1. 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

2. 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

3. 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

4. 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

5. 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

6. 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)

7. 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)

8. 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

9. Rich Data Sources Patient Pathology PAS Pac Vital Pharmacy Theatre
icnet

10. 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

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

12. 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

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

14. Was all of the information available?

15. Add Extended Properties via Admin module
More information required

16. Additional Information Added

17. 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

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

19. Surgeons data

20. Creating ownership

21. 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

22. 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

23. 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.

24. 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.

25. 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

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

27. 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

28. THANK YOU FOR LISTENING
ANY QUESTIONS?