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Transcript of Ministry Saint Michael’s Hospital. Baseline Data Purpose: Proactive approach to infection...
Ministry Saint Michael’s Hospital
Baseline Data
Purpose: • Proactive approach to infection prevention for those patients
having total joint replacement at Ministry Saint Michael’s Hospital (MSMH)
• Infection rate for MSMH/Ministry Medical Group is < 1% for FY 2012, but “1 is not zero”
• SSI infection incidence for MSMH TKA/THA:• Total 2010 4/285 • Total 2011 4/298• Total 2012 1/313 (1 – Feb. 2012)*
* MSMH/MMG elected to include TSA• Goal:
All patients having total joint replacement surgery at MSMH will receive the same level of care (2/2012)
Presented at Washington State Hospital Association Safe Table, 7/31/13
SSI Prevention Program Initiatives
• Joint Venture Project – Nov 2011• Multidisciplinary re-design of MSMH joint replacement services
encompassing care continuum• Standardized pre-op education, maximizing patient involvement • Implementation of Joint Replacement Services Coordinator
• Project JOINTS participation – Feb 2012• Preoperative skin antisepsis (2004)• CHG prep expanded to 3 days preop (June 2012)• Nasal Culture and decolonization for positive MRSA/MSSA (August
2012) Involvement of Lab, Pharmacy, Business Office in development of process to eliminate patient compliance barriers
• Expanded SSI Prevention Program – Jan 2013• Inclusion of independent orthopedic group – Dec 2012• All elective joint replacement patients at MSMH receive standardized
level of preoperative preparation
Presented at Washington State Hospital Association Safe Table, 7/31/13
Project JOINTS Participation
• Planning Team• Orthopedic Surgeon – MMG clinic• Joint Replacement Services Coordinator - Hospital• Quality Specialist - Hospital• Director of Surgical Services – Hospital • Infection Preventionist - Hospital• Clinic Staff – MMG Clinic• MSMH Administration
Presented at Washington State Hospital Association Safe Table, 7/31/13
MSMH SSI Prevention Program
• Participated in IHI Project JOINTS• MSMH successfully implemented 3 SSI
Bundle Elements:• Preoperative skin antisepsis (alcohol prep in
OR)• 3 days of CHG skin cleansing• Nasal swabs - Culture and decolonization of
MRSA/MSSA
• Focus on patient pre-op education and engagement
Presented at Washington State Hospital Association Safe Table, 7/31/13
Implementation Team
Great accomplishment of entire care team– MMG clinic providers/staff– Lab– Pharmacy– SMH surgical services
• ASD staff• Central Sterilization• OR crew
– Nursing– Environmental services
Presented at Washington State Hospital Association Safe Table, 7/31/13
Benefits
• Provides consistent, best-practice, outcome-focused care
• Aligns with our Joint Venture program
• Promotes collaboration and standardization
Presented at Washington State Hospital Association Safe Table, 7/31/13
Obstacles
• Different Provider Practice Groups
• Patient Compliance
• Financial Barriers
Presented at Washington State Hospital Association Safe Table, 7/31/13
Outcomes
• Consistently lower infection rate than national average• No infections since Feb 2012* • Integration of independent practice group• Recognized as IHI exemplar hospital for all 3 elements
Presented at Washington State Hospital Association Safe Table, 7/31/13
Biggest Change
• Implementation of culture protocol for MRSA / MSSA– 2012 only MMG providers participating, independents declined– 2013 both Ministry and independent providers at 100% during
last three months
100% 100% 100% 100% 100% 100%
0%
50%
88%
100%
0%
20%
40%
60%
80%
100%
120%
JAN FEB MAR APR MAY JUNE
MRSA/MSSA CULTURE IMPLEMENTATION
MMG2013
INDEPENDENTS2013
Presented at Washington State Hospital Association Safe Table, 7/31/13
Impact to patients
• Improved patient experience• Reduced patient recovery time• Reduced patient charges
Presented at Washington State Hospital Association Safe Table, 7/31/13
Control Plan
Mupirocin Patients 2 d CHG Eve. Prior DOS CHGOrdered completing Shower CHG on Adm
5 day RXMMGProviders
J 18 18 1 1 2 2 18 18 18F 19 19 2 3 5 5 18 19 19
M 19 19 1 3 4 4 18 19 19A 21 21 0 4 4 4 21 21 21M 17 17 1 2 3 3 17 17 17
J 23 23 1 7 8 8 23 23 23
Other Providers
J 13 na na na na na 10 12 13F 8 4 0 0 0 0 8 8 8
M 8 7 1 0 1 1 8 8 8A 10 10 0 1 1 1 10 10 10M 6 6 0 1 1 1 6 6 6
J 5 5 0 1 1 5 5 5 5
Surgical Site Infection Prevention Program
2013 Cultured MRSA + MSSA +
100% 98% 100% 100% Compliance117
100% 5.1% 17.0% 100%
100% for 5 mos. 94% 98% 100% Compliance
Total 50 86% for5 mos 2.7% 8.1%
100% for 5 mos
Presented at Washington State Hospital Association Safe Table, 7/31/13
SSI Bundle Elements
IHI JOINTS SSI Reduction Project 2012 - 2013P
roje
ct
JO
INT
SP
art
icip
atio
nC
HG
S
ho
we
ring
/Pre
p
MR
SA
/MS
SA
Te
stin
g &
D
eco
lon
iza
tio
n
Alc
oh
ol-b
ase
d
Skin
an
tise
psis
MSMH/MMG began participation
Feb. 2012
IHI data submitted;Received
Exemplar StatusJune 2012
MSMH using appropriate prep
since 2004
MMG Ortho using CHG prep wipes for TJ since 2009
MMG Ortho increasing CHG prep to 3 days
preopJune 2012
MMG Ortho implementing
process for MRSA/MSSA testing
MSMH Lab developing testing
mechanisms to perform PCR for MRSA & MSSA
DOS prep with CHG wipe to be
performed as part of admission
process in ASD
Received Exemplar Status
for Element IJune 2012
MSMH Lab developing
process to perform culture for MRSA
& MSSA
MMG developing process for &
decolonization of + patients with 5 days Mupiricin
Submitted IHI data for
Element II
December 2013
Submitted IHI data for
Element III
January 2013
Notification of Exemplar Status for Element II &
IIIJanuary 2013
Independent Ortho Practice provided
materials and invited to
participateSeptember 2013
Independent Ortho Practice began
implementation of SSI Reduction
Bundle ElementsDecember 2013
FY12Q4
Introduction of Rosie Video for staff education
December-January 2013
FY13Q1FY12Q3
FY12Q2
FY13Q2
Presented at Washington State Hospital Association Safe Table, 7/31/13
Summary
Why Ministry Saint Michael’s Story?• Demonstrates that even a small facility with limited
resources can make a difference
• Impact: Lives of 300+ patients
per year have been positively affected
• Smaller = easier???
• Patient testimonials have been marketing tool with public and with The Joint Commission
Presented at Washington State Hospital Association Safe Table, 7/31/13
Project JOINTS Implementation Outline
• Assemble the right players• Identify Team Champion who “gets it”• Introduction to Project JOINTS materials• Assess your current state• Accent the positive – publicize what you are doing
well• Implement changes incrementally• Track results• Report results• Recognize and reinforce positive changes
Presented at Washington State Hospital Association Safe Table, 7/31/13
Thank you…
Questions?
Patient Education - Joint VentureMinistry Saint Michael’s Hospital
July 31, 2013
Presented at Washington State Hospital Association Safe Table, 7/31/13
Preoperative Education Program
Patients who have chosen us for their
surgeries deserve to have the safest, most
efficient, cost-conscious and highest quality
experience possible. Our job is to find out
what our customers want and work to try and
satisfy them, while keeping our responsibilities
in mind.
Presented at Washington State Hospital Association Safe Table, 7/31/13
Charter Key Points March 2011
Opportunity/ Problem Statement:
The preadmission clearance process for surgical patients is inconsistent, fragmented, and lacks coordination. This causes errors, omissions, and patient and provider dissatisfaction, duplicative and inefficient staff work and potential cancellations.
Project Goals/Benefits:
• Develop and implement a standardized pre-surgical process • Decrease surgery cancellations/delays• Decrease repeat tests• Improve communication
Presented at Washington State Hospital Association Safe Table, 7/31/13
Patient Education Folder – Accuracy and Consistency • Patient Roadmap
– Chronological timeline for patient to follow, identifies critical activities, instructions
– Initiated at time of surgery scheduling
• Day of Surgery Information– Family information– Establishes reasonable patient expectations
• Anesthesia Information– Brief description of types, expected LOS
• Map• Procedure specific materials from surgeon
Presented at Washington State Hospital Association Safe Table, 7/31/13
Sample Pre-op Materials
Presented at Washington State Hospital Association Safe Table, 7/31/13
Project Results
“The new pre-op process will help to more accurately and efficiently bridge the gap between the office visit and day of surgery, ultimately leading to improved satisfaction of all those involved”
(Surgeon comment)
Presented at Washington State Hospital Association Safe Table, 7/31/13
Joint Venture Program
Shawn Dombrowski, RNJoint Replacement Services Coordinator, MMG
•Part of our Joint Venture Project
•Implemented December 2011
Presented at Washington State Hospital Association Safe Table, 7/31/13
Role of Joint Coordinator
• Consistent “face” of the Joint Replacement Program at MSMH
• “Navigator” for the patient and family
• Information coordinator
• Facilitator or performs home assessment
• Preoperative Educator
• Inpatient visits
• Discharge follow-up contacts
• Program evaluation; Celebration picnic
Presented at Washington State Hospital Association Safe Table, 7/31/13
Sample Joint Venture Materials
Presented at Washington State Hospital Association Safe Table, 7/31/13
Sample SSI Materials
Presented at Washington State Hospital Association Safe Table, 7/31/13
Presented at Washington State Hospital Association Safe Table, 7/31/13
MSMH Reference Materials *
• Updated SSI Prevention Program• Project Timeline• MRSA Culture Protocol• MRSA Patient Education Sheet• CHG Prep and Shower Instruction Sheet • Patient Mupirocin Use Checklist• SSI Prevention Order Sheet
*PDF copies have been sent to IHI
Presented at Washington State Hospital Association Safe Table, 7/31/13