BackgroundCatheter-associated urinary tract infection (CAUTI) is one of the most common hospital-acquired infections. The use of urinary catheters is associated with several complications and increased mortality and morbidity. At the coronary intensive care unit (CICU) of a tertiary cardiac care facility, the CAUTI rate was 7.6/1000 catheter days in January 2017. In collaboration with the Institute for Healthcare Improvement, we implemented evidence-based practices in the form of bundles based on the value improvement methodology to eliminate CAUTIs in the CICU.MethodsThis initiative aimed to reduce the CAUTI rate using a multifaceted approach. The key interventions were empowering front-line nurses for automatic stop orders and ensuring compliance to the catheter insertion and maintenance bundles. We used a model for improvement and tested the changes using small plan–do–study–act cycles. Surveillance methods and CAUTI definitions proposed by the National Healthcare Safety Network were used to monitor the outcomes. Monthly rates of CAUTIs 24 months before the intervention were compared with those 44 months after the intervention using an independent t-test. Statistical significance was set at p<0.05.ResultsThe rate of CAUTIs dropped from 7.6 per 1000 catheter days in January 2017 to 0 from October 2021 to August 2022. The unit had achieved 280 calendar days free of CAUTI untill August 2022.ConclusionsBehavioural changes, including empowerment of nurses and adherence to all elements of the care bundle, led to significant and sustained improvement in reducing the CAUTI rate in the adult CICU.

Background/Aims The COVID-19 pandemic challenged not only global healthcare systems, but also educational systems, with many large, in-person training programmes being suspended. Instead, virtual learning platforms have been used, with promising results. This study explored the effectiveness of a virtual quality improvement training programme in a healthcare setting. Methods A 6-week interprofessional virtual quality improvement training programme was developed and delivered to a total of 137 participants across three cohorts. Pre- and post-programme surveys were administered to assess knowledge gained from training. Focus groups were also conducted for more in-depth feedback about the sessions. Information was then collected regarding any quality improvement projects participants had undertaken after completing the training. Results Mean scores were higher in the post-programme than the pre-programme survey across all knowledge domains (P<0.001, Cohens d=6.63). Over 80% of participants reported that the training improved their understanding of and confidence in undertaking a quality improvement project, and that they would recommend the training to their colleagues. Participants went on to either lead or contribute to a variety of quality improvement projects across a wide range of specialisms. Conclusions The virtual quality improvement training programme is an effective method of teaching, leading to participants being able to demonstrate competency in quality improvement. This approach to training delivery represents an efficient alternative to in-person training for building capability in frontline healthcare staff.

Background: Clinical laboratories play a vital role in patient diagnosis and management. However, blood specimens may be rejected for a variety of reasons, which may have substantial clinical consequences for patient safety. The quality team observed significant numbers of rejected samples from the emergency department and inpatient units due to hemolysis. A total of 1.43% of the blood samples were rejected, which was considerably higher than the target of 0.4%. Methods: This project aimed to reduce the percentage of rejected blood samples from 1.43% (measured between January 2015 and April 2016) by 50% in the emergency department and the coronary ICU by December 2017. The team identified preanalytical errors as the primary reason for rejections. A multidisciplinary team was formed and tested several changes, including phlebotomy education, competency validation by direct observations, the use of appropriate consumables for sampling, and physician education for proper orders.. All specimens sent for blood chemistry, arterial blood gas analysis, hematology, and coagulation tests were included. Microbiology test specimens and point-of-care testing samples were excluded. Results: The percentage of rejected blood samples dropped from 1.43% (January 2015-April 2016) to 0.47% in 2018, which was a statistically significant reduction (p < 0.001). Conclusion: Using a quality improvement approach for the detailed analyses of specimen rejection rates and related issues helped to formulate efficient plans to target this issue. Weekly rapid cycle improvements from January 2018 helped to achieve the team's goals quickly and had a major impact in combination with other interventions.

Background Central venous catheterisation is commonly used in critical patients in intensive care units (ICU). It may cause complications and attribute to increase mortality and morbidity. At coronary ICU (CICU) of cardiac hospital, central line-associated bloodstream infection (CLABSI) rate was 2.82/1000 central line days in 2015 and 3.11/1000 central line days in 2016. Working in collaboration with Institute for Healthcare Improvement (IHI), we implemented evidence-based practices in the form of bundles in with the aim of eliminating CLABSI in CICU. Methods In collaboration with IHI, we worked on this initiative as multidisciplinary team and tested several changes. CLABSI prevention bundles were tested and implemented, single kit for line insertion, simulation-based training for line insertions, standardised and real-time bundle monitoring by direct observations are key interventions tested. We used model for improvement and changes were tested using small Plan-Do-Study-Act cycles. Surveillance methods and CLABSI definition used according to National Healthcare Safety Network. Results The CLABSI rate per 1000 patient-days dropped from 3.1 per 1000 device-days to 0.4 per 1000 device-days. We achieved 757 days free of CLABSI in the unit till December 2018 when a single case happened. After that we achieved 602 free days till July 2020 and still counting. Conclusions Implementation of evidence-based CLABSI prevention bundle and process monitoring by direct observation led to significant and subsequently sustained improvement in reducing CLABSI rate in adult CICU.

Background At Heart Hospital in Doha, Qatar (HH), 127 pressure injuries (PI) were identified in 2014, corresponding to an incidence of 6.1/1000 patient-days in first 4 months of 2014. Hospital-acquired pressure injury (HAPI) is one of the most common preventable complications of hospitalisation. HAPI significantly increases healthcare costs, including use of resources (dressings, support surfaces, nursing care time and medications). They also have a significant impact on patients in terms of pain, worsened quality of life, psychological trauma and increased length of stay. Working with the Institute for Healthcare Improvement (IHI), we implemented evidence-based practices in all In patient Units at HH with the aim of reducing the number of HAPIs by 60% within 2 years.Methods In collaboration with IHI, our multidisciplinary clinical and risk assessment teams tested several changes and implemented a successful programme. The Surface, Skin inspection, Keep moving, Incontinence and Nutrition bundle was implemented. Signs, turning clocks and PI incidence ‘calendars’ were used in the units as reminders. Attention was paid to endotracheal tube ties in order to address device-related pressure injuries. Counts of HAPI (incidence) and number of PIs per 100 patients surveyed (prevalence) were prominently displayed. Changes were tested using the Plan-Do-Study-Act methodology. Statistical analysis using the independent t-test was applied to detect the significance of any difference in the incidence of HAPI before and after implementation of the changes.Results The incidence of HAPI dropped from 6.1/1000 patient-days to 1.1/1000 patient-days, an 83.5% reduction. The prevalence, based on quarterly survey fell from 9.7/100 patients surveyed to 2.0/100 patients surveyed, a 73.4% decline.Conclusions The interventions proved to be successful, reducing the incidence of PI by >80%. The outcomes were sustained over a 4-year period.