Patient Safety and the Perioperative Environment

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• Patient Safety and the Perioperative Environment

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Presentation byPeggy Cullum, RN, BSN,
CNORSolution Consultant, Cerner Corporation
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(No Transcript)
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Objectives

• Identify patient safety concerns during the
  perioperative patient process
• Review patient safety standards, regulations and
  practice initiatives
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• Discuss current perioperative patient safety
  practices and how SurgiNet Solutions can help

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Lessons Learned?
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(No Transcript)
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Whos Leading the Charge?

• 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

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2007 National Patient Safety Goals
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The purpose of the Joint Commissions National
Patient Safety Goals (NPSGs) is to promote
specific improvements in patient safety.
National Patient Safety Goals
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National Patient Safety Goals

• 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.

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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

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National Patient Safety Goals

• 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

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Goal 1, Improve accuracy of patient
identification.1A Use 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 activenot
passivecommunication 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
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Goal 3 Improve the safety of using medications.
3D Label 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 Comply with
current Centers for Disease Control and
Prevention hand hygiene guidelines.(Initiate
SIP protocol.)
National Patient Safety Goals
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Goal 8, Accurately and completely reconcile
medications across the continuum of care. 8A
Implement 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. 8B A complete list of the
patients 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.11A Educate 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
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Goal 13, Encourage patients active involvement
in their own care as a patient safety strategy.
13A Define and communicate the means for
patients and their families to report concerns
about safety and encourage them to do so.
National Patient Safety Goals
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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 requirementsor 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.
National Patient Safety Goals
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Surgical Infection Prevention Project

• 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

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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

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Medicare Surgical Infection Prevention (SIP)

• Project Objective
• To decrease the morbidity and mortality
  associated with postoperative infection in the
  Medicare patient population

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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

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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

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Evolution of Surgical Infection Prevention

• To reduce preventable surgical morbidity and
  mortality by 25 by 2010

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Surgical Care Improvement Project

• The national partnership promoting SCIP believes
  that if Americas 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.

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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.

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The Institute for Healthcare Improvement (IHI)

• 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

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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

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How Can SurgiNet Solutions Improve Patient Safety
in the Periop Setting?
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Using Your Automation
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Using Your Automation
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Patient Identification
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Preoperative Verification Example
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Hand Off Communication
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Correct Patient, Site, etc.
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Operative Site Marking Example
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Time Out Example
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SIP Quality Measures SurgiNet Documentation

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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 SSIs
• 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
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Counts
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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!
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SurgiNet Special Interest Group (SIG)
www.Cerner.com
Where To Go For More Ideas
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References and Resources

• 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/accreditedo
  rganizations/patientsafety/04npsg/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

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Questions?
Patient Safety and the Perioperative Enviornment

• Thank You!