Project JOINTS Exemplar Hospital Application
Vail Valley Medical Center – Vail, CO
Number of licensed beds: 58
Non-teaching
Rural
Exemplar Hospital Contact Name:
Heather Gilmartin, MSN, RN, NP, CIC
Email:
Gilmartin@vvmc.com
Phone:
970-479-7289
[X] We give permission to IHI to make public all the information on this Project JOINTS Exemplar Hospital application.
Enhanced Surgical Site Infections Prevention Bundle element (identify one per sheet): Use of an alcohol-containing
antiseptic agent for preoperative skin preparation
What key changes did your organization make to incorporate or support use of an alcohol-containing antiseptic agent
for preoperative skin preparation?
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We created a standing order that was approved through our Surgery Section that required all patients in the preop department to receive a CHG/ETOH or CHG only (washcloth) depending on site of surgery.
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The standing order is written so nursing provides the skin prep without a written physician order
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A physician order is required to opt-out or to change the pre-op skin prep
What were the changes in existing processes your organization had to make in order for this to become part of the
routine?
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We had to change from the traditional pre-op written order for a skin prep to a standing order for a CHG skin
prep with a written order required to opt out or not use a CHG product.
How did you roll out this practice? Did you test it with one patient, a few, or all to start?
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Over 3 months, we synthesized the science and gave presentations to nursing and medical staff to seek their
support.
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We tested the practice with one surgeon’s patients and once all saw it was easy to implement it was approved by
Surgery Section for all patients.
What lessons have you learned as you've implemented this practice? What tips do you have to share?
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Patients with no skin incision (GI, GU) do not require a skin prep, but we did not indicate that specifically in the
standing order – this is being changed so nursing can use critical thinking when determining if a skin prep is
needed
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Surgeons will relinquish control for certain things if the science supports it and they do not have to change their
personal practice
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Use the science to talk with the surgeons, talk about the ease of use and time savings to the pre-op staff, talk
about the cost saving with having only one product for stocking with the finance folks.
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Standing order sets with an opt-out in writing is a great way to ensure that all patients get the right skin prep.
Relying on the memory of a medical provider to order a skin prep is unreliable and error prone.
[X] This practice is used for at least 95% of hip/knee arthroplasty cases – this is used for all of our orthopedic surgical
cases. We use the Sage CHG wipes in the pre-op area for our general surgery, plastics and OB/GYN