The Comprehensive Unit-based Safety Program (CUSP) (Text Version)
On September 19, 2011, Melinda Sawyer made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (370 KB). Plugin Software Help.
Slide 1
The Comprehensive Unit-based Safety Program (CUSP)
Melinda Sawyer, RN, MSN, CNS-BC
Armstrong Institute for Patient Safety and Quality
Slide 2
Learning Objectives
- Provide an overview of the CUSP program.
- Describe how CUSP can assist in identifying, investigating, and working toward eliminating system defects.
- List three available teamwork tools.
- Analyze CUSP's impact on the culture of safety.
Slide 3
Images: A toddler and a nurse are shown.
Slide 4
The Vision of CUSP
The Comprehensive Unit-based Safety Program is a safety culture program designed to:
- Educate and improve awareness about patient safety and quality of care.
- Empower staff to take charge and improve safety in their work place.
- Partner units with a hospital executive to improve organizational culture and provide resources for unit improvement efforts.
- Provide tools to investigate and learn from defects.
Slide 5
The Vision of CUSP
In Summary:
CUSP helps establish a safety culture and essentially forms units into clinical communities that share the same values and beliefs around a specific goal, and work to reach this goal.
Slide 6
Where is CUSP?
- Piloted in 2 Intensive Care Units at Johns Hopkins Hospital in 2001:
- In-patient units, outpatient clinics, and procedure areas.
- State-wide collaborative:
- Michigan ICU's (2003).
- Rhode Island (2006).
- Adventist Health System (2006).
- Operating Room Safety Program (2006).
- Michigan Operating Rooms (2007).
- National collaboratives (2009).
- International collaboratives:
- Spain, England, Peru (pilot testing).
Slide 7
Pre CUSP Work
- Create a team:
- At least one nurse, physician, and administrator.
- Assign a team leader.
- Background CUSP Team Information (Appendix A).
- Measure culture of safety.
- Work with hospital quality leader to have a senior executive assigned to team.
CUSP Toolkit, http://www.safercare.net/OTCSBSI/Resources.html
Slide 8
CUSP: 5 Steps
- Educate staff on science of safety.
- Identify defects.
- Assign executive to adopt unit.
- Learn from one defect per quarter.
- Implement teamwork tools.
Pronovost J. Patient Safety, 2005
CUSP Toolkit, http://www.safercare.net/OTCSBSI/Resources.html
Slide 9
Step 1: Science of Safety Education
- Understand the system determines performance.
- Use strategies to improve system performance:
- Standardize.
- Create independent checks for key process.
- Learn from mistakes.
- Apply strategies to both technical work and team work.
- Recognize teams make wise decisions with diverse and independent input.
http://www.safercare.net/OTCSBSI/Staff_Training/Staff_Training.html
Slide 10
Step 2: Identify Defects
- Ask staff how will the next patient be harmed and what we can do to mitigate that harm:
- Staff Safety Assessment (Appendix C).
- Review error reports, liability claims, sentinel events or M & M conference.
Slide 11
Step 3: Executive Partnership
- Executive should become a member of team.
- Executive should meet monthly with team.
- Executive should:
- Review defects.
- Help prioritize defects.
- Ensure the teams has resources to reduce risks.
- Hold team accountable for improving risks.
Slide 12
Prioritize Defects
- List all defects.
- Discuss with staff what are the three greatest risks.
- Identify if resources are needed:
- Select 3 that require resources and 3 that do not.
- Executive should assist/lead this process:
- Safety issues Worksheet for Senior Executive Partnership (Appendix D).
Slide 13
Step 4: Learn from Defects
- What happened?
- Why did it happen (system lenses)?
- What could you do to reduce risk?
- What specific interventions will you do to reduce risk?
- Identify a metric to know if risk is reduced.
- How do you know risk was reduced?
- Ask frontline staff.
- Use Learning from Defects Tool (Appendix G).
Pronovost 2005 JCJQI
Slide 14
Step 5: Implement Teamwork Tools
- Implement tools that are intended to support teamwork behaviors:
- Daily goals (Appendix H).
- AM briefing (Appendix I).
- Shadowing another professional (Appendix K).
- Culture check up (Appendix L).
- Call list (Appendix M).
Slide 15
Identified concern from Staff Safety Assessment (CUSP Step 2) | Recommended Improvements (CUSP Steps 4 & 5) Interventions Implemented |
---|---|
Risk of central line associated bloodstream infections | Make sure best practices are used for all central lines insertions. A line cart and checklist is used for all central lines insertions. |
Risk of central line associated bloodstream infections due to poor compliance with IV tubing changes | Make sure every central line IV tubing is changed according to best practice. New IV tubing labeling system used. |
Risk of medication errors | Point of care pharmacist available on units Pharmacist assigned |
Poor management of pain | Create guideline or protocol for pain assessment and management Pain card at every bedside |
Poor communication among ICU providers | Create Short Term “Daily” Goals Sheet Short term goals sheet used during rounds |
Poor communication during ICU discharge leading to medication errors in transfer orders | Implement medication reconciliation process at ICU discharge Medication reconciliation done at discharge |
Slide 16
Safety Climate—Culture of Safety Survey
An image of a graph titled: Safety Climate—Culture of Safety Survey" is shown. It shows the percent of respondents within an ICU reporting good safety climate. There are 5 places highlighted: 1. WICU PreCUSP (35%); 2. SICU Pre CUSP (35%); 3. WICU Post CUSP (45%); 4. SICU Post CUSP and SICU Time (58% and 60%); and 5. WICU Time 3 (88%).
Slide 17
Culture of Safety—WICU/SICU
Questions | Relative % Increase Before vs After Program |
---|---|
1. The senior leaders in my hospital listen to me and care about my concerns. | 22 |
2. The physicians and nurse leaders in my area listen to me and care about my concerns. | 30 |
3. My suggestions about safety would be acted upon if I expressed them to management. | 30 |
4. Management/Leadership will never compromise safety concerns for productivity. | 22 |
5. I am encouraged by my supervisors and coworkers to report any unsafe conditions I observe. | 32 |
Slide 18
Culture of Safety—WICU/SICU
Questions | Relative % Increase Before vs After Program |
---|---|
6. I know the proper channels to report my safety concerns. | 30 |
7. I am satisfied with availability of clinical leadership (MD, RN, RPh). | 44 |
8. Leadership is driving us to be a safety-centered institution. | 35 |
9. I am aware that patient safety has become a major area for improvement in my institution. | 30 |
10. I believe that most adverse events occur as a result of multiple system failures, and are not attributable to one individual's actions. | 34 |
Slide 19
CUSP is a Continuous Journey
- CUSP is a marathon not a sprint.
- Ask staff at least every six months how the net patient is going to be harmed and invest the time and resources to reduce this harm.
- Learn from one defect per quarter and share lessons learned.
- Implement teamwork tools that best meet the teams needs.
Slide 20
Questions?
Image: A toddler and a nurse are shown.