'High reliability' hospital obsessed with safety
‘High reliability’ hospital obsessed with safety
When you walk on an airplane, you expect layers of precautions to prevent any error that could lead to failure and injury. You demand the same or even greater care from the nearby nuclear power plant. And now, you can expect that serious attention to safety from a growing number of healthcare providers.
St. Vincent’s Medical Center in Bridgeport, CT, is an example of a “high-reliability organization,” a hospital that is “obsessively” focused on safety.
It has welcomed scrutiny from the Occupational Safety and Health Administration (OSHA) to work toward the Voluntary Protection Program. It has attained recognition as a “magnet” hospital from the American Nurses Credentialing Center. And it was profiled by The Joint Commission as a best practice for linking patient safety and worker safety. This focus on safety has translated into savings, in dollars and human terms. For example, the hospital had a 22% decrease in needlesticks and a 30% decrease in serious employee falls in 2012 compared with 2011.
Every day at St. Vincent’s starts with safety — even the weekends. The hospital CEO or a vice president leads a hospital-wide “safety huddle,” which lasts from 15 to 30 minutes, depending on the issues being discussed. Each huddle begins with a report on how many days it has been since a medical error or worker injury. If there has been an event — for example, a sharps injury in the OR — then there is a short synopsis and discussion of the root cause and what might be done to prevent future similar events.
Anyone in the hospital can come to the huddle and express a concern. “I attend hospital-wide huddle every day, and the room is so full sometimes that there’s no standing room,” says Karen J. Nefores, RN, BSN, MBA, executive director for quality, case management and patient safety. “It goes beyond our 15 minutes sometimes because so many people want to share concerns.” Employees who took steps to prevent injury or who identified a potential hazard are recognized with a safety pin. Employees who shared an idea that improved safety or quality can receive a quarterly reward of up to $100.
There are also safety huddles every day in every unit, and monthly “culture of safety” meetings geared toward frontline workers. The safety huddles encompass patient, environmental or worker safety.
“There’s always an accountable person who has to come back to the meeting with either a resolution or why there hasn’t been a resolution to the problem,” says Kathleen Ventura, RN, coordinator of employee health.
Serious safety events aren’t the only items on the agenda. They also target “precursor safety events,” which result in minimal or no harm, and near-misses. Safety coaches on the units help spread information and train other employees to use safety techniques or devices.
The hospital uses “dashboards” to monitor safety metrics, from hand hygiene audits to needlesticks. The dashboards keep people focused on goals, says Ventura. “Our dashboards are a good way to maintain our sustainability,” she says.
While injury rates dropped, needlesticks persisted. A needle safety task force met for four months and discovered that some nurses were not activating the retractable devices. The needles and syringes were a single unit, so some nurses had stashed conventional needles that could be removed from the syringe.
St. Vincent’s switched to a product that sheathes the needle with a one-handed action. A blunt needle is used to draw medication, and then it is removed and replaced with the safety needle. All other needles have been removed from the hospital, so nurses can’t revert to a conventional needle. Needlesticks declined to 25 in the first 11 months of 2012 from 32 in 2011, and St. Vincent’s hopes to reduce that number even further.
The cycle of identifying safety concerns and seeking solutions never ends, Nefores says. “[We’re] keeping it alive, constantly, every day, being relentless,” she says. “If we have a huddle where it’s quiet, the leader will be prompting and encouraging people to speak up and share.”
As serious events decline, the hospital will focus on precursor events and near-misses, so there will always be a safety goal, she says. there will always be a safety goal, she says.
The hospital also incorporates patients and family members into its culture of safety. There is an active and successful Patient and Family Advisory Board that was established several years ago, Nefores says. “Former patients and/or family members of patients participate in this committee and also on most of our hospitalwide committees and task forces,” she says. “Their voice and perspective is a key component of decision-making at St. Vincent’s, especially when it pertains to safety issues.”
When you walk on an airplane, you expect layers of precautions to prevent any error that could lead to failure and injury. You demand the same or even greater care from the nearby nuclear power plant. And now, you can expect that serious attention to safety from a growing number of healthcare providers.Subscribe Now for Access
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