• Article
  • October 31, 2018

3 Patient Safety Projects Where Standardization Was Essential

Quality improvement projects that focus on reducing patient harm can lead to cost reduction and fewer inpatient days. Here's a look at the top Pediatric Quality Award entries for the patient safety and reduction of harm category. 

Part of the Pediatric Quality Award, the patient safety and reduction of harm category recognizes important quality improvement initiatives within hospitals. These three hospitals put standardization at the forefront of their projects to improve patient outcomes.

Getting to Zero: Eliminating Unplanned Extubations in the PICU
Unplanned extubations (UE) are a serious adverse event that can lead to severe hypoxia, infection, airway trauma and prolonged mechanical ventilation. They were occurring so regularly at Ochsner Hospital for Children in New Orleans–most staff were treating UEs as an anticipated event for an intubated patient. From 2010 to 2011, there were 34 reported UE events, a rate of 1.4 events per 100 ventilator days.

After determining the average rate of UEs in the pediatric population–between 0.2 and 2.7 events per 100 ventilator days–providers explored risk factors in Ochsner's specific patient population, and they set their sights on reducing UEs by 50 percent.

The project started with data collection and an analysis of what was causing the UE events. Interventions included:

  • Reeducating staff on the proper sizing and application of endotracheal tubes, according to manufacturer guidelines. 
  • Meetings between a group of nurses, respiratory therapists and physicians to experiment with different methods of taping on mannequins to establish an improved method. 
  • Educating staff on the new method of taping. 

After achieving a 50 percent reduction in UE events within the first year, the project team adjusted its goal to reach a rate of zero.

By 2015, UEs were less common, but there continued to be room for improvement. The team introduced new tape products were introduced, and put up posters demonstrating proper taping methods. At the point of their project entry in 2017, Ochsner's had gone nearly two-thousand ventilator days without a UE.

To learn more, register for Ocshner's live webcast on Feb. 26.

Decreasing Blood Culture Contamination in a Children's Hospital
When Children's of Mississippi in Jackson noticed that its blood culture contamination rate was on the rise, staff new they had to do something.

Blood culture contamination can lead to longer hospital stays, higher costs and potential health complications. Children's of Mississippi set a goal in 2014 to reduce blood culture contamination rates from 2.8 percent to less than 1.5 percent by December 2017.

Due to the varying processes in blood culture collections, many of the efforts in Children's of Mississippi's quality improvement project consisted of standardizing how blood cultures were taken. To remedy this:

  • Staff were observed and surveyed to determine the amount of differentiation in blood collection. 
  • The blood culture collection process was standardized based on evidence-based guidelines, and nursing staff was trained using an approved checklist.
  • Blood volumes were also standardized regardless of the patient's weight to prevent false negatives. 

The estimated cost of an inpatient stay from a blood culture contamination is about $8,720. By reducing contaminations and therefore unnecessary hospital stays, Children's of Mississippi avoided monthly costs by about $58,000.

Learn more by watching Children's of Mississippi's recorded presentation.

Preventing CLABSI through Leader Engagement, Data Management and Evidence-Based Practices
In 2015, Children's Hospital Colorado in Aurora was 66 percent compliant for central line-associated blood stream infections (CLABSI) prevention, resulting in infections that were too common. The project team set out to improve compliance with CLABSI prevention bundle, an effort that was hindered due to human error and patient-specific barriers.

To reduce the number of CLABSIs, Children's Colorado:

  • Introduced weekly audits for all inpatient units, alongside leader rounding on patients with central lines and touchpoints for sharing any reasons for non-compliance. 
  • Developed system-level solutions for non-compliance and leveraged tools in the electronic health record to remind nurses when central line cares are due.
  • Standardized central line processes and implemented new, more sanitary resources, including a disinfectant cap. 

The team not only achieved 90 percent compliance by June 2017, but also a 48 percent drop in CLABSIs hospital-wide. Every instance of a non-mucosal barrier injury CLABSI became further apart; what started as every five days, became every 12 days.

Not all departments implemented the same processes due to differing patient needs. The neonatal intensive care unit (NICU), for example, needed different standards for bathing patients than the cardiac and pediatric ICUs.

Learn more by watching Children's Hospital Colorado's recorded presentation.

Send questions or comments to magazine@childrenshospitals.org.