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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:

  1. The team's degree of belief that the change will result in improvement
  2. The risks from a failed test
  3. 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)

Measures DCFs
Aggregate data (monthly)De-identified Patient-level data (daily)
Numerator and DenominatorMultiple 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 SurgeryN/A
B. Surgical ClassN/A
C. Pre-Op Shower or bath with soap or antiseptic agentSSI 9, 14, 17
D. Solution used for intra-operative intact skin cleansingSSI 10, 14, 17
E. Prophylactic antibiotic administrationSSI 8, 15, 17
F. Dose of Cefazolin used as prophylactic antibioticSSI 11, 15, 17
G. Appropriate prophylactic antibiotic redosing according to guidelinesSSI 12, 15, 17
H. Discontinuation of prophylactic antibioticSSI 2, 16, 17
I. Hair removal methodSSI 4, 14, 17
J. Glucose was below 11.1 mmol/L on each of POD 0, 1, & 2SSI 5, 16, 17
K. Temperature at end of surgery or on arrival in PACU was within range of 36.0-38.0 degrees CSSI 6, 15, 17

SSI Measures

Measure Goal Type
SSI 1 - Percent of clean and clean-contaminated patients with timely prophylactic antibiotic administration95% Process
SSI 2 - Percent of clean and clean-contaminated patients with appropriate prophylactic antibiotic discontinuation95% 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 removal95%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 295%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 PACU95%Process
SSI 7 - Percentage of clean or clean-contaminated surgical patients with appropriate selection of prophylactic antibiotic95%Process
SSI 8 - Percent of clean and clean-contaminated caesarean section patients with timely prophylactic antibiotic administration for C-Section95% Process
SSI 9 - Percent of clean and clean-contaminated surgical patients with pre-op wash with soap or antiseptic agent95% Process
SSI 10 - Percent of clean and clean-contaminated surgical patients with appropriate intra-op skin cleansing on intact skin95% Process
SSI 11 - Percent of clean and clean-contaminated adult surgical patients receiving 2 grams of Cefazolin as prophylactic antibiotic95% Process
SSI 12 - Percent of clean and clean-contaminated surgical patients receiving appropriate prophylactic antibiotic re- dosing95%Process
SSI 13 - Percent of clean and clean contaminated surgery patients with evidence of surgical site infection at the time of, or prior to dischargeReduce by 50% Outcome
SSI 14 - Surgical Site Infection Pre-operative (Pre-op) Score95% or higherOutcome
SSI 15 - Surgical Site Infection Perioperative Score95% or higherOutcome
SSI 16 - Surgical Site Infection Postoperative (Post-op) Score95% or higherOutcome
SSI 17 - Surgical Site Infection Score95% or higherOutcome

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.