Joint Commission journal on quality and patient safety / Joint Commission Resources
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Jt Comm J Qual Patient Saf · Apr 2009
Early goal-directed therapy: improving mortality and morbidity of sepsis in the emergency department.
The growing number of patients with severe sepsis or septic shock and the resulting mortality rate (30%) require changes in the current protocols used to treat these conditions. Through adaptation of early goal-directed therapy (EGDT), Carolinas Medical Center developed a process improvement strategy for decreasing mortality associated with severe sepsis and septic shock. Before implementing the EDGT protocol, the ED did not follow a written management protocol for septic patients. ⋯ As a result of this process improvement initiative, patients who might have received delayed and/or inadequate treatment for severe sepsis or septic shock are now receiving effective, life-saving treatment. Because of the emphasis on training, consistency in applying the protocol, relatively few changes in current ED practice, and low direct expenditures for equipment, the protocol can be easily integrated into existing ED environments to allow hospitals to quickly implement this successful, best-practice program.
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Jt Comm J Qual Patient Saf · Apr 2009
The final steps in converting a health care organization to a latex-safe environment.
In a follow-up to a previous article, which described the approach at The Johns Hopkins Medical Institutions to establishing a latex-safe environment, subsequent efforts to convert all the sterile gloves to nonlatex products and thereby complete the implementation of a latex-safe program are reported. Before the complete conversion to nonlatex sterile gloves, operating room use had increased to approximately one-third of our total sterile glove use during the preceding four years. ⋯ Once financial and logistical concerns were addressed, conversion to a latex-safe environment entailed readying the organization for the change in organizational culture. Key factors were (1) general acceptance from all the chiefs of the surgical departments; (2) centralization for all purchases of medical supplies, including sterile gloves, through corporate purchasing; and (3) ongoing education and vigilance.
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Jt Comm J Qual Patient Saf · Apr 2009
A comprehensive hand hygiene approach to reducing MRSA health care-associated infections.
Methicillin-resistant Staphylococcus aureus (MRSA) infections are the most common health care-associated infections (HAI) in the acute care setting. The major mode of transmission from patient to patient is through bedside care providers via contaminated hands. After individual projects within Novant Health proved to be ineffective, with any gains in hand hygiene compliance being short-lived, a program was implemented to address unsatisfactory hand hygiene compliance rates. Published studies have associated improvements in hand hygiene compliance with decreases in HAIs. ⋯ Understanding hand hygiene compliance is a simple matter of observing caregiver behavior during each hand hygiene opportunity and recording the actions taken. The improvements in hand hygiene compliance translated into a real decrease in the number of hospital-acquired MRSA infections.
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From 2003-2005, a comprehensive review of all cardiac/respiratory arrests at Mission Hospital (Mission Viejo, California) uncovered deficits in knowledge and judgment in the hours preceding 75% of our non-ICU patients. Nearly half of all arrests were occurring outside the ICU, with an overall mortality rate of 60%. In addition, transfers into ICU from the floor averaged 96 patients per month. ⋯ The RRT initiative delivered measurable outcomes demonstrating the hospital's commitment to saving the vulnerable hospitalized patient population. In addition, the identification of critical system and clinical issues resulted in efforts to improve processes and identify patient subpopulations at risk (for example, patients with congestive heart failure, end-stage heart disease, high-dose narcotics).