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How Helen DeVos Children’s Hospital created a fantastic and influential approach for the CLABSI Prevention Bundle using a lean tool

This is the beginning of a new era. At one point in time, hospitals really weren’t sure if they should standardize healthcare. “When we started the SPS Network, we weren’t sure what the right thing to do was, so we encouraged hospitals to standardize whatever they were already doing,” said Dr. Steve Muething, SPS Clinical Director. “Since then, we have gathered evidence from our Network hospitals that shows that there are very specific things that when done reliably, 90% of the time, make a difference. We have statistical evidence that shows if we do the SPS Prevention Bundles for the HACs, we will significantly reduce harm.”

For Spectrum Health Helen DeVos Children’s Hospital, ensuring adherence to the SPS Prevention Bundles has become a key focus of their hospital staff. This hospital has created a process that has enabled them to go from submitting data to SPS for one Hospital-Acquired Condition (HAC) Prevention Bundle to submitting data for five HAC Prevention Bundles in just four months, along with having in-the-moment interactions with frontline staff on prevention bundles.

Helen DeVos Children’s Hospital began their safety journey in 2007 with a hospital leadership that was steadfast in making safety their top priority. When SPS introduced Hospital-Acquired Conditions to Helen DeVos Children’s Hospital in 2013, the hospital knew they needed to focus on preventable harm and HACs, but how to get there was not clear at the time. “We knew improvements to our HACs were not going to come easy,” said Dr. Leslie Jurecko, Medical Director for Quality and Safety at Helen DeVos Children’s Hospital. “We decided to challenge ourselves by both gathering the process data and having an opportunity to round to influence at the same time.”

The small safety and quality team partnered with their health system’s process improvement team. In order to make improvement happen, the team spent a lot of time engaging middle management. Dr. Jurecko highlighted, “There is not a quality team in the country that can do this work without the engagement of your middle management.”

With the support of middle management, the team piloted “Kamishibai Card rounding.”  Kamishibai cards are often used in manufacturing as a visual control for performing audits. These are a series of cards that are placed on a board. The cards are selected at random but completed each day according to a schedule determined by the leadership of the area.

The Helen DeVos Children’s Hospital team developed “Kamishibai Cards” (i.e. “K Cards”) for four HAC Prevention Bundles. The cards include audit questions for the auditor to ask, audit details, follow-up details, and instructions for the auditor to follow when the encounter is complete.

For example, when completing the CLABSI K Card, the auditor (unit leader, safety coach, or executive) performs the first part of the interaction at the computer with the nurse to review the documentation and completion of the care of the catheter. The next step occurs at the bedside with the auditor and nurse, where the nurse has an opportunity to correct any of the elements that were not completed in the moment. Once the interaction between the auditor and the nurse is completed, the completed K card is placed next to the Managing for Daily Improvement (MDI) Board, a learning board that resides in the staff lounges in each of the units. The auditor documents his/her findings at the MDI board, allowing the team to easily see the monthly percent of compliance, trends in missed opportunities, and the follow-up actions that need to be taken. To spread the learnings as well as vet out solutions to the barriers found, the daily learnings from the K card rounding are discussed at the unit and hospital-wide huddles.

The Helen DeVos Children’s Hospital team started with a goal of doing just four cards per unit, per day. This is just one card a day for each HAC. The team initially piloted this without any formal training. Helen DeVos Children’s Hospital has seen impressive results and numbers. In just three short months, the hospital had 393 interactions on the CLABSI Prevention Bundle alone and 1590 total interactions. The team started with a small, realistic goal that spread as the hospital’s units voluntarily performed many more audits than were required.  Jen Liedke, Patient Safety Consultant at Helen DeVos Children’s Hospital stated, “Everyone is more aware and has increased their focus around preventing HACs. The increased transparency, report out and tracking at DCI has been a great opportunity to identify barriers and make improvements.”

The benefits to adopting the K Cards have far exceeded the costs this small team incurred to get to where they are today. The benefits of this approach are numerous, to name a few: awareness and transparency on HACs; face-to-face interaction with frontline staff, leaders, and executives; identification of barriers and implementation of interventions; leadership involvement; real-time data; and a clear and simple process. Dr. Jurecko quotes, “We are really proud of this work, and it goes to show that with just a few small tools in hand and engagement of leaders, you can drive this work overnight!”

The SPS Network hospitals as a whole have seen substantial progress on the 1@90 goal to get one of aviator HACs to 90% reliability by December 2014. The Network’s next stop: 4@90 in 2015, 90% reliability in four HACs in 2015. The Helen DeVos Children’s Hospital has generously shared all of their templates with Network hospitals.

As Dr. Anne Lyren, SPS Co-Clinical Director shares, “We know what we need to do. We have prevention bundles that have shown to prevent harm, and Helen DeVos Children’s Hospital has shared with us a simple, inexpensive, quick, and effective way to approach obtaining the data and then doing it in a way to foster learning.”

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