Centre intégré de santé et de services sociaux de Laval (CISSS de Laval)’s new Leading PracticeA Personalized Assessment for Hospital Acquired Conditions – presents important epidemiological data in a one-page document that is easy for care teams, as well as patients and family members to understand.

CISSS de Laval noted that this useful one-pager was born out of a need to improve infection prevention and control practices across the organization. It has been a particularly helpful tool during the COVID-19 pandemic, allowing everyone to be easily informed about active outbreaks within the hospital and related services.

“Our Accreditation Surveys showed us that our health care workers weren’t aware of the infection rates across the hospital, and they did not necessarily see the links between infection rates and their practices,” said Layal Abou-Chacra, Clinical Nurse Advisor, Infection Prevention and Control. “So, we came up with several items to help address this challenge, but the one-pager was the tool people appreciated the most.”

She noted that this new tool was developed in partnership with hospital staff, patients and family members, who provided feedback on content, symbols and other elements. Abou-Chacra added that patient partners were consulted about various symbols such as happy and sad faces, sun, clouds and rain, as well as green, yellow and red symbols. “We wanted to ensure that we had the right symbols in place, so people were able to quickly understand what is going well, what is not going well and what needs to be improved in a given hospital unit,” she said.

Abou-Chacra said the way in which data is presented to staff, patients and family members is also very important. “Based on feedback, we concluded that people better understand the data if it is presented in case numbers,” she said. “Instead of saying that we had 0.05 infections per 10,000 patients, we say that we had five cases in the last recorded period.” She added that the one-pager is not only used to track COVID-19 cases, but other hospital acquired conditions such as UTIs, among several others.

A universal tool
Abou-Chacra noted that another benefit of the one-pager is its simplicity; as the data can be easily understood by everyone, from housekeeping to the kitchen staff, to the CEO, to care teams, to patients and families. “I don’t need to simplify or translate the data further, as it is easily understood,” she said. “People like this tool. There isn’t too much text. It’s accessible and it can be easily shared.”

Since developing and implementing the one-pager tool, Abou-Chacra said that it has quickly been adopted by other organizations. “They’ve taken our tool and they’ve applied it. We visit other establishments, and we see their one-pager posted on the walls,” she said. “We’ve really seen an impact on practice.”

Abou-Chacra added that CISSS de Laval was encouraged to submit its one-pager as a Leading Practice by an Accreditation Canada (AC) surveyor. “He learned about our practice, and he wanted all of the information so that he could share it with his own organization,” she said. “He encouraged us to apply.”

Abou-Chacra noted that originally, she researched infection reporting practices and tools, as she was hoping to find something existing that CISSS de Laval could use. Then, when she couldn’t find what she wanted, she decided to work with her team to create a tool.

She explained that prior to creating the one-page tool, a survey was done to ask partners what they wanted or needed to know about infection rates in the hospital and related services. “We asked the who, what and how in terms of infection rates.” Abou-Chacra continued to say that once the one-pager was deployed, a second user satisfaction survey was done. “What we found was that people are happy with the one-pager, which they call the ‘Blue Sheet,’ and they don’t want to lose it. They don’t want to go backward,” Abou-Chacra said.

Julie Huard, Head of Infection Control and Post-Exposure Prophylaxis, Director of Nursing, said the one-page tool is a working lever for infection prevention and control teams as it puts a concrete number forward for a phenomenon that is taking place in a care unit. “It puts a spirit of congeniality and partnership into the care units,” she said. “Because people don’t want to see that their care unit has five infections for example and elsewhere, there are zero. So, it allows the care teams to reflect on their practices and work towards providing better care.”

Abou-Chacra added that at first, the one-page tool did not include COVID-19 case numbers as when it was deployed, CISSS de Laval had yet to see any COVID-19 cases. “We tracked UTIs, gastro cases, influenza, pneumonia. We also tracked resistant bacteria, which are common in a hospital environment,” she said. “Once COVID-19 appeared, it was added to the sheet.”

Providing transparency to patients and their families
Abou-Chacra noted that the one-page tool is helpful for patients and families as it brings a level of transparency to the hospital experience.

She explained that not only does the sheet offer infection numbers, but it also shows if that number has increased or decreased. “If I’m a patient and I see on the sheet that there are X number of infections in a care unit, it might worry me, but at least I know something concrete,” she said. “This did not exist before. This was data that we saved on a computer. The difference is that now, we are sharing that data and our performance, and all of this information is easily accessible to patients and families.”

Huard added that as a health organization, you have to think carefully about how to share information with patients and families. She noted that if, as an organization, you share numbers that are not easily understood, this can lead to anxiety and fear. “That’s why we’ve kept the Blue Sheet simple, with infection rates, symbols and not too much text,” Huard said. “You have to be transparent with the data, but you also have to be able to explain it and ensure it is well understood.”

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