Presenters: Pat Posa, RN, BSN, MSA Joanne Timmel, MSN, RN, NE-BC

1. Presenters:Pat Posa, RN, BSN, MSA Joanne Timmel, MSN, RN, NE-BC CLABSI Supplemental Call Series How CUSP Enables Nurse Empowerment November 15, 2011 at 2ET/1 CT/12 MT/11 PT

2. CLABSI Supplemental Call Series Pat Posa, RN, BSN, MSA System Performance Improvement Leader St. Joseph Mercy Heath System

3. Components of CUSP? Form a unit CUSP team with executive sponsorship Measure unit culture Educate staff on Science of Safety Identify defects using the Staff Safety Assessment; prioritize defects Learn from one defect per quarter Implement team/communication tools 3

4. How is CUSP different?It Empowers Nurses in the Hospital Driven by frontline staff---nurses CUSP identifies problem areas – what staff think are impeding patient care vs. what managers/directors think are priority areas CUSP improvement tools are designed for bedside caregivers – easy for busy staff to use unit drives its own quality CUSP can complement other quality improvement methods – must use multiple tools! 4

5. CUSP: St. Joseph Mercy Hospital Journey • Began in 2003 with statewide ICU Collaborative: Keystone ICU • Multidisciplinary Keystone (CUSP) team—meet monthly • Annual assessment of culture—with staff developing action plans to improve culture • Executive rounds • Learn from a defect • Team/Communication tools: • Multidisciplinary rounds with daily goals • Crucial conversation training • Structured Huddles

6. Best Practices: Learning from Defects Tool

7. Enable teams to have frequent but short briefings so that they can stay informed, review work, make plans, and move ahead rapidly. Allow fuller participation of front-line staff and bedside caregivers, who often find it impossible to get away for the conventional hour-long improvement team meetings. They keep momentum going, as teams are able to meet more frequently. Best Practices: Engaging & Sustaining Nurse Involvement in CUSPHuddles Use this strategy to begin to recovery immediately from defects---IE: falls, sepsis and daily to focus on unit outcomes 7

8. Components Metric 1: Quality/Safety Metric 2: Patient Satisfaction Metric 3: Operations Daily Critical Communications Information Ideas in Motion • How to do it? • Beginning or mid shift • 5-10 minutes • Lead by member of unit leadership team 8

9. SICU Huddle Board 9

10. Surgical Unit Huddle Board

11. Lessons to Bring Home to your Hospitals: Strategies that Promote Nurses & Leverage CUSP • Frontline staff are an integral part of the CUSP team • Meet monthly • Nurses who work in the unit processes everyday are the best people to identify where there are opportunities to improve and how to improve • Allow the nurse to take responsibility for identifying problems and give them a forum and strategy to solve them • CUSP team • Learn from a defect tool • Structured huddles

12. A Healthcare Imperative “In medicine, as in any profession, we must grapple with systems, resources, circumstances, people-and our own shortcomings, as well. We face obstacles of seemingly endless variety. Yet somehow we must advance, we must refine, we must improve.” Atul Gawande, Better: A Surgeon’s Notes on Performance

13. CLABSI Supplemental Call Series Joanne Timmel, MSN, RN, NE-BC Nurse Manager The John Hopkins Hospital

14. Implementing CUSP: Assumptions & Prerequisites • Certain beliefs predispose for success: • Direct care staff are best able to identify impediments to safe efficient care • Staff value patient centered care • Manager has participative leadership style • Setting is important; a room on the unit boosts attendance • Broad Team: Pharmacist, Social Worker, PT & OT, Chaplain, Environmental Services, Mid Level Providers, Residents, Attending, Administrator

15. Implementing CUSP: Engaging the Team • Define CUSP for your setting • Kick off with Science of Safety presentation • Ask the question: “How will the next patient be harmed on our unit?”

16. CUSP: How it Empowers Nurses in the Hospital Nurses are empowered when — • they see change happen • their concerns are affirmed • they develop a voice and can tell their story • they are supported by a unit culture that values speaking up regarding patient safety Nurses are empowered when they actually have power

17. CUSP: Example of Empowerment A surgical unit before CUSP — • Chaos • Unclear plan of care • Very poor communication with the surgeons • Patients frustrated and angry at nurses • Nurses felt powerless. • So they left — high turnover.

18. CUSP: Example of Empowerment Our first CUSP project: • Proposed cohorting • Implemented nurse-physician joint rounds • Developed a written daily goal sheet generated from rounds • Besides rounds, established other mechanisms for non-urgent communication • Continue to articulate new collaborative culture by hosting First Monday breakfasts

19. CUSP: Example of Empowerment Nurses now have a place to address their day to day intransigent system problems • Medications not available when due • Pain control issues in admitted outpatients • Inpatient nurse/ PACU nurse communication • Contributing factors to recent medication errors • New residents lack of familiarity with POE system • Strategies for coverage with decreased resident hours • Pain control issues/ narcotics issues with patients with chronic pancreatitis, Interventional Radiology pts

20. Best Practices: Engaging & Sustaining Nurse Involvement in CUSP • Absolutely requires 3 strong champions (nurse, physician, administration) • Monthly meetings require email reminders, individual invites, reminders throughout day, support to allow staff to step away from pts. • Energy maintained if you focus on what matters to the bedside nurse • Really resolve some problems!

21. Lessons to Bring Home to your Hospitals: Strategies that Promote Nurses with the Leverage of CUSP • If nurses are not engaged in the CUSP process, ask why. • Are you trying to lower CLABSI rate by ultimately requiring nurses to do more, when they know they aren’t able to do half of what they expect of themselves? • Find low hanging fruit (e.g. We need red labels on high concentration PCA)

22. Questions?

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