Objectives Mission to Care FHA HIIN 1 Chasing Zero Infections - - - PDF document

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Objectives Mission to Care FHA HIIN 1 Chasing Zero Infections - - - PDF document

Mar 21, 2023 270 likes •410 views

Chasing Zero Infections - Connecting the Dots to Thursday, May 25, 2017 Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship HOSPITAL IN ACTION SUCCESSFUL STRATEGIES FOR REDUCING C. DIFF Cathy Jaco, RN, MSN, CPHQ, HACP,

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 1

HOSPITAL IN ACTION—SUCCESSFUL STRATEGIES FOR REDUCING C. DIFF

Cathy Jaco, RN, MSN, CPHQ, HACP, CPPS

Objectives

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 2

What we are all about……

Florida Hospital-Heartland Medical Center

  • Two campuses in Southeastern Florida: Sebring (147 beds); Lake Placid

(50 beds)

  • Seasonal Patients (October-April) with average age >60+ years
  • 1,412 Employees
  • 285 physicians on the medical staff-23 Clinics
  • 43,136 Emergency Room Visits-County’s busiest ER
  • 920 Births
  • 56% Market Share in South Florida
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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 3

Creating Urgency

Creating a Sense of Urgency

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 4

Establish a Sense of Urgency

  • February 2015, PCR Test initiated at FHHMC. This graph

depicts the December AHS Dashboard with 50% increase noted in Hospital-Onset C-Diff cases.

  • April 2016, EIA – 2 Step Test begins.
  • June 2016, C-diff Urgency Taskforce starts.

1 Establish a Sense of Urgency

Create the Guiding Coalition

  • Leadership commitment
  • Taskforce
  • Guiding principle: “zero tolerance”

2

Create the Guiding Coalition

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 5

Develop a Vision & Strategy

  • What was our Vision?
  • Correct identification of patients

with Hospital-Onset C-diff Infection (HO CDI)

  • Reduce over-diagnosis and over-

treatment of HO CDI

  • Better informed providers,

nurses, patients

  • What was our Strategy?
  • Understand and educate on C-diff
  • Understand current practice for
  • rdering C-diff test
  • Change the PCR test to EIA Test
  • Understand the consequences of

higher rates of HO CDI

3 Develop a Vision & Strategy

“Turn Cathy Loose”

Strategy - Education

CBL for Nurses, CNAs, Lab Presentations to Hospitalists and Medical Staff Poster for Units

3 Develop a Vision & Strategy

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 6

Strategy -Change the Test Based on Evidence

3 Develop a Vision & Strategy

The Famous Poop Patrol

  • Dr. Gonzalez, CMO and Pam Stiles,

Quality Liaison provide treats and laughs to nursing staff.

4 Communicate the Change

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 7

Education by the Poop Patrol

  • Provided at orientation and

during 1:1 meetings on the units

  • Describes the quantity,

color and consistency

  • Monitors by the Quality

department until automatic discontinuance order finalized in the EMR

4

Communicate the Change

Empower Broad Based Action

  • Empower Change!
  • Empowered Quality department to review

cases and discontinue tests when there is no presence of diarrhea documented

  • Empowered CMO – the Head “Poopa” by

Medical Executive Committee (MEC), that no repeat PCR test would be performed by lab without consulting CMO

  • Empowered clinicians with new knowledge

5 Empower Broad-Based Action

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 8

Chasing Zero!

2 2 1

July Aug Sept Oct Nov Dec Jan Feb Mar April Number of HO-CDIFF

Number of HO-CDIFF

  • Simple data presented at meetings with case presentation of the fall outs.

6 Generate Short- Term Wins

Consolidate Gains and Make More Changes

  • EMR: Auto

Cancellation

  • f C.difficile
  • rder

7 Consolidate Gains & Make More Change

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 9

Laxative Alert for Physician Orders

7 Consolidate Gains & Make More Change

Alert fires if the individual entering an order for C-diff has either received a laxative in the past 24 hours or there is an active order for laxative

PCR Testing Started Sunday Coverage 2-Step Testing Algorithm Started C-Diff Urgency Meetings ASP "Poop Patrol"

5 10 15 20 25 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Hospital-Onset Cases (Per 10,000 Patient Days) Month

FHHMC--Hospital-Onset Clostridium Difficile Rate March 2015 – March 2017

UV Light EMR Alerts

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 10

2015 Q1 2015 Q2 2015 Q3 2015 Q4 2016 Q1 2016 Q2 2016 Q3 2016 Q4 2017 Q1 SIR 0.921 0.916 2.308 1.738 1.467 1.488 0.684 0.154 0.17

Started NAAT Sunday Coverage Started

  • C. Diff Urgency

… ASP “Poop Patrol”

0.5 1 1.5 2 2.5

Standardized Infection Ratio

FHHMC--Hospital-Onset Clostridium Difficile SIR 2014 Q4 - 2017 Q1

_

EMR UV Light

Process Measures

Nurse Completion of CBL (Target: 90%) Physician Attendance at Education (Target: 90%) ASP Referral and Antibiotic Reduction (Target: 60%) Non-C-Diff Antibiotic DC'd (Target: 90%) UV Light Cleanings (Target: 100%) Compliance 96% 92% 78% 100% 100% 0% 20% 40% 60% 80% 100% 120%

Axis Title

7 Consolidate Gains & Make More Change

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 11

Anchor New Approaches in the Culture

  • Taskforce continues to meet to discuss patients with

positive/negative tests (high risk)

  • Celebrate success and re-evaluate opportunities for other

infectious diseases (MRSA)

  • Evaluate UV-Light technology using cloud-based

technology

  • Use Urgency as a mechanism for improvement

8 Anchor New Approaches in the Culture

Anchor New Approaches in the Culture

What’s the worst thing you can hear when you have a good idea at work? “That’s not how we do it here!”

8 Anchor New Approaches in the Culture

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 12

References

  • Dubberke ER. Diagnosis of Clostridium difficile infection: Treat the patient, not the
  • test. JAMA Intern Med. Doi:10.1001/jamainternmed.2015.4607 Published online

September 8, 2015.

  • Kotter, J. P. (1996). Leading change. Boston, Mass., Harvard Business School Press.
  • Kotter, J.P., Rathgeber, H. That’s not how we do it here. Boss, Mass. Harvard

Business School Press

  • Kotter, J. P. and D. S. Cohen (2002). The heart of change : real-life stories of how

people change their organizations. Boston, Mass., Harvard Business School Press.

  • Polage, CR. Over-diagnosis of Clostridium difficile in the molecular test era. JAMA

Intern Med. Doi.10.001/jamainternmed.2015.4114. Published online: September 8, 2015.

  • The impact of C.difficile infection (CDI). National Foundation for Infectious Disease

(2014). NPID.org/C.difficile.

Questions?

  • cathy.jaco@ahss.org