INTERNAL INFORMATION | CONFIDENTIAL

Stop Central Line Associated Blood Stream Infection (caBSI)

Tufts Experience with Benefits of CUSP 2009 - 2010

Objectives

Review the purpose of the ICU Comprehensive Unit-Based Safety Program/CLABSI Initiative. Understand how your ICU and your hospital will benefit from participation.

Build the skills of physicians, nurses, and other care team to improve teamwork and build a safety culture.

Engage in discussion with national experts on best practices in reducing infections, preventing central line infections

Stop Central Line Associated Blood Stream Infection (caBSI) Team Structure, CUSP 2009- 2010

MEMBERSHIP DEPARTMENT

Margaret Vosburgh, COO Executive Sponsor

•Dorothy Didomenico RN •Clinical Educator, CCU CMC

•Shira Doron MD •Infectious Disease

•Terry Hudson-Jinks RN •Patient Care Services/Nursing

•Erik Garpestad MD •Medical Director MICU

•Tricia Lemon, RN •Infection Prevention/Quality and Patient Safety

Benefits of CUSP at TuftsLooking back

2007 – 2009 Much emphasis placed on development of best practice policy and guidelines

for caBSI elimination with a focus on: Standardizing Insertion Standardizing maintenance

caBSI remained an issue, with slight increase in rate

Fall 2009 Commitment by Senior Leadership to eliminate Hospital Acquired Infections Infection Prevention Priority Initiatives defined

CaBSI CaUTI VAP

CEO support of Tufts participation with MHA CUSP October 2009:8 Member Tufts Team attended CUSP Kick Off

Benefits of CUSP at TuftsLooking back

Benefits of CUSP:

Provided the framework to align Senior Executives with clinicians in the goal for patient safety

Validated key aspects of Tufts Policy Provided leverage Frameworks, tool kits, informational sources, rich in details necessary to make

key decisions, and the power to let go of old practices. Blood Cultures Goal Sheet Clave use Dressing and line protocols CHG bathing/Elimination of wash basins

Network of experts within and beyond New England with key first hand learning experiences.

Assisted in disbanding belief that patients are too ill, elimination not possible. Provided a competitive spirit, energizing

Benefits of CUSP at TuftsLooking back

Benefits of CUSP:

Stimulated creativity Insertion Shadow Paging Email site: nolineinfections!@tuftsmedicalcenter.org

Unified members at the bedside for common goal

Challenges along the way Eliminating previous practices, individual beliefs, reservations

Example CHG Bathing, CCU

Goal Sheet Example MICU Experience

Adult Critical Care Daily Checklist Date: _______________

Systems Plan Notes

Neuro & Pain Is pain controlled? □Yes □No What is this patients Delirium Score? _______ Daily Awakening Protocol? Y/NContraindication to weaning sedation (active seizures or ↑ICP, neuromuscular blockade,

active myocardial ischemia, acute alcohol withdrawal, high frequency oscillatory ventilation)?

□ Yes □ NoResults ____________________________

Respiratory □ Ventilator Bundle □ HOB↑ 30° □ Mouth care Q4° □ GI prophylaxis □ DVT prophylaxis □Daily assessment of readiness to wean SBT Y/N Results_________________Contraindication to vent wean? □Yes □No □N/A

Cardiovascular Goal for fluid balance within the next 8 hours 12 hours CVP Target_________ 24 hours+ ____cc - _____cc

Assessment of medical necessity

Central lines Type _____□ Continue □ Discontinue □ N/AType _____□ Continue □ Discontinue □ N/A

Day # __________Day # __________

Arterial line □ Continue □ Discontinue □ N/A Day # __________

Urinary Catheter □ Continue □ Discontinue □ N/A Day # __________

Restraints □ Continue □ Discontinue □ N/A□ Order written

Day # __________

Antimicrobials Drug __________________________□ Continue □ Discontinue □ N/ADrug __________________________□ Continue □ Discontinue □ N/A

Day # __________Day # __________

Target date of transfer _____ Med/Surg/ Tele______Intermediate Care _______

Major Daily Goals for Patient: ICU

Patient Initials_____________ Date ________

Goal done?

1.

2.

3.

4.

5.

Daily checks:SBT performed? Yes ___ No ___ Patient not eligible ___

Daily Awakening performed? Yes ___ No ___ Patient not eligible ___Central Venous Catheter needed? Yes ___ No ___

Foley Catheter needed? Yes____ No _____ Not part of permanent medical record. Please do no file in chart

Benefits of CUSP at TuftsLooking back

What would help teams succeed in doing this?

Diverse team membership Open mind, willingness to provide care differently Sense of Team Humility Strong support of CEO, CMO, CNO

Benefits of CUSP at TuftsLooking back

What was it like to participate

Compliance enhanced with structured timelines and guidelines Ability to ask questions from Peer Institutions Find new passionate leaders among staff Inspiration to target large issues Sense of accomplishment with improved outcomes

CaBSI FY 2009 – FY 2010 YTD Adult Critical Care, CUSP Units

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2010 Adult ICUs 2009 Adult ICU

Objectives

Review the purpose of the ICU Comprehensive Unit-Based Safety Program/CLABSI Initiative. Understand how your ICU and your hospital will benefit from participation.

Build the skills of physicians, nurses, and other care team to improve teamwork and build a safety culture.

Engage in discussion with national experts on best practices in reducing infections, preventing central line infections