- Email: [email protected]
Safe passage campaign to prevent catheter-related bloodstream infections (CR-BSIs) in a tertiary neonatal intensive care unit (NICU)
E128
Vol. 33 No. 5
PROJECT: Several comedy sketches were written to include key patient safety errors related to the national patient safety goals and hospital policies for infection control, fire safety, disaster, confidentiality, and ethics. The errors were primarily based on an analysis of test results from the previous year’s program. Hospital employees volunteered to be the ‘‘actors.’’ Playbills were distributed that listed the names and departments of the actors along with those who assisted with the event. For 6 weeks prior to the performances, advertising flyers and safety information on the topics to be included at the presentation were distributed to all staff. Department heads were asked to review the information with their staff members. Three performances were held and a videotape was made for future viewing. An ‘‘influenza vaccine station’’ was set up to conveniently vaccinate staff. Volunteers from many departments assisted on the day of the event. Many of the props needed were already available in the hospital, including a stage curtain cleverly constructed from old bed curtains. A construction company provided a loaner of bright ‘‘stage’’ lighting, and the local church offered us of their auditorium for the performances. The program was interactive, with the audience participating to identify errors, which were then discussed. RESULTS: The group of staff members completing the post test for 2004 was different from those doing so the previous year and so direct comparison was not possible. However, it was identified that in 2004, staff showed significant improvement in answering 11 identical questions. Grades for those questions increased from 86% to 94% for clinical staff and 78% to 89% for non-clinical staff. Disaster preparedness, an area of identified weakness, will be a focus for the 2005 program. LESSONS LEARNED: Presenting a creative educational program to adults can be done with only a small budget and a little creativity. Alternative ways to present somewhat dry but vital safety and educational materials can improve participation and learning. Abstract ID 52093 Tuesday, June 21
Safe passage campaign to prevent catheter-related bloodstream infections (CR-BSIs) in a tertiary neonatal intensive care unit (NICU) ML Manning P Gordin The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania ISSUE: Inconsistent use of the Center for Disease Control and Prevention (CDC) guidelines for prevention of CR-BSIs as well as lack of clear, concise communication between members of the healthcare team can result in CR-BSIs. Due to fluctuating CRBSI rates, a multiphased ‘‘safe passage’’ campaign was launched in our 50-bed NICU to address both issues. PROJECT: A teamwork and safety culture survey was conducted to provide a baseline measure. This was followed by a central line education and competency program. Each clinician received his or her own copy of a unitproduced DVD entitled ‘‘Safe Passage’’ which demonstrated hand hygiene, maximal sterile barrier precautions, and appropriate catheter site care. Once viewed, competency observation was required. Communication strategies consisted of coaching sessions for nurses and utilization of a standardized clinical communication tool known as SBAR (situation-background-assessment- recommendation/request). The tool helps set the expectation that relevant clinical information is going to be communicated each time the patient is discussed. RESULTS: More than 60% of eligible participants responded to the survey. Over half indicated a positive climate. Low-scoring items pertained to problem resolution and inability to express disagreement. Most clinical staff viewed the DVD and successfully completed the competency. Additional variations in central line management were discovered and eliminated as a result of the program. Coaching sessions for 60 nurses were conducted using theater-based communication tools for ‘‘finding-your-voice.’’ Sessions consisted primarily of role play around difficult clinical scenarios and challenging communications. Participation was followed by individual action plans and selection of a ‘‘buddy’’ for feedback and support. Evaluations have been extremely positive. SBAR scenarios pertaining to central line care and management were written. The scenarios were tested with and without the use of the tool. Communication tended to be more concise and factual and less narrative when the tool was used. Individual nurse training using the tool begins in February.
June 2005
E129
LESSONS LEARNED: Eliminating variation in the use of CDC central line guidelines and successful nurse-physician communication is critical for the safe, efficient, and effective patient care. This project outlines a multifaceted, practical approach that we plan to replicate and spread to other areas of our organization.
Abstract ID 53839 Monday, June 20
Improving hand hygiene compliance with comprehensive interventions over time SJ Sohn J Eagan K Sepkowitz MSKC, New York, New York ISSUE: Proper hand hygiene (HH) by healthcare workers (HCWs) is a well-established method to prevent nosocomial pathogen transmission. Despite this, HCW HH compliance is not ideal. Alcohol-based hand rub was introduced and multiple interventions were also implemented to improve HH practices. PROJECT: 1) Data collection: In June 2003, an observational, interventional study with five phases (baseline, separate staggered intervention periods) was initiated. Trained members of infection control staff recorded data on patient encounters, including whether or not HCWs washed hands before (HH pre) and after (HH post) patient care. Twenty observation sessions per week were randomly distributed during the hours of 7am to 5pm, Monday through Friday; each session lasted about 30 minutes. 2) Interventions: Alcohol-based hand rub was selected utilizing staff input; decisions regarding placement and labeling gave consideration to feedback from multidisciplinary rounds and focus groups of clinical staff. Placement was standardized wherever possible. During mandatory introductory inservices, HCWs were educated on benefits and appropriate use of hand rub. Importance of HH in preventing infection was re-emphasized and common misconceptions about HH were addressed. Surveys and follow-up surveys were conducted to assess HCW attitudes, beliefs, and knowledge about HH as well as satisfaction with the hand-rub product. Education included an interactive component and a Web-based module. Two separate HH poster campaigns were launched. Refresher inservices provided feedback on floor-specific HH rates, fingertip culture results, and self-assessments of HH practices. Nurse leaders subsequently received monthly feedback on floorspecific HH rates. RESULTS: During 1,476 sessions (total of about 738 hrs of observation over 67 weeks), observers recorded 12,814 opportunities for HH (6,407 complete episodes). Ongoing review of continuous monitoring data has shown overall improvement at the end of each campaign phase. Overall, rates of HH compliance before patient care almost tripled (6.4% at baseline, 16.5% during Phase 4, p , 0.01), and rates of HH post doubled (23.4% to 46.6%, p , 0.01). LESSONS LEARNED: Improving HH practices is difficult but possible with a comprehensive program of multiphased interventions over time. Our experience has shown that intervention components addressing physical environment, cognitive factors, clinical, and administrative buy-in and HCW involvement are beneficial.
Abstract ID 54405 Monday, June 20
Return to the fundamentals: Implementing best practice reduces cardiac bypass surgical site infection rates MA Pass P Wieczorek LE Winner
Vol. 33 No. 5
PROJECT: Several comedy sketches were written to include key patient safety errors related to the national patient safety goals and hospital policies for infection control, fire safety, disaster, confidentiality, and ethics. The errors were primarily based on an analysis of test results from the previous year’s program. Hospital employees volunteered to be the ‘‘actors.’’ Playbills were distributed that listed the names and departments of the actors along with those who assisted with the event. For 6 weeks prior to the performances, advertising flyers and safety information on the topics to be included at the presentation were distributed to all staff. Department heads were asked to review the information with their staff members. Three performances were held and a videotape was made for future viewing. An ‘‘influenza vaccine station’’ was set up to conveniently vaccinate staff. Volunteers from many departments assisted on the day of the event. Many of the props needed were already available in the hospital, including a stage curtain cleverly constructed from old bed curtains. A construction company provided a loaner of bright ‘‘stage’’ lighting, and the local church offered us of their auditorium for the performances. The program was interactive, with the audience participating to identify errors, which were then discussed. RESULTS: The group of staff members completing the post test for 2004 was different from those doing so the previous year and so direct comparison was not possible. However, it was identified that in 2004, staff showed significant improvement in answering 11 identical questions. Grades for those questions increased from 86% to 94% for clinical staff and 78% to 89% for non-clinical staff. Disaster preparedness, an area of identified weakness, will be a focus for the 2005 program. LESSONS LEARNED: Presenting a creative educational program to adults can be done with only a small budget and a little creativity. Alternative ways to present somewhat dry but vital safety and educational materials can improve participation and learning. Abstract ID 52093 Tuesday, June 21
Safe passage campaign to prevent catheter-related bloodstream infections (CR-BSIs) in a tertiary neonatal intensive care unit (NICU) ML Manning P Gordin The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania ISSUE: Inconsistent use of the Center for Disease Control and Prevention (CDC) guidelines for prevention of CR-BSIs as well as lack of clear, concise communication between members of the healthcare team can result in CR-BSIs. Due to fluctuating CRBSI rates, a multiphased ‘‘safe passage’’ campaign was launched in our 50-bed NICU to address both issues. PROJECT: A teamwork and safety culture survey was conducted to provide a baseline measure. This was followed by a central line education and competency program. Each clinician received his or her own copy of a unitproduced DVD entitled ‘‘Safe Passage’’ which demonstrated hand hygiene, maximal sterile barrier precautions, and appropriate catheter site care. Once viewed, competency observation was required. Communication strategies consisted of coaching sessions for nurses and utilization of a standardized clinical communication tool known as SBAR (situation-background-assessment- recommendation/request). The tool helps set the expectation that relevant clinical information is going to be communicated each time the patient is discussed. RESULTS: More than 60% of eligible participants responded to the survey. Over half indicated a positive climate. Low-scoring items pertained to problem resolution and inability to express disagreement. Most clinical staff viewed the DVD and successfully completed the competency. Additional variations in central line management were discovered and eliminated as a result of the program. Coaching sessions for 60 nurses were conducted using theater-based communication tools for ‘‘finding-your-voice.’’ Sessions consisted primarily of role play around difficult clinical scenarios and challenging communications. Participation was followed by individual action plans and selection of a ‘‘buddy’’ for feedback and support. Evaluations have been extremely positive. SBAR scenarios pertaining to central line care and management were written. The scenarios were tested with and without the use of the tool. Communication tended to be more concise and factual and less narrative when the tool was used. Individual nurse training using the tool begins in February.
June 2005
E129
LESSONS LEARNED: Eliminating variation in the use of CDC central line guidelines and successful nurse-physician communication is critical for the safe, efficient, and effective patient care. This project outlines a multifaceted, practical approach that we plan to replicate and spread to other areas of our organization.
Abstract ID 53839 Monday, June 20
Improving hand hygiene compliance with comprehensive interventions over time SJ Sohn J Eagan K Sepkowitz MSKC, New York, New York ISSUE: Proper hand hygiene (HH) by healthcare workers (HCWs) is a well-established method to prevent nosocomial pathogen transmission. Despite this, HCW HH compliance is not ideal. Alcohol-based hand rub was introduced and multiple interventions were also implemented to improve HH practices. PROJECT: 1) Data collection: In June 2003, an observational, interventional study with five phases (baseline, separate staggered intervention periods) was initiated. Trained members of infection control staff recorded data on patient encounters, including whether or not HCWs washed hands before (HH pre) and after (HH post) patient care. Twenty observation sessions per week were randomly distributed during the hours of 7am to 5pm, Monday through Friday; each session lasted about 30 minutes. 2) Interventions: Alcohol-based hand rub was selected utilizing staff input; decisions regarding placement and labeling gave consideration to feedback from multidisciplinary rounds and focus groups of clinical staff. Placement was standardized wherever possible. During mandatory introductory inservices, HCWs were educated on benefits and appropriate use of hand rub. Importance of HH in preventing infection was re-emphasized and common misconceptions about HH were addressed. Surveys and follow-up surveys were conducted to assess HCW attitudes, beliefs, and knowledge about HH as well as satisfaction with the hand-rub product. Education included an interactive component and a Web-based module. Two separate HH poster campaigns were launched. Refresher inservices provided feedback on floor-specific HH rates, fingertip culture results, and self-assessments of HH practices. Nurse leaders subsequently received monthly feedback on floorspecific HH rates. RESULTS: During 1,476 sessions (total of about 738 hrs of observation over 67 weeks), observers recorded 12,814 opportunities for HH (6,407 complete episodes). Ongoing review of continuous monitoring data has shown overall improvement at the end of each campaign phase. Overall, rates of HH compliance before patient care almost tripled (6.4% at baseline, 16.5% during Phase 4, p , 0.01), and rates of HH post doubled (23.4% to 46.6%, p , 0.01). LESSONS LEARNED: Improving HH practices is difficult but possible with a comprehensive program of multiphased interventions over time. Our experience has shown that intervention components addressing physical environment, cognitive factors, clinical, and administrative buy-in and HCW involvement are beneficial.
Abstract ID 54405 Monday, June 20
Return to the fundamentals: Implementing best practice reduces cardiac bypass surgical site infection rates MA Pass P Wieczorek LE Winner