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

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On the CUSP STOP BSIOverview of STOP-BSI Program
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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

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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

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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

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IMPROVE
Measure
How Often Do we Harm? Are Patient Outcomes
Improving?
Have We Created a Safe Culture? How Do We know We
Learn from Mistakes?
www.onthecuspstophai.org
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The CUSP/ CLABSI Intervention

1. Remove Unnecessary Lines
2. Wash Hands Prior to Procedure
3. Use Maximal Barrier Precautions
4. Clean Skin with Chlorhexidine
5. Avoid Femoral Lines

www.onthecuspstophai.org
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Safety Score CardKeystone ICU Safety Dashboard
  2004 2006
How often did we harm (BSI) (median) 2.8/1000 0
How often do we do what we should 66 95
How often did we learn from mistakes 100s 100s
Have we created a safe culture Needs improvement in  
Safety climate 84 43
Teamwork climate 82 42
CUSP is an intervention to improve these
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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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Intervention to Eliminate CLABSI
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Pronovost, Berenholtz, Needham BMJ 2008
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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. 200251RR-10
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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

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Ensure Patients Reliably Receive Evidence
  Senior Team Staff
  leaders leaders Staff
Engage How does this make the world a better place? How does this make the world a better place? How does this make the world a better place?
Educate What do we need to do? What do we need to do? What do we need to do?
Execute What keeps me from doing it? What keeps me from doing it? What keeps me from doing it?
Execute How can we do it with my resources and culture? How can we do it with my resources and culture? How can we do it with my resources and culture?
Evaluate How do we know we improved safety? How do we know we improved safety? How do we know we improved safety?
Pronovost Health Services Research 2006
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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

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Comprehensive Unit-based Safety Program (CUSP)
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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

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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

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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.

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To Get Help

• Email /call state project leader
• Talk to your team leader

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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

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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.

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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.

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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
  6337.
• 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.

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