Many of you are familiar with the Institute of Medicine's 2000 report, To Err Is Human.1 It highlighted the disturbing fact that some 100,000 hospital patients die each year as a result of medical errors. The report created a new level of awareness about patient safety, for both healthcare providers and consumers.
The federal government used the opportunity to launch a number of patient safety initiatives, among them the "100K Lives Campaign," developed by the nonprofit Institute for Healthcare Improvement (IHI) and cosponsored by the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, and the Centers for Medicare and Medicaid Services.
Begun in early 2005, the campaign's goal is to save 100,000 lives in 18 months (and every year thereafter) by encouraging hospitals to implement evidence-based safety improvements known to reduce avoidable deaths in hospitals. More than 2,200 hospitals have volunteered to participate in the some or all of the six designated interventions: deployment of rapid response teams; delivery of evidence-based care for acute myocardial infarction; prevention of adverse drug events; prevention of central catheter infections; prevention of surgical-site infections; and prevention of ventilator-associated pneumonia.
Here's just one of the success stories from the 100K Lives Campaign. The staff of the surgical intensive care unit at Johns Hopkins Hospital took up the challenge by working to drastically reduce the number of catheter-related bloodstream infections (CR-BSIs) in their unit. A multidisciplinary team collected research, reviewed their infection rates, and developed initiatives to reach their goal. As the staff carried out the interventions, they identified problems with compliance and created solutions to decrease the complexity of the requirements. The Hopkins "culture of safety" encouraged all staff to participate, and policy changes were communicated throughout the hospital.
The Johns Hopkins group based their key interventions on IHI's recommendations for preventing CR-BSIs. The "bundle" of the following 5 care steps has been found to cut the number of CR-BSIs to almost zero when all 5 steps are performed.
* Use proper hand hygiene. Everyone who touches the central catheter must wash his or her hands with soap and water or an alcohol-based waterless hand cleanser.
* Use maximal barrier precautions for both the clinician inserting the catheter and the patient. The person who inserts the catheter should be in sterile clothing-wearing a mask, gloves, and hair covering. The patient should be fully covered with a sterile drape, except for a very small hole where the catheter is inserted.
* Cleanse the catheter insertion site with chlorhexidine.
* Select an optimal catheter site, with the subclavian vein as the preferred site for nontunneled catheters.
* Monitor catheter and site daily, and remove catheter promptly when no longer needed.
The Hopkins unit succeeded in reducing their CR-BSI rates from an original rate of 14.56 infections per 1,000 central catheter days to 0.93 per 1,000 central catheter days.
For the experienced infusion nurse, these steps have become natural components of everyday practice. They are fundamental principles found in the Infusion Nursing Standards of Practice. With the desire to improve patient safety, it is important that the word get out regarding these effective practices.
The 100K Lives Campaign is just one example of how the government, private and public institutions, and healthcare professionals are working together to make the provision of healthcare more transparent and consumer-friendly. You can join this growing movement by encouraging your institution to join the National Quality Forum, a nonprofit organization that endorses consensus-based national standards for measurement and public reporting of healthcare performance data that provide meaningful information to consumers (http://www.qualityforum.org). For further information about performance measurement, patient safety, and public reporting, you can visit the Web site for the federal Agency for Healthcare Research and Quality (http://www.ahrq.gov).
Mary Alexander, MA, RN, CRNI(R), CAE, INS Chief Executive Officer
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