Getting Started on Central Line Associated Blood Stream Infections

1. Getting Started onCentral Line Associated Blood Stream Infections Jill Hanson Manager, Quality Improvement WHA Improvement Advisor

2. Today’s Call • Current State of CLABSI’s • Initiative Timeline and Process • Measures • Review Findings from Kick-Off Brainstorming • Next 30 Days • View Science of Safety Video • Organizing the Team • Submitting Baseline Data • Determine Process Measure Data Collection Form to Use

3. CLABSI’s in Wisconsin In one year, in Wisconsin, nearly 200 people experienced a CLABSI. Improving the Wisconsin CLABIS Rate by 40% in two years could mean 180 CLABSI’s are prevented. This could be a savings of $5.4 to $13.5 million.

4. CLABSI Partners for Patients Goals Nationally: • Reduce the mean CLABSI rate to less than one per 1,000 catheter days over two years • Improve safety culture Wisconsin: • Reduce the statewide ICU CLABSI SIR from .581 to .30 and/or 75% of WI ICUs will report zero CLABSI by 12/31/2013 • Reduce the CLABSI SIR (all units) by 50% by 12/31/2013 What’s your goal? Individualized AIM statement

5. Poll Question One – What Have You Tried? Which of the following describes your facility best in terms of progress on CLABSI? • This is the first time we have worked on it. • We have worked on it, but haven’t been able to sustain the gains. • We have successfully implemented changes and are sustaining the gains. • We have all but given up on finding ways to improve.

6. Initiative Timeline Overview • 9 Month Collaborative • 1-Hr Webinar Each Month – 4th Tuesday at 10 – 11 AM

7. Poll Question One - Results Which of the following describes your facility best in terms of progress on CLABSI? • This is the first time we have worked on it. • We have worked on it, but haven’t been able to sustain the gains. • We have successfully implemented changes and are sustaining the gains. • We have all but given up on finding ways to improve.

8. Initiative Learning Process Team Learning Opportunities Webinars • Review progress of last 30 days • New content • Discussion and sharing • Plan for the next 30 days Discussion Group • Questions • Peer-to-Peer Sharing Coaching Calls (if there is interest) • Once per month Quality Center Website • Data submissions • References and Toolkits • Reports (coming soon) Webinars Site Visits Discussion Group WHA Quality Center

9. Guide to Quality Centerhttp://www.whaqualitycenter.org/ Click Here

10. CLABSI Driver Diagram

11. Importance of Measurement Why measure? • The purpose of measurement in QI work is for learningnot judgment! • Measures should be used to guide improvement and test changes. • Demonstrate change from a baseline, or initial measurement, and assess the degree of change after an intervention. I think we improved… but I’m not sure by how much?

12. CLABSI Measures • Outcome Measure:Focus on the customer or patient. What is the result? • Adult – Number of CLABSIs & Central Line Days (All Units or Unit Specific) • Process Measures:Focus on theworkings of the system. Are the parts/steps in the system performing as planned? • Choose One: • CLABSI Bundle Adherence Rate • Insertion Compliance • Maintenance Compliance • Daily Review of Line Necessity

13. CLABSI Process Measure Data Collection Forms Available on the CLABSI References &Toolkit Page • Bundle Adherence Rate (NHSN CLIP Data Collection Form) • Maintenance Compliance Form • Insertion Compliance Form • Daily Review of Line Necessity Form (part of Daily Goals Checklist)

14. Action Item #1 – Data Submission • Baseline Outcome data due June 30 • Submit via WHA Quality Center portal or NHSN • 2011 Data – Aggregate Num, Den & Start/End Date • 2012 Data (Monthly Jan – June) • Analyze baseline data

15. Why Improvement Is Hard Reasons Improvement Projects May Have ‘Failed’ in the Past • Moved too fast to ‘Protocol and Procedure’ • Did not have the right people involved • Did not engage frontline staff in trying new changes – little buy in • Measures were not monitored consistently over time • Did not reinforce training on the new way of doing things • Used the same core group of people to fix the problem • Participants in the initiative do not address the root causes of performance deficiency

16. Partners for Patients Focus • Slow down the improvement train • Continuous measurement throughout initiative (and beyond) • Get the right people involved • Get new people involved • Small tests of change with many front-line staff • Opportunities to revisit training • Focus on project sustainability

17. Diverse and Independent Input Appreciate the wisdom of crowds • Remember health care is a team effort • Strive to create an environment where frontline providers can speak up if they have concerns and are heard when they express concerns • Get as many viewpoints as possible Think about your “tipping point”: • How many staff on your unit need to buy into a change in order for it to stick?

18. Science of Safety – How Errors Happen The Swiss Cheese Model – by James Reason Important Concepts: • Holes in any layer increase the vulnerability of the whole system. • It is virtually impossible to eliminate all holes. • Must understand the whole system, not just the steps. • Continuously monitor the health of the whole system.

19. Why do Mistakes Happen? • Inconsistency/variation • Complexity • Too many steps • Human error • Tight time constraints • Hierarchical culture • Fatigue • Inattention/distraction • Unfamiliar situations/new problem • Communication errors • Using past solutions • Mislabeling/inadequate instructions • Equipment design flaws Process Factors People Factors

20. Impact of Design on System Performance System-level factors including characteristics of: • Provider • Team • Work Environment • Department of hospital pressures

21. Principles of Process Design • Standardize - Eliminate steps if possible • Create independent checks • Think about near misses - What might happen? - Why? - What can you do to reduce risk? - How will you know it works?

22. Science of Safety Recipe • Educate on the Science of Safety • Identify Defects (Staff Safety Assessment) • Learn from Defects • Implement Teamwork & Communication Tools

23. What is a “Safety Culture”? Safety Culture encompasses the attitudes held within a workplace from the leadership to the front lines. This includes: • How open staff is to discussing patient safety issues and concerns with their colleagues and their leaders • How safe they feel about speaking out if they think that a patient is in danger • How serious they think the organizational leadership is about patient safety • How well they think they work as a team.

24. Assessing Your Organization’s Culture • Participate in a culture walk – what do you observe on your unit? • Conduct culture interviews – interview staff in small groups. Observe behaviors and interactions. How do they feel about culture? • Culture surveys (such as AHRQ or Press Ganey) Tip Sheet Available via the WHA Quality Center - CLABSI Resources Page

25. Action Item # 2 – View Patient Safety Video Create a roster of who on your team/unit needs to view the Science of Safety video. http://www.youtube.com/watch?v=GOJJHHm7lnM&feature=results_main&playnext=1&list=PL048D28C888FE3871

26. Organizing your Team Considerations • Who will you involve? • How will you communicate? • Within your team? (notify of meetings) • To others outside of the team? • How will you use the webinars? (use as weekly meeting?) • Identify team structure (key roles, expertise, leaders) • How will you keep everyone engaged?

27. Polling Question Two – Your CLABSI Team Please select who will be part of your CLABSI team (select all that apply): • Executive Champion • QI Lead • Physician • Pharmacists • Clinical Manager • Front Line Staff • Environmental Services

28. Action Item #3 - Organizing your Team Optional Tools to Use Team Charter Agenda Background QI Team Info

29. Polling Question Two - Results Please select who will be part of your CLABSI team (select all that apply): • Executive Champion • QI Lead • Physician • Pharmacists • Clinical Manager • Front Line Staff • Environmental Services

30. Reminder Please complete the three question survey before you close out of today’s webinar. Next Webinar: July 24 at 10 am Systematic Improvement

31. The Next 30 Days Tools Available On WHA Quality Center: • Science of Safety Video Link • Quality Center CLABSI References & Toolkit Section

32. Thank you! Questions? Jill Hanson Manager, Quality Improvement WHA