Joint Commission journal on quality and patient safety / Joint Commission Resources
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Jt Comm J Qual Patient Saf · Feb 2013
A multidisciplinary approach to reduce central line-associated bloodstream infections.
Stony Brook University Hospital (SBUH) joined a Critical Care Learning Collaborative in fall 2004. The collaborative incorporated application of central line and ventilator bundles, multidisciplinary rounding, and daily goal sheets to improve patient outcomes. In a two-year period, the initiative spread to the medical, pediatric, cardiac, and neonatal ICUs. ⋯ A critical feature of the approach that SBUH followed was to establish buy-in and oversight from the SICU leadership through a multidisciplinary team, which became the "learning laboratory" for many of the subsequent changes in practice. Also, the fundamental role of the Continuous Quality Improvement (CQI) Department's quality management practitioner as facilitator cannot be overstated. "Hardwiring" of process changes augmented sustainability of improvements, as did a change in the health care team's perception of central line infections--that is, from an "unavoidable complication" to "a failure."
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Jt Comm J Qual Patient Saf · Feb 2013
Multicenter StudyMaintaining and sustaining the On the CUSP: stop BSI model in Hawaii.
Hawaii joined the On the CUSP: Stop BSI national effort in the United States in 2009 (CUSP stands for Comprehensive Unit-based Safety Program). In the initial 18-month study evaluation, adult ICUs decreased central line-associated bloodstream infection (CLABSI) rates by 61%. The impact of a series of novel strategies/tools in reducing infections and sustaining the collaborative in ICUs and non-ICUs in Hawaii was assessed. ⋯ Hawaii successfully spread the program beyond adult ICUs and implemented a series of tools for maintenance and sustainment. Use of the tools shaped a culture around the continued belief that CLABSIs can be eradicated, and infections further reduced.
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Jt Comm J Qual Patient Saf · Feb 2013
Methodology and bias in assessing compliance with a surgical safety checklist.
Surgical safety checklists, such as the perioperative time-out, have been shown to improve performance on a variety of patient safety measures. A variety of methods have been used to assess compliance with the perioperative time-out, but no standardized methodology with a reliable observer group currently exists. An observation-based methodology was used to assess time-out compliance at an academic medical center. ⋯ In our cohort of observed time-outs, the compliance rate was low, calling into question time-out quality, and, more importantly, patient safety. Measures must be taken by large hospitals to regularly audit time-out compliance and create effective programming to improve performance. Although observational assessment is an effective method to assess compliance with surgical safety checklists, observer group bias has the potential to skew results.
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Jt Comm J Qual Patient Saf · Jan 2013
Multicenter StudyA cross-sectional study on the relationship between utilization of root cause analysis and patient safety at 139 Department of Veterans Affairs medical centers.
Empirical evidence is limited that root cause analysis (RCA), an event analysis tool used in health care to evaluate the systemic factors that lead to adverse events, improves patient safety. A cross-sectional study was conducted to examine the relationship between RCA and patient safety. ⋯ Large, high-spending VAMCs conduct more RCAs per year than smaller, low-spending facilities. VAMCs that do more RCAs develop more corrective actions. VAMCs that complete fewer than four RCAs per year have higher rates of postoperative complications. It is unclear if RCAs are associated with a functional patient safety program or directly improve patient safety.
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Jt Comm J Qual Patient Saf · Jan 2013
The changing nature of ICU charge nurses' decision making: from supervision of care delivery to unit resource management.
Recent findings that variations in nursing workload may affect inpatient outcomes now highlight nurse workload management and the need for an updated analysis of the role of the charge nurse (CN). ⋯ The role of ICU CNs appears to be continuing to evolve, now encompassing unit resource management in addition to supervising care delivery. Effective support tools, together with education that would enhance communication and resource management skills, will be essential to CNs' ability to support unit resilience and adaptability in an increasingly complex environment.