Zubkoff Lisa, Neily Julia, King Beth J, Dellefield Mary Ellen, Krein Sarah, Young-Xu Yinong, Boar Shoshana, Mills Peter D
Health Science Specialist, White River Junction Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont; Assistant Professor of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
VA National Center for Patient Safety (NCPS), White River Junction.
Jt Comm J Qual Patient Saf. 2016 Nov;42(11):485-AP2. doi: 10.1016/S1553-7250(16)42091-X. Epub 2016 Nov 9.
In 2014 the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) implemented a Virtual Breakthrough Series (VBTS) collaborative to help VHA facilities prevent hospital-acquired conditions: catheter-associated urinary tract infection (CAUTI) and hospital-acquired pressure ulcers (HAPUs).
During the prework phase, participating facilities assembled a multidisciplinary team, assessed their current system for CAUTI or HAPU prevention, and examined baseline data to set improvement aims. The action phase consisted of educational conference calls, coaching, and monthly team reports. Learning was conducted via phone, web-based options, and e-mail. The CAUTI bundle focused on four key principles: (1) avoidance of indwelling urinary catheters, (2) proper insertion technique, (3) proper catheter maintenance, and (4) timely removal of the indwelling catheter. The HAPU bundle focused on assessment and inspection, pressure-relieving surfaces, turning and repositioning, incontinence management, and nutrition/hydration assessment and intervention.
For the 18 participating units, the mean aggregated CAUTI rate decreased from 2.37 during the prework phase to 1.06 per 1,000 catheter-days during the action (implementation) phase (p < 0.001); the rate did not change for CAUTI nonparticipating sites. HAPU data were available only for 21 of the 31 participating units, whose mean aggregated HAPU rate decreased from 1.80 to 0.99 from prework to continuous improvement (p < 0.001). Staff education and documentation improvement were the most frequently implemented changes.
This project helped improve CAUTI and HAPU rates in the VHA and presents a promising model for implementing a virtual model for improvement.
2014年,美国退伍军人事务部(VA)的退伍军人健康管理局(VHA)实施了一项虚拟突破系列(VBTS)合作项目,以帮助VHA设施预防医院获得性疾病:导管相关尿路感染(CAUTI)和医院获得性压疮(HAPU)。
在前期准备阶段,参与的设施组建了一个多学科团队,评估其当前预防CAUTI或HAPU的系统,并检查基线数据以设定改进目标。行动阶段包括教育电话会议、指导和每月团队报告。通过电话、基于网络的方式和电子邮件进行学习。CAUTI综合措施侧重于四个关键原则:(1)避免留置导尿管,(2)正确的插入技术,(3)正确的导管维护,以及(4)及时拔除留置导尿管。HAPU综合措施侧重于评估和检查、减压表面、翻身和重新定位、失禁管理以及营养/水分评估和干预。
对于18个参与单位,CAUTI的平均综合发生率从前期准备阶段的2.37降至行动(实施)阶段的每1000导管日1.06(p<0.001);未参与CAUTI项目的地点发生率没有变化。HAPU数据仅适用于31个参与单位中的21个,其HAPU平均综合发生率从前期准备阶段到持续改进阶段从1.80降至0.99(p<0.001)。员工教育和文件改进是最常实施的变革。
该项目有助于提高VHA中的CAUTI和HAPU发生率,并为实施虚拟改进模型提供了一个有前景的模式。