Transcript Research Utilization Project

Upon completion the participant will identify and list
steps to implement
The Comprehensive Unit-based Safety Program (CUSP)
and patient care bundles
 Educate and improve awareness about patient
safety and quality of care.
 Empower staff to take charge and improve safety in
their work place.
 Partner units with a hospital executive to improve
organizational culture and provide resources for unit
improvement efforts.
© Provide tools to investigate and learn from defects.
 Respect the local wisdom of frontline providers
Assemble a Multidisciplinary Safety
Team
 Establish team leader/unit champion for
each unit, usually nurse and physician
leader
 Senior Leader (critical for success)
 Nurse Managers
 Informal leaders/bedside staff
 Patient Safety Officer

 Administer
pre-assessment safety
culture survey
 Current BSI rate
 Current CVL processes and
equipment
 Review data from survey
 Team checkup tool
 Develop action plan
Conceptual Framework
Science of Safety
Training
Standardize Work
Checklists for Key
Processes
Teams Make
Wise Decisions
Reduce
CLABSI’s
Goal:
Decrease the
number of
central line
associated
bloodstream
infections

Resources Needed
FINANCIAL:
Physician input in
new CVL kits

Practicality of Implementation
Bulls eye for desired
outcomes
Change of
habits, staff
taught to say no
Present the
evidence

Feasibility of Implementation/Culture change
Monthly Staff
Meetings
Promotion of
evidence-based
practices bundles
Transparency of
Infection Rates
Daily shift
Monitoring
Match supplies
pulled with
procedures
Reinforcement of current evidence-based practices
based on IHI care bundles.
Webcasts shared with bedside staff and our
multidisciplinary teams and council.
Webcasts placed on a shared common drive to
share with bedside staff via Charge RN
coordination. (great for night shift)
Researched IV connector caps, selected neg-neutral,
“green tip” for easy visualization of compliance.
Change policy to have CVL dressings changed every
Sunday and prn. (webcast take away)
Replacement of 10 milliliter prefilled normal saline
syringes with five milliliter syringe, supporting one time
use. (Dirty q-tip pictures promotion)
Orange disinfecting leur caps for use on all central lines
for easy visualization f or compliance.
Change IV tubing every Thursday and Sunday. Another
“take away” from participating in webcasts.
Redesigned central line insertion kit as recommended in
webcast. If all parts used, there was compliance, if
something let over, probably not compliant.
Time out Checklist developed with all critical CVL steps
on the actual form.
Change IV tubing every Thursday and Sunday. Another
“take away” from participating in webcasts
January 2012 EMR implemented, daily CVL line reports
reviewed by Charge RN’s, physicians called for CVL’s
>5days. (many physicians thank the nurse).
 Beside
RN’s created a specific
pink colored form to assess
central line care daily, along
with other quality indicators.

SJMC Outcome Measure for Bundle Success
Decrease in central line associated
bloodstream infections
8
Shands Jacksonville Overall CRBSI Trend
7
6
5
4
3
2
1
0
Shands Jacksonville Overall CRBSI Trend
Linear (Shands Jacksonville Overall CRBSI Trend)
What started as a critical care initiative has now
expanded to
- Progressive Care Units
- Medical-Surgical Units

Today, CUSP is a HOUSEWIDE
Monitor and
published
results
Drill down,
making it
personal
ZERO
CLABSI

Data Collection
Performed on
individual
units
Using a
standardized
collection tool
Infection
control
department
Problem
Solution
oriented
trust staff
Decision
Making
Success with
Bundles and
CUSP
ZERO CRBSI
Evaluate
data think
out of the
box
Research
Evaluate
outcomes

Berenholtz, S.M., Pronovost, P.J., & Lipsett, P.A. (2004). Eliminating catheter-related
bloodstream infections in the intensive care unit. Critical Care Medicine, 32 (10), 20142020.

Bowditch, J.L; Buono, A.F & Stewart, M.M. (2008). A primer on organizational
behavior, 7th e.

CDC. (2011). Central line-associated bloodstream infection (CLABSI) Event.

The Comprehensive Unit-based Safety Program (CUSP). Agency for
Healthcare Research and Quality, Rockville, MD.
http://www.ahrq.gov/about/annualconf11/mcalearney_sawyer/sawyer.htm

Gurses, A.P., Seidl, K.L., & Vaidya, V. (2008). Systems ambiguity and guideline
compliance: a qualitative study of how intensive care units follow evidence-based
guidelines to reduce healthcare-associated infections. Quality Safety Health Care, 17(1),
351-358.

IHI. (2011). Implement the IHI central line bundle . Retrieved from Present a complete
plan for implementing the solution in the work setting.

Pronovost, P.J., Goeschel, C.A., & Colantuoni, E. (2010). Sustaining reductions in
catheter related bloodstream infections in Michigan intensive care units:
observational study. British Medical Journal, Retrieved from bmj.com. 1-6.