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***Please note some slides have been removed since the webinar at the presenter’s request. CUSP for VAP Revisiting Your Action Plan: Using Reports to Drive Change. Sara Cosgrove, MD, MS Donna Fellerman, RN, CIC Chelsea Lynch, RN, MSN, MPH, CIC Elizabeth Zink, MS, RN, CCNS, CNRN

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cusp for vap revisiting your action plan using reports to drive change

***Please note some slides have been removed since the webinar at the presenter’s request.

CUSP for VAPRevisiting Your Action Plan: Using Reports to Drive Change

Sara Cosgrove, MD, MS

Donna Fellerman, RN, CIC

Chelsea Lynch, RN, MSN, MPH, CIC

Elizabeth Zink, MS, RN, CCNS, CNRN

Polly Trexler, MS, CIC

July 10, 2014

data drives outcomes
Data Drives Outcomes
  • How to Present Your Data Effectively
define the audience
Define the Audience
  • Front-line clinicians
  • Clinical committees (e.g., critical care committee)
  • Hospital administration
  • Patients/families
define the purpose of sharing the data
Define the Purpose of Sharing the Data
  • Assessment of individual cases to determine areas for improvement
  • Trending of data over time to compare units to themselves or other units
  • Dashboards or other quality improvement documents
    • Usually red, yellow, green
    • Decide in advance how these will be defined
define the message
Define the Message

Rate trending upwards in a

clinically significant way

Needs to be addressed now

Rate is very low

Nothing to worry about

Keep up the good work

  • What do you want them to take away?
  • This is often in flux and needs to re-evaluated frequently
address concerns about data validity upfront
Address Concerns about Data Validity Upfront
  • Share the surveillance definitions and how you perform surveillance
    • Describe data sources
    • Repeat often
  • Point out limitations and definitional cases without negating the validity of the data
  • Distinguish between the surveillance definition and the clinical definition
  • Allow time for venting, but rally the team back
    • Complaining is not going to make the CDC change the definition!
    • Everyone follows the same rules
determine how to display the data
Determine How to Display the Data
  • Numbers (numerators) vs. rates
  • Time frames
    • Weekly, monthly, quarterly, etc.
    • Depends on how common the event is
  • Benchmarks
    • CDC or other
  • Process and outcome measures on the same graph?
  • Indicators of when interventions started
  • Annual goals/targets
suggestions based on audience
Suggestions Based on Audience
  • Front-line clinicians
    • Numbers of cases
    • Weeks since last case
    • Process measures
    • Graphs with rates
    • Goals & benchmarks
    • Action plan
  • Administrators
    • Graphs with rates
    • High level process measure information
    • Goals & benchmarks
    • Action plan
  • Patients/families
    • Tailor message to request
slide10

Be a VAP Prevention

STAR!

Bundle Up!

Head of Bed > 30⁰

Subglottic Suctioning

Oral Care with CHG

How are we doing?

Post the unit’s VAP graph or other information here

Daily Assessment for Readiness to Wean

Sedation Vacation

change the data display when necessary
Change the Data Display When Necessary
  • Data display should be an iterative process
    • Base changes on questions from and interpretations of audience
  • Particularly difficult with VAC, IVAC, possible and probable VAP
process measures
Process Measures
  • Process measure data is only as good as the data collection
  • Need to have and apply a standard definition, which is challenging when numerous people are collecting
  • More appropriate for unit level trending and initiation of discussions regarding improvement than for reporting at high-level meetings
keep it visible
Keep it Visible
  • Give internal access (such as an intranet source)
  • Post it where staff can see it
  • Personally take it to where

staff are working (on units)

A unit “huddle” – taking information to staff and gaining feedback/ideas rather than waiting for a formal group meeting

keep it timely
Keep it Timely
  • Stay on schedule with data reports to committees
  • Distribute as soon as possible to stakeholders
    • Use multiple opportunities – staff meetings, provider meetings, QI meetings, rounds, “huddles”
make it meaningful
Make it Meaningful
  • WHO does this dot on a graph represent?
  • Tell the patient’s story. Use patients’ names for unit personnel. They will remember the patient and may have ideas for improvements in practice or products
  • Have an expectation that front line staff can answer how the unit is doing with VAP, CLABSI, CAUTI when asked
conclusions
Conclusions
  • Manage the message
  • Make the data visible, interpretable, and timely
    • Solicit input from stakeholders about effective ways to do this
  • Make it meaningful—we are talking about patients
next steps
Next Steps
  • Collect Process Measure data(7 days of data per month collected during the 1st week of the month)
  • Collect Early Mobility data(7 days of data per month collected during the 2ndweek of the month)
  • Complete Structural Assessment 3 (begins next week)
  • Data collection for Low Tidal Volume Ventilation measure (August)
additional resources
Additional Resources
  • For questions regarding data collection, email us at cuspevap@jhmi.edu
  • Society for Critical Care Medicine ICU Liberation Group
    • http://www.iculiberation.org/Pages/default.aspx
  • AHRQ CUSP Toolkit
    • http://www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/
  • Armstrong Institute CUSP Tools
    • http://www.hopkinsmedicine.org/armstrong_institute/training_services/cusp_offerings/cusp_guidance.html
  • Armstrong Institute Training Opportunities
    • http://www.hopkinsmedicine.org/armstrong_institute/training_services/cusp_offerings/
thank you
Thank You

A sincere

THANK YOU

for all of your effort

and hard work to

reduce the incidence of VAP

in your units

and prevent HAIs!