Lower VIPs for VIPsReducing peripheral line associated infectionsby using an electronic surveillance system

Presentation to theKings Fund Digital Health & Care Congress

Tuesday 16 June 2015

Jane Gorman, Head of Nursing, Croydon Health Services NHS Trust

Dr Peter Greengross, Medical Director, The Learning Clinic& Clinical Fellow, Emergency Medicine, Imperial College Healthcare NHS Trust

&

Our VIPs

The Visual Infusion Phlebitis Score

Peripheral lines - the problem

• Most common invasive procedure in hospital

– 70% inpatients have a PVC fitted

• Most common source of bacteraemia

– 1 / 3,000 cannulae

– 0.2 infected cannulae / 1,000 PVC days

• Major cause of patient harm, complaints & cost

– 37% of reported adverse events involve PVCs

Collignon 1994; McLaws 2003

Croydon Health Services

• Integrated acute& community trust

• 3,500 staff

• 380,000 population

• Croydon University &Purley War MemorialHospitals

• CUH – DGH, 500 beds

– Expected 25 infected PVCs / yr

– 15 PVC associated bacteraemias / yr

Monitoring compliance - PVCs

• Saving lives, high impact interventions care bundle

– Evidence –based approach to reduce infections

– Health & Social Care Act 2008: “Registered providers must audit compliance to key policies and procedures for infection prevention”

• Recommendations on insertion & ongoing care

Change programme

• Aim: Improve compliance with Trust protocols

– Cannula site record is current & accurate

– Is VIP score recorded

– Is VIP score accurate

• Historically - paper-based system

• Interventions

– Awareness raising all ward managers & matrons

– 80% nursing staff trained in PVC management & HII care bundle

– Use VitalPAC system for recording insertion & observation of PVCs

– Develop e-dashboard to monitor performance

– Feedback data to staff & public

• Real time bedside capture of data

• Intelligent prompts and advice on decision-making

• HII care bundles incorporated

• Automatic calculation of VIP score

• Track performance at ward & Trust level

Monitoring & feedback

VP data compared with actual condition of random selection of PVCs

RAG status each metric based on % compliance

Overall compliance reflects worst of 3 metrics

16th May 16th May 16th May 16th May 19th May 19th May 19th May 19th May 21st May 21st May 21st May 21st May

Is cannula

site

accurate

VIP score

recorded

VIP score

accurate Overall*

Is cannula

site

accurate

VIP score

recorded

VIP score

accurate Overall*

Is cannula

site

accurate

VIP score

recorded

VIP score

accurate Overall* WARD

5/6 4/6 4/6 6/6 6/6 6/6 6/6 6/6 6/6 D1

6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 D2

6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 H1

6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 H2

6/6 6/6 6/6 6/6 0/6 0/6 6/6 6/6 6/6 AMU

6/6 4/6 4/6 6/6 6/6 6/6 6/6 6/6 6/6 E1

Closed Closed Closed Closed Closed Closed Closed Closed Closed Closed Closed Closed E2

6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 F1

6/6 5/6 5/6 6/6 6/6 6/6 6/6 6/6 6/6 F2

6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 P1

6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 P2

6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 P3

6/6 6/6 6/6 6/6 6/6 6/6 6/6 0/6 0/6 Q1

6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 Q2

5/6 0/6 0/6 6/6 6/6 6/6 6/6 6/6 6/6 Q3

5/6 3/6 3/6 6/6 6/6 6/6 6/6 6/6 6/6 W1

6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 W2

6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 W3

5/6 0/6 0/6 6/6 6/6 6/6 6/6 6/6 6/6 CCU

6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 Mary

6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 Hope

6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 6/6 ED Obs

Norwood

Outcomes

• Compliance improves from 30% - 80% between May-Dec 2014

• Non-compliant wards reduce from 50% to 5% per week

• PVC related bacteraemiasApr – Dec 2014:

– 2 of 5,995 inpatients

– 25 of 5,998 community patients

Conclusions

Meaningful programme for staff High risk issue, aligned with Trust goals

Collaboration of multidisciplinary teams Infection control, practice development, IT, patient afety

Use of user-friendly, easy to use system (VitalPAC) Generates real-time, accurate and easily accessible data.

Regular transparent feedback to staff to monitor

performance.

Injecting a healthy dose of competition between

wards helps drive improvement and does no harm.

Any

questions