1. INTERNAL INFORMATION | CONFIDENTIAL Stop Central Line Associated Blood Stream Infection (caBSI) Tufts Experience with Benefits of CUSP 2009 - 2010

2. 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

3. Stop Central Line Associated Blood Stream Infection (caBSI) Team Structure, CUSP 2009- 2010 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

4. 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

5. 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

6. Benefits of CUSP at Tufts Looking back  Benefits of CUSP:  Stimulated creativity  Insertion Shadow Paging  Email site: nolineinfections!@tuftsmedicalcenter.orgnolineinfections!@tuftsmedicalcenter.org  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

7. 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 _______

8. Major Daily Goals for Patient: ICU Patient Initials_____________ Date ________ Goal done?  1. 2. 3. 4. 5. 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

9. 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

10. 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

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

13. 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