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

2. 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)

3. 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

4. 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

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

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

7. Culture of Safety- Michigan
Teamwork Climate Across Michigan ICUs

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

9. RN Turnover and Teamwork Climate: 26 Keystone ICUs reporting1
# 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.

10. 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

11. 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

12. 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

13. 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

14. 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:

15. CLA - Blood Stream Infection
Massachusetts
10/1/ /31/2011

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

17. 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

18. 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.

19. 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.

20. 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

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