CLABSI Supplemental Call Series

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

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

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!

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. Best Practices: Engaging & Sustaining Nurse Involvement in CUSPHuddles • 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. 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 Nurse Manager The John Hopkins Hospital Joanne Timmel, MSN, RN, NE-BC

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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