A new report in Health Affairs offers a framework for intervention success derived from the Agency for Healthcare Research and Quality's On the CUSP: Stop BSI, a national central line-associated bloodstream infection reduction campaign.
The initiative, which began as a pilot in intensive care units at Baltimore-based Johns Hopkins Hospital in 1998, was successful enough that AHRQ funded the project from 2008 to 2012. More than 1,100 hospitals participated in the initiative, decreasing CLABSI rates in intensive care units to 1.1 infections per 1,000 line-days, down from the baseline of 1.9 infections per 1,000 line-days. Units with no infections for at least one quarter increased from 30 to 68 percent of participating units.
The experiences of the program lend themselves to an eight-lesson framework for ensuring successful national interventions, further detailed in the report:
1. National programs must be ready to do the job for which they are intended before being nationally introduced. They must contain robust interventions, standard measures of harm, clear reasoning on how the intervention reduces patient harm and evidence demonstrating the intervention is generalizable.
2. National programs must have clear, supported structures of accountability. Each level of accountability must have defined goals and measures and must be supervised by management with time and resources to support the program. Roles and resources in the program should be clearly designated to avoid program failure.
3. National programs must have a standard measure to facilitate data comparison. This measure must allow all stakeholders to create data that may be easily shared and understood among administrative levels.
4. National programs must summarize evidence in a way that allows clinicians and administrators to adopt and modify interventions. Interventions must be developed at the clinical level so they may be incorporated into daily clinical practice.
5. National programs must focus on both quantitative and qualitative components. While scientific methods for change are important, equally important is a focus on adaptation of beliefs, attitudes and behaviors so that the science may be adopted.
6. National programs should move from the immediate goal to the bigger picture. Starting on a small scale within a hospital and moving to a local, state and national level has the most potential for reducing infection as quickly as possible.
7. Clinicians must believe that harm is a problem and that it is possible to reduce. Believing that harm is inevitable will hamper intervention efforts before they start. Improving intrinsic motivation through education and sharing of experiences is one way to combat feelings of inevitability.
8. Data should facilitate learning, not blaming. Overemphasis on failures may alienate voluntary participants. Positive presentation of performance data keeps morale high and the initiative progressing.
More Articles on Quality:
Patient Safety Tool: Kaiser Permanente's Infection Control "Plus" Measures
Patient Safety Tool: CUSP Family Engagement Toolkit
RWJF Project to Examine, Enable Nurse Innovation