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​Vital to quality improvement is measurement, and this applies specifically to implementation of interventions. The chosen measures will help to determine whether an impact is being made (primary outcome), whether the intervention is actually being carried out (process measures), and whether any unintended consequences ensue (balancing measures).

Below are some recommended measures to use, as appropriate, to track your progress. In selecting your measures, consider the following:

  • Whenever possible, use measures you are already collecting for other programs.
  • Evaluate your choice of measures in terms of the usefulness of the final results and the resources required to obtain them; try to maximize the former while minimizing the latter.
  • Try to include both process and outcome measures in your measurement scheme.
  • You may use different measures or modify the measures described below to make them more appropriate and/or useful to your particular setting. However, be aware that modifying measures may limit the comparability of your results to others.
  • Posting your measure results within your hospital is a great way to keep your teams motivated and aware of progress. Try to include measures that your team will find meaningful and exciting (IHI, 2011).

For more information on measuring for improvement, contact the Canadian Patient Safety Institute Central Measurement Team at measurement@cpsi-icsp.ca

Outcome Measure

  1. Rate of Hospital-acquired Infections: Urinary Tract Infection (Catheter-Associated, Non-Catheter-Associated), Central Line Associated Bloodstream Infection, Surgical Site Infection in Clean and Clean-Contaminated patients, Ventilator-Associated Pneumonia (Safer Healthcare Now! 2012)
  2. Incidence of Sepsis Secondary To: Urinary Tract Infection (Catheter-Associated, Non-Catheter-Associated), Central Line Associated Bloodstream Infection, Surgical Site Infection, Ventilator-Associated Pneumonia
  3. 28 Day In-Mortality Rate from Septic Illness

Process Measures

Screening

(Dellinger 2013)

  1. Percentage of Potentially Infected Seriously Ill Patients Screened for Sepsis

CAUTI

(Gould 2010)

  1. Unnecessary Urinary Catheters or Unnecessary Catheter Days
  2. Per cent Appropriate Insertion of Urinary Catheters
  3. Compliance with Urinary Catheter Insertion and Maintenance Bundles

CLABSI

(Safer Healthcare Now! 2012)

  1. Compliance with Central Line-Associated Insertion and Maintenance (Care) Bundle

VAP

(Safer Healthcare Now! 2012)

  1. Compliance with VAP Bundle Compliance (Adult, Pediatric)

SSI

(Safer Healthcare Now! 2014)

  1. Percentage of clean and clean-contaminated surgical patients with:
    1. Pre-op wash with soap or antiseptic agent
    2. Appropriate intra-op skin cleansing on intact skin
    3. Appropriate selection of prophylactic antibiotic
    4. 2 grams of Cefazolin administered as prophylactic antibiotic (adults)
    5. Timely prophylactic antibiotic administration
    6. Appropriate prophylactic antibiotic re-dosing
    7. Appropriate prophylactic antibiotic discontinuation
    8. Normothermia within 15 minutes of end of surgery or on arrival in PACU
  2. Percentage of Clean And Clean-Contaminated Caesarean Section Patients With Timely Prophylactic Antibiotic Administration for C-Section
  3. Percentage of Preoperative Surgical Patients With Appropriate Hair Removal
  4. Percentage of All Diabetic Or Surgical Patients At Risk of High Blood Glucose With Controlled Post-Operative Serum Glucose POD 0, 1, and 2

Sepsis

(Dellinger, 2013; Safer Healthcare Now! 2015)

  1. Compliance with 3 and 6 hour (modified) Sepsis Bundles
  2. Percentage of Patients with Septic Illness Who Received IV Antibiotics within 3 Hours of Time of Presentation
  3. Percentage of Patients having Blood Cultures Taken Before IV Antibiotics Were Initiated
  4. Percentage of Patients with Septic Illness having Appropriate Fluid Challenge for Hypotension or Lactatemia within the Appropriate Time
  5. Percentage of Patients with Appropriate Initial Lactate Measurement
  6. Percentage of Patients with Appropriate Repeat Lactate Measurement
  7. Percentage of patients with Hypotension or Hypoperfusion who Received Adequate and Timely Fluid Resuscitation
  8. Percentage of Fluid-Resuscitated Patients with Sepsis Who Received a Timely Repeat Lactate Measurement
  9. Percentage of Patients with Sepsis-Related Hypotension Refractory to Fluid Resuscitation Who Received Timely Administration of Vasopressors

Change Concepts

A number of "change concepts" for improving outcomes from sepsis are proposed in the Safer Healthcare Now!Sepsis Getting Started Kit (Safer Healthcare Now! Sepsis, 2015).

Implementing the Strategies

The Surviving Sepsis Campaign (SSC) partnered with the Institute for Healthcare Improvement to develop an implementation guide (Surviving Sepsis, 2013). It provides how-to guidance regarding teams, establishing process and outcome measures, setting aims, creating a protocol, educating users, and a detailed description of sepsis bundles and other supportive therapies.

These and other suggestions can also be found in the Sepsis Getting Started Kits from Safer Health Care Now! (Safer Healthcare Now!, Sepsis, 2015) and from the British Columbia Patient Safety and Quality Council (BC Patient Safety and Quality Council, 2012).