As a Quality Improvement Advisor for the Improving & Driving Excellence Across Sectors (IDEAS) Program, I have the pleasure of working with different health care teams as they embark on projects to improve the quality of health care in their organization through the Advanced Learning Program. This program is designed to equip health care professionals with the knowledge, skills and tools to lead quality improvement initiatives.
In our most recent cohort of teams, the Kristus Darzs Latvian Long-Term Care Home joined the IDEAS Advanced Learning Program to work on a Quality Improvement project.
Improving infection prevention and control
Respiratory and enteric infections among long-term care residents may lead to serious health problems, including death, due to frailty and compromised health status.
Kristus Darzs Latvian Long-Term Care Home decided to tackle this issue by developing the following aim statement:
- By April 30, 2019 the home will reduce the number of residents with respiratory and enteric symptoms by 50% compared to baseline.
Diagnosing the issue
At the onset of the project, the team worked on a Driver Diagram to demonstrate the relationship between the aim statement and the most important factors contributing to its achievement.
By engaging front line staff, the team created a Process Map identifying the critical points in workflow as they relate to the spread of infection. This discussion identified a range of reasons causing the spread of infections that was illustrated in the Fishbone Diagram below.
Click to see a
larger version of the
Fishbone Diagram.
Change ideas
Using dot stickers, staff helped identify the vital few causes that were then categorized into an Impact Effort Matrix to help select the change ideas for testing.
- Test of change # 1. Implement multi-disciplinary shift reports
- Test of change # 2. Empower front line staff to isolate symptomatic residents
Preliminary results
The first test of change, the multi-disciplinary shift report, highlighted the importance of effective communication across all departments. This intervention raised awareness of symptomatic residents and the necessary precautions to minimize the spread of infection. Staff interviews confirmed that when conducted mindfully, the multi-disciplinary shift report promoted awareness, which in turn, positively affected staff behaviour in relation to infection control practices.
The second test of change focused on identifying and isolating symptomatic residents in a timely manner. To do so, Personal Support Workers, Housekeepers and Activation Aides were empowered to isolate symptomatic residents until Registered Staff could assess them.
After testing the first change idea, the run charts showed a drastic increase in symptomatic residents. Likewise, there was a dramatic drop in symptomatic residents after testing the second change idea. Because of the small population size, limited historical data, seasonality of outbreaks, and highly variable nature of outbreak frequency and intensity, it is not possible to attribute change in respiratory and enteric symptoms to the tested change ideas at this time.
Next steps
Team member Inese Pogule, Quality Lead shares:
“To ensure that our efforts to minimize the spread of infection continue after the IDEAS project officially ends, we plan to:
Include infection control on our 2019-2020 Quality Improvement Plan
- Continue working with our IDEAS advisor
- Improve upon the delivery of the multi-disciplinary shift reports
- Continue to collect and monitor data on infections, and communicate results with staff and senior leaders of the organization”
Lessons learned
Inese Pogule shares:
“What we learned was to test one intervention at a time and to resist the temptation to implement an intervention without fully testing it. Although the effectiveness of our change ideas weren’t statistically verified, we will continue our efforts to tackle this complex issue knowing that quality improvement takes patience and time.”
Do you work in long-term care?
You may be interested in our quality improvement stories featuring the work of long-term care homes across Ontario.