national expansion overview spring 2010
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On the CUSP: Stop BSI. National Expansion Overview Spring 2010. 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 - PowerPoint PPT PresentationTRANSCRIPT
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 LeadershipAHRQ CDC CMS AHA
Field LeadershipJHU MHA HRET NW
Implementation LeadershipSHA DOH QIO
What are Next Steps
• Answer your questions:– Deborah Bohr at [email protected] 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