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Checklist overlap: Prevention of Surgical Site Infection and Venous Thromboembolism Marlies van Dijk, Western Node Leader Safer Healthcare Now! Safe Surgery Saves Lives – March 4, 2009 Safer Healthcare Now! Started in 2005 • Provide support to healthcare teams to implement evidence based practice (10 interventions) • Getting Started Kits, Tools, Measurement worksheets • Web platform: Communities of Practice • Over 1000 National Clinical Teams working on various interventions • 177 SSI teams (229 surgical procedures) – since 2005 • 13 VTE teams (New intervention in 2008) Supports the Checklist • Systematic way of looking at the problems • Establishing communication • Breaking Silos Checklist opens the door : - Universal framework for surgical care - To build stronger teams - To speak up! - Bringing patient safety culture into the OR Patient positioning and support / Warming devices ASA Class Postoperative glucose and temperature Expected procedure time Medications - Antibiotic prophylaxis: double dose? - Glycemic control - Anticoagulant therapy (e.g., Warfarin)? -Antibiotic Prophylaxis: Repeat dose? -Normothermia? VTE Prophylaxis - Anticoagulant - Mechanical Perceptions vs. Reality Current Status? • Antibiotic Admininstration within 60 minutes of incision ~ 50% (Bratzler) • Antibiotic Discontinuation within 24 hrs of surgery end time ~ 40% (Bratzler) • Normothermia; one dedicated team; taken it from 30-70% over a 2 year period Routine Use of Recommended Prophylaxis in Canadian Hospitals 100% Appropriate use 75% The care gap 50% 25% 0 94% 86% 36% 33% 30% 32% 11% W. Geerts Interested in Quick and Sustainable Results • 40-60% of SSI are preventable • Antibiotics within 60 minutes of incision is essential • Maintain normothermia during surgery • Easy wins and affordable • Implementing preprinted order sets for DVT Tips for Implementation • Time to consolidate our efforts! • Quick cycles of the improvement model have worked for SSI • Solutions to match local environment • Present your business case to leadership • Pockets of excellence – but now what … • Time sensitive …. saferhealthcarenow.ca Surgical Site Infection Lead Dr. Claude Laflamme, Director of Cardiac Anesthesia/TEE, Sunnybrook Health Sciences Centre Venous Thromboembolism Lead Dr. William Geerts, Senior Scientist, Sunnybrook Health Sciences Center Marlies van Dijk Western Node Leader Safer Healthcare Now! [email protected]