Fullerton, CA-based St. Jude Medical Center, a 359-licensed-bed hospital that is part of St. Joseph Health System (Orange, CA) learned that rather quickly. But rather than throw up its hands in frustration the critical care team accompanied infection control and materials management in going back to the drawing board.

What culminated from their collective efforts was a 50 percent reduction of the central line infection rate after one year in the cardiac care intensive care unit, as well as procedural and product standardization that improved outcomes and patient safety. The fluid partnership between the key players led Healthcare Purchasing News to select St. Jude as its 2007 Critical Care Supply Innovator.

St. Jude Medical Center, Fullerton, CA

If improved outcomes and patient safety were its inspiration, the Institute for Healthcare Improvement’s 100,000 Lives Campaign and the IHI’s bundle requirements were its strategic playbook.

Although St. Jude launched its quality outcomes project in January 2005 it didn’t really generate as much desired traction until later in the year. The IHI 100K Lives program was well underway. "We decided to sign up for this because some of the things were fitting for our projects," said Pat Wardell, R.N., vice president, quality management, and patient safety officer at St. Jude. "In November 2005, our first team went to an IHI Impact Community Meeting in San Diego where we joined and began implementing the Idealized Model for Critical Care. We meet two times a year and have conference calls to share information."

Wardell, who spearheaded St. Jude’s participation in the IHI initiative and helped to galvanize administration support that attracted other St. Joseph hospitals’ involvement, indicated that IHI came at the right time for the hospital’s CCU improvement goals.

"IHI provided a defined infrastructure and process," she said. "Although we knew all these principles, the IHI meetings and calls helped to keep us on track. Previously, other things would get in the way."

Perhaps the biggest eye-opener in the transition was the need for – and lack of – collecting data. "Prior to implementing the IHI changes we knew we should use data to identify changes we needed to make, but we weren’t doing a good job of it," she said. "After we became part of IHI and received feedback on the results, we realized that to become knowledgeable it was imperative for us to see the data on an ongoing basis and use the data to effect change and provide safer care for patients. It’s been exciting to see how staff has gotten involved here. It’s nice to see staff deciding what they need to do. For the program to work, it is important to have the buy-in from the people who care for the patients. My job is to help them understand what they need to do and they come up with their own ways to implement improvements."

Cheryl Harrod, R.N., critical care nurse manager; Phyllis Sheldon, R.N., CCU coordinator;
Kathy Nakamara, R.N., vascular access device team; Mark Garcia, R.N., vascular access device lead;
and Pam Weiss, R.N., infection control.

Among the improvements that Wardell and her interdepartmental team implemented was changing the central line insertion kit to accommodate the IHI bundle and create a central line assist kit for it, as well as changing a variety of products for patient comfort and physician use, such as using chlorhexidine sponges and wipes and antimicrobial dressings.

The effort highlighted the integral support needed by materials management. In fact, that’s probably critical care’s most important expectation. "The greatest expectation is that once we have determined the products to use that those items are available in the right amount at the right time," Wardell said. "There needs to be a really good communication link between critical care nurses and materials management, so that if changes occur in what should be included in the packet that those changes are made."

But St. Jude quickly found that those communication links had to be established first and then improved. Ultimately, that translated into a change in materials management leadership, according to Wardell. "It is important to have someone who is responsive, logical, thoughtful and good on follow through," she noted, without going into further details.

Wardell acknowledged that St. Jude’s vendors, such as Cardinal Health Inc., Johnson & Johnson and Sage Products Inc., as well as MedAssets Inc., were "very responsive" to enable the hospital to achieve its goals.

Through it all, Wardell noted that the partnership between critical care, infection control and materials management yielded some important lessons. The biggest, of course, was improving communications, she said. Clearly defining expectations and "making logical decisions about what can be done, which often involves a cost-benefit analysis," rounded out their top three lessons learned.

"Some policies we had in place to decrease infection were not being followed so we had to revise, reeducate and monitor new policies to be sure they were being followed," she said. "We get amazing compliance through the program because the kits that were developed have everything needed to ensure infection prevention. We had a policy in place to use chlorhexidine, but the policy had never been implemented. We identified a lot of things we had to do better. The whole process brought everyone together and revealed what needed to be fixed."

One monumental, if not innovative, improvement was the decision to "hardwire tubing and dressing changes"
to specific days of the week to make things simpler for the staff," Wardell noted. "We now change central line tubings on Wednesday and Sundays, no matter when it was put in place," she said. "Dressings are always changed on Sundays." The result? A 50 percent reduction in infection.

Editor’s Note: For more information on St. Jude, visit www.stjudemedicalcenter.org. For more information on the Institute for Healthcare Improvement, visit www.ihi.org.