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Implementation of a Best Practice Tracer to Reduce Hysterectomy Surgical Site Infections in a Community Hospital
INNOVATIVE PROGRAMS Proceedings of the 2017 AWHONN Convention
New Programs to Improve Maternal–Fetal Outcomes for Pregnant Women With Substance Use Disorders Nicole Donahue, BSN, MSN, RNC-OB, Christiana Care Health System, Middletown, DE Miranda H. Love, BSN, RNCOB, Christiana Care Health System, Salem, NJ Keywords substance use disorders addiction women neonatal abstinence syndrome
Women’s Health Poster Presentation
Purpose for the Program o help women with substance use disorders during pregnancy.
T
Proposed Change A medication assisted treatment program using buprenorphine was initiated. The program was based on a study done at Johns Hopkins University School of Medicine. Because of the increasing number of women with substance use disorders, there exists a need for an integrated practice team that includes behavioral health, neonatology, obstetric triage, and social services specialists. Universal drug screening was initiated. Group prenatal care is used as a way to bridge outpatient and inpatient care. Implementation, Outcomes and Evaluation Treatment with buprenorphine began in our obstetric triage within the past year. Of note, health
care providers must be certified to prescribe buprenorphine. The results of the study suggest that newborns of mothers who take buprenorphine recover more quickly after birth than those whose mothers are treated with methadone. Implications for Nursing Practice Most women who have substance use disorders never receive treatment. The vast majority of women using drugs while pregnant do so because they are addicted and unable to stop. It is equally as important to treat addiction and mental health disorders. Educating nursing staff on the management of women with substance use disorders and how to support them during recovery is essential. Educating health care providers on the new programs available is another key component.
Implementation of a Best Practice Tracer to Reduce Hysterectomy Surgical Site Infections in a Community Hospital Joan C. Rooney, MSN, RN, IBCLC, Ochsner Medical Center WestBank Hospital, Gretna, LA Nathalie Gilder, MSN-HCSM, RN, Ochsner Medical Center Westbank, Gretna, LA
the SSI rate.
weeks to narrow the focus and increase nursing adherence to tracer use. After 3 months of analyzing tracer results, several areas of weakness and inconsistency in practice were identified in the perioperative processes: patient preoperative education for showering and clipping, operating room cleanliness, and operating room traffic. In 2015, the end of year SSI average was 7%, with a high of 20%. From October 2015 thru July 2016, there has been an impressive decrease to 1% in the year to date SSI rate.
Implementation, Outcomes and Evaluation A best practice tracer was developed by the SSI task force to focus on specific quality processes for patients undergoing hysterectomies. The task force designated and educated unit champions who led the implementation of the tracer into the current workflow. Using the Plan-Do-Study-Act methodology, the tracer was reviewed every 2
Implications for Nursing Practice Nursing staff benefitted from using the tracer by increasing awareness of hysterectomy SSI prevention best practices and solidifying a consistent implementation of these practices. The tracer assisted with developing and refining the perioperative processes and caused a dramatic decrease in hysterectomy SSIs.
Purpose for the Program o decrease surgical site infections (SSI) in women with hysterectomies after an increase in the hysterectomy SSI rate was identified by the Infection Control Committee in 2015 at Ochsner West Bank Hospital.
T
Proposed Change
Kenesha S. Bradley, MSN, RN, A multidisciplinary SSI task force was convened APRN, ACNS-BC, Ochsner to identify and establish processes that included Medical Center WestBank evidence-based practices related to decreasing Hospital, Gretna, LA Carol Cox, RN, MPH, MEd, CIC, Ochsner Medical Center, Gretna, LA Keywords best practice tracer SSI hysterectomy perioperative Plan-Do-Study-Act
Women’s Health Poster Presentation
JOGNN 2017; Vol. 46, Supplement 3S
S7
New Programs to Improve Maternal–Fetal Outcomes for Pregnant Women With Substance Use Disorders Nicole Donahue, BSN, MSN, RNC-OB, Christiana Care Health System, Middletown, DE Miranda H. Love, BSN, RNCOB, Christiana Care Health System, Salem, NJ Keywords substance use disorders addiction women neonatal abstinence syndrome
Women’s Health Poster Presentation
Purpose for the Program o help women with substance use disorders during pregnancy.
T
Proposed Change A medication assisted treatment program using buprenorphine was initiated. The program was based on a study done at Johns Hopkins University School of Medicine. Because of the increasing number of women with substance use disorders, there exists a need for an integrated practice team that includes behavioral health, neonatology, obstetric triage, and social services specialists. Universal drug screening was initiated. Group prenatal care is used as a way to bridge outpatient and inpatient care. Implementation, Outcomes and Evaluation Treatment with buprenorphine began in our obstetric triage within the past year. Of note, health
care providers must be certified to prescribe buprenorphine. The results of the study suggest that newborns of mothers who take buprenorphine recover more quickly after birth than those whose mothers are treated with methadone. Implications for Nursing Practice Most women who have substance use disorders never receive treatment. The vast majority of women using drugs while pregnant do so because they are addicted and unable to stop. It is equally as important to treat addiction and mental health disorders. Educating nursing staff on the management of women with substance use disorders and how to support them during recovery is essential. Educating health care providers on the new programs available is another key component.
Implementation of a Best Practice Tracer to Reduce Hysterectomy Surgical Site Infections in a Community Hospital Joan C. Rooney, MSN, RN, IBCLC, Ochsner Medical Center WestBank Hospital, Gretna, LA Nathalie Gilder, MSN-HCSM, RN, Ochsner Medical Center Westbank, Gretna, LA
the SSI rate.
weeks to narrow the focus and increase nursing adherence to tracer use. After 3 months of analyzing tracer results, several areas of weakness and inconsistency in practice were identified in the perioperative processes: patient preoperative education for showering and clipping, operating room cleanliness, and operating room traffic. In 2015, the end of year SSI average was 7%, with a high of 20%. From October 2015 thru July 2016, there has been an impressive decrease to 1% in the year to date SSI rate.
Implementation, Outcomes and Evaluation A best practice tracer was developed by the SSI task force to focus on specific quality processes for patients undergoing hysterectomies. The task force designated and educated unit champions who led the implementation of the tracer into the current workflow. Using the Plan-Do-Study-Act methodology, the tracer was reviewed every 2
Implications for Nursing Practice Nursing staff benefitted from using the tracer by increasing awareness of hysterectomy SSI prevention best practices and solidifying a consistent implementation of these practices. The tracer assisted with developing and refining the perioperative processes and caused a dramatic decrease in hysterectomy SSIs.
Purpose for the Program o decrease surgical site infections (SSI) in women with hysterectomies after an increase in the hysterectomy SSI rate was identified by the Infection Control Committee in 2015 at Ochsner West Bank Hospital.
T
Proposed Change
Kenesha S. Bradley, MSN, RN, A multidisciplinary SSI task force was convened APRN, ACNS-BC, Ochsner to identify and establish processes that included Medical Center WestBank evidence-based practices related to decreasing Hospital, Gretna, LA Carol Cox, RN, MPH, MEd, CIC, Ochsner Medical Center, Gretna, LA Keywords best practice tracer SSI hysterectomy perioperative Plan-Do-Study-Act
Women’s Health Poster Presentation
JOGNN 2017; Vol. 46, Supplement 3S
S7