Lower VIPs for VIPsReducing peripheral line associated infectionsby using an electronic surveillance system
Presentation to theKings Fund Digital Health & Care Congress
Tuesday 16 June 2015
Jane Gorman, Head of Nursing, Croydon Health Services NHS Trust
Dr Peter Greengross, Medical Director, The Learning Clinic& Clinical Fellow, Emergency Medicine, Imperial College Healthcare NHS Trust
&
Our VIPs
The Visual Infusion Phlebitis Score
Peripheral lines - the problem
• Most common invasive procedure in hospital
– 70% inpatients have a PVC fitted
• Most common source of bacteraemia
– 1 / 3,000 cannulae
– 0.2 infected cannulae / 1,000 PVC days
• Major cause of patient harm, complaints & cost
– 37% of reported adverse events involve PVCs
Collignon 1994; McLaws 2003
Croydon Health Services
• Integrated acute& community trust
• 3,500 staff
• 380,000 population
• Croydon University &Purley War MemorialHospitals
• CUH – DGH, 500 beds
– Expected 25 infected PVCs / yr
– 15 PVC associated bacteraemias / yr
Monitoring compliance - PVCs
• Saving lives, high impact interventions care bundle
– Evidence –based approach to reduce infections
– Health & Social Care Act 2008: “Registered providers must audit compliance to key policies and procedures for infection prevention”
• Recommendations on insertion & ongoing care
Change programme
• Aim: Improve compliance with Trust protocols
– Cannula site record is current & accurate
– Is VIP score recorded
– Is VIP score accurate
• Historically - paper-based system
• Interventions
– Awareness raising all ward managers & matrons
– 80% nursing staff trained in PVC management & HII care bundle
– Use VitalPAC system for recording insertion & observation of PVCs
– Develop e-dashboard to monitor performance
– Feedback data to staff & public
• Real time bedside capture of data
• Intelligent prompts and advice on decision-making
• HII care bundles incorporated
• Automatic calculation of VIP score
• Track performance at ward & Trust level
Monitoring & feedback
VP data compared with actual condition of random selection of PVCs
RAG status each metric based on % compliance
Overall compliance reflects worst of 3 metrics
16th May 16th May 16th May 16th May 19th May 19th May 19th May 19th May 21st May 21st May 21st May 21st May
Is cannula
site
accurate
VIP score
recorded
VIP score
accurate Overall*
Is cannula
site
accurate
VIP score
recorded
VIP score
accurate Overall*
Is cannula
site
accurate
VIP score
recorded
VIP score
accurate Overall* WARD
5/6 4/6 4/6 6/6 6/6 6/6 6/6 6/6 6/6 D1
6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 D2
6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 H1
6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 H2
6/6 6/6 6/6 6/6 0/6 0/6 6/6 6/6 6/6 AMU
6/6 4/6 4/6 6/6 6/6 6/6 6/6 6/6 6/6 E1
Closed Closed Closed Closed Closed Closed Closed Closed Closed Closed Closed Closed E2
6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 F1
6/6 5/6 5/6 6/6 6/6 6/6 6/6 6/6 6/6 F2
6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 P1
6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 P2
6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 P3
6/6 6/6 6/6 6/6 6/6 6/6 6/6 0/6 0/6 Q1
6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 Q2
5/6 0/6 0/6 6/6 6/6 6/6 6/6 6/6 6/6 Q3
5/6 3/6 3/6 6/6 6/6 6/6 6/6 6/6 6/6 W1
6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 W2
6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 W3
5/6 0/6 0/6 6/6 6/6 6/6 6/6 6/6 6/6 CCU
6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 Mary
6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 Hope
6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 ED Obs
Norwood
Outcomes
• Compliance improves from 30% - 80% between May-Dec 2014
• Non-compliant wards reduce from 50% to 5% per week
• PVC related bacteraemiasApr – Dec 2014:
– 2 of 5,995 inpatients
– 25 of 5,998 community patients
Conclusions
Meaningful programme for staff High risk issue, aligned with Trust goals
Collaboration of multidisciplinary teams Infection control, practice development, IT, patient afety
Use of user-friendly, easy to use system (VitalPAC) Generates real-time, accurate and easily accessible data.
Regular transparent feedback to staff to monitor
performance.
Injecting a healthy dose of competition between
wards helps drive improvement and does no harm.
Any
questions