1. CDI Prevention Collaborative Workshop March 29, 2011

2. Welcome – our participants
Collaborative team members
From Hospitals
From Long term facilities
Disciplines: IPs, nurse managers/nurses, physicians, pharmacists, environmental services, other

3. Essential Elements for Improvement
Will
Execution
Ideas

4. Ten months in: What have we accomplished and what’s next?
Susanne Salem-Schatz, Sc.D.
CDI Prevention Collaborative Workshop II
March 29, 2010

5. Learning and Sharing 12 expert and coaching calls 3 Regional workshops
11 teams joined antibiotic stewardship workgroup

7. You Tested Changes Improve Communication of Current Precautions Status
PLAN:
Standardize location of signage
Store precautions signage in convenient location near/with PPE
DO:
Installed sign holder outside room
Store one of each precaution signs in each sign holder
ACT:
Reduce size of signs; magnetize signs to attach to door frame
Reconsider signage storage options
CHECK:
Sign holders too big for available space to accommodate 4 signs per room
Sign fit well in holders; concern sign holders will break from continual expansion to remove/replace signs

8. You tracked your rates

9. Sharon tells me that I am the envy of many of her colleagues for our data reporting system and especially for the great participation we get. Looking at data across time over the collaborative teams

10. Outcome measures may tell you
Intervention
Outcome measures may tell you the relationship
between changes in rates related to when you made
important changes or interventions. This hospital
implemented a new strategy in December, and are
fairly confident that no other related changes occurred
in this time frame. If these new rates keep up,
they may be safe in attributing the outcomes to their change.
This is why tracking measures over time is so important.

11. or…. HA-CDI Rate / 10,000 Patient Days
How the rates changed on your pilot
unit compared to the rest of the hospital

12. But they may not tell you:
Who was involved
What they did
How they got there
What important lessons were learned
Whether you rates are “good enough”

13. HA-CDI Rate / 10,000 Patient Days
A True Story
HA-CDI Rate / 10,000 Patient Days
Call from a team leader. Their hospital benchmark
is 7 per 10,000 patient days. They are achieving this benchmark,
so it is hard to get attention for c. diff prevention.
Team leader bemoaned- but it’s 18 cases.
That seems like a lot of potential harm to me.
Cases

14. Regrouping and Moving Forward
Review your aim
Review your practice
Pre-existing practices
Changes you have made
Where are your next opportunities?
Our aim for the collaborative was a 30% decrease in HA-CDI
If your team established an aim, review your progress.
If you’ve met it, where would you really like to be
(unless of course it is 0). If you haven’t met it .. Read slide

15. How to spend the rest of the day
Share and Learn
Changes
Change Concepts
One hospital is asking nurses on 3-11 shift
to clean high touch surfaces. That’s the change.
The Change concept might be: building cleaning into the workday.

16. Change or Change Concept?
Improve Communication of Current Precautions Status
PLAN:
Standardize location of signage
Store precautions signage in convenient location near/with PPE
DO:
Installed sign holder outside room
Store one of each precaution signs in each sign holder
ACT:
Reduce size of signs; magnetize signs to attach to door frame
Reconsider signage storage options
CHECK:
Sign holders too big for available space to accommodate 4 signs per room
Sign fit well in holders; concern sign holders will break from continual expansion to remove/replace signs

17. How to spend the next 20 minutes
Practice Opportunities Worksheet
What do we do?
How well do we do it?
How do we know?