Monklands I ntensive Care An I m provem ent Journey CN Angela Ham - PowerPoint PPT Presentation

Making the Safety of Patients Everyone’s Highest Priority Monklands I ntensive Care – An I m provem ent Journey CN Angela Ham ill

Making the Safety of Patients Everyone’s Highest Priority • Increasing ev eviden ence b bas ase s e sugges esting acq acquired infec ections can can be e av avoided • Was th there re a a probl problem in in ou our r ICU? Are re ou our r pa patie tients be bein ing h g harme rmed? Surveil illa lance o of infection tions

Mouth Care

Making the Safety of Patients Everyone’s Highest Priority Learning f from d dat ata a - Epis isodes o of in infection •5 Ventilator tor A Associate ted P Pneumon onias • Pro Prompted re re- exami mination o of just o one e e elemen ement o of Ventila ilator b bundle le – Mou outh Ca Care •Ask Asked st staf aff ab about m mouth c car are r routine – va variati tion in in p pra ractice e e.g. o oro ro- phar aryn ynge geal al s suction • Created b best st prac actice p protocol d desi signed b by y st staf aff. E Expert opini nion n – oral al hygi ygienist ( (free sam samples) s)

Making the Safety of Patients Everyone’s Highest Priority • COM OMMUNIC ICATION ON! • Inv nvolve ev ever eryone e – seek k op opinion ons • Ide deas as f from e m eve veryo yone • What’s s not ot work rkin ing? g? • Volunteer eers! s!!!! !!! • Test est i idea eas u s usi sing PD PDSA A cycles es

Making the Safety of Patients Everyone’s Highest Priority • Mul Multiple c cha hang nges •Mou outh c care c chart ve t version on 10! •Toothb hbrus ushe hes ( (it was h harder t than w n we tho houg ught it woul uld be to to intr trod oduce ced) •Changed to chlo lorh rhexid xidin ine g gel •Etc tc •Etc tc •Etc tc •Now Now e every ry pa patie tient ge gets ts th the same me

Daily M outh Care Chart Date 06.00 Suction Oropharynx with suction catheter to get to back of mouth Brush teeth and gums with chlorhexidine gel and paediatric toothbrush Suction Oropharynx with suction catheter to get to back of mouth Use oral balance to moisten lips 12.00 Suction Oropharynx with suction catheter to get to back of mouth Clean mouth with chlorhexidine mouthwash Suction Oropharynx with suction catheter to get to back of mouth 18.00 Suction Oropharynx with suction catheter to get to back of mouth Brush teeth and gums with chlorhexidine gel and paediatric toothbrush Suction Oropharynx with suction catheter to get to back of mouth 22.00 – 24.00 Suction Oropharynx with suction catheter to get to back of mouth Clean mouth with chlorhexidine mouthwash Suction Oropharynx with suction catheter to get to back of mouth AT ANY TIM E Use oral balance to moisten lips DENTURES Clean with Chlorhexidine mouthwash DISCUSS With consultant if needs dental referral After 7 days or once extubated introduce non foaming toothpaste once a day at 10am (eg pro-enamel or sensodine gel) use as required if eating and drinking. Do not use chlorhexidine gel and toothpaste at the same time.

Monklands Hospit al I nt ensive Car e Unit Protocol f or Oral Hygiene Aim: To promot e pat ient comf ort , prevent accumulat ion of dent al plaque and colonisat ion of oral mucosa. This prot ocol helps t o reduce t he risk of pneumonia. All it ems used are eit her ' single use it ems' or single pat ient use it ems' . As part of t he admission procedure each pat ient should be given a bot t le of Chlorhexidine mout hwash, a t ube of Chlorhexidine gel 1% and a t ube of Oral balance. Put t he pat ient s' I D st icker on each of t he it ems and eit her send t hem t o t he ward wit h t he pat ient or dispose of t hem on discharge. Wash hands, wear gloves and explain procedure t o pat ient . Perf orm t he mout h care as described on t he inst ruct ions and sign chart . Top Tip : Place a pea size blob of t he gel on t he back of your hand. Dividing t he mout h int o quadrant s apply t he gel equally. Af t er t he procedure t he t oot hbrush should be rinsed wit h st erile wat er f irst and t hen wit h t he Chlorhexidine mout hwash. I t should placed upright in a whit e disposable cup t o dry. When dry it can be st ored in t he drawer. Clean dent ures wit h Chlorhexidine mout hwash. AH. AMcS. I P. SC February 2011 Review J anuary 2015

Average length of Stay on a ventilator Monklands I CU - A Reduction of 1 day Median ALOS Vent VAP Bundle Com pliance Median VAP Bundle Com pliance 1 1 1 0 5 9 8 5 4 .8 7 6 5 3 .6 5 4 5 3 2 5 1 5 -2 -1 5

Making the Safety of Patients Everyone’s Highest Priority • Involv olve e everyon one • Use pe peopl ople’s ide ideas…the grou group kn p know ows more more th than a an in indiv dividual • Has to be to be ‘ow owned’ d’ by by th the te team • Lear earn from p pat atien ent outco comes es e. e.g. infect ections • Sh Share re th the da data ta, a and d ma make ke it it me meanin ingful • Be p e pat atien ent - For or a lon long g time time, it it will s ill seem like m like nothi hing ng i is changing ng