VAP CRBSI Collaborative - Canadian Patient Safety...
31
VAP CRBSI Collaborative Informational Calls Hosted by Canadian ICU Collaborative November 18 and 20, 2008
Transcript of VAP CRBSI Collaborative - Canadian Patient Safety...
VAP CRBSI Collaborative
Informational CallsHosted by Canadian ICU Collaborative
November 18 and 20, 2008
November 2008 2
Purpose
• By the end of this call, participants will have:– Better understanding of topics, methods and
expectations associated with the Collaborative approach
– Questions answered
Context
November 2008 4
Why these Topics?
• The Gap: Evidence vs. Practice– International– Canadian
• Canadian ICU Collaborative• Safer Healthcare Now!• Accreditation Canada• Provincial expectations
November 2008 5
BRUCE - INSERT DATA
Rat
e pe
r 10
00 V
entil
ator
Day
sVAP Rates - National Data - September, 2008
Source: Safer Healthcare Now ! Quarterly Reports - September 2008
Individuals
UCL = 18.1
Mean = 10.6
LCL = 3.1
UCL = 8.0
Mean = 5.7
LCL = 3 .3
Nov'05
Dec'05
Jan'0
6Feb
"06Mar'
06Apr'
06May
'06Ju
n'06
Jul'06
Aug'06
Sep'06
Oct'06
Nov'06
Dec'06
Jan'0
7Feb
'07Mar'
07Apr'
07May
'07Ju
n'07
Jul'07
Aug'07
Sep'07
Oct'07
Nov'07
Dec'07
Jan'0
8Feb
'08Mar'
08Apr'
08May
'08Ju
n'08
Jul'08
Aug'08
Sep'08
0
2
4
6
8
10
12
14
16
18
20
22
24
November 2008 6
Rat
e pe
r 10
00 L
ine
Day
sCLI Rates - National Data - September, 2008
Source: Safer Healthcare Now ! Quarterly Reports - September 2008
Individuals
UCL = 7.3
Mean = 2.9
UCL = 4.0
Mean = 2.0
LCL = 0.0
Nov'05
Dec'05
Jan'0
6Feb
"06Mar'
06Apr'
06May
'06Ju
n'06
Jul'06
Aug'06
Sep'06
Oct'06
Nov'06
Dec'06
Jan'0
7Feb
'07Mar'
07Apr'
07May
'07Ju
n'07
Jul'07
Aug'07
Sep'07
Oct'07
Nov'07
Dec'07
Jan'0
8Feb
'08Mar'
08Apr'
08May
'08Ju
n'08
Jul'08
Aug'08
Sep'08
0
2
4
6
8
10
What is Possible: Examples of Better Performance
Collaborative Teams
Kelowna General Hospital
Richard MiloVAP Team
November 2008 9
Interior Health’s Service Area
November 2008 10
Change Concepts
• VAP Education (Daily Rounds and Storyboard)• Replaced old HOB Posters• Beds marked with 30 degree• Oral Care Product Trial (Educational Intent)• Oral vs. Nasal Gastric Tube Placement in ER• ICU pre-printed orders
- (included VAP bundle concepts)• Sedation Protocol developed (Regionally),
education and implementation• Hand hygiene audit done by Infection Control
• Continued with HOB and Oral Care Audits
November 2008 11
Potential Barriers• Buy-in from Administration, Medical staff and front-
line staff.• Time commitments for meetings, data collection and
educational sessions.• Prioritization with other initiatives and educational
events.• Staff compliance with bundled therapy.
(HOB, mouth care and proper documentation)• Adequate equipment and supplies
(Evac tubes, dedicated suction, oral care products)• Timely notification of VAP diagnosis from IC.
November 2008 12
Achieving Buy-in
• Initial education and frequent updates • Empowered influential staff into the process• Start on a small scale (1 or 2 patients) and
then expand• Positive re-enforcement• Continued education and updates
compliance rates, VAP rates, knowledge spread
November 2008 13
ICU Collaborative
• Helped us understand and implement Rapid Cycle Change Concepts
• Provided links to other centers involved with VAP – information sharing
• Clinical resource – don’t re-invent the wheel
• Data “Run Charts”
November 2008 14
Key Lessons Learned
• Team champion is mandatory• Multidisciplinary team approach• Must be evidence and quality based• Use PDSA cycling (test small changes)• Incorporate front-line staff to achieve buy-in• Continued staff updates/education• Meet regularly• “Spread” knowledge
November 2008 15
3 5 . 0
2 7 . 0
4 0 . 0
4 8 . 0
2 6 . 0
7 . 0
1 1 . 0
9 . 0
7 . 06 . 0
7 . 0
1 9 . 0
2 1 . 0
5 . 0
0 . 0
1 0 . 21 0 . 5
1 6 . 7
1 2 . 6
4 . 7
1 1 . 2
1 7 . 9
2 2 . 6
2 4 . 7
1 2 . 2
2 0 . 0
3 . 4
6 . 6
0 . 0
5 . 0
1 4 . 2
8 . 8
5 . 33 . 8
0 . 0
1 8 . 0
5 . 5
0 . 00 . 0
3 . 7
0 . 0
8 . 5
4 . 74 . 5
0 . 0
1 1 . 2
4 . 5
9 . 7
4 . 8
0 . 0
8 . 6
0 . 00 . 0
4 . 34 . 1
0 . 00 . 00 . 00 . 00 . 00 . 00 . 00
5
10
15
20
25
30
35
40
45
50
M o n t h o r G L P e r i o d E n d i n g
# Infections Per 1000 Vent Days
Benchmark (7.4 Infections Per 1000 Vent Days)
Linear (# Infections Per 1000 Vent Days)
VAP at Kelowna General ICUVAP at Kelowna General ICU
London Health Sciences Centre
Dr. Claudio MartinCRBSI and VAP Team
November 2008 17
VAP Rates: Cases per 1000 Ventilator Days All Admissions CCTC
-2.004.006.008.00
10.0012.0014.0016.00
Jan-07
Feb-07
Mar-07
Apr-07
May-07
Jun-07
Jul-07
Aug-07
Sep-07
Oct-07
Nov-07
Dec-07
Month
Num
ber o
f cas
es
NHSN Mean for Med-Surg ICUs 3.6
NHSN Mean for TraumaICUs 10.2
Inservice blitz
November 2008 18
2008 VAP Rate -CCTC
0
2
4
6
8
10
Jan
Feb Mar AprMay Ju
n Jul
Aug Sep Oct NovDec
RateUCLMean
National Healthcare Safety Network (NHSN) mean for medical-surgical ICUs is 3.6 and for a pure Trauma ICU is 10.2
The UCL is the upper control limit (3 Sigma above our mean).
November 2008 19
2007-2008 BSI/1000 line days-CCTC
0
1
2
3
4
5
Q106
Q206
Q306
Q406
Q107
Q207
Q307
Q407
Q108
Q208
Q308
RateUCLWLMean
SHNinitiatives initiated
Flolink initiated June 11/08
November 2008 20
Success factors
• Team effort– Information services– Infection control– Educator– Data collection process
• Educational program and re-enforcement• Physician buy-in or acceptance/support
About the VAP CRBSI Collaborative
Bruce Harries
November 2008 22
Benefits of Participating
• Faster learning and quicker gains
November 2008 23
Benefits of Participating (continued)
• Face-to-face Learning Sessions• Evidence-based changes, ready to test and implement• Coaching from experienced Faculty on application of changes• Education and training on tools for improvement and
measurement• Advice on targeted strategies to overcome resistance and
address barriers• Monthly feedback on progress from the Collaborative Faculty• Monthly conference calls specific to challenges your team is
facing• A website for storing and sharing your documents with others• A comprehensive Improvement Guide with examples,
checklists, tools• No cost to join!
November 2008 24
Expectations for Participating Teams
• Commitment of a team sponsor• Full participation of a multidisciplinary team• Development of measures• Regular reporting of progress to the Faculty• Willingness and commitment to implement
rapid and widespread changes• Desire to innovate• Regular access to email and Internet
November 2008 2525
Timelines
Learning Session
One
Learning Session
One
Learning Session
Two
Learning Session
Two
Learning Session
Three
Learning Session
Three
Support
Planning & Pre-work
Action Period One Action Period Two
Distribute Findings
A
S
P
D
A
S
P
D
Action Period Three
A
S
P
D
Enrolment Deadline
November 28
Pre-Work Calls
December
January 15-16
April 27-28
Oct TBD
Dec
Questions
How to Enroll
Ardis Eliason
November 2008 28
Expression of Interestwww.saferhealthcarenow.ca
November 2008 29
Enrollment Package & Questionnaire
VAP-CRBSI Collaborative Enrolment Questionnaire
Please complete and e-mail this information to Ardis Eliason, Project Coordinator at [email protected] 1. Key Contact
Organization
Contact Name
Title
Address
Phone
Fax
2. Commitment: We wish to formally enroll in the Canadian ICU Collaborative. We have included a
Letter of Commitment from our senior leader. We agree to all the Expectations outlined in the Enrolment Package.
3. Briefly describe your organization, hospital or clinic (including type, size, patient population and
structure).
November 2008 30
Planning Team
• Dr. Claudio Martin, Collaborative [email protected]
• Cynthia Majewski [email protected]
• Clara [email protected]
• Bruce [email protected]
• Leanne [email protected]
• Ardis [email protected]
November 2008 31
Faculty
• Ms. Paule Bernier, P.Dt., MSc, Sir MB Davis Jewish General Hospital, Montreal
• Dr. Paul Boiteau, Department Head, Critical Care Medicine, Calgary Health Region; Professor of Medicine, University of Calgary
• Dr. David Creery, Head, Paediatric Intensive Care, Children's Hospital of Eastern Ontario, Ottawa
• Ms. Rosmin Esmail, BSc, MSc• Mr. Gordon Krahn, BSc, RRT, Quality and Research Coordinator, BC
Children’s Hospital• Dr Denny Laporta, Chief, Department of Adult Critical Care; Director,
Respiratory Therapy, Sir MB Davis Jewish General Hospital, Montreal• Ms. Debbie Lynch, RN, ICP, Eastern Health, St. John’s• Dr. John Muscedere, Assistant Professor of Medicine, Queens University;
Intensivist, Kingston General Hospital• Ms. Tracie Northway, RN, MSN, Quality & Safety Leader, Critical Care
Program, BC Children's Hospital, Vancouver• Ms. Kim Rafuse, RN, BN, DOHN, ICP Annapolis Valley Annapolis Valley
District Health Authority • Dr. Peter Skippen, Division Head & Medical Director, Pediatric ICU, BC
Children’s Hospital, Vancouver
