Patient safety

Safer Healthcare Now! expands to new settings

WINNIPEG – Four new interventions to improve patient safety were launched at a national conference in Winnipeg, as part of the Safer Healthcare Now! (SHN) campaign and its partner campaign in Quebec – Together, Let’s Improve Healthcare Safety.

The SHN campaign was initially launched in April 2005, with six interventions to reduce death and injury to patients in acute-care settings. Two of the four new interventions will focus on residents in facilities providing long-term care and two pilot projects will be focus on reducing potential adverse drug events in home care and paediatric settings.

“One of the primary goals of the campaign is to evolve and spread evidence-based safety initiatives into every relevant healthcare organization in Canada,” says Philip Hassen (pictured), Chair of the Safer Healthcare Now! National Steering Committee, and CEO of the Canadian Patient Safety Institute (CPSI), the campaign secretariat.

“An advisory panel of widely recognized patient safety and quality experts were consulted on patient safety target areas,” said Hassen. “Their input shaped the direction for the next phase of the campaign.”

The new interventions will focus on:

• Falls in long-term care – reduce the number of falls and injury from falls for residents in facilities providing long-term care.

• Adverse drug events in long-term care – implement medication reconciliation to prevent adverse drug events (ADEs) in long-term care settings.

• Antibiotic resistant organisms (AROs): Methicillin-resistant Staphylococcus aureus (MRSA) – implement a series of evidence-based guidelines to prevent harm from antibiotic resistant organisms, specifically MRSA.

• Venous thromboembolism (VTE) – implement evidence-based best practice guidelines to ensure that general surgery and hip fracture surgery patients receive the appropriate thromboprophylaxis to prevent deep vein thrombosis (DVT) and pulmonary embolism (PE).

In addition, two pilot projects will be implemented and lessons learned will be used to determine best practices and ways of approaching quality improvement for safer healthcare in the following two areas:

• Prevent adverse drug events through medication reconciliation in home care. Unique challenges exist when conducting medication reconciliation within diverse community care settings. This work will identify successful processes and systems to facilitate medication reconciliation in home care settings. The Victorian Order of Nurses Canada and the Institute for Safe Medication Practices (ISMP Canada) will co-lead this study.

• Prevent adverse drug events related to high-risk medications in paediatrics. Members of the Canadian Association of Paediatric Health Centres (CAPHC) and ISMP Canada, in partnership with the Canadian Patient Safety Institute (CPSI), Canadian Council on Health Services Accreditation (CCHSA) and the REISS (Research, Exchange and Impact for System Support) Study Group will work together to develop a national action plan to address high-risk medication delivery across the paediatric continuum of care.

As the next phase of the SHN campaign is rolled out, teams are now signing up to participate and the ‘Getting Started Kits’ identify tools and resources to help them implement the new interventions. The process and measures for the new interventions align explicitly with the Canadian Council on Health Services Accreditation required standards for healthcare organizations.

“Patient safety is everyone’s concern and healthcare professionals across Canada are committed to providing a better quality of care for their patients,” adds Hassen. “We thank the intervention leads for their commitment and leadership in developing the direction for new interventions. Working together, we can in fact reduce the number of needless deaths and injuries resulting from preventable adverse events.”

ISMP Canada will lead the interventions on Medication Reconciliation, expanding on the process developed with acute-care teams. “Medication reconciliation is an effective process to reduce adverse drug events and potential harm associated with the miscommunication of medication information as patient/clients/ residents transfer among healthcare settings,” says Marg Colquhoun, Project Leader, ISMP Canada. “Medication reconciliation is about reducing medication discrepancies, potential adverse drug events, duplication of work and confusion across the system. It is a critical process that will help to ensure medication safety for patients.”

The Falls intervention will be implemented using a collaborative methodology, led by the Registered Nurses’ Association of Ontario (RNAO) and co-sponsored by the Western Leadership Group. “This team- based quality improvement approach to implementing the RNAO best practice guideline for falls prevention can improve safety in facilities providing long-term care,” says Dr. Irmajean Bajnok, Director, International Affairs and Best Practice Guidelines Programs, RNAO. “Injuries from falls compromise health and quality of life for older persons. Collectively we can use knowledge, skills and experience to develop a falls strategy to reduce the number of falls and injuries from falls.”

Dr. Michael Gardam of the University Health Network in Toronto will lead implementation of the MRSA intervention initiative. “We know how to control MRSA, but it is one thing to know how to do something and a much more difficult task to actually put knowledge into practice and affect change,” says Dr. Gardam. “To fight the spread of germs involves everyone: staff, patients and visitors. It takes a change in attitude and a cultural shift from that of commonplace to one of intolerance.”

Dr. William Geerts, an international expert in thromboembolism, along with Sunnybrook Health Sciences Centre in Toronto, a national leader in patient safety, will lead the VTE intervention. “The use of thromboprophylaxis has unequivocally been shown to reduce deep vein thrombosis and pulmonary embolism, contributors to longer hospital stays and increased costs to our healthcare system,” says Dr. Geerts. “We need to eliminate the gaps in the provision of this key patient safety intervention.”

The four new interventions will augment the six interventions of the SHN campaign initially introduced in 2005. Acute-care teams can continue to sign-up for these interventions, work toward full implementation, and measure/report results:

• RRT – Implement Rapid Response Teams – prevent deaths in patients who are progressively failing outside the ICU through the intervention of specially trained teams of health professionals. (Led by the Canadian ICU Collaborative.)

• AMI – Improved care for Acute Myocardial Infarction – consistently implement protocols for heart attack patients along the continuum of care that are known to reduce complications and deaths. (Led by Theresa Fillatre, SHN Atlantic Node Leader.)

• Med Rec – Implement Medication Reconciliation – implement medication reconciliation to prevent adverse drug events (ADEs) and potential harm by creating the Best Possible Medication History (BPMH) for patients in acute care hospitals and using it during admission, transfer, or discharge. (Led by ISMP Canada.)

• CLI – Prevent Central Line Infections – implement a series of interdependent, scientifically grounded steps to reduce catheter-related bloodstream infections. (Led by the Canadian ICU Collaborative.)

• SSI – Prevent Surgical Site Infections – implement a series of protocols known as the ‘SSI bundle’ to reduce the frequency of infections and deaths in SSI. (Led by Marlies van Dijk, SHN Western Node Leader)

• VAP – Prevent Ventilator-Associated Pneumonia – implement the “VAP bundle’ of practices to prevent VAP infections and deaths. (Led by the Canadian ICU Collaborative.)

About Safer Healthcare Now!
The Safer Healthcare Now! campaign is the largest healthcare quality improvement initiative underway in Canada to reduce the number of deaths and injuries related to preventable adverse events. Currently, over 830 teams, representing more than 220 hospitals, health regions and other healthcare delivery organizations are implementing one or more of the initial six targeted interventions. The Quebec campaign, launched in April 2006, works in collaboration with the SHN campaign. To date, 46 teams are part of the “Together, Let’s Improve Healthcare Safety” campaign in Quebec. For more information on the SHN campaign, visit the website www.saferhealthcarenow.ca or www.soinsplussecuritairesmaintenant.ca.