1. Who We Are ~Where We are Going

2. Slide 2 Workshop Objectives Describe the purpose and vision of the ICU Safe Care Initiative/Comprehensive Unit-Based Safety Program. Describe the process used to identify and eliminate system defects. List three tools or strategies used to improve teamwork and build a safety culture. State research and best practices in reducing infections, preventing central line infections, and going beyond the bundle.

3. Slide 3 Session Learning Objectives To understand the goals of On the CUSP: STOP-BSI To understand how the project is organized To understand the national climate for this work

4. On the CUSP: STOP-BSI

5. Slide 5 Bilateral cued finger movements

6. Slide 6 National Evolution

8. Slide 8 Please answer each question with a score of 1 to 5. where 1 is below average, 3 is average and 5 is above average How smart am I How hard do I work How kind am I How tall am I How good is the quality of care we provide

10. Slide 10 We are part of something larger than any one of us….

11. Slide 11 Project Organization State wide effort coordinated by Hospital Association Use collaborative model ( face to face meetings, monthly calls) Standardized data collection tools and evidence Local ICU modification of how to implement interventions

12. Slide 12 Goals: Technical and Adaptive To work to eliminate central line associated blood stream infections (CLABSI); state mean < 1/10000 catheter days, median 0 To improve safety culture by 50% To learn from one defect per month

13. Slide 13 Ensure Patients Reliably Receive Evidence Pronovost: Health Services Research 2006 SeniorTeam Staff leaders Engage adaptive How does this make the world a better place? Educate technical What do we need to know? Execute adaptive What do we need to do? What keeps me from doing it? How can we do it with my resources and culture? Evaluate technical How do we know we improved safety?

14. Slide 14 Safety Score Card Keystone ICU Safety Dashboard *CUSP is intervention to improve these 20042006 How often did we harm (BSI) 2.8/10000 How often do we do what we should 66%95% How often did we learn from mistakes* 100s Have we created a safe culture % Needs improvement in Safety climate* 84%43% Teamwork climate* 82%42%

15. Slide 15 Comprehensive Unit-based Safety Program (CUSP) An Intervention to Learn from Mistakes and Improve Safety Culture 1.Educate staff on science of safety http://www.safercare.net http://www.safercare.net 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

17. CRBSI Rate Summary Data

18. Michigan ICU Safety Climate Score Distributions

19. Michigan ICU Safety Climate Survey Item Agreement

20. "Needs Improvement“ Statewide Michigan CUSP ICU Results Less than 60% of respondents reporting good safety climate =“needs improvement” Statewide in 2004 84% needed improvement, in 2006 41% Non-teaching and Faith-based ICUs improved the most Safety Climate item that drives improvement: “I am encouraged by my colleagues to report any patient safety concerns I may have”

21. % of respondents within an ICU reporting good teamwork climate Teamwork Climate Across Michigan ICUs No BSI 21% No BSI 21% No BSI 44% No BSI 44% No BSI 31% No BSI 31% No BSI = 6 months or more w/ zero The strongest predictor of clinical excellence: caregivers feel comfortable speaking up if they perceive a problem with patient care

22. Slide 22 1 # RNs who left the ICU RN Turnover and Teamwork Climate: 26 Keystone ICUs reporting r=-.650, p<.001

23. Slide 23 We are colleagues in this work: OHANA

24. Focus and Execute

26. Slide 26 Workshop Objectives Describe the purpose and vision of the ICU Safe Care Initiative/Comprehensive Unit-Based Safety Program. Describe the process used to identify and eliminate system defects. List three tools or strategies used to improve teamwork and build a safety culture. State research and best practices in reducing infections, preventing central line infections, and going beyond the bundle.