Turning patients frequently in bed. Raising the head of the bed at least 30 degrees. Getting patients to sit up in bed when possible. These are all simple tactics that have gone a long way in helping St. Michael’s reduce pneumonia in the Trauma-Neurosurgery Intensive Care Unit from 17 per cent to 10 per cent.
Amanda McFarlan updates the pneumonia rates on the dashboard behind the nursing station in the Trauma-Neurosurgery Intensive Care Unit. (Photo by Yuri Markarov)
“This is an impressive improvement over time when we compare our rates to other similar organizations in the American College of Surgeons Trauma Quality Improvement Program,” said Amanda McFarlan, a nurse, Trauma Program registry manager and quality assurance specialist.
The program is comprised of more than 200 trauma centres in the United States. St. Michael’s is the only Canadian site that compares itself to other organizations with a similar patient population.
In 2011, when the TNICU’s pneumonia rate was 17 per cent, the Trauma Quality Improvement Program average was 4.9 per cent. McFarlan and a team committed to tackling the issue by coming up with a plan that included identifying target areas for improvement, holding nursing focus group discussions and reviewing the standard recommendations to prevent pneumonia.
Target pneumonia rates were set at 10 per cent for FY2013
“The pneumonia prevention tactics have certainly helped, but simply highlighting the issue with the front-line staff and engaging them has been key,” said McFarlan. “Once they learned that our pneumonia rates were high, they reinforced their standard practice –the small things they could do to prevent pneumonia that are part of the standard bundle of recommendations for pneumonia prevention.”
While the hospital will never eradicate pneumonia in the TNICU due to its patient population, the goal is to keep the rate under 10 per cent.
McFarlan is helping Sunnybrook to join TQIP and is working with a number of Canadian groups, including the Trauma Association of Canada, Accreditation Canada and the Ontario Trauma Advisory Committee to expand quality improvement benchmarking in trauma programs across Canada.
About St. Michael’s Hospital
St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.