Critical Care Patient Case Study

Exemplary facility-level results include: an 80 percent reduction over six years in the rate of ventilator-associated pneumonia among intensive care patients; an increase from 39 percent to 100 percent in compliance with a standardized medication administration process; and a nine-percentage-point increase over one year in surgical patients receiving evidence-based treatment to prevent infections.At this nonprofit community hospital, nurses are assigned responsibility for monitoring adherence to the CLABSI prevention protocol, but all staff are encouraged to stop the central line insertion procedure if a lapse in protocol occurs.

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Other initiatives have reduced rates of health care–associated infections, patient mortality, and post-operative complications.

Success factors include leadership accountability for performance and organizational support for testing, expanding, and adopting improvements.

During the past five years, Sentara has intensified and expanded the program by engaging the health system’s physician group and other operating units in efforts to: 1) encourage employees to be mindful of the signals of inadequate care and act on those signals; 2) provide leaders with concrete methods of reinforcing employee behaviors that enhance patient safety; 3) reinforce bulwarks against medical error by instituting processes for learning from mistakes; and 4) reward the attainment of high standards of performance.

The initiative has helped to reduce the measured rate of serious safety events at Sentara hospitals by 80 percent over seven years.

Keeping the commitment to patient safety has required sustained focus on making safety a core organizational value, a willingness to innovate and adapt, and perseverance in pursuing goals.

OSF Health Care, an integrated health care delivery system serving parts of Illinois and Michigan, was an early leader in promoting a collaborative approach to patient safety improvement.The report also presents ways these hospitals are spreading prevention techniques to non-ICU units, and strategies for preventing other health care-associated infections.This nonprofit teaching hospital relies on intensivists to provide ICU caare.Safety principles have been spread outside the hospital setting to the systemâs home care group.Success factors include setting ambitious goals, empowering frontline staff to make improvements, involving executives and the board in change, and rigorously measuring and holding units accountable for results.Contact us if you experience any difficulty logging in.This private hospital has a designated team, known as the Vascular Access Specialist Team, comprising about 10 registered nurses who have a minimum of two years of nursing experience and are specially trained in central line insertion techniques, ultrasound guidance, and Centers for Disease Control and Preventioninfection prevention guidelines.OSF has enhanced these efforts during the past five years by continuing to build awareness of safety risks through systemwide error reporting and local risk assessment, by identifying clinicians who can serve as models for their peers, and by engaging staff in intraorganizational learning and competition to spur improvement.It also has raised performance expectations by educating hospital- and system-level board members about patient safety issues and quality improvement techniques.As part of their efforts to improve care, the intensivists recommended use of an evidence-based CLABSI prevention protocol that includes the use of a checklist to promote compliance.To ensure the protocol was followed, the hospital trained and empowered nurses to enforce standards during the placement process and restricted the number and type of hospital personnel permitted to insert lines.

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