<p> Safer Health Care Now SSI (Surgical Site Infection Prevention)</p><p>DRAFT PDSA: Plan Do Study Act</p><p>Project Name: Safer Healthcare Now SSI (Surgical Site Infection Prevention) Act Plan</p><p>Team Leader: Nurse Manager PACU/Perioperative Clinic/Surgery Admissions Study Do Team Members: Nurse Manager, OR RN, OR RN, OR Clinical Resource Nurse, OR RN, Perioperative Clinic/Surgery Admissions Anaesthesiologist Administrative Director, Surgery Program Infection Control RN </p><p>E Purpose of Project: R A  To improve quality of care delivered to patients during surgery by reducing the risk of Surgical Site Infections T</p><p>A  To increase the reliability and predictability of performing three components of care: optimal use of prophylactic antibiotics; appropriate hair H removal; and normothermia. W</p><p>E  To spread improvements from the test populations to all surgical populations W G N</p><p>I Goal Statements:</p><p>Y Achieve 95% or higher in implementing the 4 components of care for patients undergoing surgical procedures: R</p><p>T  Prophylactic antibiotic administration within 60 minutes prior to surgical incision O T</p><p>I  Prophylactic antibiotic discontinued within 24 hours after surgery end time L</p><p>P  Appropriate clipping pre-operatively as close to incision time as possible (not razor shaving) 0 M  Maintain normothermia (36 C) peri-operatively for patients undergoing colorectal surgery O C C A ? H S</p><p>Safer Health Care Now SSI (Surgical Site Infection Prevention)</p><p>DRAFT</p><p>Surgical Procedure: ______?</p><p>T Measures: Status: Date Aims: N</p><p>E 1. % surgical pts. with 1. 1. Achieve </p><p>M prophylactic antibiotic 95% or E</p><p>V administration within higher O</p><p>R 60 mins. prior to P incision M I 2. % surgical pts. 2. 2. Achieve N A</p><p> whose prophylactic 95% or S I</p><p> antibiotic(s) were higher E discontinued within 24 G</p><p>N hrs. after surgery end A</p><p>H time (48 hrs. for cardiac C surgery) A 3. % surgical pts. with 3. 3. Achieve W</p><p>O hair clipped or no hair 95% or N</p><p>K removal higher</p><p>E 4. % colorectal surgical 4. 4. Achieve W pts. with Temps =>360C 95% or L L</p><p>I post-operatively higher W</p><p>W O H</p><p>Safer Health Care Now SSI (Surgical Site Infection Prevention)</p><p>DRAFT</p><p>Safer Health Care Now SSI (Surgical Site Infection Prevention)</p><p>DRAFT</p><p>T Ideas for Change: A H W</p><p>S Prophylactic Abx. Timing and Discontinuation: E  Designate responsibility for pre-op prophylactic Abx. Administration (Circulating Nurse/Anesthesia/Hold Room RN) connected to key point in G</p><p>N process A</p><p>H  Standardize administration process to occur with commonly performed activity within 1 hr. prior to incision (2 hrs. for vancomycin) C</p><p>E  Develop system where Abx. is hanging at head of pts. bed ready for administration W  Ensure systematic documentation of Abx. Administration on every pt. chart (stamp on peri-operative record) N</p><p>A  Provide feedback on prophylaxis compliance data monthly C</p><p>E  Involve pharmacy, infection control & infectious disease staff for their input & involvement K</p><p>A  Standardized departmental standing orders specifying antibiotic, timing, dose and discontinuation M T</p><p>A Hair Removal: H</p><p>T  Perform hair removal when necessary with clippers right before surgery (Surgery Admissions or OR) L</p><p>L  Remove all razors from the OR I</p><p>W  Use reminders (signs, posters) N I</p><p>T</p><p>L Normothermia (Colo-rectal Surgery):</p><p>U 0</p><p>S  Offer Warm blankets, etc in Surgery Admissions and Holding Room to limit heat loss in pts. prior to operative procedure; keep at 36 C</p><p>E 0</p><p>R  Standardize use of warming devices to ensure pt. temp 36 C perioperatively E</p><p>V  Standardize temperature monitoring method intraoperatively</p><p>O  Provide devices & protocol for consistent measurement of pt. temp R P  Allow surgical staff to control room temp M I</p><p>?  Use warmed forced-air blankets during surgery and in PACU T</p><p>N  Use warmed IV fluids E  Use warming blankets under pts. on the operating table M  Use hats and booties on pts. perioperatively</p><p>Safer Health Care Now SSI (Surgical Site Infection Prevention)</p><p>DRAFT</p><p>Roles & Responsibilities of Team Members:</p><p>Team Leader – Overall leadership of team  Facilitating and keeping track of PDSAs, measurement data  Communication link with team and others  Assist with reporting</p><p>Team Members: Work with TL and team to facilitate cycles and communication with stakeholders Participate in process to collect measurement data.</p><p>OR RNs: Assist with test cycles, measures and reporting</p><p>Anesthesiologist: Liaison with anesthetists and communication link with team and others Input to ideas for change and clinical process</p><p>Perioperative Clinic/Surgery Admission RN: Assist with data collection, interpretation and input</p><p>Meeting Schedule: Standard monthly meetings Safer Healthcare Now website & conference calls – www.saferhealthcarenow.ca</p><p>Author: Beth Kennedy Date: September 2006</p>