Implementation of Modified EvidenceBased Universal Colorectal and ERP

Implementation of Modified Evidence-Based Universal, Colorectal and ERP Bundles to Reduce Surgical Site Infections in Colorectal Surgical Patients Joy Lanfranchi BSN, RN, CNOR, CMLSO Sacred Encounters Perfect Care Healthiest Communities 1

Innovation Sacred Encounters Perfect Care Healthiest Communities 2

Innovation • Creation of new standards of care • Combining several care bundles and interventions • Collaborative effort • Implementation methods • Research study Sacred Encounters Perfect Care Healthiest Communities 3

Why an SSI Bundle + ERP? • Uptick in Colorectal SSI • Anesthesia Department developing Enhanced Recovery Protocol (ERP) for colorectal surgery • Improve outcomes, decrease length of stay (LOS), opiate usage, cost Sacred Encounters Perfect Care Healthiest Communities 4

Care Bundle Sources • Universal bundle • Modified New York State Partnership For Patients Colorectal Bundle • Enhanced Recovery Protocol (ERP) • Modified Duke University /UVA ERP • Decision team • Initial implementation • Perioperative phase – higher level of control Sacred Encounters Perfect Care Healthiest Communities 5

Implementation • • Crosswalk Share evidence Requires ownership Proactive facilitation Visual management tools Reinforce compliance through audits Monitor and report data Sacred Encounters Perfect Care Healthiest Communities 6

Ongoing Research Study • The purpose of this study is to determine the effectiveness of combined bundles in reducing Surgical Site Infections (SSIs) in patients undergoing colorectal surgeries. • The primary hypothesis is that there will be a decreased incidence in colorectal SSIs after bundles of care implementation Sacred Encounters Perfect Care Healthiest Communities 7

Ongoing Research Study • Specific study aims are to: • Assess the incidence of colorectal SSIs before and after the implementation of evidence-based universal, colorectal, & ERP bundles of care • Determine staff adherence with the bundle components • Determine readmission and mortality rates in this patient population Sacred Encounters Perfect Care Healthiest Communities 8

Review of Literature • Incidence and impact of Surgical Site Infections • Colorectal rate highest, 15 - 30% • Cost - $3, 000 to $29, 000. • Physical and mental well-being • Use of evidence-based care bundles • Use of evidence-based practices can prevent greater than 30, 000 infections, with an estimated collective saving of $834 million. Joint Commission Center for Transforming Health Care (2014) Sacred Encounters Perfect Care Healthiest Communities 9

Study Design • Quantitative study • Predictive correlational design • Retrospective • Convenience sampling • Sample size • 180 subjects will give a 95% confidence level and a 5% margin of error • Demographics Sacred Encounters Perfect Care Healthiest Communities 10

Inclusion & Exclusion Criteria • Inclusion criteria • Subjects undergoing colorectal surgeries as defined by the National Health and Safety Network (NHSN) ICD-10 codes for that category • Primary wound closure • Exclusion criteria • Under age 18 • Non-English speaking Sacred Encounters Perfect Care Healthiest Communities 11

Data Collection Retrospective chart review Audit tool for non-documented interventions Subjects de-identified Subject coding kept in a secure, locked, single location during data collection • When data collection is complete, the identifier information will be destroyed • Data will be stored analyzed in IBM SPSS Statistics 24 • • Sacred Encounters Perfect Care Healthiest Communities 12

Status and Preliminary Results • Data collection ongoing • Complete data gathered on 92 subjects • Compliance increase over time • Specific elements resistant to compliance • Decrease in SIR, with outliers • Based on success, implemented similar protocol in spine surgery • Incidence of treatable BGM • Normothermia maintenance related to surgical positioning • Additional study based on data trends Sacred Encounters Perfect Care Healthiest Communities 13

Colorectal SSI Sacred Encounters Perfect Care Healthiest Communities 14

Small Bowel SSI Sacred Encounters Perfect Care Healthiest Communities 15

Spine SSI Sacred Encounters Perfect Care Healthiest Communities 16

Questions? Sacred Encounters Perfect Care Healthiest Communities 17

References Darouiche RO, Wall M, Itani KMK, et al. (2010) Chlorhexidine–alcohol versus povidone–iodine for surgical-site antisepsis. N Engl J Med; 362: 18 -26. Institute for Healthcare Improvement (IHI) (2014). What is a bundle? Available from: www. ihi. org/resources/Pages/Improvement. Stories/What. Isa. Bundle. aspx. Joint Commission Center for Transforming Healthcare (2014). Reducing Colorectal Surgical Site Infections Available from: https: //www. centerfortransforminghealthcare. org/assets/4/6/SSI_storyboard. pdf Keenan JE, Speicher PJ, Thacker JK, et al. (2010) The Preventative surgical site infection bundle in colorectal surgery: an Effective approach to surgical site infection reduction and health care cost savings. JAMA Surg (149): 1045 -52. Petrosillo N, Drapeau CMJ, Nicastri E, et al. (2008) Surgical site infections in Italian hospitals: a prospective multicenter study. BMC Infect Dis; 8: 34. Provonost P, Needham D, Berenholtz S, et al. (2006) An intervention to decrease catheter related bloodstream infections in the ICU. N Engl J Med; 355: 2725 -32. Resar R, Pronovost P, Haraden C, et al. (2005) Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. Jt Comm J Qual Patient Saf; 31: 243 -8. Tanner J, Khan D, Ball J, et al. Post discharge surveillance to identify colorectal surgical site infection rates and costs. J Hosp Infect 2009; 72: 242 -50. Tanner J, Padley W, Davey S, et al. (2013) Patients’ narratives of surgical site infection; implications for practice. J Hosp Infect; 83: 41 -5. Sacred Encounters Perfect Care Healthiest Communities 18