Becker's Clinical Quality & Infection Control

18 QUALITY IMPROVEMENT & MEASUREMENT 'Stop the line': How 1 Inova hospital has decreased infections By Kristin Kuchno S usan Carroll since 2021 has served as president of Inova Loudoun Hospital, one of only 12 in the U.S. to achieve 26 consecutive "A" grades from Leapfrog Safety Group. Infections are among the most significant factors driving safety ratings down, Ms. Carroll told Becker's. Fostering the right mindset and workplace culture has been key to developing solutions to address this and other challenges. In March 2022, Ms. Carroll and the senior nursing team at the Leesburg, Va.-based hospital met to tackle rising hospital- acquired infections, which had reached six in the first two months of the year. While the team focused on maintaining proper line techniques, Ms. Carroll suggested a different approach: examining whether lines were even necessary for certain patients. "It was a perfect example of a practice in healthcare that I'm sure all hospitals see: 'It's just the way we've always done it,'" she said. is mindset shi led to the implementation of a "stop the line" program, encouraging medical staff to evaluate whether a line was truly needed. Over two years, Inova Loudoun's ICU reduced the number of lines from 245 per month to 42. So far in 2024, the hospital has reported six confirmed infections, including two central line-associated bloodstream infections — matching the total from just the first two months of 2022. "If it wasn't for our culture and our nurses and team members being selfless about what is convenient for them and valuing the patient first, we wouldn't have been able to change this," Ms. Carroll said. "It's one example of many things in healthcare that we need to change our mindset about. Is this really what is best for our patients, or is this just something that we've always done and it's something that is convenient for us?" A cornerstone of the hospital's culture is shiing the focus from associating infections with specific units or teams to viewing them as patient outcomes, reinforcing a patient- centered care approach. ese principles extend to other metrics, including length of stay and readmissions, reflecting a system-wide commitment to a patient-first perspective, Ms. Carroll said. Mortality rates have also been a key focus, with the hospital achieving a 47% reduction in the past two years, driven by the same principles. "If we are happy with our outcomes, then our culture is perfect. If we are not happy with our outcomes, then we need to change the culture, because it 100% drives your outcomes," Ms. Carroll said. "at's really what we've been focused on. We want a culture of continuous improvement because we believe this is what we owe to our patients, and we're privileged to serve this community." n Understaffing at HCA Mission led to harmful medication errors: Report By Paige Twenter A sheville, N.C.-based Mission Hospital has lacked adequate pharmacy staffing for years, resulting in harmful medication errors, according to the Asheville Watchdog. After Andrea Leone, PharmD, posted on LinkedIn in May about safety concerns tied to the department's understaffing, she was fired. Dr. Leone filed a wrongful termination lawsuit Dec. 13, which claims that leadership said the post shared "proprietary information related to how staffing and productivity is measured" but did not specify how such information is proprietary. Dr. Leone told the Watchdog her time at the hospital was defined by constant turnover. "All I'm doing is hiring, interviewing, onboarding and losing people," said Dr. Leone, who joined the hospital in October 2021. Dr. Leone's lawsuit says she was supposed to supervise a medication reconciliation team of three pharmacists, two residents, 10 technicians and three interns. Instead, the team has two full-time pharmacists, one pharmacist on call and high turnover due to burnout and low pay, according to Dr. Leone's former colleagues. A spokesperson told the outlet in September that the hospital has made market pay increases and is actively recruiting to fill open positions in the medication reconciliation team. Her team was 60% staffed when a hiring freeze began in late 2023, according to the lawsuit. Amid poor recruitment and retention, she said the risk of medication errors increased. "We disagree with the claims in this lawsuit and will defend ourselves through the legal process," a hospital spokesperson told Becker's. Throughout 2023, there were at least 291 medication errors, including 17 harmful errors, according to a presentation Dr. Leone shared with pharmacy leadership and physicians. Due to short staffing, she said the team completed detailed medication histories for 70% of high-risk older adults and only 30% of all admitted patients in 2023. "The errors that we were seeing were almost entirely preventable," Dr. Leone told the Watchdog. The hospital — one of the 186 operated by Nashville, Tenn.-based HCA Healthcare — has experienced an exodus of hospitalists, oncologists, physicians, nurses, urologists and neurologists throughout recent years, according to the Watchdog. In February, CMS placed HCA Mission in immediate jeopardy after three patient deaths, and following a revisit with no reported deficiencies, CMS lifted the immediate jeopardy in June. With scrutiny from state officials, several hospital leaders left in 2024, including the chief medical officer and CEO. n

• Cover