BACKUSblog

Let’s not be quiet about noise reduction ideas

2007-03-15T08:59:00.000-04:00

There’s a lot of talk about noise in hospitals lately. Just last month, the Denver Post published an article about a trend developing in hospitals in that region: real attention to noise reduction.

The Rocky Mountain region is not alone in recognizing the seriousness of this seemingly simple issue. Recent research shows that noisy hospitals may increase the length of stay for patients and the chance for medical errors by staff, according to Ilene Busch-Vishniac, a sound-engineer professor at Johns Hopkins University who has studied the issue.

Her two-year study, published in 2005, showed that daytime hospital sound levels have increased from 57 decibels in 1960 to 72, equivalent to a noisy restaurant.

Here’s the difference: If you go to a bar, a bistro or a diner, you expect noise to be part of the experience. That’s not the case when you come to the hospital. Moreover, the issue is not just about amenities; excessive noise is being linked to safety and quality.

“There is an incredible amount of noise in hospitals,” said Busch-Vishniac, who said noise ranks among the top five complaints listed by patients and staff. “There appears to be a link between noise and the speed of which people heal and medical errors.”

In the coming weeks, we’ll examine the noise issue — and seek your solutions and suggestions — more closely. Remember the saying: Patients not only heal; they hear.

Patients hear as well as heal

2007-03-07T12:07:00.000-05:00

It’s ironic, isn’t it? When you’re hospitalized, everyone tells you to get some rest. But we all know it’s hard to get a good night’s sleep (or an afternoon nap) in a hospital. Some of that is the nature of providing healthcare: tests are scheduled, assessments must be made, IVs need to be started, vitals must be checked and meds given.

But some of the noise — the part that patients really don’t understand — is avoidable. Things like loud talking and laughter in the evening. Unanswered phones, with the ring-tones set at maximum. Carts that squeak and clipboards that snap. Add to that frequent overhead paging and the possibility of a roommate with late-hour TV habits and you’ve got the recipe for a sleepless night. That’s hardly going to make for a satisfied patient.

Noise is an issue at Backus Hospital, as it is for hospitals nationwide. Here at Backus, fewer than half (46.5%) of inpatients who completed our patient experience survey last quarter answered “always” to the question: How often was the area around your room quiet at night?” More telling, that score placed Backus in the 56th percentile of 917 hospitals in the NRC+Picker database — well below other areas, where we score in the upper 90th percentiles. That means 44% of those hospitals do a better job than we do.

Our patients notice. Here are some actual comments from our HCAHPS survey. Patients were asked to name “one thing they would change about the hospital”:

“Have less noise in the evening”
“Would want a quieter room”
“Nurses’ station in very early morning hours should be as quiet as need be, so as not to disturb patients with laughter, etc.”
“More quiet nights”

(You can see all the comments on the Backus Intranet: Click Patient-Centered care under the Quick Links, and then “The Patient’s Voice” link. To read an interesting Los Angeles Times article about hospital noise, visit our blog at backusblog.blogspot.com and click on the link provided with this story. )

When it comes to always providing a great patient experience at Backus, remember: Our patients not only heal; they hear.

Joint Commission to visit any time now

2007-01-26T14:23:00.000-05:00

For the past several months the Backus Hospital's weekly employee newsletter has published a “Focus on Safety” series to raise awareness about patient safety.

Although patient safety should be at the forefront of everyone’s mind year round, now is the time to raise issues and ask questions – the Joint Commission is scheduled to show up unannounced at any time beginning now.

In preparation for the Joint Commission visit, the hospital will undergo a “mock survey” Feb. 6-8.

As a refresher, here are the 2007 Joint Commission Patient Safety Goals:

• Improve the accuracy of patient identification
• Improve the effectiveness of communication among caregivers.
• Improve the safety of using medications.
• Reduce the risk of health care-associated infections.
• Accurately and completely reconcile medications across the continuum of care.
• This includes providing a complete list of the patient’s medications and communicating to the next provider of service when a patient is referred or transferred to another setting, service, practitioner or level of care within or outside the organization. The complete list of medications is also provided to the patient on discharge from the facility.
• Reduce the risk of patient harm resulting from falls.
• Encourage patients’ active involvement in their own care as a patient safety strategy. Define and communicate the means for patients and their families to report concerns about safety and encourage them to do so.
• The organization identifies safety risks inherent in its patient population, including identifying patients at risk for suicide. [Applicable to psychiatric hospitals and patients being treated for emotional or behavioral disorders in general hospitals).

For more information go to jcipatientsafety.org

Anyone with any questions about the National Patient Safety Goals, or suggestions to improve patient safety at Backus, is asked to call or email Mary Bylone, Assistant Vice President, Patient Care Services and Patient Safety Officer, ext. 2771, or Joe Hughes, Director of Quality Improvement, at ext. 2345.

New pediatric emergency kits reduce possibility of dosage error

2007-01-12T16:11:00.000-05:00

Members of the code 8 committee have devised a new process to make it safer to give medications in pediatric emergencies. The newly revised pediatric emergency kits will improve patient safety during pediatric code situations, Backus staff members say.

Eric Arlia, Director of Pharmacy Services at Backus, said previously in a pediatric emergency, medications such as dopamine, dobutamine, and lidocaine would need to be mixed specifically for each code situation. Dosages were calculated differently for patients of different sizes and ages, which could potentially result in a calculation and mixing error.

In the new system, the medications are mixed the same way no matter what the size of the child. The drugs (mentioned above), as well as epinephrine and norepinephrine, are pre-mixed and administered according to an infusion rate chart. There are no calculations or mixing needed, providing a faster way to administer medications with less chance of error.

Debbie Dolan, RN, Clinical Director of A-3, where the majority of pediatric patients are admitted, said not having to calculate doses in the midst of an emergency will certainly help pediatric patient safety.

“This is certainly going to help ensure that our pediatric patients receive the right medication, at the right dose at the right time,” she said.

Peter Shea, MD, Medical Director at Backus, agrees.

“The ability to provide a more precise, accurate dosage will greatly increase patient safety in these situations,” he said.

The revised emergency kits are in compliance with Joint Commission standards. However, the standard requirements did not specifically explain how to design such a system, which is where the committee’s ingenuity proved useful.

Mr. Arlia explained that pediatric emergencies can be very tense, and he believes the new emergency kits will help make these situations easier.

“This new system will help both physicians ,patients and staff by allowing medications to be dispensed faster and with less chance for error,” he said.

Medication safety is a major part of the commission's patient safety goals. Backus will receive an accreditation visit later this year. A mock survey will be held Feb. 6-8. Anyone with any questions about patient safety goals, or suggestions to help Backus improve patient safety, can call Mary Bylone, Assistant Vice President of Patient Care Services and Patient Safety Officer, at ext. 2771, or Joe Hughes, Director of Quality Improvement, at ext. 2345.

Prompt action by employee spurs safety change

2006-12-15T11:41:00.000-05:00

A Backus Hospital staff member recently recognized a potential patient safety issue and was the driving force behind a hospital systems change that will no doubt benefit patients.

The Critical Care Unit staff member, who asked not to be identified, noticed a potentially serious patient safety issue related to Medication Reconciliation forms and post operative procedures.

Here is what transpired:
? A patient returned from surgery with an outdated medication reconciliation form.
? The form was completed renewing medications that were not current.
? The staff member caught the problem before medications were administered, and alerted her clinical director, Debra Furtado, RN.

Ms. Furtado said the staff members actions have resulted in a change that will benefit patient safety. She said prior to the incident, when patients went from surgery to an inpatient unit, it was expected that the inpatient unit coordinator would print up and send the most current medication reconciliation form with the patient’s chart. That form was to be utilized by the surgeon during the post operative ordering of medications.

“This is an exceptionally unstable time for patients returning to the CCU from surgery with medications being of the utmost importance,” Ms. Furtado said. “If the order form in the chart was not printed up and an old, outdated version was left sitting in the chart for the surgeon to review, potential danger was just a step away.”

Under the new protocol, which is the direct result of the staff member’s actions and her recommendations, PACU simply prints the most current form in that department and makes it available to the surgeon when orders are written. PACU Clinical Director Shelbye Maynard, RN, gladly agreed with the plan and implemented the change in her department.

The staff member also recommended that Nursing Informatics be alerted to the situation, which Ms. Furtado did.

Karen Long, RN, Vice President and Chief Nursing Officer, praised the staff member for her due diligence and eagerness to alert the appropriate parties.

“This is a perfect example of the benefits of checking and double checking every step in the process of administering medication to our patients, and taking action to address a patient safety issue,” Ms. Long said. “This staff member did exactly the right thing for our patients. Patient care has been improved due to her attention to detail and willingness to communicate.”

Peter Shea, MD, Medical Director, encouraged all Backus staff to pay attention to patient safety issues in their department, and if issues are identified, think about how other departments might be involved to reduce the chances of the problem popping up again.

“In order to improve patient safety, we must push for systems-wide change,” Dr. Shea said. “That can’t happen if we aren’t thinking outside the box, and communicating with our colleagues in other departments. In most cases, more than one department is involved and need to be brought into the loop.”

Mary Bylone, RN, Assistant Vice President, Patient Care Services, said this is the perfect example of identifying and correcting a systems issue that put good people at risk for failure.

Ms. Bylone added that medication safety and communication among caregivers are important components of the Joint Commission on Accreditation of Healthcare Organization’s Patient Safety Goals. Anyone with questions about the upcoming JCAHO visit, or suggestions to improve patient safety at Backus, should call Ms. Bylone, who is the hospital’s Patient Safety Officer, at ext. 2771, or Joe Hughes, Director of Quality Improvement, at ext. 2345.

Mass casualty drill puts Backus to the test

2006-12-08T13:21:00.000-05:00

A simulated roof collapse at Dodd Stadium Dec. 5 provided a stern test for Backus Hospital’s Emergency Management Plan.

Approximately 30 people were “injured” in the incident – caused by excessive snow – and all needed to be transported by ambulance to Backus. Actors, mostly EMT and nursing students, were physically taken to Backus for treatment of a wide range of injuries, many of them serious.

The mass casualty scenario began around 6:30 p.m., when an influx of patients arrived in the newly-renovated Emergency Department, where they were triaged and in some cases taken to appropriate areas of the hospital, including the Operating Room and Diagnostic Imaging.

Nursing Supervisor Nancy Giambra, in consultation with the Administrator on call, initially called for a partial “Plan D” alert, and later upgraded it to a full-fledged alert. She established a command center in the auditorium where decisions were made on how to handle the victims, what floors to place them on and how to continue to take care of an already full house of patients.
Nick Senuta, EMS Coordinator at Backus, said there were several significant aspects to this disaster drill:

Mr. Senuta said the drill, designed to overwhelm the hospital, was a success, and much was learned. A briefing was held afterwards in which actions steps were developed, including more education for staff on the hospital’s emergency management plan, ideas to better utilize the command center structure outlined in the plan and how to better streamline the triage and patient identification processes.

In addition to Emergency Department staff, other departments involved in the drill included Security, ESD and others. Organized by Fred K. Potter, past fire chief in Bozrah and Fire Captain at the Bradley International Airport Fire Department in Windsor Locks, the exercise also involved fire and ambulance personnel from the region.

“I want to thank everyone involved in this drill – the EMS community, the actors and especially our staff,” Mr. Senuta said. “It’s not easy to concentrate on a drill when you are taking care of real patients at the same time, but that’s the nature of a disaster. It’s not just going to occur between 9 a.m. and 5 p.m., on a day when there are plenty of beds and staff available. While these kinds of drills might seem like a nuisance, it is very important that we take them seriously so that when a real event occurs, we are prepared.”

"This is a caring hospital"

2006-12-01T14:42:00.000-05:00

An 82-year-old patient on A-3 was one of the first people to receive and submit the new HCAHPS inpatient experience survey. By all accounts, she received fabulous care, and she is grateful for it.

Read her response to the survey’s open-ended question, “If you could change one thing about this hospital, what would it be?”: “I would move it to my home town, where nursing care has almost disappeared! This is a caring hospital.”

Not surprisingly, she rated the hospital a “10” on a 1-to-10 scale, said she “always” received the care she expected, and would “definitively” recommend Backus Hospital to her family and friends for their healthcare needs.

Not all patients report such positive experiences, of course, but every patient’s survey gives us a chance to assess how we’re doing — and to make the patient experience the very best it can be.

The ability to receive such quick feedback on the 27 HCAHPS questions and nearly as many other survey items is a benefit of our new NRC+Picker survey tool. All clinical directors and department heads, and several other individuals, have ready access to this data, any time on any computer. Feel free to ask any questions — or e-mail a question to Keith Fontaine, Vice President, Corporate Communications at kfontaine@wwbh.org. Our survey vendor is eager to provide as much information as possible.

So far, we have received responses from 60 surveys. You can view the survey questionnaire by clicking here.

Next week, we’ll take a closer look at the results so far.

Nurses empowered to keep patients safe

2006-11-30T17:57:00.000-05:00

Because of the inconsistent nature of vaccine supply and sporadic interest on the part of the general population, administering flu and pneumococcal shots in the hospital is an is an effective way to protect the older and chronically ill population from flu and pneumococcal disease, both of which can lead to hospitalization and even death.

That’s why it’s important that nurses remain aware that they are now empowered to give these shots without individual physician orders. Legislation was passed in 2005 allowing this important patient safety initiative to move forward.

At Backus Hospital, there is a physician-approved policy in place that allows nurses to vaccinate the older and chronically ill population – flu shots to patients 50 and older, and pneumonia shots to patients 65 and older.

“This is an important component of good medicine, and an opportunity for our nurses to identify and help patients at risk,” said Joseph Hughes, Director of Quality Improvement at Backus.

An average of 36,000 deaths and 200,000 hospitalizations related to flu occur in the U.S. each year.

Pneumococcal disease most commonly presents as a serious infection in the lungs (pneumonia), blood (bacteremia), or brain (meningitis). It kills more people in the U.S. each year than all other vaccine-preventable diseases combined.

With the height of the flu season just around the corner, nurses should keep this hospital protocol in mind for every potential patient, said Karen Long, RN, Vice President and Chief Nursing Officer.

“Both of these diseases can cause severe illness and death, especially among the sometimes frail hospitalized population,” Ms. Long said. “This is an important patient safety measure that empowers our nurses to provide the best care to our patients.”

Peter Shea, MD, Medical Director, said hospital vaccination rates are a publicly reported quality measure.

“However, what it’s really about is keeping our patients healthy and safe,” he said.

Anyone with suggestions to help Backus improve patient safety can call Mary Bylone, RN, Assistant Vice President of Patient Care Services and Patient Safety Officer, at ext. 2771 or Mr. Hughes, at ext. 2345.

A safety save results in systems change

2006-11-10T11:01:00.001-05:00

Despite rapidly expanding technology, stringent protocols and improved processes, medication errors are always possible in patient care settings.

Peggy Rankowitz, RN, BSN, OCN, found that out firsthand Wednesday on A-2. Fortunately, she exhibited the type of behavior needed to ensure patient safety at Backus Hospital.

It all began when Ms. Rankowitz went to the Pyxis machine on the oncology floor to retrieve a Heparin drip for one of her patients. She pushed the button labeled “Heparin drip” and pulled out the bag. As she removed the outer wrap, she began the process of ensuring the “five rights” – the right medication, right dose, right patient, right route of delivery and right time.

Although she has done this countless times over the course of her 16-year nursing career at Backus, this time it paid off. Something was very wrong; she was actually holding a bag of premixed Theophylline.

The Heparin and Theophylline are made by the same manufacturer and are very similar looking, so Ms. Rankowitz’s steadfast attention to medication safety protocol avoided a significant medication error, and prompted an immediate Hospital-wide systems change.

“My heart rate went up,” Ms. Rankowitz said. “It was quite alarming. This is why they teach us to do our five checks – it’s part of the job. You always have to check, because we deal with so many medications, so many patients, and they are always coming and going. We have to keep in mind that it is always a possibility.”

The U.S. Food and Drug Administration certainly agrees. The USDA reports that medication errors injure 1.5 million people annually, and the extra costs of treatment related to these injuries in hospitals nationwide each year is $3.5 billion. Approximately 41 percent of all fatal medication errors involve giving an improper dose, 16 percent giving the wrong drug and 16 percent using the wrong route of delivery.

The results of what can happen when medication checks are not properly done were magnified at an Indianapolis hospital recently, where nurses inadvertently gave two newborns adult doses of Heparin. The vials of adult and baby doses were of similar size and color, which allegedly prompted the mistakes.

In the case at Backus Hospital, Ms. Rankowitz not only noticed the problem but took steps to eliminate the chance of the same error occurring again. She re-accessed Pyxis to ensure there were no other Theophylline bags in the wrong places, and alerted her supervisor to what had happened. Her supervisor then notified the Pharmacy, which immediately evaluated the situation and decided to stop stocking Theophylline bags, which are not used very often and look too much like the more commonly used Heparin. This means that this particular medication mix-up could not possibly happen again.

“This is exactly the type of behavior we expect from our staff,” said Karen Long, RN, Vice President and Chief Nursing Officer. “This is a real-life scenario that underscores the importance of reading the label on all drugs, double-checking them before they are administered and alerting the proper people to ensure that a medication error doesn’t happen again. I commend Peggy for her efforts, and encourage all of our staff to follow her example.”

Glennie Poletti, RN, A-2, said Ms. Rankowitz’s actions are symbolic of what nurses should continuously strive for – routinely keeping patient safety at forefront of everything that they do.

“This is what we do all the time,” Ms. Poletti said. “It’s a routine that we follow, it’s how we practice, and this just goes to show that what we are doing really works.”

Mary Bylone, RN, Assistant Vice President of Patient Care Service and Patient Safety Officer, said caregivers must remain vigilant to prevent human error, even though when you do things over and over it might seem like a waste of time.

“This is a great example of how following established, routine protocols can improve patient safety,” Ms. Bylone said. “Peggy’s attention to detail, and her taking the initiative to notify the appropriate parties, is the type of behavior we want to see in our caregivers. I can’t emphasize enough how important this is to our patients. ”

Peter Shea, MD, Medical Director, said following established processes, and putting the patient first, is the basis for error prevention. He said Ms. Rankowitz’s follow-up was extremely important.

“Peggy’s actions directly resulted in an immediate hospital-wide systems change,” said Dr. Shea. “She did a tremendous job, and our patients are safer because of her.”

Ginny Mabesoone, RN, Clinical Director of A-2, said Ms. Rankowitz has always exhibited the traits of a remarkable caregiver, and her recent efforts only add to her reputation.

“Nurses like Peggy are tremendous role models,” Ms. Mabesoone said. “She deserves an enormous amount of credit for what she did this week, and for her consistent efforts to provide the best care possible to our patients.”

Medication safety is a focus of the Joint Commission on Accreditation of Healthcare Organization’s National Patient Safety Goals. Anyone with any questions about the JCAHO goals, or suggestions to help Backus improve patient safety, can call Ms. Bylone at ext. 2771, or Joe Hughes, Director of Quality Improvement, at ext. 2345.

Protect your patients by getting a flu shot

2006-10-28T10:52:00.000-04:00

The first few flu cases have been reported in Connecticut, so now is the time for healthcare workers –especially those that provide direct care to patients –to get flu shots.

“We spend a lot of time talking about putting our patients first,” said Mary Bylone, RN, Assistant Vice President of Patient Care Services and Patient Safety Officer at Backus. “Getting a flu shot is a fundamental way to do just that.”

The Centers for Disease Control and Prevention recommends that all healthcare workers receive annual flu vaccinations because they help prevent death and severe illness among patients. Despite this, only 36-40 percent of healthcare workers take the time to get flu shots, according to the CDC.

At Backus, the percentage seems to be higher, but there remains room for improvement. Faith Coleman, RN, Employee Health Nurse at Backus, reports she has already administered 800 vaccinations, and the Hospital still has 400 shots remaining.

“Protect yourself, your patients, your family and co-workers by getting vaccinated,” Ms. Coleman said.

Peter Shea, MD, Medical Director at Backus, said vaccinating staff is a key way to improve patient safety, and unlike more complex safety initiatives, it only takes a few moments of your time.

Robin Heard, RN, Coordinator of Epidemiology at Backus, said there are many reasons why healthcare workers choose not to get vaccinated, and most of these decisions are based on misconceptions. They include:

? Concern about side effects. Some people think that the shot will make them sick, but the shot does not cause influenza, according to the CDC. The most common side effect is mild soreness of the arm.
? “I don’t need a flu shot.” Wrong. The flu can cause serious illness and death even in young, healthy people. Also, you put patients at risk by not getting a shot.

Anyone with suggestions to help Backus improve patient safety, can call Ms. Bylone at ext. 2771 or Joe Hughes, Director of Quality Improvement, at ext. 2345.

Public interested in ‘curing’ the nation’s hospitals

2006-10-12T13:53:00.000-04:00

QUICKLINKS to posts in this blog:

Newsweek's "Fixing America's Hospitals" stories

PBS's "Remaking American Medicine" documentary series

Newsweek magazine devoted 20 pages in its most recent issue (Oct. 16) to stories with the provocative headline, “Fixing America’s Hospitals.” There is no doubt this would have been the cover story had not the Congressional page scandal occurred.

Last week on PBS, and for the next three weeks, a documentary series looks at “Remaking American Medicine.”

Coincidence? Hardly. Since the publication of “To Err is Human” in 1999 (which disclosed that between 44,000 and 98,000 hospitalized patients in the U.S. die each year from a medical error), public interest in creating a safer patient experience has mushroomed.

“Patient safety is not something that’s only discussed in hospitals or classrooms anymore,” said Keith Fontaine, Vice President, Corporate Communications. “It’s a real issue that has captured the public’s attention. Patients and their families want to know what we’re doing to make their experience as safe as possible.”

JCAHO’s Patient Safety Goals, the national quality measures and the new HCAHPS survey of inpatients’ experience are all outgrowths of this safety-quality-experience effort, said Peter Shea, MD, Medical Director.

“We have the goals, and we know what they are. We agree they make sense for quality patient care. Now we must live out the goals,” Dr. Shea said. “That’s what people expect, and that’s why there is huge public interest in this topic.”

The Newsweek stories can be read online at: www.msnbc.msn.com/id/15175919/site/newsweek

Information on the PBS series is at: www.pbs.org/remakingamericanmedicine

JCAHO imposters identified in Connecticut

2006-09-29T14:32:00.000-04:00

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is in charge of ensuring that quality standards are adhered to at healthcare facilities across the country.

But how do you know JCAHO is JCAHO?

Always ask for identification – they should have a JCAHO ID badge and a letter addressed to Hospital President and Chief Executive Officer Thomas P. Pipicelli, signed by a JCAHO executive, explaining who they are and the purpose of their visit.

If something doesn’t seem right, report it to your supervisor and the Security Department.

Just this week, the Connecticut Hospital Association (CHA) announced that a Connecticut hospital recently experienced a JCAHO imposter incident.

According to Carrie Brady, Vice President, Quality and Performance Reporting for CHA, several staff members from an unidentified hospital noticed three individuals in business dress (2 women and 1 male) sitting in a hospital lounge writing on clip boards and displaying an identification badge from the Joint Commission.

Staff was surprised to see the Joint Commission in the hospital and asked if they could be of assistance. After their offer was declined, staff went to report JCAHO's presence to the unit manager.

Staff returned with the unit manager a few minutes later but the three individuals had left the lounge. Security was notified and the hospital went into lock down. Shortly thereafter, the fire alarm was pulled, which automatically opens selected egress doors.

Security searched the hospital, but the imposters were not found. Please notify your immediate supervisor immediately if you experience any incident with apparent JCAHO imposters. They should then report the incident to JCAHO and CHA.

At Backus Hospital, JCAHO is scheduled to visit sometime after Jan. 1. Anyone with questions about the upcoming JCAHO visit, or suggestions to improve patient safety at Backus, should call Mary Bylone, RN, Assistant Vice President of Patient Care Services and Patient Safety Officer, at ext. 2771, or Joe Hughes, Director of Quality Improvement, at ext. 2345.

Going in Circles? Sometimes it helps

2006-09-28T17:38:00.000-04:00

“Life comes at you fast” is the slogan for the latest ad campaign for Nationwide Insurance. It might just as well be the motto for beleaguered hospital caregivers everywhere.

New National Patient Safety Goals. A new nationwide survey of the patient experience. Hospital quaolity report cards. It’s all here. It’s all an important part of hospital life. And it’s coming at us fast.

In an presentation to the Backus Board of Trustees this past Monday, Peter Shea, MD Backus Medical Director, began by making a critical point: These aren’t separate,
disconnected items. In fact, they are all part and parcel of the same thing.

It makes sense, when you put the patient at the center.

Let’s take just one example -- but an important one. No one would deny that medications are an important part of the patient experience, that preventing drug-dispensing errors is a key safety measure, and that the timely dispensing of life-saving meds to patients who present with heart attack symptoms is a quality metric. It would be easy to compartmentalize this into three separate “things to do”:

• Patient Safety Goal number 8-B from the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)
• Quality Measures number 1 through 5 as collected by the government and reported on the "Hospital Compare” website
• Patient experience questions number 15 through 17 of the new HCAHPS survey, which begins Sunday, Oct. 1.

It’s better, said Dr. Shea, to consider this as one important area of patient-centered care that’s measured in three different ways. “Put the patient at the center, and the circle goes around,” he said. “Good quality promotes a culture of safety that leads to patients who always have a good experience. It’s simply good healthcare.”

An HCAHPS Overview

2006-09-25T09:20:00.000-04:00

THE SURVEY

Q: What is HCAHPS?
A: HCAHPS stands for Hospital Consumer Assessment of Healthcare Providers and Systems. In the summer of 2002, the Centers for Medicare and Medicaid Services (CMS) asked the Agency for Healthcare Research and Quality (AHRQ) to develop an instrument to measure patient perceptions of care. This measurement would be used to publicly report hospital performance (quality of care as perceived by patients). The goal of this public reporting instrument, as stated by CMS, is to provide consumers with information that might be helpful in choosing a hospital. CMS has also stated that it should complement rather than compete with quality improvement instruments already being used by hospitals. Although the survey has changed significantly since 2002, its purpose remains the same.

Q: What is the HCAHPS questionnaire like?
A: Here is an overview of the survey:
• The instrument asks patients to rate the frequency of events during their care (never, sometimes, usually, always).
• The survey is organized under the following headings:
-- Your Care from Nurses,
-- Your Care from Doctors,
-- Your Experiences in the Hospital,
-- When You Left the Hospital,
-- Overall Rating of the Hospital,
-- About You.

• The survey questions will be reported in the following domains:
-- Communication with Doctors
-- Communication with Nurses
-- Responsiveness of Hospital Staff
-- Pain Control
-- Communication about Medicines
-- Cleanliness and Quiet of the Physical Environment
-- Discharge Information

• The survey instrument can be used either as a stand alone survey or embedded into an existing patient survey with the core HCAHPS questions at the beginning of the survey. The hospital can decide how many questions to add.

• Initially, the survey will only be available in English and Spanish.

Q: I have heard that reimbursement will be tied to HCAHPS. Is that true?
A: There have been discussions recently that indicate there could be a link between reimbursement and participation in HCAHPS. Nancy Foster of AHA indicated in an interview in AHA News (Jan. 23, 2006) that at some point, payment will be tied to HCAHPS participation.

HCAHPS TIMELINE

Q: What is the "Dry Run?"
A: Before the national implementation of HCAHPS, hospitals who will participate in the HCAHPS initiative are required to go through a Dry Run. Backus Hospital participated in the dry run during the second quarter of calendar year 2006.

Q: Will the Dry Run data be publicly reported?
A: Dry Run data will not be publicly reported. The data will be submitted to CMS for quality checks and to ensure that all processes are running smoothly before participating in national implementation. Data from national implementation will not be publicly reported until late 2007 (after nine months of data).

SAMPLING

Q: What patients are eligible to receive an HCAHPS survey?
A: The survey is designed for all (not just Medicare) adult patients discharged from general acute care hospitals after an overnight stay. Patients to be excluded include: patients who are under 18, those who died while in the hospital, and those who had either psychiatric or rehabilitative services. Other allowable exclusions would include those required to comply with any state legislation.

Q: Should patients who are discharged to another facility be mailed a survey at their home or at the other institution?
A: Vendors should attempt to contact all discharged patients at the home
address/telephone number provided in the hospital’s administrative record.

Q: Can we sample once a year to fulfill the HCAHPS requirement?
A: No. In order to have your data publicly reported, you must have data for every month. Most hospitals will sample on an ongoing basis each month.

Q: How often should a patient receive a survey?
A: A patient should receive a survey for every inpatient stay. The only allowable exclusion is for a patient who has multiple stays in one calendar month.

Q: How many completed surveys do we need to have our data publicly reported?
A: A minimum of 300 completed surveys must be received over the course of 12 months. For the initial collection period during national implementation, you need 300 returns in a nine-month period so that public reporting can take place after 10 months of data collection. This means that on average, 35 completed surveys should be collected during each of the first nine months.

SURVEY ADMINISTRATION—MODE AND TIMING

Q: What methodologies are allowed for HCAHPS?
A: The survey can be administered via any of the following: two-wave mail survey, five-attempt phone survey, combined mail/phone survey, or Active Interactive Voice Response (Active IVR). Backus Hospital, like most hospitals, has decided to perform a two-wave mail survey.

Q: When should the survey be sent to the patient and when does it need to be
returned?
A: Surveys must be distributed between 48 hours and six weeks post discharge to be included. Data collection must close six weeks following the start of data collection for each respondent.

REPORTING

Q: What will the data look like when they are publicly reported on the Hospital Compare Web site?
A: Report formats are currently being tested with consumers. It is anticipated that bar graphs will be used to note hospital performance. For composites and global items, the percent of responses in the top box (i.e., percent Always, 10, Yes, etc.) will be displayed.
The entire distribution of responses may be also displayed. Consumers will have the ability to drill down for more information. Data will likely be reported in a fashion similar to clinical data on the Hospital Compare Web site: www.hospitalcompare.hhs.gov.

Q: Will there be peer groups or adjustments for hospital characteristics (e.g., size)?
A: Reports will provide a national and state norm. There will not be peer group comparisons or other adjustments on the Hospital Compare Web site.

Q: I have heard discussions of patient-mix adjustment. What is that?
A: Patient-mix adjustment is a calculation to adjust a hospital’s results, based on patient and hospital demographics, to reflect what one would expect from a “typical” patient population. The intent of patient-mix adjustments is to make data comparable across different settings. The formula for patient-mix adjustment is currently being developed by CMS. CMS will apply patient-mix adjustments to a hospital’s data before it is publicly reported.

JCAHO announces 2007 Patient Safety Goals

2006-09-22T16:27:00.000-04:00

As Backus Hospital staff continues to focus on patient safety, attention will soon turn to The Joint Commission on Accreditation of Healthcare Organization’s 2007 National Patient Safety Goals.

Fortunately, Backus already has systems and initiatives underway to help comply with JCAHO’s new standards.

One major change includes a requirement for hospitals to define and communicate the means for patients and their families to report concerns about safety. Backus Hospital has a Patient Advocate available to patients, and her phone extension is listed in the patient handbooks that patients receive. During off hours, nursing supervisors are the contact.

“Encouraging patients to be actively involved in their healthcare is an important patient safety strategy,” said Peter Shea, MD, Medical Director at Backus.

Another new requirement is that hospitals attempt to identify psychiatric patients who might be at risk for suicide. James O’Dea, PhD, Administrative Director of Psychiatric Services at Backus, said systems have long been in place for this, and he is confident they meet the JCAHO criteria.

Hospitals will also be required to hand out complete lists of medications to patients upon discharge. Backus has a new Medication Reconciliation sheet in which patients’ medications are reviewed throughout their stay and whenever they are transferred to a different setting. This will soon be extended to include a complete list of medications when they are discharged. In addition, the Hospital will be making medication cards available to patients that they can take home with them, and update as their medications change. By carrying this card with them, it will help healthcare providers in future situations.

“We are making tremendous strides in making Backus Hospital as safe as it can be for our patients,” said Karen Long, RN, Vice President, Patient Care Services. “We must continue to monitor our procedures and identify areas for improvement.”

Anyone with questions about the JCAHO National Patient Safety Goals, or suggestions to improve patient safety at Backus, should call Mary Bylone, RN, Assistant Vice President of Patient Care Services and Patient Safety Officer, at ext. 2771 or Joe Hughes, Director of Quality Improvement, at ext. 2345.

Real example of medication error should be used as learning tool

2006-09-22T16:01:00.000-04:00

Imagine being the nurses who inadvertently gave two newborns deadly doses of Heparin at an Indianapolis Hospital earlier this week.

Or the hospital’s Chief Executive Officer, who went on national television to apologize for the error.

Or, even worse, the families who have to live with the mistakes – and without their beloved children – for the rest of their lives.

“This real-life situation magnifies the devastating impact medication errors can have, and underscores the need for Hospital staff to take all precautions possible to ensure the “five rights” –- the right medication, right dose, right patient, right route of delivery, right time,” said Peter Shea, MD, Medical Director at Backus. “Following procedure is the foundation of error prevention. Everyone should be sure to look at and read the label on everything that is administered and check it against the MAR -– it is there to protect patients and staff.”

While Backus Hospital has spent a lot of time improving its systems, protocols and technology to decrease the chances of medication errors, staff must always remain cognizant of the possibility of human error, said Karen Long, RN, Vice President and Chief Nursing Officer.

“As healthcare professionals, we should all take a long, hard look at this tragic event and use it as an educational opportunity going forward,” said Ms. Long said. “I am sure that everyone involved in this tragedy would give anything to be able to go back and follow the processes they might have thought were
unnecessary.”

Mary Bylone, RN, Assistant Vice President, Patient Care Services and Patient Safety Officer at Backus, said this particular situation, in which adult doses of Heparin were mistakenly given, clearly illustrates the human factor that the Institute for Medicine says is at least partially responsible for 40 percent of all medication errors nationwide.

The hospital unit that administered the drug usually only received doses of Heparin for newborns, and the vials of adult and baby doses are of similar size and color, so the nurses allegedly assumed they were correct, Ms. Bylone said.

“Despite all of the attention and time we have spent medication errors, and all the systems we have changed, it still comes down to you having to check the medication before you administer it,” said Ms. Bylone, who recently authored a column in Advance for Nurses magazine about medication errors, and how the “human
factor” commonly plays a role in them.

“We can’t simply sit back and wait for our employer to send us to another in-service,” Ms. Bylone wrote in the column. “We owe it to our patients to actively and continuously seek out the latest information regarding medications.”

Anyone with questions about medication safety, or suggestions to improve patient safety overall at Backus, can call Ms. Bylone at ext. 2771 or Joe Hughes, Director of Quality Improvement, at ext. 2345.

Courtesy and respect: Two important words

2006-09-16T05:02:00.000-04:00

Rodney Dangerfield has made a living off the line, “I don’t get no respect.” For our patients, though, respect is no laughing matter.

People almost always understand they need to be hospitalized, but rarely does someone really want to spend time in a hospital. Imagine if you, or a loved one, were the patient. You give up a great deal of independence, a certain amount of privacy, and -- even under the best of conditions -- some comfort.

So it’s no surprise that patients, when asked what matters most in their hospital experience, say it’s “being treated with courtesy and respect” by nurses, doctors and anyone they come in contact with. Logically, the very first question on the new HCAHPS inpatient survey is:

During this hospital stay, how often did your nurses treat you with courtesy and respect?

__ Never __ Sometimes __ Usually __ Always

We will begin using the survey on Oct. 1, and results will be publicly available in late 2007.

Using key words at key times is one action that can help improve the patient experience, and demonstrate that Backus Hospital practices patient-centered care. (Of course, words must always be matched by actions.) For example:

“Is there anything else I can do for you? I’m here to help you.”
“I am taking notes while listening to you because what you’re saying is important.”
“I am closing this door (or pulling this curtain) because we are concerned about your privacy.”
“It looks as if you’re comfortable. I’ll be back in (estimated time period) to check in on you again.”

If this sounds like the good old-fashioned manners your Mom taught you, you’re right. Laugh at Rodney Dangerfield, but listen to your Mom.

Surveys and safety are intertwined

2006-09-08T11:01:00.000-04:00

National Patient Safety Goals.
The new HCAHPS inpatient survey.
Hospital “report cards”.
Continual readiness for Joint Commission surveys.
Quality indicators.

If you consider all the different elements hospitals need to keep in mind, it can be overwhelming.

Here’s a helpful, and important, piece of advice: Don’t think of these as “different elements.”

“These are all part of the same thing: Patient-centered care,” said Peter Shea, MD, Medical Director of Backus Hospital. “One good definition of providing patient-centered care is ‘making sure our patients have the best possible hospital experience.’”

What are the components of such an experience?

An environment that is safe, clean and quiet enough to promote healing.
Caregivers who listen to concerns and explain procedures, wait times and discharge instructions effectively.
Where patients and their families are treated with courtesy and respect by everyone who interacts with them –- not just nursing staff, by anyone associated with Backus.

These are perfectly reasonable expectations. They are, in fact, what we would expect for ourselves or our loved ones. They display what it means to provide patient-centered care.

Looked at this way, the new HCAHPS survey of inpatient experiences is not “one more thing.” It is, instead, a way to get feedback on the one most important thing: Providing patient-centered care.

Let’s look at just a two of the HCAHPS questions to see how patient safety, satisfaction and standards of care are all part of the same thing:

During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?

__ Never __ Sometimes __ Usually __ Always __ I never pressed the call button

During this hospital stay, did you get information in writing about what symptoms or health problems to look out for after you left the hospital?

__ Never __ Sometimes __ Usually __ Always

“These are safety issues expressed from the consumer standpoint,” Dr. Shea said. Call buttons exist to alert caregivers to patients’ needs -— for assistance in using the bathroom, for example. Some patients who attempt that task on their own may risk falling, and reducing patient falls is a National Patient Safety goal.

Likewise, providing medication safety instructions and information on what patients should look out for once they leave the Hospital is a proactive way to prevent medication errors in the home, or avoid a recurrence of conditions that might require more treatment.

Patient safety initiatives and the new HCAHPS survey aren’t really two distinct areas. They are both part of providing patient-centered care.

New medication safety effort underway

2006-09-08T10:20:00.000-04:00

Backus Hospital this week initiated a new medication safety protocol, an effort to enhance patient safety in an area that typically is a problem nationwide.

The medication reconciliation process -– which according to the Joint Commission on Accreditation of Health Care Organizations (JCAHO) must include a review of patients’ medications at the time of admission, during transfers of level of care and at discharge -– will more efficiently analyze patients’ medications that they take at home with new medications prescribed in the hospital setting.

To help streamline the process, the sheet printed daily by the Pharmacy has been replaced by a Medication Reconciliation sheet, which provides a list of current inpatient medications, medications taken by the patient prior to arrival, and check-off boxes for continuation, discontinuation or change in order.

The sheet must be completed within 24 hours of admission and signed by a physician, and should also be used in all transfer situations in which a rewrite of orders is required, such as postoperatively or transfer from a Critical Care Unit bed to a floor bed.

Coupled with the Hospital’s new Pharmacy and robotic dispensing system, the new medication reconciliation process, which was implemented Sept. 5, will help lessen the chance of medication errors, and is part of ongoing efforts to provide the best care possible for Backus patients, said Peter Shea, MD, Medical Director.

Karen Long, RN, Vice President and Chief Nursing Officer, said abiding by the new medication protocol is an important way for clinical staff to improve patient care, and avoid preventable errors that persist in hospitals nationwide. Medication errors injure 1.5 million people annually, according to the U.S. Food and Drug Administration, and lead to billions of dollars in extra costs for treatment.

Eric Arlia, RPh, Pharmacy Director, said the medication reconciliation sheet will also help at the time of discharge, because medication regimens are sometimes tweaked during hospital stays and need to be changed back when the patient goes home. He added that there will be fewer rewritten orders and data entry points, which decreases the possibility of bad handwriting or an incorrect key stroke negatively impacting patient safety.

“This is going to help our physicians, nurses, pharmacists, unit coordinators and patients,” Mr. Arlia said.

Mary Bylone, RN, Assistant Vice President of Patient Care Services and Patient Safety Officer, thanked everyone involved with making this project a reality, especially Mr. Arlia and Michael Smith of the Pharmacy, Linda Bravard and Chris Bove-Smart of Clinical Informatics and Michael Cushing of MIS. She added that Backus will continue to test and improve its patient safety processes on an ongoing basis.

Anyone with questions about the JCAHO National Patient Safety Goals, or suggestions to improve patient safety at Backus, is asked to call Ms. Bylone at ext. 2771 or Joe Hughes, Director of Quality Improvement, at 860-889-8331 ext. 2345.

Most medication errors are preventable

2006-09-03T10:09:00.000-04:00

Medication errors injure 1.5 million people annually, and the extra costs of treatment related to these injuries in hospitals nationwide each year is $3.5 billion.

However, the ultimate cost can be someone's life.

According to the U.S. Food and Drug Administration, 41 percent of all fatal medication errors involve giving an improper dose, 16 percent giving the wrong drug and 16 percent using the wrong route of delivery.

[Click here to read the FDA's web fact-page on medication errors.]

That's why one of the Joint Commission on Accreditation of Health Care Organization's National Patient Safety Goals is to improve the safety of using medications.

[Click here to get JCAHO's Frequently Asked Questions sheet on National Patient Safety Goal #3: "Reduce Medication Errors."]

"It is imperative that all Backus Hospital staff members who have anything to do with medications follow established protocols," said Karen Long, RN, Vice President and Chief Nursing Officer. "The frequency of medication errors nationwide is cause for serious concern, and we need to do our part to eliminate them."

To comply with JCAHO standards, Backus Hospital has:

Removed concentrated electrolytes such as potassium chloride from patient care units.
Standardized the number of drug concentrations available in the organization, and ensured that drugs that look or sound alike are limited, identified and stored away from one another.
Improved communications between caregivers when ordering medications.
Added safety checks prior to dispensing medications.
Upgraded electronic medication record-keeping within the hospital, including generating a list of medications that patients take at home, to ensure that drugs administered in the hospital setting don't have a negative interaction. A complete list of medications must be reviewed when a patient enters the hospital, is in the Critical Care Unit or Emergency Department, is moved to an inpatient floor and when they are discharged. The information must include the recommended dose, timing of taking medication and any allergies. The hospital pharmacy prints out a daily list of all medications the patient is on, which is included in the patient's chart for doctors and nurses to review.
Built a brand-new pharmacy with a robotic medication dispensing system, which is nearly 100 percent accurate. Now that the robot is in place, the hospital will continue to work towards its goal of electronic ordering of medications, bar coding of medications and patients.

Still, the possibility of human error has not been eradicated, and staff must always be on the alert.

"Anyone who notices a practice that compromises our medication safety procedures is urged to speak up," said Mary Bylone, RN, Assistant Vice President, Patient Care Services and Patient Safety Officer. "Attention to detail, and speaking out as soon as a problem is noticed, can make the difference between life and death."

Peter Shea, MD, Medical Director, said staff must maintain its focus on medication-related patient safety measures, because the use of different medications has increased significantly and patients must maintain their medications as they move through the healthcare system.

"Day in and day out, it is imperative that we keep the 'five rights' in mind," Dr. Shea said. "Right medication, right dose, right patient, right route of delivery, right time. It sounds simple, but you'd be surprised how many preventable injuries occur because clinicians don't follow these guidelines."

Anyone with questions about the National Patient Safety Goals, or suggestions to help Backus improve patient safety, can call Ms. Bylone at 860-889-8331 ext. 2771, or Joe Hughes, Director of Quality Improvement, at 860-889-8331 ext. 2345.

Hospital focuses on patient falls

2006-09-03T09:53:00.000-04:00

Falling down is the leading cause of death at home, with more than 11,000 fatalities reported annually.

The news isn't much better in healthcare settings -- 38 percent of all adverse events are fall-related, according to the Fall Prevention Center of Excellence.

Why are people prone to falling in hospitals?

Mary Bylone, RN, Assistant Vice President of Patient Care Services and Patient Safety Officer at Backus Hospital, said there are several reasons. Hospital patients tend to be on medications, they are usually weakened by sickness or injury and some are too proud or afraid to ask for help when they need it. She noted that the majority of falls in hospitals are when patients attempt to go to the bathroom by themselves.

"We need to let our patients know that we are not too busy to help them," said Ms. Bylone, who is heading a Fall Prevention Team at Backus that is researching evidenced based practices, probing current policies and protocols, assessing Hospital equipment, examining ways to better monitor patients and reaching out to other institutions to see what they do.

Karen Long, RN, Vice President and Chief Nursing Officer, said fall prevention must be part of the culture of all Backus employees and Medical Staff, as it is a major patient safety issue.

"We must communicate -- verbally and through our body language -- that we are available to our patients when they need us, whether it's a major medical emergency, assisting them with their toiletry needs or whatever else comes up," Ms. Long said. "What might seem like a minor issue can turn into a major one pretty quickly."

The fall problem is so prevalent that the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has a National Patient Safety Goal dedicated to reducing the risk of patient harm due to falls.

[To download JCAHO's Frequently Asked Questions sheet on Patient Safety Goal #9, "Reduce Falls," click here].

HCHAPS inpatient experience survey questions, which patients will begin to receive on Oct. 1, 2006, ask patients whether they asked for, and received, help from nurses or other hospital staff in getting to the bathroom.

"We must stay focused on our fall prevention strategies, and continuously test and reexamine them," said Peter Shea, MD, Medical Director at Backus. "It's not about JCAHO, or HCAHPS, it's about constant attention to the needs of our patients."

Other fall prevention efforts at Backus include a fall risk assessment, which determines which patients are at high risk for falls, and the Total Care Program, which educates certain surgical patients prior to their procedures, so that they are safer in the hospital and at home.

Anyone with questions about the National Patient Safety Goals, or suggestions to help Backus improve patient safety, can call Ms. Bylone at ext. 2771 or Joe Hughes, Director of Quality Improvement, at ext. 2345.

Watch for proper hand hygiene (win a free lunch)

2006-09-03T09:20:00.000-04:00

The seemingly complicated problem of infection rates in healthcare facilities has a simple solution: Wash your hands, and do it often.

The U.S. Centers for Disease Control and Prevention (CDC) estimates that one in 20 patients contracts an infection in U.S. hospitals each year, and approximately 90,000 people die from those infections.

[Click here to go to the CDC's online recources for hand hygiene in hospitals: A fact sheet, posters, and best practices guidelines.]

"Many of these infections would not occur if hand hygiene protocols were followed," said Peter Shea, MD, Medical Director at Backus Hospital. "For the sake of our patients, we must adhere to these guidelines at all times."

Backus staff members are required to wash their hands with soap and water or hand sanitizer between every patient contact. Purell, a hand-sanitizing gel, is available in every room and in the hallways, which helps eliminate the obstacle of time. The CDC says that during an eight-hour shift, approximately one hour of a CCU nurse's time can be saved using an alcohol-based rub.

Mary Bylone, RN, Assistant Vice President of Patient Care Services and Patient Safety Officer, said that if your hands are visibly soiled, use the traditional soap and water. Otherwise, the hand sanitizing gel is very appropriate.

"Hand Hygiene is such a core component of patient care that often the importance is undervalued," said Karen Long, RN, Vice President and Chief Nursing Officer. "Constant vigilance and reminders among staff themselves is encouraged to keep this simple safety measure in the forefront of our daily routine."

Other hand hygiene tips from the CDC:

Do not wear artificial fingernails or extenders when having direct contact with patients at high risk.
Keep natural nail tips less than 1/4-inch long.
Wear gloves when contact with blood or other potentially infectious materials, mucous membranes and non intact skin could occur.
Remove gloves after caring for a patient. Do not wear the same pair of gloves for the care of more than one patient, and do not wash gloves between uses with different patients.
Change gloves during patient care if moving from a contaminated body site to a clean body site.

The use of gloves does not eliminate the need for hand hygiene, and the use of hand hygiene does not eliminate the need for gloves, which should be changed after each patient contact.

Other ways Backus seeks to reduce hospital-related infections include special clothes and sanitizing procedures in the operating room; practicing respiratory etiquette; yearly training of staff on hand hygiene guidelines; education of staff on best practices to reduce ventilator-associated pneumonia; making flu shots available for staff; and avoiding delays in administering antibiotics after surgery.

Reducing the number of healthcare-related infections is one of the Joint Commission on Accreditation of Health Care Organizations' National Patient Safety Goals.

Free lunch?

I will cover the cost of a meal in the Backus Cafeteria for anyone who catches me not washing my hands when I should."
-- Mary Bylone, Assistant Vice President, Patient Care Services, and Patient Safety Officer.

Anyone with questions about the National Patient Safety Goals, or suggestions to help Backus improve patient safety, can call Ms. Bylone at 860-889-8331 ext. 2771 or Joe Hughes, Director of Quality Improvement, at 860-889-8331 ext. 2345.

Communication is crucial to safe patient care

2006-09-02T10:17:00.000-04:00

Throughout society, whenever there is a problem, you can usually bet that ineffective communication is one of the reasons for it.

The healthcare industry is no different -- communication failures were cited as root causes in approximately 65 percent of all sentinel events reviewed by the Joint Commission on Accreditation of Health Care Organizations since 1995. This is the leading cause for serious adverse events, and a major cause for concern.

So it's no surprise that one of JCAHO's Patient Safety Goals is to improve the effectiveness of communication among caregivers.

[Learn more about Patient Safety Goal #2: Communication" by downloading JCAHO's Frequently Asked Questions sheet on this topic here.]

"Whether it is reading back orders, limiting the use of abbreviations or taking the time to properly 'hand off' patient information to fellow staff and physicians, communication is essential to assuring patient safety," said Karen Long, RN, Vice President and Chief Nursing Officer at Backus Hospital.

At Backus, staff members are expected to:

Writing down all verbal or telephone orders, and reading them back.
Not use dangerous or unacceptable abbreviations.
Communicate patient information in timely manner, including critical laboratory values.

Follow established protocol for 'hand off' communications.

Peter Shea, MD, Medical Director at Backus, said hospital and medical staff should never underestimate the importance of communication, especially in an increasingly complex healthcare environment with many different clinicians, on various shifts and at multiple locations, involved in patient care.

"Communication must always be a top priority for everyone in our organization," said Mary Bylone, RN, Assistant Vice President, Patient Care Services and Patient Safety Officer. "I cannot stress enough how important this is to the safety of our patients."

Anyone with questions about the National Patient Safety Goals, or suggestions to help Backus improve patient safety, can call Ms. Bylone at 860-889-8331 ext. 2771 or Joe Hughes, Director of Quality Improvement, at 860-889-8331 ext. 2345.

"Time outs" before surgery bolster patient safety

2006-09-02T09:59:00.000-04:00

Despite the widespread media attention that wrong site surgeries receive, they are very rare.

The rate, according to a recent study in published in the Archives of Surgery, is 1 in every 112,994 operations.

But that one case can irreparably harm the patient, ruin a hospital's reputation and potentially end a physician's career.

Last year, healthcare institutions reported 84 wrong site or wrong patient surgeries to the Joint Commission on Accreditation of Healthcare Organizations.

"That number might seem small," said Peter Shea, MD, Medical Director at Backus Hospital. "But anything more than zero is unacceptable."

At Backus, just prior to any surgical procedure, medical and nursing personnel conduct a final verification process, which includes a deliberate pause (a "time out").

[Learn more about this by downloading JCAHO's "Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery" here].

In this process, all members of the surgical team stop and confirm the correct patient, procedure and site.

Prior to transporting a patient to their procedure room, the physician marks the site of the procedure with the word "Yes" or with the physician's initials -- a process in which the patient is involved whenever possible.

Once in the procedure room, one member of the team reads the informed consent aloud while anesthesia checks the patient's hospital armband for the name, date of birth and medical record number, and all members of the team actively communicate to confirm that they are performing the right procedure on the right patient in the correct location on the body.

"We must always remain vigilant, and realize how important it is to follow our established patient safety protocols," said Karen Long, Vice President and Chief Nursing Officer at Backus. "The 'time out' process is very important."

Mary Bylone, RN, Assistant Vice President of Patient Care Services and Patient Safety Officer, said it is essential that all members of the surgical team participate in the "time out" process, each and every time.

"Not taking the time to do so can result in a major mistake," Ms. Bylone said.

According to Judi Goldberg, RN, Clinical Educator for Surgical Services, the Surgical and Special Procedures, Patient Safety Process for Patient Identification/Procedure/Site Verification policy and checklist have been used throughout the hospital since February 2000 wherever surgeries and invasive procedures are performed. The policy also requires making sure the correct x-rays, positioning supplies, implants and equipment are available prior to the start of the procedure.

"Patient safety must always be our first priority, and all members of the team are encouraged to speak up if they have concerns," Ms. Goldberg said.

Anyone with questions about the National Patient Safety Goals, or suggestions to help Backus improve patient safety, can call Ms. Bylone at 860-889-8331 ext. 2771 or Joe Hughes, Director of Quality Improvement, at 860-889-8331 ext. 2345.

Patient Safety: "Don't Just Go Through the Motions"

2006-09-02T09:45:00.000-04:00

The National Patient Safety Goals typically get plenty of attention when a hospital is scheduled for an accreditation visit or during National Patient Safety Awareness Week.

But constant attention to patient safety is how you can make a real difference for patients, and the hospital as a whole. And you don't have to be a direct patient care provider to have a major impact.

"Providing high quality, safe and efficient patient care is the most important thing that we can do as an organization," said Thomas P. Pipicelli. "Everyone who works at Backus Hospital should know the National Patient Safety Goals, and have an understanding of their own roles in making Backus Hospital the safest possible place for patients."

The Joint Commission on Accreditation of Health Care Organizations (JCAHO) is scheduled to make an accreditation visit at Backus Hospital as early as January 2007, and adherence to the National Patient Safety Goals will be a major focus.

But Peter Shea, MD, Medical Director at Backus, said patient safety should be at the forefront of everyone's minds year-round, at all times, because studies show that mistakes are made when healthcare workers let their guard down, or go on "auto pilot."

Patient safety is most often compromised when a staff member loses focus while doing something they have done successfully a thousand times, he said.

"You can't just go through the motions," Dr. Shea said. "We have to be totally committed to patient safety, every day, and everything else will fall into place."
Over the next several weeks, HospiTell will focus on the importance of each 2006 National Patient Safety Goal, and what the Hospital is doing to adhere to them.

The goals are:

Improve the accuracy of patient identification.
Improve the effectiveness of communication among caregivers.
Improve the safety of using medications.
Reduce the risk of healthcare-associated infections.
Accurately and completely reconcile medications across the continuum of care.
Reduce the risk of patient harm due to falls.

"The National Patient Safety Goals are designed to help organizations like Backus avoid mistakes that compromise patient care," said Karen Long, RN, Vice President and Chief Nursing Officer. "While it is important to adhere to them for compliance purposes, we are committed to them because it is the right thing to do for our patients. That's the bottom line."

Anyone with questions about the National Patient Safety Goals, or suggestions that can help Backus improve patient safety, can call Mary Bylone, RN, Assistant Vice President of Patient Care Services and Patient Safety Officer, at 860-889-8331 ext. 2771 or Joseph Hughes, Director of Quality Improvement, at 860-889-8331 ext. 2345.

Patient identification a key to safety

2006-09-02T09:34:00.000-04:00

National Patient Safety Goal #1 is Improving the accuracy of patient identification.

Peter Shea, MD, Medical Director at Backus Hospital, said it is important to not just go through the motions while performing these seemingly routine checks. That is how mistakes can happen, some of which have received very negative national attention and compromised patient safety.

At Backus, strategies to properly identify patients include:

* Use at least two patient identifiers (never the patients room number) whenever taking blood samples or administrating medications or blood products, including the patient's name and either medical record number or birth date.
* Medical personnel ask patients to state their name and then check that against their identification bracelet.

Here are a couple of scenarios in which these strategies are applied:

An outpatient comes in for blood tests. Just before drawing blood, the lab tech should ask the patient "What is your name?" It is not sufficient to ask, "Are you Mrs. Smith?" Then ask the patient his or her date of birth, and confirm both the name and date of birth before drawing blood.
When dealing with a patient in the Critical Care Unit who can't interact because of his or her condition, always confirm the patient's name against the arm band before medication is administered. You must also confirm either the patient's medical record or date of birth with the arm band.
The same policies apply for any inpatient or outpatient scenario, whether it is in a health center, X-ray, physical therapy, etc.

"Staff should be using two patient identifiers in any of these settings," Dr. Shea said.

Anyone with questions about the National Patient Safety Goals, or suggestions to help Backus improve patient safety, can call Mary Bylone, RN, Assistant Vice President of Patient Care Services and Patient Safety Officer, at 860-889-8331 ext. 2771 or Joe Hughes, Director of Quality Improvement, at 860-889-8331 ext. 2345.

Why "Always" always matters

2006-09-02T09:03:00.000-04:00

You're planning a dinner for a special occasion. Will you select the restaurant that usually gets your order right, and sometimes has its signature dessert available?

Your carâ€™s making a disturbing noise. Will you take it to the mechanic who sometimes finds out what's wrong the first time and usually gives you an accurate estimate?

You're juggling your schedule at work and home to make a long-standing appointment with â€” take your pick: a doctor, a hairdresser, a contractor, your child's teacher. Will you recommend that person to others if he or she sometimes sees you within a reasonable time?

Of course not. When you're the consumer, you have pretty high standards. And you expect them to be met â€” always.

That's important to keep in mind when thinking about the new inpatient experience survey called HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems). The surveyâ€™s second word is â€œconsumer,â€� and that's exactly how our patients expect to be treated.

Of the 22 patient experience questions (out of 27 in the survey), 14 ask patients to report how frequently certain things occurred during their hospital stay. These items are events that patients have said make a big difference in determining their overall experience.

Here are two typical questions:

During this hospital stay, how often did nurses treat you with courtesy and respect?
Never -- Sometimes -- Usually -- Always
During this hospital stay, how often were your room and bathroom kep clean?
Never -- Sometimes -- Usually -- Always

When the HCAHPS results are publicly reported, only one answer will be used to compare hospitals. You can guess which one: ALWAYS.

Backus â€” like all good hospitals â€” has systems and standards in place so that certain things always should happen. Checking patient identifiers is not optional; it's an â€œalwaysâ€� standard for patient safety. Making sure patients (or their families) understand their medications and discharge instructions is not optional; itâ€™s always important.

Our patients' expectations â€” to be treated with courtesy and respect, to be informed so they can understand what's happening, to have a restful and safe environment â€” are hardly unreasonable. When you, or a loved one, is the patient, it's what you always want, too. With the HCAHPS survey, we get a chance to see how we meet those expectations, and how well we live up to our own vision of providing patient-centered care.

Oct. 1: A key date for inpatient surveys

2006-09-02T08:49:00.000-04:00

There will be a new name and a new look to Backus Hospital's inpatient surveys starting Oct. 1. The purpose of the surveys remains the same, though: To better understand our patients' perception of their hospital experience, and to use the results to improve.

Starting with the new Fiscal Year, we will switch from Press, Ganey Associates surveys to those designed by the National Research Corporation and the Picker Institute, called NRC+Picker.

Oct. 1 is a very important date in another area of patient surveys, as well: It marks the start of the public survey period for a new national standardized inpatient survey, called HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems).

"Making sure our patients have the best possible hospital experience is why each os us is here," said Keith Fontaine, Vice President, Corporate Communications. "Patient-centered care is not just the job of direct caregivers. We all have important roles to play, because we all share a common purpose: Making Backus a hospital where patients and families know they'll get exceptional care."

We will explore the new inpatient survey and the HCAHPS survey in greater detail in future posts. Here are a few questions and answers you may find helpful at the outset:

Why change surveys? We've used Press, Ganey for more than five years.
The short answer is that the Picker survey aligns much better with the HCAHPS questions, which we are required to include at the start of the survey.
NRC+Picker attempts to measure the quality of patients' experience, asking the extent to which a relevant behavior or process did or did not occur (always, usually, sometimes or never).
Press, Ganey attempts to measure patients' satisfaction with the care or service they received on a 1-to-5 scale (very poor, poor, fair, good, very good).
The new national HCAHPS survey uses the experience approach, arguing that this yields less subjective and more actionable results.
Give me an example:
Press Ganey:
Nursesâ€™ attitude toward your requests:
1 -- 2 -- 3 -- 4 -- 5
(very poor, poor, fair, good, very good)

HCAHPS / Picker:
During this hospital stay, how often did the nurses listen carefully to you?
Never -- Sometimes -- Usually -- Always
Is there a Picker survey philosophy?
The Picker survey is based on eight "dimensions" of patient-centered care -- items that mattered most to patients. These areas were developed by Harvard and NRC researchers, based on focus groups with more than 8,000 patients, and have been adopted by the Institute of Medicine. The dimensions are: Respect, Coordination, Education, Comfort, Emotional Support, Family/Friends, Transition, and Access.

By measuring the frequency of specific behaviors, Picker believes hospitals can more readily know what to act upon to improve the patient experience.