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Surgical Site Infection Tools for Improvement SUSP. Learning Objectives. Review approach to SSI reduction as part of SUSP project. Review auditing tools to help identify local defects contributing to SSIs. Next steps. Surgical Care Improvement Project (SCIP). - PowerPoint PPT Presentation
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© The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011
Surgical Site Infection Tools for ImprovementSUSP
Armstrong Institute for Patient Safety and Quality2
Learning Objectives
• Review approach to SSI reduction as part of SUSP project.
• Review auditing tools to help identify local defects contributing to SSIs.
• Next steps
Armstrong Institute for Patient Safety and Quality3
Surgical Care Improvement Project (SCIP)
No single SSI prevention bundle
• Deeper dive into SCIP measures to identify local defects
• Emerging evidence– Abx redosing and weight based dosing – Maintenance of normogylcemia– Mechanical bowel preparation with oral abx – Standardization of skin preparation
• Capitalize on frontline wisdom– CUSP/Staff Safety Assessment
Armstrong Institute for Patient Safety and Quality4
Armstrong Institute for Patient Safety and Quality5
DEEPER DIVE INTO SCIP MEASURES TO IDENTIFY LOCAL DEFECTS
6
Deeper Dive: Auditing
“…to make an audit of (performance) to evaluate or improve its safety, efficiency, or the like” http://dictionary.reference.com
www.visualthesaurus.com
Armstrong Institute for Patient Safety and Quality7
• Evaluate a sample of patients – (ie: the next 5-10 patients)
• Practical and feasible strategy to evaluate performance and surface defects
• Needs to be adapted to local environment
• Empowers frontline staff
Auditing Practice
Armstrong Institute for Patient Safety and Quality8
Auditing tools
• Antibiotic – Selection, dosing, redosing
• Normothermia • Glucose Control• Skin Prep • Others?
Armstrong Institute for Patient Safety and Quality9
SCIP Measures
Quality Indicator Numerator Denominator
Appropriate antibiotic choice Number of patients who received the appropriate prophylactic antibiotic
All patients for whom prophylactic antibiotics are indicated
Appropriate timing of prophylactic antibiotics
Number of patients who received the prophylactic antibiotic within 60 minutes prior to incision
All patients for whom prophylactic antibiotics are indicated
Appropriate discontinuation of antibiotics Number of patients who received prophylactic antibiotics and had them discontinued in 24 hours
All patients who received prophylactic antibiotics
Appropriate hair removal Number of patients who did not have hair removed or who had hair removed with clippers
All surgical patients
Perioperative normothermia Number of patients with postoperative temperature ≥36.0oC
Patients undergoing surgery colorectal surgery
Antibiotics practices All cases (n = 3002) number (%)
Nonemergency (n = 2743) number (%)
Emergency cases (n = 248) number (%)
Was an SCIP-compliant antibiotic chosen? 2,431 (81.4%) 2,293 (83.6%) 130 (52.4%)
Was antibiotic given within 1 h before incision? 2,712 (90.8%) 2,544 (92.7%) 159 (64.1%)
Antibiotics weight-adjusted (n = 972) 552 (56.8%)
Antibiotics redosed (n = 398) 24 (6.0%)
Total surgical site infection 269 (9.0%) 245 (8.9%) 24 (9.7%)
10
Perioperative Antibiotic Compliance:Michigan Surgical Quality Collaborative
Hendren et al. Am. J Surg 2011
Armstrong Institute for Patient Safety and Quality11
SCIP measure performance
Johns Hopkins ComparisonHospitals
Surgery patients who were given an antibiotic at the right time (within one hour before surgery) to help prevent infection
98% 97%
Surgery patients who were given the right kind of antibiotic to help prevent infection
98% 98%
Surgery patients whose preventive antibiotics were stopped at the right time (within 24 hours after surgery)
97% 96%
Surgery patients needing hair removed from the surgical area before surgery, who had hair removed using a safer method (electric clippers or hair removal cream – not a razor)
100% 100%
Patients having surgery who were actively warmed in the operating room or whose body temperature was near normal by the end of surgery.
98% 99%
Johns Hopkins HospitalMay 2010 SCIPHospital Comparewww.medicare.gov
12
SUSP Antibiotic Audit Tool
Armstrong Institute for Patient Safety and Quality13
Antibiotic Compliance ProjectJohns Hopkins
Before After0
25
50
75
100
33%
92%
Correct Dose of Gen-tamicin Received
% o
f Pat
ient
s C
ompl
iant
Interventions:• Increased amount of
gentamicin available in the room
• Added dose calculator in anesthesia record
• Educated surgeons, anesthesia and nursing, anesthesia and nursing in grand roundsWick et al, JACS 2012
Armstrong Institute for Patient Safety and Quality14
SCIP Measures
Quality Indicator Numerator Denominator
Appropriate antibiotic choice Number of patients who received the appropriate prophylactic antibiotic
All patients for whom prophylactic antibiotics are indicated
Appropriate timing of prophylactic antibiotics
Number of patients who received the prophylactic antibiotic within 60 minutes prior to incision
All patients for whom prophylactic antibiotics are indicated
Appropriate discontinuation of antibiotics Number of patients who received prophylactic antibiotics and had them discontinued in 24 hours
All patients who received prophylactic antibiotics
Appropriate hair removal Number of patients who did not have hair removed or who had hair removed with clippers
All surgical patients
Perioperative normothermia Number of patients with postoperative temperature ≥36.0oC
Patients undergoing surgery colorectal surgery
Armstrong Institute for Patient Safety and Quality15
Johns Hopkins ComparisonHospitals
Surgery patients who were given an antibiotic at the right time (within one hour before surgery) to help prevent infection
98% 97%
Surgery patients who were given the right kind of antibiotic to help prevent infection
98% 98%
Surgery patients whose preventive antibiotics were stopped at the right time (within 24 hours after surgery)
97% 96%
Surgery patients needing hair removed from the surgical area before surgery, who had hair removed using a safer method (electric clippers or hair removal cream – not a razor)
100% 100%
Patients having surgery who were actively warmed in the operating room or whose body temperature was near normal by the end of surgery.
98% 99%
Johns Hopkins HospitalMay 2010 SCIPHospital Comparewww.medicare.gov
SCIP measure performance
Armstrong Institute for Patient Safety and Quality16
SUSP Normothermia Audit Tool
Armstrong Institute for Patient Safety and Quality17
Normothermia Project Johns Hopkins
Before After0
25
50
75
10083%
95%
Temperature > 36 °C post-op
% o
f Pat
ient
s C
ompl
iant
Interventions:• Confirmed that
temperature probes were accurate (trial comparing foley and esophageal sensors)
• Initiated forced air warming in the pre-operative area
• Heightened awareness
Armstrong Institute for Patient Safety and Quality18
Use your hospitals glucose goal
SUSP Glucose Control Audit Tool
Armstrong Institute for Patient Safety and Quality19
How Do We Conduct Audits?
• Retrospective chart review• Concurrent review
– Place audit tool on chart – Complete over continuum of care
• We recommend auditing 5-10 patients– Larger samples yield better estimates of
performance
• Your data does not need to be submitted
Armstrong Institute for Patient Safety and Quality20
Summary
• No single SSI prevention bundle– Need to identify local defects
• Auditing is a practical and feasible strategy to evaluate performance and surface defects
• Tools are adaptable to local environment
• Empowers frontline staff
Armstrong Institute for Patient Safety and Quality21
Action Items
• Pick 2-3 audit tools – [Add website for tools]
• Audit 5-10 patients with each tool
• Be prepared to share your experience with other teams on upcoming call
• Share your tools and ideas for new tools
Content Call Evaluation
We want to ensure that the content callsprovide useful and pertinent information for theSUSP teams. For this reason we request thatyou complete a brief evaluation following eachcall. The evaluation may be found at thefollowing link:
• https://www.research.net/s/SUSP_C1_2_Content_Eval
22