Striving for Improvement

 

Patient safety improvements, or data manipulation?  I don’t mean to be facetious, but I just read an article in an on-line news source called Modern Healthcare (www.modernhealthcare.com).  The article says that “1.3 million adverse events were prevented in U.S. hospitals since 2010,” according to the Agency for Healthcare Research and Quality (AHRQ).  I remember too, when the statistics came out from the IOM report in 2000, the numbers of harmful events to patients seemed staggering. 

Being a healthcare professional myself, I wondered where these hospitals were that were performing so badly – mostly because I didn’t want my family or friends to end up there!  But other estimates were much lower and in the on-line article, Peter Pronovost, a very respected quality leader affiliated with Johns Hopkins, said that they were able to decrease health care acquired conditions (HAC) “by 37% by focusing on clinical documentation and coding in response to penalties.”  This means that the improvements are not “real” improvements, but improvements on paper.   Furthermore, were the actual events as bad as initially estimated if some were attributed to documentation and coding errors?  Certainly, when reimbursement depends on accurate documentation and coding, more time and energy is spent to make certain that these are correct.  If this is happening at Johns Hopkins, it is also very likely happening elsewhere.

Surely, though, improvements have been made.  From the report, most of these are in the area of central line associated infection prevention.  This is an area that has gotten the most attention over a long period of time; bundles and checklists have been created that many institutions have shown decrease the rate of infection.  Other measures where improvements are less applicable to the neonatal population are surgical site infections (limited to certain types of surgeries), catheter related urinary tract infections, and prevention of post-operative venous thromboembolism.  The report mentioned above by Sabriya Rice states that between 2010 and 2013, central line associated blood stream infections (CLABSI) rates dropped by 49%, postoperative venous thromboembolisms by 18%, surgical site infections by 19% and catheter associated urinary tract infections by 28%.   Certainly, these may be areas where more improvements can be made by working together to create the evidence-based bundles that we now have for CLABSI prevention, although most of this work is in the adult population.

So, while I began this blog a little tongue in cheek, improvement, quality care and the best outcomes for our patients is really what we are all about, particularly in the NICU where our patients stay with us for such a long time.  This prolonged length of stay and totally dependent patients sometimes results in us being very attached to them, perhaps, but also increases the risk for “bad” things to happen.  Couple that with the fragility of the tiny, sick infants that we care for and our protective nature toward them is understandable.  So, while we may not always agree on the best approach to making improvements, everyone can agree that we want to ensure that the little ones in our care are protected from harm, either while they are with us in the hospital or the first few days or weeks while they are at home.  Ultimately the improvements we desire should not be limited to risks like CLABSI and sepsis but also include ensuring that parents have the knowledge and resources to care for their infant after discharge.

I was recently sent a story of a mother whose baby was in the NICU for a long stay.  The mother expressed so much gratitude for what the nurses had given her, her husband and her infant during their stay.  We often hear this gratitude from parents either while their infant is in the NICU, at discharge or even weeks, months and years later.  This is such a privilege and something not many nurses in other fields get to experience.  It undoubtedly brings great joy to other nurses as it does to me to see babies who you have cared for, who were so sick there was not a lot of hope for a bright future when they are 2 or 3 years old and they are running around, playing with other kids and acting like a normal healthy toddler!  A few years ago, we had a young man, then 20 years old, come to visit the NICU where I was working at the time.  He had been one of the early babies to receive extracorporeal membrane oxygenation (ECMO) and now was preparing to join one of the branches of the military.  The most remarkable about that, both to those who had cared for him and his parents, was that he was healthy enough to be able to make whatever choices he desired about how to live his life!  Recently, I was talking to a group of folks who didn’t know me very well and was asked if I had any children.  We had already talked about my work.  I started to say I did not have any children but corrected myself. Really, I have had hundreds over the years!  While I don’t care for them in the same way a parent does, the joy of seeing them go off to their parents and a full and happy life is gratifying.  So, while we work hard and give a lot to our jobs and patients, they also bring us great satisfaction.  Some nights, while working, if you have an opportunity to hold a baby and comfort them when their mom or dad can’t be there, you must realize that this is something not many nurses get to do.  While we count our blessings this holiday season, I, for one would like to include the blessings parents and the babies I’ve cared for have brought me in so many ways.

http://www.modernhealthcare.com/article/20141202/NEWS/312029936

Looking for additional reading from Sandy Beauman’s professional perspective?
View her blog entry The Prevention of Medication Errors:
Click here to read the full blog entry.