Friday, March 4, 2011

The Best Way Should Be the Only Way

We have been talking a lot about patient safety over the past several months, and with the week of March 6 – 12 being National Patient Safety Awareness Week, I feel it’s only appropriate to continue to discuss the importance of safety and quality in healthcare. I’ve said before that the hard work of our well-trained staff is, of course, critical when it comes to patient care and ensuring the safety, but it’s not everything. We need well designed systems that bring us to a high level of reliability to ensure safety and quality. All of our systems for delivering care need to be foolproof to get to 100% compliance with all of our patient safety initiatives. It comes down to creating the rules and then following them – every time. If there is a best way to do something, it should be the ONLY way.
Reliability means what should happen…happens…and what should not happen…does not happen. This is a core principle of safety in every high risk industry. 
A perfect example of how GBMC has redesigned the system and follows national best practices can be seen in the steady decline in Central Line Associated Blood Stream Infections (CLABSI), which can increase a patient’s morbidity and mortality. Only five years ago, the incidence of CLABSI at GBMC was about 7 per every 1,000 patient days. Today, it’s about 1 incidence per every 1,000 patient days. Why is this? Because we have standardized the way we put in central lines and the way we care for them while they are in. People follow the design.  It is a reliable system that has been proven to be the best way.

In fact, I’m very proud to report that the SICU has gone 75 weeks without a CLABSI and the MICU has now gone 40 weeks.  Unit 35 has gone 21 weeks without incidence of CLABSI.
Pretty impressive numbers!

The MICU and Unit 35 are also working on the Maryland Hospital Association’s "CUSP" project (a quality and patient safety program) to implement a culture of safety around prevention of these blood stream infections and have been recognized as making the MHA’s 100% list for prevention of CLABSI.    

These are achievements we must celebrate. These units didn’t get to ZERO by telling staff to work harder or pay attention- they already were. They achieved 72 weeks, 40 weeks and 21 weeks without incidence of CLABSI by taking a design that has been proven to reduce infections and then utilizing this system every day. And, the patients on these units are reaping the benefits of this reliability. 

We’re seeing more of these reliable systems across the hospital. For example, Labor and Delivery has had 100% success for 2010 with their goal of getting those patients with the urgent need for C-section (STAT cases when the fetus is in distress) into the OR within 10 minutes (decision to incision), with excellent infant outcomes.
Along these lines, implementation of CPOE among our internal medicine physicians went off without a hitch and I am most grateful to our in-house team (led by Dr. Allison Habas and Lisa Griffee) as well as our physicians and nurses who helped them learn to use the computer for ordering. CPOE implementation is just one more way for us to improve reliability.
Finally, the March 15 off-site leadership conference will focus on the topic of reliability and patient safety, so I certainly look forward to our leadership team continuing to discuss and embrace the culture of safety.
And speaking of culture of safety, thank you to all of our clinical staff for your frank input and participation in GBMC’s Culture of Safety survey. We had an 89% response rate to this survey, which shows me that our clinical teams truly recognize and appreciate the importance of creating reliable systems for improving patient safety and quality care.
Culture of Safety Survey section leaders
 and team members celebrate an
89% response rate to the recent survey.

Special thanks to Dr. John Saunders, Chief Medical Officer and our VP of Patient Safety and Quality, Carolyn Candiello and their dedicated team for all of their hard work. Results of the survey will be reported at the March 15 off-site leadership conference – stay tuned for action plans to be rolled out in the coming months.

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