CUSP 4 MVP – VAPQuantitative Implementation Assessment 1: Aggregated ResultsKisha Ali, MS

Mayo Levering, BS

September 2, 2014

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Implementation Assessment1

• ICU collaborative developed the Team Checkup Tool (TCT) in

2005 during the MHA Keystone

• Designed to close the gap between hospital executives and

frontline teams

• Purpose help identify and work with teams to provide needed

training, resources, or other aids

• Pioneered in the CUSP for VAP Maryland and Pennsylvania

Pilot Project

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Implementation Assessment2

• Measures implementation components and contextual factors that

affect quality improvement initiatives

• A metric that allows implementation of a project to be quantified

• Consist of a quantitative and qualitative portion, these are the

results of the quantitative portion

• Quantitative portion completed online sample of participants are

interviewed via telephone for the open-ended qualitative part of

the tool

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Unit Participation:Results of Compliance Participation Overall:

Participation by State :

Total Number of Units Participating the

Project

Total Number of Units Completed Implementation

Assessment

Total Number of Participating

States

Total Respondents in Project Contributing to

Result Data (%)

47 31 7 66

State Number of Units Completed Implementation Assessment

Number of Units in that

State

Compliance Per State (%)

Contribution to Result Data (%)

Florida 1 1 100 3.4

South Carolina 6 6 100 20.7

Texas 7 7 100 24.1

New Jersey 9 13 69 31.0

Michigan 6 17 35 20.7

Missouri 0 1 0 0

Virginia 0 2 0 0

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Implementation Assessment1Tool

Aggregated Quantitative Results focuses on 7 measures:

1. Training on patient safety

2. Leadership commitment and support

3. Implementation of CUSP tools

4. Implementation of CUSP 4 MVP-VAP bundle

5. Data review

6. Barriers to progress

7. Team engagement

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Measure 1: Results from Training on Patient Safety

How many of your staff have viewed a video or presentation on the Science of Safety?

Is a patient safety presentation now part of your new staff or unit orientation for all patient care providers (e.g. physicians, nurses, respiratory therapists)?

Yes 27.3%

No, but preparing to do this 54.5%

No, with no current plans to do so 0%

Don’t Know 18.2%

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Measure 2: Leadership Commitment and Support

Is your leadership taking the following steps to reinforce its support for the work?

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Measure 2: Leadership Commitment and Support

Unit leaders:  How actively engaged have the unit leaders been with your CUSP 4 MVP-VAP project and VAE prevention?

Hospital leaders:  How actively engaged have the hospital leaders been with your CUSP 4 MVP-VAP project and VAE prevention?

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Measure 3: Implementation of CUSP Tools

The CUSP process consists of implementing the following tools to improve teamwork and communication. Please indicate whether you have implemented any of these CUSP components in your VAE process thus far?

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Measure 3: Implementation of CUSP Tools

Have you conducted a Staff Safety Assessment with your unit staff about how the next patient might be harmed, to identify potential safety risks in the unit?

Have you grouped and prioritized the safety issues that emerged from the safety assessment you conducted with your staff?

Yes 63.7%No 22.7%

Don’t Know 13.6%

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Measure 4: Implementation of CUSP 4 MVP - VAP Bundle

The CUSP 4 MVP-VAP Toolkit lays out the following steps to be taken in implementing the bundle for ventilator-associated event (VAE) prevention.  Please indicate whether you have taken each of these steps in your implementation process thus far?

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Measure 5: Data Review and Sharing

How often is the CUSP team taking the following steps to review data on VAE rates and other performance data (e.g., process data, barriers faced), and share this information with other key stakeholders?

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Measure 6: Barriers to ProgressIn the past three months, how often did each of the following factors slow your CUSP 4 MVP-VAP team's progress in implementing the CUSP and VAE prevention interventions?

All Units (n=31) Number of Possible Barriers

All Barriers 18

Barrier group:  

Leadership support issues 4

Team skills and cohesion issues 6

Stakeholder push‐back issues 3

Workload and time issues 5

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Measure 6: Barriers to ProgressIn the past three months, how often did each of the following factors slow your CUSP 4 MVP-VAP team's progress in implementing the CUSP and VAE prevention interventions?

Answer Options Never/Rarely

Occasionally Frequently Almost Always Response Count

Insufficient knowledge of evidence supporting interventions

19 6 2 1 28

Not enough leadership support from executives 21 5 1 0 27Not enough leadership support from physicians 16 5 6 0 27

Not enough leadership support from nurses 19 6 2 0 27Insufficient autonomy/authority 19 7 0 1 27Lack of quality improvement skills 19 8 0 0 27Confusion about how to proceed with CUSP activities 11 10 5 1 27

Lack of team member consensus regarding goals 16 10 1 0 27

Inability of team members to work together 24 3 0 0 27Turnover on CUSP team 21 2 1 3 27Not enough buy-in from physician staff 15 8 2 2 27Not enough buy-in from nursing staff 16 10 1 0 27Not enough buy-in from other staff 16 9 2 0 27Not enough time 7 10 7 3 27Staff turnover on unit 18 4 3 2 27Data collection burden for staff 6 8 10 3 27Problems with data systems 12 9 5 1 27Competing priorities or distractions 8 11 5 3 27

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Measure 7: Unit-Level Team Engagement

On a scale of 1 to 5 (5 being the most), please indicate your team's level of engagement in the process of implementing the CUSP 4MVP-VAP and CUSP components of the intervention.

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Conclusion

• Results for 31 Quantitative Implementation Assessments in Cohort 1

• Have sampled a number of units from the quantitative for the

qualitative portion

• Have begun qualitative analysis of these interviews

• Assessments will continue to be administered semi-annually

• Units will track implementation successes and barriers of the CUSP

tools and the CUSP4MVP-VAP interventions over time

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Reference

1. Lubomski LH, Marsteller JA, Hsu YJ, Goeschel CA, Holzmueller CG, and Pronovost PJ. Team Checkup Tool: Evaluating QI Team Activities and Giving Feedback to Senior Leaders. Joint Commission Journal of Quality and Patient Safety. 2008; 34(10): 619-623.

2. Ali KJ, Farley DO, Speck K, Catanzaro M, Wicker K and. Berenholtz SM. Measurement of Implementation Components and Contextual Factors in a Two-State Healthcare Quality Initiative to Reduce Ventilator-Associated Pneumonia. Infection Control and Hospital Epidemiology. 2014; 35(10): [in press].