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U & I Preventing UTIsPost-surgical Units at Surrey Memorial

Hospital (Orthopedics and General Surgery)

Alana Cohen

Margaret Dyka

Dareena Malli

Pawan Sindhar

Brenda Smith

Lorraine Prysunka

Susann Camus

Filda Grado

Jas Sidhu

Melanie Skidmore

Leah Tennant

Angela Wilson

Team Members:

SQAN Presentation: November 16, 2012

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Team Goal

Apply National Surgical Quality Improvement Program (NSQIP) data and methods to reduceUrinary Tract Infection rates in SMHPostsurgical Patients from 1.6% on February 29, 2012 to 0.8% by June 30, 2012

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Improvement Strategies

Use NSQIP risk and non-risk adjusted data to drive improvement

Apply NSQIP best practices

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Quality Improvement Strategies Team Goals

Use Positive Deviance and TRIZ

Carry out Plan-Do-Study-Act (PDSA) cycles to test improvements and small changes

Staff and patient education

Regular facilitated meetings

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What we have done to date Developed Foley plan of care sticker for

Kardexes

PDSA Cycles performed on positioning of catheter bag, integrity of loops, catheter care and documentation of Foley plan of care on Kardex

Chart reviews

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What we have done to date con’t

Pioneered use of physician reminder sticker

Staff huddles and contests

Posters, factoids and spot checks

Patient education

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ResultsOverall UTI occurrence rate at Surrey Memorial Hospital from September

2011 to August, 2012 (non-risk adjusted data)

0

0.02

0.04

0.06

0.08

0.1

0.12

Sept,2011

Oct Nov Dec Jan,2012

Feb,2012

Mar Apr May Jun Jul Aug

SMH UTI NSQIP Overall UTI mean Upper Limit (+3 Sigma) Low er Limit (-3 Sigma)

"U & I preventing UTI" team action started

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ResultsUTI occurrence rate on the Orthopedic unit at Surrey Memorial Hospital,

Septebmer 2011 to August, 2012 (non-risk adjusted data)

0

0.02

0.04

0.06

0.08

0.1

0.12

Sep,2011

Oct Nov Dec Jan,2012

Feb,2012

Mar Apr May Jun Jul Aug

SMH Ortho NSQIP Ortho mean Upper Limit (+3 Sigma) Low er Limit (-3 Sigma)

"U & I preventing UTI" team action started

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Lessons learned No quick fixes

Important to master the basics

Essential to remind people and to ensure new staff and casual staff are included in education

Key challenge: getting the word out and getting people to change practice

Be persistent

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Hints for new teams 6-8 staff members is optimal

Every team member is actively involved

Facilitated meetings keep us on track

Build in time during meetings to do PDSA cycles

Have fun

Celebrate successes

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Wavin’ the Cath (apologies to K’naan)When we get data, we will drill downCall us high flyersHigh flyers wearing the crown

Chorus:When we get data, we will drill downCall us high flyers. High flyers wearing the

crown.We will cut back,We will cut back, We will cut back.

First Verse:From Surrey downtown, Surgical FloorThese are my patients, couldn’t ask fo’

moreThis is our way, I am a nurseCaring is first, knowledge we thirstOur patients come first, they’ll be the best,PDSA we always testPatient will heal, this is for realThis is our way, that’s all we can sayTimes struggling, Getting the word out

We’re wondering, what’s that about now

We actively wait for zero point eightIt’s not far away, For now we say

Chorus

Second Verse:Two person insertion is less exertion,Use the best practice, tell everyoneHold all our contests, we’ve just begun No easy way, Work is the wayLet’s do this together, make all

believersNSQIP best practice, strive to improveWe’re making our way to zero point

eightWe’ll not give up, Our team is great!We’re reminding, all the physiciansWe’re stickering, all our KardexesWe’ll actively wait for zero point eightIt’s not far away but for now we say.

Chorus (repeat twice)