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AHRQ Safety Program For Long-Term Care: HAIs/CAUTI
Module 1: Using the Comprehensive Long-Term Care Safety Toolkit:
Applying Safety Principles
2Using the Toolkit
Objectives
• Describe the purpose of the Long-Term Care Safety Toolkit
• Explain how the Long-Term Care Safety Toolkit supports other quality and safety tools
• Demonstrate how to apply the Long-Term Care Safety Toolkit in your facility
3
What Is the Purpose of This Toolkit?
• Improve safety culture in LTC facilities
• Support other quality improvement and safety initiatives in facilities
• Supplement technical interventions to reduce healthcare-associated infections, including catheter-associated urinary tract infections (CAUTIs)
Using the Toolkit
4Using the Toolkit
Why Is Infection Prevention Important?
5Using the Toolkit
Is Your Facility Safe?³
• Would you want a loved one to be a resident at your facility?
• Would you want to be a resident in your facility?
• Can you say with 100 percent certainty that your facility does everything it can to protect its residents?
• How do you think the next resident could be harmed in your facility?
6Using the Toolkit
T.E.A.M.S. Bundle
• Team formation to plan and implement the program
• Excellent communication skills learned
• Assess what’s working and plan to expand
• Meet monthly to learn together
• Sustain efforts and celebrate success
7Using the Toolkit
Toolkit Modules
• Using the Comprehensive Long-Term Care Safety Toolkit
• Senior Leader Engagement
• Staff Empowerment
• Teamwork and Communication
• Resident and Family Engagement
• Sustainability
Note: After a facility’s first implementation of the Long-Term Care Safety Toolkit, modules can be used in any order, depending on the needs of the facility.
8Using the Toolkit
Toolkit Users
• Senior leaders and administrators
– Help teams and staff prioritize improvement efforts
– Provide resources for interventions to succeed
– Maintain an ongoing infrastructure for improvement activities
– Provide opportunities for staff to learn and practice using teamwork and communication tools
• Frontline staff
– Engage with leaders, residents, and families in safety improvement
9Using the Toolkit
• Strategies to get the senior leaders onboard with the program and provide team support from the top down
Senior Leader Engagement
10Using the Toolkit
• Resources and tools to support independent decision making by LTC team members
Staff Empowerment
11Using the Toolkit
• Concepts and tools to improve communication among LTC team members
• Tools for communicating with residents and family members
Teamwork and Communication
12Using the Toolkit
• Methods and tools for working with residents and families to involve them in their care to increase safety, improve satisfaction, and optimize resident outcomes
Resident and Family Engagement
13Using the Toolkit
• Tools and resources to help ensure that positive changes and outcomes are truly embedded into the culture of LTC facilities after the close of the program
Sustainability
14Using the Toolkit
Implementation
• Share videos with teams to spark engagement in staff safety assessments
• Provide templates and discussion guides to project leads
• Educate teams on T.E.A.M.S. and Just Culture
• Use videos and training modules to orient new staff
• Train teams in using teamwork and communication tools
• Engage senior leaders and project champions
15Using the Toolkit
• Senior leader engagement and participation
• High staff turnover
• Staff empowerment
Challenges
16Using the Toolkit
Implementing Change Successfully
• Kotter’s Eight Steps of Change²
• Just Culture principles
Step 1:Step 2:Step 3:Step 4:Step 5:Step 6:Step 7:Step 8:
Create a sense of urgencyCreate a guiding coalitionDevelop a shared visionCommunicate the visionEmpower others to actGenerate short-term winsConsolidate gains and produce more changeAnchor new approaches in culture
17Using the Toolkit
Understanding Just Culture¹
18
18
Understanding Risk and Human Behavior1
Human Error: Inadvertently
completing the wrong action; slip,
lapse, mistake
At-Risk Behavior: Choosing to
behave in a way that increases risk where risk is not recognized, or is
mistakenly believed to be
justified
Reckless Behavior: Choosing to consciously disregard a
substantial and unjustifiable risk
Using the Toolkit
19
Managing Error and Risk¹
Human Error
Product of our current system design and behavioral choices
Manage through changes in:• Choices• Processes• Procedures• Training• Design• Environment
Console
At-Risk Behavior
A choice: risk believed insignificant or justified
Manage through:• Removal of
incentives for at-risk behaviors
• Creation of incentives for healthy behaviors
• Situational awareness
Coach
Reckless Behavior
Conscious disregard of substantial and unjustifiable risk
Manage through:• Remedial action• Punitive action
Punish
Using the Toolkit
20
Leadership’s Role in Just Culture
• Have a procedure in place for employees to follow
• Ensure employees are properly trained
• Offer positive reinforcement at monthly meetings
20Using the Toolkit
21Using the Toolkit
Why Do We Do This Work?
Long-Term Care Safety Tools and Resources
Quality and Safety Tools
• TeamSTEPPS®
• Six Sigma
• Institute for Healthcare Improvement Model for Improvement
• Plan-Do-Study-Act
• Root Cause Analysis
• Failure Mode Effect Analysis
LTC-Specific Resources
• Advancing Excellence in America’s Nursing Homes
• CDC Website for Nursing Homes and Assisted Living
• CMS QAPI - Quality Assurance Performance Improvement
• CMS National Nursing Home Quality Care Collaborative (NNHQCC) Change Package
• Pioneer Network
22• Using the Toolkit
23Using the Toolkit
References
1. Griffith S. Just Culture, Healthcare Services Overview. Outcome Engineering; 2012. https://store.justculture.org/wp-content/uploads/flipbooks/healthcare/healthcare.html
2. Kotter J, Rathgeber H. Our iceberg is melting: Changing and succeeding under any conditions: 1st ed. New York: St. Martin's Press; 2006.
3. Bowers N, Nolet K, Roberts E, et al. Implementing Change in Long-Term Care: A Practical Guide to Transformation. University of Wisconsin–Madison, School of Nursing; 2007. https://www.nhqualitycampaign.org/files/Implementation_Manual_Part_1_Attachments_1_and_2.pdf.
4. Patient and Family Engagement module, CUSP Toolkit. Rockville, MD: Agency for Healthcare Research and Quality; December 2012.http://www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/modules/patfamilyengagement/index.html.