Small and Rural & Critical Access Hospitals Supplemental Call

1. Small and Rural & Critical Access Hospitals Supplemental Call July 19, 2011

2. Agenda • Presentation by Denise Flook and Lorna Martin • Applying CUSP in the Small and Rural CAH • Using CUSP Beyond CLABSI and CAUTI • Hearing From CAH Team Leaders • Paul Frigoli, Grant Regional Health Center • IL CAH Team Leader • Suggestions for Future Calls

3. CUSP: An Intervention to Improve Safety Culture, Enhance Teamwork , Learn from Mistakes, and Sustain Improved Patient Outcomes Denise M. Flook, RN, MPH, CIC Director, Workforce Development & Infection Prevention Lorna Martin, RN Patient Safety & QI Specialist

4. Quality and Safety Are Now Key to Hospital Success • Payers, including the government, and the public demand more efficient, safer care • Limited resources will necessitate efficiency

5. The Challenge How do we provide and sustain the highest quality and safest care for every patient, every time in the current environment of diminishing resources?

6. It is easy to think that simply implementing a checklist is the path to better outcomes But………Changing culture is the key to sustained safety and improved outcomes for our patients

7. Safety/Quality Improvement Is A Two Part Process

8. What is CUSP? • Comprehensive Unit-based Safety Program • An intervention to learn from mistakes and improve safety culture for sustained improved patient outcomes

9. On the CUSP: Process Intervention Comprehensive Unit-based Safety Program (CUSP) -Improve or reinforce good cross-disciplinary communication and teamwork -Enhance coordination of care -Address overall patient safety -Work towards healthy unit culture • Reduction Protocol • -Best-evidence supplies, organization of supplies • Ensuring all patients receive the best practices • Checklist, protocol to ensure consistent application of evidence

10. The CUSP Steps • Develop a Team • Assign executive to adopt unit • Educate staff on Science of Safety http://www.safercare.net/OTCSBSI/Staff_Training/Entries/2009/9/6_1._The_Science_of_Improving_Patient_Safety.html. • Identify and prioritize defects • Implement teamwork tools • Provide timely feedback • Learn from defects – have staff investigate each occurrence Adapted from Pronovost , Patient Safety, 2005

12. CUSP is a Continuous Effort • Add Science of Safety education to orientation • Learn from one defect per quarter, share or post lessons • Use quality improvement and teamwork tools that best meet the hospital/unit’s needs • Feedback timely data, investigate each event

13. Walking Through the Process: Eliminate HA Stage 3/4 Pressure Ulcerson the Unit • Develop a team - include staff nurses • Gather baseline data • Have first team meeting, educate on science of safety, data, goals • Research the evidence based practices that eliminate Pressure ulcers

14. The CUSP/ Improvement Intervention CUSP Eliminate Stage 3, 4 Pressure Ulcers • Educate staff on Science of Safety • 2. Identify defects ,study cause • 3. Team uses evidence research and • QI tools to improve • 4. Assign executive to adopt unit • Implement teamwork tools • Provide feedback, investigate each case Comprehensive skin assessment Standardized pressure ulcer risk assessment Care planning and implementation to address areas of risk Implement other evidence based practices as needed www.onthecuspstophai.org

16. It Goes Back to Leadership – On All Levels • Engagement , commitment, communication is foremost • Provide education • Provide resources • Visibility and transparency • Feedback • Investigation and ownership of outcomes and improvement

17. Keep The Focus There are challenges ahead but everyone must not lose site of our North Star – the patient- who must be kept in the center of all we do Your commitment, leadership and persistence is an essential key to patient quality and safety

18. 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, 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.

19. Denise M. Flook, RN, MPH,CIC Director, Workforce Development/ Infection Prevention 770-249-4518 dflook@gha.org.

20. CUSP Resources • Please contact your State Hospital Association Quality Director for more information about CUSP initiatives • Please visit the On the CUSP: Stop HAI project website: www.onthecuspstophai.org

21. Hearing From Your Peers

22. Paul Frigoli Quality Director Grant Regional Health Center Lancaster, WI

23. Agenda • Why we joined the CLABSI & CAUTI projects • Barriers and Successes • Key Lessons

24. Val Pfoutz, RN ICU Director KSB Hospital Dixon, IL

25. Agenda • Why we joined the CLABSI & CAUTI projects • Barriers and Successes • Key Lessons

26. CUSP Resources • Please contact your State Hospital Association Quality Director for more information about CUSP initiatives • Please visit the On the CUSP: Stop HAI project website: www.onthecuspstophai.org

27. Hearing From You • What should future Small/Rural, CAH supplemental calls address? • What resources can you share with others? • What additional resources would help you improve patient safety?