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Welcome to the NQF Safe Practices for Better Healthcare Webinar: Preventing CLABS Infections: Safe Patients, Smart Hospitals (Safe Practice 21) Hosted by TMIT. To join the online webinar, go to: www.safetyleaders.org Online Access Password: Webinar1 (case-sensitive). Welcome.

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Welcome to the

  • NQF Safe Practices for Better Healthcare Webinar:

  • Preventing CLABS Infections: Safe Patients, Smart Hospitals

  • (Safe Practice 21)

  • Hosted by TMIT

To join the online webinar, go to:

www.safetyleaders.org

Online Access Password: Webinar1 (case-sensitive)


Welcome

Charles Denham, MD

Chairman, TMIT

Co-chairman, NQF Safe Practices Consensus Committee

Chairman, Leapfrog Safe Practices Program

Safe Practices Webinar

March 18, 2010


With regard to webinar sound volume, please check the WebEx volume (see example above in red box), computer volume, and external speaker (if any) volume.

If you are still having difficulty hearing webinar, please click on “Request Phone” button to receive a toll dial-in number (see example on right-hand side in red box).


Panelists volume (see example above in red box), computer volume, and external speaker (if any) volume.

Kathy Warye

Peter Pronovost

Charles Denham

Charles Denham: Welcome and Safe Practices Overview

Kathy Warye: APIC Resources for Targeting Zero HAIs

Peter Pronovost: Safe Patients, Smart Hospitals


Panelists volume (see example above in red box), computer volume, and external speaker (if any) volume.

Melinda Sawyer

Patti O’Regan

Deborah Hobson

Deborah Hobson

& Melinda Sawyer: Clinical Pearls for Nursing to Eliminate CLABSIs

Patti O’Regan: The Role of the Patient Advocate


Disclosure Statement volume (see example above in red box), computer volume, and external speaker (if any) volume.

  • Charles Denham: Chairman, TMIT; education grant (CareFusion) and co-production with Discovery Channel

    Peter Pronovost: Grants, AHRQ, NPSA (Reducing CLABSI), honoraria from hospitals and healthcare systems (speaking on quality and safety), co-authored book Safe Patients, Smart Hospitals

    Kathy Warye: Employed by Association for Professionals in Infection Control and Epidemiology (APIC)

    Deborah Hobson, Melinda Sawyer, and Patti O’Regan have no relevant financial interests in this

    presentation


The Role of the Patient Advocate volume (see example above in red box), computer volume, and external speaker (if any) volume.

Patti O’Regan, ARNP, ANP, NP-C, PMHNP-BC

Nurse practitioner, Port Richey, FL

Founding member, TMIT Patient Advocate Panel

Safe Practices Webinar

  • March 18, 2010


Safe Practice Overview volume (see example above in red box), computer volume, and external speaker (if any) volume.

Charles Denham, MD

Chairman, TMIT

Co-chairman, NQF Safe Practices Consensus Committee

Chairman, Leapfrog Safe Practices Program

Safe Practices Webinar

March 18, 2010


Harmonization the quality choir

Harmonization – The Quality Choir volume (see example above in red box), computer volume, and external speaker (if any) volume.


The patient our conductor

The Patient – Our Conductor volume (see example above in red box), computer volume, and external speaker (if any) volume.


2010 NQF Safe Practices for Better Healthcare: A Consensus Report

34 Safe Practices

  • Criteria for Inclusion

  • Specificity

  • Benefit

  • Evidence of Effectiveness

  • Generalization

  • Readiness


History of NQF Safe Practices for Better Healthcare Report

2009 Final Report:

  • From 30 to 34 practices

  • Culture Practice Elements Broken Up into 4 Practices

  • 2 Practices Discontinued

  • 4 Medication Management Practices Combined into 1

  • 2 Communication Practices Combined into 1

  • 8 New Practices Added

  • CMS Care Settings Defined

  • Patient and Family Involvement Section Added

2010 Final Report:

  • Format Structure Preserved

  • Problem Statement and Implementation Guide Thoroughly Updated

  • Minor Specification Changes

  • Updated References

  • Corrections and Clarifications

  • Care Setting Clarification Using CMS Classification

  • Measures Section Updated Thoroughly with NQF-Endorsed and Other Practical Measures for Consideration

  • Soft Copy Document Hyperlinks

  • Crosswalk Tables

  • Glossary



Culture Report

Consent & Disclosure

Consent and Disclosure

Workforce

Information Management and Continuity of Care

Medication Management

Healthcare-Associated

Infections

Condition- &

Site-Specific Practices

2010 NQF Report


Culture Report

CHAPTER 2: Creating and Sustaining a Culture of Patient Safety (Separated into Practices]

  • Leadership Structures and Systems

  • Culture Measurement, Feedback, and Interventions

  • Teamwork Training and Team Interventions

  • Identification and Mitigation of Risks and Hazards

Structures

and Systems

Culture Meas.,

FB., and Interv.

Team Training

and Team Interv.

ID and Mitigation

Risk and Hazards

Consent & Disclosure

Consent and Disclosure

CHAPTER 3: Informed Consent and Disclosure

  • Informed Consent

  • Life-Sustaining Treatment

  • Disclosure

  • Care of the Caregiver

Informed

Consent

Life-Sustaining

Treatment

Disclosure

Care of

Caregiver

Workforce

CHAPTER 4: Workforce

  • Nursing Workforce

  • Direct Caregivers

  • ICU Care

2010

NQF Report

Nursing

Workforce

Direct

Caregivers

ICU Care

CHAPTER 5: Information Management and Continuity of Care

  • Patient Care Information

  • Order Read-Back and Abbreviations

  • Labeling Studies

  • Discharge Systems

  • Safe Adoption of Integrated Clinical Systems including CPOE

Information Management and Continuity of Care

Patient

Care Info.

Read-Back

& Abbrev.

Labeling

Studies

Discharge

System

CPOE

Medication Management

CHAPTER 6: Medication Management

  • Medication Reconciliation

  • Pharmacist Leadership Role Including: High-Alert Med. and Unit-Dose Standardized Medication Labeling and Packaging

Med. Recon.

Pharmacist Systems Leadership:

High-Alert, Std. Labeling/Pkg., and Unit-Dose

CHAPTER 7: Hospital-Associated Infections

  • Hand Hygiene

  • Influenza Prevention

  • Central Venous Catheter-Related Blood Stream Infection Prevention

  • Surgical-Site Infection Prevention

  • Care of the Ventilated Patient and VAP

  • MDRO Prevention

  • UTI Prevention

Healthcare-Associated Infections

Hand Hygiene

Influenza

Prevention

Central V. Cath.

BSI Prevention

Sx-Site Inf.

Prevention

VAP

Prevention

MDRO

Prevention

UTI

Prevention

CHAPTER 8:

  • Wrong-Site, Wrong-Procedure, Wrong-Person Surgery Prevention

  • Pressure Ulcer Prevention

  • DVT/VTE Prevention

  • Anticoagulation Therapy

  • Contrast Media-Induced Renal Failure Prevention

  • Organ Donation

  • Glycemic Control

  • Falls Prevention

  • Pediatric Imaging

Condition-, Site-, and Risk-Specific Practices

Wrong-site

Sx Prevention

Press. Ulcer

Prevention

DVT/VTE

Prevention

Anticoag.

Therapy

Contrast

Media Use

Organ

Donation

Glycemic

Control

Falls

Prevention

Pediatric

Imaging


Values Report

Systems

Structures

Behaviors

Outcomes

LEADERSHIP STRUCTURES and SYSTEMS

Patients and Community

Leadership Structures

and Systems

Culture Measurement, Feedback, and Intervention

Teamwork Training and

Skill Building

Identification and Mitigation of Risks and Hazards

NQF 34 Safe Practices



APIC Resources for Targeting Zero HAIs Report

Kathy L. Warye

Chief Executive Officer, Association for Professionals

in Infection Control and Epidemiology (APIC)

Safe Practices Webinar

March 18, 2010


The association for professionals in infection control epidemiology
The Association for Professionals in Infection Control & Epidemiology

  • MissionTo improve health and patient safety by reducing the risks of infection and related adverse outcomes

  • Global leader in infection prevention

    Over 13,000 members worldwide, responsible for infection prevention and hospital epidemiology in a variety of healthcare settings

  • Cores services

    Education, practice guidance, research, communications and public policy


Developing and Validating Clinical Best-Practices Epidemiology

  • APIC works with 28 healthcare organizations to facilitate consensus on practice recommendations.

  • Ensures that the development of standards and guidelines are evidence-based.


Setting the theoretical goal of elimination of HAIs Epidemiology

An expectation that IPC measures will be applied consistently

A safe environment for healthcare workers, empowered to hold each other accountable

Systems and administrative support that provide the necessary foundation

Transparency and continuous learning

Prompt investigation of HAIs

Real-time data to front line staff to drive improvement

Zero tolerance for unsafe behaviors and practices that put patients and healthcare workers at risk

Targeting Zero…

APIC 2008Targeting Zero Position Statement: www.apic.org


Targeting zero crbsi clab resources
Targeting Zero: EpidemiologyCRBSI/CLAB Resources

Online Course: Elimination of Catheter-Related Bloodstream Infections

  • Part of APIC ANYWHERE™ Online Course Offerings, delivered via Healthstream

    • Helps healthcare workers recognize the role they play in the transmission and prevention of CR-BSIs

    • Participants are provided with resources and checklists to assist in developing prevention strategies

      Eliminating Catheter-Related Complications Toolkit

    • CNE-certified, features video demonstration of proper catheter insertion, check-lists for insertion and maintenance, additional learning modules and discussion of the cultural attributes of reaching zero CR-BSIs.

      Guide to the Elimination of Catheter-Related Bloodstream Infections

    • Provides step-by-step guidance to facilitate the bedside implementation of relevant clinical evidence and best practices for eliminating CR-BSIs

      Webinars

    • Strategies to Prevent Catheter-Related Bloodstream Infections

    • Access Site and Hub Disinfection: The Missing Link in the CR-BSI Prevention Bundle

Visit www.apic.org/guidelines to access the CDC Guidelines for CR-BSIs, and more.


Safe Patients, Smart Hospitals Epidemiology

Peter J. Pronovost, MD, PhD, FCCM

Professor, Johns Hopkins University School of Medicine(Departments of Anesthesiology and Critical Care Medicine,

and Surgery), Bloomberg School of Public Health

(Department of Health Policy and Management), and School of Nursing

Medical Director, Center for Innovation in Quality Patient Care

Safe Practices Webinar

March 18, 2010


A national program to eliminate clabsi peter pronovost md phd

A National Program to Eliminate CLABSI EpidemiologyPeter Pronovost, MD, PhD

“Safe Patients, Smart Hospitals”


29 Epidemiology


30 Epidemiology


Regulatory
Regulatory Epidemiology

x

Scientifically Sound

Feasible

Local Wisdom/Market


Improve
IMPROVE Epidemiology

Measure

CUSP

Comprehensive Unit-based Safety Program

(TRiP)

Translating Evidence Into Practice

Have We Created a Safe Culture?

How Do We know We Learn

from Mistakes?

How Often Do we Harm?

Are Patient Outcomes

Improving?

Educate staff on science of safety

Identify defects

Assign executive to adopt unit

Learn from one defect per quarter

Implement teamwork tools

  • Summarize the evidence in a checklist

  • Identify local barriers to implementation

  • Measure performance

  • Ensure all patients get the evidence

www.safercare.net


Pronovost EpidemiologyBMJ 2008


Checklist to prevent clabsi
Checklist to Prevent CLABSI Epidemiology

  • Remove Unnecessary Lines

  • Wash Hands Prior to Procedure

  • Use Maximal Barrier Precautions

  • Clean Skin with Chlorhexidine

  • Avoid Femoral Lines

MMWR 2002;51:RR-10


Identify barriers
Identify Barriers Epidemiology

  • Ask staff about knowledge

    • Use team check up tool

  • Ask staff what is difficult about doing these behaviors

  • Walk the process of staff placing a central line

  • Observe staff placing central line


Ensure patients reliably receive evidence
Ensure Patients Reliably EpidemiologyReceive Evidence

Pronovost: Health Services Research 2006


Ideas for ensuring patients receive the interventions the 4es
Ideas for ensuring patients receive Epidemiologythe interventions: the 4Es

  • Engage: stories, show baseline data

  • Educate staff on evidence

  • Execute

    • Create line cart that contains all needed supplies

    • Empower nurses to stop takeoff

    • Learn from mistakes: review all infections as defects

  • Evaluate

    • Feedback performance

    • View infections as defects


Partnership
Partnership Epidemiology

  • To help with 4Es, Partner with

    • ICU physician and nurses

    • Infection control staff

    • Hospital quality and safety leaders

    • Nurse educators

    • Physician leaders

ICU staff must assume responsibility for reducing CLABSI


Comprehensive Unit-based Safety Program (CUSP) EpidemiologyAn Intervention to Learn from Mistakes and Improve Safety Culture

  • Educate staff on science of safety http://www.safercare.net

  • Identify defects

  • Assign executive to adopt unit

  • Learn from one defect per quarter

  • Implement teamwork tools

Pronovost, JPatient Saf, 2005


Science of safety
Science of Safety Epidemiology

  • Understand system determines performance

  • Use strategies to improve system performance

    • Standardize

    • Create Independent checks for key process

    • Learn from Mistakes

  • Apply strategies to both technical work and team work

  • Recognize that teams make wise decisions with diverse and independent input


Learning from mistakes
Learning from Mistakes Epidemiology

  • What happened?

  • Why did it happen (system lenses)?

  • What could you do to reduce risk?

  • How do you know risk was reduced?

    • Create policy / process / procedure

    • Ensure staff know policy

    • Evaluate if policy is used correctly

Pronovost, JCJQI 2005


Teamwork tools
Teamwork Tools Epidemiology

  • Call list

  • Daily Goals

  • AM briefing

  • Shadowing

  • Culture check up

  • TEAMSTepps

Pronovost, JCC, JCJQI



Crbsi rate over time
CRBSI Rate Over Time Epidemiology

46


Vap rate over time
VAP Rate Over Time Epidemiology

47


Michigan icu safety climate improvement
Michigan ICU Safety Climate EpidemiologyImprovement

* “Needs Improvement” - Safety Climate Score <60%



Action plan
Action Plan Epidemiology

  • Join your states effort to eliminate CLABSI – contact your state hospital association or email [email protected] to find contact person

  • Meet with ICU team, infection control staff, quality and safety leaders, nurse educators and physician champions

  • Understand barriers (walk the process)

  • Use 4E grid to develop strategy to engage, educate, execute and evaluate


Focus and execute
Focus and Execute Epidemiology

51


52 Epidemiology


References
References Epidemiology

Measuring Safety

  • Pronovost PJ, Goeschel CA, Wachter RM. The wisdom and justice of not paying for "preventable complications". JAMA. 2008; 299(18):2197-2199.

  • Pronovost PJ, Miller MR, Wachter RM. Tracking progress in patient safety: An elusive target. JAMA. 2006; 296(6):696-699.

  • Pronovost PJ, Sexton JB, Pham JC, Goeschel CA, Winters BD, Miller MR. Measurement of quality and assurance of safety in the critically ill. Clin Chest Med. 2008; in press.


References1
References Epidemiology

Translating Evidence into Practice

  • Pronovost PJ, Berenholtz SM, Needham DM. Translating evidence into practice: A model for large scale knowledge translation. BMJ. 2008; 337:a1714.

  • Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. NEJM. 2006; 355(26):2725-2732.

  • Pronovost PJ, Berenholtz SM, Goeschel C, et al. Improving patient safety in intensive care units in michigan. J Crit Care. 2008; 23(2):207-221.

  • Peter J Pronovost, Christine A Goeschel, Elizabeth Colantuoni, Sam Watson, Lisa H Lubomski, Sean M Berenholtz, David A Thompson, David J Sinopoli, Sara Cosgrove, J Bryan Sexton, Jill A Marsteller, Robert C Hyzy, Robert Welsh, Patricia Posa, Kathy Schumacher, and Dale Needham.Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study. BMJ. 2010;340:c309, doi: 10.1136/bmj.c309


References2
References Epidemiology

  • Pronovost P, Weast B, Rosenstein B, et al. Implementing and validating a comprehensive unit-based safety program. J Patient Saf. 2005; 1(1):33-40.

  • Pronovost P, Berenholtz S, Dorman T, Lipsett PA, Simmonds T, Haraden C. Improving communication in the ICU using daily goals. J Crit Care. 2003; 18(2):71-75.

  • Pronovost PJ, Weast B, Bishop K, et al. Senior executive adopt-a-work unit: A model for safety improvement. Jt Comm J Qual Saf. 2004; 30(2):59-68.

  • Thompson DA, Holzmueller CG, Cafeo CL, Sexton JB, Pronovost PJ. A morning briefing: Setting the stage for a clinically and operationally good day. Jt Comm J Qual and Saf. 2005; 31(8):476-479.


Clinical Pearls for Nursing Epidemiology

To Eliminate CLABSIs

Deborah Baugher Hobson, BSN

Quality Improvement Chairperson/Staff Nurse

Johns Hopkins Hospital Surgical Intensive Care Unit

Patient Safety Clinical Specialist,

Center for Innovation in Quality Patient Care

Melinda Sawyer, RN, MSN

Patient Safety Officer, Department of Medicine,

The Johns Hopkins Hospital

Senior Clinical Research Coordinator,

The Johns Hopkins University Quality

and Safety Research Group (QSRG)

Safe Practices Webinar, March 18, 2010


Clinical pearls for nursing to eliminate clabsis
Clinical Pearls for Nursing Epidemiologyto Eliminate CLABSIs

  • Putting evidence into every day practice: “walking the process”

  • Empowering the Nurses to stop the process at any step with every insertion

  • Now that the line is inserted…how do we maintain the line to remain “infection-free”?


Q & A Epidemiology

Kathy Warye(Denise Graham - proxy)

Peter Pronovost

Charles Denham

Melinda Sawyer

Patti O’Regan

Deborah Hobson


The Role of the Patient Advocate Epidemiology

Patti O’Regan, ARNP, ANP, NP-C, PMHNP-BC

Nurse practitioner, Port Richey, FL

Founding member, TMIT Patient Advocate Panel

Safe Practices Webinar

  • March 18, 2010


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