Patient Safety

Patient safety is an important issue to everyone. Naturally, you want to keep yourself and your family safe when you're at home. Middlesex Hospital wants to keep you safe while you are in our care.

But there have been studies that say that despite the best of efforts, hospitals can actually be dangerous to your health. In fact, in 1999 the Institute of Medicine (IOM) - a branch of the National Academy of Sciences - essentially said just that. Its first report, "To Err is Human," described how tens of thousands of Americans needlessly die each year from medical errors. It didn't take long for this alarming message to be thrown into the media spotlight and reach the public.

Middlesex Hospital believes that patient safety is a serious business and believes in doing everything it can to make sure you stay safe while you're here in the hospital. We are involved in several national hospital safety-related initiatives. These, combined with our own safety programs (many of which have been in place for a long time) help to ensure your stay with us will be a safe one.

Patient safety isn't a new idea at Middlesex. But since we will never stop improving the way we care for patients, there will always be new and innovative programs to make things better. Many of these initiatives are built on existing hospital programs and give us the opportunity to compare ourselves to other hospitals, both in Connecticut and nationwide. The following are examples of some of these patient safety programs and projects throughout the healthcare industry in which Middlesex Hospital is involved.

The Institute for Healthcare Improvement (IHI)

IHI is a not-for-profit organization leading the improvement of health care throughout the world. IHI was founded in 1991 and is based in Cambridge, Massachusetts.

Middlesex participates in the following IHI programs:

The Five Million Lives Campaign
Improving Perinatal Care
Improving Flow Through Acute Care Settings

5 Million Lives Campaign – a national campaign to dramatically reduce incidents of medical harm in U.S. hospitals. The 5 Million Lives Campaign asks hospitals to improve the care they provide in order to protect patients from five million incidents of medical harm over a 24-month period, ending December 9, 2008.

The Campaign was formally unveiled on December 12, 2006 and has been endorsed by the American Hospital Association (AHA), the American Nurses Association (ANA), the Centers for Disease Control and Prevention (CDC), the Centers for Medicare and Medicaid Services (CNS), and the Joint Commission.

The 5 Million Lives Campaign builds upon the success of the 100,000 Lives Campaign in which 3,100 participating facilities (representing 75% of U.S. hospital beds) avoided unnecessary deaths by implementing six evidence-based interventions, along with other worthy improvement initiatives.

Middlesex plans to implement and continue working on the following interventions as part of their participation in the 5 Million Lives Campaign:

Reduce surgical complications . . . by reliably implementing the changes in care recommended by the Surgical Care Improvement Project (SCIP)
Prevent pressure ulcers . . . by reliably using science-based guidelines for prevention of this serious and common complication
Deliver reliable, evidence-based care for congestive heart failure . . . to reduce readmissions
Deploy Rapid Response Teams . . . at the first sign of patient decline – and before catastrophic cardiac or respiratory event
Deliver reliable, evidence-based care for acute myocardial infarction . . . to prevent deaths from heart attack
Prevent adverse drug events . . . by reconciling patient medications at every transition point in care
Prevent central line infections . . . by implementing a series of interdependent, scientifically grounded steps
Prevent surgical site infections . . . by following a series of steps, including reliable, timely administration of correct perioperative antibiotics
Prevent ventilator-associated pneumonia. . . by implementing a series of interdependent, scientifically grounded steps

Middlesex Hospital is approaching the two-year anniversary of our Rapid Response Team (RRT) program and our 600th team activation. This project was the perfect combination of collaboration among nursing, physicians, and the patients and families. Our data, which our CEO encourages us to share regularly, clearly show an impact – we’ve reduced codes outside the ICU by more than 50%. The floor staff is happier and feeling like they are getting excellent education; the patients are safer, and the doctors really feel like the best care possible is being delivered. We really feel like we’ve hit a home run. It’s been a real help to have access to the VHA Northeast RRT Network as we developed our process. We usually get six people on each call, because we get something out of every teleconference.

To keep our team activations high, we share data with our CEO, Vice Presidents, managers and supervisors regularly. The managers share the data with their staff. In addition, we make sure to spend time celebrating our successes. For instance, we passed out Lifesaver candies to celebrate our one-year anniversary (they had our RRT logo and said “You’re a Life Saver”), distributed stress ball pens, and generally tried to make the process fun. We’re looking into developing a patient/family brochure right now. Keeping the families in the loop is so important because no one knows the patient like they do. They notice the smallest changes in their loved ones and noticing those changes goes a long way to keeping our patients healthy.

American College of Surgeons (ACS)

National Surgical Quality Improvement Program

Knowing how Middlesex compares to its peer hospitals ("benchmarking") is a very effective way to identify areas where there are opportunities for improvement, as well as areas where we are "best in class." The ACS is now offering hospitals a program to accurately track patients undergoing surgery and measure the rates of complications such as wound infections, readmissions to the hospital, and death. While this kind of tracking has been done at Middlesex for many years, the ACS program will give the hospital additional tools to account for each patient's unique risks before surgery, and most importantly, to compare Middlesex Hospital's outcomes to those of all other participating hospitals. This information will make it much easier to determine exactly how Middlesex Hospital is doing, and what specific steps it can take to improve. Initially, the program will track operations limited to "general surgery" (e.g., intestinal, vascular, breast) but we anticipate this will expand to include a variety of surgical subspecialties in the future.

Middlesex Hospital began participating in this program for general and vascular surgeries in January of 2006.

Joint Commission Accreditation

Middlesex Hospital is accredited by the Joint Commission. Accreditation means that Middlesex Hospital has demonstrated compliance with organizational, patient care and safety standards. Middlesex Hospital has set standards to continuously improve performance, provide the highest quality of patient care, and ensure our patients are treated in a safe environment.

Among our many patient safety programs, we abide by the Joint Commission’s National Patient Safety Goals. We perform the following safety mechanisms to ensure our patients receive the best care possible:

Improve the accuracy of patient identification.

Our staff members and physicians checks two patient identifiers (such as verifying your name and date of birth) before giving medications, blood products, drawing blood work, or taking specimens. Staff members and physicians also check two patient identifiers when providing any other treatment or performing procedures. While this sometimes strikes patients as unusual or impersonal, it is done to ensure that the right patient receives the correct medication or the correct treatment.

Improve the accuracy of communication among caregivers.

Our staff members and physicians read back verbal orders, telephone orders, and critical test results. This is to ensure that the person receiving this information correctly understood what they were told. We have also developed a list of abbreviations that are easily confused and thus cannot be used in a patient’s medical record. In addition to these safety measures, our caregivers use a standardized report when “handing off” their patients. This ensures that important data is not left off.

Improve the safety of using medication.

We have identified medications that are easily confused because they either look alike or sound alike. Special safety measures are taken with these drugs, including special labeling and the physical separation of these medications in storage cabinets. Middlesex Hospital has also taken special measures to ensure the safety of blood thinning medications.

Reduce the risk of health care-acquired infections.

Effective hand washing is the most important way to prevent the spread of infection. All caregivers must wash their hands before and after patient care, before preparing medications, and at other critical times. We also actively encourage visitors to wash their hands.

Accurately and completely reconcile medications across the continuum of care.

We obtain a complete list of our patient’s medications including over the counter drugs, vitamins and herbal medications. Whenever a health care provider orders or changes a medication, the provider checks this list to make sure that there are no contraindications. When patients are discharge or transferred, the patient and their next care provider receive a complete list of all their medications.

Reduce the risk of patient harm resulting from falls.

Middlesex Hospital has a comprehensive fall prevention program that is discussed in detail in the following pages.

Encourage the patient’s active involvement in their own care as a patient safety strategy.

We encourage patients to be active participants in their health care. If you have questions or concerns, we want to hear about them. Please discuss your questions or concerns with your nurses, your physicians, or other health care providers.

The organization identifies safety risks inherent in its patient population.

In our hospital and behavioral health programs, we screen appropriate patients for their risk of committing suicide. In our home care program, our staff screens patients with long-term oxygen therapy for risks associated with their oxygen such as home fires.

Improved recognition and response to changes in a patient’s condition.

We are proud of our successful rapid response program. Our Rapid Response Team is designed to reduce cardiac arrests in hospitalized patients. This is done by identifying patients who might be showing critical signs of failing health. For instance, if a nurse sees that something is not quite right, a change in vital signs or breathing, or even the overall look of a patient, the Rapid Response Team can be called 24 hours a day and 7 days a week. When the team is called into action, a specialized team of health care providers respond to the bed side to stabilize the patient.

Inpatient Fall Prevention

The Patient Safety Council of Middlesex Hospital considers fall prevention to be an important safety initiative.

A comprehensive inpatient fall prevention program was implemented in July 2004 following a hospital-wide education marathon. The plan includes an in-depth fall risk assessment of all inpatients, followed by a "tiered" fall risk patient care plan, as determined by the assessment. Patients are placed into either a no risk, a standard risk or a high risk to fall category. Patients are then "color coded" as such and certain interventions are put into place based on risk. Standard risk to fall patients are identified by yellow magnets on the patient's door and a yellow sign over the patient's bed. High risk to fall patients are identified by red magnets and a red sign over the patient's bed. This helps all staff to quickly identify those patients who require higher levels of vigilance in preventing falls.

In 2007, the inpatient program was coordinated with all of the other seven fall prevention programs that were in place. Every patient fall that occurs is now reviewed by a multidisciplinary team to allow for adjustments to be made in the fall prevention plan. Evaluation of the program is ongoing. The inpatient fall prevention team meets quarterly to review outcomes and make recommendations as necessary.

Safety Management

Middlesex Health System also has a Safety Management Plan, which defines how our Health System will provide a physical environment free of hazards and determines how to reduce the risk of injury. As part of this program, a Safety Committee regularly measures and analyzes safety processes and identifies potential problems in areas such as medical equipment, security, and hazardous materials.

Education is provided through employee orientations, annual competency checks, drills, and random quizzes. Improvements are accomplished through preventive hazard surveillance rounds, multidisciplinary team incident reviews, and various performance improvement projects.

The Safety Committee reports its progress to the Quality Department and ultimately to the Board of Directors. The chairman of the Safety Committee has the authority to intervene whenever conditions exist that pose an immediate threat to life, health or of damage to equipment or physical structure of the hospital.

Idealized Design of Perinatal Care

The Hospitals Department OB/GYN enrolled in this IHI initiative in November 2006. A multidisciplinary team guides the department through the various process improvements.

Idealized Design of Perinatal Care is the fourth Idealized Design model developed by IHI. The goal of Idealized Design is to develop the best possible "ideal" care system that its designers can conceive at that time.

Idealized Design of Perinatal Care is based on reliability science (failure free cooperation over time), including both what and how care is delivered. The what consists of the best science, the soundest evidence, upon which to base practice. This evidence spans a wide spectrum, from results of randomized trials to expert opinion. The how is the method by which that evidenced-based care is delivered (e.g., by using standardized order sets). At present, the execution of best practices is highly variable, as demonstrated by chart review and malpractice claims analysis. To improve safety and reliability, what we do and how we do it must come together as the way we provide effective perinatal care.

Simply improving current processes cannot achieve acceptable levels of reliability. Idealized Design is based instead on a comprehensive redesign of the care system: determining what the best perinatal care would look like, and how all the parts and players involved in its complex processes would best fit together. Components included clinical processes, communication and teamwork, and acknowledging and honoring the expressed preferences of the mother and family.

Other Program Highlights

A variety of other safety groups with representation from different areas of the hospital work together towards a common goal of maintaining the highest level of patient safety possible.

Some current safety program highlights include:

Appointment of a Patient Safety Officer to oversee the training of all staff about patient safety goals.
Development of the Middlesex Hospital Patient "Safety Champion" Program, which includes staff members from throughout Middlesex Hospital, who serve as leaders in the area of patient safety. These safety champions act as valuable liaisons between staff and managers to identify, address and eliminate potential or real patient safety risks or concerns.
The "Great Save" Program rewards employees who go "beyond the call of duty" to provide extraordinary patient care. The program's purposes are to raise staff awareness about patient safety, encourage timely reporting of potential risks and errors affecting patients and reward staff who advocate for safety. Employees are formally and publicly rewarded and recognized at monthly management staff meetings at the hospital.
The Patient Safety Council, in cooperation with the medical staff, has refined the Middlesex Hospital Disclosure Policy. This policy ensures the protection of patients' "right to know" the details of a medical mistake. The policy reflects national goals of open disclosure between healthcare providers and patients.