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Safety Counts! a newsletter highlighting safety at Hallmark Health System
Safety Counts September 2014 2014 - Download entire PDF by clicking
Face-to-face education with handouts. “Clinicians teach patients throughout the stay,” said Karen Costigan, RN, BSN, NE-BC, Patient Care Director on Med 5 at Melrose-Wakefield Hospital. “It’s important that patients have repetition to attain a good understanding of what is needed to manage their care when they are discharged.” The handouts provided are easy to understand and can be used as a reference for what has been taught in the hospital once the patient has been discharged.
Educational videos on demand. ”Nurses also assess how each patient best learns,” she added. “We have a comprehensive library of health education videos that can be played on-demand to best meet the needs of patients and families.”
Electronic documentation in the medical record. A new documentation screen in the Meditech health information system details the type of teaching conducted and materials provided and improves caregiver communication.
Materials are available in a number of languages. “By the time of discharge, the packet contains what the patient and family need to know to help them do well,” said Costigan. “The packet is also helpful to VNA and home care staff who can see what the patient learned and continue to reinforce what is needed.”
The bottom line is patient safety, said Costigan: “When patients don’t understand how to take the medication prescribed or how to care for themselves properly to prevent health issues, they are more likely to have problems and end up back in the hospital."
A case review of such patients at Hallmark Health System (HHS) revealed inconsistencies in how the alcoholrelated portion of patients’ hospital stays was managed. “Unwarranted variation can lead to potentially serious patient safety issues,” said Vice President of Medical Affairs and CMO Steven Sbardella, MD, “so we needed to quickly determine and implement a more standardized approach.”
A group of stakeholders from psychiatry, nursing, pharmacy, education and other areas, plus hospitalists, worked together to vet a variety of approaches and settled on the Clinical Institute Withdrawal Assessment for Alcohol (CIWA), the current best-practice tool for assessing and managing alcohol withdrawal. “CIWA is an objective, 10-item scale that our staff can use when evaluating a patient,” he said, “and it automatically directs clinicians to the appropriate next steps based on its scoring system.”
Once CIWA was adopted, HHS educators worked “in blitz fashion and at warp speed,” said Sbardella, to spread the tool throughout the system. “Everyone who needed to step up did so, and we are now much more consistent in how we care for patients needing detoxification.”
To further ensure patient safety, the CIWA tool also has been linked to the HHEWS (Hallmark Health Early Warning System) tool, a similar objective assessment of vital signs for inpatients at risk. “We found that some patients required more than just CIWA, particularly when some of their symptoms may not be related to alcohol withdrawal,” said Sbardella.
Surgical-site infections (SSIs) occur in nearly 3 percent of all surgical procedures in the U.S. When they do, they add a week or more to a patient’s hospital stay and cost the health care system $10 billion annually. Many SSIs can be prevented by following some scientifically proven simple steps. “Our SSI rates were not above national averages, but we knew we could do better,” said Donna Harvey, MS, RN, CNOR, system director, Surgical Services/Endoscopy, who is the team leader for the Hallmark Health System (HHS) program to decrease SSI rates.
HHS joined a national effort to reduce SSIs and adopted a “bundled” approach that encourages a standardized process, pioneered by Johns Hopkins Hospital. Among the action steps in the bundle are practices such as:
-providing the antiseptic agent chlorhexidine topatients so they can shower with it (instead of soap and water) before their surgery
-administering antibiotics one hour prior to beginning the actual surgery and again if the surgery takes longer than three hours
-keeping patients warm before, during, and after surgery – “research has shown that cold patients are more likely to get an SSI,” said Harvey.
In addition, HHS champions engage in continuous education of staff, monitor and track results and refine the “bundle” as needed. And they review any SSIs that do occur “to see what happened and what we could have done differently,” she added. In the past 18 months, said Harvey, “we have implemented 40 practices, in a systematic way and using the team approach, to improve our SSI rate. And we’re making steady progress in both reducing SSIs and getting all of us ‘in the habit’ of taking all the appropriate infection control steps with each patient.”
Although experts can’t predict the severity of the upcoming 2014-15 flu season, Hallmark Health System is preparing for its annual mandatory vaccination campaign. All employees, contract employees, physicians, students, volunteers or others who work at an HHS site or provide an HHS service are required to get a flu vaccine. Those who cannot comply (e.g., for medical or religious reasons) are required to wear a mask at work if they come into contact with others.
This year, infection control staff will be hosting a “Flu Prevention Week” in early fall. Dates and times are to be determined, as HHS doesn’t yet have its allotment of vaccine. “Our plan is to vaccinate as many HHS-affiliated people as possible during the clinics we set up for the week,” said Michelle Corrado, PharmD, MHA, interim executive director of Clinical Services. “We want to focus on getting everyone vaccinated in a short timeframe so we can ensure that our people and our patients are protected.”
HHS staff have been exemplary in participating in flu vaccinations in recent years. “Five years ago, our employee vaccination rate was 53 percent, and last year it was 92 percent,” she added.
Vol 2, No. 8, September 2014