Measurement is essential to monitoring success and helps guide your team towards your specific intervention goal. Measurement also tells us what's working and what's not, and provides evidence to inspire other healthcare providers to improve the quality of patient safety.
The measurement methodology and recommendations regarding sampling size referenced in this GSK, is based on The Model for Improvement and is designed to accelerate the pace of improvement using the PDSA cycle; a "trial and learn" approach to improvement based on the scientific method. Langley, G., Nolan, K., Nolan, T., Norman, C., Provost, L. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco, Second Edition, CA. Jossey-Bass Publishers. 2009.
It is not intended to provide the same rigor that might be applied in a research study, but rather offers an efficient way to help a team understand how a system is performing. When choosing a sample size for your intervention, it is important to consider the purposes and uses of the data and to acknowledge when reporting that the findings are based on an "x" sample as determined by the team.
The scope or scale (amount of sampling, testing, or time required) of a test should be decided according to:
- The team's degree of belief that the change will result in improvement
- The risks from a failed test
- Readiness of those who will have to make the change
Provost, Lloyd P; Murray, Sandra (2011-08-26). The Health Care Data Guide: Learning from Data for Improvement (Kindle Locations 1906-1909). Wiley. Kindle Edition.
Please refer to the
Improvement Frameworks GSK (2015) for additional information.
Measurement Worksheets (Measures) and Data Collection Forms (DCF)
|Aggregate data (monthly)||De-identified Patient-level data (daily)|
|Numerator and Denominator||Multiple data elements|
|||Roll-up to Measurement Worksheets|
SSI Prevention Audit
The tool is designed for use in Acute Care, and was developed to allow organizations to assess the quality of their surgical site infection prevention practices and determine the areas requiring quality improvement(s).
DCF (Audit) Question||
Roll-up to Measures|
|A. Type of Surgery||N/A|
|B. Surgical Class||N/A|
|C. Pre-Op Shower or bath with soap or antiseptic agent||SSI 9, 14, 17|
|D. Solution used for intra-operative intact skin cleansing||SSI 10, 14, 17|
|E. Prophylactic antibiotic administration||SSI 8, 15, 17|
|F. Dose of Cefazolin used as prophylactic antibiotic||SSI 11, 15, 17|
|G. Appropriate prophylactic antibiotic redosing according to guidelines||SSI 12, 15, 17|
|H. Discontinuation of prophylactic antibiotic||SSI 2, 16, 17|
|I. Hair removal method||SSI 4, 14, 17|
|J. Glucose was below 11.1 mmol/L on each of POD 0, 1, & 2||SSI 5, 16, 17|
|K. Temperature at end of surgery or on arrival in PACU was within range of 36.0-38.0 degrees C||SSI 6, 15, 17|
|SSI 1 - Percent of clean and clean-contaminated patients with timely prophylactic antibiotic administration||95% ||Process |
|SSI 2 - Percent of clean and clean-contaminated patients with appropriate prophylactic antibiotic discontinuation||95% ||Process|
|SSI 3 - Percent of clean and clean contaminated surgery patients with surgical infection|| Reduce by 50%||Outcome|
|SSI 4 - Percent of surgical patients with appropriate hair removal||95%||Process|
|SSI 5 - Percent of all diabetic or surgical patients at risk of high blood glucose with controlled post-operative serum glucose POD 0, 1, and 2||95%||Process|
|SSI 6 - Percent of all clean or clean-contaminated surgical Patients with normothermia within 15 minutes of end of surgery or on arrival in PACU||95%||Process|
|SSI 7 - Percentage of clean or clean-contaminated surgical patients with appropriate selection of prophylactic antibiotic||95%||Process|
|SSI 8 - Percent of clean and clean-contaminated caesarean section patients with timely prophylactic antibiotic administration for C-Section||95% ||Process|
|SSI 9 - Percent of clean and clean-contaminated surgical patients with pre-op wash with soap or antiseptic agent||95% ||Process|
|SSI 10 - Percent of clean and clean-contaminated surgical patients with appropriate intra-op skin cleansing on intact skin||95% ||Process|
|SSI 11 - Percent of clean and clean-contaminated adult surgical patients receiving 2 grams of Cefazolin as prophylactic antibiotic||95% ||Process|
|SSI 12 - Percent of clean and clean-contaminated surgical patients receiving appropriate prophylactic antibiotic re- dosing||95%||Process|
|SSI 13 - Percent of clean and clean contaminated surgery patients with evidence of surgical site infection at the time of, or prior to discharge||Reduce by 50% ||Outcome|
|SSI 14 - Surgical Site Infection Pre-operative (Pre-op) Score||95% or higher||Outcome|
|SSI 15 - Surgical Site Infection Perioperative Score||95% or higher||Outcome|
|SSI 16 - Surgical Site Infection Postoperative (Post-op) Score||95% or higher||Outcome|
|SSI 17 - Surgical Site Infection Score||95% or higher||Outcome|
Types of Measures
Safer Healthcare Now! (SHN) has two types of measures for each of the interventions: process measures and outcome measures. Some interventions also have balancing measures and information measures. Below are examples of each.
Outcome measures - answers whether the team is achieving what it is trying to accomplish and articulates the picture of success. For example, if the team wants to reduce falls it should measure the number of falls.
Process measures - Processes which directly affect the outcome are measured to ensure that all key changes are being implemented to impact the outcome measure. For example, the delivery of timely prophylactic antibiotics to reduce surgical site infection.
Balancing measures - answer the question whether improvements in one part of the system were made at the expense of other processes in other parts of the system. For example, in a project to reduce the average length of stay for a group of patients, the team should also monitor the percent of readmissions within 30 days for the same group.
Information measures - collect general details relative to the intervention.