Safe Critical Care Project: Testing Improvement Strategies

A Tool Kit Site in collaboration with Partnerships for Implementing Patient Safety (PIPS) -- A Project funded by the Agency for Healthcare research and Quality.

Project Aims

1.Implement a campaign for Improving Critical Care (bloodstream infections and ventilator-associated pneumonia) as part of IHI (Institute for Healthcare Improvement) 100,000 Lives Campaign.

2. Develop toolkits for reducing bloodstream infections and ventilator-associated pneumonia.

3.Conduct a randomized controlled trial to compare the effectiveness of a Collaborative Campaign adn Toolkit strategy for implementing an improvment initiative.

4.Examine the organizational and providor factors that contribute toward and enable successful performance improvement.

Team

HCA:

Hayley Burgess, PharmD, Director of Medication Safety and Usage

Jane Englebright, PhD, RN, Vice President, Clinical Services Group

Susan Littleton, Project Manager

Mark Williams, MD, Professor of Medicaine, Executive Medical Director, EHCA, Emory Healthcare

Jonathan Perlin, MD, PhD, MSHA, FACP, HCA Chief Medical Officer and President, Clinical Services Group

Patsy McFadden, RN, CIC, Infection Control, Centennial Medical Center

Joan Reischel, RN, ICU Manager, Medical Center of Aurora

Sherri Tejedor, MD, Cartersville Medical Center

Laurie Brewer, RN, Supply Chain Director

Steve Mok, PharmD, Clinical Pharmacist, Centennial medical center

Steve Horner, RN, AVP, Outcomes measurement

Vanderbilt:

Ted Speroff, PhD, Director of the VA Tennessee Valley Healthcare System Health Services Research Center for Patient Healthcare Behavior

Robert Dittus, MD MPH, Director of the Vanderbitl Center for Health Services Research

Jay Deshpande, MD MPH, Professor of Anesthesiology and Pediatrics

Wes Ely, MD MPH, Associate Professor of Medicine

Tom Talbot, MD MPH, Assistant Professor of Medicine and Preventive Medicine, Associate Hospital Epidemiologist

Matt Weinger, MD, Director of the Vanderbilt Center for Patient Safety

Dan France, PhD, MPH, Assistant Director for Improving Patient Safety

Robert Alan Greevy, Jr, PhD, Assistant Professor, Department of Biostatistics

University of Washington, Seattle, Washington:

Richard Wall, MD MPH, Senior Research Fellow in Pulmonary and Critical Care

Education

The following education programs were delivered across all HCA-affiliated facilities as webcasts to watch or to view later as a recording. Each program ws or will be transferred to an online learning program on healthstream.com and available nationally. The Power Point presentations are available for viewing.

Prevention of Catheter-Related Bloodstream Infections (November 2005)

Prevention of Ventilator-Asociated Pneumonia - Part 1 (March 2006)

Prevention of Ventilator-Associated Pneumonia - Part 2 (May 2006

Sedation and Delirium: Monitoring and Management (October 2006)

Prevention of Ventilator-Associated Pneumonia (April 2007)

Central Venous Catheter Insertion and Maintenance (April 2007)

Inventories (Surveys):

ICU Overview Survey: Distributed July 2005 to all HCA-affiliated facilities to provide a description of current critical care practices in HCA-affiliated hospitals and ICA involvement in quality improvement.

Infection Control Surveillance Survey: Distributed December 2005 to all HCA-affiliated facilities to collect information about hospital ICU infection control measurement, reporting, and practices.

Safety Attitude Survey: Distributed May 2006 to the participants of the Safe Critical Care Project to assess the preceived patient safety climate within intensive care units. The SAQ and Safety Climate Scale by Sexton, Thomas, Provonost, et al, are published instruments validated for the ICU.

Sedation and Delirium Survey: Distributed October 2006 to all HCA-affiliated facilities to assess current practices that will help the filed of critical care identify steps for improving ICU sedation and delirium care.

Paper Checklists:

To ensure our staff is equipped with the essential evidence-based medicine processes, we provided paper checklists as an intervention tool and to assist teams in monitoring IHI-bundled processes of care.

--BSI Nursing Checklist

--ICU ROunding Checklist

--Central Venous Catheter Reminder Labels

Statistical Process Control:

Spreadsheet templates are provided to collect and display process and outcomes data for central-line catheter-related blood stream infections and ventilator-associated pneumonia. These templates are pre-programmed for easy minimal data entry and charting of control charts for quality improvement. The shared documents include the Excel files and the point tutorial.

--How-to Guide - Part 1

--How-to Guide - Part 2

--Control Chart Template

--Control Chart Example

Tools:

Surveillance Guides

How to Collect and Monitor Bloodstream Infection Rates

How to Collect and Monitor Ventilator-Associated Pneumonia Rates

Quality Improvement

These worksheets are templates for initiating a Quality Improvement Team and maintaining the continuous action plans of a Quality Improvement Team.

--Prework report

--Implementation Plan and Progress report

--Meeting Agenda Tool