Ministry Saint Michael’s Hospital. Baseline Data Purpose: Proactive approach to infection prevention for those patients having total joint replacement.

Ministry Saint Michael’s Hospital

Baseline Data

Purpose: • Proactive approach to infection prevention for those patients

having total joint replacement at Ministry Saint Michael’s Hospital (MSMH)

• Infection rate for MSMH/Ministry Medical Group is < 1% for FY 2012, but “1 is not zero”

• SSI infection incidence for MSMH TKA/THA:• Total 2010 4/285 • Total 2011 4/298• Total 2012 1/313 (1 – Feb. 2012)*

* MSMH/MMG elected to include TSA• Goal:

All patients having total joint replacement surgery at MSMH will receive the same level of care (2/2012)

Presented at Washington State Hospital Association Safe Table, 7/31/13

SSI Prevention Program Initiatives

• Joint Venture Project – Nov 2011• Multidisciplinary re-design of MSMH joint replacement services

encompassing care continuum• Standardized pre-op education, maximizing patient involvement • Implementation of Joint Replacement Services Coordinator

• Project JOINTS participation – Feb 2012• Preoperative skin antisepsis (2004)• CHG prep expanded to 3 days preop (June 2012)• Nasal Culture and decolonization for positive MRSA/MSSA (August

2012) Involvement of Lab, Pharmacy, Business Office in development of process to eliminate patient compliance barriers

• Expanded SSI Prevention Program – Jan 2013• Inclusion of independent orthopedic group – Dec 2012• All elective joint replacement patients at MSMH receive standardized

level of preoperative preparation


Project JOINTS Participation

• Planning Team• Orthopedic Surgeon – MMG clinic• Joint Replacement Services Coordinator - Hospital• Quality Specialist - Hospital• Director of Surgical Services – Hospital • Infection Preventionist - Hospital• Clinic Staff – MMG Clinic• MSMH Administration


MSMH SSI Prevention Program

• Participated in IHI Project JOINTS• MSMH successfully implemented 3 SSI

Bundle Elements:• Preoperative skin antisepsis (alcohol prep in

OR)• 3 days of CHG skin cleansing• Nasal swabs - Culture and decolonization of

MRSA/MSSA

• Focus on patient pre-op education and engagement


Implementation Team

Great accomplishment of entire care team– MMG clinic providers/staff– Lab– Pharmacy– SMH surgical services

• ASD staff• Central Sterilization• OR crew

– Nursing– Environmental services


Benefits

• Provides consistent, best-practice, outcome-focused care

• Aligns with our Joint Venture program

• Promotes collaboration and standardization


Obstacles

• Different Provider Practice Groups

• Patient Compliance

• Financial Barriers


Outcomes

• Consistently lower infection rate than national average• No infections since Feb 2012* • Integration of independent practice group• Recognized as IHI exemplar hospital for all 3 elements


Biggest Change

• Implementation of culture protocol for MRSA / MSSA– 2012 only MMG providers participating, independents declined– 2013 both Ministry and independent providers at 100% during

last three months

100% 100% 100% 100% 100% 100%

0%

50%

88%

100%

0%

20%

40%

60%

80%

100%

120%

JAN FEB MAR APR MAY JUNE

MRSA/MSSA CULTURE IMPLEMENTATION

MMG2013

INDEPENDENTS2013


Impact to patients

• Improved patient experience• Reduced patient recovery time• Reduced patient charges


Control Plan

Mupirocin Patients 2 d CHG Eve. Prior DOS CHGOrdered completing Shower CHG on Adm

5 day RXMMGProviders

J 18 18 1 1 2 2 18 18 18F 19 19 2 3 5 5 18 19 19

M 19 19 1 3 4 4 18 19 19A 21 21 0 4 4 4 21 21 21M 17 17 1 2 3 3 17 17 17

J 23 23 1 7 8 8 23 23 23

Other Providers

J 13 na na na na na 10 12 13F 8 4 0 0 0 0 8 8 8

M 8 7 1 0 1 1 8 8 8A 10 10 0 1 1 1 10 10 10M 6 6 0 1 1 1 6 6 6

J 5 5 0 1 1 5 5 5 5

Surgical Site Infection Prevention Program

2013 Cultured MRSA + MSSA +

100% 98% 100% 100% Compliance117

100% 5.1% 17.0% 100%

100% for 5 mos. 94% 98% 100% Compliance

Total 50 86% for5 mos 2.7% 8.1%

100% for 5 mos


SSI Bundle Elements

IHI JOINTS SSI Reduction Project 2012 - 2013P

roje

ct

JO

INT

SP

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HG

S

ho

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ring

/Pre

p

MR

SA

/MS

SA

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stin

g &

D

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Alc

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Skin

an

tise

psis

MSMH/MMG began participation

Feb. 2012

IHI data submitted;Received

Exemplar StatusJune 2012

MSMH using appropriate prep

since 2004

MMG Ortho using CHG prep wipes for TJ since 2009

MMG Ortho increasing CHG prep to 3 days

preopJune 2012

MMG Ortho implementing

process for MRSA/MSSA testing

MSMH Lab developing testing

mechanisms to perform PCR for MRSA & MSSA

DOS prep with CHG wipe to be

performed as part of admission

process in ASD

Received Exemplar Status

for Element IJune 2012

MSMH Lab developing

process to perform culture for MRSA

& MSSA

MMG developing process for &

decolonization of + patients with 5 days Mupiricin

Submitted IHI data for

Element II

December 2013

Submitted IHI data for

Element III

January 2013

Notification of Exemplar Status for Element II &

IIIJanuary 2013

Independent Ortho Practice provided

materials and invited to

participateSeptember 2013

Independent Ortho Practice began

implementation of SSI Reduction

Bundle ElementsDecember 2013

FY12Q4

Introduction of Rosie Video for staff education

December-January 2013

FY13Q1FY12Q3

FY12Q2

FY13Q2


Summary

Why Ministry Saint Michael’s Story?• Demonstrates that even a small facility with limited

resources can make a difference

• Impact: Lives of 300+ patients

per year have been positively affected

• Smaller = easier???

• Patient testimonials have been marketing tool with public and with The Joint Commission


Project JOINTS Implementation Outline

• Assemble the right players• Identify Team Champion who “gets it”• Introduction to Project JOINTS materials• Assess your current state• Accent the positive – publicize what you are doing

well• Implement changes incrementally• Track results• Report results• Recognize and reinforce positive changes


Thank you…

Questions?

Patient Education - Joint VentureMinistry Saint Michael’s Hospital

July 31, 2013


Preoperative Education Program

Patients who have chosen us for their

surgeries deserve to have the safest, most

efficient, cost-conscious and highest quality

experience possible. Our job is to find out

what our customers want and work to try and

satisfy them, while keeping our responsibilities

in mind.


Charter Key Points March 2011

Opportunity/ Problem Statement:

The preadmission clearance process for surgical patients is inconsistent, fragmented, and lacks coordination. This causes errors, omissions, and patient and provider dissatisfaction, duplicative and inefficient staff work and potential cancellations.

Project Goals/Benefits:

• Develop and implement a standardized pre-surgical process • Decrease surgery cancellations/delays• Decrease repeat tests• Improve communication


Patient Education Folder – Accuracy and Consistency • Patient Roadmap

– Chronological timeline for patient to follow, identifies critical activities, instructions

– Initiated at time of surgery scheduling

• Day of Surgery Information– Family information– Establishes reasonable patient expectations

• Anesthesia Information– Brief description of types, expected LOS

• Map• Procedure specific materials from surgeon


Sample Pre-op Materials


Project Results

“The new pre-op process will help to more accurately and efficiently bridge the gap between the office visit and day of surgery, ultimately leading to improved satisfaction of all those involved”

(Surgeon comment)


Joint Venture Program

Shawn Dombrowski, RNJoint Replacement Services Coordinator, MMG

•Part of our Joint Venture Project

•Implemented December 2011


Role of Joint Coordinator

• Consistent “face” of the Joint Replacement Program at MSMH

• “Navigator” for the patient and family

• Information coordinator

• Facilitator or performs home assessment

• Preoperative Educator

• Inpatient visits

• Discharge follow-up contacts

• Program evaluation; Celebration picnic


Sample Joint Venture Materials


Sample SSI Materials



MSMH Reference Materials *

• Updated SSI Prevention Program• Project Timeline• MRSA Culture Protocol• MRSA Patient Education Sheet• CHG Prep and Shower Instruction Sheet • Patient Mupirocin Use Checklist• SSI Prevention Order Sheet

*PDF copies have been sent to IHI


Ministry Saint Michael’s Hospital. Baseline Data Purpose: Proactive approach to infection prevention for those patients having total joint replacement.

Documents

ihi exemplar hospital

msmh tkatha

level of care

mmg providers

independent providers

patient preop education

ssi bundle elements

ihi project jointsmsmh