On the CUSP: STOP BSI Overview of STOP-BSI Program

1. On the CUSP: STOP BSIOverview of STOP-BSI Program

2. Immersion Call Overview Week 1: Project overview Week 2: Science of Improving Patient Safety Week 3: Eliminating CLABSI Week 4: The Comprehensive Unit-Based Safety Program (CUSP) Week 5: Building a Team Week 6:Physician Engagement

3. Learning Objectives • To delineate the goals of STOP-BSI • To describe the project organization • To define the interventions • To outline the planned learning sessions • To identify who to call for help

5. On the CUSP: STOP BSI Goals • To work to eliminate central line associated blood stream infections (CLABSI): reaching state means less than 1/1000 catheter days, state median 0 • To improve safety culture by 50% • To learn from one defect per quarter

6. IMPROVE Measure CUSP Comprehensive Unit based Safety program (TRiP) Translating Evidence Into Practice Have We Created a Safe Culture? How Do We know We Learn from Mistakes? How Often Do we Harm? Are Patient Outcomes Improving? Educate staff on science of safety Identify defects Assign executive to adopt unit Learn from one defect per quarter Implement teamwork tools Summarize the evidence in a checklist Identify local barriers to implementation Measure performance Ensure all patients get the evidence www.onthecuspstophai.org

7. The CUSP/ CLABSI Intervention CUSP CLABSI Remove Unnecessary Lines Wash Hands Prior to Procedure Use Maximal Barrier Precautions Clean Skin with Chlorhexidine Avoid Femoral Lines 1. Educate staff on science of safety 2. Identify defects 3. Assign executive to adopt unit 4. Learn from one defect per quarter 5. Implement teamwork tools www.onthecuspstophai.org

8. Safety Score CardKeystone ICU Safety Dashboard CUSP is an intervention to improve these*

9. Project Organization • State-wide effort coordinated by Hospital Association or designated collaborative agency • Learning collaborative model (e.g., multisite participation, 2 face-to-face meetings, monthly calls) • Standardized data collection tools and evidence • Local unit modification of how to implement interventions

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11. Intervention to Eliminate CLABSI

12. Pronovost, Berenholtz, Needham BMJ 2008

13. Evidence-based Behaviors to Prevent CLABSI • Remove unnecessary lines • Wash hands prior to procedure • Use maximal barrier precautions • Clean skin with chlorhexidine • Avoid femoral lines MMWR. 2002;51:RR-10

14. Identify Barriers • Ask staff about knowledge • Ask staff what is difficult about doing these behaviors • Walk the process of staff placing a central line • Observe staff placing central line

15. Ensure Patients Reliably Receive Evidence Pronovost: Health Services Research 2006

16. Ideas for Ensuring Patients Receivethe Interventions: the 4Es • Engage: stories, show baseline data • Educate staff on evidence • Execute • Standardize: Create line cart • Create independent checks: Create BSI checklist • Empower nurses to stop takeoff • Learn from mistakes • Evaluate • Feed back performance • View infections as defects

17. Comprehensive Unit-based Safety Program (CUSP)

18. Pre CUSP Work • Create a unit-level team • Nurse, physician administrator, others • Assign a team leader • Measure culture in the unit • Seek out a senior executive to participate on unit-level team

19. CUSP Elements • Educate staff on science of safety • Identify defects • Assign executive to adopt unit • Learn from one defect per quarter • Implement teamwork tools Pronovost J, Patient Safety, 2005

20. We are on a Continuous Journey • We have toolkits, manuals, websites, and monthly calls to learn from and with each other. • Your job is to join the calls, share with us your successes and more importantly the barriers you face. • Commit to the premise that harm is untenable.

21. To Get Help • Email /call state project leader • Talk to your team leader

22. Action Items • Review content of website at www.safercare.net • Toolkits • Slidesets • Manuals • Project Management Checklists • Pre-Implementation Checklist • CEO/ Senior Leader Checklist • Infection Preventionist Checklist

23. References Measuring Safety • Pronovost PJ, Goeschel CA, Wachter RM. The wisdom and justice of not paying for "preventable complications". JAMA. 2008; 299(18):2197-2199. • Pronovost PJ, Miller MR, Wachter RM. Tracking progress in patient safety: An elusive target. JAMA. 2006; 296(6):696-699. • Pronovost PJ, Sexton JB, Pham JC, Goeschel CA, Winters BD, Miller MR. Measurement of quality and assurance of safety in the critically ill. Clin Chest Med. 2008; in press.

24. References Measuring Safety • Pronovost PJ, Goeschel CA, Wachter RM. The wisdom and justice of not paying for "preventable complications". JAMA. 2008; 299(18):2197-2199. • Pronovost PJ, Miller MR, Wachter RM. Tracking progress in patient safety: An elusive target. JAMA. 2006; 296(6):696-699. • Pronovost PJ, Sexton JB, Pham JC, Goeschel CA, Winters BD, Miller MR. Measurement of quality and assurance of safety in the critically ill. Clin Chest Med. 2008; in press.

25. References • Pronovost P, Weast B, Rosenstein B, et al. Implementing and validating a comprehensive unit-based safety program. J Pat Safety. 2005; 1(1):33-40. • Pronovost P, Berenholtz S, Dorman T, Lipsett PA, Simmonds T, Haraden C. Improving communication in the ICU using daily goals. J Crit Care. 2003; 18(2):71-75. • Pronovost PJ, Berenholtz SM, Needham DM. Translating evidence into practice: a model for large scale knowledge translation. BMJ. 2008 Oct 6;337. • Pronovost PJ, Weast B, Bishop K, et al. Senior executive adopt-a-work unit: A model for safety improvement. Jt Comm J Qual Saf. 2004; 30(2):59-68. • Thompson DA, Holzmueller CG, Cafeo CL, Sexton JB, Pronovost PJ. A morning briefing: Setting the stage for a clinically and operationally good day. Jt Comm J Qual and Saf. 2005; 31(8):476-479.