CLABSI Experience Saint Louis University Hospital

Transcription

1 CLABSI Experience Saint Louis University Hospital Thursday, September, 01 Our Story Academic medical center Owned by Tenet Healthcare affiliated with Saint Louis University (SLU) and a closed medical staff Highly Specialized Adult Care (tertiary/quaternary care) American College of Surgeon Certified in Trauma and Level 1 Trauma Center for State of Missouri and Illinois TJC Primary Stroke Center and founder of Mid America Stroke Network. Partner with 8 hospitals as a hub for stroke care. Abdominal Transplant Services Urban campus with 0 percent inpatient admissions through emergency department 35 Licensed Beds and 5 ICU beds (5) 1

2 Central Venous Catheters Hospital Wide Central Venous Catheter Infection RATE CVC UCL + Sigma +1 Sigma Average -1 Sigma - Sigma LCL 3 CVC Insertion CVC Certification Program CVC Duke online program and 5 proctored insertions to get a blue card Added IC education and simulation lab for all new residents Proctored insertions supervised by attending physician

3 CVC Maintenance CVC Rapid Response Nurses Daily discussion with MD regarding need for CVC Responsible for daily site assessment Responsible for maintaining occlusive dressings Tries and recommends new products Implemented CHG baths Implemented Curos Caps & Site Scrub Implemented BioSeal Evaluates all maintenance policies Resource for physicians and nurses 5 7 ICU- The CUSP Experience In 010 had the highest CVC rate of any ICU 15 Bed Surgical Intensive Care Unit Provides care for abdominal transplant, cardiac, thoracic, vascular and urologic surgery Approximately 0 Staff members (Nurses, Advanced Practice Nurses, Care Partners and Unit Secretaries) Staff experience is anywhere from new graduates to 35 years 19 Attending Physicians including Surgeons and Anesthesia Critical Care Residents rotating through the unit Support Staff (Pharmacy, Respiratory Therapy) Length of Stay- one day to one year 011 Joined CVC Collaborative and Formed a CUSP Team 3

4 CUSP Implementation 7 ICU CUSP Team has been in place for 18 months Decision to Form Team Recruitment of Leadership Recruitment of Team Members Education and Training of Staff Surveys & Identifying Defects Team Meetings and Work Flow Communication & Huddle Boards 7 CVC Infections Attended Best Practices Webinars & Coaching Calls Staff completed Defect Tool on each outlier Daily follow up on all policy outliers Implemented high risk protocol & Focused on Environment Huddle Boards and Consistency of nursing practice Rate = Infections/1000 device days ICU CVC Infection Rates CUSP Team initiated CLABSI Rates 7 ICU 0.55 Missouri 0.89 Rate National 1.1 Rate 8

5 Lessons Learned Successes Leadership- Strong Nurse Manager support for the team and Team leader that is very committed to the success of the team and the concept Team Team leader one on one recruitment of team members All Shifts and Experience Standard meeting time and all members walk away with responsibilities or action items Peer to Peer Relationships strengthened & sense of Self Governance Increased awareness of safety Changed how unit relates to management- non punitive 9 Lessons Learned Challenges Formation of the Team Getting past We have to do this because we were Bad Patience Leadership- Physician Participation Surveys/Defects Everything is an Opportunity- Moving past Our patients our Sicker Syndrome Meetings Creating an atmosphere of Psychological Safety Staying on Task Buy in from the Rest of the Unit 10 5

6 Next Steps 7 ICU Successfully worked on three other projects All staff members attend one CUSP meeting per year Hospital Hospital Based Physician Advisor- 75% of time spent on prevention Develop Mastery Level CVC insertion program Add annual safety training as requirement Implementing CUSP programs in all of our ICU s 11