AHRQ Releases New Experience-Based Toolkit for Intensive Care Units

The toolkit also includes a playbook that explains how to apply AHRQ’s proven Comprehensive Unit-based Safety Program (CUSP) to prevent CLABSI and CAUTI by adjusting policies and daily procedures that take place in the ICU. The playbook is grounded in high reliability, systems thinking, and “Just Culture.”

The toolkit, developed with the assistance of physician and nursing subject matter experts, was front and center during the 2022 Critical Care Congress session, Reducing and Eliminating CLABSI and CAUTI: A New Toolkit to the Rescue. The session consisted of a panel discussion with William Miles, MD, FCCM; Patricia Posa, RN, BSN, MSA, CCRN-K, FAAN; and Kathleen Vollman, MSN, RN, CCNS, FCCM.
 
These SCCM subject matter experts provided valuable guidance and practical bedside implementation tips on how best to prevent and reduce the incidence of CAUTI and CLABSI. SCCM collaborated with the AHRQ and the American Hospital Association Health Research Education Trust on site visits, coaching, and the toolkit. The experts coached sites and contributed to the development of learning materials to address barriers and facilitators.

ICU teams can access relevant toolkit content in three different ways based on their needs:

• The “Assess” section is for teams interested in understanding their current clinical and safety practices to prevent CLABSI and CAUTI.
• The “Implement” section is for teams that need guidance as they put new prevention practices into place.
• The “Overcome” section describes common challenges that ICU teams face in decreasing CLABSI and CAUTI rates.

 
All three panelists thought that the “Overcome” section was the most valuable component of the toolkit. The section focuses on four areas: team engagement, team functioning, overcoming mindsets, and culture. Each area features resources, including tip sheets, videos, and audio interviews with experts about overcoming specific problems. “There are lots of great tools organized in a way that you can go back and forth and find things based on what challenges you’re facing in your environment,” Ms. Posa said. The toolkit was built by clinicians for clinicians and informed by the frontline experiences of more than 800 U.S. ICUs.
 
During toolkit development, it became clear that ICU team members often believe that their problems are unique to their environment. While some contributing factors may be uncommon, solutions are often similar to those used by other ICUs, often surrounding culture. “Culture is based on the attitudes and beliefs of people,” Ms. Posa said. “We need to have a culture that supports engagement, speaking up, and learning from errors and defects. That’s what’s key for sustainable change.”