Welcome to the March 2010 issue of the Indidge Advantage newsletter.
As the March winds swirl around us the helter skelter world of crazy weather and uncertain political heathcare reform stir the pot.
What you can be assured of is the policy of healthcare professionals to strive to raise the standard of quality and safety at their hospitals.
Our first article muses over just such awareness and patient safety issues. The second article concerns a change in focus on behalf of CMS. The third article addresses the wide spread use of checklists. You do use checklists don't you?
Happy kite flying in the winds of March!
The Indidge Advantage is produced by Indidge Systems, a healthcare software solutions company specializing in Compliance and Risk Management solutions.
by Heather Comak
The National Patient Safety Foundation (NPSF) has sponsored Patient Safety Awareness Week (PSAW) since 2002 as a means of making caregivers, other hospital staff, and community members more aware of patient safety issues.
This year, the event is being observed from March 7 to 13, and facilities across the country are using the opportunity to educate and involve their staff and patients.
"The origin of the focus was really to provide a week not just for heightened awareness about patient safety, but very specifically a focus on the role of the patient and the consumer in the work," says Diane C. Pinakiewicz, MBA, president of the NPSF, which has expanded the scope of the week by further focusing on the relationship between patients and healthcare providers.
This year's PSAW theme is "Let's Talk: Healthy Conversations for Safer Healthcare." Members of the NPSF's Stand Up for Patient Safety program received a host of materials from the NPSF to help them coordinate the week in conjunction with the theme.
"We've developed a whole set of tools focused on two hot topics: getting to the right diagnosis and healthcare-acquired infections [HAI]," says Pinakiewicz. The NPSF used its well-known "Ask Me Three" template that urges patients to use the following three questions when receiving care:
- What is my main problem?
- What do I need to do?
- Why is it important for me to do this?
In the PSAW toolkits, patients and caregivers are coached to use these three questions in conjunction with receiving the right diagnosis and preventing HAIs. The materials packets are created in collaboration with other healthcare groups, such as the World Health Organization, Association for Professionals in Infection Control and Epidemiology, Society of Healthcare Epidemiology of America, and the U.S. Department of Health and Human Services. Nonmembers can find more information and materials available in honor of the week on the NPSF Web site.
Whether your facility has observed PSAW for years or has just started using the week as a means to enhance awareness of patient safety across your facility, there are many events you can hold to engage patients and staff members.
Spreading the word about a culture of safety
Anne Marie Pizzi, RNC-OB, accreditation and patient safety specialist at Saint Clare's Health System in Denville, NJ, knows what it's like to try to organize events during PSAW without a strong culture of safety present at the organization. She has seen her facility's culture of safety radically improve in the few years she has planned activities for PSAW and hopes that 2010 will show even further advancement.
When Saint Clare's originally began participating in PSAW in 2007, Pizzi found that staff members were reluctant to talk to them about safety concerns.
Fast-forward to 2010: Pizzi and her fellow accreditation and patient safety specialists have made remarkable progress toward creating a culture of safety and transparency, and as part of this, have a more organized, facility-supported approach to celebrating PSAW.
During the 2009 PSAW, staff entered a poster board competition on the topic of the NPSGs. Pizzi and her partners have a small budget, so they explored creative ways to entice staff members to enter. They provided the poster board supplies to reduce individual costs. In addition, the reward for winning the contest was a premium parking spot for one month. The endoscopy group won with its poster about the Universal Protocol, Pizzi says.
"It's funny, we found that staff like to be recognized when they do a good job," says Pizzi. "They don't require huge bonuses—they'd like a raise—but it was just finding something that would make them happy."
Pizzi has planned a similar poster board competition for this year's PSAW and hopes to receive more entries than the six she got in 2009. During the week, Pizzi and her partners visit each of Saint Clare's facilities and set up the poster boards in the lobby. Volunteers will work these poster board tables and hand out literature about the week to staff members and visitors.
Pizzi runs educational games during PSAW and has found that staff members look forward to these activities and have even come to her with ideas and concerns about safety practices. A favorite is a Jeopardy!-style PowerPoint game, says Pizzi.
In keeping with this year's theme of discussing safe healthcare practices, Pizzi says Saint Clare's is concentrating on the Universal Patient Compact, a document produced by the NPSF that focuses on the relationship between patients and caregivers.
"Sometimes we forget to include the patient in our healthcare planning and conversations," says Pizzi. "So it's really bringing that to the forefront for the staff and really [getting] them to embrace this as, 'We need to partner with our patients in a way to give them better care.' "
by Les Masterson
The Centers for Medicare and Medicaid Services announced it is realigning, consolidating, and integrating functions to "allow the agency to better focus on three key areas: beneficiary services, program integrity, and strategic planning," CMS acting Administrator and Chief Operating Officer Charlene M. Frizzera announced to staff Wednesday.
In announcing the re-alignment, Frizzera said she will also continue in her interim role as acting administrator and COO.
As part of the changes, Frizzera named Marilyn Tavenner to a new principal deputy administrator position and Peter Budetti as deputy administrator for program integrity. Tavenner, a former nurse, once led Virginia’s Health and Human Resources and was an executive at the Hospital Corporation of America. Budetti, a pediatrician, was the founder and director of the Center for Health Policy Research at George Washington University and was chairman of the Department of Health Administration and Policy in the College of Public Health of the University of Oklahoma Health Sciences Center, according to The Hill.
"CMS is firmly committed to its mission of ensuring effective, up-to-date healthcare coverage and promoting high value, quality care for our beneficiaries. We are very fortunate to have dedicated employees who are passionate about CMS’ mission and who work tirelessly to achieve it. Medicare, Medicaid, and the CHIP program now provide health insurance coverage to over 90 million Americans—a number that is expected to grow in the coming years. As part of our commitment to providing quality care and quality customer service to all people who rely on our programs, we continuously seek more effective ways of operating in order to meet the healthcare needs of our beneficiaries," she wrote in an e-mail to agency staff.
In addition to creating the principal deputy administrator role, the changes will create: The Office of External Affairs and Beneficiary Services; and four centers led by deputy administrators (Center for Medicare; Center for Medicaid, CHIP and Survey & Certification; Center for Program Integrity; and Center for Strategic Planning).
- The Center for Medicare will combine Medicare fee-for-service, managed care, and Medicare Advantage.
- The Center for Medicaid, CHIP and Survey & Certification is the former Center for Medicaid and State Operations.
- The Center for Program Integrity is a combination of the Office of Financial Management’s Program Integrity Group and the Medicaid Integrity Group of the Center for Medicaid and State Operations.
- The Center for Strategic Planning brings together the Office of Research, Development, and Information, and the Office of Policy.
- The Office of External Affairs & Beneficiary Services realigns the Office of Beneficiary Information Services with the Office of External Affairs. CMS said this move will allow them to "integrate and better leverage its communication, call center and Web resources; ombudsman services; and extensive network of partners to enhance service to beneficiaries."
The realignment has not been approved by Health and Human Services Secretary Kathleen Sebelius, but CMS expects the realignment to happen within 60 days.
"This realignment will help CMS do our job better and help to improve service and quality for the millions of people who depend on our services," Frizzera wrote.
by Janice Simmons
Recent events have put the simple medical checklist in the spotlight.
For instance, the Department of Health and Human Services last summer highlighted work among Michigan hospital ICUs to sharply reduce healthcare-associated infections (HAIs) with checklists. The World Health Organization said it is supporting the global use of surgical safety checklists. And bestselling author Atul Gawande has written about the topic in his new book, The Checklist Manifesto.
But in the midst of these activities come words of caution—brought to you by the team from Johns Hopkins University that helped put the checklist in the medical spotlight: Checklists can be useful and helpful, but they are not a panacea to all patient safety problems.
Use of checklists—or at least familiarity with them—appear common in many hospitals across the country. In the HealthLeaders Media Industry Survey 2010, for instance, 88.8% of quality leaders said their organizations used a checklist system to prevent errors in the hospital operating room, while 11.2% said they did not use such a system [Question 38].
Peter Pronovost, MD, PhD, a professor of anesthesiology and critical care medicine at JHU's School of Medicine, Baltimore, and his staff are credited with preventing thousands of central line infections at Hopkins. This was done partly because of a now well-known five step checklist:
- Wash hands with soap
- Clean patient's skin with chlorhexidine antiseptic
- Put sterile drapes on the entire patient
- Wear sterile gown and mask
- Put sterile dressing over the insertion site
Pronovost and his colleagues later assisted a Michigan program that was associated with a 66% reduction in catheter related bloodstream infections in the state’s hospitals, saving more than 1,500 lives and $200 million in the first 18 months alone. Again, the checklist played an important role here.
Writing in the latest issue of the journal Critical Care, they note that checklists "have the tremendous potential to improve patient outcomes by democratizing knowledge and helping ensure that all patients receive evidence based best practices and safe high quality care."
However, in reality, these checklists need to be accompanied by a "change in the culture"—where nurses, for instance, are empowered to question doctors who don't follow the steps properly or where members of a healthcare team toss out long held beliefs that infections are an inevitable cost of being in the hospital. "Just having a checklist on a piece of paper isn't going to be enough," Pronovost said in a statement.
Sean Berenholtz, MD, an associate professor with the departments of anesthesiology, critical care medicine, and health policy and management at Hopkins, and a member of the team that has worked on the development of the checklist, says checklists do appear to be "popping up everywhere."
"Everyone wants to do a checklist. The message becomes that . . . checklists are the simple solution for solving an adaptive problem with a technical solution," he says. "It needs to be embedded in a broader effort to evaluate and address local context. It needs to add value. If providers don't believe in the value of the checklist, they'll just check a box."
Berenholtz says that when implementing checklists, it’s helpful to use the Comprehensive Unit-based Safety Program (CUSP) to help focus efforts to "improve culture and context." This initiative includes steps to:
- Educate providers on the science of safety—to help them understand that "the vast majority of errors aren't the result of one provider...[but] rather it's a whole system that allows that error to occur."
- Use a written survey with staff on how the next patient could be harmed and what can be done to reduce that harm.
- Partner with senior executives to help bridge any gaps between senior leaders and frontline providers.
- Help staff learn from defects or problems.
- Implement teamwork tools (with daily goals) and talk about the whole program that goes along with the checklists.
The eventual goal, the researchers wrote, is that checklists should be created that are "succinct, unambiguous, focused, and ultimately effective, and efficient." And, when ultimately faced with a crisis, "we can react quickly and decisively, knowing that the items we act out from the checklist are well thought out, tested, and will provide us with the results we want."
Join us Wednesday, April 14, 2010, your taxes are already done - I hope, from 10:00 AM - 11:30 AM PDT for a free educational webinar. Just click on the register button below or if this does not fit your schedule, send Tom Reid an email at tom.reid@indidge.com or call him now at (480) 829-0479 Ext. 138 to arrange a web demo that better fits your schedule.
WHAT DO YOU CALL...
What do you call cheese that isn't yours?
Nacho Cheese.
What do you call Santa's helpers?
Subordinate Clauses.
What do you call four bull fighters in quicksand?
Quatro sinko.
What do you get from a pampered cow?
Spoiled milk.
What has four legs, is big, green, fuzzy, and if it fell out of a tree would kill you?
A pool table.
What lies at the bottom of the ocean and twitches?
A nervous wreck.
Where do you find a dog with no legs?
Right where you left him.
Why do gorillas have big nostrils?
Because they have big fingers.
What do you get when you cross a pit bull with a collie?
A dog that runs for help...after it bites your leg off.
What do prisoners use to call each other?
Cell phones.
What do you call a boomerang that doesn't work?
A stick.