Quality & Safety Scoop

By Bridget M. Norton, M.D., MBA, Children’s Chief Quality & Safety Officer

As members of the Solutions for Patient Safety (SPS), a hospital engagement network collaborative of over 135 pediatric hospitals, we are currently focusing some of our safety efforts on 12 hospital-acquired conditions (HACs) that have been identified as preventable harm events that have significant implications for our patients. For example, published data estimates that 20 percent of unplanned extubations result in an arrest.A 2013 Joint Commission article showed that out of 80,000 ICU patients with a central line infection, 30,000 (37.5 percent) died, and venous thromboembolism can lead to post-thrombotic syndrome which can affect a patient for life. Since its development, it is estimated that the work of the SPS hospitals has saved 11,000 children from harm and saved over $182 million in health care costs. Children’s has been a member since 2012, and our ongoing efforts are championed by the HAC Oversight Committee and its subgroups.

Many providers feel that HAC work is largely in the hands of the nurses or other staff, and physicians don’t have a direct role in preventing them; however, there are actually many things providers can do to support this work. The table below gives some examples of ways we can make an impact. Not all of them will apply to all areas, but no matter where we work, we can all make a difference by supporting the nursing and ancillary staff in their work, answering questions and participating in cause analyses and debriefs when events do occur.

Providers and HACs — What Can You Do?

Adverse Drug EventsUtilize CPOE and verify accuracy every time. Only use verbal orders in emergent situations.
Catheter-Associated Urinary Tract Infections (CAUTI)Remove Foleys within 24 hours if not clinically indicated.
Central Line-Associated Blood Stream Infections (CLABSI)Follow the insertion bundle.
Daily review of the function, utilization and necessity of the line (can it come out?)
Look at the dressing – is it clean/dry/occlusive?
Pressure InjuriesDoes your patient need a specialty bed?
Remember that high-risk patients can still be repositioned with a slight “tilt”
or shift in weight.
Surgical Site Infections (SSI)Ensure appropriate antibiotic timing and re-dosing.
Compliance with bundle & OR sterility policies and procedures.
Unplanned ExtubationsReview extubation readiness with RN/RT/team.
Extubate at the best time for the patient.
Venous Thromboembolism (VTE)For high-risk patients, consider anticoagulation.
Accurately document patients with VTE.
Remember, central lines increase the incidence of VTEs.
Hand HygieneHand hygiene is still the #1 proven way to prevent infection.
Be cognizant of recontamination of your hands within the room after initial hand hygiene has been completed.
Advocate for objects, such as stuffed animals, to be kept out of patient beds.

For more information about our work with SPS or “K cards,” our newest initiative designed to ensure bundle compliance of 90 percent or greater, click here to read more or feel free to contact me via email at Bridget Norton, M.D., with questions or suggestions.

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