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NEJM article reviews criteria for quality process measures

As you collect data on process measures to avoid financial penalties, achieve accreditation, and prepare for value-based purchasing, you might want to consider a recent article in the August 12th issue of the New England Journal of Medicine.

Mark Chassin, MD, MPP, MPH, Jerod Loeb, PhD, and Stephen Schmaltz, PhD, all of the Joint Commission, along with Robert Wachter, MD, came together to write an opinion (as individuals, not as representatives of The Joint Commission) on the current state of core measures. They conclude that currently, not all measures live up to criteria the authors are proposing are necessary to be effective in enhancing patient safety and quality. Though it’s far too early to tell if the measures that fall short of the criteria—such as measures concerning discharge instructions for heart failure patients—will, in the future, actually cease to be a requirement, the article is an interesting read on how leaders might assess and approve measures in the future. The authors propose that measures:

  1. Have a strong, proven evidence base
  2. Accurately measure whether the care process involved has actually been implemented
  3. Is not so far “up stream” in the care process that failure to provide other, more “down stream” care processes would change the effectiveness of the measure
  4. Has a low chance of creating an adverse event

Read the article in the New England Journal of Medicine, “Accountability Measures—Using Measurement to Promote Quality Improvement.”


Patient Safety Monitor Blog Contest Entry!

Another entry received this week into the Patient Safety Monitor Blog Contest concerns a year-long effort to educate staff members about the National Patient Safety Goals (NPSG). Robin Jones, quality care coordinator at Valley Baptist Medical Center in Brownsville, TX, entered this week with a description of how staff incorporate the NPSGs into their daily activities. VBMC has a streamlined process for carrying this out. In Robins’ words:

All NPSGs have been assigned an owner, someone in the organization that is a key stakeholder in that particular goal. Each NPSG owner is responsible for formulating a team for his or her Goal. The team is responsible for developing a process, policy, and implementation plan, as well as for auditing, and monitoring compliance of each NPSG. Each NPSG goal owner submits a monthly compliance update to Quality and it is placed on a NPSG dashboard. The patient safety committee is responsible for oversight of the NPSG compliance dashboard and corrective action plans for each NPSG.

Although VBMC does host some events in honor of Patient Safety Awareness Week, like an e-mail campaign, staff have found (as many facilities have) that compliance with the NPSGs is something that needs continuous attention, and therefore staff are educated throughout the year. This includes the creation of NPSG-related posters that are displayed throughout the facility, as well as the distribution of these pocket cards to all staff during orientation or bi-annual NPSG education days.

Thanks for entering, Robin!


Patient Safety Monitor Blog Contest entry!

I want to highlight some of the entries into the Patient Safety Monitor Blog Contest, in honor of Patient Safety Awareness Week. Today I’d like to share an entry by Anna Green, who works in quality management and patient satisfaction at Boone County Hospital in Boone IA. Her facility has created a patient safety quilt as one way to observe the week.

The quilt squares are made up of three questions that each participating department developed, based off of the National Patient Safety Foundation’s “Ask Me 3″ program. Ask Me 3 is a campaign to promote patient education by arming patients with three questions they should ask their caregivers. The departments at Boone County Hospital came up with specific questions that they often receive, and creatively displayed them on a quilt square. Anna and her colleagues hung up the quilt for patients, employees, and visitors to see, and it will stay hanging throughout Patient Safety Awareness Week.

In Anna’s words:

Eleven departments were asked to create a 24 x 24 inch quilt square by listing their three most commonly asked questions and anything else creative they wanted to add that would distinguish their department and creativity. We ended up with something much more than we were expecting! The departments really had a lot of fun with this activity.

Tammy Flick, our Clinical Informatics director actually thought of the Quilt. We all instantly loved it! Tammy is creative and I knew it, so I wanted her to be a part of the team, even though she doesn’t typically attend specific pt safety committees. I think it’s a good way to get everyone involved and sends the message to other staff that we want their participation as well.

Along with the quilt, those participating developed word documents that list out the questions and answer them in detail. These documents are being given out as handouts to staff and patients during this week. You can find two examples here, one from the emergency department and from the surgical department.

Announcing a new Patient Safety Monitor Blog contest!

Our contest last summer was such at hit that we’ve decided to launch a new contest in honor of the upcoming Patient Safety Awareness Week, which takes place from March 7-13. The contest is simple: Send in examples (this can be stories or written accounts, tools/forms, policies/procedures, etc.) of how your hospital is complying with the 2010 National Patient Safety Goals (NPSG).  Have you run any events this year to teach staff about the 2010 NPSGs? Are you planning anything special in honor of Patient Safety Awareness Week?

I invite all blog readers to submit a description and any accompanying materials to me, Heather Comak, (editor of this blog) at hcomak@hcpro.com of any creative patient safety events that your facility has hosted to promote patient safety. I will post some of the entries a few times a week to showcase what has been sent in. After Patient Safety Awareness Week has passed, a panel of judges here at HCPro will choose which entry piqued their curiosity most and also trains staff best about the 2010 NPSGs. The winner will receive a free copy of The 2010  National Patient Safety Goals Calculator which helps users track NPSG compliance.

Please see the contest rules for full details.

Announcing the winner of the Patient Safety Monitor Contest!

The month-long Patient Safety Monitor Contest has come to a close, and I’d like to thank everyone who sent in entries, read the creative ideas of the week, and commented on the blog. Although there were many great ideas entered into the contest, our panel of judges at HCPro has chosen Abington Memorial Hospital’s  (AMH) “Patient Safety First” education program as the winner!

Entered by Robert C. Giannini, NHA, safety/quality specialist at AMH in Abington, PA, the program includes a month-by-month effort to focus on a different patient safety topic each month on a hospital-wide level. It’s an education campaign to train all staff members about the patient safety issues facing hospitals today.

In Robert’s words:

The objective of this monthly program is to promote communication (“a behavior a month”) and hospital-wide alignment in our efforts to establish and maintain a safe and reliable healthcare culture.

The program meshes the Joint Commission’s National Patient Safety Goals for 2009 with the hospital’s own internal goals. Part of the effort involves safety coaches, who are frontline caregivers that make it a goal to involve all of their fellow staff members in the theme of the month. This has been such a success at AMH partly because staff members know that the effort is not going away. It’s publicized in some of the hospital’s newsletters and materials are posted throughout the facility to remind staff members the focus of the month.

For 2009, AMH developed a 12-month Patient Safety First schedule. The focus in January was on hand hygiene. The hospital developed patient education materials to alert patients that handwashing was a focus that month and asked them to be a partner in their own safe care. Additionally, those in charge of the campaign created separate materials for staff members, reminding them that January’s patient safety topic was performing hand hygiene before and after contact with patients or the hospital environment.

Thanks for entering, Robert! As the winner of the contest, Robert receives a complimentary copy of the Patient Safety Officer’s Handbook.


Patient Safety Monitor Contest Update

winning-medalOnce again, this week yielded another great group of entries into the Patient Safety Monitor Blog Contest. Now at the halfway point, the contest has produced some creative and fun ways to celebrate patient safety as well as educate staff members about the topic.

The entry I’d like to highlight this week comes from Lauran Allen, MEd, PMP, in performance management and improvement at Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, TN. In the fall, the hospital hosts a Patient Safety Pumpkin Patch Bash that incorporates having fun and learning about the facility’s patient safety practices into one event. Allen says that like most facilities, her hospital struggles with maintaining staff enthusiasm and engagement toward the topic year round. This event is a great way to re-energize staff members and remind them that patient safety is a part of their everyday practices.

“We believe that fun and play are definite avenues for patient safety education and culture building,” says Allen. “With the Patient Safety Pumpkin Patch Bash we utilize the natural human affinity for fun to create an interactive fall patient safety fair that builds greater understanding of patient safety issues and concepts in all levels of the organization.”

Here is how she describes it:

The Bash is a fall fair for all staff centered on patient safety. Fun, interactive booths provide an opportunity to reinforce safety concepts in an inviting way. An example of a booth is the Mummy Wrap. This booth is centered on pressure ulcer prevention and includes a race between staff members to “unwrap” dolls wrapped in gauze and then answer pressure ulcer related questions. For those that are not as well versed in pressure ulcer prevention, a storyboard is also part of the booth and contains all the information needed to participate.

We have also used exit survey feedback to illustrate the benefit staff feel they gain by attending and participating in our Patient Safety Pumpkin Patch Bash and I think that other institutions can easily capitalize on this type of event.

 Other booths at the Bash include a “room of horrors” where staff members point out the patient safety issues, and a “patient safety fortune teller” where staff members receive insight into how they might use the hospital’s policies and procedures to help with a patient safety issue.

Thanks for entering, Lauran, and readers, keep sending your great ideas! E-mail me at hcomak@hcpro.com with a description of your event/ education session/ whatever your creative idea to incorporate patient safety into your daily work has been. 

Patient Safety Monitor Contest Update

winning-medalWe had some great entries into the Patient Safety Monitor Blog Contest this week, keep those entries coming! I’m looking forward to another week of creative submissions.

This week’s entry that I’d like to showcase is from Susan Davis, RN, QPI specialist at Betsy Johnson Regional Hospital in Dunn, NC. She described a themed safety fair the hospital hosted in 2008 called “Compliance Casino-Where Patient Safety is a Sure Bet”. Davis and her staff organized the fair as a way to test the patient safety and Joint Commission knowledge of other hospital staff members. Prior to the fair, Davis and her colleagues had had hospital employees complete an online education session about the facility’s patient safety practices. The fair was used as a way to measure how much knowledge staff members had actually retained.

Here is how Susan explained the fair:

Employees were invited to the Compliance Casino to “bet” on their knowledge regarding patient safety. Each employee was given five poker chips and they were invited to play casino-type games including black jack, roulette, billiards, and craps in order to win more chips to redeem for small prizes. The trick was that they had to answer questions about patient safety in order to play each game. If an employee answered wrong, he or she lost a chip and weren’t allowed to play the game and received education on the correct answer.

To make it more fun and really help staff members get into the spirit, Davis and her team decorated the room where the fair was held to look like a casino and the educators running the games dressed like card dealers and other casino employees. Davis said she also served snacks, which are often a staple of many patient safety-themed events.

This imaginative and fun event engaged many staff members in thinking about how to integrate patient safety into their daily jobs.

Thanks for entering, Susan, and for those of you who would like to enter, we are running this contest for the next month! I will post another sample next Friday. If you’d like to enter or have any questions, please e-mail me at hcomak@hcpro.com.


Contest in honor of National Patient Safety Day

teacher-female-11In honor of National Patient Safety Day taking place Saturday, July 25, the Patient Safety Monitor Blog is launching a month-long contest! I invite all blog readers to submit a description and any accompanying materials to me, Heather Comak, (editor of this blog) at hcomak@hcpro.com of any creative patient safety events that your facility has hosted to promote patient safety. This could be a fair, education program, or hospitalwide campaign (to name a few).

Each Friday I will choose one submission from the prior week to showcase on the blog. At the end of the month, our panel of judges from HCPro (including me) will choose the most creative and the winner will receive a free copy of The Patient Safety Officer’s Handbook, an informative book with tools to improve safety and quality published by HCPro.

Click here to see the contest rules.

I hope to see some great entries out of this contest! Thanks for participating!

Contest Rules

The following are rules that will be used for any contests run through this blog.

  1. No purchase necessary.
  2. To enter, please include your name and facility with the entry.
  3. You must be 18 years of age to enter.
  4. To be eligible, entries must be completed and received by date specified in original blog post announcing the contest. Incomplete entries will be disqualified. All entries become the property of HCPro, Inc. HCPro is not responsible for lost, misdirected, or delayed entries. Entries must be received by e-mail.
  5. Potential winners will be notified by e-mail.
  6. Decisions made by the judges are final.
  7. By entering the contest, the entrant allows his/her name to be reprinted on the Patient Safety Monitor Blog without compensation.
  8. The prize is not redeemable in cash and must be accepted as awarded.
  9. Winners must provide a valid mailing address to receive their award.
  10. Employees (or immediate family members of employees) of HCPro, Inc., are not eligible to win.
  11. HCPro, Inc. reserves the right to amend and change these rules as it deems necessary. Varying contests will have various rules.
  12. One entry per person.
  13. By entering this contest, you agree to accept and abide by these rules.