Upon completion the participant will identify and list steps to implement The Comprehensive Unit-based Safety Program (CUSP) and patient care bundles  Educate and improve awareness about patient safety and quality of care.  Empower staff to take charge and improve safety in their work place.  Partner units with a hospital executive to improve organizational culture and provide resources for unit improvement efforts. © Provide tools to investigate and learn from defects.  Respect the local wisdom of frontline providers

 Assemble a Multidisciplinary Safety Team  Establish team leader/unit champion for each unit, usually nurse and physician leader  Senior Leader (critical for success)  Nurse Managers  Informal leaders/bedside staff  Patient Safety Officer

 Administer pre-assessment safety culture survey  Current BSI rate  Current CVL processes and equipment  Review data from survey  Team checkup tool  Develop action plan

Conceptual Framework Science of Safety Training Standardize Work Checklists for Key Processes Teams Make Wise Decisions Reduce CLABSI’s

Goal: Decrease the number of central line associated bloodstream infections

 Resources Needed STANDARDIZE check lists, equipment location FINANCIAL: Physician input in new CVL kits PERSONNEL: New “CVL Culture” just say no

 Practicality of Implementation Bulls eye for desired outcomes Change of habits, staff taught to say no Present the evidence

 Feasibility of Implementation/Culture change Monthly Staff Meetings Daily shift Monitoring Match supplies pulled with procedures Transparency of Infection Rates Promotion of evidence-based practices bundles

Reinforcement of current evidence-based practices based on IHI care bundles. Webcasts shared with bedside staff and our multidisciplinary teams and council. Researched IV connector caps, selected neg-neutral, “green tip” for easy visualization of compliance. Webcasts placed on a shared common drive to share with bedside staff via Charge RN coordination. (great for night shift)

Change policy to have CVL dressings changed every Sunday and prn. (webcast take away) Replacement of 10 milliliter prefilled normal saline syringes with five milliliter syringe, supporting one time use. (Dirty q-tip pictures promotion) Orange disinfecting leur caps for use on all central lines for easy visualization f or compliance. Change IV tubing every Thursday and Sunday. Another “take away” from participating in webcasts.

Redesigned central line insertion kit as recommended in webcast. If all parts used, there was compliance, if something let over, probably not compliant. Time out Checklist developed with all critical CVL steps on the actual form. Change IV tubing every Thursday and Sunday. Another “take away” from participating in webcasts January 2012 EMR implemented, daily CVL line reports reviewed by Charge RN’s, physicians called for CVL’s >5days. (many physicians thank the nurse).

 Beside RN’s created a specific pink colored form to assess central line care daily, along with other quality indicators.

 SJMC Outcome Measure for Bundle Success Decrease in central line associated bloodstream infections

 What started as a critical care initiative has now expanded to - Progressive Care Units - Medical-Surgical Units Today, CUSP is a HOUSEWIDE

Monitor and published results Drill down, making it personal ZERO CLABSI

 Data Collection Performed on individual units Using a standardized collection tool Infection control department

Success with Bundles and CUSP ZERO CRBSI Problem Solution oriented trust staff Research Evaluate outcomes Evaluate data think out of the box Decision Making

 Berenholtz, S.M., Pronovost, P.J., & Lipsett, P.A. (2004). Eliminating catheter-related bloodstream infections in the intensive care unit. Critical Care Medicine, 32 (10),  Bowditch, J.L; Buono, A.F & Stewart, M.M. (2008). A primer on organizational behavior, 7th e.  CDC. (2011). Central line-associated bloodstream infection (CLABSI) Event.  The Comprehensive Unit-based Safety Program (CUSP). Agency for Healthcare Research and Quality, Rockville, MD.

 Gurses, A.P., Seidl, K.L., & Vaidya, V. (2008). Systems ambiguity and guideline compliance: a qualitative study of how intensive care units follow evidence-based guidelines to reduce healthcare-associated infections. Quality Safety Health Care, 17(1),  IHI. (2011). Implement the IHI central line bundle. Retrieved from Present a complete plan for implementing the solution in the work setting.  Pronovost, P.J., Goeschel, C.A., & Colantuoni, E. (2010). Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study. British Medical Journal, Retrieved from bmj.com. 1-6.