Essentials in quality improvement interventions · 2018. 1. 25. · Quality Improvement (QI)...
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Stijn BLOT Dept. of Internal Medicine Faculty of Medicine & Health Science Ghent University, Ghent, Flanders (Belgium) ～ Burns, Trauma and Critical Care Research Centre The University of Queensland, Brisbane, Queensland (Australia) Essentials in quality improvement interventions concepts appraised by the example of CAUTI prevention Patient Safety Programs in Intensive Care Units – Zero Projects Ministry of Health, Social Services, and Equality, Madrid, 12 Dec. 2017
Transcript of Essentials in quality improvement interventions · 2018. 1. 25. · Quality Improvement (QI)...
Stijn BLOT
Dept. of Internal Medicine
Faculty of Medicine & Health Science Ghent University, Ghent, Flanders (Belgium)
～ Burns, Trauma and Critical Care Research Centre
The University of Queensland, Brisbane, Queensland (Australia)
Essentials in quality improvement interventions
concepts appraised
by the example of CAUTI prevention
Patient Safety Programs in Intensive Care Units – Zero Projects Ministry of Health, Social Services, and Equality, Madrid, 12 Dec. 2017
Crash Introduction on HAI Prevention
• Healthcare-associated infections
➔ morbidity
➔ healthcare costs
➔ mortality
• Evidence-based prevention guidelines
➔ broad spectrum of measures
➔ nurses / clinicians’ knowledge is poor
➔ adherence is low
• Quality improvement interventions = solution?
Blot S, et al. Clin Infect Dis 2005 Labeau S, et al. Crit Care Med 2009
Cabana MD, et al. JAMA 1999
Crash Introduction on
Quality Improvement (QI) Interventions
• Definition of QI interventions
o Versatile method
o Clustering a variety of interventions; the most
important:
personnel education
care bundles
checklists
Intermezzo on Essentials of
Quality Improvement (QI) Interventions
• Education
o Cornerstone of QI
o Insights in…
“Why it is important”
Rational behind a preventive approach
Repetition ➔ awareness (!)
➔ attitude
Intermezzo on Essentials of
Quality Improvement (QI) Interventions
• Education
o Cornerstone of QI
o Insights in…
o E-learning
Published guidelines do not work
Flexible and student centered
Benefits the organization
Intermezzo on Essentials of
Quality Improvement (QI) Interventions
• Care bundles
o Set of 3 to 5 EB-interventions
o Executed:
always (daily, per shift,…)
together
by everyone
o Better impact on patient outcomes (compared
with separated application)
o Monitoring of the adherence!
Intermezzo on Essentials of
Quality Improvement (QI) Interventions
• Checklists
o Simple business process improvement tool
o Control of routine tasks to be executed
o No “all or nothing” philosophy
o Not necessarily based on scientific evidence
o Awareness!
Essential steps in a Quality Improvement Project
CAUTI
reduction
3
4
5
1 2
Essential steps in a Quality Improvement Project
CAUTI
reduction
…
…
…
Awareness …
I - Awareness
(!) Absolute condition to motivate the team
• CAUTI = important
o Frequent
o Morbidity ➔ costly
o Mortality…
I - Awareness
(!) Absolute condition to motivate the team
• Pathogenic mechanisms & risk factors
o Rational for prevention
o Understanding “why” and “how” prevention works
I - Awareness
(!) Absolute condition to motivate the team
• Preventable! (=key message)
o Average 17 – 69% can be avoided
Essential steps in a Quality Improvement Project
CAUTI
reduction
…
…
…
Awareness CAUTI detection
II – CAUTI detection
(!) Essential to convince the team
• Set up a surveillance system
• CAUTI definitions, aim for…
oObjective criteria
oReproducible
oUniversally used
• Methods of surveillance
oPro-active screening!
Essential steps in a Quality Improvement Project
CAUTI
reduction
Selection of prevention
measures
…
…
Awareness CAUTI detection
III – Selection of preventive measures
(!) Build your team: participation ➔ consensus
• Select relevant prevention measures, based on…
o Evidence / pathogenic mechanism
Reduction of exposure time
Insertion: sterile equipment & aseptic technique
Maintenance: closed system & unobstructed flow
o Local situation
• Consensus among all stakeholders
Essential steps in a Quality Improvement Project
CAUTI
reduction
Selection of prevention
measures Implementation
& Monitoring
…
Awareness CAUTI detection
IV - Implementation
(!) Support the team in it’s efforts
• Educate
o Invest in the teams insights
• Practice monitoring
o Bedside instruction
c
c
• Let them feel you care
c
Essential steps in a Quality Improvement Project
CAUTI
reduction
Selection of prevention
measures Implementation
& Monitoring
Performance measurement
Awareness CAUTI detection
V – Performance measurement
(!) Control & guide the team
• Process
➔ compliance rates
• Outcome
➔ CAUTI rates
c
c
c
• Feedback!
Essential steps in a Quality Improvement Project
CAUTI
reduction
Selection of prevention
measures Implementation
& Monitoring
Performance measures
Awareness CAUTI detection
Conclusion
• 5 essential steps to optimize the outcomes of a quality
improvement initiatives
• All about… team building aspects: create awareness,
reach consensus, educate, instruct, monitor,
feedback, …
Dept. of Internal Medicine, Faculty of Medicine & Health Science, Ghent University, Ghent, Flanders (Belgium)
Burns, Trauma & Critical Care Research Centre, The University of Queensland, Brisbane, QLD (Australia)
Thank you
