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Getting Started on Central Line Associated Blood Stream Infections. Jill Hanson Manager, Quality Improvement WHA Improvement Advisor. Today’s Call. Current State of CLABSI’s Initiative Timeline and Process Measures Review Findings from Kick-Off Brainstorming Next 30 Days
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Getting Started onCentral Line Associated Blood Stream Infections Jill Hanson Manager, Quality Improvement WHA Improvement Advisor
Today’s Call • Current State of CLABSI’s • Initiative Timeline and Process • Measures • Review Findings from Kick-Off Brainstorming • Next 30 Days • View Science of Safety Video • Organizing the Team • Submitting Baseline Data • Determine Process Measure Data Collection Form to Use
CLABSI’s in Wisconsin In one year, in Wisconsin, nearly 200 people experienced a CLABSI. Improving the Wisconsin CLABIS Rate by 40% in two years could mean 180 CLABSI’s are prevented. This could be a savings of $5.4 to $13.5 million.
CLABSI Partners for Patients Goals Nationally: • Reduce the mean CLABSI rate to less than one per 1,000 catheter days over two years • Improve safety culture Wisconsin: • Reduce the statewide ICU CLABSI SIR from .581 to .30 and/or 75% of WI ICUs will report zero CLABSI by 12/31/2013 • Reduce the CLABSI SIR (all units) by 50% by 12/31/2013 What’s your goal? Individualized AIM statement
Poll Question One – What Have You Tried? Which of the following describes your facility best in terms of progress on CLABSI? • This is the first time we have worked on it. • We have worked on it, but haven’t been able to sustain the gains. • We have successfully implemented changes and are sustaining the gains. • We have all but given up on finding ways to improve.
Initiative Timeline Overview • 9 Month Collaborative • 1-Hr Webinar Each Month – 4th Tuesday at 10 – 11 AM
Poll Question One - Results Which of the following describes your facility best in terms of progress on CLABSI? • This is the first time we have worked on it. • We have worked on it, but haven’t been able to sustain the gains. • We have successfully implemented changes and are sustaining the gains. • We have all but given up on finding ways to improve.
Initiative Learning Process Team Learning Opportunities Webinars • Review progress of last 30 days • New content • Discussion and sharing • Plan for the next 30 days Discussion Group • Questions • Peer-to-Peer Sharing Coaching Calls (if there is interest) • Once per month Quality Center Website • Data submissions • References and Toolkits • Reports (coming soon) Webinars Site Visits Discussion Group WHA Quality Center
Guide to Quality Centerhttp://www.whaqualitycenter.org/ Click Here
Importance of Measurement Why measure? • The purpose of measurement in QI work is for learningnot judgment! • Measures should be used to guide improvement and test changes. • Demonstrate change from a baseline, or initial measurement, and assess the degree of change after an intervention. I think we improved… but I’m not sure by how much?
CLABSI Measures • Outcome Measure:Focus on the customer or patient. What is the result? • Adult – Number of CLABSIs & Central Line Days (All Units or Unit Specific) • Process Measures:Focus on theworkings of the system. Are the parts/steps in the system performing as planned? • Choose One: • CLABSI Bundle Adherence Rate • Insertion Compliance • Maintenance Compliance • Daily Review of Line Necessity
CLABSI Process Measure Data Collection Forms Available on the CLABSI References &Toolkit Page • Bundle Adherence Rate (NHSN CLIP Data Collection Form) • Maintenance Compliance Form • Insertion Compliance Form • Daily Review of Line Necessity Form (part of Daily Goals Checklist)
Action Item #1 – Data Submission • Baseline Outcome data due June 30 • Submit via WHA Quality Center portal or NHSN • 2011 Data – Aggregate Num, Den & Start/End Date • 2012 Data (Monthly Jan – June) • Analyze baseline data
Why Improvement Is Hard Reasons Improvement Projects May Have ‘Failed’ in the Past • Moved too fast to ‘Protocol and Procedure’ • Did not have the right people involved • Did not engage frontline staff in trying new changes – little buy in • Measures were not monitored consistently over time • Did not reinforce training on the new way of doing things • Used the same core group of people to fix the problem • Participants in the initiative do not address the root causes of performance deficiency
Partners for Patients Focus • Slow down the improvement train • Continuous measurement throughout initiative (and beyond) • Get the right people involved • Get new people involved • Small tests of change with many front-line staff • Opportunities to revisit training • Focus on project sustainability
Diverse and Independent Input Appreciate the wisdom of crowds • Remember health care is a team effort • Strive to create an environment where frontline providers can speak up if they have concerns and are heard when they express concerns • Get as many viewpoints as possible Think about your “tipping point”: • How many staff on your unit need to buy into a change in order for it to stick?
Science of Safety – How Errors Happen The Swiss Cheese Model – by James Reason Important Concepts: • Holes in any layer increase the vulnerability of the whole system. • It is virtually impossible to eliminate all holes. • Must understand the whole system, not just the steps. • Continuously monitor the health of the whole system.
Why do Mistakes Happen? • Inconsistency/variation • Complexity • Too many steps • Human error • Tight time constraints • Hierarchical culture • Fatigue • Inattention/distraction • Unfamiliar situations/new problem • Communication errors • Using past solutions • Mislabeling/inadequate instructions • Equipment design flaws Process Factors People Factors
Impact of Design on System Performance System-level factors including characteristics of: • Provider • Team • Work Environment • Department of hospital pressures
Principles of Process Design • Standardize - Eliminate steps if possible • Create independent checks • Think about near misses - What might happen? - Why? - What can you do to reduce risk? - How will you know it works?
Science of Safety Recipe • Educate on the Science of Safety • Identify Defects (Staff Safety Assessment) • Learn from Defects • Implement Teamwork & Communication Tools
What is a “Safety Culture”? Safety Culture encompasses the attitudes held within a workplace from the leadership to the front lines. This includes: • How open staff is to discussing patient safety issues and concerns with their colleagues and their leaders • How safe they feel about speaking out if they think that a patient is in danger • How serious they think the organizational leadership is about patient safety • How well they think they work as a team.
Assessing Your Organization’s Culture • Participate in a culture walk – what do you observe on your unit? • Conduct culture interviews – interview staff in small groups. Observe behaviors and interactions. How do they feel about culture? • Culture surveys (such as AHRQ or Press Ganey) Tip Sheet Available via the WHA Quality Center - CLABSI Resources Page
Action Item # 2 – View Patient Safety Video Create a roster of who on your team/unit needs to view the Science of Safety video. http://www.youtube.com/watch?v=GOJJHHm7lnM&feature=results_main&playnext=1&list=PL048D28C888FE3871
Organizing your Team Considerations • Who will you involve? • How will you communicate? • Within your team? (notify of meetings) • To others outside of the team? • How will you use the webinars? (use as weekly meeting?) • Identify team structure (key roles, expertise, leaders) • How will you keep everyone engaged?
Polling Question Two – Your CLABSI Team Please select who will be part of your CLABSI team (select all that apply): • Executive Champion • QI Lead • Physician • Pharmacists • Clinical Manager • Front Line Staff • Environmental Services
Action Item #3 - Organizing your Team Optional Tools to Use Team Charter Agenda Background QI Team Info
Polling Question Two - Results Please select who will be part of your CLABSI team (select all that apply): • Executive Champion • QI Lead • Physician • Pharmacists • Clinical Manager • Front Line Staff • Environmental Services
Reminder Please complete the three question survey before you close out of today’s webinar. Next Webinar: July 24 at 10 am Systematic Improvement
The Next 30 Days Tools Available On WHA Quality Center: • Science of Safety Video Link • Quality Center CLABSI References & Toolkit Section
Thank you! Questions? Jill Hanson Manager, Quality Improvement WHA