Prevention of BSI and VAP Measuring Change in Outcomes Part I
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Transcript of Prevention of BSI and VAP Measuring Change in Outcomes Part I
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Prevention of BSI and VAPMeasuring Change in Outcomes
Part ITed Speroff, PhD
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NNIS Surveillance Data
• Central line-associated BSI rate– 5.0/1000 central line-days
• Ventilator-associated pneumonia rate– 5.8/1000 ventilator-days
• The numerator is the number of events– Number of patients with infection or pneumonia
• The denominator is the number of central-line or ventilator days, standardized to 1,000– Census data in the ICU, all patients with lines or on ventilator
• NNIS rate is calculated as number of BSI or VAP events (numerator) divided by observed number of line or vent days for the ICU (denominator) times 1,000
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Characteristics ofNNIS Rate Data
• Requires aggregating data over a large sample
• Takes time to accumulate data• Appropriate for Surveillance or Quality
assurance• Appropriate for detecting a rate increase• Not appropriate for detecting a rate
decrease unless sample is huge• Insufficient for Quality Improvement
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Statistical Process Control Charts• Used in QI to detect improvement (did it
work?)
• Chart:
Central Line is Mean
UCL
LCL
Upper (UCL) and lower (LCL) control limits are usually 3 sigma units from the mean. A data point above the UCL or below the LCL is a significant change. There are additional control chart rules for detecting change.
X-axis is Time Scale: days, weeks months
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BSI Rates and Control Chart
• Excel Tool
• Naming and Saving the File
• Entering Baseline Data
• Setting the Baseline Period for the Control Chart
• Editing Chart and Printing
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Name and Save the FileSave Often
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Rename the Template File
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HCAHospitalName_ICUName_ICUSafety_MonYr
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Spreadsheet is now calledMusic City_MICU_ICUSafety_Sep06
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Note the Tabs at the Bottom:4 WorksheetsBSI NNIS RateVAP NNIS Rate
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BSI NNIS Rate
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First Entry: Month/Year10/2004
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First Entry: CVC Days
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Collecting CVC Days
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First Entry: CVC-BSI Infections
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Continue Data Entry
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Data for Baseline Period Have Been EnteredNote: Data + Chart
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Set Baseline Period:Move Cursor to Cell F20
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Baseline goes from row 20 to 34Edit $D$50 to $D$34
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Move Cursor to Cell G3Edit the Text
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Text is a Reminder to You of the Baseline Period:
the data for mean and control limits
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Chart: To Edit TitleMove Cursor on Title and Click
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Edit to your Hospital Nameand ICU Name
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Continue Data Entry:Only Baseline Data determine
Mean and Control Limits
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Data Complete through 6/2006What do you see?
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End of Part I
Questions and Commentsso far?
Continue to Part II