Ciaran O'Gorman Project Charter 1 0 SPSP C4

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Ciaran O'Gorman Project Charter 1 0 SPSP C4 Powered By Docstoc
					SPSP Fellowship Cohort 4

Ciaran O’Gorman Project Charter

Project Title              Reducing the pseudo-bacteraemia rate in the Ulster Hospital,
                           Dundonald (UHD)

1. Aim

1.1 General description
Blood cultures are easily contaminated with bacteria and other microorganisms that do not
originate from the patients’ bloodstream. In the UHD we have noticed a specific problem
with contamination of blood cultures taken in the Emergency Department (ED).

1.2 Reason for the effort
Contamination of blood cultures leads to the phenomena of pseudo-bacteraemia, causing
laboratory and clinical staff to make diagnostic decisions based on false-positive test
results. Pseudo-bacteraemia leads to diagnostic doubt and can ultimately mislead treating
clinicians. Patients are given unwarranted antibiotics in and antibiotic courses may be
protracted unnecessarily. Case control studies suggest increased hospital length of stay is
associated with pseudo-bacteraemia.1,2 Patients may undergo invasive diagnostic
investigations on the basis of pseudo-bacteraemia.
The Trust as an organisation will benefit with cost savings and through the improved
quality of diagnostics. The principal downside for the organisation is in initial resources
needed to establish and maintain improvements in practice. These include consumable
costs for improved venepuncture systems and/ or skin disinfection preparations; clinical
staff release for appropriate training; infection control and laboratory staff time to retrieve
and feedback data to clinicians.

1. Alahmadi YM, Aldeyab MA, McElnay JC, Scott MG, Elhajji FWD, Magee FA, Dowds M, Edwards C, Fullerton L, Tate
A, Kearney MP. Clinical and economic impact of contaminated blood cultures within the hospital setting. J Hosp. Infect.
2011; 77: 233-236
2. Bates DW, Goldman L, Lee TH. Contaminant blood cultures and resource utilization. The true consequence of false
positive results. JAMA; 265: 365-369.

CO’G                                         Project Charter v1.0                                  p1 of 5
Recent data suggest the ED pseudo-bacteraemia rate is twice that of the hospital as a
whole. Furthermore it is four times that achieved by the Hospital at Night team who have
been using dedicated venepuncture equipment to draw blood for culture (Figure 1). The
ED pseudo-bacteraemia rate has trended upwards over the last year, possibly related to
the implementation of a sepsis bundle in 2011(Figure 2).

   14%                                                                13.30%



    4%                                                                                          3%


               ALL UHD 2008           ALL UHD 2011             UHD A&E 2011                UHD H@N

             Figure 1: Pseudo-bacteraemia rates UHD

                                                                                                16.7%   15.9%
                                      14.0%    13.9%   14.3%                    14.5%
       15%                    11.9%
       10%            7.5%                                     7.7%


             Figure 2: Pseudo-bacteraemia rate monthly over 2011 from ED,
                                     with trendline

CO’G                                            Project Charter v1.0                                       p2 of 5
1.3 Expected outcomes
1.3.1. There will be fewer pseudo-bacteraemias absolutely, and as a proportion of all
cultures drawn, in UHD. We will first seek improvement in the ED and the medical
assessment unit. Only following sustained improvement in these areas, we will attempt
implementation in other areas of the hospital.

1.3.2. UHD will achieve a 3% pseudo-bacteraemia rate in Q3 2012 (July to September

1.3.3. Laboratory consumable costs will be reduced commensurate with the reduction of
pseudo-bacteraemias processed. Laboratory scientist time will be significantly saved. We
will calculate this time saving based on typical time taken to read, process and
communicate results. The decrease in medical microbiology staff time relating to pseudo-
bacteraemias should increase time spent on true bacteraemia cases.

1.3.4. Mile Stones (pseudo-bacteraemia rates).
 A&E          Jan          Feb     March     April       May   June   July    Aug      Sept
              13%                            10%                      7%               3%
 All UHD      7%                             6%                       4%               3%

2. How do we know that a change is an improvement?

2.1 The pseudo-bacteraemia rate                                 outcome measure
2.2 The laboratory consumable costs and time savings            process measure
2.3 Acquisition costs for new venepuncture equipment            balancing measure
2.4Time/resource for training staff in venepuncture             balancing measure
2.5 Assessment of compliance with sepsis bundle                 balancing measure
implemented in A&E department

CO’G                              Project Charter v1.0                       p3 of 5
Data for 2.1, 2.2 and 2.4 will be collated monthly and fed back to the project team and the
clinical areas supporting the project.

The project team should meet either virtually or face-to-face for a review of monthly data
perhaps in the first week of each new month to carry out the ‘Study-Act’ elements of the
PDSA cycle and agree changes in the protocol for the following month, or to plan rollout
and wider implementation of the protocol.

3. What change can we make that will lead to improvement.

3.1 Initial Activities
Look at ED. Review their use of the sepsis bundle. Observe the process of blood taking
for cultures over a shift. ?Draft a process map of current reality.

3.2 Boundaries
We may encounter financial limitations and have to call on Director level support to
overcome there at the local level.
Constrain ourselves to Adults in the UHD, do not work yet in paediatrics or in other Trust
We must adhere to current guidelines in ED regarding the sepsis bundle.

Team Skills                          Membership
Specialist                           Ciaran
Implementer                          Ciaran
Monitor Evaluator                    Monica
Completer/Finisher                   Isobel
Team worker                          JI in MAU, Richard Donovan
Shaper                               Paddy Stewart
Co-ordinator                         Ciaran/ Isobel/ Boon Low
Resource investigator                Sean McGovern/ Karen Mcilveen
Plant                                David Hill

CO’G                                 Project Charter v1.0                   p4 of 5
Sponsorship   Primary:      Paddy Stewart (Improvement method advice)
                            Charlie Martyn (for ED leverage and advice)
              Secondary     David Hill, Gavin Lavery

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