Getting to Zero and Sustaining Success:

The Virginia ExperienceBarbara Brown, Vice President

Virginia Hospital and Healthcare AssociationMay 8, 2012

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Learning Objectives

To understand the challenges and successes the Commonwealth of Virginia experienced during the national collaborative in– Reducing and sustaining its CLABSI rate– Implementing the Comprehensive Unit-based

Safety Program (CUSP)

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Why Virginia?

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• Maintained data submission rates well above others in the project

• Demonstrated sustained drop in CLABSI rates in both its cohorts

• Demonstrated improved adoption of CLABSI reduction strategies and CUSP steps over the course of the project

Virginia and the National Collaborative

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Virginia enrolled units in two cohorts – Cohort 3 (start date: February 2010)– Cohort 6 (start date: March 2011)

Virginia # Hospitals # Units # ICUs % ICUs

Cohort 3 23 36 23 64

Cohort 6 12 22 11 50

National CLABSI Collaborative: Challenges Every State Faced

• Getting the data submitted from your teams– CLABSI data– Team Checkup Tool data

• Reducing CLABSI rates and improving safety depends on– Implementing technical changes – Implementing CUSP to change culture

• Sustainability

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Challenge #1: Data SubmissionVA CLABSI Data Submission, Cohort 3

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Challenge #1: Data SubmissionVA CLABSI Data Submission, Cohort 6

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Challenge #1: Data SubmissionVA TCT Submission, Cohort 3

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Challenge #1: Data SubmissionVA TCT Submission, Cohort 6

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Getting the Data Submitted:How did VA do it?

• Review of care counts submission reports• Follow up with individual teams not submitting• Identification of barriers– Care counts training issues– Staff changes on unit– Not sure how to do Team Checkup Tool

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Challenge #2: Reducing CLABSI RatesVA Cohort 3 CLABSI Rate Down 46%

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Challenge #2: Reducing CLABSI RatesVA Cohort 6 CLABSI Rate Down 27%

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Challenge #2: Rate Up for 2 Quarters; Reducing CLABSI Rates Not Smooth

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Challenge #2: Reducing CLABSI RatesTrend Line Not Smooth

• What worked to get rates back on track?– Identified and contacted “hot spot” units with more

than one CLABSI in the past 6 months (e.g., one unit accounted for 25% of all CLABSI’s in a 6-month look back)

– Encouraged use of Learning from Defects Tool for individual CAUTI events

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Challenge #2: Reducing CLABSI Rates Trend Line Not Smooth (cont.)

• What worked to get rates back on track?– Team presentations of success stories (e.g., changing

physician and nursing behavior)– Looked at Team Checkup Tool data: What does the data

tell us about our technical work with central lines?

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Challenge #2: Reducing CLABSI RatesUsing TCT Data: C3 Technical Work

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Challenge #2: Reducing CLABSI RatesUsing TCT Data: C3 Technical Work

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Challenge #2: Reducing CLABSI RatesUsing TCT Data: Technical Work

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• Data was robust: Excellent Team Checkup Tool submission

• Data was shared on coaching calls• Opportunities were apparent– Avoiding femoral insertion site– Daily rounding for line necessity

Challenge #2: Improving Patient SafetyUsing TCT Data: C3 CUSP Work

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Challenge #2: Improving Patient SafetyUsing TCT Data: CUSP Work

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• Data was robust: Excellent Team Checkup Tool submission

• Data was shared on coaching calls• Teams modeled CUSP on the calls– Shared what defects they identified– Shared how they implemented the Learning from

Defects process– Shared what they learned from drill down

Challenge #2: Improving Patient Safety

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• Examples of team sharing– Encouraging senior exec rounding– Engaging nurses as patient advocates– Educating patients and families re: HAIs in special

populations (e.g., NICU)– Sharing model checklists– Rolling out project across disciplines (med staff,

nursing staff, house officers, med students)

Challenge #2: Improving Patient SafetyCUSP in action

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Team Sharing Example: Shenandoah Hospital’s “Good Catch” Program•Hospital leadership gives “good catch” pins to staff who identify and correct a patient safety near miss– Wrong medication from contract pharmacy caught

before delivery to patient– Wheelchair assists booked in advance for unstable

ambulatory patients– Stretcher-locking mechanism failure noted and

prevented patient fall

Challenge #2: Reducing CLABSI RatesUsing TCT Data: C3 Barriers

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Challenge #2: Reducing CLABSI RatesUsing TCT Data: Barriers

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• Data was robust: Excellent TCT submission• Data was shared on coaching calls• “Barrier breakthroughs” shared– Teams informally shared strategies on calls– Faculty shared tips on calls– Formal presentations by model teams and faculty

to address specific barriers

Challenge # 3: Sustainability:Where do we go from here?

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• Keep CLABSI reduction/patient safety on your radar– Continue calls if possible – Make it easy for teams to stay in touch– Maintain a common site to share best practices,

resources, FAQs, national updates– Continue to share data trends– Fold this work into your other quality/patient safety

meetings (e.g., HEN work)

Challenge # 3: Sustainability:Where do we go from here? (cont.)

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• Remember: CUSP is the foundation that can drive all your improvement initiatives– Not an “add-on” but a way of making care safer – Steps and tools are applicable to any project