National Expansion OverviewSpring 2010

On the CUSP: Stop BSI

Overview Goals

• Why this initiative is important• How it works (in general)• Why it works• What it requires• What are the next steps• What can I clarify

Why This Initiative is Important

• From the patient’s perspective– Blood stream infections kill 40-60,000 persons

each year– Reducing the BSI rate from 5 per 1,000 days to 1

per 1,000 days will save 20,000 lives annually– These reductions were achieved using the

processes at the core of On the CUSP: Stop BSI

Why This Initiative is Important

• From Government’s Perspective– Key part of Secretary Sibelius’ initiative to reduce

hospital acquired infections• AHRQ funding national rollout of On the CUSP: Stop BSI• Coordination with CDC efforts to reduce HAI’s through

ARRA grants to states• Coordination with CMS efforts to reduce surgical site

infections

– Driven by belief that hospital care can and should be safer, more efficient and cheaper

Why This Initiative is Important

• From Hospital Association Perspective– Key part of AHA’s Hospitals in Pursuit of

Excellence national campaign to improve hospital care quality

– Voluntary participation and success blunts efforts to mandate onerous data collection and other activities

– State hospital association support enhances members’ abilities to achieve their mission

Why This Initiative Is Important

• Results sustained over time in MI hospital units :– from 7.7 – 2.7 infections /1,000 catheter days at

baseline to – 1.2 and 0 at 12-18 months to – 1.1 and 0 at 34-36 months

Pronovost, Goeschel, Colantuoni, Watson et al, BMJ 2010;340:c309

How On the CUSP: Stop BSI works

• Its leadership:– Health Research & Educational Trust of the

American Hospital Association (John Combes, MD)

– The Johns Hopkins University Quality & Safety Research Group (Peter Pronovost, MD, PhD)

– The Michigan Health & Hospital Association Keystone Center for Patient Safety & Quality (Spencer Johnson/Sam Watson)

How On the CUSP: Stop BSI works

• Its goals:– Reduce BSIs to 1 per 1,000 catheter days– Reach hospitals in all 50 states, the District and

Puerto Rico– Include both ICUs and other units with BSI risks– Include Critical Access Hospitals– Improve safety culture

CUSP & CLABSI Interventions

1. Educate on the science of safety

2. Identify defects

3. Assign executive to adopt unit

4. Learn from Defects

5. Implement teamwork & communication tools

CUSP CLABSI

1. Wash Hands Prior to Procedure

2. Use Maximal Barrier Precautions

3. Clean Skin with Chlorhexidine

4. Avoid Femoral Lines

5. Remove Unnecessary Lines

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On The CUSP:Stop BSI

PRIMARILY Technical (CLABSI)

CVC Insertion

CVC Line Cart

1. Contents inventory

Evidence based BSI prevention (hands,

site, skin prep, barrier, removal)

1. Presentation of evidence 2. CLABSI factsheet3. Insertion checklist 4. Vascular access quiz 5. Vascular access manual/ policy 6.Annotated bibliography

CVC Management

1. Daily goals 2. Dressing change 3. Vascular access manual/ policy protocol

PRIMARILY Adaptive (CUSP)

Science of Safety

Training

1. Science of safety presentation 2. Attendance sheet

Staff Identify Defects

1. Staff safety assessment form 2. Indentifying hazards presentation

Senior Executive

Partnership

Briefings

Learning from Defects

LFD toolkit

Implement Tools for Teamwork and

Communication

1. Daily goals 2. Shadowing 3. AM briefing 4. Call list 5. Team check up tool

Assemble a CUSP team, Partner with a senior executive;

Baseline CLABSI DataExposure Tool and Technology Assessment

How On the CUSP: Stop BSI works--Its Scope

(Will include additional hospitals from states in earlier cohorts)

We need you in this project!

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Recruit/Equip State Hospital Associations

SHAs form Consortia and Recruit Hospitals

Hospitals Collect Baseline data-culture & infections

Ongoing training & technical Support in CUSP

Improved culture, infection rates

Sustainable improvements, spread to other challenges

How On the CUSP: Stop BSI works--The Process

Why On the CUSP: Stop BSI WorksFour Key Ingredients

1. Emphasis on culture change: without a culture of safety, infection reductions will be less achievable and unsustainable– Evaluate safety culture– Educate staff on science of safety– Identify defects in care– Commit to executive partnership– Re-measure culture every 12-18 months

Why On the CUSP: Stop BSI WorksFour Key Ingredients

2. Use of proven strategies for reducing BSIs •Educate staff on evidence-based practice to eliminate

CLABSI•Implement checklist to ensure compliance with these

practices•Empower nurses to ensure doctors comply with

checklist•Utilize monthly team meetings to assess progress

Why On the CUSP: Stop BSI WorksFour Key Ingredients

3. Use of data to demonstrate need, document progress, and validate investment• Collection of infection data using simple numerators and

denominators• Assessment of safety culture using AHRQ’s Safety Culture

Survey• Simple monthly progress data submitted on Team

Checkup Tool • Reports produced centrally and shared with participants• Collection and reporting is essential—public sharing of

data is NOT expected or encouraged

Why On the CUSP: Stop BSI WorksFour Key Ingredients

4. Exceptionally qualified leadership and faculty• Peter Pronovost’s team commands enormous respect

and creates enormous enthusiasm• MHA’s experience and data warehouse assures state

hospital association’s needs are understood and addressed

• HRET and AHA are focused exclusively on making the project work for both hospitals and participating hospital associations

Why CUSP Works

• Care at the bedside is transformed• The CUSP model is applicable to other HAIs,

virtually all other patient safety issues• Incorporates existing teamwork and

communication tools, e.g., TeamSTEPPS

On the CUSP: Stop BSIProject Timeline

[1] SHA=State Hospital Association[2] DUA=Data Use Agreement

[3] HSOPS=Hospital Survey of Patient Safety Culture

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MHA/Keystone registers hospitals in data system, and hospitals complete DUA [2]

SHA[1] recruits hospitals and forms state collaborative

Hospitals take first HSOPS[3], and immersion calls begin

SHA holds kick-off meeting for its hospital teams; monthly content and coaching calls begin; hospitals begin to submit monthly CLABSI and Monthly Team Checkup Tool data

SHA holds mid-course meeting for its hospital teams

Hospitals take second (last) HSOPS

SHA holds celebration meeting for its hospital teams

Hospital

State Hospital Association

State Coordinators/Central

Mailbox

HRET LEAD:

PROJECT MANAGEMENT

•Initial planning calls

•Schedule/plan mtgs & calls

• Coordinate with CDC & CMS

• Arrange DUAs

•Statewide logistics

MHA LEAD:

DATA

•Data submission

• Data reports

• Data entry/retrieval problems

•Provide Safety Culture Feedback Report

JHU LEAD:

CONTENT

•Immersion calls

• Initial and follow-up mtgs

• Content calls

• Coaching calls

HRET

JHU

MHA

NWU

Package educational resources

Develop training resources

Hospital & Hospital Association PerspectiveWhat Participation Requires: Support from the National Project Team

What Participation Requires: A State Lead from the Association

The Lead will need to:• Lead hospital recruitment efforts• Coordinate with national project team• Oversee logistics of meetings and call planningThe Lead will NOT need to:• Create resources for hospitals• Provide any content knowledge or answer substantive

questions• Set up a website or develop an implementation manual

—both come from the national team

What Participation Requires Hospital Unit

The Hospital Unit will need to:• Participate formally for 2 years• Assemble team • Assign team leader (10% effort)• Engage executive champion • Hold monthly patient safety meetings• Listen to monthly content and coaching calls

What Participation Requires Hospital Unit

• Submit monthly CLABSI data if not already submitting to NHSN (5-10 minutes/month by one person)

• Assess monthly teamwork and communication (10 minutes/month by one person)

• Take the Hospital Survey on Patient Safety Culture (twice: @ baseline and near end of 2 years by all team members)

• Attend 3 face-to-face meetings & monthly calls

Confidentiality

• All information is confidential, blinded comparisons with others in state and with others states in the national project

On the CUSP Data CollectionMeasure / Form Frequency of

CompletionHow to submit Reports generated

Exposure & technology assessment

Once Survey Monkey(Link will be sent via email)

Descriptive

Culture assessment (AHRQ Hospital Survey on Patient Safety)

Baseline and 18 months

HSOPS administered via MHA Care Counts**

Unit reports and comparative reports from MHA

CLABSI rate

Numer = # of casesDenom = # of C.L. Days

*Monthly (beginning 2-3 months after state launch)

https://data.ncqualitycenter.org/

Comparative Reports from NCSHIM and MHA Care Counts

Team Check-Up Form *Monthly (beginning 2-3 months after state launch)

www.mhacarecounts.org Available in MHA Care Counts

Staff Safety Assessment survey ‘How is the next patient going to be harmed?’

Baseline and biannual

Not submitted No report

Learning From Defects Monthly Not submitted No report*Due by the 15th of the Month following data collection. (Ex: January is due by February 15)

** Website managed by Michigan Health & Hospital Association's (MHA) Keystone Center for Patient Safety & Quality

CLABSI Report

MTCT Report

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MTCT Common Barriers

Sample HSOPS Report

Sample HSOPS Report

Data Status Report

HAI Elimination Collaboration

Policy Leadership

AHRQ CDC CMS AHA

Field LeadershipJHU MHA HRET NW

Implementation Leadership

SHA DOH QIO

What are Next Steps

• Answer your questions:– Deborah Bohr at dbohr@aha.org or 646-678-4280– Visit www.onthecuspstophai.org

• Observe an upcoming Kickoff meeting• Join an upcoming cohort

– Cohort 4: July 2010– Cohort 5: Sep 2010