National Expansion Overview Spring 2010

1. On the CUSP: Stop BSI National Expansion Overview Spring 2010

2. 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

3. Why This Initiative is Important • From the patient’s perspective • Blood 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 annually • These reductions were achieved using the processes at the core of On the CUSP: Stop BSI

4. Why This Initiative is Important • From Government’s Perspective • Key part of Secretary Sibelius’ initiative to reduce hospital acquired infections • AHRQ funding national rollout of On the CUSP: Stop BSI • Coordination with CDC efforts to reduce HAI’s through ARRA grants to states • Coordination with CMS efforts to reduce surgical site infections • Driven by belief that hospital care can and should be safer, more efficient and cheaper

5. 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 activities • State hospital association support enhances members’ abilities to achieve their mission

6. Why This Initiative Is Important • Results 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:c309

7. How On the CUSP: Stop BSI works • Its 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)

8. 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 culture

9. 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 3

10. On The CUSP: • Stop BSI • Assemble a CUSP team, • Partner with a senior executive; • Baseline CLABSI Data • Exposure Tool and Technology Assessment • PRIMARILY Technical (CLABSI) • PRIMARILY Adaptive (CUSP) • Senior Executive Partnership • Learning from Defects • CVC Insertion • Science of Safety Training • Staff Identify Defects • Implement Tools for Teamwork and Communication • CVC Management • LFD toolkit • Evidence based BSI prevention (hands, site, skin prep, barrier, removal) • 1. Daily goals • 2. Dressing change • 3. Vascular access manual/ policy protocol • CVC Line Cart • Briefings • 1. Staff safety assessment form • 2. Indentifying hazards presentation • 1. Daily goals • 2. Shadowing • 3. AM briefing • 4. Call list • 5. Team check up tool • 1. Contents inventory • 1. Science of safety presentation • 2. Attendance sheet • 1.Presentation of evidence • 2. CLABSI factsheet • 3. Insertion checklist • 4. Vascular access quiz • 5. Vascular access manual/ policy • 6.Annotated bibliography

11. How On the CUSP: Stop BSI works-- Its Scope We need you in this project! (Will include additional hospitals from states in earlier cohorts)

12. How On the CUSP: Stop BSI works-- The Process Recruit/Equip State Hospital Associations Sustainable improvements, spread to other challenges SHAs form Consortia and Recruit Hospitals Hospitals Collect Baseline data-culture & infections Ongoing training & technical Support in CUSP Improved culture, infection rates

13. 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 unsustainable • Evaluate safety culture • Educate staff on science of safety • Identify defects in care • Commit to executive partnership • Re-measure culture every 12-18 months

14. Why On the CUSP: Stop BSI WorksFour 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 progress

15. Why On the CUSP: Stop BSI WorksFour 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

16. Why On the CUSP: Stop BSI WorksFour 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 associations

17. Why CUSP Works • Care at the bedside is transformed • The CUSP model is applicable to other HAIs, virtually all other patient safety issues • Incorporates existing teamwork and communication tools, e.g., TeamSTEPPS

18. SHA holds celebration meeting for its hospital teams SHA[1] recruits hospitals and forms state collaborative 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 On the CUSP: Stop BSIProject Timeline Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12 Month 13 Month 14 Month 15 Month 16 Month 17 Month 18 Month 19 Month 20 Month 21 Month 22 Month 23 Month 24 Month 25 Month 26 Month 27 Month 28 [1] SHA=State Hospital Association [2] DUA=Data Use Agreement [3] HSOPS=Hospital Survey of Patient Safety Culture Hospitals take first HSOPS[3], and immersion calls begin Hospitals take second (last) HSOPS SHA holds mid-course meeting for its hospital teams MHA/Keystone registers hospitals in data system, and hospitals complete DUA [2]

19. What Participation Requires: Support from the National Project Team

20. What Participation Requires: A State Lead from the Association The Lead will need to: • Lead hospital recruitment efforts • Coordinate with national project team • Oversee logistics of meetings and call planning The Lead will NOT need to: • Create resources for hospitals • Provide any content knowledge or answer substantive questions • Set up a website or develop an implementation manual—both come from the national team

21. What Participation Requires Hospital Unit The Hospital Unit will need to: • Participate formally for 2 years • Assemble team • Assign team leader (10% effort) • Engage executive champion • Hold monthly patient safety meetings • Listen to monthly content and coaching calls

22. 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

23. Confidentiality • All information is confidential, blinded comparisons with others in state and with others states in the national project

24. On the CUSP Data Collection *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 & Quality

25. CLABSI Report

26. MTCT Report 2 3 1 4

27. MTCT Common Barriers

28. Sample HSOPS Report

29. Sample HSOPS Report

30. Data Status Report

31. HAI Elimination Collaboration Policy Leadership AHRQ CDC CMS AHA Field Leadership JHU MHA HRET NW Implementation Leadership SHA DOH QIO

32. What are Next Steps • Answer your questions: • Deborah Bohr at dbohr@aha.org or 646-678-4280 • Visit www.onthecuspstophai.org • Observe an upcoming Kickoff meeting • Join an upcoming cohort • Cohort 4: July 2010 • Cohort 5: Sep 2010