Project JOINTS Exemplar Hospital Application

Willamette Valley Medical Center – McMinnville, Oregon

Number of licensed beds: 88

Non-teaching

Rural

Exemplar Hospital Contact Name: Natalie Reed

Email:

Phone: 503-435-6571

[ x] We give permission to IHI to make public all the information on this Project JOINTS Exemplar Hospital application.

Enhanced Surgical Site Infections Prevention Bundle element: Bathing or showering with chlorhexidine gluconate (CHG) soap for at least three days before surgery

What key changes did your organization make to incorporate or support bathing or showering with CHG soap for at least three days before surgery? What were the changes in existing processes your organization had to make in order for this to become part of the routine?

o  We have been instructing patients to use hibiclens cleanser two times prior to surgery since the opening of our Joint Replacement Institute in June 2010. Patients receive their bottles of hibiclens when they come to their pre-admit appointment. Prior to joining Project JOINTS, we did not provide written instructions, did not track use and did not specify if this included the morning of surgery.

o  Since joining Project JOINTS, we have changed our instructions to 3 days prior to surgery including the morning of surgery. We now provide patients with written instructions and track compliance. The instructions are briefly discussed at the patient’s pre-admit appointment and then are discussed in further detail at their pre-op class two weeks prior to surgery. We added new fields to the nursing pre-procedure checklist to allow nurses in Short Stay to document if the patient showered with hibiclens cleanser 3 times prior to surgery, including the morning of surgery. If the patient did not, they assist patients in using the Sage wipes in Short Stay. Because we are tracking compliance, we can adjust our instructions if needed.

How did you roll out this practice? Did you test it with one patient, a few, or all to start?

o  We started by discussing this change in our monthly team meeting so that pre-admit, short stay, orthopedic surgeons and clinic staff were aware of the change. For the first month, we changed our instructions to three days, including the morning of surgery, and worked on providing consistent messaging to patients. Short stay staff was trained on how to use the Sage wipes, and after the first month, we added using the Sage wipes in Short Stay the morning of surgery for non-compliant patients.

What lessons have you learned as you've implemented this practice? What tips do you have to share?

o  It is incredibly important to educate both patients and staff as to why this process is important to improve compliance. Consistent messaging to patients is critical.

Measurement

Measurement provides information on whether the changes made to implement the Enhanced Surgical Bundle are resulting in improvement. In any improvement initiative, the ultimate goal is to improve an outcome measure (e.g., reduce SSIs); hospitals and surgical practices will accomplish this by first improving the processes that are key drivers.

Please provide for us any information you can regarding compliance with process measures, in this case:

Q2 (from when we started tracking compliance): 86%

Q3 to-date: 96%

Numerator Definition: Number of patients undergoing hip or knee replacement surgery who have bathed or showered with chlorhexidine soap or wipes for at least the three days prior to surgery

Denominator Definition: Number of patients undergoing elective hip or knee replacement surgery