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839 Persistence and Perseverance: AHRQ PSI 7 (Infection Due to Medical Device) and PSI 13 (Postoperative Sepsis) Multidisciplinary Success Story

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Onna L. Koeneman, MS, RN , Clarian Health Partners, Indianapolis, IN
Amy B. Kressel, MD , Indiana Univ Schl of Medicine, Indianapolis, IN
Lisa D. Greenan, MSN , Clarian Health Partners, Indianapolis, IN
Jason A. Faux, MSN, RN , Clarian Health Partners, Indianapolis, IN
E. M. Kilbane, RN, BSN , Clarian Health Partners, Indianapolis, IN
Carmen R. Prickel, MSN, RN, CCRN , Clarian Health Partners, Indianapolis, IN
Michelle L. Treon, MSN, RN, OCN , Clarian Health Partners, Indianapolis, IN
Lauren L. Fish, BN, CIC , Clarian Health Partners, Indianapolis, IN
Terrie A. Beeson, BSN , Clarian Health Partners, Indianapolis, IN

Background: � In 2006, we had a high rate of Agency for Healthcare Research and Quality (AHRQ) PSI 7 (Infection due Medical Care) and PSI 13 (postoperative sepsis) compared with our peers in the University HealthSystem Consortium (UHC). On chart review, we found the following concerns:� coding (18%), documentation (43%), present on admission (22%), preventable (78%), surgical/non-surgical (27%/73%), non-intensive care unit (ICU)/ICU (70%/30%), bacteremia secondary to urinary tract infection (UTI).

Objective: � To prevent nosocomial infections and postoperative sepsis as measured by: decreasing PSI 7 and PSI 13 cases,� improving UHC rank for these PSIs each quarter, and decreasing unit-based catheter-associated bloodstream infections (CA-BSI).

Methods: � Our multidisciplinary team instituted interventions in multiple areas�Nursing, Information Technology, physician practice and education, documentation, and equipment.� In 2007 we instituted the following interventions:� nursing central and peripheral line policy, protocol, and education; nursing line care team outside intensive care units; �system-wide intravenous line care bundle; �product evaluation and education; adoption of a new nosocomial infection tracking application (MedMined �); physician education; central line kit & drape changes; �line insertion checklist in Interventional Radiology; line-care bundle in postanesthesia care unit (PACU) and operating room (OR); silver-coated urinary catheters.� In 2008 we continued these interventions; we emphasized fully implementing MedMined � and the nursing line care team, continuing physician education, and completing case reviews to monitor progress. �In 2009 we had improved site verification on all lab specimens, implemented the central line bundle in the OR, completed Nursing Foley bundle/protocol and education, created electronic Foley reports by unit, completed case reviews, and were working on electronic physician reminders.

Results: � Our PSI 7 and PSI 13 cases dropped, and our percentile rank compared with our UHC peers improved.� Improved patient care, documentation, and coding all contributed to the improvement.

 

Conclusions: � The multidisciplinary nature of our team allowed us, over a few years, to implement changes in multiple areas and across a wide range of healthcare professionals.� This intensive, sustained, multipronged approached enabled us to not only improve our own results but also to improved against our UHC peers.