Using the Guide to Patient Safety to Improve CAUTI and CLABSI Prevention AMANDA Welcome to all of the ICU teams participating in the AHRQ Safety Program.

Using the Guide to Patient Safety to Improve CAUTI and CLABSI Prevention
AMANDA Welcome to all of the ICU teams participating in the AHRQ Safety Program for ICUs: CLABSI/CAUTI project. We are very excited to have so many of you in attendance today and commend your dedication to improving performance and patient safety in your ICUs. By now you should have had a chance to review the on-demand learning modules on CLABSI and CAUTI prevention strategies. Today’s webinar “Using the Guide to Patient Safety to Improve CAUTI and CLABSI Prevention” builds off these modules and launches a series of webinars to help your overcome challenges you may still be facing to implement the interventions outlined in those modules on how to disrupt the lifecycle of the catheter device. We will be providing you with practical tools and resources today, as well as strategies, to augment your current quality improvement efforts. You will find that there are many approaches to improving quality. Our main objective is to help you determine what works best for your ICU and to offer support as you navigate this journey.

AHRQ Safety Program for ICUs: CLABSI/CAUTI
Presenters Sarah Krein, PhD, RN Research Career Scientist, VA Ann Arbor Research Professor, University of Michigan Milisa Manojlovich, PhD, RN, CCRN Associate Professor University of Michigan AMANDA With that I’d like to introduce today’s presenters. Dr. Sarah Krein is a… Dr. Manojlovich is a… And Shannon Davila is a… Shannon Davila, RN, MSN, CIC, CPHQ Health Research & Educational Trust (HRET) AHRQ Safety Program for ICUs: CLABSI/CAUTI

Objectives Describe the components of the Guide to Patient Safety (GPS) tool. Describe how the GPS assessment can be used to identify barriers to healthcare-associated infection (HAI) prevention. Discuss approaches to address barriers and facilitate implementation of enhanced HAI prevention strategies. AMANDA AHRQ Safety Program for ICUs: CLABSI/CAUTI

A Pivot Point to Enhance Current Prevention Efforts
Identify gaps using ICU Assessment Complete a team action plan and implement Standardize products, procedures and processes Identify barriers and strategies to overcome using the GPS Tool Develop a plan to implement small tests of change (e.g., PDSA cycle) Implement enhanced practices AMANDA We are at a pivotal point in this program and today you will learn about how the Guide to Patient Safety, or GPS, can provide an opportunity for units to further enhance the current efforts that are underway. Up to this point in the program, teams have used a variety of assessments and tools to identify gaps in both clinical and cultural practices. The ICU unit assessment, which was completed at beginning of the project, is an assessment of current clinical and safety practices and teams were encouraged to use those results to identify gaps in practice. Following the completion of the assessment, with the coaching support of the state leads and clinical mentors, teams began to create their action plans for improvement and report their progress monthly through the Team Check Up tool. Content to date has focused on basic practices, or Tier 1 interventions, such as standardizing practices, supplies and processes related to device insertion, maintenance and removal. Education has included clinical and cultural best practices to help units implement these interventions. After hardwiring the standard practices and processes, units can use enhanced practices, or T2 interventions if performance has not met target or to ensure sustainment, which we will discuss later in this webinar. [CLICK] The GPS tool can be used to "pivot" to the next level of best practices. AHRQ Safety Program for ICUs: CLABSI/CAUTI

Initial ICU Assessment of Gaps
Cultural Process Assessment Clinical Process Assessment Does your ICU work as a team to improve processes and quality care for all patients? Does your unit have a policy and/or procedure for performing daily assessment of ongoing need for the indwelling urinary catheter? Do staff members feel supported by the physicians practicing in the unit? Does your ICU currently use a nurse-initiated discontinuance of indwelling urinary catheter? Do staff members feel supported by senior administration? Does your unit have a current policy and/or procedure for prompt removal of central line if no longer necessary? Do staff members report feeling supported by other staff for their efforts to improve quality in the ICU? With whom do you share your CAUTI and/or CLABSI surveillance data? AMANDA As I just mentioned, units have completed the ICU Assessment early in the program to help identify gaps in practice. In this table we have included a sample of the questions that units responded to as part of that ICU Assessment. As you are about to hear, the GPS tool can help identify existing or new barriers that might be inhibiting forward progress in reducing CAUTIs or CLABSIs. Teams should review their initial ICU Assessment results to identify areas of vulnerability and use the GPS tool as way to create dialogue and discussion with their teams to further pinpoint barriers that are preventing successful implementation of best practices. AHRQ Safety Program for ICUs: CLABSI/CAUTI

Guide to Patient Safety (GPS) Purpose
Brief, troubleshooting guide Help identify some key reasons why hospitals may not be successful in preventing CAUTI/CLABSI Once barriers are identified, can then help identify possible strategies to overcome Sarah Today we are going to introduce a tool that we believe could be useful, especially for those who may be having some challenges with implementing the changes needed for improving their CAUTI and/or CLABSI rates. This is intended to help you build on the work you are doing by providing additional guidance and suggestions that can be incorporated into your action plans. I am going to start by providing a brief overview of the tool, including a bit about how and why it was developed, and how it has been used to date. The purpose of the Guide to Patient Safety or GPS is to serve as a brief troubleshooting guide. It was initially developed for CAUTI but a CLABSI GPS is also now under development. The GPS is designed to help identify some key reasons why hospitals (or a hospital unit) may be as successful as they might like to be in preventing CAUTI or CLABSI. And, once barriers are identified, it can then help identify possible strategies to overcome those barriers. AHRQ Safety Program for ICUs: CLABSI/CAUTI

GPS Development To understand why some hospitals are better than others in preventing infection Mixed-methods national studies focusing on three device-related infections: CAUTI, CLABSI, and VAP Funded by VA, NIH, and AHRQ Conducted phone interviews and site visits to hospitals across the United States Challenge: Site visits require considerable time and resources Solution: A self-administered tool Sarah (Note animation on click) The ideas and information used to develop the GPS started with a research study designed to better understand why some hospitals appear to do better than others in preventing infection. This led to a series of mixed-methods national studies focused on preventing device-related infections: CAUTI, CLABSI, and VAP. What I mean by mixed-methods is that we collected quantitative data (generally through a survey) and qualitative data to obtain a more in-depth picture of what hospitals were doing. This work was funded by a variety of sources, including the VA, NIH, and AHRQ. Our qualitative work included phone interviews and site visits to hospitals across the U.S. including small and large hospitals, academic medical centers, as well as rural hospitals. Initially these visits were mostly focused on us collecting information and learning from hospitals about their challenges and the strategies they used to address those challenges (sometimes successfully and sometimes not). However, over time we identified what appeared to be some common challenges and our hospital site visits became more consultative. So, we began using the information we had learned to help hospitals with troubleshooting (i.e., identifying specific barriers/challenges) and with identifying ways to overcome those barriers. While it might be rather fun to visit all hospitals, as you can imagine these types of visits require a lot of time and resources and we therefore decided to develop a tool that hospitals could use on their own identify whether they might be experiencing one or more of the common challenges and receive targeted feedback. AHRQ Safety Program for ICUs: CLABSI/CAUTI

GPS Application Online tool (currently only for CAUTI) Each question linked to troubleshooting tips Sarah The GPS (for CAUTI only), which includes the assessment tool and troubleshooting tips is currently available as an online tool at the catheterout.org website. However, a similar tool for CLABSI is being developed and the assessment part will be made available for download after today’s presentation, keeping in mind this is a work in progress so the CLABSI version is not currently linked directly to tips and techniques for addressing identified challenges. So, now that you have some background and hopefully I’ve piqued your interest let’s take a look at the CAUTI GPS. AHRQ Safety Program for ICUs: CLABSI/CAUTI

GPS GPS Questions SARAH
So I mentioned earlier that it was a brief assessment. As you can see on this slide it is only 10 yes/no questions. Also, I think you will see there are some similarities with the Team Checkup Tool that you are using.

GPS questions GPS Feedback Example SARAH
After you complete the assessment, you will receive a targeted feedback report based on your responses. And for those areas where you identify a possible challenge, there are links to more specific suggestions for addressing those challenges. So, as an example, for question 5, the respondent answered no to the question about whether bedside nurses take initiative to ensure the indwelling urinary catheter is removed when no longer needed.

GPS Troubleshooting Example
GPS questions 5 GPS Troubleshooting Example SARAH Here is an example of specific feedback describing different ways this can be approached to help empower nurses to take on this role, including using stop orders or nurse-initiated discontinuation protocols. AHRQ Safety Program for ICUs: CLABSI/CAUTI

GPS Validation Study Compared the CAUTI GPS assessment answers to qualitatively derived site assessments Four academic institutions: 2 units per site (one MICU and one other unit) Nurse manager completed GPS and then was interviewed Others (staff nurses, physicians, hospital leadership) were interviewed using more open-ended questions Observations on the involved wards SARAH After the GPS was developed we thought it was important to validate how well the responses to the GPS assessment matched with a site visit derived assessment. So, working with a collaborator at another institution, we compared the GPS assessment answers to qualitatively derived site assessments. This work took place at 4 academic institutions, 2 units per site (a MICU and a ward). The nurse manager completed the GPS assessment and was then interviewed. Others, including staff nurses and physicians were also interviewed and their description of the CAUTI prevention efforts compared with the GPS assessment. There was also some observation on the wards. Now this presentation is timely as the publication with the validation results was just published in the American Journal of Infection Control and basically, I can tell you that some questions/items generated more disagreement than others. However, I think even more importantly, this study also highlighted some other ways in which the GPS could prove useful. So, let me give you a couple of examples. AHRQ Safety Program for ICUs: CLABSI/CAUTI

Getting on the Same Page
Our observation Physicians often have no idea about formal CAUTI prevention practices on their units Examples Physicians have no idea what the nurses do with respect to CAUTI prevention Physicians often aren’t aware of the existence of champions Ideas Have physicians take the GPS and use as an opportunity to discuss identified gaps SARAH One of the issues that surfaced was the importance of having everyone on the same page. During the site visits it appeared that physicians often have no idea about formal CAUTI prevention practices on their units, they did not know what nurses do with respect to CAUTI prevention, and weren’t aware of the existence of champions. So, one idea is to use the GPS as a way to get everyone on the same page. Reminded me of a site where we actually did this . . . AHRQ Safety Program for ICUs: CLABSI/CAUTI

CAUTI Gaps, Action Plan, and Challenges Scenario
Problem: 4 West has highest CAUTI rate in hospital Gaps identified (from ICU Assessment) No policy and/or procedure for performing daily assessment of ongoing need for the indwelling urinary catheter Staff members reported NOT feeling supported by other staff or physicians for their efforts to improve quality in the ICU Action Plan Aim: To reduce CAUTIs by instituting a nurse-driven protocol to remove unnecessary catheters Action Plan: View the educational modules, conduct an in-service with staff on the appropriate indications for catheter use, and write a nurse-driven removal protocol to pilot on 4 West SHANNON Let’s consider a scenario and how this unit may use the GPS to improve their efforts at preventing CAUTI. Unit 4 West from General Hospital has joined the AHRQ safety program because General Hospital’s CAUTI report indicated that out of the five ICUs in their hospital, 4 West has the highest CAUTI rates and the most opportunity to improve. Upon completion of the ICU Assessment, 4 West identified their major gaps to be the following: The unit does not have a policy and/or procedure for performing daily assessment of ongoing need for the indwelling urinary catheter Staff members reported NOT feeling supported by other staff or physicians for their efforts to improve quality in the ICU With support of hospital leadership, and with coaching from their state lead and clinical mentors, the 4 West team has made it their aim to reduce CAUTIs by instituting a nurse-driven protocol to remove unnecessary catheters. The project manager, an infection preventionist, has viewed the educational modules, done an in-service with staff on the appropriate indications for catheter use, and written a nurse-driven removal protocol that will be piloted on 4 West. AHRQ Safety Program for ICUs: CLABSI/CAUTI

CAUTI Challenges Scenario
Progress remains slow Difficult to engage frontline clinicians Staff are resistant to change Little improvement seen SHANNON On a recent checkin call with their state lead, the team reports that progress has been slow and buy-in from frontline clinicians, both nurses and physicians, has been extremely challenging. They report that nurses are resistant to changing their urinary catheter assessment practices and are not consistently assessing for catheter need every day, and physicians view piloting the nurse-driven removal protocol as a waste of time. The team admits they are struggling with their plan and have not seen any improvement. AHRQ Safety Program for ICUs: CLABSI/CAUTI

CAUTI Challenges: Troubleshoot with GPS
Does this unit have an effective nurse champion for CAUTI prevention activities? Does this unit have an effective physician champion for CAUTI prevention activities? Do bedside nurses assess at least daily whether catheterized patients still need a urinary catheter? Do bedside nurses take initiative to ensure the indwelling urinary catheter is removed when no longer needed? Is senior leadership supportive of CAUTI prevention activities? SHANNON -> SARAH Let’s troubleshoot this scenario and see where the GPS questions lead us. Sarah, how might you use the GPS assessment to troubleshoot this scenario. NOTES Do you have an effective nurse champion for CAUTI prevention activities? (response- it does not appear that they have an effective nurse champion…) Do you have an effective physician champion for CAUTI prevention activities? (response- it does not appear that they have an effective physician champion…) Do bedside nurses assess at least daily whether catheterized patients still need a urinary catheter? (response: it does not appear that nurses consistently assess for daily need or are willing to change their practices..) Do bedside nurses take initiative to ensure the indwelling urinary catheter is removed when no longer needed? (response: we don’t have this information, but since the unit does not currently have a nurse driven protocol and physician support is low…) Is senior leadership supportive of CAUTI prevention activities? (response: Senior leadership did support the team joining the project….) AHRQ Safety Program for ICUs: CLABSI/CAUTI

CAUTI Scenario Poll Which of the following solutions would make a positive impact on this unit making progress? Identifying nurse and physician champions A process to ensure consistent daily nursing assessment of catheter use Empowering nurses to take initiative to remove the indwelling urinary catheter when no longer needed Engaging leadership support SARAH Now that we have discussed some of the likely barriers, which of the following solutions would make a positive impact on this unit making progress? Take a moment to answer this question using the poll below. Click on one radio button to cast your vote. (comment on results and transition to next slide to discuss solutions.) AHRQ Safety Program for ICUs: CLABSI/CAUTI

CAUTI Scenario: Strategies for Success
Possible Barriers Solutions Lack of effective nurse or physician champions Identify individuals who are passionate about the program and take pride in providing excellent care. Ensure they have some dedicated time to commit to the program, at least initially. Consider co-champions to lighten the work load and provide mutual support. Recognize them for their effort. Poor daily assessment of urinary catheter need Consider the use of catheter reminders, rounding, or assessment tools that fit with unit workflow. Stop orders can also be used to prompt reassessment and removal. Nurses do not take initiative to remove the catheters Empower and support nurses to take the initiative to remove the catheter when it is no longer appropriate through policy, education, and champion support. Assess and address concerns about catheter removal. Lack of senior leadership support Engage executive leadership by providing data and a business case to demonstrate the need for time and resources for CAUTI prevention. Sarah to address solutions more in depth AHRQ Safety Program for ICUs: CLABSI/CAUTI

CLABSI Gaps, Action Plan, and Challenges Scenario
Problem: 2 South is experiencing an increase in its CLABSI rate and have the highest central line utilization rate in the hospital Gaps identified (from ICU Assessment) CLABSI surveillance data is NOT being monitored or shared at the unit level The unit does NOT work as a team to improve processes and quality care for all patients The unit does NOT have a current policy and/or procedure for prompt removal of central line if no longer necessary Action Plan Aim: To reduce CLABSIs and device utilization by implementing a policy for prompt removal of central lines if no longer necessary Action Plan: Partner with Infection Prevention to write a policy for prompt removal of central lines SHANNON Now lets consider a CLABSI case scenario: After going 3 years without a CLABSI, Unit 2 South from Neighborhood Hospital has had 2 CLABSIs in the past 6 months. After reviewing their data, the unit also discovered that they had a central line utilization rate 3 times higher than any other ICU at Neighborhood Hospital. This prompted 2 South to join the AHRQ safety program. Upon completion of the Unit Assessment, 2 South identified their major gaps to be the following: CLABSI surveillance data is not being monitored or shared at the unit level The unit does not work as a team to improve processes and quality care for all patients The unit does not have a current policy and/or procedure for prompt removal of central line if no longer necessary Due to the extended period of zero CLABSIs, the previous CLABSI team disbanded over 2 years ago. To regain some momentum, the 2 South nurse manager and medical director have agreed to meet monthly to try to review the program education, unit assessment results and develop an action plan. In their first meeting, they decide their aim will be to develop a policy for prompt removal of central lines if no longer necessary. To achieve this, it will require additional input from Infection Prevention. Unfortunately, due to short staffing in that department, they are unable to meet until the following month. AHRQ Safety Program for ICUs: CLABSI/CAUTI

CLABSI Challenges Scenario
Difficult to organize and gain staff support CLABSI prevention not a priority Unit leadership taking on brunt of the work Doubtful they will achieve their goal SHANNON During a site visit with the state lead and clinical mentors, the 2 South team reports that trying to get organized and gain staff support for this initiative has been really difficult. Since CLABSI prevention has not been a priority, getting stakeholders engaged is time consuming and resource intensive. The unit nurse manager and medical director express that they are willing to take on the brunt of the work, but at the pace they are going, they are not sure if they will achieve their aim of developing a policy for prompt removal of central lines if no longer necessary. AHRQ Safety Program for ICUs: CLABSI/CAUTI

CLABSI Challenges: Troubleshoot with GPS
Does this unit have a well-functioning team focusing on CLABSI prevention? Does this unit have a project manager with dedicated time to coordinate CLABSI prevention activities? Does this unit collect CLABSI-related data? Do they provide feedback on CLABSI-related data to frontline staff? SHANNON -> MILISA Let’s troubleshoot this scenario and see where the GPS questions lead us. Milisa, how might you use the GPS assessment to troubleshoot this scenario. NOTES - Does this unit have a well functioning team focusing on CLABSI prevention? (response: no, it does not appear that this unit has a well functioning team focused on CLABSI prevention…) - Does this unit have a project manager with dedicated time to coordinate your CLABSI prevention activities? (response: No, since CLABSI prevention has not been a priority, resources have not been dedicated to coordinating CLABSI prevention activities..) - Does this unit collect CLABSI related data? (response: No, the unit does collect unit level CLABSI data..) - Do they feedback CLABSI related data to frontline staff? (response: No, staff appear to be in the dark on unit specific data, unaware that there was a problem..) AHRQ Safety Program for ICUs: CLABSI/CAUTI

CLABSI Scenario Poll Which of the following solutions would you address first to help this unit? Create a well-functioning team Identify a project manager with dedicated time to coordinate CLABSI activities Collect unit-specific CLABSI data Provide feedback on CLABSI data to frontline staff MILISA Now that we have discussed some of the likely barriers, which of these solutions would you implement first to help this unit make progress? Take a moment to answer this question using the poll below. Click on one radio button to cast your vote. (comment on results and transition to next slide to discuss solutions.) AHRQ Safety Program for ICUs: CLABSI/CAUTI

CLABSI Scenario: Strategies for Success
Possible Barriers Solutions Lack of a well-functioning team Make sure you have the right people on the team. Besides clinicians, consider an infection preventionist and a quality improvement officer. Consider TeamSTEPPS training. Lack of project manager with dedicated time to coordinate CLABSI prevention activities Identify a person with leadership skills, enthusiasm, persistence, credibility, AND time to dedicate to the program. Unit does not collect CLABSI or device utilization data Collect and review unit-level CLABSI data to evaluate if tests of change are successful. Monitor data on an ongoing basis to measure sustained impact of interventions. Unit does not routinely provide feedback on CLABSI or device utilization data to frontline staff Tailor the feedback to your audience. Nurses do not stop catheter insertion process when they witness a breach of sterile insertion technique Empower nurses to stop the catheter insertion process. Nurses need support from both nursing and physician leadership. A policy change may be needed. Physicians responsible for inserting central lines need to be informed. Milisa Team composition is very important. Although physicians are responsible for inserting central lines, nurses have a role to play in catheter maintenance. Infection preventionists gather data to track CLABSI rates and of course quality control officers can help with monitoring trends and with drill downs to help identify likely sources of CLABSI. The CLABSI project manager should have leadership skills but also enthusiasm, persistence and credibility among all members of the team. A credible project manager can often have success because he or she has “been there/done that”, and is viewed as someone who knows some of the challenges at the bedside when trying to do a procedure. Having dedicated time to work on CLABSI prevention activities is a crucial component as well. CLABSI and device utilization data help tell the story and track progress. We have found in CAUTI work that system barriers are often the culprits to reducing CAUTI, not individual clinicians, and it is likely the same with CLABSI. But to make system or practice changes, you need a baseline or launching pad. Feedback has to be meaningful to the people who are doing the work. The key to making it effective feedback is to tailor the feedback to your audience. Nurses can be great collaborators during the central line insertion process. By observing the process and noticing breaches in sterile technique, nurses can often help prevent CLABSI. In the operating room it is standard for anyone who witnesses a breach in sterility to speak up, and the same culture norm should be applied to central line insertion. AHRQ Safety Program for ICUs: CLABSI/CAUTI

CLABSI GPS Milisa A CLABSI GPS is in development While sharing many questions with the CAUTI GPS, there are some unique features in the CLABSI version. For example, in the CLABSI GPS we ask: Do nurses stop the insertion process when they witness a breach in sterile technique? Your input and feedback on the CLABSI GPS will really help improve the final product. AHRQ Safety Program for ICUs: CLABSI/CAUTI

A Note About the CLABSI GPS Assessment
Milisa/Sarah to address solutions more in depth AHRQ Safety Program for ICUs: CLABSI/CAUTI

Prepare to Implement Enhanced Practices
Basic Practices Guide to Patient Safety Enhanced Practices Senior leadership support for HAI prevention activities Well-functioning team and dedicated project manager Nurse and physician champions Collection of HAI data and routine feedback to frontline staff Over the course of this program thus far, units have learned about the lifec ycle of the urinary and central venous catheters and basic strategies to prevent CAUTI or CLABSI. Moving ahead, we will discuss enhanced practices that may require more time, resources, and support to implement. [CLICK] Dr. Krein and Manojlovich have discussed how units can use the GPS assessment to help address barriers to having effective champions, effective feedback, teamwork, and leadership support. Addressing these issues is important and will help units prepare for implementation of enhanced practices. AHRQ Safety Program for ICUs: CLABSI/CAUTI

CAUTI Enhanced Practices
Standardize products, procedures, and processes Tier 1: Place indwelling urinary catheter only for appropriate reasons Encourage use of alternatives to indwelling urinary catheters Ensure proper aseptic insertion technique and maintenance procedures Optimize prompt removal of unnecessary catheters Urine culture stewardship: Culture only if symptoms of UTI are present Enhanced Practices Tier 2: Conduct an assessment using CAUTI GPS tool Conduct catheter rounds with targeted education to optimize appropriate use Feedback infection and catheter use to frontline staff in real time Observe and document competency of catheter insertion: Education and observed behavior Perform full root-cause analysis or focused review of infections SHANNON Let’s look at the interventions for CAUTI and CLABSI using a two-tiered framework, with Tier 1 being the basic interventions. This program already introduced to you these interventions through on-demand education that describe how we can disrupt the catheter life cycle. These include placing indwelling urinary catheters only for appropriate reasons, using alternatives to indwelling catheters, using aseptic technique for insertion and maintenance, and promptly removing unnecessary catheters. Urine culture stewardship, or only culturing urine with the patient displays symptoms of a UTI is another basic strategy that will be discussed in a supplement education module to be released soon. These are interventions that all units should implement to reduce infections. Review the on-demand modules on CLABSI and CAUTI prevention for evidence-based practices and tips to implement these Tier 1 strategies. [CLICK] The T2, or enhanced practices for CAUTI, will be covered in more detail in next month’s educational session and they include conducting rounds for urinary catheter use, providing real-time CAUTI data and feedback to front line staff, observing competency of catheter insertion and maintenance, and performing RCA of CAUTI events. Tier 2, or the enhanced practices, should be considered when implementing T1 practices has not effectively reduced infection rates. T2 practices are more complex in nature, and may require additional coordination and resources. Implementation of the T2 interventions should be done in a progressive way, starting with review of the GPS [CLICK] and progressing to more complex interventions as necessary. Due to this increased level of complexity, addressing barriers becomes even more important. Dr. Krein, in your experience, which Tier 2 CAUTI practices really require an effective nurse or physician champion to be successfully implemented? AHRQ Safety Program for ICUs: CLABSI/CAUTI

CLABSI Enhanced Practices
Standardize products, procedures, and processes Tier 1: Assess appropriateness and need for Central Venous Catheter (CVC) Ensure proper aseptic insertion using maximal sterile barriers and ultrasound guidance Select appropriate site of insertion: Avoid use of femoral site Ensure proper care and maintenance of CVC (e.g., proper hand hygiene, adequate staffing, disinfection of connector, secure/intact dressing) Optimize prompt removal of clinically unnecessary CVCs Enhanced Practices Tier 2: Conduct an assessment using GPS tool Conduct multidisciplinary rounds to audit for necessity of continued CVC use Feedback CLABSI and CVC utilization metrics to frontline staff in real time Observe and document competency and compliance with CVC insertion and maintenance Use additional approaches as indicated by risk assessment (e.g., antimicrobial coated CVC) Full or mini root-cause analysis of CLABSI SHANNON Now let’s consider the CLABSI prevention tiered-approach and look at the T2 or enhanced interventions that may challenging to implement. Again, here in this framework diagram you can see the T1, or basic strategies that should be implemented on all units for CLABSI prevention. [CLICK] Similar to the CAUTI T2 interventions, the CLABSI T2 interventions include conducting multidisciplinary rounds to audit for central line use, providing real-time CLABSI data and feedback to front line staff, observing competency for central line insertion/maintenance, but also using additional approaches/equipment like antibiotic coated catheters, which may represent an added expense in both cost of product and training of staff, and RCA for CLABSI events. Dr. Manojlovich, can you discuss why have a dedicated project manager for CLABSI efforts is so important for implementation of T2 CLABSI practices, particularly when units may need to coordinate competency based training for staff or conduct RCA of infection events? AHRQ Safety Program for ICUs: CLABSI/CAUTI

Challenges to Implementing Enhanced Practices
CHAT What do you believe will be a challenge for your unit to implementing CLABSI/CAUTI enhanced practices? AHRQ Safety Program for ICUs: CLABSI/CAUTI

Using GPS Results for Action
Identify barriers to improvement Outline possible solutions Integrate solutions into unit action plan Plan Do Study Act GPS SHANNON You will recall from the onboarding phase of this program we discussed quality improvement approaches like the Plan, Do, Study, Act or PDSA cycle. Sometimes referred to as “rapid cycle improvement,” the PDSA model uses a “trial-and-learning” approach and is considered an “action-oriented” model. The GPS tool can be easily integrated into this type of approach. -Identify barriers to improvement -Outline possible solutions -Integrate solutions into unit action plan AHRQ Safety Program for ICUs: CLABSI/CAUTI

Next Steps Print and discuss GPS assessment tool with a multidisciplinary team Develop a PDSA to address barriers identified to executing your action plan Discuss how barriers might affect implementation of enhanced practices We have talked a lot today about how to the Guide for Patient Safety can help troubleshoot barriers that may be preventing units from improving the care of patients with urinary and central venous catheters. Before we end, we want to share some next steps to improve infection prevention. Print and discuss GPS assessment with a multidisciplinary team Develop a PDSA to address barriers identified to executing your action plan Discuss how barriers might affect implementation of enhanced practices AHRQ Safety Program for ICUs: CLABSI/CAUTI

Additional Resources1-5
CAUTI Guide to Patient Safety Tool that outlines key aspects of CAUTI prevention and identifies possible opportunities for improvement on your unit Comprehensive Unit-based Safety Program (CUSP) Toolkit Tools to support how physicians, nurses and other clinical team members work together to reduce harm to patients by improving safety culture Toolkit for Reducing CAUTI in Hospitals—Information for Specialty Audiences, Preventing CAUTI in the ICU Setting Tools to support implementation of evidence-based practices to prevent CAUTI in the ICU setting Tools for Reducing Central Line-Associated Blood Stream Infections Tools to support implementation of evidence-based practices to prevent CLABSI TeamSTEPPS® 2.0 A teamwork system that offers tools and strategies to improve collaboration and communication in the health care environment Targeted Assessment for Prevention (TAP) Implementation Guides Evidence-based strategies and tools to prevent healthcare-associated infections Here are some additional resources that can help units overcome these barriers. NOTES: -AHRQ CUSP: The Comprehensive Unit-based Safety Program (CUSP) Toolkit provides a foundation of how your physicians, nurses, and other clinical team members work together to reduce harm to patients through improving safety culture. -The online version of the CAUTI Guide to Patient Safety can be found at Catheterout.org. This online version provides resources to help teams find solutions to identified barriers. -AHRQ TeamSTEPPS: Is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals. -The CDC’s Targeted Assessment for Prevention (TAP) Implementation Guides provide examples of evidence-based strategies and tools targeted to preventing HAIs. AHRQ Safety Program for ICUs: CLABSI/CAUTI

References Guide to Patient Safety Tool. CatheterOut.org, Ann Arbor, MI. Accessed on September 15, 2016. CUSP Toolkit. Content last reviewed June Agency for Healthcare Research and Quality, Rockville, MD. tools/cusptoolkit/index.html. Accessed on September 15, 2016. Information for Specialty Audiences. Content last reviewed March Agency for Healthcare Research and Quality, Rockville, MD. hospitals/toolkit-info.html. Accessed on September 15, 2016. TeamSTEPPS® 2.0. Content last reviewed April Agency for Healthcare Research and Quality, Rockville, MD. Accessed on September 15, 2016. TAP Catheter-Associated Urinary Tract Infection (CAUTI) Toolkit Implementation Guide: Links to Example Resources. Content last updated June Centers for Disease Control and Prevention, Atlanta, GA. Accessed on September 15, 2016. AHRQ Safety Program for ICUs: CLABSI/CAUTI

Using the Guide to Patient Safety to Improve CAUTI and CLABSI Prevention AMANDA Welcome to all of the ICU teams participating in the AHRQ Safety Program.

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Using the Guide to Patient Safety to Improve CAUTI and CLABSI Prevention AMANDA Welcome to all of the ICU teams participating in the AHRQ Safety Program.

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Presentation on theme: "Using the Guide to Patient Safety to Improve CAUTI and CLABSI Prevention AMANDA Welcome to all of the ICU teams participating in the AHRQ Safety Program."— Presentation transcript:

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