Leading Quality and Safety

August 27, 2014

Using Antibiotics Wisely– Best Weapon in the Fight Against “Super Bugs”

Healthcare providers work hard to prevent the spread of serious bacterial illnesses through diligent hand hygiene, isolation of infected patients, and cleaning of the environment. However, these measures can only go so far. The most effective way to stop the emergence of life threatening antibiotic-resistant bacteria such as Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteriaceae is through antimicrobial stewardship (ASP).

Antibiotics are the only drug where use in one patient can impact the drug’s effectiveness in another. Interventions to improve antibiotic use improve patient outcomes, reduce antimicrobial resistance, and save money. And they can be implemented in any healthcare setting—from the smallest to the largest.

If you are a pharmacist or a physician, you can play a key role in improving ASP in our state by joining the Statewide Antimicrobial Stewardship Initiative.  For more information on the initiative or to join, see the last issue of Leading Quality and Safety or contact Amber Theel at AmberT@wsha.org or 206-577-1820.

Be sure to attend the initiative’s kick-off event at the September 5WSHA Adverse Drug Event and Antimicrobial Stewardship Safe Table. The one-day event features guest speaker Arjun Srinivasan, MD, (CAPT, USPHS) Associate Director for Healthcare Associated Infection Prevention Programs for the Centers for the Disease Control and Prevention.

To register, or for more information about the Safe Table, contact Paula Lorenz (paulal@wsha.org).

Executive Rounding Video Tool Now Available on WSHA Web page

You know that leadership rounds can have a positive impact on your patient safety efforts. But how do you engage your executives? How will they find the time? What are the best ways to do them? And where do you even start?

WSHA to the rescue! Our new 10-minute video, “Executive Rounds for Safety,” has insights, information, and real life examples to help you implement executive rounding in your hospital. For more information on the video and other tools for engaging leadership and transforming culture to improve safety visit our web page.  (Rebecca Snyders, RebeccaS@wsha.org)

Over Ten Percent Reduction Cesarean Section Rates at EvergreenHealth!

At EvergreenHealth in Kirkland, Washington, a successful campaign to reduce Cesarean sections (C-sections) in first time mothers began with a question:  “Could intentional labor management reduce the C-section rate at our hospital?”

Through self-evaluation, an educational campaign, and collaborative nursing, EvergreenHealth introduced best practices that resulted in a 10 percent reduction in first time mother (NTSV) C-sections over a 10-month period.

“C-section rates have been a concern at both the national and state level,” said Mary Kay Ausenhus, RN, clinical nurse manager of Women’s Services at EvergreenHealth. In 2013 the hospital delivered 1,389 babies by C-section. “When we evaluated our numbers, we saw an opportunity to reduce our rates while being very intentional about achieving the healthiest maternal and newborn outcomes.”

The EvergreenHealth project, Intentional Labor Management, aimed to reduce C-section rates for all patients who have a potential diagnosis of failure to progress, fetal intolerance to labor, or failure to descend. Ausenhus said these three diagnoses were chosen because they had the most potential to impact C-section rates and were areas where nurses had the opportunity to work with providers to influence the outcome. The project goal was to apply best practices for these diagnoses and then evaluate the results.

McKinlay said that one of the most successful components of the project was collaborative nursing care in the second stage of labor. Following the program’s best practices, after one hour of pushing without progress, the primary nurse consults with another staff member regarding a new tactic. This collaborative care extended further from nurses to physicians; nurses to charge nurse; nurse to nurse; and nurse to patient, family, and support person.

EvergreenHealth evaluated outcomes data at the conclusion of the program in October 2013 and found that NTSV C-section rates decreased from an average of 35 percent in 2012 to 24.8 percent in June 2013.

Participants attribute the success of the program to the engaged staff and providers at the Family Maternity Center, a strategically planned rollout, ongoing conversations, and education throughout the department, and a supportive hospital leadership team.

The program supports WSHA’s Safe Deliveries Roadmap and Safe Table Learning Collaborative, which builds upon successful efforts of local hospitals to reduce early elective deliveries.
(Rebecca Snyders, RebeccaS@wsha.org)

Qualis Health Awarded CMS Contract for Quality Improvement Program

Qualis Health, which has been the current Quality Improvement Organization (QIO) for Washington and Idaho, and also partners with the Washington State Hospital Association on a variety of quality and safety initiatives, is the recipient of a new five-year contract from the Centers for Medicare & Medicaid Services (CMS).

As part of a restructuring of the Quality Improvement Organization (QIO) Program, CMS has separated medical case review from quality improvement work, creating two separate structures. The new contracts represent the second phase of QIO restructuring, the goal of which is to create a new approach to improve care for beneficiaries, families, and caregivers. The first phase was appointing Livanta as the new point of contact for Medicare QIO appeals and quality concerns.

The contract awardees will work with providers and communities across the country on data-driven quality initiatives. These Quality Improvement Organizations will collectively be known as the Quality Innovation Network (QIN)-QIOs and will be based in communities, health care facilities, and clinical practices.

Washington has had a long and positive history with Qualis Health and their staff. We are pleased that they will continue to serve in our region. To read the press release from CMS in its entirety, click here. (Carol Wagner, CarolW@wsha.org)

Compendium Offers Help for VAP Prevention

Each year thousands of critically ill patients on life support develop ventilator-associated pneumonia (VAP). WSHA hospitals have reduced VAP by almost 90%. However, to sustain this progress, hospitals may find the extra boost they need in a document published on behalf of the Society for Healthcare Epidemiology of America.

The 2014 updateof the “Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals” includes basic prevention strategies to prevent VAP and other ventilator-associated events (VAE) in adult patients. Interventions to reduce include:

  • Avoid intubation if possible. Noninvasive positive pressure ventilation (NIPPV) is preferred whenever feasible.
  • Minimize sedation – avoid benzodiazepines whenever possible.
  • Spontaneous awakening and breathing trials.
  • Maintain and improve physical conditioning – early exercise, early mobilization.
  • Minimize pooling of secretions above the endotracheal tube cuff.
  • Elevate the head of the bed to 30°– 45°.
  • Maintain ventilator circuits and change only if visibly soiled or malfunctioning.

Hospitals not participating in VAE reporting through NHSN still have the opportunity to benchmark with others. VAP numerator and denominator data based on the 2002 NHSN definition can be submitted to the WSHA Quality Benchmarking System. For more information, contact Amber Theel, AmberT@wsha.org.


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