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USING LEAN MANAGEMENT AND TEAM RESEARCH TO ASSESS SURGICAL SITE INFECTIONS IN CARDIAC SURGERY
CCCN Abstracts
Heart Institute (Maz) Cardiology Unit identified a gap in the resources provided to semi-urgent patients, as stabilized semiurgent patients discharged home prior to cardiovascular (CV) surgery would return for their open heart surgery unprepared. In November 2014, a semi-urgent pre-operative patient package (SUPPP) was developed to support patients and staff. A checklist was designed to guide staff through preparatory tasks requiring completion prior to the patient’s discharge and patient resources developed included guidance and information supporting the CV surgery journey. To determine if the SUPPP met patient needs, interviews were conducted with patients and staff. Patients indicated that the SUPPP explained integral parts of their CV surgery and alleviated their anxiety while preparing them for surgery. Staff articulated their satisfaction indicating that patients were consistently prepared, preventing operating room delays or postponements. The Cardiology Unit participated in an innovative quality improvement project to fill a patient education gap. The team partnered to create a patient resource package and tools for staff to ensure patient preparedness. Efforts were reinforced with increased patient, family and staff satisfaction rates. This work facilitated the development of an Emergent and Urgent PreOperative Patient Package supporting the needs of a vulnerable surgical population. In addition, the SUPPP will be introduced to all Edmonton zone sites which decant CV Surgery patients to the Maz. This initiative resulted in enhanced quality care and an improved CV surgery patient experience. N011 USING LEAN MANAGEMENT AND TEAM RESEARCH TO ASSESS SURGICAL SITE INFECTIONS IN CARDIAC SURGERY J Duteil, W Senner Interior Health Authority/Kelowna General Hospital, Kelowna, BC
In 2016, clinical observations indicated rising cardiac surgical site infections (SSI) at both saphenous and sternal sites. We confirmed this observation using the cardiac surgery database. As a result, we implemented a systematic review of our clinical practices. SSIs have been shown to increase risk to patients’ morbidity; including increased length of stay, re-hospitalizations, and program costs. LEAN management steps were implemented to increase staff awareness, identify areas for clinical improvement and initiate necessary changes to lower SSI rates. We simultaneously began three streams of team research: monthly data reports, infection control statistical analysis and observational studies. Monthly data reports and infection control analysis provided us with in-depth knowledge of the types, causes and frequency of infections. The observational research followed patients through the continuum of cardiac surgery from the operating theater, cardiac surgery intensive care unit and cardiac surgery in-patient unit. We examined a total of 1,610 procedures from April 2014 to December 2016 that indicated an overall SSI rate of 2.8% (95% confidence interval, 2.0 âV“ 3.6). In addition, SSI rates
S213
rose from 1.5% in 2015 to 3.4% in 2016, (p ¼0.04). The data collected allowed us to implement changes in practice (including a back to basics approach on wound care, review of hyperglycemia management, continence care, and patient teaching) which aimed to improving patient outcomes, lowering program costs and decreasing SSI to less than 1.5%. N012 THE DEVELOPMENT OF A TELEPHONE FOLLOWUP INTERVENTION FOR ADULT PATIENTS AFTER CARDIAC SURGERY N Millar,1 M Bursey2 1
Hamilton Health Sciences, Hamilton, ON
2
Memorial University of Newfoundland, St John’s, NL
Hospital re-admission among adult patients after cardiac surgery remains high with an estimated rate of 18.7% in the United States and in Canada. This results in additional financial burden to healthcare and poor patient experience in hospitals. Although there are limited studies that demonstrate the benefits of a telephone follow-up after cardiac surgery, this intervention can potentially mitigate hospital re-admissions and promote a positive patient transition from hospital to home. The main purpose of this quality improvement (QI) project was to develop a telephone follow-up intervention for adult patients after cardiac surgery after hospital discharge. An integrated literature review and key stakeholder consultations through key informant interviews and focus group discussions were used as the methodologies for this project. The telephone follow-up intervention was designed for patients, who meet one of the 10 inclusion criteria determining their eligibility for the intervention. Ten days post-hospital discharge a registered nurse (RN) will call patients at home via telephone to assess their breathing, incisions, and presence of symptoms of common post-operative complications from cardiac surgery. To facilitate the application of this project, a Telephone Follow-up Toolkit and a Telephone Follow-up Intervention after Cardiac Surgery form were developed for the nurses involved in this project. The implementation of a telephone follow-up intervention in cardiac surgery represents a promising strategy to prevent hospital re-admissions and post-operative complications, as well as promote smooth transitions from hospital to home of adult patients after cardiac surgery. N013 THE EFFECTIVENESS OF TELEHEALTH NURSING IN HEART FAILURE SELF-MANAGEMENT M Toback Alberta Health Services, Calgary, AB INTRODUCTION:
Heart failure is one of the most common causes of readmission, disability, and death worldwide. Patients with heart failure show a complex condition including fatigue and dyspnea. Patient engagement is an important factor in managing heart failure, and self-management plays a
Heart Institute (Maz) Cardiology Unit identified a gap in the resources provided to semi-urgent patients, as stabilized semiurgent patients discharged home prior to cardiovascular (CV) surgery would return for their open heart surgery unprepared. In November 2014, a semi-urgent pre-operative patient package (SUPPP) was developed to support patients and staff. A checklist was designed to guide staff through preparatory tasks requiring completion prior to the patient’s discharge and patient resources developed included guidance and information supporting the CV surgery journey. To determine if the SUPPP met patient needs, interviews were conducted with patients and staff. Patients indicated that the SUPPP explained integral parts of their CV surgery and alleviated their anxiety while preparing them for surgery. Staff articulated their satisfaction indicating that patients were consistently prepared, preventing operating room delays or postponements. The Cardiology Unit participated in an innovative quality improvement project to fill a patient education gap. The team partnered to create a patient resource package and tools for staff to ensure patient preparedness. Efforts were reinforced with increased patient, family and staff satisfaction rates. This work facilitated the development of an Emergent and Urgent PreOperative Patient Package supporting the needs of a vulnerable surgical population. In addition, the SUPPP will be introduced to all Edmonton zone sites which decant CV Surgery patients to the Maz. This initiative resulted in enhanced quality care and an improved CV surgery patient experience. N011 USING LEAN MANAGEMENT AND TEAM RESEARCH TO ASSESS SURGICAL SITE INFECTIONS IN CARDIAC SURGERY J Duteil, W Senner Interior Health Authority/Kelowna General Hospital, Kelowna, BC
In 2016, clinical observations indicated rising cardiac surgical site infections (SSI) at both saphenous and sternal sites. We confirmed this observation using the cardiac surgery database. As a result, we implemented a systematic review of our clinical practices. SSIs have been shown to increase risk to patients’ morbidity; including increased length of stay, re-hospitalizations, and program costs. LEAN management steps were implemented to increase staff awareness, identify areas for clinical improvement and initiate necessary changes to lower SSI rates. We simultaneously began three streams of team research: monthly data reports, infection control statistical analysis and observational studies. Monthly data reports and infection control analysis provided us with in-depth knowledge of the types, causes and frequency of infections. The observational research followed patients through the continuum of cardiac surgery from the operating theater, cardiac surgery intensive care unit and cardiac surgery in-patient unit. We examined a total of 1,610 procedures from April 2014 to December 2016 that indicated an overall SSI rate of 2.8% (95% confidence interval, 2.0 âV“ 3.6). In addition, SSI rates
S213
rose from 1.5% in 2015 to 3.4% in 2016, (p ¼0.04). The data collected allowed us to implement changes in practice (including a back to basics approach on wound care, review of hyperglycemia management, continence care, and patient teaching) which aimed to improving patient outcomes, lowering program costs and decreasing SSI to less than 1.5%. N012 THE DEVELOPMENT OF A TELEPHONE FOLLOWUP INTERVENTION FOR ADULT PATIENTS AFTER CARDIAC SURGERY N Millar,1 M Bursey2 1
Hamilton Health Sciences, Hamilton, ON
2
Memorial University of Newfoundland, St John’s, NL
Hospital re-admission among adult patients after cardiac surgery remains high with an estimated rate of 18.7% in the United States and in Canada. This results in additional financial burden to healthcare and poor patient experience in hospitals. Although there are limited studies that demonstrate the benefits of a telephone follow-up after cardiac surgery, this intervention can potentially mitigate hospital re-admissions and promote a positive patient transition from hospital to home. The main purpose of this quality improvement (QI) project was to develop a telephone follow-up intervention for adult patients after cardiac surgery after hospital discharge. An integrated literature review and key stakeholder consultations through key informant interviews and focus group discussions were used as the methodologies for this project. The telephone follow-up intervention was designed for patients, who meet one of the 10 inclusion criteria determining their eligibility for the intervention. Ten days post-hospital discharge a registered nurse (RN) will call patients at home via telephone to assess their breathing, incisions, and presence of symptoms of common post-operative complications from cardiac surgery. To facilitate the application of this project, a Telephone Follow-up Toolkit and a Telephone Follow-up Intervention after Cardiac Surgery form were developed for the nurses involved in this project. The implementation of a telephone follow-up intervention in cardiac surgery represents a promising strategy to prevent hospital re-admissions and post-operative complications, as well as promote smooth transitions from hospital to home of adult patients after cardiac surgery. N013 THE EFFECTIVENESS OF TELEHEALTH NURSING IN HEART FAILURE SELF-MANAGEMENT M Toback Alberta Health Services, Calgary, AB INTRODUCTION:
Heart failure is one of the most common causes of readmission, disability, and death worldwide. Patients with heart failure show a complex condition including fatigue and dyspnea. Patient engagement is an important factor in managing heart failure, and self-management plays a