1. Getting Started on Surgical Site Infections(SSI) Travis Dollak Jill Hanson Improvement Advisors WHA 1

2. Today’s Call 1)Our Timeline and Process 2)Measures (Q&A) 3)Next 30 Days A.View Science of Safety Video B.Organizing the Team 2

3. Surgical Site Infection Background Between 750,000 and 1 Million SSI occur each year, extending hospital stays by 3.7 million days and generating more than $1.6 billion in excess cost SSI are the third most frequently reported health care-associated infection An SSI program should combine SSI prevention methods and a surgical Safety Checklist to promote teamwork and communication http://www.hret-hen.org/images/downloads/508changepacks/ssi_change%20package_508.pdf

4. Initiative Timeline Overview 9 Month Collaborative 1-Hr Webinar Each Month – 2 nd Tuesday of Each Month 10:00-11:00 PM 4 Webinars Progress of last 30 days New content Plan for the next 30 days Discussion Group Peer-to-Peer Sharing Quality Center Data submissions References and Toolkits

5. Poll Question #1: What have you tried? Which of the following describes your facility best in terms of progress on this initiative? a)This is the first time we have worked on it b)We have worked on it in the past but feel we have regressed c)We have really nailed it and are putting the finishing touches on the program d)We have all but given up on finding ways to improve 5

6. 6 Reduce SSI by 50% Adopt Surgical Safety Checklist WHO safe surgery checklist Verbally confirm all items with team members Use standardized tool (no reliance on memory) Appropriate use of prophylactic antibiotics Standardized Order Sets Pharmacist and RN Driven protocols Process to review exceptions to protocol Redose appropriately in surgeries > 4 hrs Perioperative Skin Antisepsis Standardized application practices Educate perioperative personnel DRIVER DIAGRAM

7. 7 Reduce SSI by 50% Preadmission Skin Cleansing Standardized Order Sets for Skin Cleansing Strategy for distribution of skin antiseptic to Patients Educate Patients on how to apply Normothermia – SCIP-Inf-10 Standardized Procedure for Pre-warming Standardized Procedure for active warming in operating room Perioperative Glucose Control Obtain Glucose at every anesthesia station Develop a perioperative glycemic control team DRIVER DIAGRAM continued

8. Poll Question #1: Results Which of the following describes your facility best in terms of progress on this initiative? a)This is the first time we have worked on it b)We have worked on it in the past but feel we have regressed c)We have really nailed it and are putting the finishing touches on the program d)We have all but given up on finding ways to improve 8

9. Outcome Measure: Focus on the customer or patient. What is the end result? SSI Outcome Measure: SSI rate based on CDC NHSN definition (# of SSI per 100 NHSN operative procedures) SSI Outcome Measure 9

10. SSI Process Measures 10 Process Measures: Focus on the workings of the system. Provide real time feedback. SSI Process Measures:  Adopt Surgical Safety Checklist  SCIP- Inf-1 – Antibiotic before incision  SCIP- Inf-2 – Antibiotic choice  SCIP-Inf-3 – Antibiotic discontinued  SCIP-Inf-4 – Perioperative Glucose Control  SCIP-Inf-10 – Normothermia  Perioperative Skin Antisepsis  Preadmission Skin Cleansing  Draft – Cefazolin Dosing based on (weight vs. BMI)

11. Action Item #1 – Data Submission Baseline outcome data due September 30 th Submit via WHA Quality Center Portal o 2011 Data Aggregate (if available) and/or o 2012 Data Monthly (if available) OR Confer NHSN rights to WHA 11 http://www.whaqualitycenter.org/PartnersforPatients/SurgicalSiteInfections.aspx

12. Plan for the Next 30 Days 1.Organize your Team 2.View Science of Safety Video 3.Complete Staff Safety Assessment 12

13. Organizing your Team Considerations – Who will you involve? – How will you communication? Within your team? (notify of meetings) To others outside of thee team? – How will you use the webinars? (use as weekly meeting?) – Identify team structure (key roles, expertise, leaders) – How will you keep everyone engaged? 13

14. Action Item #2 - Organizing your Team Optional Tools to Use Agenda Team Charter 14

15. Science of Safety Recipe Educate on the Science of Safety Identify Defects (Staff Safety Assessment) Learn from Defects Implement Teamwork & Communication Tools 15

16. 16 The Swiss Cheese Model – by James Reason Science of Safety – How Errors Happen

17. Seven Concepts of Patient Safety #CONCEPTSSI SPECIFIC 1Use-Centered Design (staff providing care) Make things visible Create poster with reminder to conduct the three pauses prior to surgery 2Avoid Reliance on Memory Vigilance Provide checklists, flags or alarms as reminders Adoption of surgical safety checklist – walk thru checklist prior to surgery 3Involve Patients in Their Care Teach back Surgical checklist allows patients the opportunity to verify important information with the surgical team before surgery. 17

18. Seven Concepts of Patient Safety #CONCEPTHAC SPECIFIC 4Anticipate the UnexpectedPatients may not do three day pre- wash – develop protocol for skin cleansing day of surgery. 5Build in Redundancy Assume errors will occur and build a system to accommodate Develop standardized order sets for preadmission skin cleansing. 6Hardcode Your System (process, training, culture) Develop standardized practices for application of skin antiseptic agents and educate staff 7Improve Access to Timely Data Data walls Share real-time data with project team and unit staff 18

19. Action Item # 3 – View Patient Safety Video Create a roster of who on your team/unit needs to view the Science of Safety video. http://www.youtube.com/watch?v=GOJJH Hm7lnM&feature=results_main&playnext =1&list=PL048D28C888FE3871 19

20. Science of Safety Recipe Educate on the Science of Safety Identify Defects (Staff Safety Assessment)* Learn from Defects Implement Teamwork, Communication Tools, A standardized process 20

21. The Staff Safety Assessment How will the next patient be harmed? One way to make harm visible– get staff thinking about safety and how to improve it Frontline caregivers are the eyes and ears of patient safety Use the Staff Safety Assessment to identify patient safety issues as it relates to SSI 21

22. Action Item #4 – Staff Safety Assessment Just two (2) very important questions for any clinical unit: Please describe where you think breakdowns are occurring with Prophylactic Antibiotics/Surgical checklists/Skin Preparation/Perioperative Temperature Management. Please describe what you think can be done to prevent or minimize the breakdowns. Thank you for helping improve safety in our workplace! 22 Available in SSI Getting Started Webinar Folder on the Quality Center

23. The Next 30 Days Tools Available On WHA Quality Center: Meeting Agenda/ Team Charter Science of Safety Video Link Staff Safety Assessment Surveys SSI References and Toolkits ACTION ITEMS Submit Baseline Data Organize Your Team View Science of Safety Video Conduct Staff Safety Assessment (Report Out in November) Review Resources in Quality Center 23

24. Questions? 24 Reminders: Please complete the 3 question survey when you close the webinar window Mid-month reminder survey Next month  Model for Improvement

25. Guide to Quality Center http://www.whaqualitycenter.org/ http://www.whaqualitycenter.org/ Click Here 25