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Using Patient Stories from Carbapenemase Producing

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Using Patient Stories from Carbapenemase Producing Using patient stories from Carbapenemase Producing Enterobacteriaecae (CPE) positive patients in a quality improvement project to understand and improve the patient experience at University Hospital Limerick in Ireland Barbara Slevin, ADON, Infection Prevention & Control UL Hospitals Group What I will be talking about today . Background . UL Hospitals experience . Methods . Quality Improvement measures . Results . Lessons learned, patient stories . Conclusion . What’s next This our Region UL Hospitals Group Overview 2016 Hospital Model Beds Staff University Hospital Limerick 4 320 in-patient 1,942 81 day beds University Maternity Speciality 83 in-patient 294 Hospital 19 neo-natal Speciality 37 in-patient 144 Croom Hospital 13 day beds 2 50 in-patient 206 Ennis Hospital 16 day beds 2 49 in-patient 179 Nenagh Hospital 25 day beds 2 89 Adult 268 St. John’s Hospital Surgical 10 day beds Overview July 2009 reconfiguration of services –all surgical services transferred to UHL-without an increase in bed capacity Activity levels: •ED attendances approx 65,000 per annum •>50,000 inpatient discharges per annum •>56,00 day cases per annum University Hospital Limerick (UHL) has detected the highest rates of Carbapenemase Producing Enterobacteriaecae (CPE) in Ireland since 2009. There has been an ongoing outbreak at UHL since 2011. 53% of the total national burden in 2015 (reference laboratory UCHG). To date: 186 CPE patients identified in our hospital lab. Background UL Hospitals experience Background UL Hospitals experience Nightingale Ward Overview Our Aim Statement: To improve the patient’s experience through the reduction of newly identified CPE cases in UHL from 27 (total-1st 6 months 2015) to 13 for the first 6 months 2016 A quality improvement (QI) project was undertaken to improve the experience of the patient at UHL by using CPE patient stories. Surveys were conducted on CPE patients and their families to help understand what works and what needs to improve from the CPE patient perspective. Driver Primary Drivers Secondary Drivers Diagram •Meet EMT & involve in project Sustained Leadership •Link with Previous QI RCPI participants for support •Engage with Wide IPC Team for support •Continuing liaison with CNM Cohort Ward & PPS Wards •Involvement with Bed management •Engage with and create awareness with ADONs & night managers Patient Identification •Review 2015 data to identify acquisition •Screening Protocol-education, audit of compliance, PPS To improve the (who, when & How) •ICNet alerts, iPMs alerts, bed booking process, Maxims in patient experience ED, chart alerts though the reduction •Laboratory diagnostics & reporting of newly identified CPE patients in Mitigation Code RED-Time to isolation, set target time from bed UHL from 27 (total- booked to admission (review on iPMs) 1st 6 months 2015) to Cohort Ward location monitor & trend Alert status identification review ongoing basis 13 for the first 6 Education on PPE, Hand Hygiene months 2016. Use High level alert Signage Early Risk assessment Identify Patient risk factors Stratification of risk patients (from retrospective data) & risk categories as per guidance Effective , timely admission Screening protocol (Audit compliance, PPS) screening Work with Planning, Performance & Business Information Manager to flag all admissions from nursing homes, Daily report to IPC Team Financial costing Map ALOS, HIPE Data, DRG costs per night General costs/Specific CPE costs: Pharmacy, Cleaning, staffing, consumables (PPE, Lab, incident meetings, stock loss). “Tell me a fact and I’ll learn. Tell me the truth and I’ll believe. But tell me a STORY and it will live in my heart forever” Indian proverb. Patients and their families talked about what they felt, saw, heard, the emotions that were evoked and how this affected their hospital experience. These patient stories provided varying insights from patients (including healthcare workers who were CPE patients) and family members. Experiences for patients improved following the implementation of the Infection control cohort ward which enhanced CPE management standards. Shared these patient stories with our hospital executive, consultant colleagues, National Quality Division, national leads “I don’t know where the infection came from…nobody spoke “Put a big burden on my to me…my daughter mother.. We had to adapt told me.” the house to take him “Shoved into a room, home, it caused a lot of everybody passing by, stress when the community hospital wouldn't take him” you’d swear there was something really wrong with me” “I felt as I was perceived as a nuisance despite treated like a leper” being a member of staff.. Some staff were afraid to come into my room.. they handed stuff in.” “I got a leaflet, just handed it, read that a few times… “The nurses are all so it didn’t make sense lovely here, just like to me” home from home” “My father was treated like a “What did we have to do when he came home, small pariah” children, that human touch, afraid to touch him, did we need gloves”? “I’m afraid for my grandchildren…what do “The staff all gown we need to do…I worry up & wash their about them…. I’ll get “It’s the way hands over what I have” people look at you.. - all the time” You feel they’re running away” “I know I’ll have to be in a room on my “ I couldn’t fault the own” staff on this floor, the cleaning is excellent ” “Everything was so much better on the cohort ward – they cared. “I didn’t know it lasted… more attention....thorough “My consultant I thought it would be gone when cleaning..felt safer…everyone said…you’ll get a wore gowns… hand hygiene.. the diarrhoea stops” room every time Not like the other ward.. “It’s a bug in the gut” good standards here.” you come in” Where now for the Patient Improve the patient experience . Experiences for patients improved following the implementation of the cohort ward which enhanced CPE management standards Immediate Term: . How we communicate to our patients, IPC CNS link, IPC support to patient’s team Short Term : . Develop IPC education tools for patients: . Working with Graduate Entry Medical School, software engineer with University of Limerick and our infection control cohort ward . Developing a touch screen interactive patient tablet with short videos explaining “Bugs” in simple language. Working with Patient Advocacy Liaison Services & Communications team, UL Hospitals Patient Council (the patient voice) . Test literacy levels and levels of understanding Communication . Long Term . Support and ongoing education for staff , patients and their families . Interactive tools for staff to explain CPE in simple understandable terms . IPC Team continue to assist medical teams with explanations for newly diagnosed patients and their families. Continue monitoring the patient experience and listen to patient stories The impact of the QI measures utilised have evidenced a safer, more efficient and higher quality of care provided to the patient population with an identifiable cost saving of approx €682,086 for the first 6 months of 2016 Acknowledgements IPC Team UHL: Dr Nuala O’Connell & Dr. Lorraine Power, Consultant Microbiologists, UL Hospitals Alan O’Gorman, Eimear O’Donovan, Marion Commane, Sarah Kennedy, Eleanor Mc Carthy, Siobhan Barrett, Antimicrobial Pharmacist, James Powell, Regina Monahan, Surveillance Scientists Sinead O’Donnell, Intern Dr Ciara O Connor, Microbiology SPR Patricia Treacy Financial Operations Officer Prof Colum Dunne, Graduate Entry Medical School, University of Limerick Hospital Executive UL Hospitals.
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