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

2. 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

3. 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.

4. 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

5. 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

6. 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:

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

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

10. 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%

11. Culture of Safety- Michigan
Teamwork Climate Across Michigan ICUs

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

13. RN Turnover and Teamwork Climate: 26 Keystone ICUs reporting1
# 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.

14. 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

15. 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

16. 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