AHRQ Safety Program for Long-term Care: HAIs/CAUTI

Organizational Lead

Pre-Training Webinar

Organizational Lead Onboarding

May 28, 2015

Health Research & Educational Trust

Project Team Members

OVERVIEW

Marcia Cooke

Agenda

Topic Presenter Time

Project Overview Marcia Cooke 10 minutes

National Project Support Marcia Cooke 10 minutes

How We Achieve Project Goals Sue Collier 15 minutes

Using Adobe Connect Amanda Wilkins 5 minutes

Website Justin Snow 10 minutes

Org Lead and LTC Facility Expectations Lindsay Kolczynski 10 minutes

Facility Recruitment Strategies Lindsay Kolczynski 10 minutes

Next Steps, Q&A Amanda Wilkins (Facilitator) 15 minutes

Objectives

Upon completion of this webinar, participants will be able to:

• Summarize the education and measurement components of the AHRQ Safety Program for Long-term Care: HAIs/CAUTI

• Explain how to be successful in the project

• Identify where to find project resources

• Provide support to recruited LTC facilities

Partnerships and Dissemination

National Project TeamHRET UM Abt Qualidigm APIC SHM Baylor

National Project TeamHRET UM Abt Qualidigm APIC SHM Baylor

State or Regional Lead Organizations, Multi-Facility

Operators

State or Regional Lead Organizations, Multi-Facility

Operators

FacultyFaculty

Organizational Leads

Recruitment/Coaching/Project Liaison

Organizational Leads

Recruitment/Coaching/Project Liaison

National & Regional Faculty UM, Abt, Qualidigm, APIC,

SHM, Baylor

Coaching/Endorsement

National & Regional Faculty UM, Abt, Qualidigm, APIC,

SHM, Baylor

Coaching/Endorsement

FacilitiesFacilities

Project Vitals

Lead Organization

– Participation Period:• May 2015 – August 2016

– Activities include:• Recruitment• Engagement• Monitoring• Coaching/Support

Project Period for Cohort 4

– Participation Period:• July 2015 – August 2016

– Activities include:• 2 months of kickoff and facility

onboarding• 11 months of data collection,

educational activities and coaching

Project Goals

Primary Goals—reduce CAUTI and improve Safety Culture• Develop/adapt evidence-based CAUTI elimination and safety practices and resources for LTCFs• Reduce CAUTIs• Improve safety culture

Secondary Goals—support expanded infection prevention efforts for C. diff, UTI, MDROs by providing education to:

• Improve hygiene practices (hand, environmental)• Promote antibiotic stewardship • Promote catheter stewardship• Reduce re-hospitalizations

How will LTC Facilities Benefit from Participation

Potential to:

• Improve performance on Nursing Home Compare Quality Measures

• Enhance data collection skills and prepare for mandatory reporting of infection data (NHSN)

• Benchmark against other LTC facilities (project-level and nationally)

• Improve communication and relationships with referring hospitals

• Improve compliance with survey requirement related to quality of care, infection control, etc.

Cohort 4 Timeline

NATIONAL PROJECT SUPPORT

What you can expect from us

Support from HRET and the National Project Team

• Project management– Scheduling– Monthly Org Lead Call

• Education– Live webinars– Train-the-trainer packets to train front-

line staff– Subject matter experts– Learning Session outlines and templates

• Coaching• Data collection, reports and analysis• Communications• Project resources for all stakeholders

– Organizational Lead Operations Manual

– Facility Implementation Guide– LTC Safety Toolkit

Meet the HRET Team

Sarah Dalton

Project Management Support

• Scheduling of all educational events handled by HRET, except coaching calls and learning sessions– Step-by-step guide on how to manage the project and your facility teams

(Organizational Lead Manual)

• Monthly Org Lead calls– Peer learning and open forum about project– Monthly status report

AHRQ FundingSupport

E-mail signed subcontracts to Jeanette Lyons (

jlyons@aha.org)

E-mail questions about invoicing process or payment

schedule to Lindsay Kolczynski (lkolczynski@aha.org)

CommunicationSupport

Weekly newsletter• Upcoming deadlines and events• Forward or customize for your

facilities

How HRET Advisors Support You

• Act as a liaison between Org Leads and the national project team

• Answer questions about the project and available resources

• Guide org leads in data submission and due dates

• Assist in planning three in-person Learning Sessions• Coordinate faculty coach to present• Share template agendas, presentations and handouts

• Join first four Coaching Calls

Ashley Hofmann, MSW

Katie Johnson, MHS

Anna Wojcik, MPH

Coaching Call Support

What: State-/Region-/System-specific coaching call

When: Monthly, beginning in September

Who: Facilitated and run by the organizational lead

All facility team leads

Faculty Coach provides clinical and cultural expertise

HRET Advisor provides project management support

and technical assistance

Why: Review data and track project progress

Discuss educational webinars and project interventions

Share successes, challenges and best practices with other facilities

Ask Faculty Coach and facility teams to engage in use of project tools, resources

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HOW WE ACHIEVE PROJECT GOALS

Sue Collier

Tools For Success

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Education Components: Learning Sessions

• Each Org Lead will host three Learning Sessions for recruited facilities• Suggestions for planning your Kick-off Learning Session #1 include:

• Set a date between July 1-24 and advertise to your facilities (full day, ~6.5 hours)• Determine a venue

Reserve space for 1-2 representatives from each facility recruited Provide the necessities: internet, projector/project screen, computer, lunch

• Attend the planning call with your HRET advisor to discuss other details Review agendas, presentations and resources provided to you by your HRET advisor Customize presentations with your organization and facilities’ information A representative of HRET and your faculty coach will attend the Learning Session to

present on aspects of project participation

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Education Components: Distance Learning

Name of series # of Topics Frequency What Format for Facility

Team Lead Format for Front-line Staff

Onboarding 4 Weekly Project orientation Webinar Trained by Facility Team Lead

Training Modules 4 Once every two weeks

Infection prevention Video Videos, and trained by Facility Team

Lead

Safety Culture Survey Results Forum 1 Once Safety culture Webinar N/A

Content 9 MonthlyClinical and cultural interventions

Webinar Trained by Facility Team Lead

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Education Components: Schedule

Onboarding Webinar Series Date Time

1. Building a Culture of Safety Team Thursday, August 6 1:00 – 1:45 p.m. CT

2. CAUTI Definitions Thursday, August 13 1:00 – 1:45 p.m. CT

3. CAUTI Surveillance Thursday, August 20 1:00 – 1:45 p.m. CT

4. Data Collection Training Thursday, August 27 1:00 – 1:45 p.m. CT

Training Module Series Release Date

1. Hand Hygiene Week of Aug 31 N/A

2. Environment & Equipment Week of Sep 14 N/A

3. Isolation Precautions Week of Sep 28 N/A

4. Antibiotic Stewardship Week of Oct 12 N/A

Monthly Webinar Series Date Time

National Content 3rd Thursday of each month, beginning in November 11:15 a.m. – 12:00 p.m. CT

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Support for Education Components

• Train-the-Trainer Guide• Core Team Webinar Archive

– Webinar Recording– Core Team Presentation Slides– Chat Summary and Q&A– Supplemental Materials

• All Staff Training Materials– Video and Facilitator Slides– Discussion Guide/Activity– Event Evaluation Template– Certification of Completion Template

• Additional Resources

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Each educational activity will include:

Measurements: Processes and Outcomes

Data Collected Frequency Time to Complete

Background/Cultural Measures

Registration 1x to enroll 10 minutes

Facility Demographics Baseline 15 minutes

Safety Culture Survey Baseline and follow-up 10 minutes

Process Measures

Team Communication Guide Quarterly 10 minutes

Skills Questionnaire Baseline, mid-point, final 15 minutes

Outcome Measures

Catheter Utilization CAUTI rates Urine culture order rates Monthly

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Support for Measuring Processes and Outcomes

• Checklist tools to support awareness and adherence to evidence-based recommendations

• NHSN CAUTI definition assessment worksheet

• NHSN CAUTI definition pocket cards

• Support for survey and certification regulation compliance with:

• F-tag 315 (catheter with undocumented necessity)

• F-tag 441 (infection prevention/control failure)

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USING ADOBE CONNECT

Amanda Wilkins

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Using Adobe Connect

• Adobe Connect is used to deliver all distance learning education• Informational Webinars• Onboarding Webinars• Monthly National Content Webinars• Safety Culture Results Forum

• Different ways for participants to engage during the webinar• All hyperlinks are live, many of the images of documents and infographics from the

project are live weblinks• Click on links in weblinks pod• Download files• Polling• Chat pod

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• Forward invitations to your facilities• Register for educational events

• Save webinar confirmation email to calendar

• Log in to webinar 5-10 minutes in advance• Monitor participation—strive for 80% participation rate among

your LTC facilities• Become familiar with the project website and its resources• Review webinar etiquette with facility teams

Org Lead Responsibilities

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• Register for educational events

• Save webinar confirmation email to calendar

• Log in to webinar 5-10 minutes in advance

• Make sure audio is available via computer speakers or telephone

• Participate in 100% onboarding webinar series, Safety Culture Survey Results

Forum and 80% or more of the national content webinar series

• Become familiar with the project website and its resources

LTC Facility Team Responsibilities

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LTC SAFETY WEBSITE

Justin Snow

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ORGANIZATIONAL LEAD ANDLTC FACILITY TEAM LEAD EXPECTATIONS

Lindsay Kolczynski

Org Leads are Critical to Project Success

• Recruit, register and retain at least 15 facilities throughout the project period

• Understand the project• Goals

• Expectations and Responsibilities

• Clinical and culture interventions (i.e., the change package)

• Educational offerings and schedule

• Actively engage in the project

• Attend all educational programming

• Encourage and closely mentor all facilities

• Monitor facility data reporting and monitoring

• Run and review facility data reports

• Monitor facility data/survey submission

• Share facility successes with the National Project Team (NPT)

• Provide individual and group coaching• Check-in with struggling facilities—report action plan to the NPT

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Org Lead Responsibilities

Education• Participate in and distribute train-the-trainer materials

for all educational activities:

– Onboarding Series

– Training Module Series

– National Content Series

• Share C.A.U.T.I. and T.E.A.M.S. Infographic with LTC

facilities

• Discuss components of the C.A.U.T.I. and T.E.A.M.S.

intervention during coaching calls

• Monitor LTC facility team (lead) participation rates in

educational activities and use of train-the-trainer materials to

educate front-line staff on each individual topic prior to next

event in the series

Data• Distribute data measurement materials to the

appropriate core team members• Monitor and review data submission with LTC facilities

– Outcome– Skills Questionnaire– Safety Culture Survey

• Ensure that each facility completes all surveys by the designated deadlines

• Distribute and participate in Safety Culture Survey Results Forum

• Encourage each facility to complete evaluations after each educational event

• Review and discuss data results during coaching calls and one-on-one with facility teams as needed

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LTC Facility Team Lead Expectations

• 100-105 hours over a 13-14 month period (~4.5% FTE)

• Form the facility team

• Attend all educational activities

• Train staff via the train-the-trainer module for each educational module

• Ensure data collection requirements are met

• Monitor progress toward goals

• Utilize expertise of the project team and your faculty coach

• Utilize project tools and resources

• Celebrate successes with facility team

Facility Team Lead Responsibilities

Education• Participate in all educational activities for facility team

leads– Onboarding Series– Training Module Series– National Content Series

• Use train-the-trainer materials to educate front-line staff on each educational topic prior to next event in the series.

• Display C.A.U.T.I. and T.E.A.M.S. Infographic in facility

• Discuss components of the C.A.U.T.I. and T.E.A.M.S. intervention during team huddles, with administrators and clinical leadership and residents/families.

• Consider sustainability of C.A.U.T.I. and T.E.A.M.S. interventions that are incorporated into work

Data• Complete registration and demographics assessment• Distribute data measurement materials to the appropriate

team members• Collect outcome data and enter data on a monthly basis• Utilize Team Communication Guide and submit report on

a quarterly basis• Ensure required staff complete all safety culture surveys

and skills questionnaires• Participate in Safety Culture Survey Results Forum• Encourage each facility to complete evaluations after

each educational event• Review and discuss data results facility staff, leadership,

committees and resident/family council

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RECRUITMENT STRATEGIES

Which Facilities Can Participate?

Who is eligible?– Multi-facility operators/long-term care communities– LTCFs that are part of an inpatient facility– Stand-alone nursing homes– Small and rural homes

Who is ineligible?– Long-Term Acute Care facilities (LTACs) are ineligible for this project

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What to Communicate to Facilities

• Program goals

• There are many benefits of joining this program not just CAUTI

• Be realistic about program requirements and time commitment

• Data collection and review are not optional

• This is a learning collaborative: all teach and all learn

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Discuss Program Goals

• Prevent CAUTIs and other HAIs in LTCFs

• Increase infection prevention skills of all staff

• Improve safety culture through improved teamwork and

communication

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Program Requirements & Time Commitment

Be realistic about Facility Team Lead requirements and time involved

Key Responsibilities of Facility Team Lead:• Secure program champions: administrator, nurse, physician, CNA• Build and support the facility team• Lead cultural and clinical interventions• Attend all educational webinars and in-person meetings • Comply with data requirements• Meet ≥ monthly w/ team to review progress, trouble-shoot, sustain gains (can happen

during short training sessions)• Attend monthly coaching calls

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Data collection is not optional

Facilities must supply:

Measure Frequency NotesFacility Demographics 1 time Start of the program

Nursing Home Survey on Patient Safety 2 times ≥ 60% staff complete; at the start and finish of the program

Staff Skills Questionnaires 3 times At least 10 staff

# Residents and Resident with Catheter counts Daily Collected daily and entered monthly

# CAUTIs Monthly Collected daily and entered monthly

# urine cultures ordered each month for all residents Monthly Residents with and without urinary catheters

Team Communication Guide questions 4 times

Staffing Turnover notify you, not us, of changes

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Recruitment and EnrollmentSupport

Recruitment Support• Customizable marketing flyer• Informational Slide Deck; HRET team available to present• Facility Informational Webinars

Enrollment Support• Enrollment Packet

• Facilities submit 3 forms to you: Commitment Letter, DUE, Team Roster

• Facility Team Lead Tasks & Time Commitment for you to share

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1. How to Avoid Potential Pitfalls

Barrier/PitfallFacilities enroll in the project without being fully aware of required resources and drop out of the project

Solution• Facility administration needs to be aware of resources required AND key staff

participating need to be aware of requirements• Administration participates in Facility Informational Webinar

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2. How to Avoid Potential Pitfalls

Potential PitfallFacilities do not understand that this project includes a focus on safety culture, infection prevention and antibiotic stewardship—not just CAUTI prevention

Solution• Communicate that strong safety culture is associated with better clinical and operational outcomes • Explain that implementing any change, e.g., CAUTI intervention, is influenced by culture• Educational content focuses on IP and proper use of antibiotics to prevent HAIs

Support from HRET• How to administer and interpret results• Action planning tools to assist teams to improve where needed

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QUESTIONS?

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Questions

Important Dates for Cohort 4

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Activity Date/TimeOrg Lead Subcontract Due June 19

Org Lead Training Monday, June 22 in Chicago

Facility Informational Webinars Wednesday, June 3 or Thursday, June 23 at 11:00 a.m. CT

Learning Session #1 July 1-24

Registration Due July 24

Facility Demographics Questionnaire Opens July 1, Due July 31

Skills Questionnaire Opens July 1, Due July 31

Onboarding Educational Series Every Thursday in August, from 1:00-1:45 p.m. CT

Patient Safety Culture Survey Released week of August 24, Due Sept 30

Content Webinar Educational Series 3rd Thursday of each month from 11:15 a.m.-12:00 p.m. CT,beginning in November

Next Steps

1. Email signed subcontract to Jeanette Lyons (jlyons@aha.org) by June 19

2. Ask all interested LTCFs to save-the-date for the Facility Informational Webinar on

June 3 or June 23 at 11:00 a.m. CT

3. Recruit LTCFs and ensure they register by July 24

4. Identify a date and location for Learning Session #1 between July 1-24

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