Staff Safety AssessmentStaff Safety Assessment

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Learning Objectives

• To understand Step 2 of CUSP:Identify Defects

• To understand how to Implement the Staff Safety Assessment

• To understand ways to use results of the Staff Safety Assessment

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Goals

• To identify defects

• To leverage the wisdom of the front line worker

• To prepare a list of improvement opportunities that has face validity and provides a focus for CUSP activities.

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On the CUSP: Stop BSI

CUSP

1. Educate staff on science of safety

2. Identify defects

3. Assign executive to adopt unit

4. Learn from one defect per quarter

5. Implement teamwork tools

CLABSI

1. Remove Unnecessary Lines

2. Wash Hands Prior to Procedure

3. Use Maximal Barrier Precautions

4. Clean Skin with Chlorhexidine

5. Avoid Femoral Lines

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The smaller group that spreads the intervention

to the rest of the unit

The CUSP TeamThe CUSP Team

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Education and engagement activities Education and engagement activities on the uniton the unit

• BSI: Providing Evidence, Modeling the line placement steps; stopping insertions that violate protocol; having one-on-one talks where necessary;

• Facilitating CUSP Activities

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Comprehensive Unit-based Safety Comprehensive Unit-based Safety Program (CUSP)Program (CUSP)

1. Educate staff on science of safety

2. Identify defects

3. Assign executive to adopt unit

4. Learn from one defect per quarter

5. Implement teamwork tools

We are here

You are here!!!

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Identify Defects

• Review error reports, liability claims, sentinel eventsor M and M conference

• Ask staff how the next patient will be harmed

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Identifying Defects

What DO you know?

What SHOULD you know?

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Making project and progress visible to everyone

TransparencyTransparency

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One way to make harm visible-- get staff thinking about safety and how to

improve it

How are We Going to Harm the Next Patient?

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Step 2: Staff Identify Defects

Frontline caregivers are the eyes and ears of patient safety

• Identify clinical or operational problems that negatively impact patient safety (have or could)

• Use the Staff Safety Assessment form (Part of CUSP manual)

– How will the next patient will be harmed in our unit– What can be done to minimize patient harm or prevent this safety

hazard

• ICU managers and team review suggestions, set the agenda for discussion with executive partner

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Appendix C

STAFF SAFETY ASSESSMENT – CUSP

Please describe how you think the next patient in your unit/clinical area will be harmed.

Name (optional): Job Category: Date: Unit:

Please describe what you think can be done to prevent or minimize this harm.

Thank you for helping improve safety in your workplace!

Purpose of this form: The purpose of this form is to tap into your knowledge and experiences at the frontlines of patient care to find out what risks are present on your unit that have or could jeopardize patient safety. Who should complete this form: All health care providers. How to complete this form: Provide as much detail as possible when answering the 2 questions. Drop off your completed safety assessment form in the location designated by the CUSP improvement team with your job category, date and unit in the top box (name is optional). When to complete this form: Assessing safety should be considered an iterative process with no defined end (like a moving bicycle wheel). Thus, it can be filled out by any health care provider at any time. At the very least, all health care providers should complete this form semiannually.

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Step 2: Staff Identify DefectsStep 2: Staff Identify Defects• What Team Leaders need to do:• Hand out a Staff Safety Assessment form to all staff, clinical

and non-clinical, in the unit

• Establish a collection box or envelope

• Identify and group common defects (such as communication, medications, patient falls, supplies, etc.)

• Summarize as frequencies (i.e., what percent of responses were for communication)

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Prioritize DefectsPrioritize Defects

• List all defects

• Discuss with staff what are the three greatest risks

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Step 2: Staff Identify Defects• Report the identified defects to staff, executive

partner

• ICU managers and CUSP team prioritize defects identified by the potential level of risk to the patient

• Select one to work on with support of Executive

• Step 2 should be ongoing

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Appendix D

SAFETY ISSUES WORKSHEET FOR SENIOR EXECUTIVE PARTNERSHIP - CUSP

Date of Safety Rounds: Unit: Attendees: 1. 2. 3. 4. 5. 6. 7. 8. 9. (use back of form for additional attendees)

Identified Issue

Potential/Recommended

Solution

Resources Needed Not

Needed 1.

2.

3.

4.

5.

6.

7.

8.

9.

Copy form if more than 9 safety issues are identified.

Please return this form to your project leader 17

Appendix E

STATUS OF SAFETY ISSUES – CUSP

Unit: ___________________________________________

New and Ongoing Date Safety Issue Contact Status Goal

Completed Date Safety Issue Contact Status Goal

Please return this form to your project leader

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CUSP Team activities-keeping on track

• Team meetings (recommend monthly) • Review of data (monthly)

• Meet w/ Exec Partner (monthly or more)

• Executive review of data (monthly)

• Presentations to hospital colleagues– (leadership, frontline staff, board)

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Comprehensive Unit-based Safety Comprehensive Unit-based Safety Program (CUSP)Program (CUSP)

1. Educate staff on science of safety

2. Identify defects

3. Assign executive to adopt unit

4. Learn from one defect per quarter

5. Implement teamwork tools

We are here

You are here!!!

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What Should you do NOW?What Should you do NOW?CLABSI: Collect & Submit Baseline & Monthly

BSI dataCUSP Preparation: Assemble team/Schedule meetings

CUSP Implementation1) Science of Safety Training for all staff2) Identify Defects: How will patients be

harmed?

www.onthecuspstopbsi.org

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ReferencesReferences• Pronovost PJ, Berenholtz SM, Needham DM. Translating evidence into

practice: A model for large scale knowledge translation. BMJ. 2008; 337:a1714.

• Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. NEJM. 2006; 355(26):2725-2732.

• Pronovost PJ, Berenholtz SM, Goeschel C, et al. Improving patient safety in intensive care units in michigan. J Crit Care. 2008; 23(2):207-221.

• Pronovost P, Weast B, Rosenstein B, et al. Implementing and validating a comprehensive unit-based safety program. J Pat Safety. 2005; 1(1):33-40.

• Pronovost PJ, Weast B, Bishop K, et al. Senior executive adopt-a-work unit: A

model for safety improvement. Jt Comm J Qual Saf. 2004; 30(2):59-68.

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