On the CUSP: STOP BSI The Team Check-up Tool

1. On the CUSP: STOP BSIThe Team Check-up Tool

2. Learning Objectives • To understand the tool we use to: • Describe the anticipated activities of your ICU quality improvement team • Track implementation progress and the context of progress • Assess barriers to progress • Monitor interactions on the team • To think about how the tool can be useful to you

3. The Quality Improvement Team • Core team working on the CUSP/ CLABSI project • The small group that spreads the intervention to the rest of the ICU

4. Importance of the Quality Improvement Team • This team has the greatest impact on how the intervention is “rolled out” at your site (absolute power) • Potential implications of a poor job • Slower implementation • Gaps/ uneven implementation • Higher continued risk (infection, $, lives)

5. TCT Measures: • Engagement/ educational activities of the QI team (on BSI and CUSP) • Participation in CUSP activities • Extent of implementation on unit • Barriers to progress • Interactions on team

6. Team Activities-Keeping on Track • Team meetings (recommend 2/mo) • Review of data (monthly) • Meet w/ Exec Partner on unit (monthly or more) • Executive review of data (monthly) • Presentations to the Hospital Leadership and Board of Directors

7. Education and Engagement Activities on the Unit • Modeling the line placement steps; stopping insertions that violate protocol; having one-on-one talks where necessary • CUSP Activities • Science of safety video • How will we harm the next patient? exercise • Daily Goals • Morning Briefing • Learning from a defect • Executive Partnership

8. Education and Engagement Activities on the Unit • More Activities (add your ideas!) • Internal seminar for staff • Present project at all committee meetings • Make BSI prevention part of a skills fair • Have IC dept visit/ give a talk • In-services/ demos • New written policy • Post the steps and progress updates • Put the prevention practices on all clipboards • Update/ prepare line cart/ kit with checklist • Hand out Fast Facts one-page info sheet

9. Barriers to Progress • Turnover on QI Team • Spread to other parts of the hospital • Disruptive events • Lack of skills • Lack of time • Lack of buy-in • Lack of support • Lack of autonomy

10. Interactions among Team Members • Team agrees on goals • Team values individual contributions • Team can resolve conflicts • Team is unified

11. Action Items • Look over the tool • Think about what elements are most important to watch • Share TCT data with executive partner • Make a strategic plan to address identified barriers early

12. Reference List • Lubomski, Lisa H., Jill A. Marsteller, Yea-Jen Hsu, Christine A. Goeschel, Christine G. Holzmueller, and Peter J. Pronovost, “The Team Checkup Tool: Evaluating Quality Improvement Team Activities and Giving Feedback to Senior Leaders,” Joint Commission Journal of Quality and Patient Safety, October 2008. • Marsteller, Jill A., Christine G. Holzmueller, Martin Makary, J. Bryan Sexton, David Thompson, Lisa H. Lubomski and Peter J. Pronovost. “Developing Process-Support Tools for Patient Safety: Finding the Balance Between Validity and Feasibility,“ Joint Commission Journal of Quality and Patient Safety, October 2008.