PARTNERSHIP APPROACH TO REDUCING HEALTHCARE ASSOCIATED INFECTION

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PARTNERSHIP APPROACH TO REDUCING HEALTHCARE
ASSOCIATED INFECTION

• Dr Judith Hooper DIPC, NHS Kirklees
• Susan Walker DIPC,
• Mid Yorkshire Hospitals NHS Trust
• November 2008

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About the health economy

• Mid Yorkshire Hospitals NHS Trust across 3
  acute sites
• (Wakefield, Pontefract, Dewsbury)
• Two PCTs - NHS Kirklees and NHS Wakefield
  District
• NHS Kirklees spans 2 health economies
• Key issues-
• Health inequalities
• Organisational cultures

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The Journey so far

• Outlier within the SHA for MRSA targets
• October 07 DH Improvement Team re engaged,
• Weekly Health Economy meetings with SHA and DH
• Refreshed MRSA Action plan for Health Economy
• Key Performance Indicators so clinical ownership
  of improvement
• Way of working supports drive for a partnership
  approach
• Drive to improve performance acceptance of
  clear accountability
• Learn from success elsewhere e.g. Wolverhampton

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The challenges to date

• MRSA incidence static over past 3 years.
• Acute Trust merger in 2002, different cultures
  very different estate across 3 hospital sites
• Ownership of the challenges not organisation wide
  
• When to use the stick rather than the carrot
• PCT engagement particularly with the independent
  contractors

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Current Picture

• Significant Reduction in the rate of Clostridium
  Difficile 07/08
• MRSA to date 24
• This time last year at 42
• Pre-48 hour current 8
• Last year - 15
• Post 48 hour current - 16
• Last year - 27

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MRSA Bacteraemia to date
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Current picture continued.

• The Health Economy had 47 days without a
  bacteraemia
• Then 5 in July 5 in August
• Weekly HCAI Group Acute Trust DIPC Panel
  categorise cases in 2 ways
• Avoidable or not
• If avoidable then source of infection

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How avoidable bacteraemia are categorised

• Acquired in MYHT
• PCT (Community or Social Care) acquired
• Not possible to attribute to exact healthcare
  setting
• Not possible to attribute cause to healthcare
• Attributable to health economy elsewhere

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The Learning

• Value of working together and sharing the
  workload - Whole Health Economy Approach
• Acknowledge appreciate the differences
• Its about patient outcomes, do not be defensive
• Need for trust, honesty to hold individuals to
  account for any acts or omissions
• Take responsibility for own actions
• Recognise need to be slicker when managing
  meetings (especially when weekly!)
• Infrastructure needed to support the partnership
  is important
• Develop a framework to include action plan,
  score card RCA spreadsheet
• Recognise key stakeholders and links to
  organisational structures

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Action Plan

• Developed an action plan by working together
• Gantt chart used to inform meeting agenda
• 3rd meeting of month action plan monitored by
  all organisations

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Score Card

• Developed to identify levels of compliance with
  audits
• Hand hygiene bare below elbow
• IV management
• Urethral catheter management
• Antimicrobial prescribing
• Training attendance

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MRSA RCA Spreadsheet

• Developed as an aid each case as a unique
  identifier, actions are followed from the RCA
  process
• Identifies key themes
• Lessons to learn
• Potential to identify hot spots
• Allows targeted interventions

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Achievements so far Acute Trust

• Board commitment
• Chief Executive of the Acute Trust discusses all
  avoidable infections with the patients
  consultant and ward sister
• Directors and Assistant Directors give 10-15
  minute teaching session to ALL staff in ALL
  clinical areas reiterating findings from the
  RCAs
• Clinical Leadership
• RCAs are undertaken by the multi disciplinary
  clinical team, then presented to a panel (Chief
  Nurse, DIPC, Medical Director and Microbiologist)
• Results of RCA shared with appropriate Clinical
  Directors, Heads of Nursing and Matrons

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Achievements continued

• 3. Clinical Ownership
• Letter sent to those identified as accountable
  with clear articulation of expectations to
  prevent re-occurrence
• RCA findings are discussed at ward level
• Actions from RCA are reported back to DIPC
• 4. Policies
• Policies reviewed in light of RCA findings e.g.
• Screening and decolonisation policy
• IV cannula management

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Achievements continued

• 5. Review of practices
• Early RCAs identified poor management of IV
  cannula
• HII audits revealed variable practice
• Ward Sisters (key leaders) now provide training
  for IV care, and assessment of competency (time
  allocated has been back filled)
• Cannulation packs implemented Trust wide

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Achievements continued

• 6. Health economy support
• Active support in challenging ideas that
  infections are all HAI
• Clear message that the problems are health
  economy wide not just individual organisation
• PCT CEOs involved
• 7. Screening and decolonisation
• Sub group developing policy
• Funding support for recruitment of staff for Lab
  and Pre-Assessment Services
• Commissioning incentives for achieving quality
  indicators - monitored through the score card

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Key Messages

• Remember that this is about patient safety and
  patient experience
• Appreciate and embrace organisational differences
• Learn from each others experiences
• Focus on learning, and preventing reoccurrence
  rather than blame
• Board sign up, and active pursuit of non
  compliance by Chief Executive

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Key message continued

• Recognise the value and expect clinical ownership
• Ensure individuals held to account for lack of
  compliance
• Value the commissioning input
• Ensure the performance management aspects are
  delivered sensitively received positively
• See the DH SHA as positive support and use
  their expertise experience

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• Any Questions?