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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.