Archive for May, 2010
CDC report says CLABSI rate has decreased by 18%
The Centers for Disease Control and Prevention (CDC) released a report yesterday detailing HAI reduction efforts, concluding that efforts to reduce central line-associated bloodstream infections (CLABSI) in particular have lowered rates by 18%. The report was based on data submitted by hospitals in 17 states to the CDC’s monitoring system, the National Healthcare Safety Network (NHSN). Much of the data comes from states that require their hospitals to submit infection-related data to the NHSN, and at the time the report was compiled there were 17. There are more now.
This report comes as somewhat of a shock, as much has been made about climbing CLABSI rates. In the report, the researchers say that although this news is encouraging, the report will really serve as a benchmark from which to measure future reports. The CDC plans to release these type of reports every six months, with more hospitals from more states inputting data, to create a clearer picture.
Kathleen Sebelius, Secretary of Health and Human Services, echoed this in a statement:
“As we build on those efforts, this report is also a benchmark for progress on the national goals outlined in the U.S. Department of Health and Human Services’ (HHS) Action Plan to Prevent Healthcare-Associated Infections. On a state level, this report can serve as a baseline from which we can assess the impact of state-based HAI prevention programs, including those funded by the 2009 American Reinvestment and Recovery Act.”
The report also brings up the idea that those states that have mandatory reporting might actually discourage the reporting of events, simply because they are mandatory. Those states that have voluntary reporting may have higher rates of reporting because those doing the reporting are not pressured to do so.
Overall, though, the researchers say that the data needs to be validated better in the future, but this report serves as a good starting point.
Check out Consumers Union Web site for great patient safety
To stay up on the latest patient safety news and trends, I often find myself perusing various websites. Some of them are helpful, some not so much, but I wanted to let the readers of this blog know about one great resource I’ve been using from the Consumer’s Union. The Web page is called the Safe Patient Project and it has a wealth of information, resources, and action points for those visitors who want to try to bring about real change.
The site’s tag line, “end secrecy, save lives” gets at the heart of the culture of safety issue that so often comes up on this blog. Without a culture of safety, it’s difficult to encourage reporting of near misses and adverse events. This site gives a great overview of the legislation that is out there to promote accountability among healthcare professionals, as well as legislation on other topic like the prevention of medication errors.
Right now the Safe Patient Project is giving a lot of attention to the now well-known central line-associated bloodstream infection prevention checklist, developed originally by the Keystone project. It’s now being used in hospitals across the country, but if yours isn’t using it yet, this Web site will provide you with lots of resources to start.
What are some of your favorite websites for patient safety information? I’d love to hear your thoughts.
AHRQ releases guides to help providers design public reports about quality data/outcomes
The Agency for Healthcare Research and Quality (AHRQ) has published a series of three guides to teach best practices to those staff people at hospitals in charge of putting together reports for the public. The guides are meant to help users discover how to deliver clear information about hospital quality and performance to the public, which is often unfamiliar with healthcare terminology.
Specifically, the three reports are about the following:
- Report 1, titled,How To Effectively Present Health Care Performance Data To Consumers, focuses on the presentation of comparative healthcare performance data.
- Report 2, titled Maximizing Consumer Understanding of Public Comparative Quality Reports: Effective Use of Explanatory Information, focuses on the background information contained in public reports that frames the decision question, provides a context for using the information, and details the specifics of the data.
- Report 3, titled How To Maximize Public Awareness and Use of Comparative Quality Reports Through Effective Promotion and Dissemination Strategies, focuses on the promotion and dissemination of reports.
You can find access to these AHRQ reports by clicking here.
Do you think that this type of information is useful for you, or someone else at your facility? Is this information that whoever is in charge of putting these type of reports together at your hospital is already aware of? Usually the AHRQ releases these types of reports because there is a need for them in the field, so it’s likely that if your hospital has this down pat, you’re ahead of the curve.
ASHP to The Joint Commission: Good steps taken in proposed revision to med rec
The American Society of Health-System Pharmacists (ASHP) has posted on its website its feedback to The Joint Commission’s proposed revisions to the medication reconciliation National Patient Safety Goal. Overall ASHP’s comments are that the changes made are positive ones, and that it is happy the accreditor has given hospitals more flexibility in implementing their own processes to comply with the goal.
At this time, the goal has just finished a field review and The Joint Commission is presenting the proposed goal to its The Joint Commission’s Standards and Survey Procedures Committee. The proposed goal pares down four goals with 13 elements of performance (EP) to one goal with five EPs. Notably missing is the requirement to provide a patient’s medication information to the patient’s physician or next provider of care. You can find more about the proposed goal in this earlier Patient Safety Monitor Blog post.
The accreditor is expected to announce the final version sometime in the coming months, with possible inclusion in the 2011 standards. The Joint Commission said that it has moved the location of the goal from its original location at goal 8 to goal 3, with the rest of the medication safety language.
For the most part, ASHP’s statement says that the organization agrees with The Joint Commission’s goal as written. However, some of ASHP’s specific recommendations include:
- Changing “obtain information” from the patient regarding medications to “obtain a medication list” to make the requirement more specific and useful.
- Further clarifying the definition of medication.
- Ensuring that the hospital collects at a minimum the name, dose, route, and dosing frequency of each drug, at a minimum.
- Comparing the patient’s medication list with the list of medications ordered for the patient in the hospital, and resolving those differences.
- Not only giving the patient a written list of the medications he or she should be taking upon discharge, but counseling the patient on taking his or her medications, to allow for questions.
You can find ASHP’s full comments on the proposed goal here. Did you submit feedback to The Joint Commission regarding the proposed goals? Do you have any specific feedback you would like to share on the PSM Blog?
UHC focuses on reducing HAIs, specifically CLABSI
Just as many other health systems have done in the past couple of years, University HealthSystem Consortium (UCH) is launching an initiative to combat healthcare-acquired infections (HAI), and specifically focus on central line-associated bloodstream infections (CLABSI). UCH is a collection of 107 academic medical centers. UCH is going to be focusing on preventing on HAIs as part of its Imperatives for Quality program.
As part of its Imperatives for Quality program, UHC will be providing its participating hospitals with specific guidelines for preventing CLABSI for different types of staff at hospitals, ranging from the leadership team to hospital operations, and everywhere in between. Additionally, CLABSI prevention progress will be tracked and measured. Here’s one example of the checklist mentioned above:
- Develop a system and routinely monitor and analyze CRBSI rates at the service level
- Convene a stakeholder committee to develop evidence-based protocols for central line insertion
- Convene a task force to conduct product evaluations for central line insertion systems that meet requirements for maximum barrier precautions
- Communicate protocol requirements, educate physicians and nurses
- Mandate compliance; empower care providers and hold them accountable
UCH also says it’ll provide data reporting tools and sample work plans for hospitals to use in their efforts to prevent CLABSI.
Has your hospital joined forces with others in its system or community to fight HAIs? What unique processes or techniques are you using to motivate staff to utilize best practices?
Quality Safety Investigator program empowers nurses
The University of Kansas Hospital (KUMED) has created a program to encourage nurse involvement in patient safety. Called the Quality Safety Investigators (QSI), nurses in the program are bedside caregivers who are given tools, resources, and training by KUMED to focus on unit-specific initiatives.
I heard of the QSI program during an interview for an article about the American Nurses Credentialing Center’s (ANCC) Magnet Recognition Program® (MRP). I spoke with Liz Carlton, RN, MSN, CCRN, director of quality, safety, and regulatory compliance at KUMED who also had a hand in creating the QSI program. She extolled the virtues of giving staff nurses the power and responsibility of being in charge of improvement projects, and also the benefits of being in a type of membership group at the organization.
Those nurses who are interested in becoming QSIs go through an application process and once they are selected, their managers must also sign contracts stating that they will allow the QSIs to participate in activities away from the unit because of their QSI status.
To read more, see the full article published with HealthLeaders Media.
Does your facility have any type of nursing empowerment group, like the QSI program? If so, do you think it is of benefit to both the facility and the nurses who are a part of it?
Pilot program cuts post-surgical pneumonia
As many hospital professionals know, if a patient catches post-operative pneumonia there is an increased risk of morbidity, length of stay, and costs. For quite some time, hospital surgical wards have not had programs similar to those in the ICU regarding pneumonia-prevention programs, but things could be looking up according to a recent study published in the April Journal of the American College of Surgeons.
U.S. medical scientists developed a pilot prevention program in which physicians and ward staff received education on a standardized postoperative electronic order set. The order set consisted of incentive spirometer, chlorhexidine oral hygiene, ambulation, and head-of-bed elevation. More specifically, this would include a cough and deep breathing exercise, education, twice daily oral hygiene, and bed elevation to at least 30 degrees.
During the pilot program, the staff would hold quarterly meetings in which the results and compliance of the program were discussed. After conducting the program from 2006 to 2008, the scientists found a significant decrease in ward pneumonia incidence from 0.78% in the pre-intervention group compared with 0.18% in the post-intervention group (p = 0.006), representing an 81% decrease in incidence over the two-year period.
Post-operative pneumonia is a common complication among surgical patients, and is the third-most common infectious complication after urinary tract and wound infections.
What steps is your surgical ward taking to prevent post-surgical pneumonia? Are there other tactics do you think would work better than those used in the pilot program? Please discuss.
MA water crisis does not leave MGH high and dry
For Massachusetts General Hospital (MGH) and 30 Greater Boston communities, a “boil water” order and state of emergency was the result of a major water main break in Weston, MA. The order lasted until Tuesday, May 4, but patients in the hospital never would have been able to tell the difference.
MGH is receiving high marks for deploying its Incident Command System, which is led the top supervisors who oversee everything from operating rooms and food services to the ER and housekeeping. MGH then assembled a team to ensure all clinical care and hospital operations proceeded smoothly. To top this all off, the team then issued a set of recommendations to all 22,000 staff members located throughout a dozen off-campus sites.
Despite the fact that “Do not use” signs were placed over water fountains and sinks at MGH, surgeries went on as scheduled and ambulances continued to arrive on time. Staff were reassured by Jeanette Ives Erikson, senior vice president of patient care and chief nurse, that the hospital had 21,408 bottles of water and juice stockpiled in the basement with another shipment on the way. In addition, MGH also had several 60-gallon vats in which water was boiled and then cooled to be used in food preparation.
Now, after a four-day boil alert, MGH is back to using tap water.
If a water ban or boil alert were to happen in your facility, would you be prepared? Does your facility have something similar to MGH? Would you have handled the situation in the same way to protect your staff and patients?
Hospital Culture report shows gains, areas for improvement
In more news from the Agency for Healthcare Research and Quality (AHRQ) this week, a snapshot of the nation’s culture of safety at hospitals shows some positive strides as well as room for improvement. The Hospital Survey on Patient Safety Culture: 2010 User Comparative Database Report was released yesterday, providing interested parties the chance to compare their own hospital’s culture with facilities around the nation who administer the Hospital Survey on Patient Safety Culture. This survey poses a series of questions to staff about their perceptions of the culture at their institution around the following domains:
- Communication openness
- Feedback and communication about error
- Frequency of events reported
- Handoffs and transitions
- Management support for patient safety
- Nonpunitive response to error
- Organizational learning–continuous improvement
- Overall perceptions of patient safety
- Staffing
- Supervisor/manager expectations and actions promoting safety
- Teamwork across units
- Teamwork within units
The 2010 report pulls together survey responses from 885 hospitals, representing 338,607 respondents. Of the 885 hospitals, 321 have already submitted data in previous years, and can observe their own trends within the report. The report has been released annually since 2007. The actual survey was created in 2004 to help hospitals measure their own cultures of safety and attitudes about patient safety.
The three most positively rated areas included in the report are teamwork within units, supervisor/manager expectations and actions promoting patient safety, and the overall patient safety grade of the unit or hospital (mostly As and Bs). The three areas with the largest potential for improvement nonpunitive response to error, handoffs and transitions, and number of events reported (most staff said they did not report any events).
You can find a link to the full report here. It breaks out many different characteristics of survey respondents, like facility size, location, teaching status, and even by specific work units within hospitals.
Does your hospital use the AHRQ Hospital Survey on Patient Safety Culture to assess perceptions surrounding patient safety at your facility? Do you use another tool? No tool at all? I think this report is a helpful snapshot, but it using this information for improvement is really in the hands of hospitals themselves. There is a “recommendations” section at the end of the report for analyzing survey results, which could help guide hospitals.
