Critical Care Patient Case Study

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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.

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.

Johns Hopkins Medicineâan academic medical center and nonprofit integrated health care delivery systemâset a goal in 2002 of making its care the safest in the world.

The Comprehensive Unit-Based Safety Program, which trains frontline teams to identify and mitigate patient safety hazards, is a key strategy.Approaches include developing practical methods for training, coaching, and motivating staff to engage in patient safety work; designing effective tools and systems to minimize error and maximize learning; and leading change by setting ambitious goals, measuring and holding units accountable for performance, and sharing stories to convey values.Results include advancements in safety practices, reductions in serious events of patient harm, improved organizational safety climate and morale, and declines in malpractice claims.Per hospital procedure, staff also review daily whether continued use of a central line is necessary.Sentara Healthcare, an integrated health care delivery system serving parts of Virginia and North Carolina, has developed a systematic program to foster a culture of safety throughout its member hospitals, with the aim of reducing the potential for patient harm.Access to society journal content varies across our titles.If you have access to a journal via a society or association membership, please browse to your society journal, select an article to view, and follow the instructions in this box.This report synthesizes lessons from four hospitals that reported they did not experience any central line-associated bloodstream infections in their intensive care units in 2009.Lessons include: the importance of following evidencebased protocols to prevent infection; the need for dedicated teams to oversee all central line insertions; the value of participation in statewide, national, or regional CLABSI collaboratives or initiatives; and the necessity for close monitoring of infection rates, giving feedback to staff, and applying internal and external goals.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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