the scip core measures journey
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The Surgical Care The Surgical Care Improvement Improvement Project (SCIP)Project (SCIP)
Teri Ransbury, Admin. Director Quality & Risk Management / Infection Prevention / Medical Staff
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Corona Regional Medical Center
Began in 1933, with the founding of Corona Began in 1933, with the founding of Corona community hospitalcommunity hospital
Merge in 1992 with circle City Medical CenterMerge in 1992 with circle City Medical Center Became Corona Regional Medical CenterBecame Corona Regional Medical Center 240 – bed community hospital240 – bed community hospital -160 – bed acute care hospital-160 – bed acute care hospital - 80-bed rehabilitation campus- 80-bed rehabilitation campus Employs more than 1,000 trained health care Employs more than 1,000 trained health care
professionalsprofessionals
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Corona Regional Medical Center
300 physicians representing more than 40 specialties
71% of our professionals, clinical and ancillary staff live in the greater Corona/Norco area
We seek to be the leading community healthcare provider, serving our communities as the healthcare partner of choice for patients, staff, and physicians.
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Corona Regional Medical Center2008 v 2009
0
20
40
60
80
100
120
Abx w/in
1 hr of in
cision-O
verall
Abx Selection-O
verall
Abx D/C'd w
/in 24 hrs-
Overa
ll
Appro H
air Remova
l
Colorectal Im
med Post-op N
o...
B/B prio
r to admiss
ion & peri-
op
VTE Prophyla
xis
VTE Prophyla
xis Tim
ing
2008
2009
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STAFF EDUCATION Monthly nursing staff meetings Medical staff meetings Nursing orientation SCIP/Core measure packets and tests for
nursing registry Posters
STRATEGIES
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SCIP/ CORE MEASURE TEAM Biweekly Meetings Members:
Chief Nursing Officer Nursing Directors-ED, ICU, MS,PCU Nursing Educator Nursing Managers Pharmacy Director Quality Director/Manager
SCIP Coordinator Core Measure Coordinator Core Measure Nurse
STRATEGIES
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INCLUDES: Discontinuation of prophylactic antibiotics
within 24 hours (the pharmacy places STOP date and time)
Correct selection of prophylactic antibiotics VTE Prophylaxis orders
Develop Pre-Printed Orders
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Green Sticker Documents reasons
for not discontinuing prophylactic antibiotics
DEVELOP STICKERS TO ALERT NURSES AND PHYSICIANS
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SCIP LABEL
Post-op charts are identified. The sticker is placed in front of the chart.
DEVELOP STICKERS TO ALERT NURSES AND PHYSICIANS
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Foley Necessity Sticker
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• Letters to the Nurses and Physicians• Nursing champions for each unit• Communicate with Physicians
• Correct selection of prophylactic antibiotics
• Copies of preoperative pre-printed orders
STRATEGIES
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Develop SCIP/Core Measure Bulletin Boards Posted monthly with colored graphs Posted in each unit
Recognize SCIP Stars Names of physician in each star who are SCIP
champions
Anesthesiologist are responsible for administering and documenting pre-op antibiotics in O. R.
STRATEGIES
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Preoperative pre-printed orders Core Measure Checklist Prophylactic Antibiotic orders VTE Prophylactic orders Total Joint orders Hysterectomy orders
SCIP FORMS
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Adult Surgical Antibiotic Prophylaxis Orders
Appropriate Antibiotic according to Procedure
Within 30-60 minutes of incision
Discontinuation within 24 hours of surgery
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Adult Venous Thromboembolism Prophylaxis Orders
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Post-Op Total Joint Orders
Includes Appropriate Antibiotic
Discontinuation within 24 hours
VTE Prophylaxis
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And
the journey
continues……
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SCIP
QUESTIONS ???
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THANK YOU