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

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

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Making the Safety of Patients Everyones Highest Priority Monklands I ntensive Care An I m provem ent Journey CN Angela Ham ill Making the Safety of Patients Everyones Highest Priority Increasing ev eviden ence b bas ase s e

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SLIDE 1

Making the Safety of Patients Everyone’s Highest Priority

Monklands I ntensive Care – An I m provem ent Journey CN Angela Ham ill

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SLIDE 2
  • 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

  • ur

r ICU? Are re ou

  • ur

r pa patie tients be bein ing h g harme rmed? Surveil illa lance o

  • f infection

tions

Making the Safety of Patients Everyone’s Highest Priority

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SLIDE 3

Mouth Care

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SLIDE 4

Learning f from d dat ata a - Epis isodes o

  • f in

infection

  • 5 Ventilator

tor A Associate ted P Pneumon

  • nias
  • Pro

Prompted re re- exami mination o

  • f just o
  • ne e

e elemen ement o

  • f

Ventila ilator b bundle le – Mou

  • uth 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

  • ro

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

  • pini

nion n – oral al hygi ygienist ( (free sam samples) s)

Making the Safety of Patients Everyone’s Highest Priority

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SLIDE 5
  • COM

OMMUNIC ICATION ON!

  • Inv

nvolve ev ever eryone e – seek k op

  • pinion
  • ns
  • Ide

deas as f from e m eve veryo yone

  • What’s

s not

  • t 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

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SLIDE 6
  • Mul

Multiple c cha hang nges

  • Mou
  • uth c

care c chart ve t version

  • n 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

  • duce

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

Making the Safety of Patients Everyone’s Highest Priority

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SLIDE 7

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.

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SLIDE 8

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

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SLIDE 9
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SLIDE 10

4 .8 3 .6

  • 1 5

5 2 5 4 5 6 5 8 5 1 0 5

  • 2

1 3 5 7 9 1 1

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

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SLIDE 11
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SLIDE 12
  • Involv
  • lve e

everyon

  • ne
  • Use pe

peopl

  • ple’s ide

ideas…the grou group kn p know

  • ws more

more th than a an in indiv dividual

  • Has to be

to be ‘ow

  • wned’

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

  • r a lon

long g time time, it it will s ill seem like m like nothi hing ng i is changing ng

Making the Safety of Patients Everyone’s Highest Priority