Engaging frontline staff is key to advancing clinical quality improvement projects.
By Shannon Davila, MSN, RN, CIC, CPHQ
This is an excerpt from the HCPro book, Preventing Catheter-Associated Urinary Tract Infections, Second Edition.
A variety of teams exist in the healthcare environment, and many of them can offer substantial contributions to the catheter-associated urinary tract infections prevention program. The central focus of CAUTI prevention lies with the clinicians who work directly with the patients at the unit level.
Achieving any meaningful change starts with assembling a strong unit-based team. The Comprehensive Unit-based Safety Program (CUSP) is a framework for improvement that can be combined with any existing local quality improvement model or initiative. Funded by the Agency for Healthcare Research and Quality, CUSPs have been used on the national level to improve safety culture and reduce harm to patients, including preventing CAUTIs and CLABSIs.
The CUSP Toolkit includes tools and resources to help unit-based teams address the following key components:
- Understand the science of safety
- Assemble the team
- Engage the senior executive
- Identify defects through sense-making
- Implement teamwork and communication
CUSP works on the premise that culture is local to the unit level, and unit-based teams can build a framework for improvement and safety that will engage frontline staff in the process of change. It promotes the concept of the "science of safety," which means designing systems that use standardization, defect analysis, and input from team members to improve patient care. To effectively create those systems with diverse input, a multidisciplinary CAUTI prevention team should be assembled. Nurses, physicians, clinical educators, infection preventionists, patient safety officers, senior executives, and any ancillary or support staff who have a role in preventing CAUTIs should all be considered.
When building the team, it is critical to select the right people to fill key positions. By recruiting champions and leaders who understand concepts related to CAUTI prevention, safety culture, and quality improvement, frontline staff will be more easily engaged and active in the unit-based activities. Below are key roles in a unit-based CAUTI prevention team:
- Project leader: The project leader is responsible for overseeing the CAUTI prevention team. He or she coordinates activities and meetings, documents CAUTI prevention efforts, promotes unit staff engagement in CAUTI prevention efforts, solicits feedback, and coordinates efforts with other teams within the hospital. The project leader can be a nurse or physician with both the clinical knowledge of CAUTI prevention best practices and the available time to dedicate to the project lead role.
- Physician champion: The physician champion is a person with a knowledge of and passion for CAUTI prevention. He or she must be able to serve as a leader to engage other physicians in unitb ased interventions, educate medical staff about urinary catheter best practices (e.g., appropriate Chapter 5 indications for insertion), and provide feedback to physicians who need coaching on CAUTI practices. Among his or her peers, the champion is a role model for the multidisciplinary approach to CAUTI prevention.
- Nurse champion: The nurse champion is one who is able to engage other nursing staff in CAUTI prevention. He or she must be must have clinical expertise in urinary catheter care practices and a deep knowledge of catheter-related policies and procedures. Nurse champions promote the use of teamwork and communication tools on the unit, and they must be able to educate and provide feedback to nurses who need coaching on CAUTI prevention practices.
- The senior executive: The senior executive is a senior leader in the organization and is responsible for helping the team set safety goals, prioritize CAUTI prevention efforts, and secure resources. Senior leaders should meet with the team and frontline staff regularly and communicate the team’s mission and goals to other stakeholders within the organization.
- The nurse manager: The nurse manager of the unit works closely with the project leader and champions to engage frontline staff in the CAUTI prevention activities. He or she helps coordinate the training and education of staff related to urinary catheter use practices. The nurse manager also helps orient new staff to CAUTI prevention policies and procedures.
- The infection preventionist/quality improvement advisor: The infection preventionist or quality improvement advisor supports the CAUTI prevention team by providing CAUTI and catheter use data for teams to review. He or she acts as a consultant to guide teams in the implementation of evidence-based practices, as well as assisting teams in reviewing CAUTI cases to identify an event’s root causes and facilitate the design and implementation of improvement strategies (e.g., small tests of change models).
Based on their local needs and settings, CAUTI prevention teams may identify various individuals to be on the team. Maintaining flexibility and openness to modifying the team structure allows it to expand and contract depending on the situation and team’s overarching goals.