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On the CUSP: STOP BSIOn the CUSP: STOP BSIThe Team Check-up ToolThe Team Check-up Tool

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Learning ObjectivesLearning Objectives

• To understand the tool we use to:

– Describe the anticipated activities of your ICU quality improvement team

– Track implementation progress and the context of progress

– Assess barriers to progress

– Monitor interactions on the team

• To think about how the tool can be useful to you

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The Quality Improvement TeamThe Quality Improvement Team

• Core team working on the CUSP/ CLABSI project

• The small group that spreads the intervention to the rest of the ICU

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Importance of the Quality Importance of the Quality Improvement TeamImprovement Team

• This team has the greatest impact on how the intervention is “rolled out” at your site (absolute power)

• Potential implications of a poor job − Slower implementation− Gaps/ uneven implementation− Higher continued risk (infection, $, lives)

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TCT Measures:TCT Measures:

• Engagement/ educational activities of the QI team (on BSI and CUSP)

• Participation in CUSP activities

• Extent of implementation on unit

• Barriers to progress

• Interactions on team

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Team Activities-Keeping on TrackTeam Activities-Keeping on Track

• Team meetings (recommend 2/mo)

• Review of data (monthly)

• Meet w/ Exec Partner on unit (monthly or more)

• Executive review of data (monthly)

• Presentations to the Hospital Leadership and Board of Directors

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Education and Engagement Education and Engagement Activities on the UnitActivities on the Unit

• Modeling the line placement steps; stopping insertions that violate protocol; having one-on-one talks where necessary

• CUSP Activities

− Science of safety video

− How will we harm the next patient? exercise

− Daily Goals

− Morning Briefing

− Learning from a defect

− Executive Partnership

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Education and Engagement Education and Engagement Activities on the UnitActivities on the Unit

• More Activities (add your ideas!)

− Internal seminar for staff

− Present project at all committee meetings

− Make BSI prevention part of a skills fair

− Have IC dept visit/ give a talk

− In-services/ demos

− New written policy

− Post the steps and progress updates

− Put the prevention practices on all clipboards

− Update/ prepare line cart/ kit with checklist

− Hand out Fast Facts one-page info sheet

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Barriers to ProgressBarriers to Progress

• Turnover on QI Team

• Spread to other parts of the hospital

• Disruptive events

• Lack of skills

• Lack of time

• Lack of buy-in

• Lack of support

• Lack of autonomy

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Interactions among Interactions among Team MembersTeam Members

• Team agrees on goals

• Team values individual contributions

• Team can resolve conflicts

• Team is unified

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Action ItemsAction Items

• Look over the tool

• Think about what elements are most important to watch

• Share TCT data with executive partner

• Make a strategic plan to address identified barriers early

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Reference ListReference List

• Lubomski, Lisa H., Jill A. Marsteller, Yea-Jen Hsu, Christine A. Goeschel, Christine G. Holzmueller, and Peter J. Pronovost, “The Team Checkup Tool: Evaluating Quality Improvement Team Activities and Giving Feedback to Senior Leaders,” Joint Commission Journal of Quality and Patient Safety, October 2008.

• Marsteller, Jill A., Christine G. Holzmueller, Martin Makary, J. Bryan Sexton, David Thompson, Lisa H. Lubomski and Peter J. Pronovost. “Developing Process-Support Tools for Patient Safety: Finding the Balance Between Validity and Feasibility,“ Joint Commission Journal of Quality and Patient Safety, October 2008.