Becker's Clinical Quality & Infection Control

70 QUALITY IMPROVEMENT & MEASUREMENT your help with X, Y, and Z," the first thing I'm going to ask is how many people are being harmed by that now, because I've got my team currently working on something that we know has either caused harm in the past or is sufficiently likely to cause harm in the near future because it's either poorly designed or there's no standard of work. So it gives us a barometer by which we measure what we spend our time on, and we prioritize those things that have demonstrated harm. at's a really hard philosophical concept for folks to get their heads around — that you're going to prioritize the work, and you're going to stick with that priority based on potential for harm or actual harm and stay focused on that. It means you're going to say no to a lot of stuff. We have resources that are assigned to every facility. ose facilities can help deploy those resources to a project they want to work on if that project measures up to our quality safety and service scorecard. We have a three-page scorecard with 90-plus metrics on it. If a prob- lem meets our standards, we can focus on it. Our primary focus is reducing hospital-acquired infections, and through this process we've reduced the five most common HAIs by 54 percent over the last two years. We had hospitals that have gone a year without an infection. Some of our bigger hospitals went three months in a row without specific types of infections. Zero is the goal. We're trying to get to zero harm by 2024. A lot of places in the country do this, but we've achieved an 80 per- cent reduction in serious safety events in the last three years. It's held for the last 18 months. We feel pretty good about that. Q: How do clinicians interact with these standardized work orders? LH: We hardwire these packages into the EMR. So if you're a nurse on the floor caring for the patient, the computer is expecting to see you do certain things for certain procedures and conditions. We built in the ability in real time for caregivers to see how they're performing according to the standard work process, instead of waiting on a report to come out three months later. A nurse at one of our facilities, who's been around for 20 years, said, "You know what? I finally feel like for the first time in my career quality is here to help me." In the past, quality was usually the team that would show up on your floor and say, "Hey, guys, your hand hygiene is not meeting requirements. Hey guys, you've got more infections. Stop having infections." When we implement a new program, our 100 system office employees take 24/7 hour shis at the hospital, and we stand by and answer any questions clinicians have about the new documentation, the new policy or the new devices. We call it elbow-to-elbow support. Aer implementation, we go back and audit. We have folks go around and randomly complete observational audits to make sure we're still doing the work. at's part of this whole improvement cycle, so we feel like once it's fixed it stays fixed. We don't wait for infections to occur. We look at the process measures that tell us that we're not doing everything we want to be doing. Let's go jump on it. It's a proactive intervention rather than waiting for problems. n Ohio lawmakers call for stricter hospital regulations after Mount Carmel deaths By Mackenzie Bean S ome Ohio lawmakers are calling for increased hospital oversight in the wake of a patient death investigation at Mount Carmel West hospital in Columbus, Ohio, reported The Columbus Dispatch. At present, Ohio is the only state that does not license hospitals. Instead, it requires hospitals to register with the health department annually, and undergo an in- spection and accreditation every three years. Ohio Gov. Mike DeWine, R, and Ohio Department of Health Director Amy Acton, MD, are working with other lawmakers to review state policies and draft updated recommendations for heightened hospital regulation. Opponents of stricter hospital oversight say heighten- ing regulations will create more administrative burden for hospital staff, which could detract from patient care. The call for more regulation comes about three months after Mount Carmel confirmed that William Husel, DO, a former physician at the hospital, ordered excessive doses of painkillers for at least 34 near-death patients in intensive care. The doses were likely fatal in 28 of those cases. n "Our primary focus is reducing hospital-acquired infections, and through this process we've reduced the five most common HAIs by 54 percent over the last two years." — Leigh Hamby, MD, CMO, Piedmont Health

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