Got culture change? CUSP teams can transform paitent safety

January 12th, 2015

The Agency for Healthcare Research and Quality (AHRQ) has created a website with a wealth of tools to help hospitals set up the Comprehensive Unit-based Safety Program (CUSP). Front-line users that have implemented CUSP say they not only reduced infections, but dramatically transformed their overall patient safety culture.

While a proven method to reduce central line associated bloodstream infections (CLABSIs), CUSP is adaptable to various projects and can also be used to prevent non-infectious adverse events. It combines clinical best practices with an understanding of the science of safety, improved safety culture, and an increased focus on teamwork.

“It is essentially a multipronged quality improvement program, and very importantly it is customizable and self-paced,” said Carolyn M. Clancy, MD, director of AHRQ. “It includes instructive guides, presentation materials, and implementation tools such as checklists and videos that demonstrate desired behaviors. As a physician myself, I need to point out that the toolkit was developed by clinicians for clinicians.”

Team building is a critical part of the program, as health care workers are empowered to work for positive change in ways that may break down some of the traditional roles in medicine. The key CUSP team members—nurses, physicians, and senior executives—can ensure that the initiative is implemented on the frontlines and given adequate resources. However, input and involvement from other hospital specialists is then needed to guarantee efficient use of the CUSP initiative at the unit level.

According to AHRQ, these members include:

• Infection preventionists,
• Medical directors,
• Pharmacists,
• Respiratory therapists,
• Patient safety officers,
• Chief quality officers
• Ancillary or support staff.

“The CUSP team is a concept really -- it is not necessarily a list of people,” Michael Tooke, MD, chief medical officer at Memorial Hospital in Easton, MD said. “When you put in a central line, at any given point in time, the team is an entirely different set of people because it depends on who is on duty. On the other hand, our ventilator-associated pneumonia [prevention] effort team is a multispecialty group that makes rounds in our ICU twice a day. So that team is pretty much is the same people. They make rounds and make sure that the ventilator care is appropriate.

“ Urinary catheters are all through the hospital. So you have a [CAUTI prevention] team at one level -- say overall the nursing and medical staff -- but then each unit has a team. The unit nurse mangers make sure the protocol for getting Foley catheters out is the same. The team is set up depending on where it is, the breadth of the intervention, and who’s there the day that the device or the intervention is [maintained or ] put into place,” he added