Patient Safety Goals

National healthcare trade organizations like the Institute of Healthcare Improvement, the Joint Commission for Accreditation of Healthcare Organizations and the Leapfrog Group have identified patient care areas that can greatly improve patient safety.  The WakeMed Center for Patient Safety is committed to implementing these patient safety initiatives organization-wide.

Institute for Healthcare Improvement’s (IHI) (www.ihi.org) six improvement interventions are aimed at saving 100,000 lives by summer of 2006.  More than 1,700 hospitals have joined the campaign, representing all 50 states. WakeMed has implemented the following proactive measures, which coincide with the goals of the IHI 100K Lives Campaign:

• Deployment of Rapid Response Teams: WakeMed has implemented an RRT at Raleigh Campus and Cary Hospital that responds when a caregiver calls at the first sign of patient decline.
• Delivery of reliable evidence-based care for acute myocardial infarction to prevent deaths from heart attack: WakeMed has a multidisciplinary acute myocardial infarction committee that monitors results to ensure patient care is exceeding national standards.  Both Raleigh Campus and Cary Hospital Emergency Departments follow the AMI ABC’s checklist.  Results are tracked and reported publicly.
• Preventing adverse drug events by implementing medication reconciliation: WakeMed has implemented the use of a new single form that will include all of the patient’s medication history and current medications.  The goal is aimed at reducing and eliminating medication errors.
• Preventing central line infections by implementing a series of interdependent, scientifically grounded steps: WakeMed is focusing on the FROG (Friction Rubs Out Germs) hand hygiene campaign.  Caregivers are also treating central line insertions as more of a sterile procedure, using full gloves as well as full medical drape. 
• Preventing surgical site infections by reliably delivering the correct perioperative antibiotics at the proper time: WakeMed is emphasizing appropriate use of antibiotics. Caregivers are also encouraged not to shave surgical sites, since shaving can increase the risk of infection by up to three times; keeping glucose levels normal both before and after surgery; and keeping body temperatures normal unless surgery requires a lower body temp.
• Preventing ventilator-associated pneumonia by implementing a series of interdependent, scientifically grounded steps: WakeMed introduced guidelines in 2004 that included improved hand hygiene, upgraded endotrachael tubes and added oral care.  The guidelines have helped cut the ventilator-associated pneumonia (VAP) rate in half over the past year.

In addition to these six initiatives, there are patient safety teams working on the following Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) (www.jcaho.org) 2005 patient safety goals:

• Improve the Accuracy of Patient Identification: WakeMed now requires that the patient’s first and last name and medical record numbers are confirmed prior to administering treatment.  If a medical record number is not available, the date of birth can be used as an alternate second identifier.  Additionally, information on arm bands may be cross-referenced with the medication administration record or lab/radiology requisition.
• Improve the Effectiveness of Communication Among Caregivers: WakeMed caregivers documenting in the medical record are required to utilize approved abbreviations. WakeMed has also developed specific criterion that designate a test as critical. Critical diagnostic test results require urgent notification to a healthcare provider. Additionally, verbal orders and lab results must be read back to ensure correctness, verifying the patient’s name, medical record number, and order/result.
• Improve the safety of using medication: WakeMed has removed concentrated KCl, Sodium Chloride and IV Potassium Phosphate and Potassium Acetate from all patient care areas. Concentrations for high-alert medications and the most common infusions have also been standardized.
• Improve the safety of using infusion pumps (prevent free flow, clinical alarm safety): Free flow is the uncontrolled flow of IV or other fluids into the body.  All WakeMed IV Pumps (Abbott 5000) and PCA (IV and Epidural) sets prevent free flow automatically when removed from the pump.  Additionally, syringe pumps are, by design, resistant to free flow.
• Reduce the risk of health care-associated infections: WakeMed has instituted the FROG Campaign and monitoring of hand hygiene compliance per Center for Disease Control (CDC) guidelines.  Deaths or major loss of function due to healthcare acquired infections are investigated as significant adverse events.
• Reduce risk of patient harm resulting from falls: WakeMed has created a Falls Risk Assessment form that identifies patient risk regarding mobility, elimination, medications, mental status and prior history of falls.  New inpatient beds also have 3-level bed exit alarms and low-rise capability of 18” from the floor.

The LeapFrog Group (www.leapfroggroup.org) has identified four hospital quality and safety practices that focus on health care provider performance comparisons, and hospital recognition and reward.  The four leaps are:

• Computer Physician Order Entry (CPOE): Hospital staff enter medication orders via computers that are linked to prescribing error-prevention software.  CPOE has shown to reduce prescribing errors in hospitals by more than 50%. 
• Evidence-based hospital referral (HER): Research indicates that a patient’s risk of dying could be reduced by 40% if physicians refer their patients to hospitals offering the best results, such as outcome data or the number of times a procedure is performed each year. 
• ICU Physician Staffing (IPS): Staffing ICUs with doctors who have special training in critical care medicine, called intensivists, has shown to reduce the risk of patients dying in the ICU by 40%.
• Quality Index: The National Quality Forum endorsed an additional 27 Safe Practices that would reduce the risk of harm in certain processes, systems or environments of care.