| Until recently, everyone assumed that patient safety was addressed with such issues as adequate security, emergency preparedness and building safety initiatives. These issues are now referred to as Environment of Care Safety issues. The current definition of patient safety initiatives refers to avoidance of people being harmed as a result of healthcare. Elements of DeKalb Medical’s successful patient safety programs include a wide range of patient safety initiatives, including these basic elements:
• Board of Directors leadership in prioritizing patient safety initiatives;
• Reducing variation and implementing/demanding adherence to evidence based practices for all safety initiatives;
• Annual measurement and continued development of a blame-free, or “just” culture which encourages safe reporting of system failures or mistakes;
• Transparency to patients (disclosure), within the organization, as well as externally when things go wrong;
• Horizontal relationships where any member of the team (including the patient and their family) may alert another and stop a potentially dangerous process.
Throughout DeKalb Medical individual departments and groups of staff members are identifying different safety initiatives that can improve quality as well as patient safety. Here are a few of the programs:
*Pressure Ulcer Prevention
Commonly referred to as bedsores, pressure ulcers are areas of injured skin and tissue usually caused by sitting or lying in one position for too long. Laying in one position for too long puts pressure on certain areas of the body and the pressure can reduce the blood supply to the skin and the tissues under the skin. These sores may be due to several factors such as:
• unrelieved pressure;
• friction or against bed linen and mattresses;
• humidity;
• urinary or bowel incontinence.
Pressure ulcers may occur on any part of the body, especially over bony areas such as the sacrum, elbows, knees and heels. Although easily prevented by safety initiatives and completely treatable if found early, pressure ulcers can be fatal, and in terms of healthcare-acquired conditions, result in death second only to adverse medication reactions.
DeKalb Medical’s Pressure Ulcer Prevention Program
DeKalb Medical’s pressure ulcer prevention program has been recognized by VHA Georgia as a 2009 Leadership Award winner in the Clinical Excellence category.
This patient safety initiative relies on the teamwork of the Skin Management and Resource Team (SMART), DeKalb’s pressure ulcer prevalence has dropped well below the national benchmark of 7%.
Under the leadership of our certified experts (Wound Ostomy Care Nurses) the SMART Team is comprised of nurse representatives from each nursing unit who become skin “experts.” As experts, they attend monthly educational meetings, conduct on-unit audits of compliance with our skin care program, provide staff education and ensure that this patient safety initiative related to pressure ulcer prevention stays top of mind for all staff members.
*Rapid Response Teams
Rapid Response Teams are relatively new concepts for hospitals but are proving to be an effective safety initiative to save lives. A Rapid Response Team gives nurses throughout the hospital extra support if they believe that their patients’ symptoms or complaints may be an indication that their condition is worsening. Any nurse, in any department, can call for the Rapid Response Team to evaluate the patient. An intensive care nurse and a respiratory therapist from the Rapid Response Team evaluate the patient to see if there is a need for a physician, a change in medication or other treatment. The purpose of this patient safety initiative is to provide care at the earliest possible moment, such as shortness of breath or discomfort, rather than wait for a crisis, such as heart attack.
*Hands and Bands
Another component of DeKalb Medical’s patient safety initiatives program is the “Hands and Bands” campaign in which patients and their family members are encouraged to double-check that every hospital staff member who enters the room washes their hands and checks the identification on the patient’s wristband. Washing hands is an essential safety initiative to prevent the spread of infection from one patient to another and matching the name on the wrist band to prescribed medications and treatments reduces the risk that the patient receives the wrong medication. Members of the hospital’s patient safety committee routinely visit patients to verify that all staff members take the steps identified in this safety initiative.
*Hourly Rounding
Another patient safety initiative that improves quality of care as well as safety is “hourly rounding.” This means that while you are in the hospital, a nurse or patient care assistant will come into your room every hour to make sure you are comfortable and to make sure you don’t have any unmet needs. We know that being a patient in a hospital is not easy and we want you to feel safe and secure that your needs will be met.
*Hospital-Acquired Infection Prevention
Hospital-acquired infections affect 1.7 million patients nationally each year, according to the Department of Health and Human Services. These infections can prolong recovery, cause other health problems and even be the cause of death for some patients. DeKalb Medical has made a commitment to implement safety initiatives that reduce the risk of any patient acquiring an infection once a patient has entered the hospital.
*Active Surveillance of MRSA
DeKalb Medical screens all critical care patients for Methicillin-resistant Staphylococcus aureus (MRSA), a common infection spread in the community and in the hospitals, as soon as they are admitted to a critical care unit. Although many hospitals provide a similar screening, DeKalb Medical’s emphasis on safety initiatives means that we have invested in equipment that provides the results of the test in four hours rather than the 48 to 72 hours required by traditional testing. The quick turnaround means that nurses can begin to take steps to isolate the patient from others to prevent the spread of MRSA to other patients and staff members.
*Ventilator-Associated Pneumonia
A ventilator is a machine designed to mechanically move breathable air into and out of the lungs, to provide the mechanism of breathing for a person who is physically unable to breathe, or breathing insufficiently.
Ventilators are chiefly used in intensive care medicine, home care, and emergency medicine (as standalone units) and in anesthesia (as a component of an anesthesia machine). In order to safely use a ventilator, a person must have a tube placed into their throat or windpipe, a process called intubation. This is done through the mouth (short term) or directly into the base of the throat through an incision called a tracheostomy.
Ventilator-Associated Pneumonia (VAP) is a type of pneumonia that occurs in people who are on a ventilator for 48 hours or more. People who are on a ventilator are at greater risk of developing pneumonia because the tube in their throut creates an open pathway for organisms to enter the lungs so DeKalb Medical’s patient safety initiative to reduce VAPs in our facilities is important to all patients.
VAPs account for about 15% of all hospital-acquired infections, and about 27% of hospital-acquired infections in an intensive care unit. The development of a VAP increases mortality 20-33%
DeKalb Medical’s Ventilator-Associated Pneumonia Prevention Program
DeKalb Medical has a patient safety initiative team focused exclusively on implementing evidence-based practices to reduce the potential of this deadly complication. These practices have been researched and endorsed by national organizations including the Institute for Healthcare Improvement, the American Association of Critical Care Nurses [imbed text link to http://www.aacn.org/WD/Practice/Docs/Ventilator_Associated_Pneumonia_1-2008.pdf], and the Centers for Disease Control [imbed text link to http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/VAP_largertext.pdf]. These practices include:
• strict compliance with hand hygiene;
• maintaining a bed position that reduces the risk of respiratory infection;
• preventing the development of stomach ulcers with medication;
• preventing the development of blood clots with medication;
• periodically reducing the amount of the patient’s sedation medication to make it possible to discontinue the use of the ventilator more quickly;
• implementing vigorous oral hygiene.
*Primary Bloodstream Infection Prevention
People requiring critical or lengthy hospital care often need intravenous lines that remain in place for extended periods of time. Patient safety initiatives related to bloodstream infection is important because these types of lines disrupt the integrity of the skin, making infection with bacteria and/or fungi in the blood possible. When the infection exists in the bloodstream (bacteremia), the person may develop sepsis, and die. With a 20% mortality rate, it is estimated that between 500 and 4,000 people hospitalized in the United States die annually due to bloodstream infections so safety initiatives designed to reduce these infections are critical to patient safety.
DeKalb Medical’s Primary Bloodstream Infection Prevention Program
DeKalb Medical has a patient safety initiate team focused exclusively on implementing evidence-based practices to reduce the potential of this deadly complication as one of our many patient safety initiatives. These practices have been researched and endorsed by national organizations including the Institute for Healthcare Improvement , the American Association of Critical Care Nurses, and the Centers for Disease Control. The practices that are a part of this safety initiative include:
• strict compliance with hand hygiene;
• utilizing a specific skin prep during insertion and routine dressing changes;
• implementing maximum infection prevention precautions when the lines are inserted; this includes using sterile technique, and utilizing gowns, drapes and head covers similar to those used in the surgical areas;
• discontinuing the line as soon as possible;
• emergency lines that may have been inserted under less than optimal conditions are replaced as soon as possible;
• “scrub the hub” campaign which reminds everyone to cleanse injection sites on these lines appropriately. |