AHRQ Safety Program For Long-Term Care: HAIs/CAUTI

Module 1: Using the Comprehensive Long-Term Care Safety Toolkit:

Applying Safety Principles

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Objectives

• Describe the purpose of the Long-Term Care Safety Toolkit

• Explain how the Long-Term Care Safety Toolkit supports other quality and safety tools

• Demonstrate how to apply the Long-Term Care Safety Toolkit in your facility

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What Is the Purpose of This Toolkit?

• Improve safety culture in LTC facilities

• Support other quality improvement and safety initiatives in facilities

• Supplement technical interventions to reduce healthcare-associated infections, including catheter-associated urinary tract infections (CAUTIs)

Using the Toolkit

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Why Is Infection Prevention Important?

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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?

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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

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Toolkit Modules

• Using the Comprehensive Long-Term Care Safety Toolkit

• 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 Toolkit, modules can be used in any order, depending on the needs of the facility.

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Toolkit 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

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• Strategies to get the senior leaders onboard with the program and provide team support from the top down

Senior Leader Engagement

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• Resources and tools to support independent decision making by LTC team members

Staff Empowerment

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• Concepts and tools to improve communication among LTC team members

• Tools for communicating with residents and family members

Teamwork and Communication

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• Methods and tools for working with residents and families to involve them in their care to increase safety, improve satisfaction, and optimize resident outcomes

Resident and Family Engagement

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• 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

Sustainability

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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

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• Senior leader engagement and participation

• High staff turnover

• Staff empowerment

Challenges

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Implementing Change Successfully

• Kotter’s Eight Steps of Change²

• Just Culture principles

Step 1:Step 2:Step 3:Step 4:Step 5:Step 6:Step 7:Step 8:

Create a sense of urgencyCreate a guiding coalitionDevelop a shared visionCommunicate the visionEmpower others to actGenerate short-term winsConsolidate gains and produce more changeAnchor new approaches in culture

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Understanding Just Culture¹

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Understanding Risk and Human Behavior1

Human Error: Inadvertently

completing the wrong action; slip,

lapse, mistake

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

Using the Toolkit

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Managing Error and Risk¹

Human Error

Product of our current system design and behavioral choices

Manage through changes in:• Choices• Processes• Procedures• Training• Design• Environment

Console

At-Risk Behavior

A choice: risk believed insignificant or justified

Manage through:• Removal of

incentives for at-risk behaviors

• Creation of incentives for healthy behaviors

• Situational awareness

Coach

Reckless Behavior

Conscious disregard of substantial and unjustifiable risk

Manage through:• Remedial action• Punitive action

Punish

Using the Toolkit

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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

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Why Do We Do This Work?

Long-Term Care Safety Tools and Resources

Quality and Safety Tools

• TeamSTEPPS®

• Six Sigma

• Institute for Healthcare Improvement Model for Improvement

• Plan-Do-Study-Act

• Root Cause Analysis

• Failure Mode Effect Analysis

LTC-Specific Resources

• 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

22• Using the Toolkit

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References

1. Griffith S. Just Culture, Healthcare Services Overview. Outcome Engineering; 2012. https://store.justculture.org/wp-content/uploads/flipbooks/healthcare/healthcare.html

2. Kotter J, Rathgeber H. Our iceberg is melting: Changing and succeeding under any conditions: 1st 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_Manual_Part_1_Attachments_1_and_2.pdf.

4. Patient and Family Engagement module, CUSP Toolkit. Rockville, MD: Agency for Healthcare Research and Quality; December 2012.http://www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/modules/patfamilyengagement/index.html.