Building a Multidisciplinary Team
Loretta Litz Fauerbach, MS, CIC
Fauerbach & Associates -Global Infection Prevention Services
March6, 2013
Taking Quality to the Next Level
Kentucky Hospital Association Annual Quality Conference and Hospital Engagement Network Convening
Louisville, Kentucky
Objectives
To identify key elements of teamwork
To discuss training needs for team building
To demonstrate similarities in approach from aviation to healthcare
To demonstrate the success of teams in improving outcomes and patient safety
Why Teamwork & Communications Matter?
Better patient outcomes
Higher patient satisfaction
Lower malpractice claims
The Downside
Miracle on the Hudson Lessons for Healthcare Industry
Practice Makes Perfect
Measure Proficiency Over Time
Team work is essential
Cross-monitoring: An essential element of teamwork
Crew Resource Management is modeled by TeamSTEPPS
Every healthcare team member’ s safety input should be heard
Simulation -based techniques help improve outcomes
Healthcare leaders need to invest in people like aviation has do

www.npsf.org
Porto G. Miracle on the Hudson Key Safety Lessons for the Healthcare Industry. . 2009; Vol 12/Issue 3: 2-4.
The TeamSTEPPS Program
Agency for Healthcare Research and Quality
(AHRQ) website:
www.ahrq.gov/teamstepps
Department of Defense Patient Safety Program website:
dodpatientsafety.usuhs.mil/teamstepps
Teamwork- What’ s in it for you?
Creates Common Purpose
Brings about Improvement
Mechanism for change
Produces expanded influence
Improves communication
Increase Professional satisfaction
Contributes to Joy of Work
The Science of Forming a Team
Review the Aim
Consider the system (s) that relates to the AIM
Select team members familiar with all the different parts of the process
Obtain executive sponsor who is responsible for the teams success

Examples of Team Membership
Clinical Leader
Technical Expertise
Day-to-Day Leadership
Project Sponsor
Staff
Think outside the box
Model for Improvement*
Fundamental Questions that Guide Improvement Teams
What are we trying to accomplish?
How will we know if a change is an improvement?
What changes can we make that will result in improvement?

* IHI- How to Guide: Project Joints, 2012
The Plan-Do-Study-Act (PDSA) Cycle
Infusing Fun Into Quality And Safety Initiatives
Leadership can set the tone
Got to have a Gimmick!
Rewards for progress
Pizza Party
Breakfast
Candy Bars
Certificates
Thank You Notes
Enlist the help of Marketing/PR

Staff Generated Ideas
Music themes
WHO –
APIC –
The jingle was recorded at a
local studio,
a concept for a music video
Get Your Clean On was born in early May 2010. (See the music video on the Nursing2012 iPad app.)
Foulk KC, Tocydlowski P, Snow T, et al. INSPIRING CHANGE Infusing fun into quality and safety initiatives Nursing2012 November: 14-16. www.Nursing2012.com
Contests
Poster Designs
Got In the Act –
The Pathway to Prevention
A Neurosurgical Multidisciplinary Infection Prevention Team:
Adverse Event Review and Assessment to Reduce Class I Surgical Site Infections (SSI)
Infection Prevention Performance Improvement Team Members
Champion: Neurosurgery (NSG) Chairman
NSG Department: faculty, residents, fellows, ARNPs, nurses and other members
OR NSG Team: Scrubs, Circulators, RN leader, OR Patient Safety Nurses, OR Management
NSG Nursing Units and Nursing Specialists: SICU, 82NS, 65MS
Anesthesiology: NSG Anesthesiology Team, QA Anesthesiologist/Educator
Support Departments: PI Educator, Decision Support Services, Central Sterile Supply, Facilities, Environmental Services, Pharmacy and Hospital Administration
IP&C Team: Infection Prevention & Control Department (IP & Director) plus Hospital Epidemiologist
Strategies of the Neurosurgery Infection Prevention Team
Employed Adverse Event Trigger Strategy
Every Monday IPC notified NSG Chair of potential cases
Investigation and Data Collection related to procedure and team members
NSG Team reported infections to IP
Each case reviewed with all participants at meeting 2x’ s a month initially then once a month

Strategies of the Neurosurgery Infection Prevention Team
Root Cause Analysis discussion concerning each case was done
Evaluation of Practice, including surgical and unit procedures and OR setting
OR observational studies performed by IP with feedback to team and staff
Education -every meeting addressed a hot topic
Development of Checklist for Common Practice
Surveillance & Data Trending
SSIs detected through reporting of infections from the NSG Team as well as by routine surveillance methodology used by the IPC Department.
Class I SSI and procedure-specific SSI rates were calculated on a quarterly basis.
Reported to IPC Committee, NSG team, Surgical Committee and Operations Committee of the Medical Staff and through the quality committee structure.

Education of the Team Based on Observational Studies
Hand hygiene -Implemented Alcohol Hand Rub in OR for non-scrubbed care
Monitored and reported variances from good surgical practice
Maintain 2 feet for sterile field
Handling of medications -established new protocol and taught aseptic management of vials and fluids
Empowerment of staff
Initiated Patient Safety Advocate Nurses who rounded for compliance
Foley catheter management
Pre-operative bathing
Building Trust
Respect
Empowerment of Everyone
Chair taught by example
Surgeon Specific Rates
Open and honest communication
Videos
The Enforcer
WHO Hand Hygiene Dance
Humor
Equipment and Device Reps
Educate through REPtrax
Must use laser pointer to indicate placement or device selection
Must use hospital provided scrubs labeled Sales or Technical Rep
Instruments and devices must be brought in the night before procedure for processing
No Flashing – IUSS
Process & Practice Improvements
Improved classification with implementation of a mandatory classification field
Developed & implemented checklist and improved consistency in following recommended practices
MRSA screening has identified about 8% of their elective surgical patients are MRSA positive. Noted that more patients had infections with MSSA
NSG staff screened for MRSA/MSSA- no MRSA isolated, 4 MSSA identified and decolonized. No linkage to cases.
Implemented pre-op screening for MRSA/MSSA and decolonization
Process & Practice Improvements
Improved consistency of Pre-op Showering with CHG
Improved Management of medications, vials and fluids
Created signage to make sure vial tops were scrubbed with alcohol before each entry
Improving OR environment (new carts, more storage, on-going monitoring by 2 OR patient safety nurses, no personal items in the OR room)
NSG to report infections to IP
Process & Practice Improvements
Education for Anesthesiology, OR team and Patient Care Unit staff
Pre-Op Antibiotics (ABX) Prophylaxis
Changed ABX prophylaxis to Kefzol from Vancomycin based on literature review, if Vancomycin is used Kefzol is still needed, unless allergic
DC ABX at 24 hours according to SCIP
Lessons Learned
A collaborative effort between the hospital IPC team, the Neurosurgical Department, Operating Room and other services strengthen the surveillance and prevention systems for surgical site infections.
The increase in reporting of infections strengthened the surveillance systems of the IPC Department allowing for more accurate infection rates for all surgical services.
Measures for NSG SSI prevention are multi-factorial.
Deeming every SSI an adverse event trigger can lead to improved outcomes.
Observational studies, education, and a multidisciplinary IP effort enhances awareness and results in improved outcomes.
Administrative and physician leadership support of improvement activities are key to success.

“Staging the OR for Success”
If Operating Room was on HGTV program,
Flip this House

Would you buy this OR?

Let’ s all get ready for success
“Staging the OR for Success”
Remove all trash after each procedure
Place alcohol gel in substerile room and in OR room
perform hand hygiene prior to working with patient
contact with patients devices, inserting or
Handling a foley catheter and other activities
Maintain the anesthesiology cart in proper order and protect supplies
No storage on the floor -limits ability to clean, increases chance of contamination and clutters the floor of an already crowded room.
Supplies in the OR should be protected from contamination and only be for the current case
Cleaning schedules for lead aprons established and enforced.

Stop and look objectively to make sure OR is ready for next case

Eliminating Ventriculostomy Infection Study (ELVIS)
ELVIS Task Force
Critical Steps for Improvement
Performed FMEA
Developed Insertion Checklist
Re position bed
Trained observer
Inserter must simulate practice and also demonstrate competency
Supplies including antimicrobial catheter, sterile gowns etc

Ventriculostomy Infection Rate ()
HHS Partners in Prevention Award, 2012
4E Surgical Intensive Care Unit
20 different surgical specialties including abdominal transplant services
New Unit -New Goal
NO CLABSI
Manager, Clinical Specialist, Medical Director and IP&C Partnership
Critical Care Society and the ACCN
The Pathway to CLA-BSI Prevention
Unit Activity for New ICU
Performance Improvement Group
Daily/Shift Rounding for Compliance
Communication with IP
RCA for each potential infection
Involved Clinical Specialist , Nurse Manager, and Medical Director
On the CUSP -joined 1 year after unit opened
Education, monitoring and feedback
ICU Improvement Team and CVL Complication Prevention Team
Active Participation in Hospital wide improvement teams
Supply Chain and assuring right supplies
Adoption of the CVL Prevention Bundle
Horizontal Approach to Infection Prevention
Monitoring of all CLA-BSIs

A Multi-disciplinary Team Tackles Standardization of Endoscope Practices in a Tertiary Care Setting: Finding Common Ground
Project -Multidisciplinary Task Force
Improve Patient Safety through Scope Management
To review standards and practices for scope care and sterilization to standardize cleaning
and processing
To standardize departmental practices related to the management of scopes based on AAMI,
CDC and other professional organizations recommendations
To assure compliance with recommended practices
Is This Device Ready to Be Used ?
How do you know?
READY TO USE
Do you know if a piece of equipment/device has completed the cleaning/high level disinfection/sterilization required for that piece of equipment?
To eliminate confusion, when you have completed the appropriate processing requirement for that specific device per protocols (cleaning/high level disinfection/sterilization),
Please label devices or bags they are placed in
with the READY TO USE tags.
Stakeholders
Anesthesia
All Central Sterile Processing Areas
Respiratory Therapy / Pulmonary Lab
Infection Prevention & Control staff
OR Sterile Processing
Surgical Services (FSC, CSC, NT)
Heart Station
ICUs
ED
Biomedical Engineering
Zone Mechanic
Patient Safety Officer
Champion -Vice President, Finance and Supply Chain
Co-chairs: South Tower OR Manager and Infection Prevention & Control Director
Team won CEO Patient Safety Award

Standards for Practice
AAMI
CDC Guidelines
SHEA- Multi-societal Endoscope Standards
SGNA-Society of Gastroenterology Nurses and Associates
APIC
Literature
Infection Prevention & Control Hospital Policies
Departmental Policies and Procedures
Key Elements
Pre-Clean at Point of Use
Leak Testing
Manual Clean
High Level Disinfection / Sterilization
Based on Spaulding classification
Critical
Semi-Critical
Non-Critical
Ready To Use -New Tag
Flush scope with enzymatic cleaner
Store vertically to promote drying.
Use transport bags marked contaminated
with identical stickers.
Do not transport scopes in red bags.
Use identical clean-storage and labeling
practices across departments
Flush with alcohol after processing
Team Results
Documents to assist with standardization
were developed:
Development Of Practice Standards And
Checklists For Compliance
Complete Inventory Of Scopes
Common Logs And Training
Standardization Of Supplies
Ready To Use Tag
Lessons Learned
Standardization creates opportunities for
cost savings, better practice monitoring, and
competency training.
Individual scope manufacturer’ s
recommendations must be followed.
Compliance with practice recommendations
and monitoring is improved through
standardization.
Team Diversity
Recognize differences
Celebrate uniqueness of each individual
Understand cultural and ethnic diversity

Celebrate Success
Teamwork & Communications make life better!

WHO Hand Hygiene Dance

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