Transcript Stop Central Line Infections - Massachusetts Coalition for the

Stop Central Line Associated Blood Stream Infection
(caBSI)
Tufts Experience with Benefits of CUSP 2009 - 2010
INTERNAL INFORMATION | CONFIDENTIAL
Objectives
 Review the purpose of the ICU Comprehensive
Unit-Based Safety Program/CLABSI Initiative.
Understand how your ICU and your hospital will
benefit from participation.
 Build the skills of physicians, nurses, and other
care team to improve teamwork and build a
safety culture.
 Engage in discussion with national experts on
best practices in reducing infections, preventing
central line infections
Stop Central Line Associated Blood Stream Infection (caBSI)
Team Structure, CUSP 2009- 2010
MEMBERSHIP
DEPARTMENT
Margaret Vosburgh, COO
Executive Sponsor
•Dorothy Didomenico RN
•Clinical Educator, CCU CMC
•Shira Doron MD
•Infectious Disease
•Terry Hudson-Jinks RN
•Patient Care Services/Nursing
•Erik Garpestad MD
•Medical Director MICU
•Tricia Lemon, RN
•Infection Prevention/Quality and Patient Safety
Benefits of CUSP at Tufts
Looking back
 2007 – 2009

Much emphasis placed on development of best practice policy and guidelines
for caBSI elimination with a focus on:
 Standardizing Insertion
 Standardizing maintenance

caBSI remained an issue, with slight increase in rate
 Fall 2009
 Commitment by Senior Leadership to eliminate Hospital Acquired Infections

Infection Prevention Priority Initiatives defined
 CaBSI
 CaUTI
 VAP
CEO support of Tufts participation with MHA CUSP
 October 2009:8 Member Tufts Team attended CUSP Kick Off

Benefits of CUSP at Tufts
Looking back
 Benefits of CUSP:
Provided the framework to align Senior Executives with clinicians in the goal
for patient safety
 Validated key aspects of Tufts Policy
 Provided leverage
 Frameworks, tool kits, informational sources, rich in details necessary to make
key decisions, and the power to let go of old practices.

 Blood Cultures
 Goal Sheet
 Clave use
 Dressing and line protocols
 CHG bathing/Elimination of wash basins
Network of experts within and beyond New England with key first hand
learning experiences.
 Assisted in disbanding belief that patients are too ill, elimination not possible.
 Provided a competitive spirit, energizing

Benefits of CUSP at Tufts
Looking back
 Benefits of CUSP:

Stimulated creativity
 Insertion Shadow Paging
 Email site: [email protected]

Unified members at the bedside for common goal
 Challenges along the way

Eliminating previous practices, individual beliefs, reservations
 Example CHG Bathing, CCU

Goal Sheet
 Example MICU Experience
Adult Critical Care Daily Checklist
Date: _______________
Systems
Plan
Neuro & Pain
Is pain controlled? □Yes □No
What is this patients Delirium Score? _______
Daily Awakening Protocol? Y/N
Contraindication to weaning sedation (active seizures or ↑ICP, neuromuscular blockade, active
myocardial ischemia, acute alcohol withdrawal, high frequency oscillatory ventilation)?
□ Yes
□ No
Results ____________________________
Respiratory
□ Ventilator Bundle
□ HOB↑ 30°
□ Mouth care Q4°
□ GI prophylaxis
□ DVT prophylaxis
□Daily assessment of readiness to wean
SBT Y/N
Results_________________
Contraindication to vent wean? □Yes □No □N/A
Cardiovascular
Goal for fluid balance within the next
 8 hours
 12 hours
CVP Target_________
 24 hours
+ ____cc
 - _____cc
Notes
Assessment of medical necessity
Central lines
Type _____
□ Continue □ Discontinue
Type _____
□ Continue □ Discontinue
□ N/A
Day # __________
Day # __________
□ N/A
Arterial line
□ Continue
□ Discontinue
□ N/A
Day # __________
Urinary Catheter
□ Continue
□ Discontinue
□ N/A
Day # __________
Restraints
□ Continue □ Discontinue
□ Order written
□ N/A
Day # __________
Antimicrobials
Drug __________________________
□ Continue □ Discontinue □ N/A
Drug __________________________
□ Continue □ Discontinue □ N/A
Day # __________
Day # __________
Target date of transfer
_____ Med/Surg/ Tele
______Intermediate Care _______
Major
Daily Goals for Patient: ICU
Patient Initials_____________ Date ________
Goal done?

1.
2.
3.
4.
5.
Daily checks:
SBT performed?
Yes ___ No ___ Patient not eligible ___
Daily Awakening performed?
Yes ___ No ___ Patient not eligible ___
Central Venous Catheter needed?
Yes ___ No ___
Foley Catheter needed?
Yes____ No _____
Not part of permanent medical record. Please do no file in chart
Benefits of CUSP at Tufts
Looking back
What would help teams succeed in doing this?
 Diverse team membership
 Open mind, willingness to provide care differently
 Sense of Team
 Humility
 Strong support of CEO, CMO, CNO
Benefits of CUSP at Tufts
Looking back
What was it like to participate
 Compliance enhanced with structured timelines and guidelines
 Ability to ask questions from Peer Institutions
 Find new passionate leaders among staff
 Inspiration to target large issues
 Sense of accomplishment with improved outcomes
2010 Adult ICUs
2009 Adult ICU
August
June
April
February
December
October
CaBSI FY 2009 – FY 2010 YTD Adult Critical Care, CUSP Units
Objectives
 Review the purpose of the ICU Comprehensive
Unit-Based Safety Program/CLABSI Initiative.
Understand how your ICU and your hospital will
benefit from participation.
 Build the skills of physicians, nurses, and other
care team to improve teamwork and build a
safety culture.
 Engage in discussion with national experts on
best practices in reducing infections, preventing
central line infections