Understanding CUSP & the CUSP Team | The Armstrong Institute for Patient Safety & Quality

[MUSIC] Hi I’m Julius Pham and I’m an intensive
care physician at John Hopkins hospital.>>And I’m Rhonda Wyskiel an ICU nurse
here in the Wynberg ICU. If you’re watching this video, you have an
interest in CUSP.>>In this video, we want to begin to guide you on your journey to improved
patient safety. And we’ll share some advice on how to
become a CUSP unit and hospital.>>Our guided patient safety programs
are based on more than a decade’s worth of experience working as a CUSP team here at Johns Hopkins and with hospitals across
the country.>>In this video, we’ll answer four
fundamental questions. What is CUSP? Why implement CUSP? What are the steps of CUSP? And who are the CUSP team members? Finally, we’ll share how we’ve implemented
CUSP in the Wineberg Intensive Care Unit here at the
Johns Hopkins Hospital. So let’s start with what is CUSP?>>CUSP stands for Comprehensive
Unit-based Safety Program. It includes a unit readiness assessment
and when ready a five step approach to identifying and
preventing patient harm in clinical work areas. We have found that by following the five
step approach you’re better able to stay focused on goals
important to patient safety. These include improving the culture of
safety, identifying and preventing patient harm and optimizing
the patient experience.>>So that’s what CUSP is. So why should you implement it in your
work area? We believe that implementing CUSP
accomplishes three things. First, it creates a culture of safety
based on science. So that everyone is thinking about patient
safety issues every day. Second, if everyone is thinking about
patient safety, everyone is focused on identifying those defects that
could cause patient harm. And finally, CUSP goes just beyond
identifying defects. It emphasizing learning from them. We use the knowledge of what went wrong to
build a stronger, safer healthcare system. We’ve seen that CUSP can lead to better
outcomes and a better experience for patients in
your care. That’s what CUSP does.>>So why is CUSP so effective? It relies on team empowerment and
collaboration across many disciplines. When a CUSP team identifies the defect it
wants to correct, everyone on the unit shares
that goal. Everyone on the unit has ownership of a
culture of safety.>>This is so different than the way
safety used to be approached in hospitals. Traditionally, it was top-down pressure to
improve, that drove patient safety. But efforts to execute these initiatives
lacked leadership support. It was hard to communicate up the ladder. There was little or no priority for a
culture of safety.>>We rarely knew our numbers, or how
we were performing We mostly accepted that certain harms were inevitable, and we
could not really make an impact on them.>>As we mentioned earlier, there are
five basic steps to CUSP. The first step of CUSP is training in the
science of safety. In healthcare, we often rely on individual
nurses or physicians to provide safe care. Even when the system is broken, and most
of the time they do. They really are our heroes, but in this
step we’ll introduce your teams to the principles that promote and
support patient safety and quality. These principles will help them develop
lenses to focus on system factors that can lead to
preventable harm. Teams grow to understand how system
factors can impact performance, and how when the system is broken it hurts
patients. This is all communicated to your CUSP team through a video entitled The Science of
Safety.>>The second step of CUSP is
identifying one or more patient safety problems in your
work area. We often call these defects. In this step, you’ll ask your front line
staff how will the next patient be harmed? Through a two question survey, your team will identify defects from various
sources, like their personal experience, incident reports,
liability claims, sentinel events, or even through everyday conversations on
the unit. And then it’s important to ask your team
members to share their thoughts on ways to improve your systems so that
these harms don’t occur again.>>The third step of CUSP is to engage
an executive in a real safety partnership. You’ll ask one of your hospital’s senior
executives to become an active member of your unit improvement
team, to accomplish three goals. First, you wanna develop a shared
understanding, of unit level safety defects and risks. Second, you wanna build consensus, and a
plan for how to mitigate those risks. And third, this partnership will create a
shared accountability when it comes to implementing and
evaluating your plan.>>The fourth step of CUSP is learning from defects through collective
sense making. The hallmark of an organization with
strong safety culture is that it learns from its
mistakes. To help you do this your team will use
practical tools to understand four basic questions
when things go wrong. What happened? Why did it happen? What did you do to reduce risk? And how do you know that the risks were
reduced?>>The fifth step of CUSP is to improve
teamwork and communication. We know that the majority of errors in medicine stem from poor communication
and teamwork. In other videos we’ll share with you some
tools to help improve both.>>Although you will need to engage
everyone in your work area for CUSP to be successful, you will also need to build a
CUSP team to relieve the efforts. Successful CUSP teams can come in all
shapes and sizes, but here is what we recommend. Every CUSP team should have a team leader,
a physician champion, a nurse champion and a
senior executive. Depending on the challenges you are
tackling you might want to involve other partners. For example with our work on reduction of
central line associated bloodstream infections, we included hospital infection control
practitioners.>>Now that you have a feeling for what
CUSP is, we’ll meet some of the members of our CUSP team and we’ll
see what CUSP means to them.>>Transparency, allowing those in the
place of care to come together and collaborate on making
work safer.>>CUSP has allowed the WICU to bring
all staff together whether it’s doctors, nurses,
support associates on the unit. Anybody. All different team members to come
together to talk about these concerns. [SOUND] It also empowers the staff to
speak up when they see something that they’re
concerned about. For example hand hygiene is very important and other hospital acquired
infection concerns. So for that reason anybody can speak up
whether you see somebody going into a room not
doing hand hygiene a support associate has even
spoken up and said our goal is 100% hand hygiene
compliance. You didn’t wash your hands, you wanna make
sure that you do that.>>CUSP means that we’re on ICU unit
and we all work together. And if I see things out of order, I know
it’s someone that I can go to, to get it
straightened out. And if someone go into the room and
supposed to Purell their hands, I’m not scared to
speak up. I’ll go to ’em an let ’em know that they have to Purell their hands before they go
in the room. And my team players got my back.>>The WICU is definitely a safer place
with CUSP. It is it’s made it a collaborative effort
between the team, between nurses and doctors and
support associates. It’s equal opportunity for everybody to
help and to make a change everyone has in a voice. An opinion and they’re not afraid to speak
up. There’s no such thing as a doctor problem
or a nurse problem, you know, everyone is helping each other out in a collaborative
effort to really make this place a lot safer.>>It affords me the the opportunity to
be reminded that each and every time I visit the unit of, the excellence and
commitment of our staff to do everything possible to insure that
we do no harm to our patients.>>So that’s an overview of CUSP. We hope you have a better understanding of
what it is, why you should implement it, and who is part
of your CUSP team.>>In other videos, we will offer more
detail to guide you on exactly how to implement
CUSP, from the pre-CUSP assessment of your unit’s
readiness, through the five steps, to sustaining and spreading CUSPs throughout your hospital and health
system. [MUSIC]

Written by Raul Dinwiddie

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