Three Oregon Hospitals Lead the Way in Patient Safety
Three Oregon hospitals were given the Commission’s Leading Participant Award on March 1, for their efforts to improve patient safety. Asante Rogue Regional Medical Center, Good Samaritan Regional Medical Center, and Mid-Columbia Medical Center were all honored for exceeding the Patient Safety Reporting Program’s 2012 recognition targets that were set by the Commission. These organizations are improving healthcare in Oregon through active reporting and other patient safety initiatives.
Conversations with staff at each of these hospitals revealed that key factors behind their successful patient safety efforts include the support of administrators and executive leadership and use of root cause analysis in a just culture environment that promotes teamwork, communication, and learning. With strong administrative and executive leadership support, each of these hospitals has tangibly improved patient safety through a variety of targeted programs.
Asante Rogue Regional Medical Center
Asante Rogue Regional Medical Center (ARRMC) puts a strong emphasis on conducting and learning from root cause analyses (RCA) of serious adverse events, which are reported to the Patient Safety Reporting Program. The longer ARRMC has participated in the reporting program, the better they have become at using their adverse event reports to drive improvement. This commitment to reporting, tied to their work with Healthcare Performance Improvement, has led them to a 94.3 percent reduction in the rate of cases that require root cause analysis since 2007. This accomplishment is the result of many distinct patient safety efforts that include:
- Weekly “Top 10 Safety Issues” meetings
- Rapid response and family-activated safety teams
- Use of a toolkit for resolving patient complaints at the bedside
- Physician quality teams and mandatory physician safety education at the time of credentialing
- Monthly risk continuum meetings with senior leaders
- Continued emphasis on investigating adverse events and precursors to safety events even if there is no negative patient impact
ARRMC continues to expand the reach of their root cause analysis investigations by examining less serious adverse events that involve moderate, temporary harm or near misses using a new process called apparent cause analysis. They have also begun reviewing events over time to look for common causes that might otherwise be missed.
In 2012, ARRMC lent a particular focus to improving patient safety through falls prevention and oversedation prevention. ARRMC has begun using a new scale for fall injury risk assessments and interventions that contain clear requirements for the use of alarms. The medical center has also focused on providing new education on oversedation by revamping its patient-controlled analgesia order set and monitoring their progress over time (for example, ARRMC reviews the use of rescue medications such as Narcan).
Good Samaritan Regional Medical Center
Good Samaritan Regional Medical Center (GSRMC) cites two major components of their patient safety program as being instrumental in their progress: their multi-disciplinary Patient Safety Committee and their commitment to systematic learning about problems and solutions. GSRMC has seen a dramatic reduction in various infection rates, which are known to cause significant harm to patients. GSRMC has also implemented a multitude of process improvements as a result of their commitment to patient safety at all levels of their organization, including:
- Use of audits to track the impact of their improvement initiatives, which allows for the opportunity to evaluate progress and identify where further improvements are needed
- A nurse rounding program that began in July 2012 and has improved the response to patient’s with safety concerns or risk factors
- Antimicrobial stewardship program that involves pharmacy and infectious disease physicians
- Hand hygiene surveillance of all healthcare workers showing sustained improvement and exceptionally high rates of performance
- 73% reduction in knee replacement-related surgical site infections since July 2010 and a 39% reduction of surgical site infection rates overall
- Free of central line-related infections since July 2012
- 76% reduction in catheter-associated urinary tract infection rates in the intensive care unit and the medical/surgical units in 2012
GSRMC conducts root cause analyses of serious and potentially serious “near miss” adverse events. During the root cause analysis, the contributing factors portion of the Patient Safety Reporting Program’s reporting tool is used to ensure all possible factors are considered. Staff understand that the root cause analysis process is about determining the root cause and is not about blame. Action plans are developed and process improvements are shared.
Mid-Columbia Medical Center
Today, Mid-Columbia Medical Center (MCMC) has a successful patient safety program that involves all levels of staff, including hospital leadership, in root cause analysis and efforts to improve care. In the early days of the MCMC patient safety program, discovering that an adverse event had occurred was difficult; however, by educating staff about how to identify adverse events and why doing so is important, the program has seen a positive impact on staff efforts to improve patient care. By incorporating root cause analysis discussions into management meetings and openly discussing adverse event cases, MCMC staff have been able to overcome fear of blame or punishment when something goes wrong, and instead, are able to work together to positively impact communication and investigations.
In the past year, Mid-Columbia Medical Center’s patient safety program has been engaged in several efforts including:
- Use of a safety huddle to review adverse events and determine severity levels
- Grant-funded initiatives to reduce language barriers and readmissions
- A Partnership for Patients focus on preventing surgical infections, catheter-associated urinary tract infections, and central line-associated infections, as well as antimicrobial stewardship
In 1992, MCMC implemented the Planetree philosophy of care facility-wide. The Planetree philosophy of patient-centered care is part of an effort to change the way patients experience hospitals—transforming impersonal, intimidating institutions into nurturing, healing, and educational environments. MCMC is very proud of the impact Planetree has had on personalizing, humanizing, and demystifying the healthcare experience for patients and their families.
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