The Joint Commission journal on quality improvement最新文献

{"title":"Houston, We’ve Had a Problem: When Do We Override Rules?","authors":"Daniel E. Haun (Director of Client Services), Argie Leach MHS (Competency Coordinator), Rita Vivero MBA (Performance Improvement Analyst), Sarah W. Fraser (Independent Consultant and Visiting Professor)","doi":"10.1016/S1070-3241(02)28046-3","DOIUrl":"10.1016/S1070-3241(02)28046-3","url":null,"abstract":"","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 8","pages":"Pages 453-460"},"PeriodicalIF":0.0,"publicationDate":"2002-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28046-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56462195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding a Performance Improvement Initiative in Critical Care from Hospital to System","authors":"Yosef D. Dlugacz PhD (Senior Vice President),&nbsp;Lori Stier EdD (Administrative Director),&nbsp;Dana Lustbader MD (Intensivist),&nbsp;Mitchel C. Jacobs MD (Chief),&nbsp;Erfan Hussain MD (Director),&nbsp;Alice Greenwood PhD (Information/Research Specialist)","doi":"10.1016/S1070-3241(02)28042-6","DOIUrl":"10.1016/S1070-3241(02)28042-6","url":null,"abstract":"<div><h3>Background</h3><p>Concern about the expense and effects of intensive care prompted the development and implementation of a hospital-based performance improvement initiative in critical care at North Shore University Hospital, Manhasset, New York, a 730-bed acute care teaching hospital.</p></div><div><h3>The hospital-based performance improvement initiative in critical care</h3><p>The initiative was intended to use a uniform set of measurements and guidelines to improve patient care and resource utilization in the intensive care units (ICUs), to establish and implement best practices (regarding admission and discharge criteria, nursing competency, unplanned extubations, and end-of-life care), and to improve performance in the other hospitals in the North Shore-Long Island Jewish Health System. In the medical ICU, the percentage of low-risk (low-acuity) patients was reduced from 42% to 22%. ICU length of stay was reduced from 4.6 days to 4.1 days.</p></div><div><h3>Implementing the critical care project systemwide</h3><p>A system-level critical care committee was convened in 1996 and charged with replicating the initiative. By and large, system efforts to integrate and implement policies have been successful. The critical care initiative has provided important comparative data and information from which to gauge individual hospital performance.</p></div><div><h3>Discussion</h3><p>Changing the critical care delivered on multiple units at multiple hospitals required sensitivity to existing organizational cultures and leadership styles. Merging organizational cultures is most successful when senior leadership set clear expectations that support the need for change. The process of collecting, trending, and communicating quality data has been instrumental in improving care practices and fostering a culture of safety throughout the health care system.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 8","pages":"Pages 419-434"},"PeriodicalIF":0.0,"publicationDate":"2002-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28042-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56462130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Providing the Right Infrastructure to Lead the Culture Change for Patient Safety","authors":"Peter Wong PhD, MBA, RPh (Vice President),&nbsp;Dena Helsinger RN, MS (Director),&nbsp;Jeff Petry MD (Chairperson)","doi":"10.1016/S1070-3241(02)28036-0","DOIUrl":"10.1016/S1070-3241(02)28036-0","url":null,"abstract":"<div><h3>Background</h3><p>In early 2000 the hospital leadership of Good Samaritan Hospital (GSH), a community teaching hospital in Dayton, Ohio, made patient safety a strategic priority and devoted resources to incorporate safety as a part of the hospital's culture and care processes. The vice president of clinical effectiveness and performance improvement, as a champion for safety, led a consensus-building effort to enlist the support of key physician and hospital leaders to a safety program. GSH added a Safety Board to its administrative infrastructure, which was to serve as an oversight body to ensure the advance of the safety program and to produce policies and procedures that are associated with safety.</p></div><div><h3>Addressing patient safety aims</h3><p>To assess GSH's progress toward achieving three aims—demonstrate patient safety as a top leadership priority, promote a nonpunitive culture for sharing information and lessons learned, and implement an integrated patient safety program throughout the organization—the Safety Board evaluates GSH's performance bimonthly, using a 5-point-scaled self-assessment tool. For example, for the third aim, the Safety Board oversaw the formation of three subcommittees, which were to test ideas and achieve improvements in three areas—medication, clinical, and environmental.</p></div><div><h3>Discussion</h3><p>The administrative structure provides the leadership and momentum necessary to fuel a cultural change in the way that patient safety issues are perceived and acted on throughout the organization. “To err” may be human, but so is the ability to increase patient safety awareness, to promote cultural change within existing systems, and to improve the patient care processes and outcomes.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 7","pages":"Pages 363-372"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28036-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56462048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First Do No Harm: Integrating Patient Safety and Quality Improvement","authors":"Zubina Mawji MD, MPH (Clinical Director),&nbsp;Paula Stillman MD, MBA (Senior Medical Director),&nbsp;Robert Laskowski MD, MBA (Chief Medical Officer),&nbsp;Susan Lawrence MS, CPHQ (Administrator),&nbsp;Elizabeth Karoly MBA, RRT (Senior Clinical Information Analyst),&nbsp;Terry Ann Capuano RN, MSN, MBA (Senior Vice President),&nbsp;Elliot Sussman MD, MBA (President and Chief Executive Officer)","doi":"10.1016/S1070-3241(02)28037-2","DOIUrl":"10.1016/S1070-3241(02)28037-2","url":null,"abstract":"<div><h3>Background</h3><p>Lehigh Valley Hospital’s (LVH’s; Allentown, Penn) interdisciplinary quality improvement program <em>Primum Non Nocere</em> (PNN), or First Do No Harm, is composed of 12 quality improvement (QI) projects that are a combination of ongoing operations improvement projects and new projects in patient safety. The projects stress delivery of cost-effective medical care while reducing preventable adverse events through improved communication, process redesign, and evidence-based protocol use.</p></div><div><h3>Example:Wrong-site surgery</h3><p>In response to an initial alert warning in 1998, LVH developed a policy of marking “yes” on the surgical site and “no” on the other side. However, several near misses occurred, and a root cause analysis indicated that the policy was not always followed for some very specific reasons. For example, the operative record included no prompt to address laterality, and the procedures in which laterality should be addressed were never specified. Interventions to address these issues were quickly developed that were in keeping with the recommendations outlined in a second alert warning on the issue in December 2001. A year after these stepwise changes, compliance with the policy is almost 100%, and there have been no further near misses.</p></div><div><h3>Discussion</h3><p>Specific project barriers included the initial challenge of changing the mindset in the institution from gradual change on a grand scale to smaller, more rapid changes, analyses, and actions. Another issue identified early in the initiative was the tendency of project groups to outline elaborate process improvements without determining how to measure and monitor success. A project’s sustainability is inherently linked to its initial strengths and the successful solutions to barriers that are encountered.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 7","pages":"Pages 373-386"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28037-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56462058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Multidisciplinary Team Approach to Reducing Medication Variance","authors":"Terri A. Sim RPh (Chief Operating Officer),&nbsp;Julie Joyner RN (Director)","doi":"10.1016/S1070-3241(02)28040-2","DOIUrl":"10.1016/S1070-3241(02)28040-2","url":null,"abstract":"<div><h3>Background</h3><p>In March 2000 a multidisciplinary team was formed at Williamsburg Community Hospital (Williamsburg, Virginia) to address medication-related patient safety initiatives.</p></div><div><h3>Medication Safety Team</h3><p>The team focused on promoting a nonpunitive reporting environment, developing a collaborative medication administration policy, and designing an education and communication plan that promoted safe medication practices. In creating a nonpunitive environment, the first step was to revise the medication variance reporting policy. The team focused on process improvement and removed all references to corrective action from the policy. It launched an extensive educational effort throughout the hospital to raise awareness of the change in policy and to increase the focus on patient safety initiatives. The team also oversaw development of a comprehensive medication administration policy, which consolidated nursing, physician, and pharmacy practices. The team implemented a number of quick fixes that generated momentum and provided some immediate successes.</p></div><div><h3>Results</h3><p>Within a 9-month period (May 2001 – January 2002), the number of reports doubled. As the number of variance reports increased, a subcommittee formed, with the specific responsibility of reviewing the reports on a weekly basis.</p></div><div><h3>Discussion</h3><p>The team sought to change the environment and attitudes related to medication variances and reporting. This was an organizationwide change that required employees to change their perceptions regarding the purpose of reporting. Implementing the changes in small bites to realize immediate successes helped provide the impetus to keep the team focused and energized in tackling this huge endeavor. The team provided the ability to solve problems and recommend changes quickly and effectively from a variety of perspectives.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 7","pages":"Pages 403-409"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28040-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56462101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Going Paperless with Custom-Built Web-Based Patient Occurrence Reporting","authors":"John F. Dixon MSN, RN","doi":"10.1016/S1070-3241(02)28038-4","DOIUrl":"10.1016/S1070-3241(02)28038-4","url":null,"abstract":"<div><h3>Background</h3><p>Baylor University Medical Center (Dallas) converted patient occurrence reporting from a paper form to a custom-built Web-based system that used the medical center’s intranet.</p></div><div><h3>Developing the Web-based system</h3><p>Nonmedication patient occurrences were documented manually on paper forms known as incident reports, and medication variances were entered electronically. The medical center had used the same paper form for many years, without any interim updates or revisions. With a delay of more than a week in receiving forms, the process was not efficient or timely. In addition, paper forms were sometimes illegible or incomplete.</p></div><div><h3>Launching the project</h3><p>The project team, representing the Center for Quality and Care Coordination and information services, decided that the best approach would be a phased implementation based on development of system functionality and a facility’s readiness for conversion. Reporting was to be conducted in terms of 10 standardized patient occurrence reporting categories.</p></div><div><h3>Results and evaluation</h3><p>Comparison of quarterly data pre- and post-Web forms showed an 83.5% increase in number of submissions and a 79.5% reduction in event-to-submission time. Web forms also eliminated paper form limitations of legibility, completeness, and security.</p></div><div><h3>Conclusion</h3><p>It is still an individual responsibility to report and then transform collected data into usable information, which will drive process improvement. Technology can make an important contribution to these efforts, but the culture of the organization must have a complete program strategy. The focus must shift to reporting as a cornerstone to quality and safety and away from traditional notions of error and blame.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 7","pages":"Pages 387-395"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28038-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56462070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Sharps Injuries Among Health Care Workers: A Sharps Container Quality Improvement Project","authors":"Irene B. Hatcher MSN, RNC","doi":"10.1016/S1070-3241(02)28041-4","DOIUrl":"10.1016/S1070-3241(02)28041-4","url":null,"abstract":"<div><h3>Background</h3><p>Many needlestick injuries at Vanderbilt University Medical Center were found to be related to the method of disposal in sharps containers. The “straight-drop” system allowed staff to stuff more needles into a full box, resulting in needlestick injuries. This was also a common problem elsewhere, as reflected in the literature.</p></div><div><h3>Analyzing the problem</h3><p>A multidisciplinary committee reviewed other sharps containers, piloted one, found problems, and then piloted and selected another. Implementation was complex and difficult, but focus was kept on the goal of decreased needlestick injuries. Staff identified other problems, which were taken to the manufacturer of the sharps container selected and resulted in product design changes.</p></div><div><h3>Results</h3><p>Several months after implementation, data analysis showed that the needlestick injury rate was reduced by two-thirds, a statistically significant change (<em>p</em> = 0.002). Despite the increased cost of the sharps container, savings of prevented needlestick injuries represented a total cost savings to the medical center of more than $62,000 a year.</p></div><div><h3>Discussion</h3><p>This experience is an example of real-life implementation—and the problems institutions may have to overcome before success can be realized.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 7","pages":"Pages 410-414"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28041-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56462116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Creating a Culture of Medication Administration Safety: Laying the Foundation for Computerized Provider Order Entry","authors":"Helen S. Karow RN, MSN (Director of Surgical Services)","doi":"10.1016/S1070-3241(02)28039-6","DOIUrl":"10.1016/S1070-3241(02)28039-6","url":null,"abstract":"<div><h3>Background</h3><p>Computerized provider order entry (CPOE) systems are recognized as an effective tool for reducing preventable adverse drug events; however, implementation is a complex process that involves much more than installing new software. The literature addresses the use of these systems in large tertiary care hospitals and university settings; yet there is little information on their implementation and use in smaller hospitals. Beaver Dam Community Hospital, a small, rural hospital, set about laying the foundation for implementing CPOE.</p><p>Actions were taken in terms of context (the culture and attitude, acceptance, and importance regarding the change), process (roles, workflow, and policies relating to the change), and content (how-to, such as procedural steps and rules).</p></div><div><h3>Use of the rapid-cycle improvement process</h3><p>The team elected to use the rapid-cycle improvement process for implementation to allow it to move ahead quickly, adjusting changes as necessary for maximum success. Each change was considered an individual Plan-Do-Check-Act cycle, with its own action plan and measurement for successful implementation.</p></div><div><h3>Planning actual implementation</h3><p>The Patient Safety Committee has begun the planning of actual implementation–Phase II. Issues addressed include how to phase in the system–in which units to bring up first, how to structure the transitional period, how to redesign workflow, and how to plan role changes.</p></div><div><h3>Summary</h3><p>The changes already implemented contribute to medication safety and are important from that perspective alone, without the use of CPOE. The addition of an electronic system will enhance the organization’s ability to provide safe, accurate medication administration.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 7","pages":"Pages 396-402"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28039-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56462090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a Systemwide Approach to Patient Safety: The First Year","authors":"Susan Penn Ketring MS (Vice President),&nbsp;James P. White MD (Chief Medical Officer and Managing Director)","doi":"10.1016/S1070-3241(02)28028-1","DOIUrl":"10.1016/S1070-3241(02)28028-1","url":null,"abstract":"<div><h3>Background</h3><p>Health care organizations face an imperative to ensure that care is provided to patients in the safest manner possible. In 2000 INTEGRIS Health, an Oklahoma City-based health system including ten acute care organizations, developed a patient safety framework that was built on the foundation of a culture of patient safety and began implementation in January 2001.</p></div><div><h3>Importance of leadership in patient safety</h3><p>The first step in establishing a culture of safety was to ensure that leadership and the entire organization understand the rationale for a focus on patient safety. The traditional blaming approach will not prevent human error; staff need to speak freely, to talk about errors that happen and those that almost happen, and to identify where mistakes are likely and where systems allow mistakes to get through. Systems and processes should make it difficult for staff to make mistakes and easy for them to do things correctly.</p></div><div><h3>Experience to date</h3><p>Since our efforts began, staff have helped identify multiple accidents waiting to happen. For example, an anesthesiologist, the service chief at one of our large hospitals, prepared a list of safety issues immediately after hearing a presentation to the Medical Executive Committee. Many system flaws have been identified as a result of our discussions; some of the solutions are easy and some much more complex.</p></div><div><h3>Challenges</h3><p>Challenges include keeping patient safety highly visible and demonstrating progress in our implementation, developing effective mechanisms for communicating safety solutions and ensuring that they are implemented in all the facilities, and figuring out how to measure success in a meaningful way.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 6","pages":"Pages 287-295"},"PeriodicalIF":0.0,"publicationDate":"2002-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28028-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overview of the Partnership Symposium 2001: Patient Safety—Stories of Success","authors":"Jack L. Cox MD,&nbsp;Louis H. Diamond MB, ChB (Interim Director of Programs),&nbsp;Martin J. Hatlie Esq (President),&nbsp;Gina Pugliese RN, MS (Vice President),&nbsp;Nancy J. Wilson MD, MPH (Vice President)","doi":"10.1016/S1070-3241(02)28027-X","DOIUrl":"10.1016/S1070-3241(02)28027-X","url":null,"abstract":"","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 6","pages":"Pages 283-286"},"PeriodicalIF":0.0,"publicationDate":"2002-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28027-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}