(Inside MossRehab Spring 2014) - When MossRehab initiates the critically acclaimed five-step Comprehensive Unit-based Safety Program (CUSP) later this year, it will be among the first stroke rehabilitation programs in the nation to do so. Less about changing an already collaborative culture at MossRehab and more about fine-tuning quality improvement, CUSP is expected to enhance high levels of patient safety.

“Safety is an issue everywhere,” says Justine Sgrillo, RN. “I oversee care in a 30-bed stroke unit where almost every patient has cognitive and physical impairments. Keeping them safe is a huge challenge and a primary goal. CUSP will help our staff take an interdisciplinary approach to solving potential patient safety problems.”

The concept of CUSP was developed by the Johns Hopkins Quality and Safety Research Group and deployed to selected hospitals across the country with federal support. It is designed to improve clinicians’ communication, awareness of safety and ability to learn from errors, and to help improve teamwork. MossRehab expects to leverage CUSP to translate clinical evidence into practice and decrease potential safety problems.

Science of Safety

“CUSP should help us ensure all team members have an understanding of the science of safety,” explains Julie Hensler-Cullen, RN, MSN, MossRehab’s director of education and quality. “The scope of knowledge of the many MossRehab professionals and the unique involvement of the different team members will serve us well.”

Significant improvements in safety have been reported by hospitals using CUSP, which recognizes that a unit’s safety culture is a predictor of sustainable safety, including fewer patient complications and infections. For people who have had a stroke, CUSP’s interdisciplinary approach should drive improvements in decreasing specific issues regarding fall risk, medication errors, infections and aspiration.

“I also predict we will positively affect the patient experience and have improved staff satisfaction,” says Hensler-Cullen.

Key to generating improved outcomes is the way that CUSP empowers staff to assume responsibility.

“Our staff are already very engaged, but CUSP will further unite staff and administration and enhance our teamwork,” explains Sgrillo, who has been involved with a CUSP initiative in the medical/surgical unit at Einstein Medical Center Philadelphia.

CUSP Framework

There are five steps to the CUSP framework:

• Train staff – Teach staff about the science of safety and its application to teamwork and technical work on the unit.
• Engage staff to identify risks – Provide a two-question survey to each unit member asking: How is the next patient going to be harmed on this unit? How can we prevent this harm from occurring?
• Hold safety rounds – Organize monthly safety rounds with senior executives and all unit staff to discuss safety issues and identify any clinical or operational risks.
• Address identified risks – Review identified risks and list the factors that have contributed or could contribute to the risk. Implement changes to reduce the probability of recurring risks, and produce a summary of what was learned from the investigation.
• Implement tools for improvement – Highlight priority risks and identify tools to address them on a continuing basis.

At MossRehab, quality improvement and patient safety are already top priorities. The CUSP framework promises to help to effectively join executives and physicians with front-line caregivers, staff and unit managers who have the expertise and the knowledge needed to further improve safety.

“I expect that CUSP will result in further encouragement of problem solving that could lead to new treatment protocols such as clinical guidelines embedded in our electronic medical records and practical, user-friendly care checklists,” says Hensler-Cullen.