Implementation of NYSPFP Colon Surgery Bundle & SSI: Steps for

Success David E. Rivadeneira, M.D., M.B.A., FACS, FASCRS

Vice Chair, Surgical Strategic Initiatives for Northwell Health System Director, Surgical Services & Colorectal Surgery at Huntington Hospital

Professor of Surgery at Hofstra-Northwell School of Medicine

Surgical site infections (SSIs) are the second most common healthcare-associated infection (HAI). SSI rates are disproportionately higher among patients following colorectal surgeries. Resulting SSIs are known to have significant patient complications with adverse clinical and economic impact.

2

The Problem

Possible Solution

3

Our Problem

4

We asked

1. How will the next patient develop a wound infection? How can we prevent the next wound infection? 2. How will the next patient be harmed? How can we prevent that harm?

5

What is Culture*?

“The way we do things around here”

1 attitude = opinion…everyone’s attitude = culture

*aka Climate © JHU and JHHS, 2011

6

Not just about the checklist: Safety Culture and Improvement

7

Our Solution

Implementation of Colon Bundle Identify “Key” Personnel

Develop Champions Must Have “Buy In”

Interdisciplinary Team Approach

8

Interdisciplinary Team Approach Jay Enden, MD, Medical Director

Bob Scanlon, MD, Associate Medical Director Scott Wodicka, MD, Chief Surgery David Rivadeneira, MD, Regional Vice Chair Surgical Services John Simon, MD, Director, Colorectal Surgery Jay Yelon, MD, Vice Chair, Surgery Trauma Alexander Shukis, MD, Chair, Anesthesia Renee Stewart, Associate Executive Director Nancy Cox, RN, Associate Executive Director, Quality Management Fran Edwards, RN, Director, Infection Prevention Lori Ottaviano, RN, Director, OR Anthony Aprile, Administrative Director, Surgical Services Robyn Schmid-Carbonaro, RN, Director, Patient Care Services Tricia Lewis, RN, Director Nurse Education Ann Tadlock, RN, Nurse Manager Judith Stauder, RN, Nurse Manager Diane De Stefano, RN, Nurse Manager John Hallowell, Director Physician Assistants Loretta Rispoli, Nurse Practitioner Lorraine Freire, Nurse Practitioner Christine Amoroso, RN, Quality Management

9

Advanced Colon Surgery Bundle

10

Antimicrobial Prophylaxis

Mechanical bowel prep (numerous available), and oral antibiotics (Neomycin, metronidazole)

11

.

12

Separation of “Dirty” and “Clean” Instruments

Colorectal Bundle Tool

14

Colorectal Bundle Tool (continued)

15

2015 Colorectal Bundle Elements Tool Compliance – Original Method

Southside Hospital 2014 vs. 2015 Monthly Infection Rate Colon Procedures

2014 – 2015 SSI Comparison

Wound Class Comparison 2014 vs. YTD Nov 2015

ASA Score Comparison

Addressing Defects: Pre-op Education

Problem: Patients did not know why we do the preparations we do Enhanced pre-op education to improve patient compliance with preparation for surgery Explain the importance of of adhering to body wash, and bowel prep Interactive Teachback

Addressing Defects: Bowel Prep Kit and Reminder Call

Addressing Defects

Candid discussion with surgeons about effective strategies for approaching the bundle OR briefing/debriefing wound classification Keep tract of data: Logbook of defects Small wins first

23