Improvements in care quality driven by front-line changesAug. 16, 2012, 8:54 AM
Efforts to improve quality of care at Vanderbilt have expanded rapidly in recent years.
Notable achievements such as the central line-associated blood stream infections (CLABSI) reduction program — recently lauded for achieving infection levels significantly lower than the national average — have put Vanderbilt in the spotlight as a leader of such efforts.
The CLABSI project also serves as an example of how efforts aimed at supporting and sustaining change at the frontlines have changed the culture of care for the better.
Trish Polman, R.N., a nurse in the Surgical Intensive Care Unit (SICU) has been impressed with the quality projects, and the care with which they are implemented.
“The way the projects are rolled out to staff has been great. For CLABSI reduction, our unit managers did rounds at the bedside and brought a practice hub coated with this liquid that glows under black light. When you scrub the hub you could see if you didn’t get everything. It was very concrete and informative,” Polman said.
Polman notes that quality improvement projects are now points of pride for bedside staff. The use of signs on each unit that allow staff and families alike to chart the number of days without an infection has bridged the gap between changing how a task is done, and knowing it improves care.
Tom Talbot, M.D., MPH, associate professor of Medicine and Preventive Medicine, said the success of training projects and tools is the result of many years of trying, testing and re-engineering. He said as much is learned from failure as from success. He recalled a previous iteration of a CLABSI reduction program that was quite successful until the focus was shifted to another program. As the Ventilator Associated Pneumonia (VAP) reduction program became very successful, CLABSI rates began to rise again.
“What we learned was the changes weren’t hardwired yet so we had to double back, re-examine our efforts, and learn from the experience. We do remain concerned and vigilant for ‘issue-of-the-moment’ fatigue on the front lines,” said Talbot, who serves as chief hospital epidemiologist for VUMC.
Today, supporting, examining, and sustaining these quality efforts has become a full-time priority at the Medical Center. Julie Morath, R.N., M.S., chief quality and safety Officer, says the Office of Quality and Patient Safety for VUMC is the overall sponsor of these initiatives.
“Quality is a Pillar Goal at Vanderbilt because of the importance of these projects to patients, outcomes and costs of health care,” Morath said.
And as the investment in time and effort grows, so does the number and type of quality initiatives under way at Vanderbilt. There are projects in every discipline and age group of patient care and every location, including outpatient settings, surgical settings and acute and critical care inpatient units.
Today on the SICU, new signs have been posted that not only show the days since the last CLABSI, but also the number of days since the last patient fall, or fall with injury, or catheter-related urinary tract infection. Polman said despite the pace of implementation of these projects, enthusiasm has not waned at the front line.
“It’s a challenge because there are more things on your list of things to do, but within that, we know this is part of care. We’re there 12 hours a day, day to day, hour to hour, making sure patients are turned, mouth care is done, monitoring IV sites, watching out for fall risks. There is a lot of accountability and we know it starts at the bedside,” Polman said.
Polman said she believes part of the reason there has been such success at the front lines is because of the culture change she attributes to the quality improvement movement. She says it requires a teamwork approach that means staff members are involved and feel like valid contributors.
The efforts have paid off. Today all inpatient units have met and surpassed 100 days free of a CLABSI. Goals for some projects are even more aggressive than those set by state or federal guidelines. At the SICU, there are bragging rights to a recent record-breaking streak of more than 400 CLABSI-free days.
Morath says in addition to monitoring the signs on each unit to track the progress of quality projects, staff and faculty are welcome and encouraged to sign on to monthly newsletters from the VUMC Office of Quality and Patient Safety, available here.