Module 1: Using the Comprehensive Long-Term Care Safety Modules: Applying Safety Principles

AHRQ Safety Program for Long-Term Care: HAIs/CAUTI

Slide 1: Module 1: Using the Comprehensive Long-Term Care Safety Modules: Applying Safety Principles

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Slide 2: Objectives

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  • Describe the purpose of the Long-Term Care Safety Modules.
  • Explain how the Long-Term Care Safety Modules support other quality and safety tools.
  • Demonstrate how to apply the Long-Term Care Safety Modules in your facility.

Slide 3: What Is the Purpose of These Modules?

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  • 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).

Slide 4: Why Is Infection Prevention Important?

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Image: Click the video icon to view the video.

PLAY VIDEO:
Video 2.1: Importance of Infection Prevention

Slide 5: Is Your Facility Safe?3

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  • 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?

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.

Slide 6: T.E.A.M.S. Bundle

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  • 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.

Slide 7: Modules

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  • Using the Comprehensive Long-Term Care Safety Modules.
  • 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 Modules, modules can be used in any order, depending on the needs of the facility.

Slide 8: Modules Users

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  • 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.

Slide 9: Senior Leader Engagement

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  • Strategies to get the senior leaders onboard with the program and provide team support from the top down.

Image: It shows leaders and staff around a table.

Slide 10: Staff Empowerment

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  • Resources and tools to support independent decisionmaking by LTC team members.

Image: A toolbox.

Slide 11: Teamwork and Communication

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  • Concepts and tools to improve communication among LTC team members.
  • Tools for communicating with residents and family members.

Image: A gorup of people with a resident in a wheelchair

Slide 12: Resident and Family Engagement

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  • Methods and tools for working with residents and families to involve them in their care to increase safety, improve satisfaction, and optimize resident outcomes.

Image: A group of people with a resident in a wheelchair.

Slide 13: Sustainability

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  • 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.

Image: Two people shaking hands.

Slide 14: Implementation

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  • 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.

Slide 15: Challenges

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  • Senior leader engagement and participation.
  • High staff turnover.
  • Staff empowerment.

Image: 2 people trying to push together 2 puzzle pieces that don't fit together.

Slide 16: Implementing Change Successfully

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  • Kotter's Eight Steps of Change2
    Step 1:
    Step 2:
    Step 3:
    Step 4:
    Step 5:
    Step 6:
    Step 7:
    Step 8:
    Create a sense of urgency
    Create a guiding coalition
    Develop a shared vision
    Communicate the vision
    Empower others to act
    Generate short-term wins
    Consolidate gains and produce more change
    Anchor new approaches in culture
  • Just Culture principles.

Slide 17: Understanding Just Culture1

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Image: Click the video icon to view the video

Video available at Understand Just Culture.

1. Griffith S. Just Culture, Healthcare Services Overview. Outcome Engineering; 2012.

Slide 18: Understanding Risk and Human Behavior1

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  • 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.

1. Griffith S. Just Culture, Healthcare Services Overview. Outcome Engineering; 2012.

Slide 19: Managing Error and Risk1

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Human Error

At-Risk Behavior

Reckless Behavior

Product of our current system design and behavioral choices

Manage through changes in:

  • Choices
  • Processes
  • Procedures
  • Training
  • Design
  • Environment

A choice: risk believed insignificant or justified

Manage through:

  • Removal of incentives for at-risk behaviors
  • Creation of incentives for healthy behaviors
  • Situational awareness

Conscious disregard of substantial and unjustifiable risk

Manage through:

  • Remedial action.
  • Punitive action.

Console

Coach

Punish

1. Griffith S. Just Culture, Healthcare Services Overview. Outcome Engineering; 2012.

Slide 20: Leadership's Role in Just Culture

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  • Have a procedure in place for employees to follow.
  • Ensure employees are properly trained.
  • Offer positive reinforcement at monthly meetings.

Image: Group of people sitting around a table

Slide 21: Why Do We Do This Work?

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Image: Click the video icon to view the video.

PLAY VIDEO:
Video 2.4: Building Safety and Quality into the System

Slide 22: Long-Term Care Safety Tools and Resources

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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

Slide 23: References

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  1. Griffith S. Just Culture, Healthcare Services Overview. Outcome Engineering; 2012.
  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.
Page last reviewed March 2017
Page originally created March 2017
Internet Citation: Module 1: Using the Comprehensive Long-Term Care Safety Modules: Applying Safety Principles. Content last reviewed March 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/implementation/long-term-modules/module1/mod1-slides.html