Patients undergoing cardiac surgery recover post surgery in the Cardiac Surgical Intensive Care Unit (CSICU) before transferring to the cardiac inpatient step-down unit.
No roadmap just jumped in to get started. Talk about our first meeting that did not go so well in Bed 15, the move into the pods, the initial players. Our connection to the Safer Heatlhcare Now initiative.
Important to note that the 85% was the staff number, not a random number chosen by us.
We switched our approach to huddles at the bedside.Luckily we got some quick buy-in.
Marshmallows influenced our first “Tip of the Week”.Marshmallows were offered during the PD Huddle.And yes, someone did eat them without first completing hand hygiene.It was a brilliant teaching moment.
Do we have a new picture?
F3 Rapid Fire: It's In Your Hands - C. O'donnell, S. Brace and M. Arget
The Unit that Could: Searching for theLost Art of Hand Hygiene Cardiac Surgery ICU Royal Columbian Hospital Sue Brace, Patient Care Coordinator Michael Arget, Infection Control Practitioner Catherine O’Donnell, Quality Improvement/Patient Safety Consultant 1
Raiders of“The Lost Art” In search of the Lost Art of Hand Hygiene in healthcare In late 2009/2010, hand hygiene compliance across FHA was well below 30% 2
The Healthcare JungleRoyal Columbian Hospital (RCH) is a430 bed tertiary centre located inNew Westminster, British Columbia.RCH is the centre for Fraser HealthCardiac Services including:•Interventional Cardiology•Cardiac SurgeryApprox 840 open heart surgeries willbe completed this fiscal year. 3
Gathering the Expedition Team Patient Care Coordinator and Infection Control Practitioner had a brief discussion on how to look at improving care in the CSICU. Third Wave of the New Approach to Controlling Superbugs provided by Cdn Pt Safety Institute. Surgical Healthcare Associated Infection Prevention Excellence Collaborative (SHAIPE) had been launched within FHA. 4
The Right Gear for the Journey Principles of Positive Deviance (PD) • Community ownership • Self – Discovery • The people are the “experts” • Immediacy of action • Emphasis on practice • On-going measurement reinforcing change 5
To Recover “The Lost Art”The Unit’s goals:1. To increase Hand-hygiene compliance to 85% in CSICU by September 2011 X 6
Our Strategy to capture “The Art” Weekly huddles with staff to discuss barriers to providing great patient care E-mail summary sent to all staff Review 4 Moments of Hand Hygiene Regular hand hygiene audits PD Notice board on Unit: Audit Results, Tip of the Week Use different engagement tools (PD Skits) De-cluttering of unit 7
The Trek to the Lost Art of Hand Hygiene X Base Camp 8
Venturing into the JungleIt was lonely in the beginning Staff were unsure about these “huddles” Concerned about speaking out Staff couldn’t get away from the bedside 9
Some Successes en routeEasy changes were made to the unit thatimproved work flow and awareness forstaff including:• New corner shelving; computer keyboard covers, removal of large garbage containers• All gloves latex-free• New hypoallergenic soap product• Install barrier cream dispensers• Signage (on soap bottles, hand washing reminders for staff/visitors) 10
The Trek to the Lost Art of Hand Hygiene X Base Camp 11
Hand Hygiene Audits100%90%80%70%60%50%40%30%20%10% 0% Jan-11 Feb-11 Mar-11 Apr-11 May-11 Sep-11 Dec-11 Jan-12 Feb 4 2012 Feb 15 2012 15
The Trek to the Lost Art of Hand Hygiene X Base Camp 16
PDSA...The ScissorsScissors became a major issue.Used for patient care situations.Removed scissors from bedside.Tied them to bedside carts. Discussed at Professional Practice Council.Back to initial practice with modification. 17
The Trek to the Lost Art of Hand Hygiene X Base Camp 18
Falling into the Snake PitOver the summer, we took a break fromhuddles due to vacations, etcHand hygiene audits were not being doneregularlyAn audit in the fallshowed HH compliancewas at ~50 % 19
The Need to Regroup Met with the manager to discuss future steps… Weekly HH audits Frequent PD huddles February was our target month. 20
The Trek to the Lost Art of Hand Hygiene X Base Camp 21
What staff think about the HuddlesWhat do you like? What have you changed?• Increased I am more conscious communication and about 4 moments of HH awareness of practice “I use way more Isagel”• Involvement of “I am more comfortable multiple telling others to wash their perspectives hands” including QI & ICP. “Have A Squirt” 23
Reflecting on the Ongoing JourneyStaff/Physician EngagementSuccesses have been due to:Management SupportCommitment of TeamConsistency of huddles & summariesRegular audits 24
The Art of Hand Hygiene is very elusive and it is difficult to achieve without focused efforts to change culture. “The Art” will hopefully be within reach for CSICU with ongoing efforts from the unit. X 25