On the CUSP: STOP BSIOn the CUSP: STOP BSIThe Comprehensive Unit-based Safety Program The Comprehensive Unit-based Safety Program

(CUSP):(CUSP):

An Intervention to Learn from Mistakes and Improve Safety Culture

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Immersion Call OverviewImmersion 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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The CUSP/ CLABSI InterventionThe CUSP/ CLABSI Intervention

CUSP

1. Educate staff on science of safety

2. Identify defects

3. Assign executive to adopt unit

4. Learn from one defect per quarter

5. Implement teamwork tools

CLABSI

www.safercare.net

1. Remove Unnecessary Lines

2. Wash Hands Prior to Procedure

3. Use Maximal Barrier Precautions

4. Clean Skin with Chlorhexidine

5. Avoid Femoral Lines

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Learning ObjectivesLearning Objectives

• To explain the philosophy and approach of CUSP

• To describe the steps in CUSP

• To introduce available teamwork tools on safercare.net

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What is CUSP?What is CUSP?

• Comprehensive Unit-based Safety Program• An Intervention to Learn from Mistakes and

Improve Safety Culture

On the CUSP: Stop BSI Intervention

Comprehensive Unit-based Safety Program (CUSP)

-Improve or reinforce good cross-disciplinary communication and teamwork

-Enhance coordination of care

-Address overall patient safety

-Work towards healthy unit culture

BSI-Reduction Protocol

-Best-evidence supplies, organization of supplies

-Ensuring all patients receive the best practices

--Checklist to ensure consistent application of evidence

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Safety Score CardSafety Score CardKeystone ICU Safety DashboardKeystone ICU Safety Dashboard

* CUSP is intervention to improve these

  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 100sHave we created a safe culture What areas need improvement (%)

 

Safety climate* 84% 43% Teamwork climate* 82% 42%

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Pre CUSP WorkPre CUSP Work

• Create a CUSP/CLABSI team– Nurse, physician administrator, others– Assign a team leader

• Measure culture in the unit

• Work with hospital quality leader or hospital management to have a senior executive assigned to CUSP/CLABSI team

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Steps of CUSPSteps of CUSP

1. Educate staff on Science of Safety

2. Identify defects

3. Assign executive to adopt unit

4. Learn from one defect per quarter

5. Implement teamwork tools

Pronovost J, Patient Safety, 2005

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Step 1: Science of SafetyStep 1: Science of Safety• Understand system determines performance

• Use strategies to improve system performance– Standardize– Create independent checks for key process– Learn from mistakes

• Apply strategies to both technical work and team work

• Recognize teams make wise decisions with diverse and independent input

• http://www.safercare.net/OTCSBSI/Staff_Training/Entries/2009/9/6_1._The_Science_of_Improving_Patient_Safety.html

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Step 2: Identify DefectsStep 2: Identify Defects

• Review error reports, liability claims, sentinel eventsor M and M conference

• Ask staff how will the next patient be harmed

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Prioritize DefectsPrioritize Defects

• List all defects

• Discuss with staff what are the three greatest risks

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Step 3: Executive Step 3: Executive PartnershipPartnership

• Executive should become a member of ICU team

• Executive should meet monthly with ICU team

• Executive should review defects, ensure ICU team has resources to reduce risks, and hold team accountable for improving risks and central line associated blood steam infection

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Step 4: Learning from MistakesStep 4: Learning from Mistakes

• What happened?

• Why did it happen (system lenses) ?

• What could you do to reduce risk ?

• How do you know risk was reduced ?– Create policy / process / procedure– Ensure staff know policy– Evaluate if policy is used correctly

Pronovost 2005 JCJQI

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Step 4 cont’d: Identify Most Step 4 cont’d: Identify Most Important Contributing FactorsImportant Contributing Factors

• Rate each contributing factor

– importance of the problem and contributing factors in causing the accident

– importance of the problem and contributing factors in future accidents

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Step 4 cont’d: Identify Most Step 4 cont’d: Identify Most Effective InterventionsEffective Interventions

• Rate Each Intervention

– How well the intervention solves the problem or mitigates the contributing factors for the accident

– Rates the team belief that the intervention will be implemented and executed as intended

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Step 4 cont’d: Evaluate Whether Step 4 cont’d: Evaluate Whether Risks were ReducedRisks were Reduced

• Did you create a policy or procedure

• Do staff know about the policy

• Are staff using it as intended

• Do staff believe risks have been reduced

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Step 5: Teamwork ToolsStep 5: Teamwork Tools

• Call list

• Daily goals

• AM briefing

• Shadowing

• Culture check up

Pronovost JCC, JCJQI

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Step 5 cont’d: Call ListStep 5 cont’d: Call List

• Ensure your ICU has a process to identify what physician to page or call for each patient

• Make sure call list is easily accessible and updated

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Step 5 cont’d: AM BriefingStep 5 cont’d: AM Briefing

• Have a morning meeting with charge nurse and unit attending(s) about the unit-level plan for the day

• Discuss work for the day– What happened during the evening– Who is being admitted and discharged today– What are potential risks during the day, how can we reduce

these risks

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Step 5 cont’d: ShadowingStep 5 cont’d: Shadowing

• Follow another type of clinician doing his or her job for between 2 to 4 hours

• Have the shadower discuss with staff what she will do differently now that she has walked in another person’s shoes

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CUSP is a Continuous EffortCUSP is a Continuous Effort

• Add Science of Safety education to orientation

• Learn from one defect per quarter, share or post lessons

• Implement teamwork tools that best meet the unit’s needs

• Details are in the CUSP manual

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Action Items--CUSPAction Items--CUSP

• Look over the CUSP manual with team members

• Brainstorm potential hazards with team • Assess team composition with respect to CUSP

elements • REVIEW PRE-IMPLEMENTATION CHECKLIST—

where are you?

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ReferencesReferences

• 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, 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.