1. Implementation of Care Bundles in an Acute Children’s Care Setting ‘not without its challenges’! Paula McGrath Project Co-Ordinator Quality Department 7 th November 2014

2. “a small set of evidence-based interventions for a defined patient segment/ population and care setting, that when implemented together will result in significantly better patient outcomes than when implemented individually”. (Institute for Health Improvement 2012) What is a Care Bundle?

3. Any ideas?? So What Does This Mean? Recipe

4. Result The Perfect Scone

5. Background to Care Bundles  Introduced in PICU – VAP, CVC, PICC & Urinary Catheter  National Standards for Safer Better Healthcare Standards (HIQA, 2012)  National Standards for the Prevention and Control of Healthcare Associated Infections (HIQA, 2009)

6. In 2013 OLCHC had a HIQA announced visit One of the recommendations from the visit Theme 3: Safe care - Recommendations Recommendation 5. OLCHC should put in place arrangements to ensure that care bundles are rolled out throughout the hospital as planned, and that their efficacy is monitored on an ongoing basis. Background to Care Bundles

7. Our Team Working Group Project Sponsor Surveillance Scientist Consultant Microbiologist Nurse Educators Ward Managers Nurse Practice Development Project Co- Ordinator

8. The Model for Improvement  What do we want to achieve?  Can the change be measured?  How can we be sure a change is an improvement? Planning Stage

9. Project Aim “To prevent healthcare associated device infections by the implementation of 3 care bundles to all ward areas over a 10 month period” What do we want to achieve?

10. Phased Approach Method Phase 1: Phase 1: Designing and creating the bundles and audit tools Communication and education with all stakeholders Phase 2: 4 week pilot on an infant medical / surgical ward. Modification of tools and education based on staff evaluation Modification of tools and education based on staff evaluation

11. Phased Approach Phase 3: Official launch at Ward Managers’ Quality & Leadership Day. Phase 4: Staged implementation of the 3 bundles with continuous evaluation and feedback.

12. Phased Approach Bundle 1: Nov 2013 – PICC / CVC Bundle Bundle 2: March 2014 – Urinary Catheter Bundle Bundle 3: May 2014 – PVC Bundle

13. The Bundle

14. Challenges  Staff Perception:  Not another tick box!!!!  More paperwork  Who benefits????  Designing Paperwork…..content –v- user friendly  Surveillance & Reporting  Care Plan v Care Bundle

15. Success

16. Celebrations

17. MarAprMayJuneJulyAugSeptTotal CVC days 146124608370151120754 PICC days 38825111465567350 Ur Cath days 37408358914862419 Can The Change Be Measured?

18. Days Since Last Line Infection

19. ECLS Co-ordinator costing review exercise Line Infection in PICU 4 day increased LOS €20,000 Line infection on ward 42 day increased LOS €54,000 Its Costs How Much?

20. Benefits and Outcomes  The hospital now have data to support device free infection How Can We Be Sure A Change Is an Improvement?  Reduced duration of use of invasive devices  Device free infection rates are now available to all hospital staff  MIST (Making It Safe Together) – collaboration and sharing of knowledge  “Care bundles” are now part of the hospital vocabulary.

21. Sustainability The success of this project has led to many developments which are aligned to the hospital’s quality agenda:  Posting of device free infection days in all clinical areas – Quality Boards  Senior Management Quality Walk Arounds  Monthly reporting of device free infection rates to Corporate Management and clinical teams  Creation of a Nursing Quality group to lead, implement and support future quality initiatives

22. Our Future Onwards and Upwards!!!!