AHRQ Safety Program for LongTerm Care HAIsCAUTI LongTerm

AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules Module 1: Using the Comprehensive Long-Term Care Safety Modules: Applying Safety Principles AHRQ Pub. No. 16(17)-0003 -03 -EF March 2017

Objectives • Describe the purpose of the Long-Term Care Safety Modules • Explain how the Long-Term Care Safety Modules support other quality and safety tools • Demonstrate how to apply the Long-Term Care Safety Modules in your facility AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules Applying Safety Principles | 2

What Is the Purpose of These Modules? • Improve safety culture in LTC facilities • Support other quality improvement and safety initiatives in facilities • Supplement technical interventions to reduce healthcare-associated infections, including catheterassociated urinary tract infections (CAUTIs) AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules Applying Safety Principles | 3

Why Is Infection Prevention Important? PLAY VIDEO: Video 2. 1: Importance of Infection Prevention - https: //youtu. be/Rbl. Xy. SGGKG 8 AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules Applying Safety Principles | 4

Is Your Facility Safe? 3 • Would you want a loved one to be a resident at your facility? • Would you want to be a resident in your facility? • Can you say with 100 percent certainty that your facility does everything it can to protect its residents? • How do you think the next resident could be harmed in your facility? AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules Applying Safety Principles | 5

T. E. A. M. S. Bundle • Team formation to plan and implement the program • Excellent communication skills learned • Assess what’s working and plan to expand • Meet monthly to learn together • Sustain efforts and celebrate success AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules Applying Safety Principles | 6

Modules • Using the Comprehensive Long-Term Care Safety Modules • Senior Leader Engagement • Staff Empowerment • Teamwork and Communication • Resident and Family Engagement • Sustainability • Note: After a facility’s first implementation of the Long-Term Care Safety Modules, modules can be used in any order, depending on the needs of the facility. AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules Applying Safety Principles | 7

Modules Users • Senior leaders and administrators • Help teams and staff prioritize improvement efforts • Provide resources for interventions to succeed • Maintain an ongoing infrastructure for improvement activities • Provide opportunities for staff to learn and practice using teamwork and communication tools • Frontline staff • Engage with leaders, residents, and families in safety improvement AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules Applying Safety Principles | 8

Senior Leader Engagement • Strategies to get the senior leaders onboard with the program and provide team support from the top down AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules Applying Safety Principles | 9

Staff Empowerment • Resources and tools to support independent decisionmaking by LTC team members AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules Applying Safety Principles | 10

Teamwork and Communication • Concepts and tools to improve communication among LTC team members • Tools for communicating with residents and family members AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules Applying Safety Principles | 11

Resident and Family Engagement • Methods and tools for working with residents and families to involve them in their care to increase safety, improve satisfaction, and optimize resident outcomes AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules Applying Safety Principles | 12

Sustainability • Tools and resources to help ensure that positive changes and outcomes are truly embedded into the culture of LTC facilities after the close of the program AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules Applying Safety Principles | 13

Implementation • Share videos with teams to spark engagement in staff safety assessments • Provide templates and discussion guides to project leads • Educate teams on T. E. A. M. S. and Just Culture • Use videos and training modules to orient new staff • Train teams in using teamwork and communication tools • Engage senior leaders and project champions AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules Applying Safety Principles | 14

Challenges • Senior leader engagement and participation • High staff turnover • Staff empowerment AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules Applying Safety Principles | 15

Implementing Change Successfully • Kotter’s Eight Steps of Change² Step 1: Step 2: Step 3: Step 4: Step 5: Step 6: Step 7: Step 8: Create a sense of urgency Create a guiding coalition Develop a shared vision Communicate the vision Empower others to act Generate short-term wins Consolidate gains and produce more change Anchor new approaches in culture • Just Culture principles AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules Applying Safety Principles | 16

Understanding Just Culture 1 Video available at http: //www. ahrq. gov/professionals/education/curriculumtools/cusptoolkit/videos/07 a_just_culture/index. html. AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules Applying Safety Principles | 17

Understanding Risk and Human Behavior 1 Human Error: Inadvertently completing the wrong action; slip, lapse, mistake AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules At-Risk Behavior: Choosing to behave in a way that increases risk where risk is not recognized, or is mistakenly believed to be justified Reckless Behavior: Choosing to consciously disregard a substantial and unjustifiable risk Applying Safety Principles | 18

Managing Error and Risk 1 Human Error At-Risk Behavior Reckless Behavior Product of our current system design and behavioral choices A choice: risk believed insignificant or justified Conscious disregard of substantial and unjustifiable risk Manage through changes in: • Choices • Processes • Procedures • Training • Design • Environment Manage through: • Removal of incentives for at-risk behaviors • Creation of incentives for healthy behaviors • Situational awareness Console AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules Coach Manage through: • Remedial action • Punitive action Punish Applying Safety Principles | 19

Leadership’s Role in Just Culture • Have a procedure in place for employees to follow • Ensure employees are properly trained • Offer positive reinforcement at monthly meetings AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules Applying Safety Principles | 20

Why Do We Do This Work? PLAY VIDEO: Video 2. 4: Building Safety and Quality into the System - https: //youtu. be/vx 8 n 8 g 3 c 0 y. A AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules Applying Safety Principles | 21

Long-Term Care Safety Tools and Resources Quality and Safety Tools LTC-Specific Resources • Team. STEPPS® • Six Sigma • Institute for Healthcare Improvement Model for Improvement • Plan-Do-Study-Act • Root Cause Analysis • Failure Mode Effect Analysis • Advancing Excellence in America’s Nursing Homes • CDC Website for Nursing Homes and Assisted Living • CMS QAPI - Quality Assurance Performance Improvement • CMS National Nursing Home Quality Care Collaborative (NNHQCC) Change Package • Pioneer Network AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules Applying Safety Principles | 22

References 1. Griffith S. Just Culture, Healthcare Services Overview. Outcome Engineering; 2012. https: //store. justculture. org/wpcontent/uploads/flipbooks/healthcare. html 2. Kotter J, Rathgeber H. Our iceberg is melting: Changing and succeeding under any conditions: 1 st ed. New York: St. Martin's Press; 2006. 3. Bowers N, Nolet K, Roberts E, et al. Implementing Change in Long-Term Care: A Practical Guide to Transformation. University of Wisconsin–Madison, School of Nursing; 2007. https: //www. nhqualitycampaign. org/files/Implementation_M anual_Part_1_Attachments_1_and_2. pdf. AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Long-Term Care Safety Modules Applying Safety Principles | 23