Iowa’s Waverly Health Center Uses AHRQ Tools to Improve Patient Safety

Waverly Health Center, a critical access hospital in Waverly, Iowa, has used three AHRQ resources to improve communication, teamwork, and leadership engagement as part of ongoing efforts to increase patient safety. The AHRQ resources are:

• Comprehensive Unit-based Safety Program (CUSP), an evidence-based method that helps clinical teams address safety issues by combining clinical best practices and the science of safety.
• TeamSTEPPS®, an evidence-based patient safety training program developed by AHRQ and the Department of Defense to improve communication and teamwork skills among health care professionals.
• Hospital Survey on Patient Safety Culture, a standardized survey that assesses staff perspectives on patient safety issues, medical errors, and event reporting.

"Although our hospital's rate of central line-associated bloodstream infections (CLABSI) was already zero when the Iowa Hospital Association invited us to participate in CUSP in 2011, we saw that CUSP aligned with our safety improvement needs and nursing excellence strategic plan," said Iris Vering, M.S., Waverly's director of quality services.

"The hospital's nursing initiatives sought to reduce infections to no more than one per 1,000 catheter days by 2013 or within a year of implementation," explained Cathy Wilson-Sands, M.S.N., R.N., associate director of nursing practice.

The CUSP method was implemented smoothly since the hospital already had most evidence-based practices in place. "We had support and staff buy-in from the beginning," noted Ms. Vering.

One CUSP tool Waverly found most useful is the "Learn From Defects Tool," which helps reduce incidents that could put patients at risk. The evidence-based practices for peripherally inserted central catheter (PICC) lines, a procedure that causes high rates of hospital infection, have also proven beneficial. Waverly’s CUSP team developed a checklist for PICC line insertions.

For 2014, the hospital had saved approximately $605,000 with system improvements related to its infection prevention program, according to Ms. Vering. As of early 2015, the hospital's CLABSI rate remained at zero.

About the same time CUSP was being implemented, AHRQ's TeamSTEPPS program was rolled out.

"TeamSTEPPS improved the hospital's communication techniques, enhancing some existing communication methods, and offering new ones, as well as improving safety," Ms. Wilson-Sands noted.

Waverly created teams and participated in AHRQ-sponsored training to implement both CUSP and TeamSTEPPS. The CUSP team was composed of eight individuals representing nursing, infection prevention, quality services, administration, and physicians. TeamSTEPPS trainers included three nurses and one nonclinical staff member.

"Since TeamSTEPPS was regarded as important hospital-wide, the training offered to clinical and nonclinical staff was identical. Approximately 97 percent of staff—412 individuals—have been trained in TeamSTEPPS," noted Pamela Brahn, B.S.N., R.N., education specialist.

Before the TeamSTEPPS implementation, AHRQ's Hospital Survey on Patient Safety Culture was administered as a benchmark measure to all staff delivering care on the medical-surgical unit. The survey is now conducted every two years. A 2012 survey conducted after implementation of the AHRQ resources showed the measure for "Improvement in Feedback and Communication About Error" increased from 58 to 66 percent, while "Communication Openness" improved from 51 to 58 percent.