Deployed system redesign lean principles and Change Management strategies to move key stakeholders from buy-in to ownership were used effectively to roll-out best practice management of C-diff in acute care and nursing home community living centers (NHCLC). Reduction in C-diff rates demonstrated a challenge because the denominator was small so the slightest increase in numerator influenced the overall performance matrix. From FY19 FY20, the C. diff rate increased from 5.16% to 7.24% in acute areas and from 1.6% to 2.8% in the NHCLC. These rates exceeded the internal and community C-diff rates for acute (4.89) and NHCLC (0.00).
Problem: Gap analysis and process map of current state reflected inconsistent ordering of screening, Bristol scale not followed and difficult to access, inconsistent process for terminal room cleaning, inability to differentiate carrier vs. active infection, variation in knowledge and role of C-diff management in all disciplines.
Measurement: VA Community Care Compare (VAC3) Acute Care rate of hospital onset C-Diff. NHCLC resident onset of c-diff per 10,000 bed days of care. Limitations were PCR versus 2 step testing process. A control chart was used to evaluate internal best and community comparison for improvement points and stability of processes.
Analysis :A Pick Chart was used to prioritize impact and effort of pre-posed interventions. Pre-post test, algorithms to facilitate decision making along with just in time re-teaching and evaluation were the hall marks of the methodology. Basics statistics were used to determine outcomes and reinitiation of the feedback loop.
Implementation: Used huddle boards to create the climate of ‘ownership’, developed standardized order set, badge buddy Bristol scale, RN C-Diff assessment note, standardized physician and direct care staff education, amended Lab contract to add second of EIA Toxin Testing, revised EMS cleaning process and deployed moon beams back to designated units.
Results/Discussion: VA Community Care Compare (VAC3) Acute care rate of hospital onset C-diff improved FY2022 (5.47) to FY2023 (0.00). NHCLC resident onset C-diff rate FY2022 (0.74) to FY2023 (0.32). The improved process was handed over to the Process Owner after 90 days of sustainment. HAI-infections are included on the C-suite dashboard.
