Staff Safety Assessment 1 Learning Objectives • To understand Step 2 of CUSP:Identify Defects • To understand how to Implement the Staff Safety Assessment • To understand ways to use results of the Staff Safety Assessment 2 Goals • To identify defects • To leverage the wisdom of the front line worker • To prepare a list of improvement opportunities that has face validity and provides a focus for CUSP activities. 3 On the CUSP: Stop BSI CUSP CLABSI 1. Educate staff on science of safety 1. Remove Unnecessary Lines 2. Identify defects 2. Wash Hands Prior to Procedure 3. Assign executive to adopt unit 3. Use Maximal Barrier Precautions 4. Learn from one defect per quarter 4. Clean Skin with Chlorhexidine 5. Implement teamwork tools 5. Avoid Femoral Lines 4 The CUSP Team The smaller group that spreads the intervention to the rest of the unit 5 Education and engagement activities on the unit • BSI: Providing Evidence, Modeling the line placement steps; stopping insertions that violate protocol; having one-on-one talks where necessary; • Facilitating CUSP Activities 6 Comprehensive Unit-based Safety Program (CUSP) 1. Educate staff on science of safety (www.safercare.net) 2. Identify defects 3. Assign executive to adopt unit 4. Learn from one defect per quarter 5. We are here Implement teamwork tools You are here!!! 7 Identify Defects • Review error reports, liability claims, sentinel events or M and M conference • Ask staff how the next patient will be harmed 8 Identifying Defects What DO you know? What SHOULD you know? 9 Transparency Making project and progress visible to everyone 10 How are We Going to Harm the Next Patient? One way to make harm visible-- get staff thinking about safety and how to improve it 11 Step 2: Staff Identify Defects Frontline caregivers are the eyes and ears of patient safety • Identify clinical or operational problems that negatively impact patient safety (have or could) • Use the Staff Safety Assessment form (Part of CUSP manual) – How will the next patient will be harmed in our unit – What can be done to minimize patient harm or prevent this safety hazard • ICU managers and team review suggestions, set the agenda for discussion with executive partner 12 Appendix C STAFF SAFETY ASSESSMENT – CUSP Purpose of this form: The purpose of this form is to tap into your knowledge and experiences at the frontlines of patient care to find out what risks are present on your unit that have or could jeopardize patient safety. Who should complete this form: All health care providers. How to complete this form: Provide as much detail as possible when answering the 2 questions. Drop off your completed safety assessment form in the location designated by the CUSP improvement team with your job category, date and unit in the top box (name is optional). When to complete this form: Assessing safety should be considered an iterative process with no defined end (like a moving bicycle wheel). Thus, it can be filled out by any health care provider at any time. At the very least, all health care providers should complete this form semiannually. Name (optional): Job Category: Date: Unit: Please describe how you think the next patient in your unit/clinical area will be harmed. Please describe what you think can be done to prevent or minimize this harm. Thank you for helping improve safety in your workplace! 13 Step 2: Staff Identify Defects • What Team Leaders need to do: • Hand out a Staff Safety Assessment form to all staff, clinical and non-clinical, in the unit • Establish a collection box or envelope • Identify and group common defects (such as communication, medications, patient falls, supplies, etc.) • Summarize as frequencies (i.e., what percent of responses were for communication) 14 Prioritize Defects • List all defects • Discuss with staff what are the three greatest risks 15 Step 2: Staff Identify Defects • Report the identified defects to staff, executive partner • ICU managers and CUSP team prioritize defects identified by the potential level of risk to the patient • Select one to work on with support of Executive • Step 2 should be ongoing 16 Appendix D SAFETY ISSUES WORKSHEET FOR SENIOR EXECUTIVE PARTNERSHIP - CUSP Date of Safety Rounds: Unit: Attendees: 1. 2. 3. 4. 5. 6. 7. 8. 9. (use back of form for additional attendees) Identified Issue Potential/Recommended Solution Resources Needed Not Needed 1. 2. 3. 4. 5. 6. 7. 8. 9. Copy form if more than 9 safety issues are identified. Please return this form to your project leader 17 Appendix E STATUS OF SAFETY ISSUES – CUSP Unit: ___________________________________________ Date Safety Issue New and Ongoing Contact Status Goal Date Safety Issue Completed Contact Status Goal Please return this form to your project leader 18 CUSP Team activitieskeeping on track • Team meetings (recommend monthly) • Review of data (monthly) • Meet w/ Exec Partner (monthly or more) • Executive review of data (monthly) • Presentations to hospital colleagues – (leadership, frontline staff, board) 19 On The CUSP Stop BSI Assemble a CUSP team, Partner with a senior executive; Baseline Data Exposure Survey and Technology Survey Adaptive (CUSP) Technical CLABSI CVC Insertion CVC Line Cart 1. Contents inventory Evidence based BSI prevention (hands, site, skin prep, barrier, removal) 1. Presentation of evidence 2. CLABSI factsheet 3. Insertion checklist CVC Management Science of Safety Training Staff Identify Defects Senior Executive Partnership 1. Daily goals Implement Tools for Teamwork and Communication LFD toolkit 2. Dressing change 3. Vascular access manual/ policy protocol Learning from Defects 1. Science of safety presentation 3. Attendance sheet 1. Staff safety assessment form 2. Indentifying hazards presentation Briefings 1. Daily goals 2. Shadowing 3. AM briefing 4. Call list 6. Team check up tool 4. Vascular access quiz 5. Vascular access manual/ policy 6.Annotated bibliography 20 Comprehensive Unit-based Safety Program (CUSP) 1. Educate staff on science of safety (www.safercare.net) 2. Identify defects 3. Assign executive to adopt unit 4. Learn from one defect per quarter 5. We are here Implement teamwork tools You are here!!! 21 What Should you do NOW? CLABSI: Collect & Submit Baseline & Monthly BSI data CUSP Preparation: Assemble team/Schedule meetings CUSP Implementation 1) Science of Safety Training for all staff 2) Identify Defects: How will patients be harmed? www.safercare.net www.onthecuspstopbsi.org 22 References • 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):27252732. • 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. • Pronovost P, Weast B, Rosenstein B, et al. Implementing and validating a comprehensive unit-based safety program. J Pat Safety. 2005; 1(1):33-40. • 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. 23