Hospitals innovate safety measures to prevent patients from being harmed during a pandemic | Modern Medical

2021-12-14 16:28:04 By : Ms. ruth luo

The new coronavirus is forcing hospitals to speed up the pace of improving safety, which is different from the usual glacier pace. As the virus continues to mutate, hospital managers now see that some of the changes they have implemented to respond quickly in 2020 should remain as they are.

From allowing patients to sleep longer to establishing daily escalation meetings, even after the serious consequences of COVID-19 disappear, there are still some processes that may last a long time because they improve safety and quality.

"This has changed the way healthcare is provided in so many ways that some components can't go back," said Charleen Tachibana, senior vice president and chief quality, safety and patient experience officer at the Virginia Mason Francis Health Center in Seattle. .

Virginia Mason Franciscan created the role of a nurse observer and monitor, which proved to be crucial because the system found that patients were more sensitive and labor shortages.

The non-profit health system already has a centralized mission control center. Due to the pandemic, nurses now use the system to remotely observe the vital signs of patients. The mission control center also provides consulting services for remote hospitals in the network.

Virginia Mason Franciscan also uses the system to provide virtual supervision to bedside nurses to ensure that tasks are completed correctly. "You will have a concentrated nurse somewhere, and he can come in remotely through a camera and check with you," Tachibana said. "Now on top of the burdened and stretched labor force that provides monitoring, there is another layer of nursing supervision."

Workers inserted more catheters and more centerlines, and because of their serious illness, more patients were using ventilators. In the final analysis, these factors mean more opportunities for patients to be harmed.

The Bassett Health Care Network in Cooperstown, New York recognized these risks and began to upgrade daily. Frontline employees of each unit meet at 8:30 every morning to express concerns about safety and quality. Then, their managers report these gatherings at a supervisor-level meeting at 9 am, and the issues are dealt with on-site and then communicated to the senior management.

"The executive leadership team really wants to know day-to-day issues, which is critical, because traditionally, executives don't want to be interrupted by trivial matters," said Russell Grant, director of the non-profit system. Infection control and prevention. “This is a real shift, and I think it’s a very positive shift for the organization. The plan is to continue these shifts long after the COVID-19 pandemic.”

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Hospitals must also figure out how to reduce the exposure of front-line workers to COVID-19 patients. Many hospitals do this through so-called “clusters”. Therefore, instead of saying that workers enter the patient area 100 times during a shift, it can be reduced by half.

NYC Health + Hospitals does this by modifying its electronic health record system and other technologies. Often, workers are prompted to do a routine task, such as drawing blood for laboratory tests. Previously, these tasks would sound an alarm every two hours, interrupting patients’ rest, which has been shown to have a negative impact on recovery. As a result, the New York-based municipal health system programmed the alarm to prevent the patient from falling asleep for 6 hours, or to sound only when the patient was awake.

Dr. Eric Wei, Senior Vice President and Chief Quality Officer of NYC Health + Hospitals, said: "Or, if the call rings, we can register via video," and then provide whatever the patient needs. "(We must) improve the monitoring of patients while reducing the number of times people have to enter the ward."

The medical procedure in which health workers must touch the patient's breathing has become a major event. For example, hospitals usually treat asthma patients with nebulization, which forces the medicine to enter the airways through high-power oxygen and often causes coughing. COVID-19 has changed this practice.

Daria Kring, vice president of clinical and patient education at Novant Health, said: "Before people receive respiratory therapy, we don't even wear masks to go in and out-this is not something we have thought of." Winston-Salem, North Carolina. "I can imagine that we won't treat them as benign events for a long time."

Now, if a patient requires CPR, Novant employees can follow this guide to perform this aerosol-generating procedure. Now, staff must wear respirators when performing these treatments, and there are notices on the doors to warn others not to enter until the space is vacant for a long time.

Of course, some safety innovations can lead to unexpected negative results, said Patricia McGafagan, vice president of safety programs at the Institute for Healthcare Improvement. She said that many hospitals have wisely implemented so-called failure mode and impact analysis.

"We must consider the unintended consequences of making changes — or what we think of improvements — will not outweigh the overall benefits," McGaffigan said. "What we are focusing on is the expansion of collective learning and the development of skill sets that we have seen spreading more widely throughout the organization."

Despite efforts to act quickly to ensure patient safety, the Centers for Disease Control and Prevention has shown that despite a significant decline since 2015, various infection rates have risen during the first year of the pandemic. These include catheter-related urinary tract infections and MRSA cases.

Leah Binder, President and CEO of Leapfrog Group, said: "Ironically, it (the pandemic) has increased our ability to deal with infections other than COVID-19."

This may be partly due to the practice of placing intravenous infusion tubes in the corridors outside the wards to reduce labor exposure to the virus. Or it could be because visitors are restricted or completely banned.

"Visitors are actually another pair of eyes. They are often with the patient for a long time, and they keep coming out to tell the staff that their loved ones don’t look right, or the intravenous injection doesn’t look right, etc. The way they act as patient advocates ," said Ann Marie Pettis, president of the Professional Association for Infection Control and Epidemiology. "We lost that."

Other hospitals have converted some hospitals with more administrative positions to work from home, such as those in the safety, quality, and patient experience departments. This is the case with the Allegheny Health Network, a health system in Pittsburgh. Chief Nursing Officer Claire Zangerle (Claire Zangerle) said that not only did these employees not show up in hospitals to help alleviate patient problems, but their quality improvement projects were also stranded during the pandemic.

"Those people are not speeding up as we hoped, because when this situation—perhaps a length of hospital stay—emerges suddenly, it becomes more difficult to talk on the phone [with clinicians and other frontline staff]. "Zangele said.

These workers are now back to work in person. As visitors were allowed to return to the hospital, Binder saw some positive factors that might persist. She said: "Now, tourists only need to wash their hands and wear masks, and they have the responsibility to protect their families and other patients from infection."

There are still big questions about how regulators integrate COVID-19 policies into how they measure hospitals’ performance in terms of quality and safety.

Dr. Graham Snyder, Medical Director of Pittsburgh Infection Prevention and Hospital Epidemiology, said: “When it comes to healthcare-related infections, we discussed how to decide when to get SARS-COV-2 in the hospital.” Based on the system UPMC.

The legacy of COVID-19 security procedures will be long-lasting, including innovations that arguably should have been in place, and the entire industry’s lessons about what works and what does not work. For example, UPMC in Pittsburgh is building a new hospital with a single ward to predict the emergence of new, highly infectious and rapidly deforming viruses. The next pandemic may look very different.

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