Quality and Patient Safety

Courtesy Saint Francis Hospital and Medical CenterConnecticut hospitals have set themselves apart by leading the nation with an ambitious statewide initiative to eliminate all-cause preventable harm using high reliability science to create a culture of safety.  Thousands of hospital staff, leaders, and physicians have been trained in high reliability science and behaviors across the state.  CHA’s tenth annual Patient Safety Summit in March 2012 marked the official start of the initiative.

Key Objectives Include:

  • Understanding core concepts about human error and event prevention in complex systems.
  • Identifying what leaders can do to demonstrate safety as a core value.
  • Understanding a behavior-based approach for improving and sustaining performance.
  • Understanding success factors for building and sustaining a high reliability performance culture.
  • Self-assessing organizational readiness.

The high reliability process reduces the number of serious safety events by reducing human errors and improving system reliability. Through extensive training and hands-on interactive workshops, hospital leaders are developing skills and learning to use practical tools that will enable them to create a culture of safety and fix systemic problems that lead to patient harm, decreasing events of preventable harm.

CHA’s tenth annual Patient Safety Summit in March 2012 marked the official start of the initiative.

Integrated with this groundbreaking statewide effort is CHA’s work with the American Hospital Association’s Health Research & Educational Trust (HRET) on the Partnership for Patients effort, a national initiative to decrease preventable patient harm by 40% and prevent avoidable readmissions by 20% by December 2013.  Among other areas, hospitals are committed to eliminating all healthcare-associated infections (HAI), including central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and surgical site infections (SSI).  Engagement in these collaboratives builds upon hospitals’ prior work with the federal Agency for Healthcare Research and Quality (AHRQ) Stop HAI projects: Stop BSI and Stop CAUTI, which successfully resulted in fewer healthcare-associated infections nationally.

Fourteen hospitals were engaged in the Stop BSI project and have achieved a reduction in their central line-associated blood stream infection (CLABSI) rates to an overall statewide rate of 1.1/1000 central line days.  Connecticut’s experience in the Stop BSI project, “Decreasing Central-Line-Associated Bloodstream Infections in Connecticut Intensive Care Units,” was published in the Journal for Healthcare Quality, September 2013.

The On the CUSP: Stop CAUTI program began with nine hospitals in November 2011. Teams are now in the implementation phase of the project. This national patient safety program is aimed at reducing catheter associated urinary tract infections and implementing the comprehensive unit-based safety program (CUSP).

Several other ongoing clinical collaboratives unite hospitals around key safety objectives, including reducing preventable heart failure readmissions and infection prevention. Recently, hospital teams and community care partners have participated in the Heart Failure Readmissions Collaborative, a partnership between CHA’s Patient Safety Organization and Qualidigm.

Also, 28 Connecticut hospitals participated in the national HCAHPS Patient Safety Learning Network to improve quality, patient safety, and patient experience. This national program currently involves 19 states.

Through its Patient Safety Organization (PSO), CHA is providing leadership and resources for ongoing improvement activities.

CHA's Towards Excellence in Care (TEIC) program provides facilities with quality improvement services through data collection and analysis of clinical processes and outcomes.

CHA, in partnership with Qualidigm and DPH, has developed a Wallet Medication Card and questions and answers about patient safety strategies for consumers.

Position Statement

Ensuring the Highest Standards of Patient Safety and Quality Care

Questions and Answers About Patient Safety Strategies for Consumers

How Can I Help with Correct Patient Identification?

Carefully reviewing the spelling of your name, age, address, and other information and correcting any errors at the time you register at the hospital.

Making sure the nurse, doctor, or other healthcare worker checks your wristband and asks your name before taking any tests or giving you any medications or treatments.

Trying not to get frustrated when doctors and nurses repeat the same questions, such as asking your name; this is an important double check to confirm that your information is correct.

Telling a doctor, nurse, or other healthcare worker if you think he or she has confused you with someone else. For example, if the medication that you are given or procedure you are about to have is not what you were expecting, speak up and ask the provider to confirm that it is correct.

How Can I Help with Communication?

Take an active role in your care by:

Asking the person doing the test how long it will take for results to be reported to your doctor.

Asking your doctor to review the test results with you and to explain what that means for your future care.

Always confirming test results with your doctor, even if you are told that no call from the doctor means everything is fine.

How Can I Help with Medication Safety?

Take an active role in your care by:

Knowing what medications you take and why you take them.

Asking questions if you don't recognize a medication.

Telling the doctor or nurse about any allergies you have, or any bad reactions you have had to medications in the past, before taking a new medication.

Learning both the brand name and generic name for each medication you take.

Keeping a current written list of all the medication you take and bringing it with you whenever you go to the hospital or any other healthcare provider to help you remember to tell the hospital or other provider about all of your medicines. Click here for a wallet card to help you track your medications.

If there is a medication that you took at home that you have not been given in the hospital, asking your doctor or nurse if you should still be taking that medication.

Reviewing your list of medications with the doctor or nurse before you leave the hospital to make sure you understand which medicines to take and how often. You may also want to involve a family member or friend in that discussion so they can help you remember which medications to take.

After you leave the hospital, calling your doctor if you have any questions about which medication you should be taking. Do not assume that you should take all of the same medication that you took before you went into the hospital.

How Can I Help with IV Safety?

Sometimes in the hospital, you will be given liquid or liquid medicines through a thin tube attached to a bag of fluid. This is called an IV.

If you are given an IV, ask the nurse how long it should take for the liquid to "run out."

Tell the nurse if your IV doesn't seem to be working properly.

How Can I Help Reduce Infections?

Thorough hand washing is an important way to reduce the spread of infections anywhere, at home, at work, in the community, and in healthcare facilities. For information on the best techniques for hand washing, as well as a list of situations in which you should always wash your hands click here for the federal Centers for Disease Control's Clean Hands Campaign information.

Always wash your hands before touching a hospital patient that you are visiting and don't visit anyone in the hospital while you are ill.

If you are a hospital patient and have a family member or friend who is ill, ask that person not to visit you in the hospital until they are well.

Many hospitals have sinks or hand washing gel dispensers outside of patient rooms so you may not always see your healthcare personnel clean their hands. If you have not seen your doctor, nurse, or other healthcare worker wash their hands, however, don't be afraid to ask them if they have washed their hands before allowing them to touch you.

Before you leave the hospital, if you have any breaks in your skin, such as from an injury or where you had surgery, make sure you understand how you are supposed to care for the area once you get home. Your doctor or nurse will give you specific instructions about when you can get the area wet, whether you should keep it covered, and how to keep it clean. If you have not received these instructions, ask before you leave the hospital. It is very important that you follow these instructions carefully because it is easy for bacteria that cause infections to get into your body through a break in your skin.

How Can I Reduce the Risk of Falling?

In the hospital, take an active role in your care by:

Telling your nurse at the time you are admitted to the hospital if you have difficulty walking or have to get up in the middle of the night to use the bathroom.

Always calling your nurse if the nurse or doctor tells you that you should ask for help when getting out of bed. You are not disturbing the nurses -- keeping you safe is an important part of the work they do.

Even if you have not been told to ask for help when getting up, any time you feel weak, dizzy, or sleepy, don't get out of bed without calling the nurse or nurse's assistant for help.

For other strategies on fall prevention in the community, click here for information from the Connecticut Collaboration for Fall Prevention.

How Can I Help My Doctor Perform the Correct Procedure?

At the time your surgery/procedure is scheduled:

Carefully read your surgery/procedure consent form and ask questions if you don't understand something. You may want to bring a trusted family member or friend with you who also can listen and ask questions.

At the hospital:

Ask the hospital personnel to confirm what kind of surgery/procedure you are having and on what body part the surgery/procedure is to be performed. If the hospital personnel give a different answer than you were expecting, ask to speak with the doctor before the procedure starts to confirm that you are having the correct procedure.

Participate in marking your own surgical site if the hospital asks you to do so and you are confident that you know the site of your surgery.

If hospital staff ask you to verify the procedure that is being done or the location of the procedure and you don't know, tell the hospital staff that you don't know. Don't guess or just agree with the hospital staff if you actually don't know the exact procedure or location of the procedure.


Links

Agency for Healthcare Research and Quality
Hospital Compare: Centers for Medicare and Medicare Services
Institute for Healthcare Improvement
Institute of Medicine
Joint Commission
National Patient Safety Foundation
National Quality Forum
Qualidigm