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Safety Counts! a newsletter highlighting safety at Hallmark Health System
Safety Counts April 2014 - Download entire PDF by clicking
Studying the past can inform the future for health care professionals. In 2012, a team of Hallmark Health System (HHS) nurse leaders delved into history to improve patient safety. They studied several very challenging cases and found some common issues related to nursing practice.
“These issues concerned nurses noticing, interpreting, and responding to the signs presented by each patient,” said HHS Chief Nursing Officer Nancy Gaden, RN. “These are subjective, based on a nurse’s experience and other factors. We wanted a more objective way to assess who is at risk and take action before the patient’s condition deteriorates.”
The team modified a tool found in the literature that became the Hallmark Health Early Warning System (HHEWS). It offers clear, objective criteria, based on a score, for when a nurse should
take action such as calling in the rapid response team (Critical
Assessment Team, or CAT).
Eight vital signs – including respiratory and heart rates, oxygen saturation level, white blood count and temperature – are scored. The total is the HHEWS score. Signs are rechecked at least every four hours. If the score is increasing, nurses can take quick action to escalate care as needed. HHEWS also can aid nurse-doctor discussions. HHS Chief
Medical Quality Officer Steven Sbardella, MD, said “the HHEWS tool can improve communication by creating an accepted ‘standard language’ and action plan for a patient. It’s not meant to
replace clinical expertise and interpretive skills, but the HHEWS focus on objective signs helps clinicians at all levels.”
During the last year, HHEWS was piloted on nursing floors at both hospitals. Of the more than 1,300 scoring sheets documented, 84 patients (6 percent) had scores high enough to trigger action such as transfer to a higher level of care.
Since then, the scoring system has become a part of the medical record for patients on medical-surgical floors. “We’ve seen an increase in the number of patients who are moved to a higher level of care before their condition worsens,” said Gaden. “This improves the likelihood for good outcomes for at-risk patients.”
“It is essentially an instant-read Q-Tip that helps us evaluate the cleanliness of surfaces,” said Mark Leonard, Hallmark Health System (HHS) director of Environmental Services. HHS and Crothall Healthcare, its contracted support services firm, use 3M Clean Trace™ technology as part of their cleaning programs to reduce the incidence of infections spread from touching contaminated surfaces.
The technology works by using the moistened swab to obtain a sample from an area that has been cleaned – for example, a light switch, bed rail, callbutton or door knob – and inserting it into a test tube containing a reagent.“A luminometer then measures the intensity of light being produced; more intense light means more contamination,” he added. “The technology shows whether a surface is clean or not. If it’s not, we go back and clean it again.”
3M Clean Trace™ has been in use at HHS since 2010. It has two main functions. One is to provide cleanliness checks, particularly when looking to stem the spread of certain health care associated infections or HAIs.
The other is to train Environmental Services staff. “It’s an ‘objective observer,’” said Leonard. “We’ll bring the technology into a room after one of our staff has cleaned it and, along with the staff member, check some surfaces. It’s a one-on-one coaching opportunity for staff, who can see how well they’ve cleaned these high-touch surfaces.”
The technology comes with software that can track cleaning results and capture trends. And it adds to the department’s other infection-control practices, such as visual inspections, employee observations, ongoing staff training and participation in infection control committees. “We try to leverage technology and incorporate it into day-to-day operations,” he said. “We want to do our part to promote safety
and reduce the possibility of infection for patients, staff and visitors.”
Infection risks are everywhere but are especially prevalent in health care settings, where patients are vulnerable, at risk and exposed to others in similar circumstances. In hospitals, among the most intractable infections are those caused by three types of bacteria – Clostridium difficile (C. diff ), methicillin-resistant Staphylococcus aureus (MRSA) and streptococcal (strep) infections – plus the viruses that cause flu and norovirus.
Among the most effective remedies is hand hygiene. “Since anything you touch carries a risk for infection, cleaning your hands can cut risks considerably,” said Elaine Boerger, RN, Hallmark Health System (HHS) infection control nurse. Since 2006, HHS has improved hand hygiene compliance significantly (see chart).
Soap-and-water and alcohol-based rubs are the most common hand hygiene practices. “Most often, staff use the foam rubs,” said Boerger. “They are fast, efficient, effective and convenient, with dispensers outside and inside patient rooms.” Soap and water is recommended in some circumstances, such as with certain infections or when staff have come in contact with blood or bodily fluids.
In home care, Paula McCartney, RN, Hallmark Health VNA and Hospice education coordinator, said “we have specific protocols on every aspect of hand hygiene, including when and how to wash and specific products to use.” Staff are supplied with everything they need (liquid soap, paper towels, hand gel and towelettes), carried in their clinical bags.
Patient education is an important aspect of infection control. “We encourage patients and visitors to wash their hands frequently,” said Boerger, “and to remind their caregivers to do so, too.”
McCartney added that home care education includes “suggesting that families use liquid rather than bar soap and paper rather than cloth towels.”
Also important is surveillance. Timely, unit-specific tracking helps identify hospital infection control spikes. Checks and balances in home care also include annual competency reviews and periodic supervisory visits where hand hygiene is assessed to ensure compliance.
Chasing Zero: Winning the War on Healthcare Harm is a 50-minute documentary film hosted and narrated by actor Dennis Quaid, whose newborn twins nearly died in 2007 from a medication error. The
film supports a call to action for health care leaders to create systems that protect patient safety.
Chasing Zero is also the foundation for a special 2014 Lunch and Learn series at Hallmark Health System (HHS) focused on patient safety. “This is the first Lunch and Learn series developed for front-line
staff,” said Johna Wasdyke, HHS director of Human Resources. “The film was part of our Cornerstone Academy for managers back in the fall and attendees felt strongly that it’s something everyone should
see.” (A DVD copy is available from Wasdyke for use at departmental meetings.)
Target attendance for each session is 20 staff members. “We know how difficult it is for front-line staff to leave the floor during their shifts,” she added, “but we had several at the first session whose supervisors encouraged them to take the time to come.”
The safety-focused series capitalizes on separate modules that are part of the Chasing Zero educational package. The first session, held in February, screened the documentary itself. Subsequent
modules consist of a short video followed by open discussion facilitated by an HHS staff member. These videos, like the main documentary, contain personal stories of staff who have made mistakes and
families of patients to whom harm was done from medical errors.
“These modules contain stories that really resonate with all those who interact with patients,” said Wasdyke. “Storytelling is a very powerful way to remind us of the importance of safety practices and helps us see patient safety as a set of tools rather than rules.”
Vol 2, No. 4, April 2014
Vol. 2, No. 2, February 2014
Vol. 2, No. 3, March 2014
Vol. 1, No. 5, December 2013
Vol. 1, No. 4, November 2013
Vol. 1, No. 3, October 2013
Vol. 1, No. 2, August 2013
|Vol.1, No. 1, July 2013|