EXECUTIVE SUMMARY
The safety issues that concern healthcare employees on the frontline sometimes are not recognized by risk managers and other hospital leaders. A program developed by Johns Hopkins Hospital helps give voice to those who deal with patient safety most directly.
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The program focuses on two key questions for staff.
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Hospitals have seen significant improvements in patient safety after implementing the program.
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Safety rounding with a hospital executive is an important part of the program.
When hospital leaders conduct safety rounds at The Johns Hopkins Hospital and Health System in Baltimore, MD, they don’t rely on just friendly chat and a checklist of policies and procedures. They ask staff members two important questions:
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How is the next patient going to be harmed on this unit?
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How can we prevent this harm from occurring?
Those questions are a fundamental part of the Comprehensive Unit-based Safety Program (CUSP), a patient safety-focused change model developed by The Johns Hopkins Hospital and used widely at hundreds of other healthcare organizations nationwide. Asking those questions helps hospital leaders identify safety issues that concern the employees but which might not be among the metrics being tracked or the current hot topics in patient safety, explains Melinda D. Sawyer, MSN, RN, CNS-BC, assistant director for patient safety. She is in charge of the CUSP program.
This approach uncovers safety issues that otherwise might be overlooked, Sawyer says. Additionally, learning of these concerns and addressing them helps motivate staff members to be active participants in improving patient safety, she says.
CUSP is a five-step intervention designed in 2001 to give frontline staff the knowledge, tools, and organizational support they need to tackle safety hazards in their environment. CUSP units have targeted a wide range of problems, such as patient falls, hospital-acquired infections, mislabeled specimens, and medication administration errors. Using the CUSP framework, Sawyer says more than 1,100 intensive care units (ICUs) across the United States reduced central-line associated bloodstream infections by 40%, and catheter-related bloodstream infections at 103 intensive care units dropped 66%. Ventilator-associated pneumonia infections dropped 71% among 112 ICUs. Michigan hospitals saw a 10% reduction in mortality, compared to 350 hospitals in surrounding states.
Implementing the CUSP program involves five steps:
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Educate staff on the science of safety.
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Identify defects.
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Assign an executive to adopt the unit.
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Learn from defects.
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Use teamwork tools.
“We know that the safety culture lives within the unit level of an organization, so this structure gives us the ability to identify safety concerns and address them,” Sawyer says. “Pairing an executive with the frontline staff makes it possible to act on those concerns quickly and effectively.”
Johns Hopkins Hospital has 140 safety teams throughout the organization, including non-clinical areas such as the pharmacy and admissions. Implementing the CUSP program requires the support of at least one senior executive who will partner with the clinical unit or department.
“It takes about three to four months of planning before you actually launch one of these teams,” Sawyer says. “The CUSP team is fully established in about a year, and from that point on it is a matter of sustaining that team and continuing to identify issues that the team can address.” (For more on the CUSP program, go to Johns Hopkins Medicine.org. Also see “Patient safety project reduces central line infections by 40%,” Healthcare Risk Management, November 2012.)
SOURCE
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Melinda D. Sawyer, MSN, RN, CNS-BC, The Johns Hopkins Hospital and Health System, Baltimore, MD. Telephone: (443) 287-2085. Email: [email protected].
