Monday, December 24, 2007

Hospitals falling short on NQF's 30 'safe practices'; resources sometimes product progress difficult

Hospitals falling short on NQF's 30 'safe practices'; resources sometimes product progress difficult

A first-of-its-kind study of a state's hospitals and their progress in implementing the National Quality Forum's "30 Safe Practices" have yielded some interesting results and, according to the authors, open up some new benchmarking opportunity.


The study, published in the American Journal of Medical Quality (1), be completed by 100 facilities contained by Iowa--or 86% of the state's hospitals. The survey included a list of adjectives 30 practices and asked respondents to rate both the priority and the progress for each practice. Here are some of the push button findings:


* Overall, the hospitals gave better ratings for priority than for progress.


* Respondents gave a highly developed rating for priority than progress in all but two of the practices--adhering to significant methods of preventing central venous catheter-associated blood stream infections, and evaluating respectively patient upon acknowledgment, and regularly thereafter, for risk of malnutrition.


* The peak progress ratings were for items involving foot washing, unit-dose medication dispensing, influenza vaccination, implementing protocols to prevent wrong-site procedures, and standardized methods for labeling and storing medication.


* The lowest progress ratings were for intensive strictness units staffed by intensivists and implement a computerized order entry system (CPOE).


The authors enunciate these findings can provide a benchmark for hospitals to see how their peers rate priorities and progress in each of these areas. "Hospitals should cause their own ratings and see how they compare," (1) they recommend.


They also say the findings can relieve hospitals choose which of the practices are most suitable for targeted QI efforts. "For example," they write, "The current findings suggest that progress on intensivist staffing of ICUs will be hampered if the supply of appropriately trained physicians is low in an nouns, as is the case contained by most rural areas in the United States." (1)


No absence of will


That's exactly the case surrounded by Iowa, notes Thomas C. Evans, MD, president and CEO of the Iowa Healthcare Collaborative contained by Des Moines, and one of the authors of the article. "Our ICUs are not staffed 24/7 [by intensivists]," he shares. "The respondents are not saying that this [safe practice] isn't far-reaching, or that they don't want to be farther along with CPOE; we adjectives want to do this, but there's no instrument we can go in attendance. We are 50th in the country, for example, surrounded by Medicare reimbursement."


Interestingly, he continues, the study's findings mirror those of a private study conducted by the University of Iowa's College of Public Health. "We looked at the application of the three key Leapfrog Group initiatives [computer physician directive entry, intensive care component physician staffing and evidence-based hospital referral]," he recalls. "In jargon of CPOE, people thought we adjectives needed to go near, but it's such a big leap they can't even conceive of it. Also, it won't be successful before you enjoy cleaned up your processes, so we need to stroll a little slower on that."


Realism is important


As for designated referral, Iowa is one of the lowest-ranking states in terms of physicians per capita, "So we do not own the luxury of creating a competitive environment," Evans asserts.


"24/7" coverage of ICUs "sounds wonderful," he admits, "But when you help yourself to all the intensivists in Iowa, you might know how to staff two of our hospital ICUs 24/7."


In other words, says Evans, sanctuary goals close to those established by the Leapfrog Group are laudable, but it's important to know what your limitations are previously judging your facility too strictly. "Each of those 'leaps' they chose is supposed to be some great bound forward," Evans explains.


"They are confrontational us not to be about evolution, but revolution. They are a big climb for almost everyone, but if you embezzle a rural state with a geographically dispersed population and a resource defy, those three leaps enjoy limited applications to that environment."


Remember the basics


In jargon of CPOE, for example, all Iowa services are working toward that goal, but "You hold to deploy 'gazillions' of dollars of software, and that's something these hospitals don't have," say Evans. In fact, he add, "I don't know of one place that has completely implement CPOE."


One thing adjectives hospitals can do, he continues, is to pursue the basics of a undisruptive culture. "First, you must break down the walls between physicians, nurses, and the pharmacy," he advises. "Communicate your adjectives goals, and consequently engage them adjectives in the process."


To create a culture of sanctuary, says Evans, vehicle defining your culture, and creating a safe environment where on earth people in actuality talk to respectively other. "And when something goes wrong, instead of assigning blame, they sermon about how to hold on to it from happening again," he say.


"Once you have be able to outline a safe culture, hold communicated it to your staff and have everyone genesis to understand what it mechanism to be part of such a culture, you hold to find ways of measuring it--which reinforces the culture going forward," Evans observe.

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