Keeping the Success Going

It is not easy to change our way of doing things, to go from no particular approach to treating severe sepsis, for example, to actually adopting a stance and systematically giving every patient the best shot of survival that is available to them and to us.  As difficult as it is to make some changes and to see some successes, it is even more arduous to continue the changes we've made and the successes we've had.

At the University of Kansas Hospital, where I work, we had some success in the past 2 to 3 years in reducing our rates of nosocomial urinary tract infection.  By instituting some changes in Foley catheter maintenance, we had driven the rate down to well below one infection per thousand catheter days.  Yet, in the most recent two quarters our rates have risen again, almost to pre-intervention levels.  Simply put, we did not sustain the measures that we had put in place to drive the infection rate down.  We are looking now to determine why the measures fell by the wayside; we are analyzing what factors may have impeded our ability to keep doing them routinely.

This problem illustrates a couple of things about sustaining change, though.  The first, which we have done an OK job of, is that if an outcome is important you must track it.  We must not assume that the measures we took continue to be at play, nor that the outcome we desire continues to be present.  The second is that the outcome has to be apparent to all the right people.  If we at KU have made a mistake to this point, I believe that it lies in not keeping bedside nurses sufficiently informed of a) the tremendous job they did in making a change and saving patients from UTI and possible severe sepsis and b) the fact that we began to lose ground.  If we do not know whether our actions are making a difference, it is difficult for us to do anything that may slow us down.  On the other hand, the pride of knowing that even some things that seem small are making a difference, can often sustain our efforts, especially at those seemingly little things.

Two years ago, we explored in the MWCCC mechanisms for preventing nosocomial UTI, and I know that several of our member hospitals were successful in reducing their rates of infection.  I have two questions for those of you who have been successful.  Have you been able to sustain your changes?  How have you done it?  If it's because you have a simple protocol or standard operating procedure, please share it with us.

This time, it's my hospital.  Next time, it could be yours, in one area or another of critical care.  Remember, the MWCCC is here to help all of us get  the best achievable outcomes all the time.  Please talk about it here, and if you have documents to upload for sharing, send them to me at sqsimpson@mwcritcare.org. I will post them to the MWCCC web site.