© 2009 On the CUSP: STOP BSI Identifying Barriers to Evidence-based Guideline Compliance.

Slides:

Advertisements

Similar presentations

© 2009 On the CUSP: STOP BSI The Comprehensive Unit-based Safety Program (CUSP): An Intervention to Learn form Mistakes and Improve Safety Culture.

Advertisements

Peter Pronovost, MD, PhD Johns Hopkins University

© 2009 On the CUSP: STOP BSI Physician Engagement.

Evaluating and Institutionalizing

Preventing Central Line Associated Bloodstream Infections (CLABSIs)

CLINICIAN ENGAGEMENT MAY 13 TH, 2013 Julian Marsden Clinical Director BC Patient Safety & Quality Council.

Patient safety bundles for critical care

CLABSI Investigation Melinda Sawyer, RN, MSN, PCCN David A. Thompson DNSc, MS, RN.

EHR and Clinical Workflow A Human Factors Engineering Approach Ayse P. Gurses, PhD Ant Ozok, PhD April 19th, 2013.

Vanderbilt Infection Control & Prevention Central Line Associated Bloodstream Infections Tennessee Center for Patient Safety Vicki Brinsko RN, CIC.

Certification of Central Venous Lines Georgia Health Sciences Medical Center Augusta, Georgia November 13, 2012.

The Introduction of a Specialist Paediatric Vascular Access team Sara Melville, Lead Nurse Vascular Access, Alder Hey.

On the CUSP: STOP BSI Physician Engagement. Immersion Call Overview 1.Project overview 2.Science of Improving Patient Safety 3.Eliminating CLABSI 4.The.

© 2009 On the CUSP: STOP BSI Evidence for Best Practices for Placement and Maintenance of Central Lines.

The Nature of Quality Improvement Donald M. Berwick, MD, MPP Institute for Healthcare Improvement Testimony to the Secretary’s Advisory Committee on Human.

NICU CLABSI Affinity Group Meeting September 12, 2012 Denise Flook, RN, MPH, CIC HAI Collaborative Lead Vice President, Infection Prevention/Staff Engagement.

© The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011 Audit Your Care A Closer Look at CLABSI and SSI Audit Forms Armstrong.

CSTS: The Cardiovascular Surgical Translational Study Senior Leadership of Quality and Safety Initiatives in Health Care Peter J. Pronovost, MD, PhD The.

Designing Survey Instrument to Evaluate Implementation of Complex Health Interventions: Lessons Learned Eunice Chong Adrienne Alayli-Goebbels Lori Webel-Edgar.

© 2009 On the CUSP: STOP BSI The Science of Improving Patient Safety.

Building Your CUSP Team Part I Michael Rosen, PhD August 28, 2012 Armstrong Institute for Patient Safety and Quality Conference Number(s):

© 2009 On the CUSP: STOP BSI Overview of STOP-BSI Program.

© 2009 On the CUSP: STOP BSI Identifying Barriers to Evidence-based Guideline Compliance.

© 2009 On the CUSP: STOP BSI Building a Team. © 2009 Learning Objectives To understand the central importance of your ICU quality improvement team To.

Toward Eliminating Central Line Associated Blood Stream Infections.

Improving ICU Care Through Teamwork

Comparative Effectiveness Grant Toward Eliminating Central Line Associated Blood Stream Infections.

Learning Objectives 2 2 Explain the role of the senior executive in addressing technical and adaptive work Identify characteristics to search for when.

© The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011 Identifying and Mitigating Barriers and Hazards Armstrong Institute.

Physician Engagement. Learning Objectives To relate what is meant by physician engagement To discuss strategies at management and staff levels to enhance.

Factors determining success in reduction of Central Line Associated Blood Stream Infection (CLABSI) on statewide levels HeeWon Lee, Doris Duke Clinical.

 1850 Semmelweiss found increased rate of mortality with puerperal sepsis patients and advocated hand washing to stop spread of disease  Died.

© 2009 On the CUSP: STOP BSI Nurse Empowerment.

© 2009 On the CUSP: STOP BSI Identifying Hazards.

CUSP for VAP: EVAP Shadowing Another Professional Kathleen Speck, MPH November 14, 2013.

11/10/20111 On The Cusp Journey: Sentara CarePlex Hospital Gail J. Rudder RN, CRNI Infection Preventionist November 10 th, 2011.

Unit 9a: The BSI Story HIT Infecting a Patient Safety Culture This material was developed by Johns Hopkins University, funded by the Department of Health.

The Comprehensive Unit-based Safety Program (CUSP)

Comprehensive Unit Based Safety Program    A webinar series for QI Managers, Nurse Leaders and others supporting healthcare improvement in Wisconsin’s.

CUSP/Stop BSI Collaborative of Kansas and Missouri Kimberly O’Brien, MHATonya Crawford Project ManagerProgram Manager Missouri Center for Patient SafetyKansas.

Improving Care Through Technical & Adaptive Work Chris Goeschel RN MPA Director, Patient Safety &Quality Initiatives JHU Quality & Safety Research Group.

Comprehensive Unit based Patient Safety Program Deepa Jose,RN,CCRN.

Barriers to EBP Prepared by: Dr. Hoda Abed El-Azim.

Lessons from CUSP/CLABSI – Getting to Zero and Sustaining your Improvements On the CUSP: Stop BSI Jill Marsteller, PhD, MPP Armstrong Institute for Patient.

AN INTRODUCTION Managing Change in Healthcare IT Implementations Sherrilynne Fuller, Center for Public Health Informatics School of Public Health, University.

AHRQ Safety Program for Long-term Care: HAIs/CAUTI A Team Member’s Guide to a Culture of Safety Onboarding #1 for All Long-term Care Staff.

ICU TO PREVENT CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS.

Identifying Barriers to Evidence-based Guideline Compliance On the CUSP: STOP BSI.

A Team Members Guide to a Culture of Safety

Based on the performance appraisal system, the nursing home reported an improvement in the reduction of medication errors. However, adverse clinical.

Staff Safety Assessment 1. Learning Objectives To understand Step 2 of CUSP:Identify Defects To understand how to Implement the Staff Safety Assessment.

Aseptic catheter insertion practices in the ED: A Focus on Engagement Milisa Manojlovich PhD, RN, CCRN Associate Professor University of Michigan, School.

Identifying Defects Chris Goeschel June Identifying Defects What DO you know? What SHOULD you know?

Upon completion the participant will identify and list steps to implement The Comprehensive Unit-based Safety Program (CUSP) and patient care bundles.

© 2009 On the CUSP: STOP BSI Senior Leadership of Quality and Safety Initiatives in Health Care.

Enhanced Recovery After Surgery Alan Willson 17 November 2010

Toward Eliminating Central Line Associated Blood Stream Infections

An Intervention to Learn from Mistakes and Improve Safety Culture

On the CUSP: STOP BSI Overview of STOP-BSI Program

IT Tools: Their Usability and Clinical Effectiveness

Staff Safety Assessment

Staff Safety Assessment

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

An Intervention to Learn from Mistakes and Improve Safety Culture

Meeting Objectives Build skills among care team members that will improve teamwork, communication, and create a patient safety culture in your unit Hear.

MA ICU Safe Care Initiative: Comprehensive Unit Based Safety Program (CUSP) 2010.

MA ICU Safe Care Initiative: Comprehensive Unit Based Safety Program (CUSP) October 25, 2010.

I Will. I Will CLA-BSI Rate for All ICUS at JHH: Q

Presentation transcript:

© 2009 On the CUSP: STOP BSI Identifying Barriers to Evidence-based Guideline Compliance

© 2009 Learning Objectives To learn about the different types of barriers to guideline compliance To learn how to identify the barriers to guideline compliance To understand how to develop a process to eliminate or reduce the effects of these barriers

© 2009 Remove unnecessary lines Wash hands prior to procedure Use maximal barrier precautions Clean skin with chlorhexidine Avoid femoral lines Evidence-based Behaviors to Prevent CLABSI

© 2009 Ask Front-line Staff What are some of the leading problems and barriers encountered in your unit that may hinder compliance with this guideline? Does the front-line staff know what is expected from them regarding guideline compliance? Do they agree with the guideline? What are some of the strategies and tools you have implemented to improve compliance with this guideline in your unit?

© 2009 Specific Items Who are the care providers responsible for ensuring compliance with this guideline? Can you describe their roles with regards to complying with this guideline? What information do you need to be able to follow this guideline? How do you find out the date that a central venous catheter was inserted to a patient? What are your practices to reduce central venous catheter- related bloodstream infections? What are the common lapses in compliance?

© 2009Observe Shadow a care provider while following a guideline (multiple times, multiple providers) −Include different lenses – nurse, infection control, human factors/ QI expert shadowing physician −Focus on system characteristics rather than the individual physician

© 2009 Try out the Guideline Triability of a guideline increase guideline compliance Usability testing of a technology (guideline) – Walkthrough: Walk the process of inserting and maintaining a central line – Scenario-based testing – How easy is it to comply with the guideline?

© 2009 Types of Barriers (4As) Awareness → Implement education Agreement → Group discussion Ambiguity → Clarify any type of ambiguity Ability → Identify any impeding system factors and eliminate them or reduce their impact

© 2009 Beliefs of a Clinician Behavioral beliefs: Does complying with a guideline lead to positive outcome(s)? Normative beliefs: What are the expectations of my colleagues regarding complying with a particular guideline? Control beliefs: What are the factors that may impede or facilitate guideline compliance and how much I can control these?

© 2009Ambiguities Task ambiguity Expectation ambiguity Responsibility ambiguity Method ambiguity Exception ambiguity

© 2009 Examples to Barriers Unclear feedback (expectation ambiguity): Presenting bloodstream infection rates in the format of 4.6 per 1000 line days is not perceived by nurses as directly relevant to their practice Forgetting to review line necessity daily due to inadequate reminder mechanism High workload negatively affecting hand washing compliance Central line cart is not stocked regularly

© 2009 Identifying Barriers Conduct preliminary interviews to understand causes of non- compliance. Is guideline compliance intentional or non- intentional? −Non-intentional: Interview care provider −Intentional: Conduct observations and interviews Include different types of care providers in the process of identifying barriers (physicians, nurses, respiratory therapists, infection control, human factors expert)

© 2009 Reporting Findings Reporting framework – Provider: job category, skills, beliefs – Tasks: Ambiguities (role, task, exception), guideline – Environment – Tools – Organization Interdisciplinary meeting – Discuss findings – Prioritize barriers and develop action plans

© 2009 Action Plan Form an interdisciplinary group of people (physician, nurse, inf control, resp therapy, human factors/QI expert, other) responsible with identifying barriers Each one conducts at least one observation and one interview. One clinician and one non-clinician walks through the process together. Summarize findings using the barrier reporting framework Discuss findings in an interdisciplinary meeting (including unit administrators) and prioritize the barriers to tackle. Identify action plans and assign responsibilities Review the progress periodically

© 2009References Azjen (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, Carayon et al. (2006) Works system design for patient safety: the SEIPS model. QSHC 15: i50 - i58. Gurses et al. (2008) Systems ambiguity and guideline compliance, QSHC 17: Pronovost et al. (2008). Translating evidence into practice: a model for large scale knowledge translation. BMJ 337:a1714 Reason (1990) Human Error. Cambridge University Press, Cambridge. Rogers, E. M. (1995). Lessons for guidelines from the diffusion of innovations. Jt.Comm J.Qual.Improv. 21, Thompson (2008) View the world through a different lens: shadowing another Jt.Comm J.Qual.Improv. 34, (5).