When I think about how most hospitals audit their work processes, a favorite commercial comes to mind: the LifeLock™‘Bank’ TV spot. It begins with several armed robbers entering a bank filled with people. The robbers tell bank customers and employees to drop to the floor, but the security “monitor” remains standing. One of the customers looks up and whispers, “Hey, do something.” He responds, “Oh, I’m not a security guard, I’m a security monitor. I only notify people if there’s a robbery.” PAUSE. “There’s a robbery.” Then, a screen pops up that reads, “Why monitor a problem if you don’t fix it?”
Infection prevention practices are an area that hospitals across the country regularly audit (monitor). Front-line nurses are generally tasked with performing compliance audits. These seemingly endless audits are in addition to their heavy patient care workload. And, like the bank security monitor, they are often only empowered to measure compliance, not take action. Without an action plan designed to achieve sustained improvements or process changes that will completely resolve the issue being audited, where is the value to the staff and the organization?
Here are three tips that can make your audit efforts for infection prevention more effective:
1. Start with the end in mind. By continuing to ask nurses to audit with no target end date, there is a dramatic impact on nurse efficiency and job satisfaction. Pick an end date for the audit and work towards it. Include an actual process change for infection prevention or compliance goal to the audit timeline.
2. Don’t try to audit and fix everything. In a typical hospital, the top three indicators contribute to 95 percent of the infection root causes. Pick approximately three areas to audit with a goal to reach 100 percent compliance in seven days or less.
Examples of leading indicators achieving rapid improvement include:
- Handwashing
- Usage of proper personal protection equipment (PPE)
- Central lines and dressings managed, flushed and sealed to care standards
- Compliance to sepsis bundle elements
- Timely de-escalation or discontinuation of antibiotics and/or antimicrobials
By closely measuring when these leading indicators achieve target performance, hospitals experience dramatic improvement in lagging indicators such as mortality, LOS, CLABSI, C. difficile or CAUTI infection rate, number of transfers to the ICU/CCU and others.
3. See something, DO something. Instead of just auditing to report the percentage of compliance, establish the practice of “auditing to change non-compliant practices at time of observation.” Simply put, if you see someone out of compliance, intervene.
Create a system of steps that deal with the problem at the time of observation. This practice establishes a foundation that defines clear expectations and assigns responsibility and accountability for compliance. As a result, hospitals can improve their performance from 30 percent to over 90 percent in seven to 10 days.
When organizations decide to move beyond monitoring to actively changing their practices, the benefits are endless. Front-line nurses especially appreciate this approach because once target performance is achieved, audit volume is then cut to coincide with the level of sustained performance. And most importantly, a few simple changes to the root causes of infection can have exponential impacts on positive patient outcomes.
