Highlights
from the Quality Improvement Patient Safety Committee (QIPSC) Report
sent to the Medical Board in February. Joseph Hopkins, associate chief
of staff, chairs the SHC QIPSC:
Patient
Safety - Quality Indicators
Six committees have begun work to provide in-depth studies of clinical
events in various areas to determine if process improvements can improve
overall outcomes:
1. Post-operative hemorrhage and hematoma,
Stephen Coutre, hematology, lead physician.
Cases are being reviewed by a team of physicians and appropriate follow
up steps will be taken if identified.
2.
Accidental puncture and laceration, Edward Damrose,
faculty otolaryngology and Bruce Reitz, chair of cardiovascular surgery,
lead physicians:
Exploration of "sterile cockpit" is under discussion. Other indicators
currently being studied. Lead physicians noted:
Iatrogenic
pneumothorax, Norman W. Rizk, director of ICUs, pulmonary and critical
care
Post-operative pulmonary embolism or deep vein thrombosis, David Spain,
trauma service chief, surgery
Selected
infections due to medical care, Lucy Tompkins, chief of infectious diseases,
and Jose Montoya, faculty infectious disease
Postoperative
physiologic and metabolic derangements, Stephen J. Ruoss, pulmonary
and critical care
Performance
Improvement (PI) teams currently working:
Lab
specimen requisition completeness
Behavioral
emergencies
Tight
Glucose Control in ICUs
OR
instrument count (FEMA)
Trauma
patients transferred from ED to OR
Patient
Safety Goals
Compliance
sought for 100 percent of the JCAHO Patient Safety Goals. SHC needs
support from all staff to reach 100 percent implementation and compliance
as required by JCAHO.
Transplant
Service
The
ABO compatibility for donor organs check was implemented Jan. 21.
Radiology
PI Team Status Report
The
recommendations made by the PI team have not been implemented. A meeting
to discuss the implementation of the recommendations was scheduled.
Operative
and Invasive Procedure Monitoring
Ophthalmology
has implemented a three-day preoperative antibiotic prophylaxis for
cataract surgery, which has demonstrated significant decrease in bacteria
in the conjunctiva at the time of surgery.
Closed
ICU Model
The
committee discussed a recent review article on limiting ICU practice
to intensivists, or requiring a consultation from intensivists in subspecialty
groups. Data from 26 studies indicate these practice requirements result
in a 30 to 40 percent reduction in mortality. The study also showed
a considerably shorter length of stay. (Pronovost, et. al., JAMA. 2002;
288:2151-2162) The QIPSC approved a resolution strongly recommending
that such a policy be implemented at SHC and directed that a policy
be created for presentation to the Medical Board.
Massive
Transfusion Policy
The
draft of the blood usage/massive transfusion protocol developed by the
Critical Care Committee was discussed. The policy mandates that a small
group of physicians meet with any attending physician caring for a patient
who has received 50 or more units of blood/blood components in a 24
hour period. The purpose of this meeting would be to ensure the attending
had a clear treatment plan in place and understood the consequences
and possible outcomes of patients receiving massive amounts of blood/blood
components. The policy would not prevent the attending from continuing
to administer blood to the patient. The committee endorsed these ideas,
but requested that the policy be revised to include additional steps
which could be taken if the attending physician, despite the recommended
discussion, continued to order blood products under conditions of markedly
questioned benefit, particularly when the blood order impedes the ability
of the hospital to care for other patients. This addition to the policy
should specify the process to be used to override the questionable blood
use or take steps to mitigate the effects of the order on other services.
Principals
of Clinical Practice
The
QIPSC adopted a resolution asking that a Statement of Principles of
Clinical Practice be drafted to include the importance of collaboration
and appreciation of limitation of resources.
Medical
Leadership
The
QIPSC requested that an ad hoc group be convened to determine whether
the institution has in place the necessary elements to support effective
medical leadership.
Core
Measures
Community acquired pneumonia:
SHC
will put in place immediately a default process that will provide pneumococcal
vaccine for everyone admitted to select units (DGR, EGR & B2) unless
a mandatory screening shows the immunization is contraindicated or the
patient has received prior immunization.
Smoking
cessation counseling was offered to 88 percent of patients in December
'03, compared to 53 percent in September '03.
Patient
Safety Net
Picker
data shows patient dissatisfaction with discharge teaching and availability
of staff to help with toileting. An interdisciplinary team, The Patient
Experience Team, has implemented a PDCA intervention.
Policies
for Approval
Fourteen
policies were forwarded to the Medical Board for approval. The Medication
Administration policy contains a key recommendation: verbal orders should
be read back to the issuer.
