SUSP team has been an open opportunity to all of the staff. The staff has been very excited to come to meetings, bring attention to safety concerns, have a hand in the planning process, gathering data and implementing change.

10. Noble Hospital HSOPS administration 98% completion rate Excitement The SUSP team’s excitement for change has proliferated to the entire staff. Reasoning The SUSP team provided to the staff why completing the HSOPS survey was important Encouragement They encouraged each other to complete the surveys! We have a great staff!!

11. Noble Hospital Technical and adaptive work Infection Control Standardization of the cleaning process Skin Asepsis Audit Review of policy; plans for revision of Standardization of prep Purchasing sterile prep tray Creation of an education module

12. Noble Hospital Technical and adaptive work Equipment Safety straps Sliding stretchers New Armboards Organization Ordering problems Unable to find proper equipment in emergency situations Safety Electrosurgical education module

13. Noble Hospital SUSP Challenges Time!!!! Surgeon involvement Anesthesiologist involvement

14. Noble Hospital Successes 98% completion of HSOPS Growth as a team Increase in safety

15. Noble Hospital What’s next for your team? Begin Audit on Normothermia Antibiotic procedure and policy

16. Noble Hospital How have you obtained physician buy-in?

17. Questions

18. Hospital Team Experiences Palmetto Health Baptist Anne Brittain PhD RT(R)(M)(QM), CPHQ PI Project Manager

19. Palmetto Health Baptist Located in the heart of downtown Columbia, SC Part of a 5 hospital system 489 bed acute care hospital 4,000+ physicians, staff and volunteers at PHB alone Celebrating 100 th anniversary in 2014

20. Palmetto Health Baptist

21. Team Formation- We wanted: –Mixture of peri-op and inpt care staff –Mixture of frontline staff, educators, physicians, and management –People who are interested and willing to work SUSP Plan –Implement The Joint Commission Center for Transforming Healthcare’s recommendations for reducing colorectal SSI’s with a goal of reducing our colon SSI rate to <5.81/100 cases

22. Palmetto Health Baptist Joint Commission Center for Transforming HealthCare recommendations to reduce Colorectal SSI: 1.Pre-Op health optimization 2.Pre-Op CHG bathing 3.Alcohol based prep agents 4.Peri-op patient warming 5.Weight-based antibiotic dosing with redosing after 4 hours 6.Entire team changes gowns/gloves after anastomosis 7.Segregation of clean and dirty instruments during and after anastomosis 8.Ensuring wound classification is correct at end of case

23. Palmetto Health Baptist HSOPS Administration –Educated staff prior to beginning survey process –Daily reports of participation rates –Resent survey link as many times as needed –Promised homemade Italian cookies to all units that had > 60% participation –Results shared at monthly meeting with staff and physicians

24. Palmetto Health Baptist PSSA Administration –Created a fact sheet related to science of safety and SUSP –Did the survey at a monthly staff meeting –Core group convened to categorize results –Results shared and discussed with staff at next staff meeting –Same process followed with physicians

25. Back to Basics Campaign –Hand hygiene –OR traffic –Surgical scrub –Sterile Technique –EVS in all areas Safe Surgery Checklist Surgeon engagement –Monthly update and participation at surgeon led surgical services meeting –Surgeon drilldown and review of all colorectal SSI Palmetto Health Baptist THIS MONTH’S FOCUS:

26. Palmetto Health Baptist Gender (male) Procedure (open) Operative Time (>4hr) ASA (>2) Emergency? (yes) Transfusion (yes) Ostomy (yes) BMI (>25) Age (>70) Smoker (yes) Wound class ( >clean-contaminated ) Left colon/Rectum (yes) Diabetic pt pre-op A1c (>8.0) Peri-Op BG (>200) Pre-Op Albumin (<3.3) Pre-Op Steroids (yes) Cancer pt (yes) Multiple comorbidities (yes) Redose abx for case > 4 hrs (no) Colon SSI Drilldown

27. Palmetto Health Baptist FY13 Colon SSI rate = 7.917/100 cases. Patients who ended up with a colon SSI had an average of 5.8 risk factors. 5% SSI pts > 9 risk factors FY14 Colon SSI rate is 5.988/100 cases. Patients who ended up with a colon SSI had an average of 7 risk factors. 40% SSI pts > 9 risk factors Equates to a 25% decrease in infection rate with those that get an SSI being at higher risk

28. Palmetto Health Baptist Successes –Implementation of CHG baths pre-op –Setting the same expectations for everyone –Physician engagement in process Getting beyond “our patients are sicker” & questioning whether or not it is “really an infection” –Staff awareness of infections Challenges –New hospital opening –New management team in OR –Push back from a few very vocal surgeons –Staff fear

29. Palmetto Health Baptist What’s next for your team? –Regroup once “aftershocks” of new hospital grand opening die down –Continue with a new focus in our “Back to Basics” campaign each month –Audits to gauge implementation of the various TJC Center for Transforming Healthcare recommendations –Expansion of current SSI drilldown as newly identified factors emerge

30. Thank you! Questions? anne.brittain@palmettohealth.org

31. DRAFT – final pending AHRQ approval Join SUSP Affinity Groups! Learn from experts and other SUSP hospital teams who are working on what you’re working on Early recovery protocol (ERP) Preop care coordination SCIP measuresEnvironmental management Pain management, fluid management, postop mobility Glucose control, bowel prep, oral antibiotics Antibiotic prophylaxis, normothermia, skin prep OR traffic, sterile technique, surface contamination Traci Hedrick, MD University of Virginia Melanie Morris, MD University of Alabama Skandan Shanmugan, MD University of Pennsylvania Mariana Pehar Johns Hopkins Hospital Coaching calls every other month Quarterly Coaching Calls Click this link SUSP Affinity Group Registration Link to register for an affinity group by Tuesday, May 20 th !SUSP Affinity Group Registration Link Click this link SUSP Affinity Group Registration Link to register for an affinity group by Tuesday, May 20 th !SUSP Affinity Group Registration Link