FEBRUARY 2016 IS SSI PREVENTION AUDIT MONTH:

WHAT YOU NEED TO KNOW TO

PARTICIPATE

Welcome to our francophone attendees Bienvenue à nos participants francophones Conseillère en sécurité et en amélioration Safety Improvement Advisor Gina Peck

Dr. Curtis Smecher VP, Quality and Patient Safety BC Anesthesiologists Society Dept Head, Anesthesiology Abbotsford Regional Hospital and Cancer Center Virginia Flintoft, MSc BN, Manager Safer Healthcare Now! Central Measurement Team Carla Williams Patient Safety Improvement Lead Safer Healthcare Now!

Today’s Speakers

The Event has been planned in partnership with: – Alberta Health Services-Surgery Strategic

Clinical Network – Atlantic Health Quality & Patient Safety

Collaborative – BC Patient Safety & Quality Council – Health Quality Ontario – Saskatchewan Ministry of Health- Patient Safety

Unit

SSI Prevention Audit is New this year!

• Why focus on SSI Prevention and measurement?

• Why should I participate? • What is SSI Prevention Audit? • Who may participate? • How do I participate? • Where can I find resources for the SSI

Audit?

Overview

Why Focus on SSI Prevention?

James 71 years old retired barber “I worked hard all of my life” Family:

• A Brother • Brian

• 3 Sisters • Janet, Louise, Mary

• 2 Sons: • Jesse, Roy

• 6 Grandchildren: • Elizabeth (18),

Margaret (18), Allen (13), Nicholas (12), Brenda (8), Thomas (6)

Well prior to his first surgery

James My Introduction to James by a colleague:

“You have a patient next week who’s risk assessment is 50%” That’s a 50% chance of death or a Major cardiac event.

50/50 Chance of leaving the hospital alive.

James

Medical Background Well until… 3 years ago:

• Ruptured AAA, with a Stent Repair

• Stormy post-op course including Cardiac Arrest

• Infected Aortic Graft • Too sick to remove graft • Plan: long term Antibiotics

• Sacral Plexopathy with parapelegia – wheelchair dependant

• Living in Residential Care

More Recently:

• A number of Urosepsis events

• Ureteric Obstruction due to inflammation around infected graft

• Poor Kidney Function

• Anemia of Chronic Disease

Chronic infection Poor Kidney Function Prior Cardiac Arrest Parapelegic Chronic Anemia Huge operation with large anticipated blood loss

James The Operation

1. Route his blood flow from his

Left Axillary Artery to his Femoral Artery (Ax-Fem Bypass)

2. Connect the two Femoral Arteries (Fem-Fem Crossover)

3. Remove his Aorta and Aortic Grafts from his Kidneys to his Iliac Arteries

James The Operation

1. James was given a 50/50

Chance 2. The Operation took about 8

hours 3. The OR went very well 4. He lost most of his blood

volume, which was replaced from the Blood Bank: PRBC, Plasma, Platelets

James The Operation

His Aorta and grafts were heavily infected. It was a very dramatic presentation. The OR staff (who have seen it all…) were “impressed” that James had survived the infection at all, much less 3 years.

Infection by: Drug Resistant Pseudomonas

James Now… James is doing amazingly well. • He is finding more movement of

his legs • His Kidney function is improving • He is getting stronger every day

Surgical Site Infections

SSI’s happen to real people • People with real lives • People with Families • People with Communities

SSI’s are not about statistics, they are about real people

James

James How many people? • SSI’s are the most common

Healthcare Associated Infection among Surgical Patients

• 2-5% of all Surgeries (1.3 M in Canada)

And at what cost?

26-65,000 patients yearly

James

Dollars: • $350,000 to 1 Million

Canadian ?

James Resources: • 11 Days increased LOS • 60% more ICU time • 5x more likely to be

readmitted

• 60% Preventable

• 2x the mortality

James Personal Cost

James: • His health • Years of his life being unwell • Almost, his life

Jesse, Roy

• Their Father

Brian, Janet, Louise, Mary • Their Brother

Elizabeth, Margaret, Allen, Nicholas, Brenda, Thomas

• Their Grandfather

SSI’s are not about statistics, they are about people

But,

We need statistics to improve how we treat people

like James

Join the SSI National Audit

Nationally and Provincially • It is important to know how we’re doing • Where are we having problems • Where do we need to put effort in • Where will we get (need) the biggest improvement for

people like James Locally

• How do you stack up? • We all think we’re doing a good job, but

without measuring, we don’t really know • Where do you need to improve?

How many problems like James’ can we avoid?

National SSI Prevention Audit Call to Action

Virginia Flintoft, MSc, BN and Alexandru Titeu, BA (Hons)

January 7, 2016

The Canadian SSI Prevention Audit is designed to establish a national perspective of the

adoption and implementation of established process measures for preventing SSI.

It is hoped that the results will be used to

inform and drive local and systemic improvement efforts

What is the SSI Prevention Audit?

Identify areas of excellence and areas for improvement Measurement is critical to improve the

delivery of safe and effective healthcare

Why Should I Participate?

Who may participate?

All organizations at which surgery is performed are encouraged to use measurement to support SSI Prevention quality improvement efforts throughout the month (and throughout the year!) .

Safer Healthcare Now! has made available a SSI Prevention Audit tool to support collection of measures related to SSI Prevention pre, peri, and post-operative processes.

25

How Do I Participate?

26

Visit the Canadian Surgical Site Infection Prevention Audit webpage to get started http://www.patientsafetyinstitute.ca/en/Events/SSIAudit/Pages/default.aspx

How to Register

27

STEP Register to participate in SSI Prevention Audit month

There is no cost to register! By registering you are committing to auditing your SSI

processes and submitting your data during the month of February.

Regardless of whether you are currently or have never used the SSI Prevention Quality Audit tool, we would like all organizations to register.

Registration allows the SHN Central Measurement Team to contact you with information on how to access your site/unit-specific SSI Prevention Quality Audit tool(s).

All SSI audit data collected for February and submitted before the second week of March will be included in the analysis (even if you have not registered).

28

Registration

29

https://secure.e-registernow.com/cgi-bin/mkpayment.cgi?MID=1527&state=step2direct&event=500000405134979

STEP Determine the audit areas

Consider which care areas you would like to audit and how you might wish to group/analyze the

audit results. For example, would you like to collect and analyze audit data from multiple units?, across multiple

sites?, across a region?

Drill down Roll up

No specific sample size Base sample size on patient volumes and

resources available

STEP ❸ Choose a sampling approach

Average Monthly Population Size "N"

Minimum required sample "n"

< 20 No sampling; 100% of population required

20 – 100 20

> 100 15 - 20% of population size

Example of a Sampling Strategy

Features: Free, cloud-based data collection and reporting tool Available in English and French User friendly and simple to navigate Accessible from website with login details Tracks >100 process and outcome measures over 14 interventions Provides real time reporting and export of data to CSV/Excel Reduces burden of data collection, entry and analysis Roll Up or Drill Down Reports (i.e. Unit Organization Health Region Province National) with automated Run Charts

Capacity to customize measures and reports Provides real time reporting and export of data to CSV/Excel

Patient Safety Metrics - Introduction

34 34

Computer generated barcode identifies your audit area/unit

35

35

Need this entered on every page So we may contact you if there is an error

Date is required on every form 10’s

units

36

36

37 37

SSI Infection PRE-OP Score SS

I PRE

-O

PERA

TIVE

SC

ORE

(14)

38 38

SSI Infection PERI-OP Score

SSI P

ERI-O

PERA

TIVE

SC

ORE

(15)

39 39

SSI Infection POST-OP Score SS

I PO

ST-

OP

SCO

RE

(16)

40 40

SSI Infection Score

SSI I

NFE

CTIO

N S

CORE

(17)

DO …

Colour inside the line - fill in bubble completely (Sharpie is best) Avoid stacking forms when filling in bubbles to avoid bleed

through Use the void bubble for entry errors – avoid scratch out Print new form each time - avoid photocopying Avoid using 3-hole punch on forms Keep form free from extra markings Fax without a cover sheet Fax form in FINE RESOLUTION - check setting on fax machine

Data Collection (Audit) tool- BE AWARE!

41

SSI Audit Form Instructions (4 pages)

Accessing Instructions from PSM

STEP ❹ Access your audit tool

You can: Use a previously generated SSI Prevention tool(s)

OR Have the Central Measurement Team assist to generate

your SSI Prevention tool(s) OR

Generate the SSI Prevention tool(s) yourself, using the Patient Safety Metrics System

44

Accessing or Creating a Form from PSM

STEP Complete the audit

46

Detailed instructions are available at:

http://www.patientsafetyinstitute.ca/en/Events/SSIAudit/P

ages/default.aspx

STEP Submit your results

Submit your results to the Patient Safety Metrics system

Using a high resolution setting,

fax your audit tool to the number found at the top of the audit tool

47

Resources

Patient Safety Metrics System: https://shn.med.utoronto.ca/metrics/Login.aspx

SSI audit details – Methodology – FAQ’s – Instruction booklet http://www.patientsafetyinstitute.ca/en/Events/SSIAudit/Pages/default.aspx

Register for the audit https://secure.e-registernow.com/cgi-bin/mkpayment.cgi?MID=1527&state=step2direct&event=500000405134979

48

What then?

Post Audit results March 24, 2016

49

Questions?

50

We are here to help!

51

For Audit forms, Data Questions and SSI Content CPSI Central Measurement Team metrics@saferhealthcarenow.ca Virginia Flintoft - 416-946-8350 Alexandru Titeu - 416-946-3103

Anne MacLaurin – amaclaurin@cpsi-icsp.ca CPSI Patient Safety Intervention Lead

Carla Williams cwilliams@cpsi-icsp.ca

We looking forward to your participation in the

Canadian SSI Prevention Quality Audit Month!

Thank you for attending!

52