Category Archives for Healthcare Quality
5 Tips on surgical attire — what to wear in, or around the operating room
Source: Becker’s Hospital Review
AORN’s New Surgical Attire Recommended Practices: Five Points to Know
The Association of Perioperative Registered Nurses has released an updated version of recommended practices for surgical attire, providing guidance on what to wear in or around an operating room. An article from the AORN Journal detailed some of the practices outlined below:
- New guidelines cite evidence on the use of antimicrobial fabrics and say using fabric with that technology in scrubs could help protect patients from surgical site infections.
- Jewelry like earrings, watches and rings that cannot be confined in scrubs should not be worn in semi-restricted or restricted areas, as those items can increase bacterial counts on the skin
- Personal items like briefcases, backpacks and electronic devices should be kept off the floor and cleaned with a disinfectant before and after being brought into a perioperative setting
- Cover apparel like lab coats that are worn over scrubs should be single-use or, if reusable, should be cleaned in a health care-accredited facility after each use
- Any apparel worn in a perioperative setting should be cleaned in a health care-accredited laundry facility, as evidence suggests scrubs cleaned in a home setting have a risk for carrying pathogenic organisms.
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Hospitals Face Penalties On Patient Injuries
During a hernia operation, Dorothea Handron’s surgeon unknowingly pierced her bowel. It took five days for doctors to determine she had an infection. By the time they operated on her again, she was so weakened that she was placed in a medically induced coma at Vidant Medical Center in Greenville, North Carolina.
Comatose and on a respirator for six weeks, she contracted pneumonia. “When they stopped the sedation and I woke up, I had no idea what had happened to me,” said Handron, 60. “I kind of felt like Rip Van Winkle.”
Because of complications like Handron’s, Vidant, an academic medical center in eastern North Carolina, is likely to have its Medicare payments docked this fall through the government’s toughest effort yet to crack down on infections and other patient injuries, federal records show.
A quarter of the nation’s hospitals – those with the worst rates – will lose 1 percent of every Medicare payment for a year starting in October. In April, federal officials released a preliminary analysis of which hospitals would be assessed, identifying 761. When Medicare sets final penalties later this year, that list may change because the government will be looking at performance over a longer period than it used to calculate the draft penalties. Vidant, for instance, says it lowered patient injury rates over the course of 2013, and Handron praises their efforts.
The sanctions, estimated to total $330 million over a year, kick in at a time when most infections measured in hospitals are on the decline, but still too common. In 2012, one out of every eight patients nationally suffered a potentially avoidable complication during a hospital stay, the government estimates. Even infections that are waning are not decreasing fast enough to meet targets set by the government. Meanwhile new strains of antibiotic-resistant bacteria are making infections much harder to cure.
Dr. Clifford McDonald, a senior adviser at the federal Centers for Disease Control and Prevention, said the worst performers “still have a lot of room to move in a positive direction.”
Are The Metrics Right?
Medicare’s penalties are going to hit some types of hospitals harder than others, according to an analysis of the preliminary penalties conducted for Kaiser Health News by Dr. Ashish Jha, a professor at the Harvard School of Public Health. Publicly owned hospitals and those that treat large portions of low-income patients are more likely to be assessed penalties. So are large hospitals, hospitals in cities and those in the West and Northeast. Preliminary penalties were assigned to more than a third of hospitals in Alaska, Colorado, Connecticut, the District of Columbia, Nevada, Oregon, Utah, Wisconsin and Wyoming, Medicare records show.
“We want hospitals focused on patient safety and we want them laser-focused on eliminating patient harm,” said Dr. Patrick Conway, chief medical officer of the Centers for Medicare & Medicaid Services.
The biggest impact may be on the nation’s major teaching hospitals: 54 percent were marked for preliminary penalties, Jha found. The reasons for such high rates of complications in these elite hospitals are being intensely debated. Leah Binder, CEO of The Leapfrog Group, a patient safety organization, said academic medical centers have such a diverse mix of specialists and competing priorities of research and training residents that safety is not always at the forefront. Nearly half of the teaching hospitals — 123 out of 266 in Jha’s analysis —had low enough rates to avoid penalties.
The government takes into account the size of hospital, the location where the patient was treated and whether it is affiliated with a medical school when calculating infection rates. But the Association of American Medical Colleges and some experts question whether those measures are precise enough. “Do we really believe that large academic medical centers are providing such drastically worse care, or is it that we just haven’t gotten our metrics right?” Jha said. “I suspect it’s the latter.”
Medicare assigned a preliminary penalty to Northwestern Memorial Hospital in Chicago, for instance, but Dr. Gary Noskin, the chief medical officer, said hospitals that are more vigilant in catching problems end up looking worse. “If you don’t look for the clot, you’re never going to find it,” he said.
Another concern is there may be little difference in the performance between hospitals that narrowly draw penalties and those that barely escape them. That is because the health law requires Medicare to punish the worst-performing quarter of the nation’s hospitals each year, even if they have been improving.
“Hospitals that have been working hard to reduce infections may end up in the penalty box,” said Nancy Foster, vice president for quality and public safety at the American Hospital Association.
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Americans Rate Nurses Highest on Honesty, Ethical Standards
WASHINGTON, D.C. — In 2014, Americans say nurses have the highest honesty and ethical standards. Members of Congress and car salespeople were given the worst ratings among the 11 professions included in this year’s poll. Eighty percent of Americans say nurses have “very high” or “high” standards of honesty and ethics, compared with a 7% rating for members of Congress and 8% for car salespeople.
Americans have been asked to rate the honesty and ethics of various professions annually since 1990, and periodically since 1976. Nurses have topped the list each year since they were first included in 1999, with the exception of 2001 when firefighters were included in response to their work during and after the 9/11 attacks. Since 2005, at least 80% of Americans have said nurses have high ethics and honesty. Two other medical professions — medical doctors and pharmacists — tie this year for second place at 65%, with police officers and clergy approaching 50%.
Historically, honesty and ethics ratings for members of Congress have generally not been positive, with the highest rating reaching 25% in 2001. Since 2009, Congress has ranked at or near the bottom of the list, usually tied with other poorly viewed professions like car salespeople and — when they have been included — lobbyists, telemarketers, HMO managers, stockbrokers and advertising practitioners.
Although members of Congress and car salespeople have similar percentages rating their honesty and ethics as “very high” or “high,” members of Congress are much more likely to receive “low” or “very low” ratings (61%), compared with 45% for car salespeople. Last year, 66% of Americans rated Congress’ honesty and ethics “low” or “very low,” the worst Gallup has measured for any profession historically.
Other relatively poorly rated professions, including advertising practitioners, lawyers, business executives and bankers are more likely to receive “average” than “low” honesty and ethical ratings. So while several of these professions rank about as low as members of Congress in terms of having high ethics, they are less likely than members of Congress to be viewed as having low ethics.
No Professions Improved in Ratings of High Honesty, Ethics Since 2013
Since 2013, all professions either dropped or stayed the same in the percentage of Americans who said they have high honesty and ethics. The only profession to show a small increase was lawyers, and this rise was small (one percentage point) and within the margin of error. The largest drops were among police officers, pharmacists and business executives. But medical doctors, bankers and advertising practitioners also saw drops.
Honesty and ethics ratings of police dropped six percentage points since last year, driven down by many fewer nonwhite Americans saying the police have high honesty and ethical standards. The clergy’s 47% rating last year marked the first year that less than 50% of Americans said the clergy had high ethical and honesty standards — and the current 46% rating is, by one percentage point, the lowest Gallup has measured for that profession to date.
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Imported Drug-Resistant Stomach Bug Spreading In U.S.
Source: ModernHealthcare.com
Associated Press — A drug-resistant strain of a nasty stomach bug made its way into the U.S. and spread, causing more than 200 illnesses since last May, health officials said Thursday.
Many cases were traced to people who had recently traveled to the Dominican Republic, India or other countries. Outbreaks of the shigella (shih-GEHL’-uh) bacteria are not unusual, but this strain is resistant to the antibiotic most commonly prescribed for adults.
“This is the first time we’ve documented this large an outbreak of antibiotic-resistant (shigella) linked to international travel,” said Dr. Anna Bowen of the Centers for Disease Control and Prevention.
Since last May, the imported superbug has sickened at least 243 people, with large recent outbreaks in Massachusetts, Pennsylvania and California.
Shigella is a common cause of diarrhea. The bacteria spread very easily through contaminated food or pools and ponds. Outbreaks also are common at daycare centers when staff members don’t wash their hands well enough after changing diapers.
For most people, it’s an unpleasant but temporary illness that ends within a week and can be helped with over-the-counter medicines like Pepto-Bismol or Imodium. Sometimes antibiotics are used: usually azithromycin for children and ciprofloxacin, sold as Cipro, for adults.
The past few years, health officials have been detecting shigella bugs resistant to azithromycin. The Cipro-resistant superbug has sickened people in 32 states and Puerto Rico.
“It’s moving itself around the country,” but it’s too early to know if the superbug has rooted in the U.S. for good, Bowen said.
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Eliminating Hospital Acquired Infections
Hand-hygiene helps. But, studies show hospital workers wash their hands less frequently by end of workday
A few weeks back we talked about how hand-hygiene can significantly decrease hospital-contracted infections, and by extension reduce healthcare organization costs — not to mention reduce unnecessary infection-related deaths. A new study out shows that hand washing frequency drops off near the end of healthcare professional worker’s shifts.
Led by Hengchen Dai, a Ph.D. candidate at the University of Pennsylvania, researchers analyzed three years of hand-washing data from more than 4,000 caregivers in 35 hospitals across the U.S. They discovered that hand-washing compliance rates plummeted an average of 8.7% by the end of a normal 12-hour shift.
Hospital-contracted infections account for nearly 100,000 deaths per year in the United States, making it a serious problem in need of attention. From December 2006 through December 2008, the Institute for Healthcare Improvement (IHI) initiated the 5 Million Lives Campaign with the aim of supporting the improving medical care, and significantly reducing levels of morbidity (illness or medical harm such as adverse drug events or surgical complications) and mortality.
Hospitals participating in the Campaign were asked to prevent 5 million incidents of medical harm over the two-year period. The IHI continues its efforts to reduce incidents of medical harm in the article What Zero Looks Like: Eliminating Hospital Acquired Infections.
There is no doubt that hospital-acquired infections are a serious issue. There are also large amounts of evidence that shows a few simple methods can significantly reduce their number.
The road to lower mortality rates, and reduced hospital costs, begins with establishing a commitment to a culture of quality. Then providing staff with the tools they need to easily record, measure and report their performance.