Published by: Michael Kaiser on 3/10/2011 9:40:02 AM
As Chief Medical Officer of a highly diverse, seven-hospital system that includes rural and urban institutions, both large and small, academic and community, I see healthcare practiced in a variety of settings and by a variety of healthcare professionals, but what I constantly see, regardless of location or provider, is a clear culture of assuring patient safety. Similar to many of our projects, what started out fairly small has grown and expanded over time.
Taking a cue a decade ago from the Institute of Medicine’s To Err is Human: Building a Safer Health System, we made patient safety one of our core strategies and competencies. We’ve allowed each hospital to implement strategies that suit them best, while we’ve simultaneously built infrastructure to meet our goals. Our participation in the NPSF-NAPH Patient Safety Initiative became one natural step.
We’ve developed medication safety initiatives, including bar coding and IV pumps with “smart technology,” which assures the five “rights” and stores and monitors dosing limits and clinical advisories. We review all incidents of a provider bypassing these rules, allowing us to revise guidelines or provide education and counseling. In 2010, these initiatives saved or averted costs for us estimated to be $3,449,600.
We’ve enhanced our electronic medical record with e-allergy and e-home medication list documentation, e-prescribing and medication reconciliation. These assure legibility of prescriptions and enable real-time, drug-interaction checking and potential adverse-event alerting to prescribers for drug allergy, drug-drug, drug-dose, and pregnancy and breast-feeding precautions. After every hospitalization or outpatient visit, the patient receives a complete list of current prescribed and over-the-counter medications. Each provider has access to this list at the patient’s next visit.
As part of the NPSF-NAPH Patient Safety Initiative, each hospital established a Patient Safety Committee whose organization allows patient safety information to move to each employee, both clinical and non-clinical. Our hospitals also participate in Patient Safety Awareness Week, have implemented the “Ask Me 3” campaign and completed the AHRQ Hospital Survey on Patient Safety. Three of our hospitals are participating in the AHRQ-sponsored program to improve patient safety and eliminate central line-associated bloodstream infections.
As CMO, I receive reports on all significant adverse medical events. We keep a log of these events, ensuring that the hospital completes root cause or other analyses to minimize the occurrence of similar events and to identify and address potential patterns in the facility and system wide.
Additionally, in quarterly meetings with each hospital’s leadership, we review the hospital’s “report card,” comparing patient-safety performance to system, state and national benchmarks and, if necessary, develop specific performance improvement plans. Our data specificity has so improved that we now measure performance at the hospital, unit and provider levels.
Though our efforts are manifold in a wide variety of settings, they all target patient safety—in every hospital, in every unit, by every employee, every day.
Michael Kaiser, MD
Chief Medical Officer
LSU Health Care Services Division