1. Staff Safety Assessment 1

2. Learning Objectives To understand Step 2 of CUSP:Identify Defects To understand how to Implement the Staff Safety Assessment To understand ways to use results of the Staff Safety Assessment 2

3. Goals To identify defects To leverage the wisdom of the front line worker To prepare a list of improvement opportunities that has face validity and provides a focus for CUSP activities. 3

4. On the CUSP: Stop BSI CUSP 1.Educate staff on science of safety 2.Identify defects 3.Assign executive to adopt unit 4.Learn from one defect per quarter 5.Implement teamwork tools CLABSI 1.Remove Unnecessary Lines 2.Wash Hands Prior to Procedure 3.Use Maximal Barrier Precautions 4.Clean Skin with Chlorhexidine 5.Avoid Femoral Lines 4

5. The smaller group that spreads the intervention to the rest of the unit The CUSP Team 5

6. Education and engagement activities on the unit BSI: Providing Evidence, Modeling the line placement steps; stopping insertions that violate protocol; having one-on-one talks where necessary; Facilitating CUSP Activities 6

7. Comprehensive Unit-based Safety Program (CUSP) 1. Educate staff on science of safety (www.safercare.net) 2.Identify defects 3.Assign executive to adopt unit 4.Learn from one defect per quarter 5.Implement teamwork tools We are here You are here!!! 7

8. Identify Defects Review error reports, liability claims, sentinel events or M and M conference Ask staff how the next patient will be harmed 8

9. Identifying Defects What DO you know? What SHOULD you know ? 9

10. Making project and progress visible to everyone Transparency 10

11. One way to make harm visible-- get staff thinking about safety and how to improve it How are We Going to Harm the Next Patient? 11

12. Step 2: Staff Identify Defects Frontline caregivers are the eyes and ears of patient safety Identify clinical or operational problems that negatively impact patient safety (have or could) Use the Staff Safety Assessment form (Part of CUSP manual) – How will the next patient will be harmed in our unit – What can be done to minimize patient harm or prevent this safety hazard ICU managers and team review suggestions, set the agenda for discussion with executive partner 12

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14. Step 2: Staff Identify Defects What Team Leaders need to do: Hand out a Staff Safety Assessment form to all staff, clinical and non-clinical, in the unit Establish a collection box or envelope Identify and group common defects (such as communication, medications, patient falls, supplies, etc.) Summarize as frequencies (i.e., what percent of responses were for communication) 14

15. Prioritize Defects List all defects Discuss with staff what are the three greatest risks 15

16. Step 2: Staff Identify Defects Report the identified defects to staff, executive partner ICU managers and CUSP team prioritize defects identified by the potential level of risk to the patient Select one to work on with support of Executive Step 2 should be ongoing 16

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19. CUSP Team activities- keeping on track Team meetings (recommend monthly) Review of data (monthly) Meet w/ Exec Partner (monthly or more) Executive review of data (monthly) Presentations to hospital colleagues – (leadership, frontline staff, board) 19

20. On The CUSP Stop BSI Technical CLABSI CVC Insertion CVC Line Cart 1. Contents inventory Evidence based BSI prevention (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 Adaptive (CUSP) Science of Safety Training 1. Science of safety presentation 3. 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 1. Daily goals 2. Shadowing 3. AM briefing 4. Call list 6. Team check up tool Assemble a CUSP team, Partner with a senior executive; Baseline Data Exposure Survey and Technology Survey 20

21. Comprehensive Unit-based Safety Program (CUSP) 1.Educate staff on science of safety (www.safercare.net) 2.Identify defects 3.Assign executive to adopt unit 4.Learn from one defect per quarter 5.Implement teamwork tools We are here You are here!!! 21

22. What Should you do NOW? CLABSI: Collect & Submit Baseline & Monthly BSI data CUSP Preparation: Assemble team/Schedule meetings CUSP Implementation 1)Science of Safety Training for all staff 2)Identify Defects: How will patients be harmed? www.safercare.net www.onthecuspstopbsi.org 22

23. References Pronovost PJ, Berenholtz SM, Needham DM. Translating evidence into practice: A model for large scale knowledge translation. BMJ. 2008; 337:a1714. Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. NEJM. 2006; 355(26):2725- 2732. Pronovost PJ, Berenholtz SM, Goeschel C, et al. Improving patient safety in intensive care units in michigan. J Crit Care. 2008; 23(2):207-221. Pronovost P, Weast B, Rosenstein B, et al. Implementing and validating a comprehensive unit-based safety program. J Pat Safety. 2005; 1(1):33-40. Pronovost PJ, Weast B, Bishop K, et al. Senior executive adopt-a-work unit: A model for safety improvement. Jt Comm J Qual Saf. 2004; 30(2):59-68. 23