On the CUSP: STOP BSI

The Comprehensive Unit-based Safety Program (CUSP): An Intervention to Learn from Mistakes and Improve Safety Culture

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 2

The CUSP/ CLABSI Intervention

CUSP CLABSI

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 1. Remove Unnecessary Lines 2. Wash Hands Prior to Procedure 3. Use Maximal Barrier Precautions 4. Clean Skin with Chlorhexidine 5. Avoid Femoral Lines www.onthecuspstophai.org

3

Learning Objectives • To explain the philosophy and approach of CUSP • To describe the steps in CUSP • To introduce available teamwork tools on www.onthecuspstophai.org

4

Your Feedback is Important http://www.surveymonkey.com/s/ZZ77L25 5

What is CUSP?

• Comprehensive Unit-based Safety Program • An intervention to learn from mistakes and improve safety culture 6

On the CUSP: Stop BSI Intervention Comprehensive Unit-based Safety Program (CUSP)

-Improve or reinforce good cross disciplinary communication and teamwork -Enhance coordination of care -Address overall patient safety -Work towards healthy unit culture

BSI-Reduction Protocol

-Best-evidence supplies, organization of supplies -Ensuring all patients receive the best practices -Checklist to ensure consistent application of evidence

Safety Score Card Keystone ICU Safety Dashboard How often did we harm (BSI) (median) How often do we do what we should

How often did we learn from mistakes* Have we created a safe culture What areas need improvement (%) Safety climate* Teamwork climate*

2004 2.8/1000 66% 100s 84% 82%

* CUSP is intervention to improve these

2006 0 95% 100s 43% 42% 8

Pre CUSP Work • Create a CUSP/CLABSI team – Nurse, physician administrator, others – Assign a team leader • Measure culture in the unit • Work with hospital quality leader or hospital management to have a senior executive assigned to CUSP/CLABSI team 9

Steps of CUSP 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 10 Pronovost J, Patient Safety, 2005

Step 1: Science of Safety • Understand system determines performance • Use strategies to improve system performance – Standardize – Create independent checks for key process – Learn from mistakes • Apply strategies to both technical work and team work • Recognize teams make wise decisions with diverse and independent input http://www.safercare.net/OTCSBSI/Staff_Training/Entries/2009/9/6_1._The_Science

of_Improving_Patient_Safety.html

11

Step 2: Identify Defects • Review error reports, liability claims, sentinel events or M and M conference • Ask staff how will the next patient be harmed 12

Prioritize Defects • List all defects • Discuss with staff what are the three greatest risks 13

Step 3: Executive Partnership • Executive should become a member of unit team • Executive should meet monthly with unit team • Executive should review defects, ensure unit team has resources to reduce risks, and hold team accountable for improving risks and central line associated blood steam infection 14

Step 4: Learning from Mistakes • What happened?

• Why did it happen (system lenses) ?

• What could you do to reduce risk ?

Pronovost 2005 JCJQI • How do you know risk was reduced ?

– – – Create policy / process / procedure Ensure staff know policy Evaluate if policy is used correctly 15

Step 4 cont’d: Identify Most Important Contributing Factors • Rate each contributing factor – Importance of the problem and contributing factors in causing the accident – Importance of the problem and contributing factors in future accidents 16

Step 4 cont’d: Identify Most Effective Interventions • Rate Each Intervention – How well the intervention solves the problem or mitigates the contributing factors for the accident – Rate the team belief that the intervention will be implemented and executed as intended 17

Step 4 cont’d: Evaluate Whether Risks Were Reduced • Did you create a policy or procedure • Do staff know about the policy • Are staff using it as intended • Do staff believe risks have been reduced 18

Pronovost JCC, JCJQI Step 5: Teamwork Tools • Call list • Daily goals • AM briefing • Shadowing • Culture check up 19

Step 5 cont’d: Call List • Ensure your unit has a process to identify what physician to page or call for each patient • Make sure call list is easily accessible and updated 20

Step 5 cont’d: AM Briefing • Have a morning meeting with charge nurse and unit attending(s) about the unit-level plan for the day • Discuss work for the day – – – What happened during the evening Who is being admitted and discharged today What are potential risks during the day, how can we reduce these risks 21

Step 5 cont’d: Shadowing • Follow another type of clinician doing his or her job for between 2 to 4 hours • Have the shadower discuss with staff what she will do differently now that she has walked in another person’s shoes 22

CUSP is a Continuous Effort • Add Science of Safety education to orientation • Learn from one defect per quarter, share or post lessons • Implement teamwork tools that best meet the unit’s needs • Details are in the CUSP manual 23

Action Items--CUSP • • • • Look over the CUSP manual with team members Brainstorm potential hazards with team Assess team composition with respect to CUSP elements REVIEW PRE-IMPLEMENTATION CHECKLIST—where are you?

24

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, 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.

• 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.

25

Please give us your feedback http://www.surveymonkey.com/s/ZZ77L25 26