INTERNAL INFORMATION | CONFIDENTIAL Stop Central Line Associated Blood Stream Infection (caBSI) Tufts Experience with Benefits of CUSP

Objectives  Review the purpose of the ICU Comprehensive Unit-Based Safety Program/CLABSI Initiative. Understand how your ICU and your hospital will benefit from participation.  Build the skills of physicians, nurses, and other care team to improve teamwork and build a safety culture.  Engage in discussion with national experts on best practices in reducing infections, preventing central line infections

Stop Central Line Associated Blood Stream Infection (caBSI) Team Structure, CUSP MEMBERSHIPDEPARTMENT Margaret Vosburgh, COOExecutive Sponsor Dorothy Didomenico RN Clinical Educator, CCU CMC Shira Doron MD Infectious Disease Terry Hudson-Jinks RN Patient Care Services/Nursing Erik Garpestad MD Medical Director MICU Tricia Lemon, RN Infection Prevention/Quality and Patient Safety

Benefits of CUSP at Tufts Looking back  2007 – 2009  Much emphasis placed on development of best practice policy and guidelines for caBSI elimination with a focus on:  Standardizing Insertion  Standardizing maintenance  caBSI remained an issue, with slight increase in rate  Fall 2009  Commitment by Senior Leadership to eliminate Hospital Acquired Infections  Infection Prevention Priority Initiatives defined  CaBSI  CaUTI  VAP  CEO support of Tufts participation with MHA CUSP  October 2009:8 Member Tufts Team attended CUSP Kick Off

Benefits of CUSP at Tufts Looking back  Benefits of CUSP:  Provided the framework to align Senior Executives with clinicians in the goal for patient safety  Validated key aspects of Tufts Policy  Provided leverage  Frameworks, tool kits, informational sources, rich in details necessary to make key decisions, and the power to let go of old practices.  Blood Cultures  Goal Sheet  Clave use  Dressing and line protocols  CHG bathing/Elimination of wash basins  Network of experts within and beyond New England with key first hand learning experiences.  Assisted in disbanding belief that patients are too ill, elimination not possible.  Provided a competitive spirit, energizing

Benefits of CUSP at Tufts Looking back  Benefits of CUSP:  Stimulated creativity  Insertion Shadow Paging  site:  Unified members at the bedside for common goal  Challenges along the way  Eliminating previous practices, individual beliefs, reservations  Example CHG Bathing, CCU  Goal Sheet  Example MICU Experience

Adult Critical Care Daily ChecklistDate: _______________ SystemsPlanNotes Neuro & Pain Is pain controlled? □Yes □ No What is this patients Delirium Score? _______ Daily Awakening Protocol? Y/N Contraindication to weaning sedation (active seizures or ↑ ICP, neuromuscular blockade, active myocardial ischemia, acute alcohol withdrawal, high frequency oscillatory ventilation)? □ Yes □ No Results ____________________________ Respiratory□ Ventilator Bundle □ HOB↑ 30° □ Mouth care Q4° □ GI prophylaxis □ DVT prophylaxis □Daily assessment of readiness to wean SBT Y/N Results_________________ Contraindication to vent wean? □Yes □No □N/A CardiovascularGoal for fluid balance within the next  8 hours  12 hours CVP Target_________  24 hours  + ____cc  - _____cc Assessment of medical necessity Central linesType _____ □ Continue □ Discontinue □ N/A Type _____ □ Continue □ Discontinue □ N/A Day # __________ Arterial line □ Continue □ Discontinue □ N/A Day # __________ Urinary Catheter □ Continue □ Discontinue □ N/A Day # __________ Restraints □ Continue □ Discontinue □ N/A □ Order written Day # __________ AntimicrobialsDrug __________________________ □ Continue □ Discontinue □ N/A Drug __________________________ □ Continue □ Discontinue □ N/A Day # __________ Target date of transfer  _____ Med/Surg/ Tele  ______Intermediate Care _______

Major Daily Goals for Patient: ICU Patient Initials_____________ Date ________ Goal done?  Daily checks: SBT performed? Yes ___ No ___ Patient not eligible ___ Daily Awakening performed? Yes ___ No ___ Patient not eligible ___ Central Venous Catheter needed? Yes ___ No ___ Foley Catheter needed? Yes____ No _____ Not part of permanent medical record. Please do no file in chart

Benefits of CUSP at Tufts Looking back What would help teams succeed in doing this?  Diverse team membership  Open mind, willingness to provide care differently  Sense of Team  Humility  Strong support of CEO, CMO, CNO

Benefits of CUSP at Tufts Looking back What was it like to participate  Compliance enhanced with structured timelines and guidelines  Ability to ask questions from Peer Institutions  Find new passionate leaders among staff  Inspiration to target large issues  Sense of accomplishment with improved outcomes

CaBSI FY 2009 – FY 2010 YTD Adult Critical Care, CUSP Units

Objectives  Review the purpose of the ICU Comprehensive Unit-Based Safety Program/CLABSI Initiative. Understand how your ICU and your hospital will benefit from participation.  Build the skills of physicians, nurses, and other care team to improve teamwork and build a safety culture.  Engage in discussion with national experts on best practices in reducing infections, preventing central line infections