Universal Components of an IV Culture of Safety

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Russ Nassof, JD
EVP
RiskNomics, LLC

3M I.V. Leadership Summit
May 15-17, 2013
St. Paul, MN

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  • Low or Middle Income= < $3705 gross national income per capita/per yearAs the economic status of a given population DECREASES, the significance and impact of HAIs on mortality INCREASESSocioeconomic conditions affect the quality of healthcare including infection preventionHealthcare capacity is affected by infrastructure, HCW training, patient knowledge and purchasing power
  • TRUE FOR MOST ANTIBIOTIC RESISTANCE EXCEPT VRE
  • In addition, MOST RESOURCE POOR COUNTRIES HAVE NO ENFORCEABLE LEGISLATION OR NATIONAL INFECTION CONTROL GUIDELINES AND NO ACCREDITATION PROGRAMSCORRELATION BETWEEN LACK OF REGULATION AND LOWER HH COMPLIANCEAlso many problems due to lack of staffing, over crowding, and lack of supplies all of which directly impact DA-HAI rates
  • EDUCATION DOES NOT EQUAL COMPETENCY AND TRAINING DOES NOT EQUAL EDUCATIONTraining is all too often liability protection and not competency validation.Lack of training/experience directly tied to increased DA-HAI ratesSurveillance – must be done – If you don’t do it, how do you know what you have.
  • WHAT DID YOU DO AND WHY?
  • CONCLUSIONThe Issues- Easy to IdentifyThe Solutions- Can be IdentifiedImplementation-Very difficult.REMEMBER THE ACRONYM- IEIEIE/Identify, Educate, Improve, Embed, Innovate, Empathize !!!
  • Universal Components of an IV Culture of Safety

    1. 1. Universal Components of an IVCulture of Safety3M IV Leadership SummitMay 15-17, 2013St Paul, MNRuss Nassof, JDEVPRiskNomics, LLC1
    2. 2. Conflict of Interest• Russ Nassof is a paid consultant to Becton, Dickinson andCompany2
    3. 3. Objectives• Define issues contributing to the disparity in device-associatedhealthcare-associated infection practices from nation tonation;• Identification of 6 key elements which can reduce disparityand form the foundation for establishment of a uniformculture of safety to prevent device-associated healthcare-associated infections; and,• Identification of critical risk exposure points for device-associated infections and how to manage those risks toeffectively create a universal IV culture of safety. 3
    4. 4. Prevention• Once it is established that an adverse healthcare event can be“PREVENTED”…• Best evidence based practices will be revised as necessary;• The standard of care (what another reasonably prudentprofessional would do in the same or similar circumstances)will change as necessary; and,• Liability can be imposed based on the failure to adhere to bestpractices and meet the standard of care.However… What Can Be Prevented in MinnesotaMay Not Be Reasonably Preventable in Mali 4
    5. 5. Diversity of Problems• Difficult to Find Commonality in the Prevention of Device-associated Healthcare-associated Infections (DA-HAIs) Acrossthe Globe5
    6. 6. Diversity of Problems• Difficult to Find Commonality…Disparity in Wealth- World Bank- 68% of World EconomiesRepresenting 75% of the World Population Identified as LowResource Countries6
    7. 7. Diversity of Problems• Difficult to Find Commonality…Disparity in Infection Control PracticeReporting/Collecting DataRegulations/AccreditationDefinitionsVariability in PracticePatient PopulationsSurveillanceHealthcare StructureResourcesHCW/Patient Ratios7
    8. 8. Diversity of Problems• Difficult to Find Commonality…Disparity in HAI Device-associated Rates- While the rate ofdevice use in low resource country ICUs is analogous or evenlower than that in the USA, device-associated HAIs rates andantimicrobial resistance rates are HIGHER8
    9. 9. Culture of Safety• What Doesn’t Work?Do NOT impose solutions- “ASK, don’t Tell”Healthcare Microcosm/GladwellPronovost/Rosenthal- CLABSI solutions that work in Lansingmay not work in LhasaDon’t include CHG in your bundle if povidone iodine is the onlyoptionDon’t require single patient rooms if you don’t have single patientbedsIncluding unattainable interventions in infection preventionbundles creates more problems than not having any bundles atall9
    10. 10. Culture of Safety• What Does Work –FINDING COMMONALITYASK- IDENTIFYFOCUS ON IV PRODUCT ISSUES-selection, technologyFOCUS ON IV PRACTICE ISSUES-insertion, maintenance, hygieneEDUCATION/COMPETENCYSOLICIT MULTIDISCIPLINARY INPUTKEEP IT LOCALKEEP IT SIMPLEKEEP IT ECONOMICAL10
    11. 11. Culture of Safety• What Does Work- FINDING COMMONALITYMAKE IMPROVEMENTSSIMPLEEASILY ATTAINABLEMUST BRING “VALUE”11
    12. 12. Culture of Safety• What Does Work-FINDING COMMONALITYEMBED IMPROVEMENTS-SUSTAINABILITYCOMPETENCYSTANDARDIZATION/UNIFORMITYMULTIDISCIPLINARY INVOLVEMENTBUNDLES/CHECKLISTSINCENTIVESDOCUMENTATIONCONSISTENCY (IMPROVEMENT)12
    13. 13. Culture of Safety• What Does Work-FINDING COMMONALITYINNOVATECONTINUOUS EVALUATION OF NEW PRODUCTS/PRACTICEIMPLEMENT WHEN REALISTICBE AWARE OF NEW RISKS CREATED13
    14. 14. Culture of Safety• What Does Work- FINDING COMMONALITYCOMMUNICATE/TEAMWORKCommunication problems in healthcare are considered to be aleading cause of medical errors and are often the root cause ofsentinel eventsMost medical errors result from a breakdown in communicationamong staff, physicians, and patientsPoor communication and lack of teamwork in the healthcarearena have been identified as major causes of errors leading topatient morbidity and mortality14
    15. 15. Culture of Safety• What Does Work-FINDING COMMONALITYAPOLOGIZE (when mistakes are made)EMPATHY VS. ADMISSION OF FAULT/LIABILITYASSURANCE THAT MISTAKE WILL NOT RECURVOW TO DO BETTER IN THE FUTURESINCERITYTIMINGTRANSPARENCYIN PERSON/IN PRIVATE/ENGAGEDDOCUMENT 15
    16. 16. Culture of Safety• What Does Work-Finding Commonality• Critical Risk Exposure Points for Device-associated InfectionsEducation/CompetencyInsertionMaintenanceResponding to Adverse EventsIncorporating Technology16
    17. 17. Risk Exposure Points• Education/CompetencyWhat standards/policies/practices are being followed and why?Are written policies in place reflecting those standards? If yes- do those policies adhere to the standards? If yes, do practices comport with the written policies? If no, do practices comport with the standards adopted?Is training/education provided to applicable HCPs on policies?Are appropriate products/devices/ medications available to meetpolicy requirements?Are inappropriate products/devices/medications available?Are controls in place to ensure compliance?Are competency evaluations performed?Is Surveillance performed?17
    18. 18. Risk Exposure Points• InsertionHand hygieneSite preparationSite selectionDevice selectionSite assessmentTechniqueStabilizationMedicationPatient factors 18
    19. 19. Risk Exposure Points• MaintenanceMonitorDressing changeDevice securementReplacementFlushingMedicationSite observation19
    20. 20. Risk Exposure Points• Responding to Adverse EventsPeriodic site assessmentCriteria for response and procedural next stepsCriteria for removal of deviceCriteria for dressing change20
    21. 21. Risk Exposure Points• TechnologyProduct innovationPractice innovationDevice securementAntimicrobial dressing/devices• Technological innovation may result in shifting preventabilityand may also create new areas of risk.21

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