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Do no harm

Five Million Lives Campaign aims to reduce patient risk of medical harm

Five Million Lives Campaign aims to reduce patient risk of medical harm

February 04, 2008|By JULIE E. GREENE

Form an in-house medical team that responds quickly when a nurse recognizes a patient needs assistance beyond what the nurse can offer.

Make sure patients on ventilators keep their heads angled at least at a 30-degree angle - even if it's more comfortable to lie down completely - to prevent contracting pneumonia.

Do more to ensure patients receive the right medication at the proper dose.

These are things that many people might think their local hospital already should have been doing, but these steps are among 12 changes the Institute for Healthcare Improvement has asked U.S. hospitals to voluntarily adopt to save lives and reduce the harm that can come to patients during hospital stays.

These are not issues hospitals ignore, but these might be practices where there are loopholes that need to be closed, said Julia Blackburn, clinical manager for the Washington County Hospital's critical care unit and catheter lab.

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The program was initially called the 100,000 Lives Campaign, but was expanded to the Five Million Lives Campaign. The idea being to protect patients from five million incidents of medical harm from December 2006 to December 2008, according to the institute's Web site.

The IHI defines medical harm as an unintended physical injury resulting from something medical professionals did or didn't, which results in a patient needing more monitoring, treatment or hospitalization, or that results in death.

The institute estimated almost 15 million incidents of medical harm occurred in the U.S. each year - an average of more than 40,000 incidents a day.

Some of the changes, such as the one dealing with patients on ventilators, came from studies that raised awareness of ways to improve recovery, said Rick Pietrolungo, a respiratory therapist at Washington County Hospital. Some of the practices are ways to reduce mistakes.

"We're all human. Mistakes are going to be made," Pietrolungo said. But officials with the institute and participating hospitals want to curtail those mistakes as much as possible, he said.

Sometimes people take little things for granted at work. But in the health-care field, it's important to pay attention to the details because, Blackburn said, peoples' lives are "in our hands."

Rapid Response Team

Washington County Hospital started working on the institute's initial six improvements to standard around 2004, Blackburn said.

Those improvements included establishing a Rapid Response Team, consisting of a physician, a critical care nurse and a respiratory therapist.

Before the team was established, reponses to noncritical calls for physician help might have taken 15 minutes or more. If family members called for their doctor or a nurse determined she or he needed physician assistance but the situation wasn't critical, they could end up waiting many minutes to be contacted by the doctor, Blackburn said. The wait might be expecially long if the doctor were in surgery, at an office outside the hospital or in transit.

There was one instance at a Pittsburgh hospital, Pietrolungo said, in which the wait was 90 minutes for the doctor to call back.

The Rapid Response Team's average response time is approximately three minutes, Blackburn said.

Some examples of calls for the team could be a patient whose blood pressure drops suddenly, or heart rate increases suddenly or who isn't getting enough oxygen, Pietrolungo said.

The hospital began a pilot program in January 2006, then implemented it hospital-wide two months later. From March to December 2006, the team handled 159 calls. During the hospital's first year with the team, the number of cardiac or respiratory arrests that occurred outside the critical care unit decreased by 40 percent, from 45 in 2005 to 27 in 2006.

Also, since the team began, noncritical patients who experienced cardiac or respiratory arrests have had a higher survival rate from the time of the incident to being discharged from the hospital, Blackburn said.

Other changes

Standardizing many procedures has been helpful in meeting several of the changes the Institute for Healthcare Improvement has recommended to help medical professionals from harming patients, Blackburn said.

Some of the changes Washington County Hospital has undergone or are in the works are:

· Making sure drugs with similar names or appearances aren't kept near each other. The drug-dispensing drawers at the nursing stations have compartments containing different drugs. Now there are lids on those compartments so only the lid for the desired medication opens after a medical official enters the desired medicine on a keyboard, Blackburn said.

· Later this winter, the hospital will start a program to help protect patients from becoming infected with Methicillin-Resistant Staphylococcus aureus (MRSA). Anyone admitted to the hospital's critical care unit will be screened for community-acquired MRSA, Blackburn said.

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