1st Stage: "The data are wrong." 2nd Stage: "The data are right, but it is not a problem." 3rd Stage: "The data are right. There is a problem, but it is not my problem." 4th Stage: "The data are right. There is a problem, and it is my problem."
I remember back in the beginning, when I was first seconded to my surveillance role, everything data-related was slow, peculiar work. The basic data collection process was tedious, checking theatre lists, digging through medical notes to find knife to skin times and finish -then doing the math to figure out the number of minutes!-, binders bursting full of papers which should have ultimately been filed with the patients’ medical notes (since they are actually a record of that patient care), but never were because we needed to count and re-count them for totals and validations.
Back then, we entered the figures into an Excel sheet but we didn’t actually use any calculate function in the Excel spreadsheet. Nope, we did that manually, with a calculator. First I would calculate the SSI rate (%) manually, then a senior nurse would re-check the math, again using a calculator*.
Slow, peculiar work.
Not entirely surprisingly, errors were made using this system, despite the 15 hours of administration and 12 hours surveillance nurse Band 6 hours allotted each week (plus a fair bit of time spent on the calculator in the evenings in the run up to the report time). Even if the calculations were sound, there was still hot debate of rates which could be over 100% (possible in CABG as one patient can have multiple SSI) or ridiculously high (for consultant-level monthly reporting if the denominators were low and they had an SSI in the cohort). Report-time was always angst ridden, and I was always mentally bracing for the comments from clinicians and managers, or worse still, no comment at all, just simply:
Subject: Not read: November XXXX Surgical Site Infection Data. Your message was deleted without being read on Wednesday, January 19, XXX 1:29:45 PM (GMT) Greenwich Mean Time : Dublin, Edinburgh, Lisbon, London.
My experience isn’t unique – the Cardiac SSI Network was set up to share challenges, sometimes solutions and as often as not, those stories that make SSI surveillance one of the most interesting and exciting jobs going. If you haven’t been to one of the meetings in central London, come along! We are an informal group and passionate about quality data and efficiency. Most importantly, though, we are there to improve patient experience and outcomes using our combined learning.
Whether you are new to surveillance or having been involved for years, bring your ideas and experiences in adult and paediatric SSI work- we even have the odd session on implant devices for those who are interested. We haven’t got all the answers, but we have got an amazing forum of open discussion – sign up for the next free meeting on Friday 15th June 2018.
* This was not a cool new way to double check the data - no one in the office knew how to use Excel.