Westward Trails is a 108-bed nursing and rehabilitation facility located outside the Stephen F. Austin State University campus in Nacogdoches, a small city in East Texas also known as “The Oldest Town in Texas.” After Westward Trails was referred to the TMF Quality Innovation Network-Quality Improvement Organization (QIN-QIO) by a local hospital for high sepsis admission rates, it reduced its number of total in-house infections by almost half, which reduced hospitalizations. In fact, new sepsis diagnoses within the facility have decreased to almost zero due to early recognition.
“Our facility averaged 22−24 total infections [such as urinary tract infections, sepsis, wounds, C.diff, pneumonia, etc.], and we now average 10−12 infections per month,” said director of nursing Sammi Jo Moore.
Beginning in March 2024, the Westward Trails staff focused on proper hand and perineal hygiene (peri-care). Moore started with random audits to determine if there were educational needs or changes in habits. “We provided facility-wide education regarding sepsis signs and symptoms, proper hand hygiene and peri-care,” she said. Hallway linen and trash barrels were also eliminated, and staff were educated on the correct ways to dispose of soiled items post-peri-care.
After the initial audits were completed in March and results were reviewed, Moore began implementing additional interventions. “We started using a monthly peri-care audit tool,” said Moore. “If a staff member did not pass their peri-care audit, they were pulled off the floor until they were able to pass.”
In addition, TMF QIN-QIO specialists offered alternate solutions for improving infection control practices. “TMF was positive and helpful in reinforcing our hard work and ensuring we were on the right track,” Moore said. The TMF QIN-QIO began to see April results in its first outcome meeting with Westward Trails in the beginning of May; by that point, the facility was below half of its average infections, historically.
Because sepsis prevention affects everyone in a nursing home, Westward Trails staff attended a resident council meeting and provided education to residents, with a focus for continent residents to learn proper self peri-care. “We provided handouts to the residents to help them understand how they can get ahead of sepsis by spotting the signs and symptoms,” said Moore.
Continued infection control audits help the facility to identify ways to improve. They found that a key component was establishing a performance improvement plan (PIP) team with the nursing leadership. The PIP team reviewed weekly infection control practices, including peri-care audits, trash barrel removal, facility infections and mapping/trending infections. These innovations required more staff education and buy-in on the importance of infection control best practices for residents.
“One big thing we learned was the importance of following up with the hospital and collaborating with them,” Moore said. “Infection control is an ongoing battle with a continuous need for additional monitoring. Inviting resources and help from outside agencies has helped us improve the interventions we have in place. Having a second set of eyes was incredibly helpful,” she said.
As new issues arise, Westward Trails now has a system in place to identify and add new interventions to combat them. The facility continues to use their tools and ongoing audits are still being conducted to ensure compliance with best practices.
The TMF QIN-QIO is contracted by the Centers for Medicare & Medicaid Services (CMS) to assist nursing homes free of charge. To find out how the TMF QIN-QIO can help your facility with challenges related to sepsis and infection prevention, email NHconnect@tmf.org.