JCAHO Update for Infection Control

Joint Commission recognizes Pittsburgh hospital for quality and infection control in patient safety

A common language changes patient safety culture

A multifaceted patient safety program that included a focus on infection control has garnered a Pittsburgh hospital a 2004 John M. Eisenberg Patient Safety and Quality Award.

The awards are given out annually by the Joint Commission on Accreditation of Healthcare Organizations and the National Quality Forum.

The University of Pittsburgh Medical Center (UPMC) in McKeesport, PA, was honored for "innovations in patient safety and quality at a local or organization level."

Program focus

The program features teaching/learning packets that focus on key areas such as infection control, patient falls, and rapid clinical response to a change in patient status.

"We have a nursing education department that is primarily responsible for formatting the learning packet once the topic has been identified," says Doris Gaudy, RN, MS, senior director of patient services.

"Many experts within our institutions contribute to the information that is placed in the learning packets. We try to do the learning packets in a way that they are very informative but simple, because time is a precious commodity," she explains.

Health care workers, who must sign off on them after the course is completed, see the learning packets as having "a lot of merit" she notes.

"The signatures at the end of the packet help us in two ways," Gaudy points out. "One, when you sign your name to something, it brings to it a certain level of accountability. Secondly, the teaching/learning packet is used to provide [medical] education credits."

According to T. Michael White, MD, senior vice president of value and education at UPMC McKeesport, the infection control component of the program includes an emphasis on hand hygiene; standard and transmission-based precautions; prevention and early diagnosis of Clostridium difficile infections; appropriate antibiotic usage; and prevention of central line-associated bacteremia.

The focus on C. difficile, for example, is yielding early signs of improvement, White says. Reports of both C. difficile and associated colitis conditions are in decline, he notes.

"I won’t say that this is statistically significant, but they are moving in the right direction," White adds.

Education to prevent patient falls

In addition to infection control, the teaching/ learning packets used in the program are designed to prevent patient falls and improve the clinical response to a change in patient status.

The latter includes an educational emphasis on "calling for help early" by physicians, nurses, and therapists in the institution.

Clinicians have been taught to summon a clinical team to the bedside whenever a patient experiences a significant, unanticipated change in status.

"The concept is a very simple one," White says. "Instead of waiting to call the crisis team when a patient is near death, we call the crisis team early when [patients] have a change in status. Our institution has gone from calling for help or a code about six times a month to about 35 times a month.

"The [patient] survival rate has gone from about 50% to 95%. But of course, we are getting there much, much earlier," he explains.

"The number of true codes has diminished, and the survival rate [for those] has improved as well," White notes.

Developing a common language

Another patient safety approach in the program centers on preventing patients from falls that can increase morbidity and extend hospital stays.

"We recognized that nationally and regionally falls were a major issue," White says, noting that patient falls are now designated as "failure mode" to prompt investigation.

As with the other facets of the program, prevention of patient falls requires knowledge and involvement — using a common language — among physicians, nurses, pharmacists, and therapists. Contributing factors to falls include medication and syndromes of confusion (delirium/dementia), the program emphasizes, he adds.

Changing the culture

"The teaching/learning packet itself is nice, but the [overall] concept has helped change our culture here," White continues. "What we have found is that if we can develop a common language among our professionals — get everybody on the same page — it actually [leads to] behavior changes."

For example, educators at the hospital have drawn specific attention to the fact that C. difficile colitis may present as a life-threatening sepsis syndrome with impressive leukocytosis, and a paradoxically unimpressive abdomen without diarrhea.

Such a condition might be missed until it worsens, but now it is the subject of a common clinical language and an interactive patient safety culture, White adds.

"Nurses began to ask doctors, You know this white [blood cell] count is very high. Do you think it could be that syndrome?’"