AHRQ Safety Program For Long-Term Care: HAIs/CAUTI Module 1: Using the Comprehensive Long-Term Care...
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![Page 1: AHRQ Safety Program For Long-Term Care: HAIs/CAUTI Module 1: Using the Comprehensive Long-Term Care Safety Toolkit: Applying Safety Principles.](https://reader035.fdocuments.in/reader035/viewer/2022062409/5697bf731a28abf838c7eebb/html5/thumbnails/1.jpg)
AHRQ Safety Program For Long-Term Care: HAIs/CAUTI
Module 1: Using the Comprehensive Long-Term Care Safety Toolkit:
Applying Safety Principles
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2Using the Toolkit
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
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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
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4Using the Toolkit
Why Is Infection Prevention Important?
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5Using the Toolkit
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?
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6Using the Toolkit
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
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7Using the Toolkit
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.
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8Using the Toolkit
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
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9Using the Toolkit
• Strategies to get the senior leaders onboard with the program and provide team support from the top down
Senior Leader Engagement
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10Using the Toolkit
• Resources and tools to support independent decision making by LTC team members
Staff Empowerment
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11Using the Toolkit
• Concepts and tools to improve communication among LTC team members
• Tools for communicating with residents and family members
Teamwork and Communication
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12Using the Toolkit
• 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
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13Using the Toolkit
• 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
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14Using the Toolkit
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
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15Using the Toolkit
• Senior leader engagement and participation
• High staff turnover
• Staff empowerment
Challenges
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16Using the Toolkit
Implementing Change Successfully
• Kotter’s Eight Steps of Change²
• Just Culture principles
Step 1:Step 2:Step 3:Step 4:Step 5:Step 6:Step 7:Step 8:
Create a sense of urgencyCreate a guiding coalitionDevelop a shared visionCommunicate the visionEmpower others to actGenerate short-term winsConsolidate gains and produce more changeAnchor new approaches in culture
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17Using the Toolkit
Understanding Just Culture¹
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18
18
Understanding Risk and Human Behavior1
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
Reckless Behavior: Choosing to consciously disregard a
substantial and unjustifiable risk
Using the Toolkit
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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
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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
20Using the Toolkit
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21Using the Toolkit
Why Do We Do This Work?
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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
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23Using the Toolkit
References
1. Griffith S. Just Culture, Healthcare Services Overview. Outcome Engineering; 2012. https://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_Manual_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.