1. Essentials in quality improvement interventions concepts appraised
Patient Safety Programs in Intensive Care Units – Zero Projects
Ministry of Health, Social Services, and Equality, Madrid, 12 Dec. 2017
Essentials in quality improvement interventions concepts appraised
by the example of CAUTI prevention
Stijn BLOT
Dept. of Internal Medicine
Faculty of Medicine & Health Science
Ghent University, Ghent, Flanders (Belgium) ～
Burns, Trauma and Critical Care Research Centre
The University of Queensland, Brisbane, Queensland (Australia)

2. Crash Introduction on HAI Prevention
Healthcare-associated infections
➔ morbidity
➔ healthcare costs
➔ mortality
Evidence-based prevention guidelines
➔ broad spectrum of measures
➔ nurses / clinicians’ knowledge is poor
➔ adherence is low
Quality improvement interventions = solution?
Blot S, et al. Clin Infect Dis 2005
Labeau S, et al. Crit Care Med 2009
Cabana MD, et al. JAMA 1999

3. Quality Improvement (QI) Interventions
Crash Introduction on
Quality Improvement (QI) Interventions
Definition of QI interventions
Versatile method
Clustering a variety of interventions; the most important:
personnel education
care bundles
checklists

4. Intermezzo on Essentials of Quality Improvement (QI) Interventions
Education
Cornerstone of QI
Insights in…
“Why it is important”
Rational behind a preventive approach
Repetition ➔ awareness (!)
➔ attitude

5. Intermezzo on Essentials of Quality Improvement (QI) Interventions
Education
Cornerstone of QI
Insights in…
E-learning
Published guidelines do not work
Flexible and student centered
Benefits the organization

6. Intermezzo on Essentials of Quality Improvement (QI) Interventions
Care bundles
Set of 3 to 5 EB-interventions
Executed:
always (daily, per shift,…)
together
by everyone
Better impact on patient outcomes (compared with separated application)
Monitoring of the adherence!

7. Intermezzo on Essentials of Quality Improvement (QI) Interventions
Checklists
Simple business process improvement tool
Control of routine tasks to be executed
No “all or nothing” philosophy
Not necessarily based on scientific evidence
Awareness!

8. CAUTI reduction Essential steps in a Quality Improvement Project 1 2 53 4

9. CAUTI reduction Essential steps in a Quality Improvement Project
Awareness …
CAUTI
reduction … … …

10. I - Awareness (!) Absolute condition to motivate the team
CAUTI = important
Frequent
Morbidity ➔ costly
Mortality…

11. I - Awareness (!) Absolute condition to motivate the team
Pathogenic mechanisms & risk factors
Rational for prevention
Understanding “why” and “how” prevention works

12. I - Awareness (!) Absolute condition to motivate the team
Preventable! (=key message)
Average 17 – 69% can be avoided
How much you can avoid… that depends on the local situation, and therefore you need the following essential step.

13. CAUTI reduction Essential steps in a Quality Improvement Project
Awareness
CAUTI detection
CAUTI
reduction … … …

14. II – CAUTI detection (!) Essential to convince the team
Set up a surveillance system
CAUTI definitions, aim for…
Objective criteria
Reproducible
Universally used
Methods of surveillance
Pro-active screening!

15. CAUTI reduction Essential steps in a Quality Improvement Project
Awareness
CAUTI detection
CAUTI
reduction …
Selection
of prevention
measures …

16. III – Selection of preventive measures
(!) Build your team: participation ➔ consensus
Select relevant prevention measures, based on…
Evidence / pathogenic mechanism
Reduction of exposure time
Insertion: sterile equipment & aseptic technique
Maintenance: closed system & unobstructed flow
Local situation
Consensus among all stakeholders
Local situation: step away from nation-wide initiative… if one item is already going very good (and its practice has been completely embrased by the team), it has little use to put it in a care bundle.
Consensus: example: local quality champion… with lots of knowledge BUT without diplomatic or educational skills… there will be only marginal support for this team member…

17. CAUTI reduction Essential steps in a Quality Improvement Project
Awareness
CAUTI detection
CAUTI
reduction …
Selection
of prevention
measures
Implementation
& Monitoring

18. IV - Implementation (!) Support the team in it’s efforts Educate
Invest in the teams insights
Practice monitoring
Bedside instruction c c c
Let them feel you care

19. Performance measurement
Essential steps in a Quality Improvement Project
Awareness
CAUTI detection
CAUTI
reduction
Performance measurement
Selection
of prevention
measures
Implementation
& Monitoring

20. V – Performance measurement
(!) Control & guide the team
Process
➔ compliance rates
Outcome
➔ CAUTI rates c c
Feedback! c

21. CAUTI reduction Essential steps in a Quality Improvement Project
Awareness
CAUTI detection
CAUTI
reduction
Performance measures
Selection
of prevention
measures
Implementation
& Monitoring

22. Conclusion
5 essential steps to optimize the outcomes of a quality improvement initiatives
All about… team building aspects: create awareness, reach consensus, educate, instruct, monitor, feedback, …

23. Thank you
Dept. of Internal Medicine, Faculty of Medicine & Health Science, Ghent University, Ghent, Flanders (Belgium)
Burns, Trauma & Critical Care Research Centre, The University of Queensland, Brisbane, QLD (Australia)