1. Model for Improvement What can we change that will result in an improvement? PLAN DO STUDY ACT How will we know that a change is an improvement ? What are we trying to accomplish? AIM MEASUREMENTCHANGE

2. PDSA –testing a change MARU What is Maru trying to achieve? How many ideas does he try? Is he successful? What was the possible negative outcome? From YouTube

3. Rapid Cycle Change What can we change that will result in an improvement? PLAN DO STUDY ACT How will we know that a change is an improvement? What are we trying to accomplish? PLAN DO STUDY ACT PLAN DO STUDY ACT PLAN DO STUDY ACT

4. AIM of this change: PROBLEM :

5. AIM of this change: Do a PDSA to solve a problem at home

6. AIM: unpack the dishwasher in a more efficient way PROBLEM : unpacking the dishwasher is inefficient Put half the cups and half the glasses in the cupboard just above the dishwasher How easy it is to unpack the dishwasher -Tom to rearrange cupboard today --Mary and Tom to unpack into one cupboard for 4 days Mary – it will look horrible and I will hate it Tom – it will be easy and Mary will like it

9. Model for Improvement What can we change that will result in an improvement? PLAN DO STUDY ACT How will we know that a change is an improvement ? What are we trying to accomplish? AIM MEASUREMENTCHANGE

10. Measurement Are we getting closer to our target? Outcome measure

11. Measurement Did we use the whole bundle in every patient every time? Process measure (Bundle compliance)

12. Measurement Was the change an improvement? Measuring the impact of a change

13. Measuring over time a volunteer to write a volunteer to measure graph paper

14. Annotated Run Chart Community Need I Change Made in June

15. Interpreting Data: what is the story? I Before (Feb) After (Aug)

16. What is the real story? Change Made Change Made in June FebAug FebAug FebAug FebAug FebAug I Change Made

17. Prevention of Mother to Child Transmission. A sub-district in a province in SA Positive PCRs at 6 weeks (target <5%) Feb 2010 8.2% Feb 2011 3.2% Improvement?

18. Positive PCRs at 6 weeks (target <5%) Feb 2010 8.2% Feb 2011 3.2% Improvement?

20. Run Charts One of the most powerful tools for improvement Describe a process over time Shows trends the process is experiencing Can be used to analyse whether the change was an improvement Data can be used to drive change

21. Outcome measurement Are we getting to our target? Was the change an improvement? How do we measure HAIs?

22. Measuring infection rates Lessons from an ICU

23. Quality Improvement 101 Problem?

24. Measuring Infection Rates Total number of infective cases per 1,000 device days: Total No. of VAP cases Ventilator days X 1,000 Numerator Denominator

25. Definition of VAP “VAP is suspected when a patient on mechanical ventilation develops: a new or progressive pulmonary infiltrate with fever / leucocytosis and purulent tracheobronchial secretions” “Pneumonia is considered as ventilator associated if the patient was intubated and ventilated at the time or within 48hrs before the onset of the infection”

26. Overcoming Numerator Issues Total No. of VAP cases Ventilator days X 1,000 Numerator Denominator Patients with

27. Overcoming Numerator Issues – diagnosing the HAI (workbook) Checklists for Diagnosing the HA Infection used by the team

28. Overcoming Denominator Issues At the same time every day the Unit manager counts devices in use in the ward

29. Working out the infection rates (workbook)