On 9/1/2009 Debbie Nadzam said:

Thank you everyone for participating today. We look forward to our next interactive session on Tuesday, September 15th. Should you have any questions or would like more information on Chapter 6 of the Antibiotic Resistance Toolkit, please feel free to contact me at dnadzam@jcrinc.com. Have a good week and wash your hands! Debbie

On 9/1/2009 Debbie Nadzam said:

Bryan, With regard to your question about PICC insertions. My colleauge Barb Soule has responded to my question to her - and she knows of no such requirements coming, as you have outlined. However, it may be best to contact TJC's standards interpretation group to confirm this (630-792-5900). Barb and Louise Kuhny from Joint Commission's standards department recently held an audio conference on the NPSGs related to infection, and these were not requirements discussed.

On 9/1/2009 Debbie Nadzam said:

Nancy, I can appreciate your dilemma when software is not available. For the best solution, I am going to ask you to contact Barb Soule, JCR's Practice Leader for Infection Prevention. You can email her at bsoule@jcrinc.com. She has visited many health care organizations and will likely have a great suggestion for you!

On 9/1/2009 Debbie Nadzam said:

Dennis, In the leadership standards, there are expectations that medical staff members have access to the Board, so engaging your medical staff leaders to present to the Board may be one way to address your concern. However, making a strong case to the Executive Team about MDROs,showing them the data(see last blog comment), and implementing a strong, successful program to minimize the risk of MDROs will help leaders take the issue to the Board too. Leaders will share concerns that they (the leaders) are also concerned about and want to fix; and they certainly want to share success with the Board.

On 9/1/2009 Debbie Nadzam said:

Fiorella, Leaders care about patient outcomes and financial outcomes. They know that BOTH are important to the organization's success and reputation. But you need to show them data- in a succinct, but comprehensive manner. And better yet, have a well respected member of the medical or nursing staff show them the data. The data may include actual counts of patients who experienced an MDRO while hospitalized - show the difference in length of stay between these patients and other similar patients who did NOT have an MDRO. Show the differences in costs; engage your finance director to help you find these data. Your leaders want to know if there are patient problems, as well as issues that affect the financial bottomline. A strong message can be sent if finance and clinical staff bring the issue to leaders as a team.

On 9/1/2009 Nancy Johnson said:

I work at a small surgical hospital and have no software available to enable me to provide infection rates for physician or per services. We are supposed to provide data to stock holders regarding infection rates and MDRO rates. Could you recommend how I can provide information to stake holders?

On 9/1/2009 Debbie Nadzam said:

Pam, As written, the NPSG EPs related to the alert system for MDROs (NPSG.07.03.12 and NPSG.07.03.13) do not limit the system to certain MDROs, or only those defined as such by the hospital. Since an alert system is intended to identify any patient (new or readmitted or transferred)that brings this risk, it should be comprehensive.

On 9/1/2009 Dennis Gumphrey said:

How do we ensure leadership has our Board of Directors "on board" with respect to MDROs?

On 9/1/2009 Fiorella Salzar-Vargas said:

How can we bring MDROs to Senior Leaders' attention when they have so many priorities?

On 9/1/2009 Pam Bierbaum said:

In regards to the MDRO NPSG.... What is the expectation re: the alert system that identifies readmitted or transferred patients? Does the process address only those organisms that as a hospital our risk assessment indicates is a problem area? Or does the alert need to be in place for all MDROs? We currently have a system for this for all MDRO's at the time of transfer. Readmitted pts are identified for MRSA and VRE only.

On 9/1/2009 Debbie Nadzam said:

Monica, Readiness for change can be assessed using specific survey instruments, such as the Organizational Capacity for Change survey. Readiness for change is closely related to the organization's culture. A few main issues of import include leaders and staff trust of each other; communication within the organization; capable champions for change who know HOW to implement change; effective managers who support change, while also getting the work done on a daily basis; and a culture that supports innovation while also holding staff accountable. Again, the ability to use data to evaluate performance is also a critical component of readiness for change.

On 9/1/2009 Debbie Nadzam said:

Kurt, Well that is a great question and we talk all day about it! But a few of the most important points: - be sure you have leadership support for the project, including an executive champion who can serve as the communicator with the leadership team. - be clear about the objective of the project - involve the staff who are closest to the issue, for they will help identify primary reasons the process is not working well. In addition, they will help to design a solution that they can committ to implementing. - identify the root cause(s) of the unacceptable level of performance before trying to design a solution. You want to be sure your solution is targeting the problem. - use data! measure before, during and after to assess effectiveness. THere is much more we can talk about on this issue!

On 9/1/2009 Monica Stewart said:

What is the best way to assess an organization's readiness for change?

On 9/1/2009 Kurt Fry said:

How can the quality office and IPC design an improvement project to reduce MDRO infections that will be effective and sustained?

On 9/1/2009 Debbie Nadzam said:

Betty, Thank you for asking about the two-dimensional model. When implementing a performance improvement project, two types of expertise are necessary- the two dimensions of Competence and Improvement Capability. Competence requires expertise in the particular area of concern (for example - expertise in infection prevention and control for MDRO related projects). Improvement Capability requires expertise in performance improvement activities (for example, how to measure, PDCA, six-sigma, team facilitation, data display, RCA). Both skill sets are necessary to best address a performance issue of concern.

On 9/1/2009 Debbie Nadzam said:

Betty, Thank you for asking about the two-dimensional model. When implementing a performance improvement project, two types of expertise are necessary- the two dimensions of Competence and Improvement Capability. Competence requires expertise in the particular area of concern (for example - expertise in infection prevention and control for MDRO related projects). Improvement Capability requires expertise in performance improvement activities (for example, how to measure, PDCA, six-sigma, team facilitation, data display, RCA). Both skill sets are necessary to best address a performance issue of concern.

On 9/1/2009 Debbie Nadzam said:

Margaret, Surveyors certainly ask patients and families about their involvement in care and about the education received. When a standard states that the patient/family is to be included or educated, then you can expect that the surveyor may very well ask, including to see the material that is provided.

On 9/1/2009 Betty Madison said:

In your audio you described a two-dimensional model of performance challenges: competence and improvement capability - would you please explain the difference in the two dimensions.

On 9/1/2009 Debbie Nadzam said:

Bryan, Thank you for this question. To be sure, we are checking on this issue, and will get back to you as soon as we get the correct answer... hopefully still during this blog time!

On 9/1/2009 Margaret L Reyes said:

Do THC surveyors interview patients and families about IC education provided upon admission. Are questions specific to isolation precautions, wounds, safety and signage? Do they ask about any hand-out materials offered?

On 9/1/2009 Bryan Rogers said:

Good morning, Regarding Central Line Infections, there has recently been some talk of TJC requiring a 2nd person in the room during PICC insertion (nurse, physicain, or other healthcare personal)who has received appropriate education to ensure that aseptic technique is maintained. Is this a requirement? Will this be? Should PICC insertion be defined as an invasive procedure, requiring timeout and consent? Thank You!