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Looking forward, we're going to talk about how our implementation plan worked and
how it played out developing a program for a state many states away.
And how we were going to keep them engaged throughout
this process of quality improvement.
What we did was we choose to include them in
a lot of our decision making, and we call this our collaborative model.
The collaborative model has been successful in some areas for
quality improvement, other areas has not.
We have found that the more we make the collaborative model unique to
the intervention that we're working with, and we provide a lot of examples,
and the paper work that they are going to need, and examples of some
of the things they need to develop, that has become very successful.
And actually, what we call I learning network,
because it allows people from all over, from every different hospital,
to participate in developing this program.
So I think one of the first things that we had to do was develop a CLABSI toolkit.
And a little bit later I'm going to walk you through
what was included in some of the CLABSI toolkit development.
But really what we needed to do to provide adequate information for
the 108 hospitals that were participating, and again,
103 actually were able to provide data through the whole thing, was to
give them everything that we talked about that we did at the local level and more.
So what that means was we
gave them all of the evidence that our literature search identified.
So everybody had copies of the different articles that we used.
We had fast fact sheets because we knew that there were would be some physicians
that did not have the time to read all of the articles that we supported.
So there was a synopsis of every one of the fast fact sheets, and a synopsis about
how each one of those pieces of evidence was able to impact CLABSIs.
So whether that was site placement, and
how the subclavian line was really the best option at removing line,
because if you don't have a line it can't become infected.
We had to provide that.
And we also had to do a lot of education because instead of working in
a large academic hospital that we where use to hear at John Hopkins,
we had hospitals that represented across all of Michigan.
So we had some rural hospitals, we had community hospitals,
we had teaching hospitals, and we had university affiliated hospitals.
And their are level of practice was very different,
their ability to put together policies and procedures and
have some of the support that we have in academic medicine.
We really needed to focus on so
that they would have some of the same things that we had going into this work.
In addition to the fast facts, and the we also made sure that they had protocols,
protocols that talked about placing a central line.
We made sure that they had protocols on how to maintain the central line.
And what we did was provide them the protocols that we had here at
Johns Hopkins that were developed using the CDC guidelines.
We also had our protocol on how to use a StatLock to keep the central line
in place because during the study they said, let's not use sutures,
but let's use a StatLock to hold the central line in place.
So for everything that came up about maintaining a central line or
placing a central line, we provided them not only the evidence but
provided our own protocols that we developed here at Johns Hopkins.
And they were to be used as an example, not to be implemented solely
because Johns Hopkins did it, because we didn't think that would work.
But really to be a guideline for that hospital to write a policy and
procedure that, in their eyes, was as black and white as possible.
No grey areas, we wanted it to be
not something that was subject to interpretation.
We wanted it to be as black and white as possible based on their local culture.
And really that's what we've worked it to do.
We also provided them with the CUSP component, so
how do you implement the CUSP program?
We also provided each one of the CUSP tools that we had.
And I think at the time we had at least a dozen CUSP tools,
including daily goals, learning from defects, and many other ones.
And for those tools, we also provided an opportunity for
them to read the articles where we publish that work.
So I wrote an article on a morning briefing,
how do you have an effective day by seeing the patients that had
the most acuity and then moving on from there.
We also had a shadowing tool
that also was accompanied by an article that had been published in
the Joint Commission Journal because it explained how the tool was used.
And it also gave them an opportunity to understand that different units
within their hospital all impacted the care that was being delivered.
