comprehensive unit safety program (cusp)
DESCRIPTION
Comprehensive Unit Safety Program (CUSP). Teamwork Tools. David Thompson DNSc , MS, RN Kristina Weeks, MHS, DrPh (c) . Steps of CUSP. Pronovost J, Patient Safety , 2005. 1. Educate staff on Science of Safety 2. Identify defects 3. Assign executive to adopt unit - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/1.jpg)
Comprehensive Unit Safety Program (CUSP)
David Thompson DNSc, MS, RNKristina Weeks, MHS, DrPh(c)
Teamwork Tools
![Page 2: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/2.jpg)
2
Steps of 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 Pronovost J, Patient Safety, 2005
![Page 3: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/3.jpg)
3
You got a problem, we’ve got an app for that
• https://armstrongresearch.hopkinsmedicine.org/csts/cusp/resources.aspx
![Page 4: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/4.jpg)
Learning from Defects
Joint Commission Journal Quality & Safety Feb 2006
• What happened?• Why?• What will you do to reduce probability that it
will happen again?• How do you know risk is reduced?• Share your learning throughout organization
![Page 5: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/5.jpg)
Learning
• Invite all who touch process to attend• Learn deeply from smaller number, rather
than “re-educate” staff on a large number• Learn at different levels
– System/hospital: one per quarter– Department: one per quarter– Nursing unit: one per month
• Share your learning throughout organization
![Page 6: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/6.jpg)
6
Familiarity with others is a critical component of effective teamwork:
• 74% of all commercial aviation accidents happen on the first day of a team flying together
• Familiarity trumps fatigue• Highlights the importance of predictable
patterns of behavior
![Page 7: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/7.jpg)
7
Intensive Care Unit (ICU) and Inpatient unitsDaily Goals
![Page 8: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/8.jpg)
9
Background
• Communication defects common• People and organizations who create explicit
goals achieve more than those who do not• Rounds generally patient rather than provider
centered
![Page 9: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/9.jpg)
10
ICU Physicians and ICU RN Collaboration
51%
88%
0
10
20
30
40
50
60
70
80
90
100
K P L &D
RN rates ICU Physician ICU Physician rates RN
% o
f res
pond
ents
repo
rting
abo
ve a
dequ
ate
team
work
![Page 10: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/10.jpg)
11
Percent Understanding Patient Care Goals
00.10.20.30.40.50.60.70.80.9
1
1 2 3 4 5 6
ResidentsNurses
Implemented patientgoals sheet
J Crit Care 2003,18, 71-75
![Page 11: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/11.jpg)
12
Impact on ICU Length of Stay
0
0.5
1
1.5
2
2.5
Avg
. LO
S (d
ays)
ICU LOS
Daily Goals
654 New Admissions: 7 Million Additional Revenue
![Page 12: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/12.jpg)
13
Thoughts for Daily Goals
• Leading question: Why is patient in ICU?• Save teaching for a separate session (avoid
pontification)• Fellow/resident wrote note on each patient
daily before attending reached patient for rounds – need to summarize this and convert into the work for the patient
![Page 13: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/13.jpg)
14
How to use daily goals form?
• Be explicit• Ask the Important questions
– What needs to be done for discharge– Safety risk– Scheduled labs
• Completed on rounds• Stays with bedside nurse• Modify to fit your hospital
![Page 14: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/14.jpg)
17
Conducting a Morning Briefing (ICU)Conducting a Morning Huddle (OR)
Improving Situational Awareness by
![Page 15: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/15.jpg)
18
Situation AwarenessAn Overview
• Members of the team have and understanding of “what’s going on” and “what is likely to happen next”
• Teams are alert to developing situations, sensitive to cues and aware of their implications.
![Page 16: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/16.jpg)
20
Briefing Defined
What a Briefing immediately does? 1. Map out the plan of care. 2. Identify Roles and Responsibilities for each team
member.3. Heightens awareness of the situation. 4. Allows the team to plan for the unexpected.5. Team members needs, and expectations are met.
A briefing is a discussion between two or more people, often a team, using succinct information
pertinent to an event.
![Page 17: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/17.jpg)
22
Morning Briefing Process
Three simple questions1. What happened overnight that I need to
know about? 2. Where should I begin rounds? 3. Do you anticipate any potential defects
in the day?
![Page 18: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/18.jpg)
23
What happened overnight that I need to know about?
• You should be thinking about…Was there adequate coverage?
• Were there any equipment issues?• Were cases posted to the ICU?• Unexpected changes in patient acuity?• Were there any adverse events?
![Page 19: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/19.jpg)
24
Where Should Rounds Begin?
1. Is there a patient who requires my immediate attention secondary to acuity?
2. Which patients do you believe will be transferring out of the unit today?
3. Who has discharge orders written?
![Page 20: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/20.jpg)
25
As you continue planning rounds
4. How many admissions are planned today?5. What time is the first admission?6. How many open beds do we have?7. Are there any patient having problems on an
inpatient unit?
![Page 21: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/21.jpg)
26
Do you anticipate any potential defects in the day?
• Patient scheduling• Equipment availability/ problems• Outside Patient testing/Road trips• Physician or nurse staffing• Provider skill mix
![Page 22: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/22.jpg)
28
Shadowing another Provider
![Page 23: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/23.jpg)
29
Why do we need to Follow?
To gain perspective of the other providers• Practice, • Responsibilities, • Work environment,To identify issues that effect teamwork and
communication that may impact patient care and patient outcomes.
![Page 24: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/24.jpg)
30
Who should have this experience?
• Patient care areas as part of the Comprehensive Unit Based Safety Program (CUSP)
• When there is a difference of > 20% in SAQ scores between provider types.
• As part of orientation to a new unit• Units with little collaboration between
disciplines.
![Page 25: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/25.jpg)
31
Preparing to Follow
• Review the tool prior to your shadowing experience
• Follow your health care provider through their daily activities.
• Review your list of communication and teamwork problems
• Discuss with the Provider• Make a plan for resolution
![Page 26: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/26.jpg)
32
Our Findings
• Handoffs for 4 hour shifts not thorough, increased opportunity to forget key details as this increased the total number of people…
• Physician consults usually obtained but not always read by the requesting team…
• Nurse often most informed team member on the patient’s plan of care but does not always speaks up
![Page 27: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/27.jpg)
34
A fly on the WallObserving Rounds
![Page 28: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/28.jpg)
35
Observe and don’t participate
• A method to add structure to interdisciplinary rounds.
• Improve collaboration and identify communication defects.
• Can be done by any discipline.• Should be debriefed with the team
afterwards.
![Page 29: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/29.jpg)
36
Setting priorities for improving the culture in your unit.
Culture Check up Tool
![Page 30: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/30.jpg)
37
Prioritize your weak areas
• Pick the 3 lowest values from you HSOPS• Identify a plan to address those areas where
improvement is needed. • Remember you are looking to improve your
scores to the 75 percentile.• Implement your strategy and reassess after
the next HSOPS survey.
![Page 31: Comprehensive Unit Safety Program (CUSP)](https://reader036.vdocuments.net/reader036/viewer/2022062411/56816696550346895dda7d7e/html5/thumbnails/31.jpg)
38
Questions?