On the CUSP: Stop CAUTI Cohort 4

1. On the CUSP: Stop CAUTI Cohort 4 Mapping the Journey Hospital Unit Team Project Orientation Webinar April 11, 2012

2. Your Feedback is Important! https://www.surveymonkey.com/s/CAUTICallEvaluation

3. Agenda

4. Project Goals The Project Goals for CAUTI are to: reduce mean CAUTI rates in participating clinical units by 25 percent; and improve safety culture as evidenced by improved teamwork and communication by employing CUSP methodology.

5. Learning the Language CAUTI – Catheter Associated Urinary Tract Infection CUSP – Comprehensive Unit Safety Program AHRQ – Agency for Healthcare Research and Quality HSOPS – Hospital Survey on Patient Safety Culture NHSN – National Healthcare Safety Network CDC HICPAC – Center for Disease Control and Prevention Healthcare Infection Control Practices Advisory Committee

6. Learning the Language • Cohort • Learning session • Content call • Coaching call • Process measures • Outcome measures

7. Learning the Players AHA – American Hospital Association HRET – Health Research and Educational Trust MHA – Michigan Health and Hospitals Association, Keystone Patient Safety Center U of M – University of Michigan St John – St. John Hospital and Medical Center JHU – Johns Hopkins University, Armstrong Institute for Patient Safety and Quality APIC – Association for Professionals in Infection Control and Epidemiology, Inc. SHEA– Society for Healthcare Epidemiology of America SHM– Society of Hospital Medicine 

8. CAUTI National Project Team HRET MHA UM/St. Johns JHU State Hospital Associations, Partners & Coalitions Extended Faculty State Leads, QIO, HEN- Coaching/CUSP/ Recruitment/Project Liaison National & Regional CAUTI Faculty APIC, SHEA, SHM Coaching/Recruitment/ Endorsement Partnerships & Dissemination Hospitals/Units

9. Project Vitals Original Contract - Aug 2010 – 2011 Expansion Awarded - Aug 15, 2011 • Base year + 3 option years Duration 18 months Components - Technical and Adaptive All units

10. First 3 Cohorts, 19 States, 441 Hospitals

11. Registered Unit Types

12. Cohort 4 - Vitals Start date May 2012 End date October 2013 Duration 18 months

13. Deliverables Educational events: Teleconferences, webinars, in-person meetings (with video conferencing) Materials: Implementation guide with tools (guidelines, posters, forms, educational materials) Coaching: National and regional supported calls Data: On-line secure collection and reporting Site visits: Selected sites within selected states

14. Cohort 4 Timeline

15. Next Steps Recruitment of hospitals: March 6, 2012-May 3, 2012 Teams, registration, Data Use Explanation (DUEs) Learning Session #1 – May 3, 2012 On-boarding calls – Begins two weeks after Learning Session #1

16. CUSP - CAUTI Goals: Required Data GOAL #1 Improving the Culture of Safety: CUSP Required Data STEPS: 1. Educate on the science of safety 2. Senior Executive Adopts Unit 3. Identify Safety Defects 4. Learn from Defects 5. Use teamwork/ communication tools Quarterly Team Checkup Tool (TCT) HSOPS at baseline and post-intervention

17. CUSP - CAUTI Goals: Required Data GOAL #2 Reduce CAUTI’s by 25% Required Data STEPS: 1. Educate staff about impact of CAUTI’s 2. Educate staff about appropriate indications for a catheter 3. Daily Catheter Rounds 4. Proper Insertion Technique 5. Proper Maintenance Technique Process Measures (Prevalence and appropriateness) Outcome Measures (CAUTI Rates – using NHSN definition)

18. Data Collection Processes Each Cohort has a specific data collection schedule (timing differs by Cohort) Data is collected through MHA Care Counts, NHSN and online surveys Process data is defined by CDC HICPAC Guidelines Outcome data is defined by CDC NHSN Definitions

19. Data Collection Prevalence & Appropriateness (Process)- How often do we do what we should? • Assess each patient on the unit for the presence of a urinary catheter • Record the reason for the catheter CAUTI Rates (Outcome)-Did we make a difference? • Number of Symptomatic CAUTI’s attributable to your unit for that month • Number of urinary catheter days per month (number of patients with urinary catheter device is collected daily at the same time each day and the total is summed for the month) • Number of patient days per month Team Checkup Tool (Culture) Quarterly Hospital Survey on Patient Safety (Culture) Baseline and Follow-up Readiness Assessment (Once)

20. Cohort 4: Data Collection Schedule

21. Cohort 4: Data Collection Schedule

22. Cohort 4: Data Collection Schedule

23. Unit Team’s Goal Develop and or expand capacity at the hospital unit level to support improvement by: • CUSP content expertise • CAUTI prevention expertise Reduce CAUTI and Improve Safety

24. Hospital Project Unit Team Leader Tasks Review Implementation Manual Develop a unit based (frontline care provider) team Attend /participate in educational and coaching opportunities Schedule regular meetings Involve all team members in team tasks Communicate to all team members Communicate with Sr executive Assure data is collected and submitted Assure team is meeting project milestones

25. Hospital Unit Team Tasks Attend and participate in unit team meetings Provide frontline care providers perspective Implement 5 steps of CUSP program Share in responsibility of team’s work • Participate in design of processes to support prevention of CAUTI • Educate of staff, physicians, others • Communication to others on the unit • Champion effort • Data collection and submission

26. A Success Story for Engagement Chester River Hospital Center (CRHC) Intensive Care Unit Intermediate Care Unit Med/Surg TEAM MEMBERS: Libby Tannahill, RNC, BSN Donna Saunders, RN, CIC Emily Welsh, RN Linda Pippin, RN Brenda Morgan, LPN Carol Bragg, PCT Dr. Neil Stoddard, MD Mary Jo Keefe, RN, BSN, MSM, VP of Patient Care Services

27. Our Hospital • 46 bed rural community hospital on the Eastern Shore of Maryland • Most of our population are elderly • Limited resources and in the middle of massive change • The closest hospital is 40 miles away

28. Why We Joined the NationalOn the CUSP Collaborative Because it was “the right thing to do” for our patients • Less patient pain & suffering • Reduce length of stay • Decrease cost per stay It was a way to formulate a plan to reduce CAUTI’s We had success with the national CLABSI Project Joint Commission National Patient Safety Goal for 2013

29. Massive Change Became part of the University of Maryland Medical System • A new model of care for nursing • A new computer system for patient care • Loss of all but one part-time educator • Redefining role as acute care hospital • loss of service lines • Rural hospital makes it necessary to wear multiple hats

30. Engagement & Implementation Identified gap in staff knowledge • CAUTI Cultivation Survey • Unable to access Health Stream, our online learning system • Executive assistant trained to install all education material into the system Management of processes • Results of surveys, prior practice • Action Plan • Data collection

31. Engagement & Implementation Staff engagement • Use of tools • Other strategies We improved communication • Making rounds – asking Nurse’s about their foley patients • Education Blast’s via our Intra-net • Nurse Champions in each area And lo and behold, our CAUTI Rates and Utilization Ratios are coming down!

32. Lessons Learned To-date It is OK to ask for assistance from the state implementation team Take A Deep Breath – Be Methodical – set a plan with deadlines for your team It is possible to get all responsibilities accomplished Use 3 steps to drill down the process for each item on the action plan

33. Lessons Learned To-date • We can create a safer environment for our patients by using the tools and resources available • Change of Culture: Not so easy but necessary for real, long-lasting change • Change of Procedure: Easier but requires buy-in by all providers

34. Questions? For future questions, contact:

35. Your Feedback is Important! https://www.surveymonkey.com/s/CAUTICallEvaluation