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Quality & Prevention Update

West Valley Medical Center - May 22, 2017
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Clinical Safety Improvement Plan (CSIP) Update

Ron Folwell
Director of Quality

With the first quarter of 2017 completed, and data submitted to the Clinical Safety Improvement Program (CSIP), we have made significant progress in reaching our annual goals. Our efforts in the first quarter have reinforced the importance of patient event reporting, our utilization of TeamSTEPPS for improved patient safety, reevaluating policies surrounding observers in operative areas, the importance of timely and thorough hand-offs between clinicians, oxytocin management, complete analysis of sentinel events and the effectiveness of our patient safety leadership team. As of April 15 of this year, we have secured at least a 3 percent reduction in our malpractice premiums, plus a $8,000 credit through certification and orientation bonuses. We expect the reduction in premiums to total 11-13 percent by the end of this year.

Antimicrobial Management Program

Staph Aureus bacteremia

Dave Calley
Director of Pharmacy

  • One of the goals for the AMP (Antimicrobial Management Program) committee is to monitor all Staph Aureus bacteremia cases to verify proper treatment and duration of antibiotics.
  • The current WV antibiogram indicates that MRSA (Methicillin Resistant Staph Aureus) in 2016 was sensitive to Vancomycin 100 percent of the time. Reserve Cubicin (Daptomycin) and Zyvox (Linezolid) for patients that have absolute contraindications to Vancomycin.
  • Patients with MSSA (Methicillin Sensitive Staph Aureus) bacteremia should be promptly treated with (or switched to) a Beta-lactam antibiotic (Nafcillin/Oxacillin/Cefazolin) and NOT treated with Vancomycin due to improved outcomes.*
  • Repeat blood cultures should be obtained after 48-72 hours of treatment to ensure that the bacteremia has cleared; failure to document sterilization of the blood may suggest a deep-seated (or complicated) infection requiring a longer course of IV antibiotics.
  • Patients with Staph aureus bacteremia, due to either MSSA or MRSA, should receive a minimum of 14 days of IV antibiotics, with complicated infections treated for 4-6 weeks.
  • Uncomplicated infections: No indwelling grafts/prosthetic valves, prompt defervescence within 48-72 hours after starting antibiotic, prompt clearance of bacteremia
  • Complicated infections: febrile despite antibiotics, suspicion of endocarditis, persistent positive blood cultures, prosthetic heart valve.
  • Duration of antibiotic treatment starts at time of first negative blood culture.

*McDaniel et al, Comparative effectiveness of beta-lactams versus vancomycin for treatment of methicillin-susceptible Staphylococcus aureus bloodstream infections among 122 hospitals. Clin Infect Dis 2015; 61(3): 361-7

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