CLABSI Supplemental Call Series
How CUSP Enables Nurse Empowerment
November 15, 2011 at 2ET/1 CT/12 MT/11 PT
Presenters:
Pat Posa, RN, BSN, MSA
Joanne Timmel, MSN, RN, NE-BC
CLABSI Supplemental Call Series
Pat Posa, RN, BSN, MSA
System Performance Improvement Leader
St. Joseph Mercy Heath System
Slide 2
Components of CUSP?
1. Form a unit CUSP team with executive
sponsorship
2. Measure unit culture
3. Educate staff on Science of Safety
4. Identify defects using the Staff Safety
Assessment; prioritize defects
5. Learn from one defect per quarter
6. Implement team/communication tools
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How is CUSP different?
It Empowers Nurses in the Hospital
• Driven by frontline staff---nurses
• CUSP identifies problem areas –
– what staff think are impeding patient care vs.
what managers/directors think are priority areas
• CUSP improvement tools are designed for bedside
caregivers – easy for busy staff to use
– unit drives its own quality
• CUSP can complement other quality improvement
methods – must use multiple tools!
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CUSP: St. Joseph Mercy Hospital Journey
• Began in 2003 with statewide ICU Collaborative: Keystone ICU
• Multidisciplinary Keystone (CUSP) team—meet monthly
• Annual assessment of culture—with staff developing action
plans to improve culture
• Executive rounds
• Learn from a defect
• Team/Communication tools:
– Multidisciplinary rounds with daily goals
– Crucial conversation training
– Structured Huddles
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Best Practices:
Learning from Defects Tool
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Best Practices:
Engaging & Sustaining Nurse Involvement in CUSP Huddles
• Enable teams to have frequent but short briefings so that they
can stay informed, review work, make plans, and move ahead
rapidly.
• Allow fuller participation of front-line staff and bedside
caregivers, who often find it impossible to get away for the
conventional hour-long improvement team meetings.
• They keep momentum going, as teams are able to meet more
frequently.
Use this strategy to begin to recovery
immediately from defects---IE: falls, sepsis
and daily to focus on unit outcomes
7
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Components
Metric 1: Quality/Safety
Metric 2: Patient Satisfaction
Metric 3: Operations
Daily Critical Communications
Information
Ideas in Motion
How to do it?
•Beginning or mid shift
•5-10 minutes
•Lead by member of unit
leadership team
8
Slide 8
SICU Huddle Board
9
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Surgical Unit Huddle Board
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Lessons to Bring Home to your Hospitals:
Strategies that Promote Nurses & Leverage CUSP
• Frontline staff are an integral part of the CUSP team
• Meet monthly
• Nurses who work in the unit processes everyday are the
best people to identify where there are opportunities to
improve and how to improve
• Allow the nurse to take responsibility for identifying
problems and give them a forum and strategy to solve
them
– CUSP team
– Learn from a defect tool
– Structured huddles
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A Healthcare Imperative
“In medicine, as in any profession,
we must grapple with systems,
resources, circumstances,
people-and our own
shortcomings, as well. We face
obstacles of seemingly endless
variety. Yet somehow we must
advance, we must refine, we
must improve.”
Atul Gawande, Better: A Surgeon’s Notes on Performance
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CLABSI Supplemental Call Series
Joanne Timmel, MSN, RN, NE-BC
Nurse Manager
The John Hopkins Hospital
Slide 13
Implementing CUSP:
Assumptions & Prerequisites
• Certain beliefs predispose for success:
– Direct care staff are best able to identify
impediments to safe efficient care
– Staff value patient centered care
• Manager has participative leadership style
• Setting is important; a room on the unit boosts
attendance
• Broad Team: Pharmacist, Social Worker, PT & OT,
Chaplain, Environmental Services, Mid Level
Providers, Residents, Attending, Administrator
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Implementing CUSP: Engaging the Team
• Define CUSP for your setting
• Kick off with Science of Safety presentation
• Ask the question: “How will the next patient be
harmed on our unit?”
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CUSP: How it Empowers Nurses in the
Hospital
Nurses are empowered when —
•
•
•
•
they see change happen
their concerns are affirmed
they develop a voice and can tell their story
they are supported by a unit culture that values speaking up
regarding patient safety
Nurses are empowered when they actually have
power
Slide 16
CUSP: Example of Empowerment
A surgical unit before CUSP —
• Chaos
• Unclear plan of care
• Very poor communication with the surgeons
• Patients frustrated and angry at nurses
• Nurses felt powerless.
• So they left — high turnover.
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CUSP: Example of Empowerment
Our first CUSP project:
• Proposed cohorting
• Implemented nurse-physician joint rounds
• Developed a written daily goal sheet generated from
rounds
• Besides rounds, established other mechanisms for
non-urgent communication
• Continue to articulate new collaborative culture by
hosting First Monday breakfasts
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CUSP: Example of Empowerment
Nurses now have a place to address their day to day intransigent
system problems
• Medications not available when due
• Pain control issues in admitted outpatients
• Inpatient nurse/ PACU nurse communication
• Contributing factors to recent medication errors
• New residents lack of familiarity with POE system
• Strategies for coverage with decreased resident hours
• Pain control issues/ narcotics issues with patients with chronic
pancreatitis, Interventional Radiology pts
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Best Practices:
Engaging & Sustaining Nurse Involvement in CUSP
• Absolutely requires 3 strong champions (nurse,
physician, administration)
• Monthly meetings require email reminders,
individual invites, reminders throughout day, support
to allow staff to step away from pts.
• Energy maintained if you focus on what matters to
the bedside nurse
• Really resolve some problems!
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Lessons to Bring Home to your Hospitals:
Strategies that Promote Nurses with the Leverage
of CUSP
• If nurses are not engaged in the CUSP process, ask
why.
• Are you trying to lower CLABSI rate by ultimately
requiring nurses to do more, when they know
they aren’t able to do half of what they expect of
themselves?
• Find low hanging fruit (e.g. We need red labels
on high concentration PCA)
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Questions?
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Your Feedback is Important
https://www.surveymonkey.com/s/Z6FJ28T
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