Quality

Key Quality & Safety Measures

Saving Lives

Patient safety is a top priority at CRH, and last year we continued our efforts toward improving the quality of our services. A large portion of those efforts is centered around our ongoing participation in the Institute for Healthcare Improvement’s (IHI)5 Million Lives Campaign.This national campaign was created to dramatically reduce the number of medical-harm incidents occurring in U.S. hospitals, and CRH is actively working on all 12 of the campaign’s initiatives. The following are just a few of last year’s highlights:

Rapid Response Team (RRT)

We put the finishing touches on our plan to deploy a new rapid response team. An RRT, which is made up of skilled clinicians, responds immediately to patients exhibiting the preliminary signs and symptoms of a full cardiac\respiratory arrest. By arriving early on the scene and assessing and treating the patient in a proactive manner, the RRT can prevent an arrest from happening.

Pressure Ulcers

Prior to our participation in the IHI campaign, we started a program to prevent and proactively treat pressure ulcers. Our efforts included: special equipment, such as beds that rotate where the pressure will be applied; screening tools for at-risk patients; and intervention methods, such as frequently turning the patients. As a result, we now have fewer patients developing pressure ulcers and fewer patients with extended ulcers. The length of stay was also reduced by several days for the patients who enter our hospital with pre-existing pressure ulcers. With some minor tweaking, our program is now compliant with the campaign’s pressure ulcer initiative.

Methicillin-Resistant Staphylococcus Aureus (MRSA)

We also worked on reducing MRSA infections prior to our involvement with the IHI campaign, and we’re proud to say the IHI actually borrowed some of the recommendations from the problem pathogen protocol work we conducted with the University of Virginia (UVA) seven years ago. Since then, we have been screening patients who are at higher risk for MRSA, such as those who have been in the hospital for several months, those who have been in long-term care facilities, and those who are living in close quarters. We have also been isolating patients who transfer to CRH with MRSA, using the proper universalized patient techniques. As a result, we routinely score below the national limit for MRSA cases in our hospital.

Other Patient Programs

By participating in the IHI campaign, we’ve made considerable progress toward preventing adverse drug events (by reconciling patient medications at every transition point in care using up-to-date computerized medical records), and preventing central line infections and ventilator-associated pneumonia (by putting into place a standing order set that incorporates all the elements of the IHI central line and ventilator initiatives). We went one step further for our ventilator patients by marking the wall at the elevated height required for the head of the bed. There is a notice posted on the wall for individuals to notify the nursing staff immediately if the bed’s elevation goes below this mark.

Exceeding Expectations

Another quality and safety area we continue to excel in is our Core Measures program. This program is a joint initiative of the Centers for Medicare and Medicaid Services (CMS) and the Joint Commission. Last year we exceeded national averages in many areas, including the following:

Project Upstart

We worked with UVA on a new program to assist in getting our acute myocardial infarction (MI) patients to the UVA cardiac catheterization laboratory within the 90-minute window recommended for optimum patient survival. By the end of this year, CMS will start holding community hospitals accountable when they fail to get their acute MI patients to cath labs within the allowed timeframe. With Project Upstart already in place at CRH, we’re not only ahead of schedule on this initiative, but we’re saving more lives as a result of it.

Surgical Site Infections

We made great strides in reducing surgical site infections by identifying the categories of surgery patients who need an antibiotic one hour prior to surgery and up to 24 hours after surgery, and updating our standing orders so that they are compliant with the surgical site infection protocol. This ensures that our surgical patients get the antibiotics they need within the right timeframes to prevent infection.

Communicating our Quality Message

We’ve made great strides in sharing our quality and safety message with our Board of Trustees (BOT), staff, and patients.

Board Quality Committee

Our BOT recently established a separate committee that reviews quality and safety issues on a monthly basis. This committee asks the hard questions, empowers the staff to take action, and does whatever it takes to ensure that our quality and safety problems are resolved. During board meetings, rather than focusing entirely on financial issues like they did in the past, our BOT now hears about patient experiences, which keeps the members actively involved in quality and safety issues.

Ongoing Training

We’re constantly emphasizing quality and safety to our employees through routine staff meetings, in-service training sessions, and quarterly nursing skills events. We also conduct root cause analysis investigations immediately after medical errors or near-misses occur, which helps us identify and learn ways those problems could have been prevented, and we conduct failure mode effects analysis investigations for high-risk processes to help us identify possible future problem areas.    

New Hand-Off Communication Procedure

Last year we introduced a new hand-off communication procedure that has proven to be much more beneficial to our staff and patients. Each time a nursing shift changes, rather than each nurse giving a report to the entire nursing group in a back room, the outgoing nurse now gives a detailed report to the incoming nurse at the patient’s bedside using the patient’s electronic medical record information. Being able to hear the nurses talking allows our patients to verify the medical information for accuracy, ask questions, and take a more active role in their own health care.

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