Using the CUSP Model in Healthcare: Step-by-Step Guide

The Comprehensive Unit-Based Safety Program (CUSP) model is a thorough, evidence-based framework that healthcare facilities can use to improve patient safety and quality of care by establishing unit-level teams. The methodology focuses on engaging frontline caregivers in the pursuit of addressing hazards and providing safe care. Many of the program’s training materials are web-based and can be reviewed and implemented according to a facility’s goals and resources.

Initially, the model was developed with a focus on lowering the incidence of hospital-acquired infections (HAIs) but it has since been adopted in hospitals worldwide to address a broad range of safety concerns. We’ll provide an overview of the model and go over the steps your facility can take to get your first CUSP team up and running.

The Development of the CUSP Method

The seeds for the CUSP framework were planted in 2001 at Johns Hopkins Hospital, following the death of an 18-month-old patient. The incident was partly attributed to a breakdown of communication within her clinical team, and served as a turning point within the healthcare community that motivated providers to investigate medical errors and ways to make care safer.

Safety researchers at the hospital collaborated with other patient-safety experts to begin development of the model. In 2009, the Agency for Healthcare Research and Quality (AHRQ) announced that it would provide $17 million in funding toward fighting HAIs. This funding supported further work on the CUSP model and led to a pilot study within Michigan ICUs.

Initial Successes With Comprehensive Unit-Based Safety Programs

When CUSP training was implemented in ICUs across Michigan, the potential for the model became evident. Researchers documented a lower incidence of central line associated bloodstream infections (CLABSIs) and a significant improvement in safety culture.

These results spurred further interest nationwide and the program was piloted in 1,100 ICUs. Researchers documented the model’s remarkable potential by showing a 40% reduction in CLABSIs in the ICUs that used CUSP teams and toolkits.

Since these early years of research, the model has been implemented in many hospitals with a focus on other types of safety hazards such as falls, medication errors, and communication breakdowns.

An Overview of the Approach

The CUSP model encompasses a wide array of CUSP safety strategies and potential action steps. The approach is designed to be integrated over time and customized to a unit’s safety concerns or safety goals. Overall, the model is based on the core teachings that:

• Culture is the unit-level phenomenon and reform must happen on that level.
• Culture change is difficult but worthwhile.
• Support from executives and facility leaders is crucial when addressing safety challenges.
• Patient harm is unacceptable.

Though each unit has unique needs, most units using the method will go through a process that involves:

• CUSP training via modules and toolkits.
• Gathering a team.
• Engaging facility leaders.
• Identifying safety hazards.
• Implementing solutions.

The framework can be used to augment other safety and quality improvement systems that the facility already has in place, such as the continuous quality improvement (CQI) framework and the just culture approach. A unit’s safety concerns may change while using the CUSP model, meaning additional toolkits and resources should be explored in an effort to address new challenges and issues.

Step-by-Step Guide to Implementing the CUSP Model

The CUSP framework can be applied by anyone working at a healthcare facility, from nurse managers and staff to chief executive officers. The model is designed so that it can be used in all types of units, including those in acute care and long-term care settings.

Step 1: Understand the Basics of CUSP in Healthcare

If you’re interested in implementing a CUSP program at your facility, a great place to start is AHRQ’s Core CUSP Toolkit. This will provide the groundwork for your understanding of the method. Though the toolkit covers 10 modules for learning about CUSP, AHRQ recommends that new users focus on the following 6:

• Understand the Science of Safety
• Assemble the Team
• Engage the Senior Executive
• Identify Defects Through Sensemaking
• Implement Teamwork and Communication
• Apply CUSP

Step 2: Gather Your CUSP Team and Establish Leadership

A key part of the CUSP method is assembling a team. Team members should have enough time and energy, and sufficient structure, for the initiative. It’s also important to solicit consistent input from all team members.

Once your team is in place, you’ll also need to recruit a senior executive to take part in the initiative. The CUSP principle that change happens at the unit level depends on the engagement of facility leadership.

Step 3: Put the CUSP Safety Process to Work

At this point, your team will be ready to identify hazards and utilize CUSP nursing toolkits and resources as they work toward solutions. The CUSP framework acknowledges how difficult it can be to face problems that are overwhelming, messy, and complex, and offers solutions to common barriers and challenges faced by healthcare workers.

Step 4: Identify Additional Problem Areas

Once you understand the basics and have a CUSP healthcare team and engaged leaders on board, you can explore the many toolkits available to help you target the specific safety issues your unit faces. Consider the treatments and technology your unit uses, such as central lines, indwelling foley catheters, and ventilators.

Analyzing incident reports may help you decide which areas need more attention. Additional CUSP toolkits you could utilize include:

• MRSA Prevention Toolkit: Targeting Surgical Site Infections
• Toolkit for Reducing Catheter Associated Urinary Tract Infections in Hospitals
• Toolkit To Reduce Central Line Associated Bloodstream Infections in ICUs
• Toolkit To Improve Safety for Mechanically Ventilated Patients

Continue to Develop a Culture of Safety at Your Facility

Facility leaders and nurse managers can utilize patient safety frameworks like the CUSP model to improve patient outcomes and quality of care. Looking for more ways to create a culture of safety? Our expert-written healthcare management resources offer a wealth of insights and guidance.