Spring 2010 On the CUSP Stop BSI Overview Goals Why this initiative is important How it works in general Why it works What it requires What are the next steps What can I clarify Why This Initiative is Important ID: 705895
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Slide1
National Expansion Overview
Spring 2010
On the CUSP: Stop BSISlide2
Overview GoalsWhy this initiative is importantHow it works (in general)
Why it worksWhat it requiresWhat are the next stepsWhat can I clarifySlide3
Why This Initiative is Important From the patient’s perspectiveBlood stream infections kill 40-60,000 persons each year
Reducing the BSI rate from 5 per 1,000 days to 1 per 1,000 days will save 20,000 lives annuallyThese reductions were achieved using the processes at the core of On the CUSP: Stop BSISlide4
Why This Initiative is ImportantFrom Government’s Perspective
Key part of Secretary Sibelius’ initiative to reduce hospital acquired infectionsAHRQ funding national rollout of On the CUSP: Stop BSICoordination with CDC efforts to reduce HAI’s through ARRA grants to statesCoordination with CMS efforts to reduce surgical site infectionsDriven by belief that hospital care can and should be safer, more efficient and cheaperSlide5
Why This Initiative is Important
From Hospital Association
Perspective
Key part of AHA’s
Hospitals in Pursuit of Excellence
national campaign to
improve hospital care quality
Voluntary
participation and success blunts
efforts to mandate onerous data collection
and other activitiesState hospital association support enhances members’ abilities to achieve their missionSlide6
Why This Initiative Is ImportantResults sustained over time in MI hospital units :
from 7.7 – 2.7 infections /1,000 catheter days at baseline to 1.2 and 0 at 12-18 months to 1.1 and 0 at 34-36 months Pronovost, Goeschel, Colantuoni, Watson et al, BMJ 2010;340:c309Slide7
How On the CUSP: Stop BSI worksIts leadership:Health Research & Educational Trust of the American Hospital Association
(John Combes, MD)The Johns Hopkins University Quality & Safety Research Group (Peter Pronovost, MD, PhD)The Michigan Health & Hospital Association Keystone Center for Patient Safety & Quality (Spencer Johnson/Sam Watson)Slide8
How On the CUSP: Stop BSI works
Its goals:
Reduce BSIs to 1 per 1,000 catheter days
Reach hospitals in all 50 states, the District and Puerto Rico
Include both ICUs
and other units with BSI risks
Include Critical
Access Hospitals
Improve safety cultureSlide9
CUSP & CLABSI Interventions
1. Educate on the science of safety
2. Identify defects
3. Assign executive to adopt unit
4. Learn from Defects
5. Implement teamwork & communication tools
CUSP
CLABSI
Wash Hands Prior to Procedure
Use Maximal Barrier Precautions
Clean Skin with Chlorhexidine
Avoid Femoral Lines
Remove
Unnecessary Lines
3Slide10
On The CUSP:
Stop BSI
PRIMARILY Technical (CLABSI)
CVC Insertion
CVC Line Cart
1. Contents inventory
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
CVC Management
1.
Daily goals
2. Dressing change
3. Vascular access manual/ policy protocol
PRIMARILY Adaptive (CUSP)
Science of Safety Training
1. Science of safety presentation
2. Attendance sheet
Staff Identify Defects
1
.
Staff safety assessment form
2. Indentifying hazards presentation
Senior Executive Partnership
Briefings
Learning from Defects
LFD toolkit
Implement Tools for Teamwork and Communication
1.
Daily goals
2. Shadowing
3. AM briefing
4. Call list
5. Team check up tool
Assemble a CUSP team,
Partner with a senior executive;
Baseline CLABSI Data
Exposure Tool and Technology AssessmentSlide11
How On the CUSP: Stop BSI works--
Its Scope
(Will include additional hospitals from states in earlier cohorts)
We need you in
this project!Slide12
12
Recruit/Equip State Hospital AssociationsSHAs
form Consortia and Recruit Hospitals
Hospitals Collect Baseline data-culture & infections
Ongoing training & technical Support in CUSP
Improved culture, infection
rates
Sustainable improvements, spread to other challenges
How On the CUSP: Stop BSI works--
The ProcessSlide13
Why On the CUSP: Stop BSI WorksFour Key Ingredients
Emphasis on culture change: without a culture of safety, infection reductions will be less achievable and unsustainableEvaluate safety cultureEducate staff on science of safetyIdentify defects in careCommit to executive partnershipRe-measure culture every 12-18 monthsSlide14
Why On the CUSP: Stop BSI Works
Four Key Ingredients
2. Use of proven strategies
for reducing BSIs
Educate
staff on evidence-based practice to eliminate CLABSI
Implement
checklist to ensure compliance with these practices
Empower
nurses to ensure doctors comply with checklist
Utilize
monthly team meetings to assess progressSlide15
Why On the CUSP: Stop BSI Works
Four Key Ingredients
3
. Use of data to demonstrate need, document progress, and validate investment
Collection of infection data using simple numerators and denominators
Assessment
of safety culture using AHRQ’s Safety Culture Survey
Simple monthly progress data submitted on Team Checkup Tool
Reports produced centrally and shared with participants
Collection and reporting is essential—public sharing of data is NOT expected or encouraged
Slide16
Why On the CUSP: Stop BSI Works
Four Key Ingredients
4
. Exceptionally qualified
leadership and faculty
Peter Pronovost’s team commands enormous respect and creates enormous enthusiasm
MHA’s experience and data warehouse assures state hospital association’s needs are understood and addressed
HRET
and AHA are focused exclusively on making the project work for both hospitals and participating hospital associationsSlide17
Why CUSP WorksCare at the bedside is transformedThe CUSP model is applicable to other HAIs, virtually all other patient safety issues
Incorporates existing teamwork and communication tools, e.g., TeamSTEPPSSlide18
On the CUSP: Stop BSIProject Timeline
[1] SHA=State Hospital Association
[2] DUA=Data Use Agreement
[3] HSOPS=Hospital Survey of Patient Safety Culture
Month 1
Month 2
Month 3
Month 9
Month 10
Month 8
Month 4
Month 5
Month 6
Month 7
Month 11
Month 12
Month 13
Month 14
Month 15
Month 21
Month 22
Month 20
Month 16
Month 17
Month 18
Month 19
Month 23
Month 24
Month 25
Month 26
Month 27
Month 28
MHA/Keystone registers hospitals in data system, and hospitals complete DUA [2]
SHA[1] recruits hospitals and forms state collaborative
Hospitals take first HSOPS[3], and immersion calls begin
SHA holds kick-off meeting for its hospital teams; monthly content and coaching calls begin; hospitals begin to submit monthly CLABSI and Monthly Team Checkup Tool data
SHA holds mid-course meeting for its hospital teams
Hospitals take second (last) HSOPS
SHA holds celebration meeting for its hospital teamsSlide19
What Participation Requires: Support from the National Project TeamSlide20
What Participation Requires: A State Lead from the Association
The Lead will need to:Lead hospital recruitment effortsCoordinate with national project teamOversee logistics of meetings and call planningThe Lead will NOT need to:Create resources for hospitalsProvide any content knowledge or answer substantive questionsSet up a website or develop an implementation manual—both come from the national teamSlide21
What Participation Requires Hospital Unit
The Hospital Unit will need to:Participate formally for 2 yearsAssemble team Assign team leader (10% effort)Engage executive champion Hold monthly patient safety meetingsListen to monthly content and coaching callsSlide22
What Participation Requires Hospital Unit
Submit monthly CLABSI data if not already submitting to NHSN (5-10 minutes/month by one person)Assess monthly teamwork and communication (10 minutes/month by one person)Take the Hospital Survey on Patient Safety Culture (twice: @ baseline and near end of 2 years by all team members)Attend 3 face-to-face meetings & monthly calls Slide23
Confidentiality All information is confidential, blinded comparisons with others in state and with others states in the national projectSlide24
On the CUSP Data Collection
Measure / Form
Frequency of Completion
How to submit
Reports generated
Exposure & technology assessment
Once
Survey Monkey
(Link will be sent via email)
Descriptive
Culture assessment (AHRQ Hospital Survey on Patient Safety)
Baseline and 18 months
HSOPS administered via MHA Care Counts**
Unit reports and comparative reports from MHA
CLABSI rate
Numer = # of cases
Denom = # of C.L. Days
*Monthly (beginning 2-3 months after state launch)
https://data.ncqualitycenter.org/
Comparative Reports from NCSHIM and MHA Care Counts
Team Check-Up Form
*Monthly (beginning 2-3 months after state launch)
www.mhacarecounts.org
Available in MHA Care Counts
Staff Safety Assessment survey ‘How is the next patient going to be harmed?’
Baseline and biannual
Not submitted
No report
Learning From Defects
Monthly
Not submitted
No report
*Due by the 15th of the Month following data collection. (Ex: January is due by February 15)
** Website managed by Michigan Health & Hospital Association's (MHA) Keystone Center for Patient Safety & QualitySlide25
CLABSI ReportSlide26
MTCT Report
1
2
3
4Slide27
MTCT Common BarriersSlide28
Sample HSOPS ReportSlide29
Sample HSOPS ReportSlide30
Data Status ReportSlide31
HAI Elimination Collaboration
Policy Leadership
AHRQ CDC CMS AHA
Field Leadership
JHU MHA HRET NW
Implementation Leadership
SHA DOH QIOSlide32
What are Next StepsAnswer your questions:Deborah Bohr at
dbohr@aha.org or 646-678-4280Visit www.onthecuspstophai.org Observe an upcoming Kickoff meetingJoin an upcoming cohortCohort 4: July 2010
Cohort 5: Sep 2010