MA Safe Care Initiative CUSP-CLABSI-CAUTi December 15, 2011 8:00 am – 4:00 pm

Meeting Objectives Build skills among care team members that will improve teamwork, communication, and create a patient safety culture in your unit Hear from local and national experts the strategies to eliminate CLABSI, and ensure that improvements can be sustained Learn strategies to prevent Catheter Associated Urinary Tract Infections (CAUTI)

CUSP and CLABSI Interventions Improving the culture of safety: 1. Educate on the science of safety 2. Identify defects 3. Learn from defects 4. Assign executive to adopt unit 5. Implement teamwork tools Primarily technical interventions: CVC line insertion CVC line management

On The CUSP Stop BSI PRIMARILY Adaptive (CUSP) PRIMARILY Technical (CLABSI) CVC Insertion CVC Line Cart 1. Contents inventory Evidence based BSI prevention – the bundle (hands, site, skin prep, barrier, removal) 1. Presentation of evidence 2. CLABSI factsheet 3. 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 2. Shadowing 3. AM briefing 4. Call list 5. Team check up tool Assemble a CUSP team, Partner with a senior executive; Baseline CLABSI Data Exposure Survey and Technology Survey 4

Percent understanding patient care goals Communication Among Care Providers: Percent Understanding Patient Care Goals Daily Goals Percent understanding patient care goals 5

Impact of Daily Goals on ICU Length of Stay 654 New Admissions = $7 Million Additional Revenue 6

Culture of Safety- Michigan Teamwork Climate Across Michigan ICUs

Culture of Safety- Michigan Safety Climate Across Michigan ICUs   % of respondents within an ICU reporting good safety climate

RN Turnover and Teamwork Climate: 26 Keystone ICUs reporting 1 # RNs who left the ICU r=-.650, p<.001 # leaving indicates both terminations and transfers within the organzation # indicates warm bodies, not FTEs Demonstrates that teamwork predicts nursing turnover. If nurses are not happy with teamwork they will talk with their feet.

2 yr CLABSI Results from ICUs in Michigan Time period Median CLABSI rate Baseline 2.7 Peri intervention 1.6 0-3 months 4-6 months 7-9 months 10-12 months 13-15 months 16-18 months Pronovost NEJM 2006

4 yr CLABSI Results from ICUs in Michigan Time period Median CLABSI rate 19-21 months 22-24 months 25-27 months 28-30 months 31-33 months 34-36 months Pronovost BMJ 2010

Results Lives Saved – 1,729* Patient Days Saved – in excess of 127,000* Dollars Saved – 0ver $246 Million* Culture of Safety improved 28% Teamwork improved 15% * Based on the Johns Hopkins Opportunity Estimator

Massachusetts Teams New Teams Current Teams Bay state Franklin Medical Center Baystate Mary Lane Cambridge Health Alliance Harrington Hospital Holyoke Medical Center New England Baptist Hospital Southcoast Hospitals Group Spaulding Rehabilitation Network (CAUTI) Current Teams Baystate Medical Center Berkshire Medical Center Fairview Hospital Jordan Hospital Melrose Wakefield Hospital Marlborough Hospital Morton Hospital & Medical Center Mount Auburn Hospital Noble Hospital Tufts Medical Center

Framework for MA ICU Safe Care Initiative Improvement Collaborative MHA and Coalition Work together as state leads Recruitment of hospital teams and resources to the teams State “hub” for managing ongoing participation and improvement Role of National Project Team Two Year Collaborative for each cohort Data Collection – CareCounts website Improvement Monthly Content Calls Monthly Coaching Calls Resources at: www.onthecuspstophai.org/Stop-7611.html

CLA - Blood Stream Infection Massachusetts 10/1/2009 - 10/31/2011

CLA - Blood Stream Infection Massachusetts cf. CUSP nationally 10/1/2009 - 10/31/2011

CUSP - Preventing CLABSI – Preventing CAUTI Coordinating related work in Massachusetts CUSP/CLABSI CMS/HRET – Safety culture Preventing CLABSI Preventing CAUTI Masspro Scope of work – CUSP/CAUTI

MASSPRO A Quality Improvement Organization The QIO Program is the largest federal program dedicated to improving health quality at a community level. Independently contracted QIOs are in every state and territory, united in a network administered by CMS and have the flexibility to respond to local needs.

Improve Individual Patient Care Reducing Healthcare Acquired Infections (HAI) The MASSPRO Learning and Action Network provides hospitals throughout Massachusetts with the opportunity to come together to learn and share the latest evidence-based measures to prevent HAIs. CAUTI (catheter associated urinary tract infection) is MASSPRO’s initial focus of this initiative.

The Benefits… Receive facility specific data and analytical reports Recognition as a facility dedicated to improving patient outcomes Receive facility specific data and analytical reports HAI surveillance can be incorporated into existing HAI teams

The Benefits… Utilize participation with this initiative as part of your implementation strategy to comply with The Joint Commission’s 2012 NPSG 07.06.01. catheter associated urinary tract infections. The Joint Commission plans full implementation of this NPSG as of January 1, 2013