ICU Safe Care Initiative/CUSP November 16, 2010 8:30 am – 3:30 pm

Massachusetts Teams New Teams Current Teams Baystate Franklin Medical Center Cambridge Health Alliance Caritas Christi Healthcare Harrington Hospital Milton Hospital Quincy Medical Center Southcoast Charlton Memorial Hospital Southcoast St. Luke's Hospital Southcoast Tobey Hospital Shaughnessy-Kaplan Rehabilitation Hospital Spaulding Rehabilitation Network Sturdy Memorial Hospital Current Teams Baystate Medical Center Berkshire Medical Center Fairview Hospital Jordan Hospital Melrose Wakefield Hospital Marlborough Hospital Morton Hospital & Medical Center Mount Auburn Hospital Noble Hospital Tufts Medical Center

Meeting Objectives Review the purpose of the ICU Safe Care Initiative/Comprehensive Unit-Based Safety Program (CUSP). Understand how your ICU and your hospital will benefit from participation. Build the skills of physicians, nurses, and other care team members in identifying and eliminating system defects that can result in patient harm, and in improving teamwork and communication and building a safety culture. Hear from local and national experts on the strategies and best practices to prevent central line infections.

CUSP and CLABSI Interventions Improving the culture of safety: 1. Educate on the science of safety 2. Identify defects 3. Learn from defects 4. Assign executive to adopt unit 5. Implement teamwork tools Primarily technical interventions: CVC line insertion CVC line management

On The CUSP Stop BSI PRIMARILY Adaptive (CUSP) PRIMARILY Technical (CLABSI) CVC Insertion CVC Line Cart 1. Contents inventory Evidence based BSI prevention – the bundle (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 PRIMARILY Adaptive (CUSP) Science of Safety Training 1. Science of safety presentation 2. 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 2. Shadowing 3. AM briefing 4. Call list 5. Team check up tool Assemble a CUSP team, Partner with a senior executive; Baseline CLABSI Data Exposure Survey and Technology Survey 5

Framework for MA ICU Safe Care Initiative Improvement Collaborative Hospital Association and Patient Safety Organization Work together as state leads Recruitment of hospital teams and resources to the teams State “hub” for managing ongoing participation and improvement Role of National Project Team Two Year Collaborative Data Collection – CareCounts website Improvement Monthly Content Calls Monthly Coaching Calls Resources at: www.onthecuspstophai.org/Stop-7611.html

Percent understanding patient care goals Communication Among Care Providers: Percent Understanding Patient Care Goals Daily Goals Percent understanding patient care goals 8

Impact of Daily Goals on ICU Length of Stay 654 New Admissions = $7 Million Additional Revenue 9

Safety Climate- Culture of Safety Survey   % of respondents within an ICU reporting good safety climate WICU- 35% to 52% to 87% SICU- 35% to 68% to 70%

Culture of Safety- Michigan Teamwork Climate Across Michigan ICUs

Culture of Safety- Michigan Safety Climate Across Michigan ICUs   % of respondents within an ICU reporting good safety climate

RN Turnover and Teamwork Climate: 26 Keystone ICUs reporting 1 # RNs who left the ICU r=-.650, p<.001 # leaving indicates both terminations and transfers within the organzation # indicates warm bodies, not FTEs Demonstrates that teamwork predicts nursing turnover. If nurses are not happy with teamwork they will talk with their feet.

2 yr CLABSI Results from ICUs in Michigan Time period Median CLABSI rate Baseline 2.7 Peri intervention 1.6 0-3 months 4-6 months 7-9 months 10-12 months 13-15 months 16-18 months Pronovost NEJM 2006

4 yr CLABSI Results from ICUs in Michigan Time period Median CLABSI rate 19-21 months 22-24 months 25-27 months 28-30 months 31-33 months 34-36 months Pronovost BMJ 2010

Results Lives Saved – 1,729* Patient Days Saved – in excess of 127,000* Dollars Saved – 0ver $246 Million* Culture of Safety improved 28% Teamwork improved 15% * Based on the Johns Hopkins Opportunity Estimator