Develop a Quality Improvement Implementation Project Health Team

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Develop a Quality Improvement Implementation Project “Health Team Quality Improvement Implementation Project and the

Develop a Quality Improvement Implementation Project “Health Team Quality Improvement Implementation Project and the Impact upon Congenital Heart Surgery Infection Rate” Bustamante P RN, Perez Ferrero J RN, Rodriguez R RN, Benedetto E RN, Oyola D RN, Juaneda I MD, Juaneda E MD.

Outline Local Problem Study Question Challenges Parcial Results Objetives Evaluation Methods Study Stages

Outline Local Problem Study Question Challenges Parcial Results Objetives Evaluation Methods Study Stages

Local Problem • CICU at HNST semiannual unadjusted infection rate: 24% and 23% at

Local Problem • CICU at HNST semiannual unadjusted infection rate: 24% and 23% at 2012; 26% and 14% during 2013 and 14% on 2014. • Data infection rate are higher than 4 -6% IQIC participants.

Study Question • Is it possible to reduce unadjusted infection rate through Prevention Infection

Study Question • Is it possible to reduce unadjusted infection rate through Prevention Infection Bundles (PIB) implementation on CHS postoperative recovery in the CICU at HNST ?

Objetives • Health Team: Incorporate patient's safety culture, improving efficiency and quality of care

Objetives • Health Team: Incorporate patient's safety culture, improving efficiency and quality of care of children with Congenital Heart Surgery (CHS) and assess if through to quality improvement project decreased infection rates on CHS. • Patients: To decrease morbidity and mortality in children with CHS.

Methods • A quantitative, correlational and prospective study. • Postoperatory of CHS in children’s

Methods • A quantitative, correlational and prospective study. • Postoperatory of CHS in children’s from 0 14 years of age between January 1 st 2014 to December 31 st 2015.

Study Stages: – Staff Capacitation and Strategy Orientation – Strategy Implementation – Monitoring Implementation

Study Stages: – Staff Capacitation and Strategy Orientation – Strategy Implementation – Monitoring Implementation – Data quantification and analysis – Changes implemented by the analysis

Analysis and Evaluation • Specific Prevention Infection Bundles (Daily. Checklist for NAV, CVL, SSIs

Analysis and Evaluation • Specific Prevention Infection Bundles (Daily. Checklist for NAV, CVL, SSIs and UTI) rate adherence according score 0 -Incompleted, 1 -Completed, unadjusted infection rate provided by IQIC and correlation statistics analysis between both.

Parcial Results May 2015 CVC 100 90 90 80 80 70 70 60 60

Parcial Results May 2015 CVC 100 90 90 80 80 70 70 60 60 Adherence % January 2015 CVC 50 40 . . . 30 50 40 30 20 20 10 10 0 . . . 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Observation set 1 2 3 4 5 6 7 8 9 101112131415161718192021222324252627 Observation set

Parcial Results May 2015 VAP 100 90 90 80 80 70 70 60 60

Parcial Results May 2015 VAP 100 90 90 80 80 70 70 60 60 50 Adherence % January 2015 VAP . . . 40 30 50 30 20 20 10 10 0 . . . 40 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Observation set 1 2 3 4 5 6 7 8 9 1011121314151617181920212223242526 Observation set

Parcial Results May 2015 UTI 100 90 90 80 80 70 70 60 60

Parcial Results May 2015 UTI 100 90 90 80 80 70 70 60 60 50 . . . 40 30 Adherence % January 2015 UTI 50. . . 40 30 20 20 10 10 0 1 2 3 4 5 6 7 8 9 Observation set 10 11 12 13 14 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Observation set

Challenges • Obtain the 80% percentage adhesion to the Prevention Infection Bundles • Implement

Challenges • Obtain the 80% percentage adhesion to the Prevention Infection Bundles • Implement new strategies related to Safety patient, control infection and team work • Showing statistics monthly • Developed staff training in Simulated Practice Lab.

References • Richardson W et al. Crossing the Quality Chasm: A New Health System

References • Richardson W et al. Crossing the Quality Chasm: A New Health System for the 21 st Century (Free executive summary) http: //www. nap. edu/catalog/10027. html • Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson. To Err Is Human: Building a Safer System, Editors; Comittee on Quality of Health Care in America, Institute of Medicine; National Academy Press 2000. • Bode, L. 2010). Preventing Surgical-Site Infections in Nasal Carriers of Staphylococcus Aureus. The New England Journal of Medicine. • Guardia et al. 2008). Infeccion Nosocomial en Postoperados de Cirugia Cardiaca. Anales de Pediatria. , http: //analesdepediatria. org/es/infeccion-nosocomial-postoperados-cirugiacardiaca/articulo/S 1695403308702352/. • Ministerio de Salud de la Nacion Secretaria de Politicas, R. e. (2011). Reporte Semestral Enero-Junio 2010. Programa Nacional VIDHA. Obtenido de www. vihda. gov. ar • Hales, M. a. (2006) The Checklist – a Tool for Error Management and Perfomance Improvement. Journal of Critical Care, http: //www. jccjournal. org/article/S 0883 -9441(06)0081 -5/abstract#. • Weiser. T et al. (2010) Perspectives in Quality: Designing the WHO Surgical Safety Checklist. International Journal for Quality in Health Care. http: //intqhc. oxfordjournals. org/content/22/5/365. article-info. • International Quality Improvement Collaborative for Congenital Heart Surgery in Developing Countries. Annual Data Report 2012, 2013, 2014. Hospital de Niños – Cordoba-Argentina.

Thanks for your attention

Thanks for your attention