National Program to Improve Patient Safety and Eliminate CLABSI

On the CUSP: Stop BSI

National Program to Improve Patient Safety and Eliminate CLABSI

Fact Sheet

Updated March 2010

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AT A GLANCE

Who: The Health Research & Educational Trust (HRET) of the American Hospital Association (AHA) administers this program. HRET’s partners are Peter Pronovost, MD, PhD, and other faculty from the Johns Hopkins Quality & Safety Research Group, and Sam Watson and his staff at the Keystone Center for Patient Safety and Quality at the Michigan Health & Hospital Association. John Combes, MD of AHA and Peter Pronovost, MD, PhD are the project leads.

What: The Agency for Health Research and Quality (AHRQ) is funding educational and technical support to states and their hospitals for implementation of a unit-based quality improvement/patient safety program to eliminate hospital-acquired, central line-associated bloodstream infections (CLABSI). The Comprehensive Unit-based Safety Program (CUSP) is transforming care and patient safety in all hospital units—the ICU, the ED, the OR, and medical-surgical units by improving patient safety culture and practices. CUSP is being applied in adult and children’s acute care hospitals and Critical Access Hospitals.

When: HRET is now recruiting State Hospital Associations (SHAs) to participate in this national program. SHAs should try to recruit at least 10 hospitals (adult and children’s acute care hospitals) in their states, and all eligible hospitals in the state are encouraged to participate. States and their participating hospitals will take part in two or more different cohorts beginning in January 2010.

Where: AHRQ is funding this program so that all 50 states, including the District of Columbia and Puerto Rico, may participate.

OVERVIEW

The Agency for Healthcare Research & Quality (AHRQ) is supporting a patient safety in-service training initiative to improve teamwork and patient safety culture in hospital units and to reduce central line-associated bloodstream infections (CLABSI) throughout the nation. In providing support to HRET and its partners—the Johns Hopkins University Quality & Safety Research Group (JHU) and the Keystone Center for Patient Safety and Quality of the Michigan Health & Hospital Association (MHA)—AHRQ seeks to replicate the success of Michigan ICUs in dramatically reducing CLABSI and improving patient safety culture throughout the nation. Through the use of the CUSP model developed by Peter Pronovost and others at JHU, and through the use of CLASBI-reduction protocols, Michigan hospitals have saved lives and significantly reduced costs.

Participation is open to all acute care and Critical Access Hospitals in all states. States currently participating in the program are encouraged to recruit additional hospitals to participate and to include ICU and non-ICU units. States that are currently participating or have committed to participate are: AR, CA, CO, CT, DE, FL, GA, HI, KY, IL, IN, MA, MN, MO, NC, NE, NH, NJ, NM, NY, OH, OK, OR, PA, SC, TN, TX, VA, WA, WV, and WI.

PROJECT GOALS

·  To replicate the success of the Michigan Keystone/John Hopkins project to reduce the mean CLABSI rate in 10 states to less than 1 per 1,000 catheter days by implementing CUSP in acute care hospital ICUs, non-ICU units, and pediatric units

·  To improve safety culture in participating hospitals

·  To disseminate CUSP educational modules to improve patient safety

·  To partner with the CDC to support the measurement and timely feedback of CLABSI and other health care-acquired infection (HAI) data, and for SHAs to partner with state-based organizations to address the elimination of HAIs in a coordinated fashion

NATIONAL PROJECT TEAM CONTRIBUTIONS

·  Technical program and content support

·  Tools for measuring and monitoring CLASBI and safety culture in ICUs and other units

·  Faculty for all conference calls and face-to-face meetings

·  Assigned advisors from Johns Hopkins and Michigan Keystone

·  All conference call expenses

·  Dedicated Web site and continually updated resources (manuals and tools)

BENEFITS TO PARTICIPATING HOSPITALS

We believe that all hospitals will benefit from participating in the evidence-based CUSP and CLABSI reduction program. Each participating hospital ICU and non-ICU unit will learn how to apply the CUSP program and CLABSI-reduction tools. Participation will include access to expert faculty and data collection and monitoring support throughout the state’s two-year participation. This program is a quality improvement, in-service education program not subject to IRB requirements.

Specifically, each participating hospital ICU and non-ICU unit will receive:

·  Detailed manuals on CUSP and CLABSI prevention

·  Dedicated and continually updated Web site, www.onthecuspstophai.org

·  CUSP and CLABSI reduction tools and training, including tools for multidisciplinary rounding, and use of daily goal sheets

·  Ongoing support through two calls each month: one call devoted to educational content and one focused on Q&A and team coaching

·  A total of 3 face-to-face educational conferences

·  Tools for measuring and monitoring CLABSI and safety culture in units

·  Expert faculty for conference calls and educational conferences

Even hospitals that have achieved their goals in CLABSI reduction will benefit from learning and applying CUSP. Successful teams have experienced marked improvement in effective teamwork and patient safety culture. An additional benefit has been substantial reduction in average length of stay and improvements in patient management.

Overview of the Five Elements of CUSP

·  Educate staff on the science of safety

·  Identify defects in care

·  Engage executives

·  Learn from one defect per month and implement one culture improvement tool

·  Implement teamwork tools

In addition to these five elements, a core component of the CUSP program is measurement of safety culture at the beginning and near the end of the project using AHRQ’s Hospital Survey on Patient Safety Culture (HSOPS).

Overview of the Five Interventions for CLABSI Elimination

·  Educate staff on evidence-based practices to reduce CLABSI

·  Implement a checklist to ensure compliance with these practices

·  Empower nurses to ensure that doctors comply with the checklist

·  Provide feedback on infection rates to hospitals and at the unit level

·  Implement monthly team meetings to assess progress

HOSPITAL UNIT-LEVEL COMMITMENT

As part of the program, participating hospitals and their participating units will commit to the following:

·  Providing a commitment letter from the hospital CEO to the state hospital association

·  Identifying a project team leader, typically a nurse manager

·  Forming a project team that includes, at a minimum:

o  Physician champion (5-10% effort)

o  Nurse manager/champion if not the project leader (10-20% effort)

o  Data collector

o  Hospital executive champion

·  Submitting baseline and monthly CLABSI data

·  Submitting monthly one-page Team Check-up Tool that is filled out by one person based on monthly team discussions regarding barriers to teamwork and communication

·  Completing the Hospital Survey on Patient Safety Culture (HSOPS), the AHRQ culture survey at program onset and approximately 18 months later

·  Participating in four weeks of immersion calls at the start of the program (once a week on overall program content), then participating in two conference calls a month (the first call is on content; the second focuses on coaching and peer learning)

·  Participating in 2-3 state face-to-face meetings

·  Implementing the improvement tools that are part of the project

·  Holding monthly patient safety meetings in the unit to review data results and apply CUSP improvement tools, e.g., Learning From Defects and assessing teamwork and communication through the Monthly Team Check-up Tool

STATE HOSPITAL ASSOCIATION COMMITMENT

The State Hospital Associations are key players in this national initiative to eliminate HAIs in this country. The national program team works very closely with each State Hospital Association on all aspects of the program. The State Hospital Association will also establish a state-wide consortium comprised of the state’s QIO, state health department, and other relevant patient safety and infection prevention organizations and stakeholders to help promote a coordinated approach to HAI prevention and to help reduce the data collection burden on hospitals. Each state will participate in the program for 2 years.

There will be no charge to states or hospitals for the technical components of the program including consultation and coaching by an expert faculty. As part of the program, participating hospital associations will commit to the following:

·  Promote and help support 2-3 state-wide meetings with representatives from each of the participating hospital unit teams, except for faculty costs, which will be supported by AHRQ (partial meeting support is provided by AHRQ)

·  Participate in monthly conference calls with participating hospital teams and faculty (John Hopkins and Keystone Center staff)

·  Identify a project manager (25% FTE) for this project

·  Coordinate all communications with participating hospitals within the state

·  Commit to collecting CLABSI and safety culture data, and submitting this data to a protected and confidential national database

·  Monitor monthly reports generated by MHA Keystone about the data completeness of each participating hospital unit in order to follow up if needed with individual hospital teams to encourage timely data submission

FOR MORE INFORMATION

Interested State Hospital Associations should contact Deborah Bohr, Senior Director, HRET, at or 646-678-4280, or Jenna Rabideaux, Research Specialist, or 312-422-2640.

Rev. March 23, 2010

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