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Linking Quality Improvement and Infection Prevention

Linking Quality Improvement and Infection Prevention. Manoj Jain, MD, MPH Medical Director, QSource 19 February, 2009. Objectives. Personal Journey in ID Personal Journey with QI What is QI? What are Quality Measures? Methods of QI – PDSA/Lean/Six Sigma Applying PDSA Cycle.

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Linking Quality Improvement and Infection Prevention

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  1. Linking Quality Improvement andInfection Prevention Manoj Jain, MD, MPH Medical Director, QSource 19 February, 2009

  2. Objectives • Personal Journey in ID • Personal Journey with QI • What is QI? • What are Quality Measures? • Methods of QI – PDSA/Lean/Six Sigma • Applying PDSA Cycle

  3. Goals for Quality Improvement

  4. Know Your Quality Indicators

  5. Rate of VAP Rate of UTI Rate of BSI Rate of SSI Rate of MRSA incidence Outcome Measures inInfection Prevention

  6. Rate for hand washing compliance Antibiotic in a timely manner (within 1 hour) to reduce SCIP VAP bundle followed? Catheter days Process Measures inInfection Prevention

  7. Surgical Care ImprovementProject Performance Measures - Process • Surgical infection prevention • Antibiotics • Administration within one hourbefore incision • Use of antimicrobialrecommended in guideline • Discontinuation within24 hours of surgery end • Glucose control in cardiac surgery patients • Proper hair removal • Normothermia in colorectal surgery patients

  8. Measure the rates Educate others on how to reduce the rates, i.e., hand hygiene, prophylaxis antibiotics Encourage others to do interventions – hope the strategy works Result – rates remains the same. Infection Preventionist’s Job

  9. If an outbreak occurs, then take action!!! In fact – the present rates are an outbreak We never had the tools to intervene Infection Preventionist’s Job

  10. Goal is reducing infections Strategy is QI Tool is PDSA cycle Reducing infections is the Goal VAP and BSI are the outcome measures Hand Hygiene and bundles(checklist is the process measure) What is QI? PDSA?

  11. Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Act Plan Study Do PDSA: The Wheel of Improvement

  12. 4 Elements of Change • Multidisciplinary Teams • Staff ownership • Flow Meetings • Administrative support • Bundles • Evidence based medicine • Culture of Change • Horizontal decision-making

  13. Wheels in Motion:Continuous Quality Improvement

  14. IMPACT: Patient OutcomesCan Improve The overall surgical infection rate fell 27%, from 2.28% (215 infections among 9435 surgical cases) in the first 3 months to 1.65% (158 infections among 9584 cases) between the first and the last 3 reporting months. Dellinger EP, et al. Am J Surg.2005;190:9–15.

  15. Adverse Events Per ICU Day* Multidisciplinary Rounds Hand Hygiene Protocol Vent Bundles ICU Medical Director Central Line Bundles UTI Bundles * A list of event triggers that have been shown to be indicators of potential quality of care issues (See trigger tool)

  16. Nosocomial Infection RatesFY 2001-FY 2004 YTD

  17. ICU ALOS Per Episode

  18. Average Cost Per ICU Episode 8.6% Decrease 15.6% Decrease

  19. Public Reporting • Public Reporting of Quality Data • CMS – Hospital/NH/Dialysis • AHRQ – State Data • Health Grades A+

  20. Thank You! Linking Quality Improvement andInfection Prevention Manoj Jain, MD, MPH Medical Director, QSource This presentation and related materials were developed by QSource, the Medicare Quality Improvement Organization for Tennessee, under contract with the Centers for Medicare & Medicaid Services (CMS), a division of the Department of Health and Human Services. Contents do not necessarily reflect CMS policy. QSOURCE-TN-109.62-2008-04

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