Of more than 200,000 surgeries performed in British Columbia annually where the Safe Surgery Checklist is used, some 95 per cent of patients don't get an infection. However, the British Columbia Patient Safety & Quality Council (BCPSQC) knows that 4.4 per cent of patients do get a surgical site infection (SSI), or surgical urinary tract infection (UTI). That translates to 10,000 patients per year.
Fourteen teams from nine sites across British Columbia are participating in the 10K Race for Infection Prevention, a quality improvement collaborative to cut the number of surgical site and surgical urinary tract infections in half by November 2016. The teams are implementing best practices to prevent surgical UTIs (catheter and non-catheter associated), and using four key prevention strategies that significantly reduce the risk of SSIs: perioperative antimicrobial coverage, appropriate hair removal, maintenance of perioperative glucose control, and perioperative normothermia.
"Rather than re-teaching the evidence, we are getting teams to focus on the evidence using a team-based care approach," says Geoff Schierbeck, Quality Leader, Surgery, BCPSQC. "There is a lot of information out there, but it does not necessarily get to everyone on the team and we need to get everyone on the same page."
What makes this collaborative unique is that it is frontline and clinically driven. The individuals driving the work are the physicians, nurses, anesthesiologists, operating room cleaners, porters, and other care providers. It brings the whole team together to make improvements. Teams decide what they would like to work on together, and have the support and encouragement of their managers to free up the time to do the perioperative improvements.
Schierbeck says that they looked at the Safer Healthcare Now! Preventing Surgical Site Infections Getting Started Kit and the Institute for Healthcare Improvement's How-to Guide: Prevent Catheter-Associated Urinary Tract Infection to create a driver diagram. The driver diagram takes all of the evidence around prevention of SSIs and surgical UTIs and incorporates it into one document, which identifies change ideas and what teams can work on. From there a work sheet was created that allows the teams to identify their priorities and create an aim statement.
The teams initially got together in Vancouver on October 29 and 30, 2015 to kick-start their efforts. Ongoing support is provided by a quality improvement team with clinical experience, and teams will share their successes and challenges through regular webinars over the next year. Teams dictate the topics to be covered for the webinars. The first webinar, held on December 1, 2015, focused on gynecological surgery UTIs, highlighting the successful work being done at the Royal Inland Hospital in Kamloops. The webinar was well-attended and participants asked a plethora of questions around this troubling issue. The January 2016 webinar will feature work around SSI normothermia.
Data collection is an integral part of understanding and improving systems, at both the individual site and provincial levels. Each site shares its data for learning and provincial analysis. Data from existing sources, including the Safer Healthcare Now! Patient Safety Metrics and the National Surgical Quality Improvement Program (NSQIP) are being used to reduce the data collection burden.
An Apple and Android-driven app, called "The10K", has been created that provides the teams with a Race Page where they can track their progress compared to other teams. Other information, TED Talks, webinars, articles, resources, and measurement processes are also available on the app. "The app puts the information at the point of care. If you want to look up information quickly, the app will show what the driver diagram says, or what evidence there is to support the care that is being given," says Schierbeck.
"By sharing our successes and challenges we have found that most teams are having the same problems in changing evidence into practice and the culture aspect of doing both," says Schierbeck. "A lot of our efforts are going into culture improvement, teamwork, and communication, and how that will help facilitate implementation of the best practice guidelines. As well, we are showing people real-time data on how they are performing. Displaying and sharing that information publicly where everyone can see it will help the teams stay engaged in this work."
To learn more about the 10K - 10,000 Reasons to Race for Infection Prevention, visit www.10Kreasons.ca