Minnesota regulators have cited Regions Hospital in St. Paul for neglect of care in the case of a patient who died last year after suffering brain damage. In a report, investigators from the Minnesota Department of Health said hospital staff members chose to silence the alarm on a device monitoring the patient's oxygen level "rather than make a proper assessment" of the patient's condition. Because Regions has taken corrective action, however, the state did not issue a licensing "deficiency," a penalty that, in rare cases, could lead to loss of eligibility for state and federal reimbursements.
U.S. officials said on Wednesday morning that swine flu has killed a 23-month old child in Texas, the first U.S. flu death. The number of confirmed U.S. swine flu cases rose from 45 to 66 on Tuesday as health officials warned that at least some American fatalities are likely.
The number of U.S. cases remains small compared with the outbreak's epicenter, Mexico, where about 150 people are reported to have died from the new, highly contagious viral strain.
Infection prevention and control issues continue to weigh heavily on hospitals.
National Patient Safety Goals focus on healthcare-acquired infections in 2009, providing consistent challenges in identification and prevention for hospitals preparing for Joint Commission surveys. Some states have targeted specific infections for education and prevention.
In Kentucky, a collaborative has targeted methicillin-resistant Staphylococcus aureus (MRSA) as a focus point for improvement.
Initially, the plan was to focus on rural hospitals, using funding through a rural grant, explains Elizabeth Cobb, MPH, vice president of health policy with the Kentucky Hospital Association. As discussions continued, however, the University of Louisville School of Public Health and Information Sciences was brought into the loop, and funding from emergency preparedness grants came into play.
"The timing was right in that we were able to leverage work done as part of emergency preparedness training grants and submit for some additional funding that was targeted toward emerging infections and healthcare worker training," says Ruth Carrico, PhD, RN, CIC, assistant professor and health promotion and behavioral sciences director with the school.
The organizations decided to pool their resources and target MRSA across the state.
"We decided from the beginning that this needed to be bigger than just hospitals or healthcare," says Cobb. "It's a community problem, not just a hospital or healthcare problem."
"I once worked with a state epidemiologist who would say, 'There's no such thing as a leak on your side of the canoe,'" says Carrico. "We're all impacted by the actions of others."
This concept drove the collaborative to not only target MRSA in hospitals, but build in a range of components to the program, particularly providing resources to nursing homes, home health, first responders, correctional institutions, schools, and athletics groups.
"We are really reaching out to all types of organizations where these infections are of concern," says Cobb.
Among the key targets: Hot topic (and NPSG) hand hygiene.
"We're encouraging everyone to educate visitors to your facilities about hand hygiene, and how that is so key to stopping the spread of MRSA and infections in general," says Cobb. "While we've built a MRSA toolkit, [MRSA prevention] really goes across borders."
Legislation requiring the reporting of infection rates was introduced at the state level in Kentucky in 2008. This legislation arrived early on in the development of the toolkit, prompting the collaborative to take a different approach demonstrating whether the program was making progress.
"How can we approach this at a statewide level and not be led by the drumbeat of mandatory reporting?" says Carrico. "We really wanted to lead instead of be led. We wanted to be very transparent, look at our issues, bring in concepts like standardization and social networking where improvements begin at the ground level."
The data collected will be applied directly as a method tracking process improvement.
"We wanted to do some data collection so we could share successes of the collaborative's efforts, but also if we find some components are not working, this will allow us to go back and modify the toolkit to get better results," says Cobb. "It will also help identify hospitals that are really excelling so that we can share those processes."
This will also provide an opportunity to improve through example.
"We will be able to identify facilities [that] are high performers, and also enable those who are not doing as well to make appropriate changes and figure out what is different about those facilities," says Carrico. "You can't do that if you're mired in mandatory regulations."
The number of confirmed cases of a deadly new strain of the flu continued to rise Monday, as the World Health Organization moved one step closer to declaring a pandemic. The United Nations public-health agency raised its global alert to phase 4 from phase 3. The change recognizes that the new A/H1N1 virus spreads from person to person, and signals that governments should prepare for outbreaks. Phase 6 is a pandemic.
Dublin (OH) Methodist Hospital has not had a hospital-acquired infection since January 8, 2008, when it opened. Chief Nursing Officer Lamont Yoder, RN, attributes the hospital's infection control success not just to its staff members' compliance, but to the physical environment in which they work every day.
"Private rooms are not just for the luxury of having a private room," says Yoder. "They're actually for the [patient's] outcome afterward."
Private rooms are not the only design helping Yoder keep his hospital a safe place to heal. Dublin Methodist was designed with consultation from the Center for Health Design (CHD), a non-profit research, education, and advocacy organization that conducts research to guide hospitals on best design practices for healthcare organizations.
Hundreds of research reports conducted by the center have gathered evidence on the impact of healthcare design on patient care, quality, outcome, and safety.
"The work [the CHD has] done over these last 10 to 20 years have shown quite conclusively that physical environment actually makes a difference to patient safety and quality improvement," says Anjali Joseph, PhD, director of research at CHD. "What we've been suggesting is that physical environment should be a part of the bundle of interventions that are put in place."
Dublin Methodist is contributing to more research as a partner in the Center's Pebble Project, which aims to collect information on newly-designed hospitals to find out what works best. "Patient safety was our top strategy in how we designed the building, from an architectural and work flow standpoint," says Yoder.
In November, 2008, the Joint Commission released its Guiding Principles for the Development of the Hospital of the Future, a report that guides hospitals in meeting the challenges of the future. Hospital design was one of its five core areas of action. In the report, the Joint Commission urges hospitals to offer private rooms, decentralize work stations, and reduce noise through evidence-based design.
More recently, the Institute for Healthcare Improvement published Using Evidence-Based Environmental Design to Enhance Safety and Quality, as part of its Innovation Series 2009. Joseph served as one of the paper's authors. The paper attempts to highlight the connection between world of hospital and patient safety and that of architectural design.
Private rooms, fewer transfers
Apart from patients having their own rooms at Dublin Methodist, they also move around much less, which Yoder says reduces infection rates.
"This is probably one of the most unique aspects in the design," says Yoder, referring to the hospital's acuity adaptable model of care, which allows any patient to stay in the same room until he or she is discharged, "no matter what happens to them in the hospital" according to Yoder.
"We don't have geographically delineated locations for certain types of patients. We don't have a medical floor, then a surgical floor, and then an intensive-care unit (ICU)." Instead, rooms are adaptable and medical equipment and nurses are brought to the patient.
Better light, less noise
Light and noise are both significant areas of interest for the CHD. Natural light in patient rooms can help patients gain better orientation, decreasing confusion in some patients, and is associated with both a shorter length of stay and lower use of pain medications, says Yoder. And though Joseph says there hasn't been much research to determine the environmental effects on medical errors, one CHD study found better lighting in the pharmacy lowers medication dispensing errors.
"We have an extremely, extremely quiet environment," says Yoder, explaining that this improves patient sleep patterns and communication between staff members and physicians, as well as between patients and their caregivers. Yoder says most hospitals are at the decibel level of highway traffic. Although most healthcare workers would probably not be surprised by that estimation, says Yoder, the noise can affect care.
"Those of use who have worked in busy units know that it can become extremely loud during shift change, when you have multiple nurses, caregivers, and physicians in an area where they all gather together. Our ability to lower noise was done by having no centralized location for people to gather," says Yoder.
Dublin Methodist has no centralized nursing stations; instead, it has working areas called perches, which are smaller, sitting or standing height stations closer to patient rooms. From each perch, a nurse can see three to five rooms. The perches also eliminate communication barriers.
Environment of safety in older hospitals
Though Yoder concedes that having breakthrough design and technology helps reduce errors and improve patient safety, he says that without the implementation of a culture of safety—which he adds can be implemented at any hospital—it wouldn't be enough.
"You can have the most beautiful building that is designed with the greatest architectural pieces that add into outcomes, but if you don't have the culture of safety developed, it will not work."
In addition to implementing a culture of safety, Joseph says any hospital should consider small implementations to improve the safety of its environment. She suggests conducting light and noise audits, ensuring there is enough light in critical spaces such as pharmacy, and find the source of loud noises to see whether the source can be removed. Installing sound-absorbing ceiling tiles, if possible, helps reduce noise, while rubber floors reduce noise and soften patient falls. She also suggests adding visual cues to highlight hand washing facilities.
Tami Swartz is an associate editor at HCPro, Inc., where she serves as editor for books, videos, and other resources in the accreditation and quality/patient safety markets. Tami also writes for Briefings on Patient Safety, an HCPro monthly publication. Contact Tami by e-mailingtswartz@hcpro.com
New Jersey health officials are trying to unravel how 15 dialysis patients at an Atlantic City hospital have contracted hepatitis C since 2005. Hospital administrators at AtlantiCare Regional Medical Center City Campus contacted the state after discovering five new hepatitis C cases during federally required annual hepatitis C testing of all dialysis patients. The testing, in late March and early April, showed the five patients had become positive for the disease since starting dialysis treatment at the hospital.