Pulse

January/February 2012

Pulse

Technology Issues Hospital Executives Should Watch in 2012

Electronic health records, new surgical options, advances in imaging technologies, cardiac developments, and more covered in new white paper, available for free download from ECRI Institute.

ECRI Institute, an independent nonprofit that researches the best approaches to improving patient care, listed 10 health technology issues that hospital leaders should have on their watch lists for 2012. The just-released list takes into account the convergence of critical patient safety, economic, and regulatory pressures currently facing healthcare executives.

Technology issues on this year’s list span a variety of clinical and operational areas, including health IT, cardiovascular implants, minimally invasive surgical advancements, cancer therapies, and imaging and radiology services. According to the report, careful consideration of all the factors affecting whether and how to adopt these interventions will be crucial for short and long-term strategic planning, cost-effective implementation, and optimal safety and effectiveness for patients.

“Technology is increasingly a top management concern, and is no longer confined to clinical and technical decision making. Themes emerging on our 2012 list reflect ongoing impacts of healthcare reform initiatives and new technology developments that emphasize patient-centered care,” says ECRI Institute President and CEO Jeffrey C. Lerner, PhD.

“This list addresses safety improvements, interconnectedness of technology, personalized medicine tailored to individual care characteristics and preferences, and increasing cost pressures,” adds Lerner.

ECRI Institute’s new report, Top 10 C-Suite Watch List: Hospital Technology Issues for 2012, available for free download, contains executive-level overviews and ECRI Institute’s unbiased perspectives on complex and high-profile technologies and processes of care that are prominent and will continue to be so in the next few years. It complements ECRI Institute’s Top 10 Hazards report, which was issued separately.

ECRI Institute’s top 10 lists are designed to help hospital leaders prioritize their efforts.  

Four of the technologies on ECRI Institute’s Top 10 C-Suite Watch List include:

  1. Electronic Health Records: Is your hospital making all the right connections?     
  2. Transcatheter Heart Valve Implantation: Is your hospital prepared for a surge in demand for hybrid ORs?
  3. Digital Breast Tomosynthesis: Is leap-frogging from film to 3-D digital mammography the right decision?
  4. New CT Radiation Reduction Technologies: Are you doing enough to slice the dose and the risk?

This year’s watch list draws upon ECRI Institute’s 43 years of experience evaluating the safety, effectiveness, and cost-effectiveness of health technologies, and through the comparative effectiveness and health technology assessment work of its Evidence-based Practice Center. The list reflects the unbiased, independent judgment of the Institute’s multidisciplinary staff of clinical and technical researchers, engineers, risk management specialists, and healthcare planners and consultants.

For a complete list of the top 10 technologies, including overviews and perspectives, download the 32-page white paper, ECRI Institute’s Top 10 C-Suite Watch List: Hospital Technology Issues for 2012, at no charge on ECRI Institute’s website at www.ecri.org/2012watchlist (registration required).

AORN Releases New Recommended Practice for Medication Safety

Recommendations include discontinuing use of multidose vials.

Following months of research and evaluation, the Association of periOperative Registered Nurses (AORN) has released “Recommended Practices for Medication Safety.” Available in the association’s newly released 2012 edition of Perioperative Standards and Recommended Practices, the medication safety recommended practice (RP) supports positive outcomes and quality patient care before, during and after surgery.

Medication safety has become increasingly important as state and federal inspections are focusing on safe injection practices and accreditation organizations focus on national goals aimed at reducing medication errors. In the past, perioperative nurses may have watched closely for errors while medications are being administered. But the 2005 MEDMARX® Data Report revealed that errors at the point of care often stem from mistakes that took place earlier in the medication use process.

“Recommended practices for medication safety” outlines best practices for all six phases of medication use:

  • Procuring
  • Prescribing
  • Transcribing
  • Dispensing
  • Administering
  • Monitoring

As with all published AORN RPs, the medication safety review process included a 30-day public comment period, at which time comments were submitted by perioperative nurses from across the United States, as well as representatives from ANA, ASA, AANA, the FDA, and the Institute for Safe Medication Practices (ISMP). The new RP includes a multidisciplinary approach and can be used by all members of the perioperative team in all perioperative practice settings.

“This medication safety RP expands the description of medication safety by looking at broader risk points in the ‘life’ of a medication from the point of storage through to the point of disposal of the medication after it has been given,” said Bonnie Denholm, MS, BSN, RN, CNOR, AORN perioperative nursing specialist and lead author of the RP.

According to Ramona Conner, MSN, RN, CNOR, manager of AORN’s standards and recommended practices, the recommendation that intravenous solution containers be punctured as close as possible to time of use is controversial because it may impact efficiency. She also anticipates that some OR personnel may disagree with the recommendation against the use of multidose vials because they are a cost-saving measure, but with the new RP, evidence indicates they pose a risk of cross contamination.

“We have received quite a few inquiries about outbreaks that have been reported relating to the use of multidose vials and syringes,” Conner explained. “It was important that this RP lay it out, be very specific and provide comprehensive guidance.”

Other key recommendations in this RP address:

  1. Taking a multidisciplinary team approach that includes pharmacist involvement in the perioperative medication management process.
  2. Developing systems to evaluate compliance with safe practices at each step in the medication use process.
  3. Assessing patients before and after administering medication.
  4. Using aseptic technique when transferring medications to the sterile field and during  incremental injections.  

Also new in the 2012 edition of Perioperative Standards and Recommended Practices are recommended practices for the prevention of deep vein thrombosis and perioperative health care information management. These RPs were released in 2011 and are now available for the first time in book and CD formats. The medication safety RP will be available on CD in February. For pricing and ordering information, please go to: www.aorn.org.

2012 Patient Safety Awareness Week

March 4-10, 2012

Patient Safety Awareness Week will take place March 4-10, 2012. The National Patient Safety Foundation (NPSF) is the founding sponsor of Patient Safety Awareness Week and has led the event since 2002.

This year’s theme, Be Aware for Safe Care, highlights the need for everyone to understand the importance of patient safety and to recognize the range of efforts being made to improve health safety in the United States and worldwide. Moreover, the campaign seeks to make patients, providers, and the public aware of the ways they can participate in these efforts and partner to improve patient safety. While efforts of the past decade have brought improvements, recent studies indicate that much work remains to be done—and can be done most effectively through the involvement of all parties.

Be Aware for Safe Care emphasizes the fact that safety issues impact everyone. The more we work together to promote patient safety, the more we all benefit from a safe healthcare system,” said Diane C. Pinakiewicz, MBA, president, National Patient Safety Foundation. NPSF encourages creative collaboration among provider groups, patient advocates, and other community organizations to help patients and consumers understand how they can participate to be part of the solution.

The campaign is in alignment with the national Partnership for Patients, a groundbreaking initiative launched earlier this year by the U.S. Department of Health and Human Services to improve care and reduce costs, in part by reducing all causes of harm in healthcare.

Patient Safety Awareness Week is recognized internationally. Each year, NPSF produces educational resources for providers, patients, and communities who wish to take part.

Now more than ever in healthcare, a focus on empowering patients and strengthening patient-provider communications are seen as paramount to reducing errors. We all need to Be Aware for Safe Care.

For more information on Patient Safety Awareness Week visit www.npsf.org.

Interdisciplinary Call-to-Action: Reduce Surgical Site Infections

White paper targets teamwork, communication, and collaboration as keys to improving infection prevention.

A cross-functional team of infection prevention experts has released Educate, Empower, Engage: A Collaborative Interdisciplinary Call-to-Action for Reducing Surgical Site Infections, outlining potential solutions for preventing surgical site infections (SSIs) at healthcare facilities. Co-authored by recognized experts in infection prevention, epidemiology, the operating room, and sterile processing, the call-to-action focuses on breaking down barriers and improving collaborative teamwork and communication across each hospital function to improve patient safety and outcomes. Information and recommendations in the call-to-action resulted from the fourth annual Infection Prevention Leadership Summit (IPLS).

According to the Centers for Disease Control (CDC), as many as 500,000 SSIs are estimated to occur annually,[i] [ii]a rate representing as much as 22% of total healthcare-associated infections (HAIs).[iii] New 3M research gathered from IPLS attendees showed the barriers to reducing the number of infections may reside within a healthcare facility’s workplace culture. Responses from professional healthcare organizations and industry experts indicate healthcare facilities face challenges related to teamwork, communication and collaboration, process improvements, and compliance with infection prevention recommended practices on site:

  • More than 50% of those surveyed cited teamwork and collaboration as a top challenge, with 40% identifying it as a barrier.
  • Only 43% of surgical staffs receive SSI hospital report cards/dashboards.
  • Process improvements were a challenge among 31% of facilities.

The impact of these barriers is costly; it has been estimated that SSIs may result in as many as 3.7 million additional hospitalization days and an annual overall cost of $1.6 billion in the United States.[iv]

To drive reductions in these statistics, the Educate, Empower, Engage call-to-action identifies three areas that, if put into practice, would increase a healthcare facility’s ability to reduce SSIs:

  • Educate: Because healthcare institutions are complex and multi-faceted, personnel training must focus on understanding interactions and relationships across departments, demonstrating personal competency, reporting data and outcomes and utilizing electronic medical records.
  • Empower: Healthcare institutions must adopt a culture that delineates responsibility and increases accountability among all personnel, not solely leadership.   
  • Engage: Employees should be encouraged to make a psychological investment in patient care, with all disciplines performing their jobs with a level of pride beyond simply achieving formal indicators of success.

“If facilities put all three of these disciplines into practice, it would produce positive change toward the goal of preventing SSIs in every patient, every time,” said E. Patchen Dellinger, MD, professor, vice chair and chief of the Division of General Surgery,  University of Washington Medical Center. The Educate, Empower and Engage call-to-action was the result of a three-day summit focused specifically on reducing HAIs and SSIs. The summit, All for None: Eliminating HAIs through Knowledge, Collaboration and Leadership, brought together 80 professionals representing infection prevention, surgery, sterile processing, and epidemiology. 3M and its partners convened the group to share ideas‚ network and generate dialogue about possible interdisciplinary steps that can be taken toward the reduction of HAIs, with special focus on SSIs. “This is the fourth year we’ve convened a cross-functional summit of infection prevention experts, and we are proud of work they have produced,” said Debra Rectenwald, president and general manager of 3M’s Infection Prevention Division. “We challenge healthcare facilities to use these concepts in their strategic planning moving forward.”

The Educate, Empower, Engage call-to-action is available for download at http://solutions.3m.com/wps/portal/3M/en_US/Leadership-Conference/WhitePaper/.

The summit and call-to-action is a collaborative effort supported by an educational grant from 3M and its partners Sage Products, Belimed, and Rochester Medical and with participation by the following professional associations: Association of periOperative Registered Nurses (AORN), Association for Professionals in Infection Control and Epidemiology (APIC), International Association of Healthcare Central Service Material Management (IAHCSMM), National Patient Safety Foundation (NPSF), Society for Healthcare Epidemiology of America (SHEA)‚ and Surgical Infection Society (SIS).

References

[i] Berríos-Torres, S. I. (2009). Surgical site infection (SSI) toolkit slide deck.  Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention.
[ii] Anderson, D. J., et al. (2008).  Strategies to prevent surgical site infections in acute care hospitals.  Infection Control and Hospital Epidemiology, 29 (suppl 1):s51-s61.
[iii] Stone, P. W., Braccia, D., & Larson, E. (2005). Systematic review of economic analyses of health care-associated infections. American Journal of  Infection Control, 33, 501-509.
[iv] Martone, W. J. & Nichols, R. L. (2001). Recognition, prevention, surveillance, and management of surgical site infections: introduction to the problem and symposium overview. Clinical Infectious Diseases, 33, Suppl 2, S67-68.

SPONSORS

ABQAURP American Society for Quality American Society for Quality Healthcare Division Consumers Advancing Patient Safety
EMPSF Institute for Safe Medical Practices
           
Medically Induced Trauma Support Services (MITSS) Medication Safety Officers Society NPSF Partnership for Patient Safety Society to Improve Diagnosis in Medicine