1. DRAFT – final pending AHRQ approval Perform an SSI Investigation Deb Hobson, RN BSN March 10 & 12, 2014 1

2. DRAFT – final pending AHRQ approval Objectives Distinguish between process and outcome data. Describe how the SSI Investigation Tool can guide improvement work even when SSI rates are low. Adapt an SSI Investigation Tool to reflect the care processes in your SSI Prevention Bundle. 2 Questions? Contact the SUSP helpdesk at SUSP@jhmi.edu.

3. DRAFT – final pending AHRQ approval SUSP Readiness Bridge  Are your frontline SUSP team members aware of the SUSP project?  Have you completed a safety culture survey (e.g. HSOPS) and debriefed your frontline SUSP team members?  Has your staff received the Science of Safety Training?  Have you collated Perioperative Staff Safety Assessment responses from your staff?  Have you held your Executive Safety Rounds Kickoff meeting? 3 Questions? Contact the SUSP helpdesk at SUSP@jhmi.edu.

4. DRAFT – final pending AHRQ approval Assess Your Performance Collect process and outcome data to assess current performance and progress towards improving patient care. Process DataOutcome Data What we do to patientsWhat happens to patients Depends on your local SSI Prevention Bundle Every hospital in SUSP is tracking the same outcome data e.g. Percentage of patients receiving appropriate antibiotic re-dosing e.g. SSI Rate Questions? Contact the SUSP helpdesk at SUSP@jhmi.edu.

5. DRAFT – final pending AHRQ approval Get SSI Data from the SUSP Website Log onto the SUSP Website Locate the SSI Data Registry Access your SSI Data Report 5 Questions? Contact the SUSP helpdesk at SUSP@jhmi.edu.

6. DRAFT – final pending AHRQ approval Log onto the SUSP Website 6 Questions? Contact the SUSP helpdesk at SUSP@jhmi.edu.

7. DRAFT – final pending AHRQ approval Locate the SSI Data Registry 7 Questions? Contact the SUSP helpdesk at SUSP@jhmi.edu.

8. DRAFT – final pending AHRQ approval Access your SSI Data Report 8

9. DRAFT – final pending AHRQ approval Sample SSI Data Report 9

10. DRAFT – final pending AHRQ approval Always room for improvement 10 Questions? Contact the SUSP helpdesk at SUSP@jhmi.edu.

11. DRAFT – final pending AHRQ approval 1 Organ Space SSI means… 11 4.9% mortality rate $14,448 additional cost of care 24 additional length of stay

12. DRAFT – final pending AHRQ approval Because a multitude of factors influence outcome, it is not possible to know for certain, even after extensive adjustments for differences in case mix are made, the extent to which an observed outcome is attributable to an antecedent process of care. Confirmation is needed by a direct assessment of the process itself…” Avedis Donabedian (1998) 12 Questions? Contact the SUSP helpdesk at SUSP@jhmi.edu.

13. DRAFT – final pending AHRQ approval Uncover Defects with SSI Investigation Tool Identify lapses in infection prevention processes that may have contributed to your SSI case. Assess adherence to your local SSI Prevention Bundle. 13 Questions? Contact the SUSP helpdesk at SUSP@jhmi.edu.

14. DRAFT – final pending AHRQ approval Patient or Provider Factors 14

15. DRAFT – final pending AHRQ approval Normothermia Maintenance 15

16. DRAFT – final pending AHRQ approval Glucose Control 16 Questions? Contact the SUSP helpdesk at SUSP@jhmi.edu.

17. DRAFT – final pending AHRQ approval Antibiotic Redosing 17

18. DRAFT – final pending AHRQ approval Adapt the SSI Investigation Tool Johns Hopkins Hospital clinicians designed this tool to assess adherence to their local SSI Prevention Bundle. –Your team may want to investigate care processes that are not included in this tool. –This tool may include processes that your team does not use. Please modify this tool to best fit your team’s needs. 18 Questions? Contact the SUSP helpdesk at SUSP@jhmi.edu.

19. DRAFT – final pending AHRQ approval What Your Team Can Do Abstract this information from the patient’s chart. Use SSI Audit tools to dig deeper into your care delivery system. Present process data to the team at a routine SUSP meeting. Share investigation results monthly or quarterly with your frontline staff and OR leadership. 19 Questions? Contact the SUSP helpdesk at SUSP@jhmi.edu.

20. DRAFT – final pending AHRQ approval Next Steps Complete an SSI investigation of your most recent SSIs. Share your findings on a March coaching call. 20 Questions? Contact the SUSP helpdesk at SUSP@jhmi.edu.

21. DRAFT – final pending AHRQ approval What questions do you have? Remember you have a support network –You can ask questions any time on MedConcert –You can ask questions during coaching calls –You can contact the SUSP helpdesk 21 Questions? Contact the SUSP helpdesk at SUSP@jhmi.edu.

22. DRAFT – final pending AHRQ approval Content Call Evaluation 22 We want to ensure that the content calls provide useful and pertinent information for the SUSP teams. For this reason we request that you complete a brief evaluation following each call. The evaluation may be found at the following link: https://www.surveymonkey.com/s/SUSP_Cohort4