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CAUTI Content Call #2

CAUTI Content Call #2. Coaching 101: The Basics of Coaching and How to Derive Meaning from your Data May 17, 2012. Presented by: Barbara Lucas, MD, MHSA Marie Masuga, MSN, RN. Objectives. Provide an overview of what “coaching” means in respect to the CAUTI/CUSP collaborative

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CAUTI Content Call #2

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  1. CAUTI Content Call #2 Coaching 101: The Basics of Coaching and How to Derive Meaning from your Data May 17, 2012 Presented by: Barbara Lucas, MD, MHSA Marie Masuga, MSN, RN

  2. Objectives • Provide an overview of what “coaching” means in respect to the CAUTI/CUSP collaborative • Share tools and tips to help interpret your unit’s CAUTI data trends and drive individual unit performance • Learn how to apply CUSP techniques to improve unit performance, based on national TCT data in the CAUTI project

  3. Overview: Coaching • What is “coaching?” • What does coaching mean to me, based on my role in the project? • Staff member • Administrator • Physician • State Lead • Infection Preventionist • Other?

  4. Overview: Coaching (Continued…) • Two Levels of Coaching for this project: • State Lead: responsible for shepherding all the teams in the project; this includes • monitoring timely data submission • review of data trends • obtaining additional faculty support /advice on technical issues when needed • leading regular coaching calls • Individual hospital/unit team leads: responsible for ensuring: • timely data submission • education of physicians, nursing, and staff about CAUTI • implementation of project steps, both CAUTI reduction and CUSP • sharing progress, trouble-shooting barriers, smoothing communication

  5. Overview: Coaching Monthly or regular state-level calls Opportunity to: • Communicate state and team progress on the project, based on • data trends • team sharing of implementation on their units • Collaborate with peers • share success stories and tips • receive guidance and advice on barriers • be open to feedback

  6. Coaching with Data to Improve Performance GOAL: Reduce your CAUTI rate by 25% HOW DO WE DO THIS? REMEMBER PROJECT STEPS: • Make sure catheter is really need • Use correct insertion technique • Care for catheter properly • Remove catheters soon as possible

  7. Coaching with Data to Improve Performance (continued…) Three Tools to Help you Coach: • Care Counts Reports: Trend Interpretation • Learning from Defects: for Individual CAUTI’s • Big Picture: What’s the story on your unit?

  8. Using Data to Improve Performance: Care Counts Report Trends • Reports to Run: • Outcome Data: • CAUTI Rates • # infections/by pt days and catheter days • CAUTI Prevalence (catheter days/patient days) • Process Data: • Percent of catheterized patients with at least one appropriate HICPAC indication

  9. Interpreting Your Care Counts Reports:Algorithm for Data Trends • Algorithm located on the national website: Go to www.onthecuspstophai.org Click on Stop CAUTI Click on Resources for state leads Click on Implementation tools Go to Phase 3 tools Click on 3.15: Interpreting CAUTI data trends

  10. Interpreting Your Care Counts Reports:Algorithm for Data Trends (continued…) • Algorithm based on 3 questions: 1) Is your CAUTI rate decreasing? 2) Is your % of catheterized patients with an appropriate indication increasing? 3) Is your prevalence of catheters decreasing?

  11. Interpreting Your Care Counts Reports:Algorithm for Data Trends (continued…) Start by looking at your CAUTI rate trends: Is your CAUTI rate decreasing (favorable) OR increasing (unfavorable) ? Then use the appropriate algorithm table

  12. CAUTI Data Trend Interpretation:If your CAUTI rate is DECREASING (favorable)

  13. CAUTI Data Trend Interpretation:If your CAUTI rate is INCREASING (unfavorable)

  14. Interpreting Your CAUTI Data:Other Tools to Drill Down Tools to help Coaches: • For Individual CAUTI Events: • Learning from Defects Exercise • Big Picture: • What is your hospital unit’s catheter “story”?

  15. For Individual CAUTI Events:Learning from Defects Key CUSP Element; Used for individual CAUTI events • Examples: located on www.onthecuspstophai.org 1) From JHU: -- click on Stop CAUTI; go to Toolkits and Resources -- click on Implementation Guide, go to Appendix D 2) From NC Center for Hospital Quality and Patient Safety: -- click on STOP CAUTI; go to Additional Resources -- click on CAUTI Event Report Template

  16. Big Picture: What’s the story with catheters on your unit? Don’t miss the forest for the trees! Think about a journalistic approach: who, what, when, where, why, how

  17. Capturing the Story: Who, What, When, Where, Why, and How By TOM WICKER Special to THE NEW YORK TIMES Dallas, Nov. 22--President John Fitzgerald Kennedy was shot and killed by an assassin today. He died of a wound in the brain caused by a rifle bullet that was fired at him as he was riding through downtown Dallas in a motorcade. Vice President Lyndon Baines Johnson, who was riding in the third car behind Mr. Kennedy's, was sworn in as the 36th President of the United States 99 minutes after Mr. Kennedy's death. Mr. Johnson is 55 years old; Mr. Kennedy was 46. Shortly after the assassination, Lee H. Oswald, who once defected to the Soviet Union and who has been active in the Fair Play for Cuba Committee, was arrested by the Dallas police. Tonight he was accused of the killing. What? Who? When/where? How? Why?

  18. Big Picture: What’s the story on your unit? • Useful to look at the broad picture of your unit and hospital’s systematic approach to catheters • Choose a limited recent sample of your catheterized patients (e.g., the last 20 catheterized patients on your unit) • Consider: who, what, when, where, why, and how

  19. Big Picture: What’s the “catheter story” on your unit? • WHO: • who ORDERED those catheters? • be sure there was an order! • who PLACED those catheters? • looking for broad category of provider, not individuals; e.g., med student, OR tech, nursing assistant, etc. • WHAT: • what was their training for catheter insertion? • do you have documentation of competency?

  20. Big Picture: What’s the “catheter story” on your unit? • WHEN was the catheter placed? • chronic catheter present prior to admission? • placed when admitted? • placed later in hospital stay? • WHERE was the catheter placed? • on your unit or elsewhere?

  21. Big Picture: What’s the “catheter story” on your unit? (continued…) • WHY was the catheter placed? • does it meet HICPAC criteria for an approved indication? • HOW was the catheter maintained? • do you monitor catheter maintenance technique on your unit? • do you educate staff and document competency re: proper catheter care and maintenance?

  22. Interpreting Your “Catheter Story”:EXAMPLE: Mini Case Study, Med Surg Unit(last 20 catheterized patients)

  23. Coach’s Role: Transforming Data into ActionEXAMPLE: Mini Case Study, Med Surg Unit(last 20 catheterized patients)

  24. SUMMARY: Coaching with Data to Improve Performance • Care Counts Reports: Are you trending in the right direction? • CAUTI rates, Appropriateness, Prevalence • Use the algorithm to drive corrective actions • Individual CAUTI’s: Use Learning from Defects or similar tool • Big Picture: What is your unit’s catheter “story”? • Who orders? Who inserts? • What is their competence? • When are they inserted? • Where are they inserted? • Why are they inserted? • How are they maintained?

  25. Applying CUSP • Comprehensive Unit-Based Safety Program • Five “Steps” • Educate on the science of safety • Identify Defects • Assign executive to unit • Learn from defects • Teamwork tools

  26. CUSP: Science of Safety Video

  27. Systems lens Show video using existing forums Discuss – before and after Link to other quality/safety work Use personal/facility/unit-specific example Repeat, repeat, repeat CUSP: Science of Safety Video

  28. CUSP: Executive Partnership

  29. CUSP: Executive Partnership • Senior executive champion • Purpose of executive rounding • Share data • Prep staff and executive • Close the feedback loop

  30. CUSP: Staff Safety Assessment & Learning from Defects

  31. CUSP: Staff Safety Assessment • How will the next patient be harmed? What can be done to reduce harm? • Frontline staff have the ability to identify problems and solutions • Keep it simple • Consider other sources to obtain information • Prioritize and choose one issue to address • Share results with staff, senior executive

  32. CUSP: Learning from Defects • What happened? Why? How do we reduce risk? Did it work? • Focus on the system, not the people • Involve frontline staff and senior executive • Consider teamwork tools • Close the loop • Share

  33. CUSP: Top BarriersTime, Distraction, Physician Issues

  34. Barriers: Time & Data Collection • Is safety a priority? • Back to basics • Speak up • Allocate burden • Get creative • Fun

  35. Barrier: Staff Distraction • Due to competing priorities for time/resources • EMR/CPOE, Magnet, Joint Commission • Due to other events in your unit/hospital • Wireless devices, medical leave, staff turnover, construction, high/low census • Re-evaluate, change for the better, integrate

  36. Barrier: Physician Support • Physician buy-in • Physician leadership support • Physician champion and executive champion • Go to them • Lead with hard facts • What’s in it for me?

  37. Staff Education

  38. CAUTI Reduction Practices

  39. Take Home Messages • Coaching • Think about: What does coaching mean to me? • CAUTI Data: Use it to drive improvement! • Track your Care Counts report trends • For individual CAUTI’s”: Use Learning from Defects • Big Picture: What’s your unit’s “catheter story”? • (who, what, when, where, why, how)

  40. Take Home Messages • CUSP Application • Framework to support change • Engage frontline staff, physicians, executives • Speak up • Teamwork • Remember: We are all coaches for each other!

  41. Your Feedback is Important! https://www.surveymonkey.com/s/CAUTICallEvaluation

  42. Questions?

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