Standardizing the look of medication labels could significantly decrease costly and potentially harmful medication errors, according to a study by anesthesiologists at Penn State Hershey. Researchers tested a simple color-coding system in simulated emergency room situations and said a universal system could help prevent some of the 1.5 million adverse drug reactions each year caused by medication mistakes. These mistakes cost the healthcare industry an estimated $3.5 billion annually.
The death rate at top-ranked U.S. hospitals is 70% lower than at the lowest-ranked hospitals, according to a study that examined 41 million patient records at 5,000 hospitals over three years. The study focused on 17 procedures and found that overall death rates declined by 14.7% from 2005 to 2007. Top-performing five-star hospitals reduced their death rates faster (about 13.2%) than poorer-performing one- and three-star hospitals (12.3 and 13.1%, respectively).
There has been a considerable amount of attention paid recently to "never events," serious medical errors that should not happen. The Centers for Medicare & Medicaid Services raised the visibility of these events by mandating that when such errors occur, CMS will not pay for additional expenses incurred. Hospitals are currently preparing for implementation of CMS' "no pay" plan and expending tremendous resources in the process.
Never events are relatively infrequent occurrences, but underlying the events are failures in patient-centered care that affect thousands of patients every day. Seven years after the Institute of Medicine identified patient-centered care as one of six aims of a quality healthcare system, hospitals still struggle to consistently deliver care that "is respectful of and responsive to individual patient preferences, needs, and values." The lapses in patient-centered care are documented in the HCAHPS survey results, which confirm that hospitals nationwide are not always listening to patients, communicating in a way that patients understand, being responsive to patient requests, or managing patients' pain.
The quantitative portrait offered by HCAHPS is supplemented by the qualitative stories of patients who experience humiliation, shame, hopelessness, and powerlessness in a system that is intended to help the patients it is inadvertently harming. A recent Picker Institute-funded analysis of more than 100 patient focus groups conducted by Planetree at 35 hospitals of all sizes and locations across the country found disturbing evidence of major failures in the provision of respectful and responsive care. Major themes emerging from the focus groups included lack of caring attitudes on the part of hospital staff, dismissal/trivialization of patients' knowledge and views about their own bodies and their health, and a troubling phenomenon of "reverse caring" in which patients witnessing the stress and strain on caregivers makes them reluctant to inconvenience or aggravate staff by asking for the care they need.
Ultimately patient-centered care is about culture change and must involve not only caring for patients, but also caring for staff members who often feel demoralized and shamed themselves by constant reminders of how they are falling short. In the safety movement, the focus has shifted from individual providers to system solutions, and the patient-centered care movement needs to evolve in the same direction. We need to advance beyond the amorphous public policy goal of patient-centered care to tangible operational objectives. These objectives must reflect and honor the good work done every day by passionate people who dedicate their professional lives to helping others, but work in a system that doesn't always honor that intention.
Expanding focus from never events to the patient-centered "ever events" is a significant step in the right direction. Never events focus on preventing horrific clinical outcomes for a small number of patients, while ever events focus on what should happen for all patients, every time they interact with the healthcare system. Never events are nationally standardized; ever events are customized by each institution. Never events highlight what goes wrong; ever events celebrate what is done right.
The Cleveland Clinic is one of several patient-centered hospitals that are making this leap. The Clinic's Office of Patient Experience is guiding teams of physician and nurse leaders who are defining what actions will create the ideal experience for patients. One initial ever event defined by the Cleveland Clinic is that prior to the induction of anesthesia, all staff members in the operating room should introduce themselves to the patient and explain their role in caring for the patient. This ever event was identified by a patient who called the Office of Patient Experience to report how amazed he was by this approach. In stark contrast to the ever event is the more frequent patient-centered never event of OR staff chatting about their weekend plans, ignoring the patient who is lying terrified on the table waiting for anesthesia. The patient-centered never event will be prohibited, while the ever event is celebrated.
Ironically, CMS' no-pay for never events policy became effective October 1, 2008; the same day marked the beginning of the second annual Patient-Centered Care Awareness Month. This month we call on all hospitals to broaden their focus from "never events" to "patient-centered ever events," and we ask each hospital to identify its own patient-centered ever events. Many patient-centered practices that promote an effective partnership between patients, families, and providers, as well as among all staff members, clinical and non-clinical, are described in a Patient-Centered Care Improvement Guide that Planetree and the Picker Institute will publicly release in late October. Together we can build a future where the never events are more rare than they are today and the patient-centered ever events are not simply something we do, but an inseparable part of who we are.
Susan B. Frampton, PhD, is president of Planetree. Patrick A. Charmel is president and chief executive officer of Griffin Hospital.
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Guidelines for reducing healthcare-associated infections are not hard to find. They're everywhere, in fact. But a new infection control compendium released last week is no ordinary guideline.
Myriad organizations have created specific recommendations for hand washing and inserting catheters and shaving the operative site and anything else you can think of (or might not want to think of, for that matter). Senior leaders are well aware of the numbers—roughly 2 million HAIs associated with nearly 100,000 deaths in U.S. hospitals every year, according to the Centers for Disease Control and Prevention—and have implemented all manner of prevention initiatives in an effort to reduce those figures. I have edited many stories for HealthLeaders magazine in which a hospital executive explains how his or her organization has made infection control a priority and is taking steps to make HAI prevention efforts part of the hospital's "culture."
The availability of recommendations isn't the problem—it's the adherence part of the equation that causes the trouble. Last year, a Leapfrog Group study found that 87% of hospitals don't consistently follow guidelines for preventing some of the most common HAIs. Only 35% of hospitals had full compliance with hand hygiene practices. A guideline is one thing, but following that guideline is quite another.
So when I first read about the Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals, the new HAI-prevention guidance released last week by The Joint Commission, the American Hospital Association, the Society for Healthcare Epidemiology of America, and the Infectious Diseases Society of America, I was skeptical. The new guidelines offer recommended practices for preventing methicillin-resistant Staphylococcus aureus, Clostridium difficile, central-line-associated bloodstream infections, ventilator-associated pneumonia, catheter-associated urinary tract infections, and surgical site infections. The compendium's authors don't claim that the guidelines are all that different from existing guidelines—they're just more concise and collected in a single source. So if the main problem with infection control has long been lack of adherence, not lack of recommendations, why should this latest attempt be any different?
The messengers, for one thing. The Joint Commission and the AHA uniting to create a singular infection control guidebook is quite different from a random organization offering its two cents on infection control. And by 2010, some of the new guidelines will show up in The Joint Commission's accrediting standards.
The format, for another. A consensus like this presented in relatively concise form should be much easier for healthcare workers to digest than the current volumes of infection control recommendations. Having a multitude of guidelines might seem like a good thing, but it's really not, says Robert A. Wise, MD, vice president of The Joint Commission's division of standards and survey methods. "One of the reasons hospitals are having difficulty now is that when they look at guidelines, they are drinking from a fire hose," Wise told The New York Times. "There are thousands of these things, and they don't quite know what to do with them."
So now we have a single playbook, backed by major organizations and organized in clear form, for preventing six of the most common HAIs. Practical advice on what to do and what not to do. No more excuses.
Will it work?
Personally, I think there's something to the theory that too much information from too many sources can cause paralysis. This compendium could genuinely help provider organizations take meaningful strides in the HAI fight. But infection control ultimately comes down to the individual. We've told you to wash your hands. You know the risks if you don't wash your hands. So wash your hands.
Will your people listen?
Jay Moore is managing editor for HealthLeaders magazine. He can be reached at jmoore@healthleadersmedia.com.
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Two Pennsylvania senators are trying to resurrect a state agency that has developed a national reputation for reporting trends in hospital, surgical, and medical costs. Sens. Wayne Fontana, D-Brookline, and Pat Vance, R-Cumberland, said they will introduce a bill to reauthorize the Pennsylvania Health Care Cost Containment Council. Since the Pennsylvania Senate has gone home for the year with no agreement with the governor on health costs, the cost containment council will die Nov. 30. The proposed bill, which will be introduced in January, would extend the Council's life for five more years.
More Americans are changing their behavior when it comes to taking care of their health, according to a new EBRI Health Confidence Survey underwritten by Des Moines, IA-based Principal Financial Group. The survey of 1,000 people indicates that Americans are showing some level of personal responsibility through heightened awareness and action: Two out of five Americans report they are often or always aware of the cost of a doctor's visit. "The economic crisis is serving as 'the tipping point' in terms of how Americans are changing behavior concerning their healthcare," said Jerry Ripperger, practice leader of consumer health at Principal.