Who We Are ~ Where We Are Going

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Who We Are Where We Are Going
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Learning Objectives

• To understand the goals of On the CUSP STOP BSI
• To understand how the project is organized
• To understand the national climate for this work

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Please answer each question with a score of 1 to
5, where 1 is below average, 3 is average, and 5
is above average

• How smart am I?
• How hard do I work?
• How kind am I?
• How tall am I?
• How good is the quality of care we provide?

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We are part of something largerthan any one of
us.
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Project Organization

• State wide effort coordinated by Hospital
  Association
• Use collaborative model (face to face meetings,
  monthly calls)
• Standardized data collection tools and evidence
• Local ICU modification of how to implement
  interventions

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Goals Technical and Adaptive

• To work to eliminate central line associated
  blood stream infections (CLABSI) state mean lt
  1/10000 catheter days, median 0
• To improve safety culture by 50
• To learn from one defect per month

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Ensure Patients ReliablyReceive Evidence
  Senior Team Staff
  leaders leaders Staff
Engage adaptive How does this make the world a better place? How does this make the world a better place? How does this make the world a better place?
Educate technical What do we need to know? What do we need to know? What do we need to know?
Execute adaptive What do we need to do? What keeps me from doing it? What do we need to do? What keeps me from doing it? What do we need to do? What keeps me from doing it?
Execute adaptive How can we do it with my resources and culture? How can we do it with my resources and culture? How can we do it with my resources and culture?
Evaluate technical How do we know we improved safety? How do we know we improved safety? How do we know we improved safety?
Pronovost Health Services Research 2006
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Comprehensive Unit-based Safety Program (CUSP)
An Intervention to Learn from Mistakes and
Improve Safety Culture

• Educate staff on science of safety
  http//www.onthecuspstophai.org
• Identify defects
• Assign executive to adopt unit
• Learn from one defect per quarter
• Implement teamwork tools

Pronovost J, Patient Safety, 2005

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CRBSI Rate Summary Data
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Michigan ICU Safety ClimateSurvey Item Agreement
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CRBSI Rate Over Time
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"Needs Improvement Statewide Michigan CUSP ICU
Results

• Less than 60 of respondents reporting good
  safety climate needs improvement
• Statewide in 2004 84 needed improvement, in 2006
  41
• Non-teaching and Faith-based ICUs improved the
  most
• Safety Climate item that drives improvement I
  am encouraged by my colleagues to report any
  patient safety concerns I may have

 
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Teamwork Climate Across Michigan ICUs
The strongest predictor of clinical excellence
caregivers feel comfortable speaking up if they
perceive a problem with patient care
of respondents within an ICU reporting good
teamwork climate
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RN Turnover and Teamwork Climate 26 Keystone
ICUs reporting
r-.650, plt.001
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We are colleagues in this work

• OHANA

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Focus and Execute
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