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St. John's
Mercy Medical Center holds a sacred trust. Patients trust us with
their lives; family members trust us with their loved ones. Nothing
we do is more important than working to ensure the safest environment possible
for our patient, to show that their trust is well-placed.
Our goal and organizational
priority is to foster a culture of patient safety which values reporting,
disclosure of events (including near misses) and process improvement. To
accomplish this goal, our Patient Safety
Committee provides a foundation for reporting, surveillance
and analysis of event processes for co-workers and physicians. This
committee follows a Patient Safety Plan that gives framework for a Culture
of Safety.
Choose from the links below for more information about our patient safety
initiatives:
Safety Objectives
- National
Patient Safety Goals - St. John's Mercy
strives to meet rigorous safety goals. Our goal is to ensure
that we provide the highest standard of safety when delivering health
care to our patients. The National Patient Safety Goals outline
some of the work that St. John's Mercy does to obtain top quality of
care. These
goals focus on safe practices that St. John's Mercy is dedicated to
providing.
- Universal Protocol
- St. John's Mercy has created a Universal Protocol for preventing
wrong site, wrong procedure and wrong person surgery for all patients
who come to our facility for invasive surgery. This protocol
outlines several safety steps that are routine.
Patients
rely on us at a time when they are most vulnerable. All patients
are involved in marking their surgical site and our surgery staff
utilizes a “timeout” before
any invasive surgical procedure. This timeout stops the surgical
team and everyone involved assures that the right patient, right procedure
and right site is identified before surgery continues.
- Mercy Alerts
- St. John's Mercy
is a part of a large network of hospitals that are under the Sisters
of Mercy Health System. The Sisters of Mercy believe that as human beings,
competent and caring co-workers will sometimes make mistakes. With
that understanding, co-workers should not fear punishment for reporting events
or near misses. Because of this understanding,
Mercy has created a Web site that shares Mercy Alerts. All facilities
participate and share their safety mistakes. This allows other facilities
to learn from these events and participate in adopting suggested action plans.
Mercy Alerts is a proactive approach to safety mistakes. We believe
in sharing best practices. Facilities can also share their unfortunate
safety events so that other facilities can avoid the same mistakes.
Creating a Culture of Safety
Our CEO and senior leaders promote a “Culture of Safety” by
supporting a Non-Punitive Policy for St. John’s Mercy Medical Center
co-workers.
A culture of safety is
based upon a non-punitive and open approach to reporting events and near-misses. St.
John's Mercy created a Culture of Safety brochure which was sent out to all
employees to inform them of our non-punitive policy. As
human beings, competent and caring co-workers will sometimes make mistakes. With
that understanding, co-workers should not fear punishment for reporting events
or near-misses.
The St. John's Mercy
Culture of Safety brochure is presented on the Institute for Healthcare Improvement
(IHI) Web site for all hospitals across the country to adopt.
Technology
for Coworker Reporting
Mercy Event Reporter is a new, customized event reporting system utilized across all Sisters of Mercy Health System facilities. The secure, Web-based system allows co-workers and physicians to electronically submit patient safety events and other issues, including near misses, in a few simple steps. Mercy Event Reporter will improve the way we record, monitor and respond to events, near misses and customer feedback across our healthcare system. More importantly, it will provide the information we need to learn from occurrences, implement appropriate changes and achieve our goal that no event that causes serious harm will ever be repeated.
Leadership Safety Rounds
In February 2004, St. John's Mercy started Leadership Safety Rounds. Leadership
Rounds is a tool that connects senior leaders with people working on the front
line. Front
line co-workers work daily with our patients. Through Leadership Rounds
they can express their patient safety concerns and get immediate action from
a St. John's Mercy senior leader.
Medication Safety
- Medication Reconciliation - Physicians, pharmacists and
nurses work as a team to ensure correct medication information is communicated
and patients understand their entire drug regimens before they are discharged.
The staff also works with patients to obtain a complete list of current medications.
- Dangerous Abbreviations – Health
care professionals often rely on handwritten communication, making legibility
and clarity of meaning critical. St. John’s Mercy has prohibited
use of abbreviations that have been shown to be easily confused in written
communications. St. John's Mercy pharmacists have provided education for
nurses and physicians about the risks of these abbreviations and the need
to eliminate the use in written communications.
- Safe Medication Practice Award - St.
John’s Mercy
Medical Center was the recipient of the Institute of Safe Medication Practices
(ISMP) 2005 Cheers Award for innovative use of technology to improve the
medication delivery process for patients.
St. John's Mercy implemented automated medication dispensing cabinetry,
bedside point-of-care medication verification technology and deployment
of pharmacists to high-risk medication areas. St. John's Mercy’s
Medication Transformation Design Team tested and validated design decisions
and re-worked processes as needed. The implementation process on the pilot
units provided lessons and opportunities to improve future deployments
of technologies on the units, such as developing standard medication administration
times and creating education and training materials to help with compliance.
More than 2,500 hospital co-workers received training on the use of the
new technologies and medication safety is now part of new co-worker orientation.
The new technology has helped create four specific high-alert warnings
for “wrong
patient,” “wrong dose,” “dose omitted,” and “no
order in system.” To demonstrate the effectiveness of the new technology,
349 “wrong patient” warnings were identified by the system in
2004, resulting in no medication errors for the patients.
St. John’s Mercy Continues to participate in the IHI’s “5 million Lives Campaign”
The 5 Million Lives Campaign is a voluntary, nationwide initiative of the Institute for Healthcare Improvement (IHI), launched December 12, 2006 and will run for 24 months until December 9, 2008. The goal is to prevent 5 million incidents of medical harm over the next two years.
How does the Campaign reduce harm and help save lives?
IHI and its partners in this Campaign encourage hospitals and other health care providers to take the following steps to reduce harm and deaths:
- Prevent Pressure Ulcers ... by reliably using science-based guidelines for prevention of this serious and common complication
- Reduce Methicillin-Resistant Staphylococcus aureus (MRSA) infection ... through basic changes in infection control processes throughout the hospital
- Prevent Harm from High-Alert Medications ... starting with a focus on anticoagulants, sedatives, narcotics, and insulin
- Reduce Surgical Complications ... by reliably implementing the changes in care recommended by the Surgical Care Improvement Project (SCIP)
- Deliver Reliable, Evidence-Based Care for Congestive Heart Failure …to reduce readmission
- Get Boards on Board ….by defining and spreading new and leveraged processes for hospitals Boards of Directors, so that they can become far more effective in accelerating the improvement of care
The Campaign will also continue to offer support to hospitals as they introduce and sustain their work on interventions from the 100,000 Lives Campaign:
- Deploy Rapid Response Teams …at the first sign of patient decline
- Deliver Reliable, Evidence-Based Care for Acute Myocardial Infarction …to prevent deaths from heart attack
- Prevent Adverse Drug Events (ADEs) …by implementing medication reconciliation
- Prevent Central Line Infections …by implementing a series of interdependent, scientifically grounded steps called the "Central Line Bundle"
- Prevent Surgical Site Infections …by reliably delivering the correct perioperative antibiotics at the proper time
- Prevent Ventilator-Associated Pneumonia …by implementing a series of interdependent, scientifically grounded steps including the "Ventilator Bundle"
When reliably implemented, all 12 of these interventions can greatly reduce morbidity and mortality. The Campaign also strongly encourages participants to pursue additional interventions to improve care; without such contributions we will not be able to meet our ambitious aim.
To learn more about IHI 5 Million Lives Campaign go to: http://www.ihi.org/IHI/programs/campaign
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