Preventing Patient-to-Patient Assaults with CUSP

Date: 12/19/2019

Morgan Sickles discovered her passion for working with young patients while at Northern Light Acadia Hospital. As a former psychiatric technician and now as an inpatient support specialist in the Pediatric Inpatient Unit, she helps staff care for patients ranging from ages five through 18-years old.

“We have kids who come in for all kinds of things from Post-Traumatic Stress Disorder, to suicidal thoughts, to not being able to self-regulate their emotions,” explains Morgan. “They’re here for things that make it difficult for their guardians to keep them safe in a space.” But, creating a safe space within the hospital was a growing problem within the unit. Staff were beginning to see an increase in children becoming aggressive with one another.

Unlike an acute care hospital, pediatric inpatients at Acadia Hospital spend much of their waking hours together as a community, or milieu. “These patients are ambulatory and active,” says Jason Shorey, LCPC, director of Quality and High Reliability. “We have to adapt our treatment model to keep them engaged and that's where our CUSP program really came in to help us focus on what the safety challenges are with this group.”

The Comprehensive Unit-Based Safety Program (CUSP) was pioneered by Johns Hopkins and is the Northern Light Health evidence-based program for patient safety. “It's a way to engage the frontline staff members in patient safety and performance improvement science like I've never seen before,” says Jason. Rolled out for the first time at the hospital, CUSP was used to tackle patient-to-patient assaults, an effort largely coordinated by Morgan as the CUSP Champion.

Once she and the CUSP team sat down with staff, they broke down the problem to a communication issue. There wasn't enough communication going on between the psychiatric technicians—who spend the most time with the patients—at shift handoffs about any negative group and interpersonal dynamics happening among the patients.

“Now we're talking about relational challenges that Johnny's not getting along with Mary, or that there's this clique that's not getting along with this other clique,” says Jason. Those things weren't really highlighted in the medical record or the typical handoff in Cerner.” Missing that crucial information about the milieu was proving to be a gap in mitigating behavior that could escalate to assaults.

In following the CUSP model, Morgan describes how staff began to resolve the problem. “We updated the 24-hour safety huddle report, which goes out to everyone on the second floor, to our house administrators, and people who might come up and help on the unit. It gives more information about kids that are struggling with certain things, like boundaries. So, if people are more likely to assault someone, we know that now. It's written down for people to see.”

The success of the CUSP model greatly depends on the multidisciplinary team built from all levels of the organization including this project’s executive sponsor. “It is very important to have someone who is not directly overseeing clinical care be involved,” says Marie Dickinson, vice president of Finance and Operations. “It not only helps us better understand the challenges staff face each day making our hospital a safe and caring environment, but also gives us all an opportunity to step back and ensure that our priorities and strategic goals are well aligned.”

“CUSP is a simple and elegant model—it’s not filled with complex jargon,” says CUSP team member Joshua Newman, MD, medical director of Inpatient Pediatric Psychiatry and acting director of Pediatric Outpatient Psychiatry. He adds, “It’s a whole different way of looking at the universe than most people would be familiar with but, it's accessible and manageable—a very worthwhile effort.”

Morgan gets to the heart of the program’s success by saying, “It's not about leadership coming in and telling us what we need to do and how we're going to do it. It's staff saying, ‘This is the issue, and these are the steps that we are going to do to fix it.’”