ROUNDS Preview: The High-Performance Clinical Organization

The scope of the No Harm campaign includes an approach to study and report harm events, to identify the causes, to prioritize, and then to change practice to eliminate harm. Harm itself was defined as: "Any unintended physical injury resulting from or contributed to by medical care (including the absence of indicated medical treatment) that requires additional monitoring, treatment, or hospitalization, or that results in death. Such injury is considered harm whether or not it is considered preventable, resulted from a medical error, or occurred within a hospital."

Having such a broad definition of harm was an intentional choice—it ensured that quibbling over the definition of "preventable" was not going to be a barrier, says James Kalus, PharmD, senior clinical pharmacy manager and a member of the system's No Harm steering committee.

"From a clinical standpoint, you can always argue something is not preventable," Kalus says. "From a pragmatic standpoint, if you say that you're only going to target preventable harm or you say that there's a difference between preventable and nonpreventable, then you're also setting yourself up that zero is never the goal. If you say everything is preventable, then theoretically you can target a lower number."

The harm index includes a formula of nationally reported measures in infection-related harm (HAIs, MRSA, UTIs, VAP), procedure-related harm, medication-related harm, falls, pressure ulcers, hospital-acquired acute renal failure, and employee injuries. New measures include two additions for perinatal harm and trauma.