Joint Commission journal on quality and patient safety / Joint Commission Resources
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Jt Comm J Qual Patient Saf · Apr 2011
High rates of venous thromboembolism prophylaxis did not increase the incidence of heparin-induced thrombocytopenia.
Venous thromboembolism (VTE) prophlaxis is recommended for most hospitalized patients. At a 505-bed urban academic medical center, the rate of VTE prophylaxis recently increased from 50%-55% to > 95% of eligible patients. Heparin-induced thrombocytopenia (HIT) is a potentially devastating, but rare, reaction to medications commonly used for VTE prophylaxis. ⋯ Optimizing the VTE prophylaxis rate to > 95% of eligible patients at a single academic institution did not cause an increase in the rate of HIT. Concerns about HIT should not limit implementation ofVTE prophylaxis protocols. HIT surveillance in patients on VTE prophylaxis may have a very low yield.
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Jt Comm J Qual Patient Saf · Apr 2011
Paying for outcomes, not performance: lessons from the Medicare Inpatient Prospective Payment System.
Drawing on lessons learned from the implementation of the Medicare Inpatient Prospective Payment System (IPPS), the authors propose principles for the design and implementation of a hospital payment system based on paying for outcomes.
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Sixty-three (approximately 80%) of the 81 hospitals that responded to a survey sent to all hospitals in The Netherlands with nonpediatric intensive care units had a rapid response system (RRS) in place or were in the final process of starting one. Among many other findings regarding RRS infrastructure and implementation, only 38% of the hospitals allowed nurses to activate the rapid response team without physician consent.
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Lean principles have been used at Denver Health Medical Center since 2005 to streamline nonclinical processes. Despite allocation of significant resources, particularly the expense of low molecular weight heparin (LMWH), to prophylaxis of venous thromboembolism (VTE), the incidence of postoperative VTE was significantly worse than national benchmarks. VTE risk factors were not consistently assessed, and the prescribing of prophylaxis varied widely. Lean was employed to standardize and implement risk assessment and evidence-based VTE prophylaxis for the institution. ⋯ Applying Lean to the clinical management of VTE prophylaxis improved compliance with standards and saved the hospital a significant amount of money. This was achieved without compromising clinical outcomes. This experience could be replicated at other institutions.
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Jt Comm J Qual Patient Saf · Mar 2011
Establishing a comprehensive networkwide pressure ulcer identification process.
Pressure ulcers (PUs) are a critical concern, endangering patients and requiring significant resources for treatment in Stage II/IV. The Centers for Medicare & Medicaid Services (CMS) denies reimbursement in cases where a more complex diagnosis-related group (DRG) is assigned as a result of hospital-acquired conditions such as a PU that could have been reasonably prevented. ⋯ The data suggest that the identification of all PUs that are present at time of admission is clinically feasible.