Patient safety is at the core of our mission at Seattle Children’s Hospital and we continually strive to improve on all aspects of patient care.
We have well-developed policies and procedures in place for immediate response to medical errors, disclosure of errors to patients and families, and clear systems for internal and external reporting of errors.
We have created a culture of safety at Children’s that allows staff to report events directly or anonymously. Staff must report events that harm or have the potential to seriously harm a patient. All serious events require a thorough analysis and process improvement action plan with follow-up specified to reduce the chance of reoccurrence of a similar event.
We also listen to our patients and their families and involve them in the design and implementation of improved safety efforts.
Following are examples of many procedures we have in place to protect children in our care from medical errors and hospital-acquired infections.
Reducing Hospital-Acquired Infections
According to the Centers for Disease Control and Prevention (CDC), nearly 250 people die in the United States every day from infectious diseases they acquired while in a hospital. Those numbers, according to the CDC and World Health Organization, could be cut in half just with proper hand washing.
Children’s has had consistent improvement in hand hygiene compliance rates, from 70% in 2004 to our current sustained rates of over 90%. This compliance rate - as measured by anonymous observers - is the result of a long-term effort that includes placing hand sanitizing gel dispensers in convenient locations; signage to remind staff, patients and families to use gel; ongoing educational campaigns; and posting quarterly compliance data in public locations with motivational messaging to encourage improvement. We track data for doctors, nurses and other providers in each unit to promote accountability and reveal groups that need improvement. We strive for 100% compliance.
Blood Stream Infections
A central line catheter is a small plastic tube that is placed into the blood vessels near the heart. In some patients, the catheter is used to deliver important medications, nutrition and nutritional supplements, to draw blood tests, and to monitor blood pressure. Occasionally this catheter can introduce bacteria into the bloodstream resulting in a central line infection. Central line infections cause a patient to become ill. A low rate of central line infection can be an indication of the cleanliness and safety of a hospital.
At Children’s, we take central line infections seriously and have a goal to reduce central line-associated blood stream infection (BSI) rates to zero. By following national best practices and standardizing the steps we take to prevent infections, we’ve reduced the rate of hospital acquired BSIs from 4.7 per 1,000 line days in 2006 to 3.3 per 1,000 line days in 2009.
While we applaud systems for health care consumers to compare hospitals, patients should be aware that the rates are not adjusted for severity of illness and there is variance in the methods of collection and how aggressively hospitals identify infections.
For example, we have a high level of complex, bone marrow transplant patients who have multiple risk factors including low white blood cell counts. In the last ten years, we have had an 80 percent reduction in BSIs for bone marrow transplant patients. In addition, we have also reduced our BSI rate in our Intensive Care Unit (ICU) by 50 percent over the last three years. Pediatric ICUs have traditionally had higher BSI rates than adult ICUs.
We use evidenced-based protocols for the insertion and maintenance of central lines, and we continually monitor the lines to determine when they can be removed. When there is a blood stream infection, we conduct an investigative review with the patient, parents and medical providers to identify how to prevent this in the future. We have been tracking and using evidence-based improvement methodologies for years to improve our care.
Surgical Site Infections
A surgical site infection, referred to as SSI, is a complication resulting from surgery. SSIs can develop when germs get in the surgical wound. A patient that develops an SSI may have delayed healing from their surgery and may face a longer stay in the hospital. In the past three years alone, Children’s has reduced cardiac surgical site infections by 50%.
When a patient has an illness that can be shared (contagious), healthcare workers, parents and visitors have to follow extra steps before entering the patient’s room. The extra steps are called isolation precautions. The CDC identifies isolation precautions as one of the most important strategies for reducing the spread of MRSA and other infections.
At Children’s we have used isolation precautions for more than 20 years and continually enhance them to increase the safety of our patients. Part of those precautions has been the use of isolation precaution signs on patient room doors. The signs remind all who enter of the extra steps needed to protect themselves and others in the hospital from getting the contagious illness. In 2008, we worked with other Washington hospitals to develop standardized isolation signs that have been in use since September 2009.
We also track rates of hospital-acquired MRSA, VRE (vancomycin resistant enterococcus), rotavirus, RSV, and Clostridium difficile infection. Hand hygiene, isolation precautions and other measures taken at Children’s have decreased these hospital-acquired infections from 8.5 new cases per 1000 discharges in fiscal year 2007 to 4.0 new cases per 1000 discharges year-to-date in fiscal year 2009. Our staff is continually working to improve our precautions and strives to reduce hospital-acquired infections to zero.
Surgery Safety Checklist
In July 2009 Children’s implemented a new operating room surgery safety checklist to increase communication and patient safety. We did this as part of a worldwide safety initiative sponsored by the World Health Organization and endorsed by the Institute for Healthcare Improvement. Children’s was one of the first pediatric hospitals in the nation to fully implement the checklist in all operating rooms.
The checklist drives conversation between the patient and family and healthcare team members before, during and after a procedure. The list is used prior to surgery when an anesthesiologist and a nurse meet with the patient and family to review information like known allergies, patient consent and identity.
Before a procedure begins, there is a ‘Time Out’ where the entire surgical care team pauses to review the checklist for key information including the identity of the patient, procedure site, special instrumentation, antibiotics and more.
The list creates opportunities for communication and provides a better experience for our patients and their families.
Across the nation, hospitals are looking for ways that they can reduce the risk of harm to patients. In reviewing adverse event data from across the nation, it was identified that some errors have come from the variation in the use of color-coded wristbands by hospitals. In accordance with other hospitals in the state of Washington, Children’s has adopted standard wristband colors.
Computerized Provider Order Entry
Many of the more than 1 million serious medication errors estimated to occur in hospitals every year can start with a physician’s illegible writing.
The high-tech solution is computerized provider order entry, or CPOE. Placing orders by computer for medications reduces the chance of incorrect dosages and dangerous drug interactions.
At Children’s, CPOE, which was installed in November 2003, has cut in half the time for medications to reach patients in the hospital, and pharmacy errors due to hard-to-decipher prescriptions have dropped to zero.
Rapid Response Team
In April 2008, Children’s implemented a standardized system called the rapid response team (RRT), for nursing and medical staff to call for help when they perceive a patient’s condition is deteriorating. Activation of the RRT may be based on specific concerns, observations or scores in an assessment tool called the Modified Pediatric Early Warning System.
The primary goal of the RRT is to avoid cardiopulmonary and respiratory arrests whenever possible by improving staff recognition of the warning signs and the ability to intervene quickly when patients’ conditions are deteriorating. Although Children’s rate of cardiopulmonary arrests is low compared to other children’s hospitals, there is always room to improve.
In November 2009, the RRT was expanded to allow families to activate the system if they feel the patient’s condition is deteriorating and their concerns are not being addressed.
Emergency Code Calls
In reviewing adverse event data from across the nation, it was identified that some errors have come from the variation in the use of emergency code calls by hospitals. The purpose of emergency code calls is to quickly communicate an emergency and to mobilize expert assistance, i.e. “Code Red” for fire. Children’s has participated in and adopted a modified version of the Washington Standardized Emergency Code Calls project.
Involving Patients and Families
Patients and their families are essential members of the health care team.
- We build partnerships based on mutual respect and open communication
- We respect each family’s uniqueness
- We listen with care and seek to understand the perspectives and needs of families
- We share information clearly, completely and consistently
- We ensure privacy and confidentiality
- We collaborate with families in the development and evaluation of new and existing programs, policies and facilities
- We work together with providers and services in the family’s home community
- We have a Family Advisory Council that provides recommendations and feedback for policy and organizational changes that affect the family experience
- Children’s also solicits parent feedback through the Family Experience Survey, which is provided to parents of our patients
For more information about patient safety at Children’s visit http://www.seattlechildrens.org/home/patients_families/patient_safety.asp
About Seattle Children's Hospital
Consistently ranked as one of the best children’s hospitals in the country by U.S. News & World Report, Children’s serves as the pediatric and adolescent academic medical referral center for the largest landmass of any children’s hospital in the country (Washington, Alaska, Montana and Idaho). For more than 100 years, Children’s has been delivering superior patient care and advancing new treatments through pediatric research. Children’s serves as the primary teaching, clinical and research site for the Department of Pediatrics at the University of Washington School of Medicine. The hospital works in partnership with Seattle Children’s Research Institute and Seattle Children’s Hospital Foundation. For more information, visit http://www.seattlechildrens.org.