Lynn M. Nolan, MSN, RN, Manager of the Universal Care Center and post anesthesia care unit at Northwestern Medicine Lake Forest (Ill.) Hospital, shared her tips and insight on how to improve quality and infection control at ASCs.
Note: Responses have been lightly edited for style and clarity.
Question: For ASCs looking to improve quality, where would you recommend they start?
Lynn Nolan: When looking to improve quality in ambulatory surgery, it is essential to be familiar and understand the current American Society of PeriAnesthesia Nurses standards and the evidence-based practices directed at improving quality and patient outcomes. ASPAN standards outline the minimum requirements and recommendations in assessment and documentation and acuity-based staffing in all phases of care. In these standards there are also specific practice recommendations supported by peer reviewed journals to help guide practice. After ensuring the basics are in place by following the standards, it is important to identify appropriate staffing ratios based on ASPANs acuity and the patient flow.
ASCs are a rapidly changing environment, and effective throughput is one of the most important factors in ensuring efficient, high quality and cost-effective care. Analytic data is necessary and something often thought of after implementing process improvement. I would recommend identifying your specific metrics and then having analytic data in place to evaluate the effectiveness of process change.
Q: What would you say are the quality measures (hand washing, medications, etc.) that get overlooked the most, and how can ASCs improve?
LN: On-time starts is an interdisciplinary team approach. Key stakeholders must be able to identify the barriers and then track the data very closely. It requires continuous follow up and the ability to address the reasons immediately to effect change.
Surgical site infections are also a big issue. There are multiple strategies to reduce SSIs —- not all of these are implemented in ASCs. To decrease the number of surgical site infections, ASCs can implement SSI prevention bundles, track the data and drill down if an SSI occurs to determine gaps and make changes and lastly, improve hand washing.
Q: What are some ways staff can improve hand washing?
LN: I have seen a handwashing tutorial where they used something called Glow Germ. This was one of the most powerful lessons I saw because it focused on how effective/ineffective handwashing was based on how much “glow” showed on the hands after washing.
I have also seen hand washing improve when outside staff or leaders evaluated another area and were honest about the handwashing fallouts or failures and addressed it in the moment.