Making Progress in Patient Safety
BY ANN HENDRICH
Patient safety in the healthcare industry has been under the harsh spotlight over the last several years. While there is more work to be done, the industry is making progress.
The Institute for Healthcare Improvement (IHI) launched the 100,000 Lives Campaign, a national effort to reduce preventable deaths in United States hospitals. The IHI and 3,100 hospitals participated and saved an estimated 122,000 lives in 18 months (January 2005 to July 2006). The response was so positive that the IHI announced in January 2007 the 5 Million Lives Campaign to protect patients from 5 million incidents of medical harm over the next two years,measured from December 2006 to December 2008.
So what are hospitals around the country specifically doing as part of this effort?
Ascension Health, the largest not-for-profit healthcare system in the United States, began its commitment to transform healthcare in 2002. The call to action for its 68 hospitals across the country, including Baptist and Saint Thomas Hospitals in Nashville, Middle Tennessee Medical Center in Mufreesboro, and Hickman Community Hospital in Centreville, was to provide excellent clinical care with no preventable injuries or deaths by July 2008.
Ascension Health and its network of hospitals adopted eight priorities for action:
- Compliance with JCAHO national patient safety goals and core measures.
- Mortality reduction with a special emphasis on six tactics: rapid response teams, controlling blood sugars, SBAR communication, multidisciplinary rounds, ventilator associated pneumonia bundles and central line blood stream infections bundles.
- Increasing perinatal safety efforts to improve safety for mothers and babies and achieve zero preventable birth traumas.
- Eliminating adverse drug events, specifically in four areas: anticoagulants, insulin, medication reconciliation and narcotics/sedatives.
- Reducing falls and fall injuries by identifying known risk factors at admission and at change of caregiver, using a standardized risk assessment tool and implementing fall risk prevention strategies.
- Eliminating pressure ulcers through use of the Braden Scale© for standardized assessment of patients and the SKIN Bundle (Surface selection, Keep them turning, Incontinence management and Nutrition support) as the standardized plan of care for patients at risk for pressure ulcers.
- Reducing nosocomial (or hospital-acquired) infections with an effort to reduce central line blood stream infection, eliminating ventilator associate pneumonia, eliminating urinary tract infections and implementing multidisciplinary rounds.
- Reducing surgical complications, focusing on surgical site infections; perioperative myocardial infarction; postoperative hemorrhage; and, postoperative deep vein thrombosis.
These priorities for action were further validated upon the announcement of the IHI's 100,000 Lives Campaign that suggested six specific interventions, many of which were very similar to Ascension Health's priorities in preventing medical injuries and deaths. The 5 Million Lives campaign has added six more interventions including three that are similar to Ascension Health's Priorities for Action: preventing harm from high-alert medications, reducing surgical complications and preventing pressure ulcers.
Ascension Health launched its Priorities for Action by selecting "alpha" sites to develop methods and strategies that could be shared with other hospitals in the network. Benchmarks were measured and monitored and the culture within each hospital related to patient safety has been assessed on an ongoing basis.
So far, the hospitals within Ascension Health have been overwhelmingly enthusiastic in implementing the new strategies. The first year of implementation resulted in a 21 percent decrease of the mortality rate among non-end-of-life-care patients. To date, Ascension Health has estimated that nearly 2,000 lives have been saved.
The examples of progress are plentiful at Ascension Health's hospitals located in the Middle Tennessee area. Baptist Hospital, Saint Thomas Hospital, Middle Tennessee Medical Center and Hickman Community Hospital have all implemented rapid response teams that can be called upon at the first indication of a patient's deteriorating condition. Saint Thomas Hospital served as the alpha site for preventing falls and fall-related injuries and reduced the number of falls by 30 percent within the first year. Baptist Hospital and Middle Tennessee Medical Center are using a computerized mannequin, which simulates different birth situations, to train nurses, obstetricians and anesthesiologists in an effort to reduce its birth trauma rate even further below what is already a lower rate than the national average.
Ann Hendrich, RN, MSN, FAAN, is Ascension Health's vice president of clinical excellence operations. She also serves as chief nursing officer for Ascension Health.