Quality Improvement Activity
Below is a selection of Quality Improvement Projects undertaken within Cardiff Critical Care.
Innovation of Eye Care of the critically ill patient within ICU [Coles et al, 2021]
QI Team: Victoria Coles, Louise Ludlam, Sophie McClure, Debbie Davies and Katie Hook
Motivation: - Quality improvement (QI) is a systemic multi-dimensional approach to ensure the care provided by health professionals is safe, effective, person-centred, timely, efficient and equitable. (The Health Foundation 2013) Within critical care, standards are set by organisations to provide up to date good quality care to all patients.
The problem: - The author identified an increase in eye injuries during the Covid 19 pandemic within ICU requiring ophthalmology intervention. Eye injury ranged from minor injuries to severe, and complications were exacerbated due to workload and greater number of inexperienced staff.
The Intensive Care Society (ICS) endorsed a guideline to prevent eye injury and increase education surrounding the subject. Variability is still significantly affected in practice with the authors unit demonstrating a low compliance compared to ICS standards of >90% compliance.
The study design: - Ocular surface disease is common within the authors practice with 20–42% of patients developing corneal epithelial defects (Johnson & Rolls 2014). Cases highlighted as ‘avoidable harm’ within the authors area of practice could have been prevented with a standardised approach to care. Despite the high number of patients effected by this issue there is a severe lack of education and documentation surrounding eye care within ITU.
The team implemented structured educational guidance and documentation to improve compliance within ITU to reach ICS standards. Measured compliance through 3/6/12 monthly audit
Prediction and results: - Aim of study was to increase unit compliance to ICS standards of >90% compliance. First 3 monthly audits identified a significant increase in compliance. 6 monthly audits achieved compliance. Current aim is to continue to achieve 100% compliance within the ICU.
Conclusion: - The study identified a significant problem in ICU that was causing avoidable patient harm. The results of this QI project are generalisable to other areas by increasing patient safety and staff education on the potential harm of ineffective eye care within ICU.
Early data collection identifies high compliance despite the Covid-19 pandemic. More research and work are needed to develop and raise awareness eye care in the critically ill. (292)
Submitted to BACCN 2021
Intensive care society. 2020. Eye care in the intensive care. Available at: unithttps://www.rcophth.ac.uk/wp-content/uploads/2020/04/Eye-Care-in-the-Intensive-Care-Unit-2020.pdf
Johnson, K & Rolls, K. 2014. Eye Care for Critically Ill Adults, Version 2. Chatswood, NSW: Agency for Clinical Innovation, pp.1–43.
The Health Foundation. 2013. Quality improvement made simple.
Chlorhexidine bathing compliance to reduce unit acquired infections [Peters et al, 2021]
QI Team: Shiela Capulso, Christy Viliruz, Gigi Enriquez, Jo Peters.
The purpose of the quality improvement project was to increase the compliance of chlorhexidine (CH) bathing to 90% in a large ICU in a tertiary UK hospital.
CH bathing can be beneficial in preventing colonisation and infection with healthcare associated pathogens in critical care, although compliance should be monitored. Unit acquired bacteraemia had increased in our ICU as shown in our Intensive Care National Audit & Research Centre (ICNARC) data. This project was to ensure high compliance with CH bathing to minimise the risk of these infections. CH bathing is recommended in the Guidelines for the Provision of Intensive Care Services.
The team followed SMART criteria to plan and support the project. The use of PDSA cycles was used to assess and maximise compliance with daily CH washes in eligible patients. Audits were carried out during the course of day shifts when patient bathing is usually undertaken. The number of patients who received CH baths and those who did not was recorded as well as reasons why in those who did not. The data was collected and reviewed each week by the team followed with solutions for non-compliance being discussed and implemented.
Over the course of the project, compliance in CH bathing increased to achieve our aim although this was not a steady increase with several challenges encountered. There was a lack of awareness especially among new staff, issues with access to resources and changes in nursing priorities. The PDSA actions included increased education, improved documentation and ensured access to CH wipes throughout the unit.
The ability to flag high bacteraemia rates via ICNARC was a successful trigger to improve CH bathing in our organisation. The use of PDSA cycling was successful in improving CH bathing compliance. The authors will continue auditing routinely to ensure standards are maintained.
Submitted to BACCN 2021
Donskey, C.J. and Deshpande, A. 2016. ‘Effect of chlohexidine bathing in preventing infections and reducing skin burden and environmental contamination: A review of the literature’, American Journal of Infection Control, 44, Suppl2, e17-e21. [Online] Available at: https://www.ajicjournal.org/article/S0196-6553(16)00200-5/fulltext
Faculty of Intensive Care Medicine. 2019. Guidelines for the Provision of Intensive Care Services. [Online] Available at: https://www.ficm.ac.uk/sites/default/files/gpics-v2.pdf
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