1. AHRQ Safety Program for Long-term Care: HAIs/CAUTI Organizational Lead Pre-Training Webinar Organizational Lead Onboarding May 28, 2015 Health Research & Educational Trust Project Team Members

2. OVERVIEW Marcia Cooke

3. Agenda TopicPresenterTime Project OverviewMarcia Cooke10 minutes National Project SupportMarcia Cooke10 minutes How We Achieve Project GoalsSue Collier15 minutes Using Adobe ConnectAmanda Wilkins5 minutes WebsiteJustin Snow10 minutes Org Lead and LTC Facility ExpectationsLindsay Kolczynski10 minutes Facility Recruitment StrategiesLindsay Kolczynski10 minutes Next Steps, Q&AAmanda Wilkins (Facilitator)15 minutes

4. Objectives Upon completion of this webinar, participants will be able to: Summarize the education and measurement components of the AHRQ Safety Program for Long-term Care: HAIs/CAUTI Explain how to be successful in the project Identify where to find project resources Provide support to recruited LTC facilities

5. Partnerships and Dissemination National Project Team HRET UM Abt Qualidigm APIC SHM Baylor National Project Team HRET UM Abt Qualidigm APIC SHM Baylor State or Regional Lead Organizations, Multi-Facility Operators Faculty Organizational Leads Recruitment/Coaching/ Project Liaison Organizational Leads Recruitment/Coaching/ Project Liaison National & Regional Faculty UM, Abt, Qualidigm, APIC, SHM, Baylor Coaching/Endorsement National & Regional Faculty UM, Abt, Qualidigm, APIC, SHM, Baylor Coaching/Endorsement Facilities

6. Project Vitals Lead Organization – Participation Period: May 2015 – August 2016 – Activities include: Recruitment Engagement Monitoring Coaching/Support Project Period for Cohort 4 – Participation Period: July 2015 – August 2016 – Activities include: 2 months of kickoff and facility onboarding 11 months of data collection, educational activities and coaching

7. Project Goals Primary Goals—reduce CAUTI and improve Safety Culture Develop/adapt evidence-based CAUTI elimination and safety practices and resources for LTCFs Reduce CAUTIs Improve safety culture Secondary Goals—support expanded infection prevention efforts for C. diff, UTI, MDROs by providing education to: Improve hygiene practices (hand, environmental) Promote antibiotic stewardship Promote catheter stewardship Reduce re-hospitalizations

8. How will LTC Facilities Benefit from Participation Potential to: Improve performance on Nursing Home Compare Quality Measures Enhance data collection skills and prepare for mandatory reporting of infection data (NHSN) Benchmark against other LTC facilities (project-level and nationally) Improve communication and relationships with referring hospitals Improve compliance with survey requirement related to quality of care, infection control, etc.

9. Cohort 4 Timeline

10. NATIONAL PROJECT SUPPORT What you can expect from us

11. Support from HRET and the National Project Team Project management – Scheduling – Monthly Org Lead Call Education – Live webinars – Train-the-trainer packets to train front- line staff – Subject matter experts – Learning Session outlines and templates Coaching Data collection, reports and analysis Communications Project resources for all stakeholders – Organizational Lead Operations Manual – Facility Implementation Guide – LTC Safety Toolkit

12. Meet the HRET Team Sarah Dalton

13. Project Management Support Scheduling of all educational events handled by HRET, except coaching calls and learning sessions – Step-by-step guide on how to manage the project and your facility teams (Organizational Lead Manual) Monthly Org Lead calls – Peer learning and open forum about project – Monthly status report

14. AHRQ Funding Support E-mail signed subcontracts to Jeanette Lyons (jlyons@aha.org)jlyons@aha.org E-mail questions about invoicing process or payment schedule to Lindsay Kolczynski (lkolczynski@aha.org)lkolczynski@aha.org

15. Communication Support Weekly newsletter Upcoming deadlines and events Forward or customize for your facilities

16. How HRET Advisors Support You Act as a liaison between Org Leads and the national project team Answer questions about the project and available resources Guide org leads in data submission and due dates Assist in planning three in-person Learning Sessions Coordinate faculty coach to present Share template agendas, presentations and handouts Join first four Coaching Calls Ashley Hofmann, MSW Katie Johnson, MHS Anna Wojcik, MPH

17. Coaching Call Support What :State-/Region-/System-specific coaching call When :Monthly, beginning in September Who :Facilitated and run by the organizational lead All facility team leads Faculty Coach provides clinical and cultural expertise HRET Advisor provides project management support and technical assistance Why :Review data and track project progress Discuss educational webinars and project interventions Share successes, challenges and best practices with other facilities Ask Faculty Coach and facility teams to engage in use of project tools, resources

18. HOW WE ACHIEVE PROJECT GOALS Sue Collier 18

19. Tools For Success 19

20. Education Components: Learning Sessions Each Org Lead will host three Learning Sessions for recruited facilities Suggestions for planning your Kick-off Learning Session #1 include: Set a date between July 1-24 and advertise to your facilities (full day, ~6.5 hours) Determine a venue Reserve space for 1-2 representatives from each facility recruited Provide the necessities: internet, projector/project screen, computer, lunch Attend the planning call with your HRET advisor to discuss other details Review agendas, presentations and resources provided to you by your HRET advisor Customize presentations with your organization and facilities’ information A representative of HRET and your faculty coach will attend the Learning Session to present on aspects of project participation 20

21. Education Components: Distance Learning Name of series # of Topics FrequencyWhat Format for Facility Team Lead Format for Front-line Staff Onboarding4Weekly Project orientation WebinarTrained by Facility Team Lead Training Modules4 Once every two weeks Infection prevention Video Videos, and trained by Facility Team Lead Safety Culture Survey Results Forum 1OnceSafety cultureWebinarN/A Content9Monthly Clinical and cultural interventions WebinarTrained by Facility Team Lead 21

22. Education Components: Schedule Onboarding Webinar SeriesDateTime 1. Building a Culture of Safety TeamThursday, August 61:00 – 1:45 p.m. CT 2. CAUTI DefinitionsThursday, August 131:00 – 1:45 p.m. CT 3. CAUTI SurveillanceThursday, August 201:00 – 1:45 p.m. CT 4. Data Collection TrainingThursday, August 271:00 – 1:45 p.m. CT Training Module SeriesRelease Date 1. Hand HygieneWeek of Aug 31N/A 2. Environment & EquipmentWeek of Sep 14N/A 3. Isolation PrecautionsWeek of Sep 28N/A 4. Antibiotic StewardshipWeek of Oct 12N/A Monthly Webinar SeriesDateTime National Content 3 rd Thursday of each month, beginning in November 11:15 a.m. – 12:00 p.m. CT 22

23. Support for Education Components Train-the-Trainer Guide Core Team Webinar Archive – Webinar Recording – Core Team Presentation Slides – Chat Summary and Q&A – Supplemental Materials All Staff Training Materials – Video and Facilitator Slides – Discussion Guide/Activity – Event Evaluation Template – Certification of Completion Template Additional Resources 23 Each educational activity will include:

24. Measurements: Processes and Outcomes Data CollectedFrequencyTime to Complete Background/Cultural Measures Registration 1x to enroll10 minutes Facility Demographics Baseline15 minutes Safety Culture Survey Baseline and follow-up10 minutes Process Measures Team Communication Guide Quarterly10 minutes Skills Questionnaire Baseline, mid-point, final15 minutes Outcome Measures Catheter Utilization CAUTI rates Urine culture order rates Monthly 24

25. Support for Measuring Processes and Outcomes Checklist tools to support awareness and adherence to evidence-based recommendations NHSN CAUTI definition assessment worksheet NHSN CAUTI definition pocket cards Support for survey and certification regulation compliance with: F-tag 315 (catheter with undocumented necessity) F-tag 441 (infection prevention/control failure) 25

26. USING ADOBE CONNECT Amanda Wilkins 26

27. Using Adobe Connect Adobe Connect is used to deliver all distance learning education Informational Webinars Onboarding Webinars Monthly National Content Webinars Safety Culture Results Forum Different ways for participants to engage during the webinar All hyperlinks are live, many of the images of documents and infographics from the project are live weblinks Click on links in weblinks pod Download files Polling Chat pod 27

28. Forward invitations to your facilities Register for educational events Save webinar confirmation email to calendar Log in to webinar 5-10 minutes in advance Monitor participation—strive for 80% participation rate among your LTC facilities Become familiar with the project website and its resources Review webinar etiquette with facility teams 28 Org Lead Responsibilities

29. Register for educational events Save webinar confirmation email to calendar Log in to webinar 5-10 minutes in advance Make sure audio is available via computer speakers or telephone Participate in 100% onboarding webinar series, Safety Culture Survey Results Forum and 80% or more of the national content webinar series Become familiar with the project website and its resources 29 LTC Facility Team Responsibilities

30. LTC SAFETY WEBSITE Justin Snow 30

31. ORGANIZATIONAL LEAD AND LTC FACILITY TEAM LEAD EXPECTATIONS Lindsay Kolczynski 31

32. Org Leads are Critical to Project Success Recruit, register and retain at least 15 facilities throughout the project period Understand the project Goals Expectations and Responsibilities Clinical and culture interventions (i.e., the change package) Educational offerings and schedule Actively engage in the project Attend all educational programming Encourage and closely mentor all facilities Monitor facility data reporting and monitoring Run and review facility data reports Monitor facility data/survey submission Share facility successes with the National Project Team (NPT) Provide individual and group coaching Check-in with struggling facilities—report action plan to the NPT 32

33. Org Lead Responsibilities Education Participate in and distribute train-the-trainer materials for all educational activities: – Onboarding Series – Training Module Series – National Content Series Share C.A.U.T.I. and T.E.A.M.S. Infographic with LTC facilities Discuss components of the C.A.U.T.I. and T.E.A.M.S. intervention during coaching calls Monitor LTC facility team (lead) participation rates in educational activities and use of train-the-trainer materials to educate front-line staff on each individual topic prior to next event in the series Data Distribute data measurement materials to the appropriate core team members Monitor and review data submission with LTC facilities – Outcome – Skills Questionnaire – Safety Culture Survey Ensure that each facility completes all surveys by the designated deadlines Distribute and participate in Safety Culture Survey Results Forum Encourage each facility to complete evaluations after each educational event Review and discuss data results during coaching calls and one-on-one with facility teams as needed 33

34. LTC Facility Team Lead Expectations 100-105 hours over a 13-14 month period (~4.5% FTE) Form the facility team Attend all educational activities Train staff via the train-the-trainer module for each educational module Ensure data collection requirements are met Monitor progress toward goals Utilize expertise of the project team and your faculty coach Utilize project tools and resources Celebrate successes with facility team 34

35. Facility Team Lead Responsibilities Education Participate in all educational activities for facility team leads – Onboarding Series – Training Module Series – National Content Series Use train-the-trainer materials to educate front-line staff on each educational topic prior to next event in the series. Display C.A.U.T.I. and T.E.A.M.S. Infographic in facility Discuss components of the C.A.U.T.I. and T.E.A.M.S. intervention during team huddles, with administrators and clinical leadership and residents/families. Consider sustainability of C.A.U.T.I. and T.E.A.M.S. interventions that are incorporated into work Data Complete registration and demographics assessment Distribute data measurement materials to the appropriate team members Collect outcome data and enter data on a monthly basis Utilize Team Communication Guide and submit report on a quarterly basis Ensure required staff complete all safety culture surveys and skills questionnaires Participate in Safety Culture Survey Results Forum Encourage each facility to complete evaluations after each educational event Review and discuss data results facility staff, leadership, committees and resident/family council 35

36. RECRUITMENT STRATEGIES 36

37. Which Facilities Can Participate? Who is eligible? – Multi-facility operators/long-term care communities – LTCFs that are part of an inpatient facility – Stand-alone nursing homes – Small and rural homes Who is ineligible? – Long-Term Acute Care facilities (LTACs) are ineligible for this project 37

38. What to Communicate to Facilities Program goals There are many benefits of joining this program not just CAUTI Be realistic about program requirements and time commitment Data collection and review are not optional This is a learning collaborative: all teach and all learn 38

39. Discuss Program Goals Prevent CAUTIs and other HAIs in LTCFs Increase infection prevention skills of all staff Improve safety culture through improved teamwork and communication 39

40. Program Requirements & Time Commitment Be realistic about Facility Team Lead requirements and time involved Key Responsibilities of Facility Team Lead: Secure program champions: administrator, nurse, physician, CNA Build and support the facility team Lead cultural and clinical interventions Attend all educational webinars and in-person meetings Comply with data requirements Meet ≥ monthly w/ team to review progress, trouble-shoot, sustain gains ( can happen during short training sessions ) Attend monthly coaching calls 40

41. Data collection is not optional Facilities must supply: MeasureFrequencyNotes Facility Demographics1 timeStart of the program Nursing Home Survey on Patient Safety2 times≥ 60% staff complete; at the start and finish of the program Staff Skills Questionnaires3 timesAt least 10 staff # Residents and Resident with Catheter countsDailyCollected daily and entered monthly # CAUTIsMonthlyCollected daily and entered monthly # urine cultures ordered each month for all residents MonthlyResidents with and without urinary catheters Team Communication Guide questions4 times Staffing Turnover notify you, not us, of changes 41

42. Recruitment and Enrollment Support Recruitment Support Customizable marketing flyer Informational Slide Deck; HRET team available to present Facility Informational Webinars Enrollment Support Enrollment Packet Facilities submit 3 forms to you: Commitment Letter, DUE, Team Roster Facility Team Lead Tasks & Time Commitment for you to share 42

43. 1. How to Avoid Potential Pitfalls Barrier/Pitfall Facilities enroll in the project without being fully aware of required resources and drop out of the project Solution Facility administration needs to be aware of resources required AND key staff participating need to be aware of requirements Administration participates in Facility Informational Webinar 43

44. 2. How to Avoid Potential Pitfalls Potential Pitfall Facilities do not understand that this project includes a focus on safety culture, infection prevention and antibiotic stewardship—not just CAUTI prevention Solution Communicate that strong safety culture is associated with better clinical and operational outcomes Explain that implementing any change, e.g., CAUTI intervention, is influenced by culture Educational content focuses on IP and proper use of antibiotics to prevent HAIs Support from HRET How to administer and interpret results Action planning tools to assist teams to improve where needed 44

45. QUESTIONS? 45 Questions

46. Important Dates for Cohort 4 46 ActivityDate/Time Org Lead SubcontractDue June 19 Org Lead TrainingMonday, June 22 in Chicago Facility Informational WebinarsWednesday, June 3 or Thursday, June 23 at 11:00 a.m. CT Learning Session #1July 1-24 RegistrationDue July 24 Facility Demographics QuestionnaireOpens July 1, Due July 31 Skills QuestionnaireOpens July 1, Due July 31 Onboarding Educational SeriesEvery Thursday in August, from 1:00-1:45 p.m. CT Patient Safety Culture SurveyReleased week of August 24, Due Sept 30 Content Webinar Educational Series3 rd Thursday of each month from 11:15 a.m.-12:00 p.m. CT, beginning in November

47. Next Steps 1.Email signed subcontract to Jeanette Lyons (jlyons@aha.org) by June 19jlyons@aha.org 2.Ask all interested LTCFs to save-the-date for the Facility Informational Webinar on June 3 or June 23 at 11:00 a.m. CT 3.Recruit LTCFs and ensure they register by July 24 4.Identify a date and location for Learning Session #1 between July 1-24 47

48. AHRQ Safety Program for Long-term Care: HAIs/CAUTI Project Website Login information Username: ltcsafety Password: ltcsafety TeamSTEPPS ® for Long-term Care Stay Updated with Useful Resources 48

49. AHRQ Safety Program for Long-term Care: HAIs/CAUTI EVALUATE EVENT NOW Please take a moment to complete the evaluation for today’s event