FRONT LINE OWNERSHIP TO IMPROVE SAFETY IN LONG TERM CARE AND HOME CARE
Michael Gardam
Leah Gitterman

Link to slides for today’s call
will be posted in the chat box

Call will be taped

Certificate of attendance
B...
Interacting in WebEx: Today’s Tools Interagir dans Webex : outils à utiliser
4
Be prepared to use: - Raise hand - CHAT
...
Lots of work has been done with hand hygiene in acute care but what about long term care and home care?
Available Tools

Staff hand hygiene

Patient/client hand hygiene

Environmental cleaning

cleaning multiuse eq...
Acute care ≠Long term/home care
ICU

multiple IV lines

Acute physical stress

Frequent recent wounds/broken ski...
Hand Hygiene
Moment
Acute, CCC, LTC
Home Care
Before contact with patient or their environment
beds, chairs, patients...
Some examples from WHO guidance document
Same principles
as acute care
culture eats strategy for breakfast
How we think the healthcare world works:
A B
How most of it really works:
W B
BLACK BOX
Simple
Complicated
Complex
Types of Problems
Adapted from Brenda Zimmerman
Simple problems

One size fits all

Search for standardization

Problem solving

Checklists

Best Practices
Complex problems

Social Immune response

One size never fits all

Multiple actions (no “one big fix”)

Parado...
This won’t work
Minimum Specifications (simple rules)
An approach to complex problems: Positive Deviance
Increasing performance
Positive Deviance in action 24
RONT
INE
WNERSHIP
Zimmerman et. al. Healthcare Papers, 2013
Improving safety in a complex world
Prevention
Resilience
How to get here?
From here?
Principles of This Work

Work with willing participants

change spreads in infinite ways

Make the invisible visi...
This work is about the HOW rather than the WHAT
Available Infection Control Tools

Staff hand hygiene

Patient/client hand hygiene

Environmental cleaning

cl...
31
The Hand Hygiene Hurdles
Fall Prevention Ideas…
different socks
fall monitors
Bedside report
talking to patients
stay with patients while in t...
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
Q1 2011
Q1 2012
Q2 2012
Q3 2012
Q4 2012
Q1 2013
Q2 2013
Q3 2013
Q4...
Culture SHIFT

Taking time to think

Practice-based evidence (social proof)

Stories and relationships are truste...
“Insanity: doing the same things over and over again and expecting different results.”
38
igniteconsulting.net leah.gitterman@uhn.ca michael.gardam@uhn.ca @DrMichaelGardam
Instructions to download certificate
1
2
3
4
5
6
7
8
9
Infection Prevention and Control Strategies in Home Care and Long Term Care
Infection Prevention and Control Strategies in Home Care and Long Term Care
Infection Prevention and Control Strategies in Home Care and Long Term Care
Infection Prevention and Control Strategies in Home Care and Long Term Care
Infection Prevention and Control Strategies in Home Care and Long Term Care
Infection Prevention and Control Strategies in Home Care and Long Term Care
Infection Prevention and Control Strategies in Home Care and Long Term Care
Infection Prevention and Control Strategies in Home Care and Long Term Care
Infection Prevention and Control Strategies in Home Care and Long Term Care
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Infection Prevention and Control Strategies in Home Care and Long Term Care

Please join us at 12 EST November 7th as we learn more about Infection Prevention and Control in the Home Care and Long Term Care practice environments. Dr. Michael Gardam, our Safer Healthcare Now! IPAC faculty lead will: •Discuss infection control strategies in the home care and long term care sectors, with a special emphasis on hand hygiene •Explain why more traditional quality improvement strategies may not work for hand hygiene, and •Illustrate how front-line ownership can be used to bring about practice improvements.​ Click to watch the webinar recording: http://bit.ly/1yDu6c5
Published on: Mar 3, 2016
Published in: Healthcare      
Source: www.slideshare.net


Transcripts - Infection Prevention and Control Strategies in Home Care and Long Term Care

  • 1. FRONT LINE OWNERSHIP TO IMPROVE SAFETY IN LONG TERM CARE AND HOME CARE Michael Gardam Leah Gitterman
  • 2.  Link to slides for today’s call will be posted in the chat box  Call will be taped  Certificate of attendance Before We Get Started
  • 3. Interacting in WebEx: Today’s Tools Interagir dans Webex : outils à utiliser 4 Be prepared to use: - Raise hand - CHAT Have you used WebEx before? Avez-vous déjà utilisé WebEx? Soyez prêts à utiliser les outils : - lever la main - clavardage Type your message & click ‘send’ Select ‘send to’
  • 4. Lots of work has been done with hand hygiene in acute care but what about long term care and home care?
  • 5. Available Tools  Staff hand hygiene  Patient/client hand hygiene  Environmental cleaning  cleaning multiuse equipment  Vaccination  Staff sick policies  Visitor sick policies  Aseptic technique  catheter avoidance  antimicrobial stewardship  Ventilation  Surveillance  Isolation
  • 6. Acute care ≠Long term/home care ICU  multiple IV lines  Acute physical stress  Frequent recent wounds/broken skin barriers  Frequently ventilated  Frequent infections, multiple antibiotic exposures  Surrounded by very sick people  Constantly touched by healthcare workers Long term/home care  rarely any IV lines  Chronic physical ailments  May have broken skin barriers  Almost never ventilated  Rarely infected, much less frequent antibiotics  Much less and different physical contact
  • 7. Hand Hygiene Moment Acute, CCC, LTC Home Care Before contact with patient or their environment beds, chairs, patients, clients, etc Between home visits Before performing aseptic procedure as it says! Ditto After contact with body fluids as it says! Ditto After contact with patient or their environment beds, chairs, patients, clients, etc Between home visits
  • 8. Some examples from WHO guidance document
  • 9. Same principles as acute care
  • 10. culture eats strategy for breakfast
  • 11. How we think the healthcare world works: A B How most of it really works: W B BLACK BOX
  • 12. Simple Complicated Complex Types of Problems Adapted from Brenda Zimmerman
  • 13. Simple problems  One size fits all  Search for standardization  Problem solving  Checklists  Best Practices
  • 14. Complex problems  Social Immune response  One size never fits all  Multiple actions (no “one big fix”)  Paradoxes exist  Social Proof matters  Relationships matter
  • 15. This won’t work
  • 16. Minimum Specifications (simple rules)
  • 17. An approach to complex problems: Positive Deviance Increasing performance
  • 18. Positive Deviance in action 24
  • 19. RONT INE WNERSHIP Zimmerman et. al. Healthcare Papers, 2013
  • 20. Improving safety in a complex world Prevention Resilience
  • 21. How to get here? From here?
  • 22. Principles of This Work  Work with willing participants  change spreads in infinite ways  Make the invisible visible  Include the unusual suspects  Go slow to go fast  Nothing about me without me  Act your way into a new way of thinking  Things may get worse before they get better
  • 23. This work is about the HOW rather than the WHAT
  • 24. Available Infection Control Tools  Staff hand hygiene  Patient/client hand hygiene  Environmental cleaning  cleaning multiuse equipment  Vaccination  Staff sick policies  Visitor sick policies  Aseptic technique  catheter avoidance  antimicrobial stewardship  Ventilation  Surveillance  Isolation
  • 25. 31 The Hand Hygiene Hurdles
  • 26. Fall Prevention Ideas… different socks fall monitors Bedside report talking to patients stay with patients while in the bathroom “busy” aprons change blood draw time
  • 27. 0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 Q1 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Falls per 1000 patient days Total Falls Rate, ACTIVE BOZ Units BOZ Total Rate Linear (BOZ Total Rate) Linear (Baseline)
  • 28. Culture SHIFT  Taking time to think  Practice-based evidence (social proof)  Stories and relationships are trusted  Culture change is simple  Leaders need to step back  Bottom up leadership from the front-line
  • 29. “Insanity: doing the same things over and over again and expecting different results.” 38
  • 30. igniteconsulting.net leah.gitterman@uhn.ca michael.gardam@uhn.ca @DrMichaelGardam
  • 31. Instructions to download certificate 1 2 3 4 5 6 7 8 9

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