Friday, September 08, 2006

Surveys and safety are intertwined

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

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.

Sunday, September 03, 2006

Most medication errors are preventable

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

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)

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.