1. AHRQ Safety Program For Long-Term Care: HAIs/CAUTI Module 1: Using the Comprehensive Long-Term Care Safety Toolkit: Applying Safety Principles

2. 2 Objectives Describe the purpose of the Long-Term Care Safety Toolkit Explain how the Long-Term Care Safety Toolkit supports other quality and safety tools Demonstrate how to apply the Long-Term Care Safety Toolkit in your facility Using the Toolkit

3. 3 What Is the Purpose of This Toolkit? Improve safety culture in LTC facilities Support other quality improvement and safety initiatives in facilities Supplement technical interventions to reduce healthcare-associated infections, including catheter-associated urinary tract infections (CAUTIs) Using the Toolkit

4. 4 Why Is Infection Prevention Important? Using the Toolkit

5. 5 Is Your Facility Safe?³ Would you want a loved one to be a resident at your facility? Would you want to be a resident in your facility? Can you say with 100 percent certainty that your facility does everything it can to protect its residents? How do you think the next resident could be harmed in your facility? Using the Toolkit

6. 6 T.E.A.M.S. Bundle Team formation to plan and implement the program Excellent communication skills learned Assess what’s working and plan to expand Meet monthly to learn together Sustain efforts and celebrate success Using the Toolkit

7. 7 Toolkit Modules Using the Comprehensive Long-Term Care Safety Toolkit Senior Leader Engagement Staff Empowerment Teamwork and Communication Resident and Family Engagement Sustainability Note: After a facility’s first implementation of the Long- Term Care Safety Toolkit, modules can be used in any order, depending on the needs of the facility. Using the Toolkit

8. 8 Toolkit Users Senior leaders and administrators – Help teams and staff prioritize improvement efforts – Provide resources for interventions to succeed – Maintain an ongoing infrastructure for improvement activities – Provide opportunities for staff to learn and practice using teamwork and communication tools Frontline staff – Engage with leaders, residents, and families in safety improvement Using the Toolkit

9. 9 Strategies to get the senior leaders onboard with the program and provide team support from the top down Senior Leader Engagement Using the Toolkit

10. 10 Resources and tools to support independent decision making by LTC team members Staff Empowerment Using the Toolkit

11. 11 Using the Toolkit Concepts and tools to improve communication among LTC team members Tools for communicating with residents and family members Teamwork and Communication

12. 12 Methods and tools for working with residents and families to involve them in their care to increase safety, improve satisfaction, and optimize resident outcomes Resident and Family Engagement Using the Toolkit

13. 13 Tools and resources to help ensure that positive changes and outcomes are truly embedded into the culture of LTC facilities after the close of the program Sustainability Using the Toolkit

14. 14 Implementation Share videos with teams to spark engagement in staff safety assessments Provide templates and discussion guides to project leads Educate teams on T.E.A.M.S. and Just Culture Use videos and training modules to orient new staff Train teams in using teamwork and communication tools Engage senior leaders and project champions Using the Toolkit

15. 15 Senior leader engagement and participation High staff turnover Staff empowerment Challenges Using the Toolkit

16. 16 Implementing Change Successfully Kotter’s Eight Steps of Change² Just Culture principles Using the Toolkit Step 1: Step 2: Step 3: Step 4: Step 5: Step 6: Step 7: Step 8: Create a sense of urgency Create a guiding coalition Develop a shared vision Communicate the vision Empower others to act Generate short-term wins Consolidate gains and produce more change Anchor new approaches in culture

17. 17 Understanding Just Culture¹ Using the Toolkit

18. 18 Understanding Risk and Human Behavior 1 Human Error: Inadvertently completing the wrong action; slip, lapse, mistake Human Error: Inadvertently completing the wrong action; slip, lapse, mistake At-Risk Behavior: Choosing to behave in a way that increases risk where risk is not recognized, or is mistakenly believed to be justified At-Risk Behavior: Choosing to behave in a way that increases risk where risk is not recognized, or is mistakenly believed to be justified Reckless Behavior: Choosing to consciously disregard a substantial and unjustifiable risk Reckless Behavior: Choosing to consciously disregard a substantial and unjustifiable risk Using the Toolkit

19. 19 Managing Error and Risk¹ Human Error Product of our current system design and behavioral choices Manage through changes in: Choices Processes Procedures Training Design Environment Console At-Risk Behavior A choice: risk believed insignificant or justified Manage through: Removal of incentives for at-risk behaviors Creation of incentives for healthy behaviors Situational awareness Coach Reckless Behavior Conscious disregard of substantial and unjustifiable risk Manage through: Remedial action Punitive action Punish Using the Toolkit

20. 20 Leadership’s Role in Just Culture Have a procedure in place for employees to follow Ensure employees are properly trained Offer positive reinforcement at monthly meetings 20 Using the Toolkit

21. 21 Why Do We Do This Work? Using the Toolkit

22. Long-Term Care Safety Tools and Resources Quality and Safety Tools TeamSTEPPS® Six Sigma Institute for Healthcare Improvement Model for Improvement Plan-Do-Study-Act Root Cause Analysis Failure Mode Effect Analysis LTC-Specific Resources Advancing Excellence in America’s Nursing Homes CDC Website for Nursing Homes and Assisted Living CMS QAPI - Quality Assurance Performance Improvement CMS National Nursing Home Quality Care Collaborative (NNHQCC) Change Package Pioneer Network 22 Using the Toolkit

23. 23 References 1.Griffith S. Just Culture, Healthcare Services Overview. Outcome Engineering; 2012. https://store.justculture.org/wp- content/uploads/flipbooks/healthcare/healthcare.htmlhttps://store.justculture.org/wp- content/uploads/flipbooks/healthcare/healthcare.html 2.Kotter J, Rathgeber H. Our iceberg is melting: Changing and succeeding under any conditions: 1st ed. New York: St. Martin's Press; 2006. 3.Bowers N, Nolet K, Roberts E, et al. Implementing Change in Long- Term Care: A Practical Guide to Transformation. University of Wisconsin–Madison, School of Nursing; 2007. https://www.nhqualitycampaign.org/files/Implementation_Manu al_Part_1_Attachments_1_and_2.pdf. https://www.nhqualitycampaign.org/files/Implementation_Manu al_Part_1_Attachments_1_and_2.pdf 4.Patient and Family Engagement module, CUSP Toolkit. Rockville, MD: Agency for Healthcare Research and Quality; December 2012.http://www.ahrq.gov/professionals/education/curriculum- tools/cusptoolkit/modules/patfamilyengagement/index.html.http://www.ahrq.gov/professionals/education/curriculum- tools/cusptoolkit/modules/patfamilyengagement/index.html Using the Toolkit