Welcome to the NQF Safe Practices for Better Healthcare Webinar: Preventing CLABS Infections: Safe Patients, Smart Hosp

1. Welcome to the • NQF Safe Practices for Better Healthcare Webinar: • Preventing CLABS Infections: Safe Patients, Smart Hospitals • (Safe Practice 21) • Hosted by TMIT To join the online webinar, go to: www.safetyleaders.org Online Access Password: Webinar1 (case-sensitive)

2. Welcome Charles Denham, MD Chairman, TMIT Co-chairman, NQF Safe Practices Consensus Committee Chairman, Leapfrog Safe Practices Program Safe Practices Webinar March 18, 2010

5. With regard to webinar sound volume, please check the WebEx volume (see example above in red box), computer volume, and external speaker (if any) volume. If you are still having difficulty hearing webinar, please click on “Request Phone” button to receive a toll dial-in number (see example on right-hand side in red box).

6. Panelists Kathy Warye Peter Pronovost Charles Denham Charles Denham: Welcome and Safe Practices Overview Kathy Warye: APIC Resources for Targeting Zero HAIs Peter Pronovost: Safe Patients, Smart Hospitals

7. Panelists Melinda Sawyer Patti O’Regan Deborah Hobson Deborah Hobson & Melinda Sawyer: Clinical Pearls for Nursing to Eliminate CLABSIs Patti O’Regan: The Role of the Patient Advocate

8. Disclosure Statement • Charles Denham: Chairman, TMIT; education grant (CareFusion) and co-production with Discovery Channel Peter Pronovost: Grants, AHRQ, NPSA (Reducing CLABSI), honoraria from hospitals and healthcare systems (speaking on quality and safety), co-authored book Safe Patients, Smart Hospitals Kathy Warye: Employed by Association for Professionals in Infection Control and Epidemiology (APIC) Deborah Hobson, Melinda Sawyer, and Patti O’Regan have no relevant financial interests in this presentation

9. The Role of the Patient Advocate Patti O’Regan, ARNP, ANP, NP-C, PMHNP-BC Nurse practitioner, Port Richey, FL Founding member, TMIT Patient Advocate Panel Safe Practices Webinar • March 18, 2010

10. Safe Practice Overview Charles Denham, MD Chairman, TMIT Co-chairman, NQF Safe Practices Consensus Committee Chairman, Leapfrog Safe Practices Program Safe Practices Webinar March 18, 2010

11. Harmonization – The Quality Choir

12. The Patient – Our Conductor

13. 2010 NQF Safe Practices for Better Healthcare: A Consensus Report 34 Safe Practices • Criteria for Inclusion • Specificity • Benefit • Evidence of Effectiveness • Generalization • Readiness

14. History of NQF Safe Practices for Better Healthcare 2009 Final Report: • From 30 to 34 practices • Culture Practice Elements Broken Up into 4 Practices • 2 Practices Discontinued • 4 Medication Management Practices Combined into 1 • 2 Communication Practices Combined into 1 • 8 New Practices Added • CMS Care Settings Defined • Patient and Family Involvement Section Added 2010 Final Report: • Format Structure Preserved • Problem Statement and Implementation Guide Thoroughly Updated • Minor Specification Changes • Updated References • Corrections and Clarifications • Care Setting Clarification Using CMS Classification • Measures Section Updated Thoroughly with NQF-Endorsed and Other Practical Measures for Consideration • Soft Copy Document Hyperlinks • Crosswalk Tables • Glossary

15. 2003, 2006, and 2009 Update Versions

16. Culture Consent & Disclosure Consent and Disclosure Workforce Information Management and Continuity of Care Medication Management Healthcare-Associated Infections Condition- & Site-Specific Practices 2010 NQF Report

17. Culture CHAPTER 2: Creating and Sustaining a Culture of Patient Safety (Separated into Practices] • Leadership Structures and Systems • Culture Measurement, Feedback, and Interventions • Teamwork Training and Team Interventions • Identification and Mitigation of Risks and Hazards Structures and Systems Culture Meas., FB., and Interv. Team Training and Team Interv. ID and Mitigation Risk and Hazards Consent & Disclosure Consent and Disclosure CHAPTER 3: Informed Consent and Disclosure • Informed Consent • Life-Sustaining Treatment • Disclosure • Care of the Caregiver Informed Consent Life-Sustaining Treatment Disclosure Care of Caregiver Workforce CHAPTER 4: Workforce • Nursing Workforce • Direct Caregivers • ICU Care 2010 NQF Report Nursing Workforce Direct Caregivers ICU Care CHAPTER 5: Information Management and Continuity of Care • Patient Care Information • Order Read-Back and Abbreviations • Labeling Studies • Discharge Systems • Safe Adoption of Integrated Clinical Systems including CPOE Information Management and Continuity of Care Patient Care Info. Read-Back & Abbrev. Labeling Studies Discharge System CPOE Medication Management CHAPTER 6: Medication Management • Medication Reconciliation • Pharmacist Leadership Role Including: High-Alert Med. and Unit-Dose Standardized Medication Labeling and Packaging Med. Recon. Pharmacist Systems Leadership: High-Alert, Std. Labeling/Pkg., and Unit-Dose CHAPTER 7: Hospital-Associated Infections • Hand Hygiene • Influenza Prevention • Central Venous Catheter-Related Blood Stream Infection Prevention • Surgical-Site Infection Prevention • Care of the Ventilated Patient and VAP • MDRO Prevention • UTI Prevention Healthcare-Associated Infections Hand Hygiene Influenza Prevention Central V. Cath. BSI Prevention Sx-Site Inf. Prevention VAP Prevention MDRO Prevention UTI Prevention CHAPTER 8: • Wrong-Site, Wrong-Procedure, Wrong-Person Surgery Prevention • Pressure Ulcer Prevention • DVT/VTE Prevention • Anticoagulation Therapy • Contrast Media-Induced Renal Failure Prevention • Organ Donation • Glycemic Control • Falls Prevention • Pediatric Imaging Condition-, Site-, and Risk-Specific Practices Wrong-site Sx Prevention Press. Ulcer Prevention DVT/VTE Prevention Anticoag. Therapy Contrast Media Use Organ Donation Glycemic Control Falls Prevention Pediatric Imaging

18. Values Systems Structures Behaviors Outcomes LEADERSHIP STRUCTURES and SYSTEMS Patients and Community Leadership Structures and Systems Culture Measurement, Feedback, and Intervention Teamwork Training and Skill Building Identification and Mitigation of Risks and Hazards NQF 34 Safe Practices

19. HAI Guidelines

20. APIC Resources for Targeting Zero HAIs Kathy L. Warye Chief Executive Officer, Association for Professionals in Infection Control and Epidemiology (APIC) Safe Practices Webinar March 18, 2010

22. The Association for Professionals in Infection Control & Epidemiology • MissionTo improve health and patient safety by reducing the risks of infection and related adverse outcomes • Global leader in infection prevention Over 13,000 members worldwide, responsible for infection prevention and hospital epidemiology in a variety of healthcare settings • Cores services Education, practice guidance, research, communications and public policy

23. Developing and Validating Clinical Best-Practices • APIC works with 28 healthcare organizations to facilitate consensus on practice recommendations. • Ensures that the development of standards and guidelines are evidence-based.

24. Setting the theoretical goal of elimination of HAIs An expectation that IPC measures will be applied consistently A safe environment for healthcare workers, empowered to hold each other accountable Systems and administrative support that provide the necessary foundation Transparency and continuous learning Prompt investigation of HAIs Real-time data to front line staff to drive improvement Zero tolerance for unsafe behaviors and practices that put patients and healthcare workers at risk Targeting Zero… APIC 2008Targeting Zero Position Statement: www.apic.org

25. Targeting Zero:CRBSI/CLAB Resources Online Course: Elimination of Catheter-Related Bloodstream Infections • Part of APIC ANYWHERE™ Online Course Offerings, delivered via Healthstream • Helps healthcare workers recognize the role they play in the transmission and prevention of CR-BSIs • Participants are provided with resources and checklists to assist in developing prevention strategies Eliminating Catheter-Related Complications Toolkit • CNE-certified, features video demonstration of proper catheter insertion, check-lists for insertion and maintenance, additional learning modules and discussion of the cultural attributes of reaching zero CR-BSIs. Guide to the Elimination of Catheter-Related Bloodstream Infections • Provides step-by-step guidance to facilitate the bedside implementation of relevant clinical evidence and best practices for eliminating CR-BSIs Webinars • Strategies to Prevent Catheter-Related Bloodstream Infections • Access Site and Hub Disinfection: The Missing Link in the CR-BSI Prevention Bundle Visit www.apic.org/guidelines to access the CDC Guidelines for CR-BSIs, and more.

27. Safe Patients, Smart Hospitals Peter J. Pronovost, MD, PhD, FCCM Professor, Johns Hopkins University School of Medicine(Departments of Anesthesiology and Critical Care Medicine, and Surgery), Bloomberg School of Public Health (Department of Health Policy and Management), and School of Nursing Medical Director, Center for Innovation in Quality Patient Care Safe Practices Webinar March 18, 2010

28. A National Program to Eliminate CLABSI Peter Pronovost, MD, PhD “Safe Patients, Smart Hospitals”

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33. Regulatory x Scientifically Sound Feasible Local Wisdom/Market

34. IMPROVE Measure CUSP Comprehensive Unit-based Safety Program (TRiP) Translating Evidence Into Practice Have We Created a Safe Culture? How Do We know We Learn from Mistakes? How Often Do we Harm? Are Patient Outcomes Improving? Educate staff on science of safety Identify defects Assign executive to adopt unit Learn from one defect per quarter Implement teamwork tools • Summarize the evidence in a checklist • Identify local barriers to implementation • Measure performance • Ensure all patients get the evidence www.safercare.net

35. Pronovost BMJ 2008

36. Checklist to Prevent CLABSI • Remove Unnecessary Lines • Wash Hands Prior to Procedure • Use Maximal Barrier Precautions • Clean Skin with Chlorhexidine • Avoid Femoral Lines MMWR 2002;51:RR-10

37. Identify Barriers • Ask staff about knowledge • Use team check up tool • Ask staff what is difficult about doing these behaviors • Walk the process of staff placing a central line • Observe staff placing central line

38. Ensure Patients ReliablyReceive Evidence Pronovost: Health Services Research 2006

39. Ideas for ensuring patients receivethe interventions: the 4Es • Engage: stories, show baseline data • Educate staff on evidence • Execute • Create line cart that contains all needed supplies • Empower nurses to stop takeoff • Learn from mistakes: review all infections as defects • Evaluate • Feedback performance • View infections as defects

40. Partnership • To help with 4Es, Partner with • ICU physician and nurses • Infection control staff • Hospital quality and safety leaders • Nurse educators • Physician leaders ICU staff must assume responsibility for reducing CLABSI

41. Comprehensive Unit-based Safety Program (CUSP) An Intervention to Learn from Mistakes and Improve Safety Culture • Educate staff on science of safety http://www.safercare.net • Identify defects • Assign executive to adopt unit • Learn from one defect per quarter • Implement teamwork tools Pronovost, JPatient Saf, 2005

42. Science of Safety • Understand system determines performance • Use strategies to improve system performance • Standardize • Create Independent checks for key process • Learn from Mistakes • Apply strategies to both technical work and team work • Recognize that teams make wise decisions with diverse and independent input

43. Learning from Mistakes • What happened? • Why did it happen (system lenses)? • What could you do to reduce risk? • How do you know risk was reduced? • Create policy / process / procedure • Ensure staff know policy • Evaluate if policy is used correctly Pronovost, JCJQI 2005

44. Teamwork Tools • Call list • Daily Goals • AM briefing • Shadowing • Culture check up • TEAMSTepps Pronovost, JCC, JCJQI

45. CRBSI Rate Summary Data

46. CRBSI Rate Over Time 46

47. VAP Rate Over Time 47

48. Michigan ICU Safety ClimateImprovement * “Needs Improvement” - Safety Climate Score <60%

49. How do we move to level 4? 5?

50. Action Plan • Join your states effort to eliminate CLABSI – contact your state hospital association or email stopbsi@jhmi.edu to find contact person • Meet with ICU team, infection control staff, quality and safety leaders, nurse educators and physician champions • Understand barriers (walk the process) • Use 4E grid to develop strategy to engage, educate, execute and evaluate