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Safe Surgery Saves Lives – March 4, 2009

Checklist overlap: Prevention of Surgical Site Infection and Venous Thromboembolism Marlies van Dijk, Western Node Leader Safer Healthcare Now!. Safe Surgery Saves Lives – March 4, 2009. Safer Healthcare Now! Started in 2005.

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Safe Surgery Saves Lives – March 4, 2009

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  1. Checklist overlap:Prevention of Surgical Site Infectionand Venous ThromboembolismMarlies van Dijk, Western Node LeaderSafer Healthcare Now! Safe Surgery Saves Lives – March 4, 2009

  2. Safer Healthcare Now! Started in 2005 • Provide support to healthcare teams to implement evidence based practice (10 interventions) • Getting Started Kits, Tools, Measurement worksheets • Web platform: Communities of Practice • Over 1000 National Clinical Teams working on various interventions • 177 SSI teams (229 surgical procedures) – since 2005 • 13 VTE teams (New intervention in 2008)

  3. Supports the Checklist • Systematic way of looking at the problems • Establishing communication • Breaking Silos Checklist opens the door : • Universal framework for surgical care • To build stronger teams • To speak up! • Bringing patient safety culture into the OR

  4. Patient positioning and support / Warming devices ASA Class Postoperative glucose and temperature  Expected procedure time  Medications - Antibiotic prophylaxis: double dose? - Glycemic control - Anticoagulant therapy (e.g., Warfarin)? • Antibiotic Prophylaxis: Repeat dose? • Normothermia?

  5.  VTE Prophylaxis - Anticoagulant - Mechanical

  6. Perceptions vs. Reality

  7. Current Status? • Antibiotic Admininstration within 60 minutes of incision ~ 50% (Bratzler) • Antibiotic Discontinuation within 24 hrs of surgery end time ~ 40% (Bratzler) • Normothermia; one dedicated team; taken it from 30-70% over a 2 year period

  8. Routine Use of Recommended Prophylaxis in Canadian Hospitals 100% 75% 50% 25% 0 The care gap Appropriate use 11% 94% 86% 36% 33% 30% 32% Hip fracture surgery Hip / knee replacement Major gynecology Major trauma General surgery (cancer) General surgery (benign) General Internal Medicine W. Geerts

  9. Interested in Quick and Sustainable Results • 40-60% of SSI are preventable • Antibiotics within 60 minutes of incision is essential • Maintain normothermia during surgery • Easy wins and affordable • Implementing preprinted order sets for DVT

  10. Tips for Implementation • Time to consolidate our efforts! • Quick cycles of the improvement model have worked for SSI • Solutions to match local environment • Present your business case to leadership • Pockets of excellence – but now what … • Time sensitive ….

  11. saferhealthcarenow.ca Surgical Site Infection Lead Dr. Claude Laflamme, Director of Cardiac Anesthesia/TEE, Sunnybrook Health Sciences Centre Venous ThromboembolismLead Dr. William Geerts, Senior Scientist, Sunnybrook Health Sciences Center Marlies van Dijk Western Node Leader Safer Healthcare Now! Marlies.vandijk@hqca.ca

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