At the 11th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference on June 15, Nicole Gritton, RN, vice president of nursing and ASC services at the Laser Spine Institute based in Tampa, Fla., gave clinicians and administrators tips for ensuring high quality and infection control.
"Quality assurance is pivotal to patient safety, and ultimately leads to the health of our bottom line," Ms. Gritton said. "Quality and infection prevention cannot be assured, but it can be measured, assessed and improved."
Effective, long-lasting quality assurance must be ongoing, data-driven, peer facilitated and reviewed, and organized in a systematic way, she said. Data must not only be gathered but intentionally used to drive decisions. "Data that is just there is just data, it does't really work for you. It doesn't translate to true improvements in performance," she added.
An ASC's first step should be establishing an accountability committee or coordinator who will own the outcomes of the improvement initiative. That team should meet at least quarterly to assess performance and determine where the next opportunities lie. Their improvement plans should be written and well-communicated to staff, because great plans can only work or be tested if their implemented consistently and correctly. If staff can't articulate the plan verbally, it's safe to assume they can't perform it accurately either, she said. Be sure the team has identified the key indicators that will be measured to determine whether the plan has been effective, she cautioned.
Once a center has improved its quality and infection control, the focus and enthusiasm can't let up. Leadership and the accountability committee must sustain the fervor to continue that improvement. Ms. Gritton said her organization made strides with their 2009 campaign to boost hand hygiene from 40 percent to 90 percent within one year. But because they didn't sustain that vigorous focus, the compliance rate fell again to 60 percent.
In addition to mandatory incident reporting requirements, centers should internally track adverse events to identify trends and devise solutions derived from staff members themselves. It also helps identify discrepancies between facilities.
Surveillance is an essential component of an effective infection prevention program, Ms. Gritton said. "I'm fortunate to work for an organization that takes these things very seriously. If I say 'We're dropping the ball here,' they say, 'What do you need to get it done?'"
Following up with patients for six weeks or more post operation and up to one year later for medical devices is important to get an accurate assessment of the quality and infection control the patient received in a center's care, she said.
Some practical tips she offered include:
• Installing alcohol-based hand sanitizer dispensers throughout the facility
• Training staff in safe injection practices
• Using spiked IV bags within one hour and eliminating vent spikes for propofol and manifolds from inventory
• Listing open dates on multi-use drugs and discarding within 28 days or the manufacturer's recommended use period, whichever is more stringent
• Requiring staff to clean all surgical tools and equipment before and after a procedure as a failsafe, because "if you didn't do it yourself, in my opinion, it hasn't been done," Ms. Gritton said
• Recording airflow, humidity and temperature levels in rooms, in accordance with many state's requirements
• Enforcing that clinicians never wear scrubs from home, and personal items and jewelry never enter the operating room
• Wearing a buffon hat over cloth head covers
• No artificial nails, gels and chipped nail polish
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Study: 50% Catheter Use Decrease Associated With 70% CAUTI Reduction
"Quality assurance is pivotal to patient safety, and ultimately leads to the health of our bottom line," Ms. Gritton said. "Quality and infection prevention cannot be assured, but it can be measured, assessed and improved."
Effective, long-lasting quality assurance must be ongoing, data-driven, peer facilitated and reviewed, and organized in a systematic way, she said. Data must not only be gathered but intentionally used to drive decisions. "Data that is just there is just data, it does't really work for you. It doesn't translate to true improvements in performance," she added.
An ASC's first step should be establishing an accountability committee or coordinator who will own the outcomes of the improvement initiative. That team should meet at least quarterly to assess performance and determine where the next opportunities lie. Their improvement plans should be written and well-communicated to staff, because great plans can only work or be tested if their implemented consistently and correctly. If staff can't articulate the plan verbally, it's safe to assume they can't perform it accurately either, she said. Be sure the team has identified the key indicators that will be measured to determine whether the plan has been effective, she cautioned.
Once a center has improved its quality and infection control, the focus and enthusiasm can't let up. Leadership and the accountability committee must sustain the fervor to continue that improvement. Ms. Gritton said her organization made strides with their 2009 campaign to boost hand hygiene from 40 percent to 90 percent within one year. But because they didn't sustain that vigorous focus, the compliance rate fell again to 60 percent.
In addition to mandatory incident reporting requirements, centers should internally track adverse events to identify trends and devise solutions derived from staff members themselves. It also helps identify discrepancies between facilities.
Surveillance is an essential component of an effective infection prevention program, Ms. Gritton said. "I'm fortunate to work for an organization that takes these things very seriously. If I say 'We're dropping the ball here,' they say, 'What do you need to get it done?'"
Following up with patients for six weeks or more post operation and up to one year later for medical devices is important to get an accurate assessment of the quality and infection control the patient received in a center's care, she said.
Some practical tips she offered include:
• Installing alcohol-based hand sanitizer dispensers throughout the facility
• Training staff in safe injection practices
• Using spiked IV bags within one hour and eliminating vent spikes for propofol and manifolds from inventory
• Listing open dates on multi-use drugs and discarding within 28 days or the manufacturer's recommended use period, whichever is more stringent
• Requiring staff to clean all surgical tools and equipment before and after a procedure as a failsafe, because "if you didn't do it yourself, in my opinion, it hasn't been done," Ms. Gritton said
• Recording airflow, humidity and temperature levels in rooms, in accordance with many state's requirements
• Enforcing that clinicians never wear scrubs from home, and personal items and jewelry never enter the operating room
• Wearing a buffon hat over cloth head covers
• No artificial nails, gels and chipped nail polish
More Articles on Quality and Infection Control:
Study: Hand Hygiene, Other Interventions Cut PICU InfectionsStudy: Administrative Data Does Not Identify All HAIs
Study: 50% Catheter Use Decrease Associated With 70% CAUTI Reduction
