simple is effective · hywel dda local health board peripheral vascular cannula and short term...

Hywel DdaLocal Health Board

Peripheral Vascular Cannula and Short Term Urinary Catheter

Insertion and Maintenance Bundles

September 2011 – ‘Simple is Effective’

Presenter: Tracey Nicholas

PLUS


Baseline Data Prevalence Survey 2010 Hywel

Dda Health Board

Total Number Hospital Acquired

Peripheral Line 52 5

Catheter 22 2


2. ChloraPrep 0.67ml Sepp Implemented 2010 √3. Peripheral Vascular Cannula

Insertion Bundle revised roll out

August/Sept 2011

Hand hygiene PPE

Skin Prep Dressing

(Chloraprep)

Signature ……………………..

√ Prescription Chart sticker

Hand hygiene PPE

Aseptic Technique Clean urethral meatus

Sterile closed drainage system

Documentation

Signature …………………………….

4. Short Term Urinary Catheter Roll

out August/Septemeber 2011 √

DEVICES/PROCEDURES Total Number

Peripheral Line 52

Catheter 22

Defined Types of HAI

SSI

15%

Resp Tract

15%

GI Tract

12%

Pneumonia

12%

Bone & Joint

8%

Blood Stream

8%

UTI

4% Skin & Soft

Tissue

22%

Systemic

infection

4%

1. Baseline August

2010 √

OUTCOME = MRSA Bacteraemias April 2010-March 2011 Prescription Chart sticker


Sticker DevelopmentPeripheral Vascular Catheter Insertion Bundle Date ..../..../.... Day 1 Time ......................

Hospital ............................ Ward ............................

Reason for Insertion (Please cross all that apply)

IV Fluids Antibiotics Blood Transfusion Pain

Control

Other (Please

state)

..............................

Insertion Technique yes no ye

s

no

Hand Hygiene Sterile Gloves

Informed Patient consent Dressing Applied – clear,

semi-permeable dressing

Skin Preparation – 2% Chlorhexidine in

70% Alcohol

Cannula Flushed

Allow to dry for 30 secs Number of attempts

Cannula Size Batch No Cannula Site

Print Name ............................ Signature...................................... Designation.....................


`

Reorder Form Number; WTA152 (pack 50)

Peripheral Intravenous Cannula Care Plan and Maintenance Bundle


Short Term Urinary Catheter Care Plan and Maintenance Bundle


Roll out Programme‘Start Small and Roll Out!’


SPREAD &

SUTAINABILITY


Compliance

• Required to fit into 1000 lives plus requirements

• Report Locally & Nationally

• Compare practice between wards

• Fit with Nursing Metrics/Dashboard

• Be aware of where we need to improve

• Collect data


Compliance Audit:

• Took methodology used for Hand Hygiene Compliance

• Developed Tool x2

• Pilot Results/Sampling 10 each ward each month

Audit Process


Excel Template

• Automatically Calculates compliance

• Summarises results per hospital

• Summarises Results of LHB

• Data formatted so that it is cut and pasted into PowerPoint Template

• Example graph overleaf.

• Process takes very little time


Hand Hygiene Compliance Rates – Staff Type

94%

87%

100%

53%

78%

71%

86%

100%

78%

0%

95%

75%

100%

94%

85%

92%

83%

60% 60%

NA

100%

0%

25%

50%

75%

100%

Manager/

Sister

Nurses Student

Nurses

CNS/NNP/

Bed Mngr

Consultants Senior Dr Junior Dr HCA AHP Ancillary Other

PPH WWGH


Type of Decontamination Missed

14

6

7

8

3

8

0

5

10

15

Before Patient

Contact

Before a clean

Aseptic Proceedure

After Body Fluid

Exposure

After Pt Contact After Contact

Patient Immediate

Surroundings

PPH WWGH


Title

9 Criteria identical to Care Bundle. Reply Yes, NO, NA


• Currently piloting Catheter and IV Data Collection Tools

• Automate the Audit process

• Fit for all reporting purposes

• Compare compliance rates

• Feedback Good and Bad Practice

Excel Templates in Draft


• 3 Wards Audited

• Good Compliance Rates

• Excel Data Collection Tool still needs tweaking to be as effective as Hand Hygiene

• Has highlighted areas of the bundle that require further input

Pilot Results


13%

75% 75% 75% 75% 75% 75%

0%

25%

50%

75%

100%S

ticker

Pre

sent

Care

Bundle

s

Com

ple

ted

Hand H

ygein

e

Indic

ation f

or

Use

VIP

Score

Less

than 2

Dre

ssin

g D

ry &

Inta

ct

Access P

ort

Dis

sin

fecte

d a

nd

Allo

wed t

o D

ry

Pilot Results


Just the Tip of the Iceberg! Part 1

Clostridium difficileMRSA/MSSA

Elective Orthopaedic

SSICaesaran Section SSI

Breast SSICVL/VAP Bundles

CABSI - Peripheral Lines

SSI :

• Vascular

•Gynaecology

• Urology

• ENT

•Ophthalmology

CAUTI- LDP

Other Multi Resistant Germs:

• VRE

• GRE

• MDR TB

• ESBL s E.Coli Klebsiella

• Acinetobcater

• Candida

•Serratia


Just the Tip of the Iceberg! Part 2

Clostridium difficileMRSA/MSSA

Caesaran Section SSICVL/VAP BundlesElective Orthopaedic SSI

Breast SSI

CABSI -

SSI :

Vascular

Gynaecology

Urology

ENT

Ophthalmolog

y

Other Multi Resistant Germs:

• VRE

• GRE

• MDR TB

• ESBL s E.Coli Klebsiella

• Acinetobcater

• Candida

•Serratia

Peripheral Lines CAUTI


Thankyou

Any Questions?

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