1. Small and Rural Critical Access Hospitals July 19, 2011

2. Agenda Denise Flook and Lorna Martin Applying CUSP in the Small and Rural Critical Access Hospital Using CUSP Beyond CLABSI and CAUTI Critical Access Hospital Team Leaders Paul Frigoli, Grant Regional Health Center Illinois Critical Access Hospital Team Leader Suggestions for future calls

3. Denise M. Flook, RN, MPH, CIC Director, Workforce Development & Infection Prevention Lorna Martin, RN Patient Safety & Quality Improvement Specialist Applying CUSP in the Small and Rural Critical Access Hospital

4. Quality and Safety are Now Key to Hospital Success Payers, including the Government and the public, demand more efficient, safer care Limited resources will necessitate efficiency

5. The Challenge How do we provide and sustain the highest quality and safest care for every patient, every time in the current environment of diminishing resources? It is easy to think that simply implementing a checklist is the path to better outcomes, but Changing culture is the key to sustained safety and improved outcomes for patients

6. Safety/Quality Improvement is a Two-Part Process

7. What is CUSP? Comprehensive Unit-based Safety Program An intervention to learn from mistakes and improve safety culture for sustained improved patient outcomes

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9. The CUSP Steps 1.Develop a team 2.Assign executive to adopt unit 3.Educate staff on science of safety 4.Identify and prioritize defects 5.Implement teamwork tools 6.Provide timely feedback 7.Learn from defects – Have staff investigate each occurrence Adapted from Pronovost, Patient Safety, 2005

11. CUSP is a Continuous Effort Add science of safety education to orientation Learn from one defect per quarter; share or post lessons Use quality improvement and teamwork tools that best meet the hospital/unit’s needs Feed back timely data; investigate each event

12. Walking Through the Process Eliminate Hospital-Acquired Stage 3/4 Pressure Ulcers on the Unit Develop a team -- Include staff nurses Gather baseline data Have first team meeting; educate on science of safety, data, goals Research the evidence-based practices that eliminate pressure ulcers

13. The CUSP/Improvement Intervention

15. It Goes Back to Leadership – On All Levels Engage, commit Communicate Provide education Provide resources Be visible and transparent Give feedback Investigate and own outcomes and improvement

16. Keep the Focus There are challenges ahead, but everyone must not lose sight of our North Star – the patient -- who must be kept in the center of all we do Your commitment, leadership, and persistence are essential to patient quality and safety

17. References 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 P, Berenholtz S, Dorman T, et al. Improving communication in the ICU using daily goals. J Crit Care. 2003; 18(2):71-75. 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. Thompson DA, Holzmueller CG, Cafeo CL, et al. A morning briefing: Setting the stage for a clinically and operationally good day. Jt Comm J Qual and Saf. 2005; 31(8):476-479.

18. Denise M. Flook, RN, MPH,CIC Director, Workforce Development/Infection Prevention 770-249-4518 dflook@gha.orgdflook@gha.org.

19. CUSP Resources Contact your State Hospital Association quality director for more information about CUSP initiatives Visit the On the CUSP: Stop HAI project Web site: www.onthecuspstophai.orgwww.onthecuspstophai.org

20. Hearing From Your Peers

21. Paul Frigoli Quality Director Grant Regional Health Center Lancaster, WI

22. Agenda Why we joined the CLABSI & CAUTI projects Barriers and successes Key lessons

23. Val Pfoutz, RN ICU Director KSB Hospital Dixon, IL

24. Agenda Why we joined the CLABSI & CAUTI projects Barriers and successes Key lessons

25. CUSP Resources Contact your State Hospital Association quality director for more information about CUSP initiatives Visit the On the CUSP: Stop HAI project Web site: www.onthecuspstophai.orgwww.onthecuspstophai.org

26. Hearing From You What should future small & rural critical access hospital supplemental calls address? What resources can you share with others? What additional resources would help you improve patient safety?