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Patient Safety and the Perioperative Environment. Presentation by Peggy Cullum, RN, BSN, CNOR Solution Consultant, Cerner Corporation. Objectives. Identify patient safety concerns during the perioperative patient process Review patient safety standards, regulations and practice initiatives
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Presentation byPeggy Cullum, RN, BSN, CNORSolution Consultant, Cerner Corporation
Objectives • Identify patient safety concerns during the perioperative patient process • Review patient safety standards, regulations and practice initiatives • Discuss current perioperative patient safety practices and how SurgiNet Solutions can help
Joint Commission – National Patient Safety Goals CMS and CDC – SIP Protocol National Quality Partnership – SCIP The Institute of Healthcare Improvement (IHI) – “5 Million Live Campaign” AORN – Council on Surgical and Perioperative Safety Who’s Leading the Charge?
National Patient Safety Goals The purpose of the Joint Commission’s National Patient Safety Goals (NPSGs) is to promote specific improvements in patient safety.
The Requirements highlight problematic areas in health care and describe evidence and expert-based solutions to these problems. The Requirements focus on system-wide solutions, wherever possible. National Patient Safety Goals
National Patient Safety Goals Sentinel Event Alerts • Potassium chloride • Wrong site surgery • Suicide • Restraint deaths • Infant abductions • Transfusion errors • High alert medications • Op/post-op complications • Fatal falls • Infusion pumps • Proactive risk reduction • Home fires (O2 therapy) • Kernicterus • Look-alike, sound-alike drugs • Dangerous abbreviations • Ventilator-related events • Delays in treatment • Bed rail deaths & injuries • Nosocomial infections • Surgical fires • Perinatal death and injury • Anesthesia awareness • Patient controlled analgesia • Vincristine administration errors • Kreutzfeldt-Jakob disease • Medical gas mix-ups • Needles & sharps injuries • Look-alike, sound-alike drugs
All accredited health care organizations are expected to review each issue of Sentinel Event Alert Accredited organizations should consider information in an Alert when designing or redesigning relevant processes and consider implementing relevant suggestions or reasonable alternatives National Patient Safety Goals
National Patient Safety Goals Goal 1, Improve accuracy of patient identification.1AUse at least two patient identifiers when providing care, treatment or services. 1B Prior to the start of any invasive procedure, conduct a final verification process, (such as a “time out”) to confirm the correct patient, procedure, and site using active—not passive—communication techniques.Goal 2, Improve the effectiveness of communication among caregivers.2C Measure, assess and, if appropriate, take action to improve the timeliness of reporting, and the timeliness, of receipt by the responsible licensed caregiver, of critical test results and values. 2E Implement a standardized approach to “hand off” communications, including an opportunity to ask and respond to questions.
National Patient Safety Goals Goal 3 Improve the safety of using medications. 3DLabel all medications, medication containers (e.g., syringes, medicine cups, basins), or other solutions on and off the sterile field in perioperative and other procedural settings.Goal 7, Reduce the risk of health care-associated infections.7A Complywith current Centers for Disease Control and Prevention hand hygiene guidelines.(Initiate SIP protocol.)
National Patient Safety Goals Goal 8, Accurately and completely reconcile medications across the continuum of care.8AImplement a process for obtaining and documenting a complete list of the patient's current medications upon the patient's admission to the organization and with the involvement of the patient. This process includes a comparison of the medications the organization provides to those on the list.8BA complete list of the patient’s medications is communicated to the next provider of service when it refers or transfers a patient to another setting, service, practitioner or level of care within or outside the organization. The complete list of medications is also provided to the patient on discharge from the facility. Goal 11, Reduce the risk of surgical fires.11AEducate staff, including operating licensed independent practitioners and anesthesia providers, on how to control heat sources and manage fuels, and establish guidelines to minimize oxygen concentration under drapes.
National Patient Safety Goals Goal 13, Encourage patients’ active involvement in their own care as a patient safety strategy.13ADefine and communicate the means for patients and their families to report concerns about safety and encourage them to do so.
National Patient Safety Goals As of January 1, 2007, all Joint Commission accredited health care organizations and the Disease-Specific Care certified programs will be surveyed for implementation of applicable 2007 goals and requirements—or acceptable alternatives —as appropriate to the services the organization or program provides. Compliance with applicable requirements (or an acceptable alternative) will be scored as an element of performance in the NPSGs chapter of each standards manual.
August 2002, the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) implemented the Surgical Infection Prevention Project CDC had extensive experience in surgical site infection (SSI) surveillance through the National Nosocomial Infection Surveillance (NNIS) System CMS had a network of state-based Quality Improvement Organizations (QIOs) with experience in promotion of performance measurement and improvement and ongoing relationships with local providers of care Surgical Infection Prevention Project
Surgical Infection Prevention Surgical Site Infections (SSI) • Complicate an estimated 780,000 operations/year • Patients who get an SSI are… • Twice as likely to die • 5 to 6 times more likely to require re-admission • Likely to stay in the hospital twice as long • Additional cost from complication $30,000-$50,000 per major surgery • An estimated 40-60% of SSIs are preventable • Overuse, underuse, improper timing, and misuse of antibiotics occurs in 25-50% of operations
Project Objective To decrease the morbidity and mortality associated with postoperative infection in the Medicare patient population Medicare Surgical Infection Prevention (SIP)
Surgical Infection Prevention Project Quality Measurements for Surgical Infection Prevention (SIP) • Quality Measure #1: • Administration of antibiotics within 60 minutes of surgical incision • Quality Measure #2: • Use of appropriate antibiotics • Quality Measure #3: • Discontinuation of antibiotics within 24 hours after the end of surgery (48 hours for cardiac) Additional quality measures… • Control of glucose levels during surgery • Avoiding hypothermia during surgery • Use of supplemental oxygen during surgery & recovery • Clipping rather than shaving the surgical site
Surgical Infection Prevention Project Results • Preventing Surgical Site Infections: • 56 hospitals from 50 states participated • Sponsored by the Centers for Medicare & Medicaid Services (CMS) • Quality Improvement Organization (QIO) • www.ahqa.org Results from the National Infection Prevention Collaborative • Participating hospitals cut infection rate 27% in one year using quality measures • Overall infection rate fell more than a quarter, from 2.3% in the first three months of the collaborative to 1.7% in the last three months • Participating hospitals increased compliance for administration of antibiotics w/in 60 min of incision by 22% • Prior to quality measures, 70% rate of administering antibiotics within 60 minutes of incision • By the end of the collaborative, median compliance had risen to 92% administration w/in 60 min of incision
Evolution of Surgical Infection Prevention • To reduce preventable surgical morbidity and mortality by 25% by 2010
The national partnership promoting SCIP believes that if America’s hospitals adopt SCIP, these complications could be reduced by 25 percent by 2010. The national partnership American Hospital Association American College of Surgeons Veterans Health Administration Institute for Healthcare Improvement American Society of Anesthesiologists Association of periOperative Registered Nurses Joint Commission, the centers for Medicare and Medicaid Services Agency for Healthcare Research and Quality and Centers for Disease Control. Our goal is to enroll every eligible hospital in SCIP. Surgical Care Improvement Project
The Surgical Care Improvement Project (SCIP) provides evidence-based educational and clinical management tools proven to reduce the most common surgical complications: surgical wound infections blood clots perioperative heart attack and pneumonia SCIP focuses on process measures, such as the appropriate use of antibiotics near the time of surgery and the use of beta blockers, to prevent cardiovascular events and reduce complications. Surgical Care Improvement Project
Goal: Significantly reduce surgical complications by reliably implementing the four changes in care recommended by the Surgical Care Improvement Project (SCIP). 1. Surgical Site Infection Prevention 2. Beta Blockers for Patients on Beta Blockers prior to admission 3. Venous Thromboembolism 4. Ventilator- Associated Pneumonia Prevention Additional Considerations: Teamwork and Organizational Culture The Institute for Healthcare Improvement (IHI)
Association of periOperative Registered Nurses Council on Surgical and Perioperative Safety • Healthcare professional organizations • Patient safety advocacy groups • Industry companies developing technology for surgical uses
How Can SurgiNet Solutions Improve Patient Safety in the Periop Setting?
SURGICAL INFECTION PREVENTION: A SUCCESS STORY • La Porte Hospital & Health Services: • 227 bed hospital • Recognizing excellence in nursing services as 126th in the nation & 2nd in Indiana • 5,908 inpatient visits, 78,030 outpatient visits • 2,389 inpatient & 7,989 ambulatory surgery procedures Using SurgiNet to Reduce SSI’s • 98% compliance in efforts for safe administration of antibiotics w/in 60 minutes of incision… a 57% improvement in 9 months • Document whether an antibiotic was administered, when it was given and the antibiotic the patient received “I think having staff more aware of the need to get antibiotics infused prior to incision has really made all staff look at this issue more closely.” Lindia LaFrance, BS, R.N., SurgiNet Analyst, La Porte Hospital & Health Services
The Original Computer Memory was something you lost with ageAn application was for employmentA program was a TV showA cursor used profanityA keyboard was a pianoA web was a spider's homeA virus was the fluA CD was a bank accountA hard drive was a long trip on the roadA mouse pad was where a mouse livedAnd if you had a 3 inch floppy . . . . you just hoped nobody ever found out!
Where To Go For More Ideas… SurgiNet Special Interest Group (SIG)www.Cerner.com
Beyea, Suzanne C. (2003).“The national patient safety goals and their implications for perioperative nurses.” AORN, 77, 1241-1245. Joint Commission on Accreditation of Healthcare Organizations – www.jcaho.org Association of Operating Room Nurses (AORN)– www.aorn.org Institute of Safe Medication Practices (ISMP)–www.ismp.org Implementation Tips for Eliminating Dangerous Abbreviations -- http://www.jcaho.org/accredited+organizations/patient+safety/04+npsg/tips.htm Guidelines for Implementing the Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery™ Center for Disease Control – CDC Hand Hygiene Guideline Recommendations – www.cdc.gov References and Resources
Patient Safety and the Perioperative Enviornment Questions? Thank You!
