NoCVA HEN CLABSI Collaborative “ Sharing Success Stories ”

1. NoCVA HENCLABSI Collaborative“Sharing Success Stories” December 6, 2012 NoCVA Hospital Engagement Network

2. NoCVA NoCVA Hospital Engagement Network This activity is part of the North Carolina Virginia Hospital Engagement Network(NoCVA) NoCVA is led by the NC Quality Center in partnership with the VA Hospital and Health Association NoCVA exists to support the goals of the CMS national effort - The Partnership for Patients

3. Partnership for Patients Goals NoCVA Hospital Engagement Network By the end of 2013, preventable hospital acquired conditions would be reduced by 40%, compared to 2010 By the end of 2013, 30-day hospital readmissions would be reduced by 20%, compared to 2010 The CLABSI Collaborative is designed to impact the goal if reducing CLABSI’s.

4. CLABSI Rates NoCVA Hospital Engagement Network

5. Webinar Objectives NoCVA Hospital Engagement Network Name 3 strategies that have helped other hospitals achieve and maintain success in preventing central line associated blood stream infections Understand the importance that staff knowledge and leadership commitment related to patient safety have in achieving and sustaining improvement List 2 ways an EMR can help with nursing compliance in central line care

6. Guest Presenters NoCVA Hospital Engagement Network • Augusta Health, Fishersville, VA • Carolyn Palmer, BSN, RN Infection Control • Stefanie Bartley, BSN, RN, Information Technology • Tracy Sansossio, MSN, CMSRN, Clinical Education • Sentara CarePlex, Hampton, VA • Gail J. Rudder RN, CRNI, CIC Infection Preventionist • MCV-VCU, Richmond, VA • Lauren R. Goodloe, PhD, RN, NEA-BCDirector of Medical & Geriatric Nursing,Administrative Director - Nursing Research andAssistant Dean for Clinical Operations, VCU School of Nursing • DarciBowles, MS RN RRT CNML Nurse Manager North 9 Progressive Care Medicine UnitAdjunct Faculty, VCU School of Nursing

7. Getting to Zero at Sentara CarePlex Hospital Gail J. Rudder RN, CRNI, CIC Infection Preventionist NoCVA Hospital Engagement Network

8. Sentara CarePlex HospitalWho We Are NoCVA Hospital Engagement Network • One of ten acute care hospitals within the Sentara Healthcare system, • Located in Hampton, an independent city, in southeastern Virginia. • A not-for-profit organization, advanced 224 bed hospital which serves a very complex and diverse community comprising urban, suburban, rural, military and transient groups.

9. Sentara CarePlex HospitalWho We Are NoCVA Hospital Engagement Network • Main campus includes: • the Orthopedic Hospital at SCP, • an Outpatient Diagnostic Imaging center , • a comprehensive Cancer Institute and • one of the state’s largest emergency departments, comprising of 52 treatment beds.

10. Our History“History is the narrative of great actions with praise or blame”….Cotton Mather NoCVA Hospital Engagement Network According to the Centers for Disease Prevention & Control, an estimated 41,000 Central Line Associated Blood Stream Infections (CLABSI) occur in US hospitals each year. Sentara CarePlex Hospital has focused on National Patient Safety Goal 7, reduction of Hospital Acquired Infections (HAIs), including CLABSI prevention. By April 2010, there were 4 CLABSI’s already reported in the Intensive Care Unit at Sentara CarePlex Hospital.

11. Our Journey to ZeroThe journey of a thousand miles begins with a single step”…Lao Tzu NoCVA Hospital Engagement Network GOAL: Reduce CLABSI within ICU to CDC/NHSN benchmark and Sentara goal of 0.28/1000 catheter days. Hitting the Road and Getting Started • Enrolled in “On The Cusp: StopBSI” initiative – April 2010 • Focused on improving Safety Culture • Identified responsible team • Identified key areas of focus for prevention of CLABSIs - 1. Educate staff on evidence-based practices 2. Empower nurses to ensure compliance with best practice 3. Provide feedback on infection rates at the unit level 4. Assess monthly progress

12. Our Journey to ZeroWhat We Did; What We Found Out NoCVA Hospital Engagement Network Identified CLABSI rate for SCPH Assigned staff surveys on culture of safety - “How we do things around here” - “How will the next patient be harmed” Assigned Preventing Errors through Safety Habits video (CUSP) Developed Sentara-specific “Science of Safety” video Conducted monthly team meetings

13. Our Journey to ZeroChange is Possible! NoCVA Hospital Engagement Network Areas of Focus for Prevention of CLABSI • Change the culture • Ensure best practice during Selection, Insertion & Maintenance • Educate staff on best practice • Improve Hand Hygiene • Reduce device days • Revise daily goals

14. Our Journey to Zero Has Spread NoCVA Hospital Engagement Network • Expanded prevention measures to Medical-Surgical Units outside of ICU • Developed CLABSI Prevention & Performance Improvement Committee • Reports provided to Administrative and Unit leadership on monthly basis. • Zero CLABSI in ICU since April 2010 • 18 CLABSIs were identified outside of the ICU, CYE 2008; 7 CLABSIs identified YTD 2012

15. Our Journey to ZeroWe’ve Arrived and the Goal is Sweet! NoCVA Hospital Engagement Network

16. Questions? NoCVA Hospital Engagement Network

17. VCUHS CLABSI Prevention Story Lauren Goodloe, PhD RN NEA-BC Darci Bowles, MS RN RRT CNML Janis Ober BSN RN CIC NoCVA Hospital Engagement Network

18. Background NoCVA Hospital Engagement Network 28 bed medicine progressive care unit Unit is covered by 8 MD teams MD rounds are not consistent or at set time Attending MD’s rotate every 2 weeks Patient safety initiative started more than 2 years ago mandated for all employees

19. Issues NoCVA Hospital Engagement Network Attending preference followed – lack consistency Discharges are not scheduled Admissions are not predictable based on discharge variability Nursing staff may not be available for rounds Lack of engaged unit medical director

20. Interventions NoCVA Hospital Engagement Network • Face to face bedside nursing handoff (after listening to recorded report) at shift change • When was IV access inserted? • If PICC line, is it still needed? • What is condition of dressing and site? • Are IV fluids correct and running at correct rate?\ • Is the tubing and bag within date? • What is the pts. biggest safety risk? • What can be done to reduce the risk? • Brief overview of plan of care for next 24 hours • Does the pt. have any questions?

21. Safety Huddles NoCVA Hospital Engagement Network • Take place after each 12 hour shift change • Conducted by the Charge RN • Review staffing levels for next 24 hours • Identify any safety issues: • Falls, high risk pts., inmates, psych pts., etc. • Identify the most unstable or highest acuity pts. • Identify any pts. or family members requiring extra attention

22. Results NoCVA Hospital Engagement Network Concurrent Central Line related blood stream infection (CLBSI) data collection Each identified CLABSI is reviewed by Infection Preventionist and reported to Nurse Manager and Nurse Clinician Rates of infection and device utilization are monitored and reported on quarterly basis Incidence of CLABSI went from 1/month to less than 1/quarter applying same definition

23. Questions? NoCVA Hospital Engagement Network

24. Augusta Health Carolyn Palmer, BSN, RN Infection Control Stefanie Bartley, BSN, RN, Information Technology Tracy Sansossio, MSN, CMSRN, Clinical Education NoCVA Hospital Engagement Network

25. Augusta Health NoCVA Hospital Engagement Network 12,000+ annual admissions equally 52,000 days of care 60,000 + emergency visits annually 2,300 staff members 225 + active full time physicians Eight bed ICU considered a Medical ICU

26. How We Made a Difference • Physician Involvement: Physician Champion, Chair of CLABSI Prevention Team. • Education: Physicians, LIPs, NP, PA and Nursing in new hire orientation and annually. • Implementation of Central Line Insertion Check List/Bundle • Facility wide Daily Central Line Rounds and documentation improvements initiative daily and quick review Status Board • Dressing occlusive • Dressing dated • Dressing changed per protocol • Daily necessary of line • Increased awareness of line type, care and maintenance NoCVA Hospital Engagement Network

27. Nursing Dashboard for Central Lines NoCVA Hospital Engagement Network

28. EMR Documentation for CL’s NoCVA Hospital Engagement Network

29. Nursing Documentation in EMR NoCVA Hospital Engagement Network

30. EMR List of Patients with CL’s NoCVA Hospital Engagement Network

31. Challenges and Monitoring • Challenges • Check list completed • Follow up with compliance and education • Monitoring • IC and Directors monitor central lines • Feedback given to staff at unit staff meetings and also addressed at point of care with daily rounding NoCVA Hospital Engagement Network

32. Lessons Learned • Work remains • Critical check list that can be incorporated into daily rounding that includes central line awareness • Hospitalists to begin intentional rounding with nursing staff on all units January 1, 2013 • Measures of Success • In 2011, CLABSI rate of 1.29 for our ICU, DU=0.7 • In 2012, CLABSI rate =0, DU = 0.56 NoCVA Hospital Engagement Network

33. Questions? NoCVA Hospital Engagement Network

34. Polling Question #1 NoCVA Hospital Engagement Network How well did this Learning activity meet the stated objectives? Excellent Good Fair Poor N/A

35. Polling Question #2 NoCVA Hospital Engagement Network Amount of useful information and ideas provided: Excellent Good Fair Poor N/A

36. Polling Question #3 Excellent Good Fair Poor N/A NoCVA Hospital Engagement Network Usefulness to my hospital of the information and ideas provided:

37. Polling Question #4 NoCVA Hospital Engagement Network Chance that the information and ideas provided will improve my effectiveness and results: Excellent Good Fair Poor N/A

38. Announcements NoCVA Hospital Engagement Network • Scheduling of Coaching Calls • Review progress, barriers, issues • Review Culture of Safety Survey results and Action Plan development • Health Literacy through Teach Back Webinar • December 20th, 130-230pm • VHHA Annual Patient Safety Summit • January 31-February 1 • Pre-Summit Hospital Engagement Learning Session • January 30

39. Contact Information Jan Mangun, MT(ASCP), MSA, CPHRM Executive Directive, Quality & Patient Safety jmangun@vhha.org 804-965-1202 Debbie Roddenberry Assistant Director droddenberry@vhha.com 804-965-5714