AHRQ Safety Program for Long-Term Care: HAIs/CAUTI
Purpose: To provide senior leaders a checklist to plan and implement quality improvement and resident safety projects in a long-term care facility.
Who should use this tool? Senior leaders (long-term care facility administrator, director of nursing, medical director, etc.)
How should you use this tool? Highlighted text can be edited with facility-specific project names and goals.
| Completed ✓ |
Task | Responsible Party | Notes |
|---|---|---|---|
| Assign a senior executive (administrator or another leader) to serve as an active member of the AHRQ Safety Program for Long-Term Care: HAIs/CAUTI team to meet with the facility team(s) at least monthly. | |||
| Ensure all employees receive education concerning the AHRQ Safety Program for Long-Term Care: HAIs/CAUTI. | |||
| Make CAUTI reduction a facility wide priority goal. Include this goal in the facility’s strategic plan. | |||
| Collaborate with staff, residents, and family members to develop a coordinated plan to achieve the goal of CAUTI reduction throughout the long-term care facility. | |||
| Work with the facility team to determine what project success will look like, plan for hardwiring the process into facility culture, and plan for sustainability. | |||
| Create a process for facility-level accountability by monitoring and ensuring team progress on agreed-upon project activities. | |||
| Require that the appropriate office (e.g., Infection Prevention) produce a weekly report of harm. Ensure there is a clear threshold within the data, which indicates areas of concern that require immediate action. The leader should investigate, communicate, and lead action planning on these concerns. | |||
| Foster organizational learning by disseminating “learn from defect” lessons. | |||
| Recognize project needs and provide administrative time and resources to support staff participation. Provide time for team leaders (doctor, nurse, certified nursing assistant, data collector, etc.) to complete duties. | |||
| Acknowledge the teams’ work and celebrate success. Post stories in the facility newsletter and provide opportunities for teams to share success stories with management and other teams. | |||
| Monitor progress toward the goal no less than quarterly and report performance to all employees and the board. | |||
| Make executive rounds an organization-level standard of practice. | |||
