CLABSI Supplemental Call

1. CLABSI Supplemental Call A Recipe for Success: Why Nurse Leadership & Empowerment is Key to Sustaining CUSP April 17, 2012 1pm CT/2pm ET Christine Goeschel ScD, RN, FAAN Director, Patient Safety and Quality InitiativesJohns Hopkins School of Medicine The Armstrong Institute for Patient Safety and Quality

2. Learning Objectives • Discuss nurse empowerment as a key factor for sustaining CUSP • Delineate strategies proven to help empower nurses and other caregivers • Describe regulatory and accreditation mandates for nursing leadership that reinforce CUSP efforts

3. CUSP/ (CLABSI, CAUTI, “you choose”)What We Know • Change involves technical challenges • Evidence • Measurement • Analysis • Change involves adaptive challenges • How to Engage nurses, physicians, executives • Competing priorities • Organization hierarchies • How to hardwire practice changes

4. Empowerment • “To equip or supply with an ability; enable” • “To invest with authority, authorize” • The giving or delegation of power or authority”

5. Lead • To guide on a way especially by going in advance • To direct on a course or in a direction • To serve as a channel

6. Improve Patient Safety Culture: Create Trust • Caring • Keep Patients your North Star • Commit that preventable harm is not tenable • Tell your own story of harm • Competent • Learn from mistakes • Implement teamwork tools (CUSP)

7. Ensure Patients ReliablyReceive Evidence

8. Nurse Empowerment Keep patient as north star ~ Harm is not tenable • Decision to speak up • Must feel competent • Must feel it is safe • Must feel it will work • Transparency when harm occurs • At patient level • At provider level • At organization level

9. Strategies for Nurse Empowerment • Policy Level • Code of conduct • Require nurses to assist with central line placement • Require adherence to checklist • Policy to deal with disruptive behavior • Require that bedside nurse attend rounds

10. Strategies for Nurse Empowerment • Practice Level • Licensure • Nurse Practice Act • Magnet Nursing • Collaborative Practice Models • Infection Preventionists • Attending Physicians

11. Strategies for Nurse Empowerment • Performance Level • Orientation /Skill Building • Annual Competency Assessment • Clinical ladder ~ leadership recognition

12. Strategies for Nurse Empowerment • Use tools to practice nurse empowerment in safe space • Nurse participates in patient rounds • Daily Goals with nurse read back • Learn from Defects • Participate in M&M • Address disruptive behavior quickly

13. Strategies for Nurse Empowerment • In conflict, keep focus on patient as north star • Remind staff that teams make wise decisions with diverse and independent input • All voices add value

14. Sustaining Change: • Are necessary structures and human resources in place – policies, people, roles, authority and responsibility? • Are project support processes codified and clear: decision making, problem solving, coordination and conflict management? • Are material resources in place – space, equipment, supplies, • Are performance tracking mechanisms in place?

15. Endure—Plan for Sustainability • Why worry about the distant future? • What you can anticipate: • Turnover of staff • New projects/ distractions • Complacency • Emergencies and complex cases (someone will call for exceptions to be made)

16. Endure—Plan for Sustainability • Things you can do now to support long term viability of the BSI reduction • Write it into policy • Include in training for all new members • Check to be sure it is routine practice • Set up reliable supply chain (borrowing protocol; alert system) • Quarterly review by executive partner • Set up a Learning Network of peers • Have regular meetings with your HEIC dept

17. Expand—Spread the Interventions • Why think about expanding to other units? • Requires self study • Solidifies own understanding • Equal protection for all patients • Unique challenges of other units may offer new ideas and methods

18. Expand—Spread the Intervention • What quality and safety issues are a priority in your organization? • Might CUSP provide a foundation for progress? • Understand the science of safety • Staff Safety Assessment • Partner with Executives • Learn from Defects • Implement teamwork tools

19. If you falter: Back to Basics • A senior leader commits to a goal of zero. • A senior leader holds unit-level leaders (not Infection Prevention) accountable for CLABSI rates. • Infection preventionists work closely with unit-level teams to train, monitor, and investigate infections, and improve performance. • Unit physicians and nurse leaders own the problem. • Providers avoid placing catheters in the groin whenever possible. • Hospital managers make it easy to comply with the checklist.

20. Institute of Medicine Report released October. 6, 2010

21. Practice • Nurses should practice to the full extent of their education and training.

22. Education and Training 2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.

23. How Patient needs have become more complicated, and nurses need to attain requisite competencies to deliver high-quality care. These competencies include • leadership, • health policy, • system improvement, • research and evidence-based practice, • and teamwork and collaboration, as well as competency in specific content areas including community and public health and geriatrics.

24. Leaders of Change 3.Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States.

25. How • Leadership development and mentoring programs need to be made available for nurses at all levels • A culture that promotes and values leadership needs to be fostered. • All nurses must take responsibility for their personal and professional growth by developing leadership competencies and exercising these competencies across all care settings.

26. We need to know who we are • 4) Effective workforce planning and policy making require better data collection and an improved information infrastructure.

27. How • Once an improved infrastructure for collecting and analyzing workforce data is in place, systematic assessment and projection of workforce requirements by role, skill mix, region, and demographics will be needed to inform changes in nursing practice and education.

28. IOM Conclusion • The United States has the opportunity to transform its health care system, and nurses can and should play a fundamental role in this transformation.

29. Accountability in a New Era • Classroom to critical care unit • Bedside to Board Room • Professional Society to Public Policy

30. In the New Era Who will lead?

31. Safe, Evidence Based Care Should not depend on a roll of the dice • Who will lead? “Knowing is not enough; we must apply. Willing is not enough; we must do.” -Goethe

32. Action Plan • Meet with CUSP/CLABSI team • Create strategy to involve beside nurses in sustaining and spreading CUSP: use the 4Es • Discuss what tools you can use to enhance nurse empowerment • Explore whether policies are needed to enhance nurse empowerment • Create a concrete plan to spread and sustain • Listen and learn

33. COURAGE “Never doubt that a small group of thoughtful committed citizens can change the world. Indeed, it’s the only thing that ever has.” Margaret Meade

34. Thank YOU for Your Leadership • For more information: cgoesch1@jhmi.edu

35. Your feedback is important to us https://www.surveymonkey.com/s/Z6FJ28T

36. Questions