CUSP and the NCABSI project
description
Transcript of CUSP and the NCABSI project
Disclosures
Nothing to disclose
No discussion of “off-label” use of medications
Objectives
Be able to list key components of CUSP
Be able to discuss methods to engage staff in CUSP / NCABSI
Be able to describe NCABSI, including goals
CUSP
Comprehensive Unit-based Safety Program
Developed at Johns Hopkins University Science of Safety - Dr. Peter Provonost
First used in Keystone Project in Michigan – reduced CLABSI state-wide
Used in the CLABSI and CAUTI projects from the American Hospital Association
Now a part of NCABSI
Key components of CUSP
Educate the team on the “Science of Safety”
Identify Defects (Staff Safety Assessment)
Engage Senior Executive Leadership
Learn from Defects
Implement Teamwork and Communication Tools
Engaging the Staff
Education of the staff as to the nature of the problem
Empower them to be the drivers of improvement with the CUSP program
Emphasize the patient at all times and relate the reason for the project back to them
Get the informal leaders on board
Frequent discussions about the program and the project
The problem
In the United States 100,000 patients die every year from Healthcare
Associated Infections (HAI) The annual cost is ~ $30 billion Of the 100,000 patient deaths, it is estimated that 30,000
– 60,000 are from Central Line Associated Blood Stream Infections (CLABSI)
However, elimination of CLABSI from the NICU is possible
How does your NICU compare to others?
Vermont Oxford Network for NICU data
Hospital Networks Based on ownership, such as HCA Based on specialty affiliations, such as CWISH (Council
of Women’s and Infant’s Specialty Hospitals) Based on physician groups, such as Pediatrix
“Every system is designed to achieve the results it gets”
Unit-Based
One of the keys of the CUSP program is that it is meant to be driven by those at the bedside What is the next source of harm (or in NCABSI –
infection) for our patients? What can be done to prevent that harm (or infection)?
It is NOT a program that is handed down from the board or administration or nursing leadership
Executive leadership is critical to ensure that staff is safe to express opinions and contribute to discussion
Safe systems
Are standardized (Science vs. Art) Checklists, such as those in aviation Humans are NOT infallible
Are designed to find out when things go wrong and to learn from those events
Rely on diverse and independent input Allow people to contribute in a “psychologically safe”
way
Emphasize the patient
The patient should be at the heart of all
The NCABSI project has a video that all teams should watch, called the “Gabby” video. In the video, a father relates the story of his daughter, Gabby, who was born at 25 weeks and weighed 614 grams. Gabby was slowly but steadily improving, but then became ill and died from a CLABSI.
Relate similar stories from your own NICU
Engaging the physicians
A physician champion is critical Respected Knowledgeable Willing to discuss the issues with other physicians
Have frequent discussions with the physician champion regarding progress and comparison to benchmarks
Other enticements with NCABSI ABP maintenance of certification credit
NCABSI
Neonatal Catheter Associated Blood Stream Infections
8 state collaborative ~ 100 NICUs ~ 7500 lines ~ 60000 line days
Supported by American Hospital Association (AHA) with funding from Agency for Healthcare Research and Quality (AHRQ)
NCABSI goals
Reduce catheter related infections in participating NICUS by 75% over the course of the year long study
Utilize CUSP to change local NICU culture so that changes made become part of the norm
Lay the groundwork for individual CQI projects by developing a group of people familiar with the methodology
Lay a foundation for future multi-state collaborative projects
Each NICU creates a team
Project leader
Physician champion
Nurse manager champion
Executive champion
Infection control representative
Data entry contact
Other team members
Review the Action Plan
Each center reviews the action plan
Determine if there are significant differences between the action plan and the current practices in your NICU Is there a reason for this difference? Is the difference clinically significant? Do we desire to change our current plan to be more
consistent with the NCABSI project action plan?
Implement those changes you desire using a series of Plan-Do-Study-Act (PDSA) cycles
Data collection
Patients with central lines are enrolled through the NCABSI website NCABSI
All data is collected through the website
Enter an insertion checklist form for each line placed
Enter a daily maintenance form
When the line is removed or a patient is discharged, enter that information on the website
Training videos are under “Data” in the “Resources” section of the website
NHSN data
National Healthcare Safety Network (NHSN) is an internet based surveillance system from the CDC
Most hospitals report NHSN data already Infection control / prevention are generally familiar with
the format and the requirements
This data will be entered through the NCABSI website as baseline for the 3-6 months prior to the project and monthly during the project
PDSA cycles
Look at your maintenance failures for potential system changes
Learning from defects (from CUSP) helps you identify how to address system failures
Make small changes – PDSA cycles should be rapid
Pilot changes on a limited basis
“A Primer on Quality Improvement Methodology in Neonatology”. Ellsbury, Ursprung. Clinics in Perinatology, 2010 Mar; 37(1): 87-99.
Pearls
Submit data on at least a weekly basis
Hold team meetings often – at least monthly to review progress and develop new rapid cycle changes to evaluate
Develop PDSA cycles with an end that is different from the project as a whole