Transcript Project Report

On the CUSP: STOP BSI
Overview of STOP-BSI Program
Immersion Call Overview
Week 1: Project Overview
Week 2: Science of Improving Patient Safety
Week 3: Eliminating CLABSI
Week 4: The Comprehensive Unit-Based Safety
Program (CUSP)
Week 5: Building a Team
Week 6: Physician Engagement
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State Participation Map
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Learning Objectives
• To delineate the goals of STOP BSI
• To describe the project organization
• To define the interventions
• To outline the planned learning sessions
• To identify who to call for help
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Your Feedback is Important
http://www.surveymonkey.com/s/Z6FJ28T
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On the CUSP: STOP BSI Goals
• To work to eliminate central line-associated bloodstream
infections (CLABSI): reaching state means
less than 1/1000 catheter days, state median 0
• To improve safety culture by 50%
• To learn from one defect per quarter
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Measure
1.
2.
3.
4.
5.
Have We Created a Safe Culture?
How Do We Know We Learn
from Mistakes?
How Often Do We Harm?
Are Patient Outcomes
Improving?
CUSP
Comprehensive Unit based Safety
Program
(TRiP)
Translating Evidence Into Practice
Educate staff on science of safety
Identify defects
Assign executive to adopt unit
Learn from one defect per quarter
Implement teamwork tools
1.
2.
3.
4.
Summarize the evidence in a checklist
Identify local barriers to implementation
Measure performance
Ensure all patients get the evidence
Improve
www.onthecuspstophai.org
CUSP/CLASBSI Intervention
CUSP
CLABSI
1. Educate staff on science of safety
1. Remove Unnecessary Lines
2. Identify defects
2. Wash Hands Prior to Procedure
3. Assign executive to adopt unit
3. Use Maximal Barrier Precautions
4. Learn from one defect per quarter
4. Clean Skin with Chlorhexidine
5. Implement teamwork tools
5. Avoid Femoral Lines
www.onthecuspstophai.org
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Safety Score Card
Keystone ICU Safety Dashboard
2004
2006
2.8/1000
0
How often do we do what we should
66%
95%
How often did we learn from mistakes*
100s
100s
Have we created a safe culture
% Needs improvement in
Safety climate*
Teamwork climate*
84%
82%
43%
42%
How often did we harm (BSI) (median)
CUSP is an intervention to improve these*
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Project Organization
• State-wide effort coordinated by Hospital Association or
designated collaborative agency
• Learning collaborative model (e.g., multisite participation, two
face-to-face meetings, monthly calls)
• Standardized data collection tools and evidence
• Local unit modification of how to implement interventions
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On The CUSP
Stop BSI
Assemble a CUSP team,
Partner with a senior executive;
Baseline Data
Exposure Survey and Technology Survey
Culture Survey
Adaptive (CUSP)
Technical CLABSI
CVC Insertion
CVC Line
Cart
1. Contents
inventory
CVC Management
Evidence based BSI
prevention (hands,
site, skin prep,
barrier, removal)
1. Presentation
of evidence
2. CLABSI
factsheet
3. Insertion
checklist
4. Vascular access
quiz
5. Vascular access
manual/ policy
6.Annotated
bibliography
Science of
Safety
Training
Staff Identify
Defects
Senior Executive
Partnership
1. Daily goals
Implement Tools for
Teamwork and
Communication
LFD toolkit
2. Dressing change
3. Vascular access
manual/ policy
protocol
Learning
from
Defects
1. Science of
safety
presentation
3. Attendance
sheet
1. Staff safety
assessment
form
2. Indentifying
hazards
presentation
Briefings
1. Daily goals
2. Shadowing
3. AM briefing
4. Call list
6. Team check up
tool
Intervention to Eliminate CLABSI
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Pronovost, Berenholtz, Needham BMJ 2008
Evidence-based Behaviors to Prevent CLABSI
• Remove unnecessary lines
• Wash hands prior to procedure
• Use maximal barrier precautions
• Clean skin with chlorhexidine
• Avoid femoral lines
MMWR. 2002;51:RR-10
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Identify Barriers
• Ask staff about knowledge
• Ask staff what is difficult about doing these behaviors
• Walk the process of staff placing a central line
• Observe staff placing central line
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Ensure Patients Reliably Receive Evidence
Senior
leaders
Team
leaders
Staff
Engage
How does this make the world a better place?
Educate
What do we need to do?
Execute
What keeps me from doing it?
How can we do it with my resources and
culture?
Evaluate
How do we know we improved safety?
Pronovost: Health Services Research 2006
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Ideas for Ensuring Patients Receive
the Interventions: the 4Es
• Engage: stories, show baseline data
• Educate staff on evidence
• Execute
–
–
–
–
Standardize: Create line cart
Create independent checks: Create BSI checklist
Empower nurses to stop takeoff
Learn from mistakes
• Evaluate
– Feed back performance
– View infections as defects
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Comprehensive Unit-based Safety
Program (CUSP)
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Pre CUSP Work
• Create a unit-level team
– Nurse, physician administrator, others
– Assign a team leader
• Measure culture in the unit
• Seek out a senior executive to participate on unit-level
team
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CUSP Elements
1.
Educate staff on science of safety
2.
Identify defects
3.
Assign executive to adopt unit
4.
Learn from one defect per quarter
5.
Implement teamwork tools
Pronovost J, Patient Safety, 2005
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We are on a Continuous Journey
• We have toolkits, manuals, websites, and monthly calls to
learn from and with each other.
• Your job is to join the calls, share with us your successes
and more importantly the barriers you face.
• Commit to the premise that harm is untenable.
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To Get Help
• Email /call state project leader
• Talk to your team leader
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Action Items
• Review content of website at www.onthecuspstophai.org
• Toolkits
• Slidesets
• Manuals
• Project Management Checklists
– Pre-Implementation Checklist
– CEO/ Senior Leader Checklist
– Infection Preventionist Checklist
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References
Measuring Safety
• Pronovost PJ, Goeschel CA, Wachter RM. The wisdom and justice of not
paying for "preventable complications". JAMA. 2008; 299(18):2197-2199.
• Pronovost PJ, Miller MR, Wachter RM. Tracking progress in patient safety:
An elusive target. JAMA. 2006; 296(6):696-699.
• Pronovost PJ, Sexton JB, Pham JC, Goeschel CA, Winters BD, Miller MR.
Measurement of quality and assurance of safety in the critically ill. Clin
Chest Med. 2008; in press.
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References
Measuring Safety
• Pronovost PJ, Goeschel CA, Wachter RM. The wisdom and justice of not
paying for "preventable complications". JAMA. 2008; 299(18):2197-2199.
• Pronovost PJ, Miller MR, Wachter RM. Tracking progress in patient safety:
An elusive target. JAMA. 2006; 296(6):696-699.
• Pronovost PJ, Sexton JB, Pham JC, Goeschel CA, Winters BD, Miller MR.
Measurement of quality and assurance of safety in the critically ill. Clin
Chest Med. 2008; in press.
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References
•
Pronovost P, Weast B, Rosenstein B, et al. Implementing and validating a
comprehensive unit-based safety program. J Pat Safety. 2005; 1(1):33-40.
•
Pronovost P, Berenholtz S, Dorman T, Lipsett PA, Simmonds T, Haraden C. Improving
communication in the ICU using daily goals. J Crit Care. 2003; 18(2):71-75.
•
Pronovost PJ, Berenholtz SM, Needham DM. Translating evidence into practice: a
model for large scale knowledge translation. BMJ. 2008 Oct 6;337.
•
Pronovost PJ, Weast B, Bishop K, et al. Senior executive adopt-a-work unit: A model
for safety improvement. Jt Comm J Qual Saf. 2004; 30(2):59-68.
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Thompson DA, Holzmueller CG, Cafeo CL, Sexton JB, Pronovost PJ. A morning
briefing: Setting the stage for a clinically and operationally good day. Jt Comm J
Qual and Saf. 2005; 31(8):476-479.
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