Evidence-Based Practice Poster Session (Posters #1-#10)
4 - Coordinating the Spectrum of Care for Surgical Patient Safety
Introduction: The hospital noted an opportunity with total hip and knee, as well as spinal fusion infection rates. Using a multi-disciplinary approach, a standardized audit tool was developed to increase compliance using evidence- based practice along with Association of Perioperative Registered Nurses (AORN) and Association for Professionals in Infection Control and Epidemiology (APIC) guidelines. Implementation/
Methods: Coworkers were educated to the audit tool that would follow the patient from Pre-operative to Discharge. Elements not currently in use that were added to practice included: CHG bathing prior to day of surgery, OR temperature and humidity range documentation, Standardization of OR door signs and external hall door barrier straps limiting door openings and traffic and patient education at admission and prior to discharge was initiated on surgical site infection prevention using an SSI FAQs Sheet. This tool created a challenge as it crossed over many departments. Staff were educated in small groups or team meetings. Unit huddles provided a forum for questions, issues and additional shared information. Audit tool use began in the Pre Admission Clinic Evaluation (PACE) clinic and then placed in the patient’s paper chart. The audit sheet follows the patient through the entire spectrum of care, is completed by the floor nurse prior to discharge, retrieved by IP and results complied in an audit spreadsheet that is reported to OR leadership.
Results: The challenge was to successfully implement a project uniting several departments for staff compliance with safety measures and provide high visibility of best practice for each patient that came into the perioperative setting. Before implementation, SSI rates were higher than facility goal. Since the new audit tool implementation began, compliance of best practice elements have been higher than hospital goals and there has been an average 31.3% decrease in SSIs across all audit tool surgical procedures, with decreases ranging from 15.5% to 60.6% per surgery type. Staff feedback praised the tool for ease of use and great reminder for items in a chaotic environment. The next step will be targeting increased compliance across areas with less than clinically significant decreases.
Conclusion: Compliance equals results. With a unified surgical audit tool there are checks and balances. Safety measures to prevent surgical infections and complications will work in an atmosphere where all members of the team share responsibility.