Patient Safety and the Perioperative Environment

Cerner Corporation.: Saturday, April 22, 2023

Innovation You Can Trust

Patient Safety and the Perioperative Environment



Presentation by

Peggy Cullum, RN, BSN, CNORSolution Consultant, Cerner Corporation



Objectives

Identify patient safety concerns during the perioperative patient process

Review patient safety standards, regulations and practice initiatives

Discuss current perioperative patient safety practices and how SurgiNet Solutions can help



Lessons Learned?



Joint Commission – National Patient Safety Goals

CMS and CDC – SIP Protocol

National Quality Partnership – SCIP

The Institute of Healthcare Improvement (IHI) – “5 Million Live Campaign”

AORN – Council on Surgical and Perioperative Safety

Who’s Leading the Charge?



2007 National Patient Safety Goals



The purpose of the Joint Commission’s National Patient Safety Goals (NPSGs) is to promote specific improvements in patient

safety.

National Patient Safety Goals




The Requirements highlight problematic areas in health care and describe evidence and expert-based solutions to these problems.

The Requirements focus on system-wide solutions, wherever possible.



Sentinel Event AlertsSentinel Event AlertsPotassium chlorideWrong site surgerySuicideRestraint deathsInfant abductionsTransfusion errorsHigh alert medicationsOp/post-op complicationsFatal fallsInfusion pumpsProactive risk reductionHome fires (O2 therapy)KernicterusLook-alike, sound-alike drugs Dangerous abbreviations

Ventilator-related eventsDelays in treatmentBed rail deaths & injuriesNosocomial infectionsSurgical firesPerinatal death and injuryAnesthesia awarenessPatient controlled analgesiaVincristine administration errors Kreutzfeldt-Jakob diseaseMedical gas mix-upsNeedles & sharps injuriesLook-alike, sound-alike drugs





All accredited health care organizations are expected to review each issue of Sentinel Event Alert

Accredited organizations should consider information in an Alert when designing or redesigning relevant processes and consider implementing relevant suggestions or reasonable alternatives



Goal 1, Improve accuracy of patient identification.1A Use at least two patient identifiers when providing care, treatment or services. 1B Prior to the start of any invasive procedure, conduct a final verification process, (such as a “time out”) to confirm the correct patient, procedure, and site using active—not passive—communication techniques.

Goal 2, Improve the effectiveness of communication among caregivers. 2C Measure, assess and, if appropriate, take action to improve the timeliness of reporting, and the timeliness, of receipt by the responsible licensed caregiver, of critical test results and values. 2E Implement a standardized approach to “hand off” communications, including an opportunity to ask and respond to questions.




Goal 3 Improve the safety of using medications. 3D Label all medications, medication containers (e.g., syringes, medicine cups, basins), or other solutions on and off the sterile field in perioperative and other procedural settings. Goal 7, Reduce the risk of health care-associated infections. 7A Comply with current Centers for Disease Control and Prevention hand hygiene guidelines.

(Initiate SIP protocol.)




Goal 8, Accurately and completely reconcile medications across the continuum of care. 8A Implement a process for obtaining and documenting a complete list of the patient's current medications upon the patient's admission to the organization and with the involvement of the patient. This process includes a comparison of the medications the organization provides to those on the

list. 8B A complete list of the patient’s medications is communicated to the next provider of service when it refers or transfers a patient to another setting, service, practitioner or level of care within or outside the organization. The complete list of medications is also provided to the patient on discharge from the facility.

Goal 11, Reduce the risk of surgical fires.11A Educate staff, including operating licensed independent practitioners and anesthesia providers, on how to control heat sources and manage fuels, and

establish guidelines to minimize oxygen concentration under drapes.




Goal 13, Encourage patients’ active involvement in their own care as a patient safety strategy. 13A Define and communicate the means for patients and their families to report concerns about safety and encourage them to do so.




As of January 1, 2007, all Joint Commission accredited health care organizations and the Disease-Specific Care certified programs will be surveyed for implementation

of applicable 2007 goals and requirements—or acceptable alternatives —as appropriate to the services the organization or program provides. Compliance with applicable requirements (or an acceptable alternative)

will be scored as an element of performance in the NPSGs chapter of each standards manual.




Surgical Infection Prevention Project

August 2002, the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) implemented the Surgical Infection Prevention Project

CDC had extensive experience in surgical site infection (SSI) surveillance through the National Nosocomial Infection Surveillance (NNIS) System

CMS had a network of state-based Quality Improvement Organizations (QIOs) with experience in promotion of performance measurement and improvement and ongoing relationships with local providers of care



Surgical Site Infections (SSI)

Complicate an estimated 780,000 operations/year

Patients who get an SSI are… Twice as likely to die 5 to 6 times more likely to require re-admission Likely to stay in the hospital twice as long Additional cost from complication $30,000-$50,000 per

major surgery

An estimated 40-60% of SSIs are preventable

Overuse, underuse, improper timing, and misuse of antibiotics occurs in 25-50% of operations

Surgical Infection Prevention



Project Objective

To decrease the morbidity and mortality associated with postoperative infection in

the Medicare patient population

Medicare Surgical Infection Prevention (SIP)



Quality Measurements for Surgical Infection Prevention (SIP)

Quality Measure #1: Administration of antibiotics within 60 minutes of

surgical incision Quality Measure #2:

Use of appropriate antibiotics Quality Measure #3:

Discontinuation of antibiotics within 24 hours after the end of surgery (48 hours for cardiac)

Additional quality measures… Control of glucose levels during surgery Avoiding hypothermia during surgery Use of supplemental oxygen during surgery &

recovery Clipping rather than shaving the surgical site

Surgical Infection Prevention Project



Preventing Surgical Site Infections: Preventing Surgical Site Infections: 56 hospitals from 50 states participated Sponsored by the Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organization (QIO) www.ahqa.org

Results from the National Infection Prevention CollaborativeParticipating hospitals cut infection rate 27% in one year using quality measures Overall infection rate fell more than a quarter, from 2.3% in the first three months of the collaborative to 1.7% in the last three months Participating hospitals increased compliance for administration of antibiotics w/in 60 min of incision by 22%

Prior to quality measures, 70% rate of administering antibiotics within 60 minutes of incision

By the end of the collaborative, median compliance had risen to 92% administration w/in 60 min of incision

Surgical Infection Prevention Project Results



Evolution of Surgical Infection Prevention

To reduce preventable surgical morbidity and mortality by 25% by

2010



Surgical Care Improvement Project

The national partnership promoting SCIP believes that if America’s hospitals adopt SCIP, these complications could be reduced by 25 percent by 2010. The national partnership

American Hospital Association American College of Surgeons Veterans Health Administration Institute for Healthcare Improvement American Society of Anesthesiologists Association of periOperative Registered Nurses Joint Commission, the centers for Medicare and Medicaid Services Agency for Healthcare Research and Quality and Centers for Disease Control.

Our goal is to enroll every eligible hospital in SCIP.



Surgical Care Improvement Project

The Surgical Care Improvement Project (SCIP) provides evidence-based educational and clinical management tools proven to reduce the most common surgical complications:

surgical wound infections blood clots perioperative heart attack and pneumonia

SCIP focuses on process measures, such as the appropriate use of antibiotics near the time of surgery and the use of beta blockers, to prevent cardiovascular events and reduce complications.



The Institute for Healthcare Improvement (IHI)

Goal:Significantly reduce surgical complications by reliably implementing

the four changes in care recommended by the Surgical Care Improvement Project (SCIP).1. Surgical Site Infection Prevention2. Beta Blockers for Patients on Beta Blockers prior to admission3. Venous Thromboembolism4. Ventilator- Associated Pneumonia Prevention

Additional Considerations: Teamwork and Organizational Culture



Association of periOperative Registered Nurses

Healthcare professional organizationsPatient safety advocacy groups Industry companies developing technology for surgical uses

Council on Surgical and Perioperative Safety



How Can SurgiNet Solutions Improve Patient Safety in the Periop Setting?



Using Your Automation…Picture from 1954 Popular Mechanics Magazine.... read the caption and marvel. I'm not sure if you would need an IT person or a Submarine Pilot / TV repair guy !



Using Your Automation…



Patient Identification



Preoperative Verification Example



“Hand Off” Communication



Correct Patient, Site, etc.



Operative Site Marking Example



“Time Out” Example



SIP Quality Measures & SurgiNet Documentation



La Porte Hospital & Health Services: La Porte Hospital & Health Services: 227 bed hospital Recognizing excellence in nursing services as 126th in the nation & 2nd in Indiana 5,908 inpatient visits, 78,030 outpatient visits 2,389 inpatient & 7,989 ambulatory surgery procedures

Using SurgiNet to Reduce SSI’s98% compliance in efforts for safe administration of antibiotics w/in 60 minutes of incision… a 57% improvement in 9 months

Document whether an antibiotic was administered, when it was given and the antibiotic the patient received

“I think having staff more aware of the need to get antibiotics infused prior to incision has really made all staff look at this issue more closely.”

Lindia LaFrance, BS, R.N., SurgiNet Analyst, La Porte Hospital & Health Services

SURGICAL INFECTION PREVENTION: A SUCCESS STORY



Counts



The Original Computer

Memory was something you lost with ageAn application was for employmentA program was a TV showA cursor used profanityA keyboard was a pianoA web was a spider's homeA virus was the fluA CD was a bank accountA hard drive was a long trip on the roadA mouse pad was where a mouse lived

And if you had a 3 inch floppy . . . . you just hoped nobody ever found out!



Where To Go For More Ideas…

SurgiNet Special Interest Group

(SIG)

www.Cerner.com

http://www.cerner.com/



References and Resources

Beyea, Suzanne C. (2003).“The national patient safety goals and their Beyea, Suzanne C. (2003).“The national patient safety goals and their implications for perioperative nurses.” implications for perioperative nurses.” AORN, 77,AORN, 77, 1241-1245. 1241-1245.

Joint Commission on Accreditation of Healthcare OrganizationsJoint Commission on Accreditation of Healthcare Organizations – – www.jcaho.org

Association of Operating Room Nurses (AORN)– Association of Operating Room Nurses (AORN)– www.aorn.org

Institute of Safe Medication Practices (ISMP)–Institute of Safe Medication Practices (ISMP)– www.ismp.org

Implementation Tips for Eliminating Dangerous Abbreviations -- Implementation Tips for Eliminating Dangerous Abbreviations -- http://www.jcaho.org/accredited+organizations/patient+safety/04+npsg/tips.htm

Guidelines for Implementing the Universal Protocol for Preventing Wrong Site,Wrong Procedure and Wrong Person Surgery™

Center for Disease Control – CDC Hand Hygiene Guideline Recommendations – www.cdc.gov

http://www.jcaho.org/

http://www.aorn.org/

http://www.ismp.org/

http://www.jcaho.org/accredited+organizations/patient+safety/04+npsg/tips.htm



Patient Safety and the Perioperative Enviornment

Questions?

Thank You!

Patient Safety and the Perioperative Environment

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