National Expansion Overview Spring 2010 On the CUSP: Stop BSI

Overview Goals Why this initiative is important How it works (in general) Why it works What it requires What are the next steps What can I clarify

Why This Initiative is Important From the patient’s perspective – Blood stream infections kill 40-60,000 persons each year – Reducing the BSI rate from 5 per 1,000 days to 1 per 1,000 days will save 20,000 lives annually – These reductions were achieved using the processes at the core of On the CUSP: Stop BSI

Why This Initiative is Important From Government’s Perspective – Key part of Secretary Sibelius’ initiative to reduce hospital acquired infections AHRQ funding national rollout of On the CUSP: Stop BSI Coordination with CDC efforts to reduce HAI’s through ARRA grants to states Coordination with CMS efforts to reduce surgical site infections – Driven by belief that hospital care can and should be safer, more efficient and cheaper

Why This Initiative is Important From Hospital Association Perspective – Key part of AHA’s Hospitals in Pursuit of Excellence national campaign to improve hospital care quality – Voluntary participation and success blunts efforts to mandate onerous data collection and other activities – State hospital association support enhances members’ abilities to achieve their mission

Why This Initiative Is Important Results sustained over time in MI hospital units : – from 7.7 – 2.7 infections /1,000 catheter days at baseline to – 1.2 and 0 at months to – 1.1 and 0 at months Pronovost, Goeschel, Colantuoni, Watson et al, BMJ 2010;340:c309

How On the CUSP: Stop BSI works Its leadership: – Health Research & Educational Trust of the American Hospital Association (John Combes, MD) – The Johns Hopkins University Quality & Safety Research Group (Peter Pronovost, MD, PhD) – The Michigan Health & Hospital Association Keystone Center for Patient Safety & Quality (Spencer Johnson/Sam Watson)

How On the CUSP: Stop BSI works Its goals: – Reduce BSIs to 1 per 1,000 catheter days – Reach hospitals in all 50 states, the District and Puerto Rico – Include both ICUs and other units with BSI risks – Include Critical Access Hospitals – Improve safety culture

CUSP & CLABSI Interventions 1. Educate on the science of safety 2. Identify defects 3. Assign executive to adopt unit 4. Learn from Defects 5. Implement teamwork & communication tools CUSPCLABSI 1.Wash Hands Prior to Procedure 2.Use Maximal Barrier Precautions 3.Clean Skin with Chlorhexidine 4.Avoid Femoral Lines 5.Remove Unnecessary Lines 3

PRIMARILY 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 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 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 1. Science of safety presentation 2. Attendance sheet Staff Identify Defects 1. Staff safety assessment form 2. Indentifying hazards presentation 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 5. Team check up tool 1. Daily goals 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 Tool and Technology Assessment Assemble a CUSP team, Partner with a senior executive; Baseline CLABSI Data Exposure Tool and Technology Assessment

How On the CUSP: Stop BSI works-- Its Scope (Will include additional hospitals from states in earlier cohorts) We need you in this project!

12 Recruit/Equip State Hospital Associations SHAs form Consortia and Recruit Hospitals Hospitals Collect Baseline data-culture & infections Ongoing training & technical Support in CUSP Improved culture, infection rates Sustainable improvements, spread to other challenges How On the CUSP: Stop BSI works-- The Process

Why On the CUSP: Stop BSI Works Four Key Ingredients 1.Emphasis on culture change: without a culture of safety, infection reductions will be less achievable and unsustainable – Evaluate safety culture – Educate staff on science of safety – Identify defects in care – Commit to executive partnership – Re-measure culture every months

Why On the CUSP: Stop BSI Works Four Key Ingredients 2. Use of proven strategies for reducing BSIs Educate staff on evidence-based practice to eliminate CLABSI Implement checklist to ensure compliance with these practices Empower nurses to ensure doctors comply with checklist Utilize monthly team meetings to assess progress

Why On the CUSP: Stop BSI Works Four Key Ingredients 3. Use of data to demonstrate need, document progress, and validate investment Collection of infection data using simple numerators and denominators Assessment of safety culture using AHRQ’s Safety Culture Survey Simple monthly progress data submitted on Team Checkup Tool Reports produced centrally and shared with participants Collection and reporting is essential—public sharing of data is NOT expected or encouraged

Why On the CUSP: Stop BSI Works Four Key Ingredients 4. Exceptionally qualified leadership and faculty Peter Pronovost’s team commands enormous respect and creates enormous enthusiasm MHA’s experience and data warehouse assures state hospital association’s needs are understood and addressed HRET and AHA are focused exclusively on making the project work for both hospitals and participating hospital associations

Why CUSP Works Care at the bedside is transformed The CUSP model is applicable to other HAIs, virtually all other patient safety issues Incorporates existing teamwork and communication tools, e.g., TeamSTEPPS

On the CUSP: Stop BSI Project Timeline [1] SHA=State Hospital Association [2] DUA=Data Use Agreement [3] HSOPS=Hospital Survey of Patient Safety Culture Month 1Month 2Month 3Month 9 Month 10 Month 8Month 4Month 5Month 6Month 7 Month 11Month 12Month 13Month 14Month 15Month 21Month 22Month 20Month 16Month 17Month 18Month 19Month 23Month 24Month 25Month 26Month 27Month 28 MHA/Keystone registers hospitals in data system, and hospitals complete DUA [2] SHA[1] recruits hospitals and forms state collaborative Hospitals take first HSOPS[3], and immersion calls begin SHA holds kick-off meeting for its hospital teams; monthly content and coaching calls begin; hospitals begin to submit monthly CLABSI and Monthly Team Checkup Tool data SHA holds mid-course meeting for its hospital teams Hospitals take second (last) HSOPS SHA holds celebration meeting for its hospital teams

What Participation Requires: Support from the National Project Team

What Participation Requires: A State Lead from the Association The Lead will need to: Lead hospital recruitment efforts Coordinate with national project team Oversee logistics of meetings and call planning The Lead will NOT need to: Create resources for hospitals Provide any content knowledge or answer substantive questions Set up a website or develop an implementation manual—both come from the national team

What Participation Requires Hospital Unit The Hospital Unit will need to: Participate formally for 2 years Assemble team Assign team leader (10% effort) Engage executive champion Hold monthly patient safety meetings Listen to monthly content and coaching calls

What Participation Requires Hospital Unit Submit monthly CLABSI data if not already submitting to NHSN (5-10 minutes/month by one person) Assess monthly teamwork and communication (10 minutes/month by one person) Take the Hospital Survey on Patient Safety Culture baseline and near end of 2 years by all team members) Attend 3 face-to-face meetings & monthly calls

Confidentiality All information is confidential, blinded comparisons with others in state and with others states in the national project

On the CUSP Data Collection Measure / FormFrequency of Completion How to submitReports generated Exposure & technology assessment OnceSurvey Monkey (Link will be sent via ) Descriptive Culture assessment (AHRQ Hospital Survey on Patient Safety) Baseline and 18 months HSOPS administered via MHA Care Counts** Unit reports and comparative reports from MHA CLABSI rate Numer = # of cases Denom = # of C.L. Days *Monthly (beginning 2-3 months after state launch) Comparative Reports from NCSHIM and MHA Care Counts Team Check-Up Form*Monthly (beginning 2-3 months after state launch) in MHA Care Counts Staff Safety Assessment survey ‘How is the next patient going to be harmed?’ Baseline and biannual Not submittedNo report Learning From DefectsMonthlyNot submittedNo report *Due by the 15th of the Month following data collection. (Ex: January is due by February 15) ** Website managed by Michigan Health & Hospital Association's (MHA) Keystone Center for Patient Safety & Quality

CLABSI Report

MTCT Report

MTCT Common Barriers

Sample HSOPS Report

Data Status Report

HAI Elimination Collaboration Policy Leadership AHRQ CDC CMS AHA Field Leadership JHU MHA HRET NW Implementation Leadership SHA DOH QIO

What are Next Steps Answer your questions: – Deborah Bohr at or – Visit Observe an upcoming Kickoff meeting Join an upcoming cohort – Cohort 4: July 2010 – Cohort 5: Sep 2010