On the CUSP: Stop CAUTI Cohort 8

1. On the CUSP: Stop CAUTI Cohort 8 Mapping the Journey: Hospital Unit Team Informational Webinar January 27, 2014

2. Today’s Presenters Tina Adams, RN Clinical Content Lead HRET Barbara Meyer Lucas, MD, MHSA Project Consultant Michigan Health & Hospital Association Keystone Center for Patient Safety and Quality Jenny Tuttle RN, MSNEd Tucson Medical Center Adult Critical Care Unit

3. Agenda

4. Objectives for today • Understand the inpatient unit catheter associated urinary tract infection (CAUTI) prevention program including the comprehensive unit safety program (CUSP) • Understand the collection and use of outcome and process measures data • Understand the role of the unit’s Team Leader

5. National Project Goals The Project Goals for CAUTI are to: • reduce mean CAUTI rates in participating clinical units by 25 percent; and • improve safety culture as evidenced by improved teamwork and communication by employing CUSP methodology.

6. Resources, CAUTI Website • CAUTI prevention:http://www.onthecuspstophai.org/on-the-cuspstop-cauti/ • CUSP patient safety culture modules: http://www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/ • Emergency Department Improvement Intervention:http://www.onthecuspstophai.org/on-the-cuspstop-cauti/toolkits-and-resources/emergency-department-improvement-intervention/

7. National Project Team HRET – Health Research & Educational Trust MHA – Michigan Health and Hospitals Association, Keystone Patient Safety Center U of M – University of Michigan St John – St. John Hospital and Medical Center Extended Faculty Network: APIC – Association for Professionals in Infection Control and Epidemiology, Inc. SHEA – Society for Healthcare Epidemiology of America SHM – Society of Hospital Medicine  ENA – Emergency Nurses Association All biographies located here: http://www.onthecuspstophai.org/about-us/key-personnel/

8. National Project Partnerships & Dissemination Model CAUTI National Project Team HRET MHA UM/St. Johns JHU State Hospital Associations, Partners & Coalitions Extended Faculty Network State Leads, Quality Improvement Organization, Hospital Engagement Network,- Coaching/CUSP/ Recruitment/Project Liaison National & Regional CAUTI Faculty APIC, SHEA, SHM, ENA Coaching/Recruitment/ Endorsement Hospitals/Units

9. Learning the Project Language • Cohort • “State” or “Regional” Lead • Unit CUSP Team and Team Leader • Unit Survey Coordinator • Outcome Measures • Process Measures

10. First 7 Cohorts, 42 sates, ~962 Hospitals

11. Registered Unit Type

12. Key Components of Intervention What will you be doing in this project? Technical (Clinical) • Catheter Insertion • Appropriate vs. Inappropriate Indications • Process to Evaluate Urinary Catheter Need Socio-Adaptive (Cultural) • Teamwork and communication improvements surrounding the unit’s patient safety culture

13. Key Components of Intervention 2) Socio-Adaptive (Cultural) continued • Comprehensive Unit-based Safety Program (CUSP) • Unit CUSP Team formed • Requires a Team Leader • Meets regularly (weekly or at least monthly) • Composed of engaged frontlinestaff who take ownership of patient safety (e.g. bedside nursing staff) • Includes staff members who have different levels of experience • CUSP Team includes nurse manager, physician, senior executive • CUSP Team may include infection control/prevention, central supply staff member, PT/OT staff, discharge planner • Tailored to include members based on clinical intervention

14. What will be provided? Educational events: Teleconferences, webinars, in-person meetings (with video conferencing) • For example: 6 Onboarding Calls, Monthly Content Calls, and 3 Learning Sessions Materials: Implementation guide with tools (guidelines, posters, forms, educational materials) Coaching: National and regional supported calls Data: On-line secure collection and reporting Site visits: NPT determined

15. Cohort 8 Timeline

16. Next Steps – Cohort 8 • Hospital Unit Informational Webinars – January 27 and 30, 2014; same content offered twice, recording available online • Recruitment of hospital units: January – March, 2014 • Team registrationdeadline: April 1, 2014 • Learning Session (LS) #1: March 17 – 31 at the state/sponsor level • LS #1 NPT Office Hours – April 2, 2014 from 3-4pm ET • Onboarding Webinar Series (6) – Begin early April through min June

17. On the CUSP: Stop CAUTI CAUTI Project Data: An Overview for Unit Teams Barbara Meyer Lucas, MD, MHSA, CPPS Michigan Health and Hospital Association (MHA) Keystone Center for Patient Safety and Quality

18. DATA COLLECTION: Why is it crucial to the project? Project’s data elements will help you: • Stay on course to achieve BOTH project goals • reduce your unit CAUTI rate by 25% • improve your unit’s culture of safety • Track your use of recommended technical work and CUSP interventions • Identify barriers to your progress

19. DATA COLLECTION: Where is it housed? MHA CARE COUNTS DATA BASE: • Each registered unit will have protected access • MHA will provide webinar training and technical support for: • entering your data • running your own reports

20. CAUTI PROJECT DATA ELEMENTS: • Background/Culture Data: • Readiness Assessment • HSOPS: Baseline and Follow-up • Ongoing Data Submission: • Outcome data • Process Data (optional) • Team Checkup Tool

21. BACKGROUND/CULTURE DATA: Readiness Assessment • PURPOSE: Tells us about your unit: • Size, type, patient demographics, etc. • LOGISTICS: • Completed ONCE at start of project • Done via Survey Monkey by ONE person per unit

22. BACKGROUND/CULTURE DATA: Hospital Survey on Patient Safety (HSOPS) • PURPOSE: Standardized measure of safety culture for individual patient care unit (NOT hospital-wide) • LOGISTICS: • Done twice: at the start of the project, and after the project intervention • Given to all unit staff

23. ONGOING DATA COLLECTION:Outcome and Process Data • OUTCOME DATA: What impact have we made on our 2 project goals: • reducing the CAUTI rate by 25% and • improving our unit’s culture of safety • PROCESS DATA (optional): Are we changing our daily work activities to reduce the risk of infection and make care safer, via BOTH: • technical work re: catheters • CUSP work (unit culture change)

24. CAUTI OUTCOME DATA: What Do We Collect? For the entire month (not just M-F) each enrolled unit must collect and submit: • Total # of patient days for that unit • Total # of indwelling urinary catheter days for that unit • Total # of CAUTI’s for that month Result: CAUTI Rates and Catheter Prevalence

25. CAUTI OUTCOME DATA: What Infrastructure Do Teams Need? • Someone to collect the data • Should be knowledgeable about NHSN criteria • Should resolve any “questionable CAUTI” issues before entering data • Good resource: ICP • Someone to enter the data • Either into Care Counts or NHSN (if state level data will be imported from NHSN into Care Counts)

26. CAUTI OUTCOME DATA: When is it due? Starts in MAY, with Three Phases • BASELINE (Monthly submission) May, June, July 2014 • IMPLEMENTATION (Monthly submission) August and September 2014 • SUSTAINABILITY: (1 month per quarter) Dec 2014; March and June 2015

27. PROCESS DATA (optional submission): What Do We Collect? DAILY, following the submission schedule: • # of patients on the unit that day • # of catheterized patients on the unit that day • Main reason why patient has a catheter TODAY • Where the catheter was inserted (on the floor, off the floor, unknown) Result: Catheter Appropriateness Information

28. PROCESS DATA: When is it due? Starts in JULY, with Three Phases Submit to Care Counts database on specific scheduled dates: • July 2014:M-F for 3 weeks • August and September 2014: on 16 scheduled days • After that: M-F for one week per quarter (December 2014; March and June 2015) Note: Process data submission is optional

29. CAUTI PROCESS DATA: What Infrastructure Do Teams Need? • Need a rounding process (not record review) • IDEAL: piggyback on existing unit rounds • We provide a model audit tool • Need a designated point person to: • Record data • Contact physicians for catheter removal order • Submit data to Care Counts

30. CAUTI PROCESS DATA: What Infrastructure Do Teams Need? • EXPECTATION: • Rounding for catheter appropriateness goes on daily, regardless of whether you choose to submit that data. Remember: This rounding process IS the intervention!!!

31. ONGOING DATA COLLECTION:Quarterly Team Checkup Tool (TCT) What it assesses: • Implementation of CUSP and CAUTI reduction activities • Team functioning • Barriers to project progress Submit to Care Counts database at MHA

32. TEAM CHECKUP TOOL: When Is it Due? Starts in AUGUST 2014 • Team submits their consensus response quarterly • Reflects the team’s work for the previous 3 months • Schedule: due quarterly AUGUST 2014 (reflects work of May-July), then: Nov 2014; Feb and May 2015

33. TAKE HOME MESSAGE: • Data Collection Process: • Is front-end loaded, but manageable • You will have support from the national team • Remember: Data drives change! Daily rounding for catheter presence and appropriateness IS the intervention!

34. Unit CUSP Team’s Goal • Develop and or expand capacity at the hospital unit level to support improvement by: • CUSP content expertise • CAUTI prevention expertise Reduce CAUTI and Improve Safety

35. Where do we start? • Select a CUSP-CAUTI Program Team Leader • Characteristics: • Seen as an leader by bedside staff • Go-to person to get questions answered • Able to influence others

36. Team Leader Tasks • Review Implementation Manual • Attend all program educational opportunities • Develop a CUSP-CAUTI team (bedside caregivers) • Schedule regular CUSP-CAUTI Team meetings • Educate CUSP-CAUTI Team • Involve all Team members in Team tasks • Provide feedback to Team members • Communicate with Senior Executive • Assure data/survey results submitted

37. Unit Team Tasks Attend and participate in CUSP Team meetings Provide bedside staff member’s perspective Implement CUSP-CAUTI program by sharing responsibility for the Team’s work • Participate in design of processes to prevent CAUTI and to employ CUSP interventions on your unit • Educate staff, physicians, patients and families • Champion effort, provide feedback to bedside staff • Data collection and submission • Celebrate successes along the way

38. CAUTI Unit Team: A Success Story Unit 450 CAUTI Team: Melanie Bunger RN - Nights AunneShepler RN - Nights Julie Davis RN- Days Pat Smothers, PCT - Days Stephanie Donovan RN, MSNEd Jenny Tuttle RN, MSNEd Lisa Hymson, Infection Control Lisa Vasquez RN - Days Nina Mazzola, Manager Infection Control

39. Hospital Information • 611 bed – Major teaching hospital • Unit 450 – 16 bed ICU • Neuro/Neurosurgical • Medical • Pulmonary • Vascular surgery • General surgery

40. Why we Joined the NationalOn the CUSP Collaborative • 2012 CAUTI rate data for the unit reflected a need for an improvement process. • Worst CAUTI rate in the house. • CUSP program provided us a venue of support and structure – Cohort #5

41. Our Journey Audit Process Customizing tool to evaluate for deficits Identifying barriers – Cracking the ICU mentality Case Reviews - Team Isolating root cause Review processes/practices Identifying vented patient populations - guideline Collaboration with other Departments Emergency Room Operating Room Transportation Radiology Providing the staff the tools/supplies Assessing supplies currently available Product trials

42. Audit Tool

43. Ventilated Patient Guidelines Chronic

44. Unit Success Reduction in Utilization Rates Reduction in CAUTI rates CUSP start 63% Reduction in CAUTIs in 9 months!

45. Lessons Learned Constant conversations A simple thing as WHO is doing the audit can make a difference Continual evaluation of audit tool/process Improved compliance when staff given the tools to change Physician buy in Still work to be done

46. CONTACTS • Nina Mazzola - Infection Control Manager (520) 324-2536 Nina.mazzola@tmcaz.com • Jenny Tuttle RN, MSNEd, CNRN - ACCU Manager (520) 903-4090 Jennifer.tuttle@tmcaz.com

47. Did We Meet Today’s Call Objectives? • Understand the inpatient unit catheter associated urinary tract infection (CAUTI) prevention program including the comprehensive unit safety program (CUSP) • Understand the collection and use of outcome and process measures data • Understand the role of the unit’s Team Leader

48. Resources on CUSP-CAUTI Websites Comprehensive Unit Safety Program AND CAUTI prevention: http://www.onthecuspstophai.org/on-the-cuspstop-cauti/ Emergency Department Improvement Intervention: http://www.onthecuspstophai.org/on-the-cuspstop-cauti/toolkits-and-resources/emergency-department-improvement-intervention/ Agency for Healthcare Research & Quality (AHRQ): http://www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/

49. Your Feedback is Important! https://www.surveymonkey.com/s/CAUTI_Orientation

50. Questions? For future questions, contact: