Improvement Interventions and the IOM Aims for Quality: STEEP-7
By Shea Polancich, PhD, RN; Terri Poe, DNP, RN; and Rebecca Miltner, PhD, RN
Healthcare organizations should be continuously looking for ways to improve the quality and safety of the care they provide. The current healthcare environment, however, is complex and constantly changing, making the quest for continuous improvement a challenge. In 2001, the Institute of Medicine (IOM) report Crossing the Quality Chasm highlighted the gap that existed between the current and ideal state of the healthcare industry regarding the quality of patient care. This seminal work illuminated the need to provide care to patients with defined aims—namely, that patient care should be all of the following: safe, timely, effective, efficient, equitable, and patient centered. A call to action ensued for providers in the industry to develop strategies for closing the quality chasm in care delivery in accordance with the IOM aims. Now, 15 years later, there are still opportunities to improve the quality and safety of the healthcare delivery system.
Simulation Techniques for Teaching Time-Outs: A Controlled Trial
Incorrect surgery and invasive procedures sometimes occur on the wrong patient, wrong side, or wrong site; are performed at the wrong level; use the wrong implant; or in some way represent a wrong procedure on the correct patient. Although rare, with a reported incidence of 1 in 112,994 cases, incorrect invasive procedures have potentially disastrous consequences for patients, staff, and healthcare organizations (Dillon, 2008). Patients suffer preventable harm, staff may be censured and emotionally traumatized, and healthcare organizations experience a loss of public reputation and trust.
Minnesota State Coalition Works to Prevent Violence Against Healthcare Workers
By Rachel Jokela, RRT, RCP; Diane Rydrych, MA; Tania Daniels, PT, MBA; and Rahul Koranne, MD, MBA, FACP.
Injury data from the U.S. Bureau of Labor Statistics show that doctors, nurses, and mental health workers are more likely than other workers to be assaulted on the job. Nationally in 2013, one in five healthcare and social assistance workers reported nonfatal occupational injuries, the highest number of such injuries reported for any industry (Gomaa et al., 2015). While similar data is not available by state, in Minnesota in 2013, 16.7 per 10,000 healthcare employees missed work due to injuries caused intentionally by others (U.S. Bureau of Labor Statistics, 2013), nearly six times the overall U.S. rate for all industries. Despite these numbers, many incidents that do not cause missed work may go unreported in healthcare. Healthcare providers may choose not to report incidents out of compassion for residents or patients, or they may mistakenly believe that tolerating threats or physical violence from those they care for is just “part of the job.”
Opioids: What Do Healthcare Professionals Want and Need to Know?
By Patricia McGaffigan, RN, MS; Caitlin Y. Lorincz, MS, MA; and Tejal K. Gandhi, MD, MPH, CPPS
The availability of, and access to effective and safe treatments for pain remain serious problems in the United States (Institute of Medicine, 2011). Opioid medications are important for addressing short-term and chronic pain management. Given the benefits that they provide, usage of opioids has become widespread over the past decade. However, opioid medications also carry substantial risk, and their increased usage has introduced a host of unintended consequences across the care continuum. Given this, opioids have significant implications for patient safety. The National Patient Safety Foundation (NPSF) conducted a convenience flash poll survey to obtain a snapshot of opioid-related patient safety concerns, learning needs, and familiarity with existing seminal publications among healthcare professionals.
Fall Prevention: Stand Up to Falls
“Why do we fall? So we can learn to pick ourselves back up.” That inspirational quote is designed to focus on lessons that can be learned in order to move forward effectively and ultimately succeed.
When a fall is approached as an opportunity to learn, new knowledge is gained, informing changes that can lead to improvement. Learning is at the heart of improvement, innovation, and growth. But when a patient fall is treated as a failure, the learning stops.
ABQAURP: The Road from Volume to Value
Our first goal is for 30% of all Medicare provider payments to be in alternative payment models that are tied to how well providers care for their patients, instead of how much care they provide—and to do it by 2016. Our goal would then be to get to 50% by 2018.
—HHS Secretary Sylvia Burwell, HHS Blog, January 26, 2015
One of the earlier steps along this road from volume to value was the Inpatient Prospective Payment System enacted in 1983, which bundled payments for inpatient care episodes into Diagnosis Related Groups (DRGs). The tremendous complexity of the DRG system, however, probably encouraged as much documentation and coding proliferation as it did efficient care.
Health IT & Quality: Precision Requires FHIR
By Barry P. Chaiken, MD, MPH On January 20, 2016, President Barack Obama celebrated the one-year anniversary of his announcement of the Precision Medicine Initiative. The initiative, first announced in the president’s 2015 State of the Union address, initially included $215 million in research funding (“Precision Medicine Initiative,” n.d.). Most medical treatments are designed to … Continued
Education: Interdisciplinary Skills Labs for Quality Improvement
By Ariadne K. DeSimone
In spring 2014, one day after taking the United States Medical Licensure Examination: Step 2 Clinical Knowledge, I finally had time to turn my attention to thoughts about my future and to the email messages that had accumulated over the past month. One announcement stood out: the Emory University Institute for Healthcare Improvement (IHI) Open School Chapter was seeking applications for its leadership team. With plans to begin the master of public health (MPH) in health policy and management program at the end of the summer, between my third and fourth years of medical school, I was searching for extracurricular opportunities that would complement my studies. In that moment, as I read the email solicitation, I took a leap of faith. I had never heard of IHI, yet within a week I had applied, interviewed, and accepted a position as director of education for Emory’s Chapter of IHI Open School. I was compelled to act so spontaneously by what I understood to be the vision, mission, and approach of IHI: to work with health systems and other organizations around the world to improve healthcare quality, safety, and value.
Leadership: Ending Nurse-to-Nurse Hostility
Years ago, at a National League of Nursing meeting, Loretta Nowakowski, former director for Health Education for the Public at Georgetown University School of Nursing in Washington, D.C., proposed that disease could be best understood by looking at hurricanes. She noted that, like a serious illness, hurricanes occurred only when many factors were present within relatively narrow parameters and that an appropriate intervention could alter the severity or course of a disease or hurricane. This discovery was encouraging to Nowakowski—it meant that an intervention, made at any point, could alter the final outcome.
ISMP: Key Medication Errors in the Surgical Environment
Medication errors in the perioperative area received widespread media attention with the publication of an article in the journal Anesthesiology (Nanji, Patel, Shaikh, Seger, and Bates, 2016). The perioperative area is one of the most medication-intensive locations in a hospital, often with more medications, particularly high-alert medications, administered per patient than other patient care units. Yet, this area of the hospital often operates with fewer medication safety strategies in place than most other patient care units. For example, the anesthesia provider often selects, prepares, labels, and administers medications without the benefit of electronic clinical decision support, pharmacy review of medication orders prior to administration, barcode scanning of products prior to administration, and other secondary checks by other healthcare providers (Nanji et al., 2016; Brown, 2014). This lack of normal checks and balances, along with the use of multiple medications, time-sensitive tasks, complex and stressful working conditions, distractions, and fatigue all contribute to making the perioperative area particularly error-prone when medications are administered.