Local hospital improving safety practices
By Sarah Smith
As most Minnesota hospitals assess their adverse incidents by looking internally, St. Joseph’s Area Health Services in Park Rapids is looking externally in trying to prevent falls throughout its coverage area.
Last week the Minnesota Department of Health released its annual error report for hospitals.
St. Joe’s, during 2012-13, experienced a serious fall in which a patient suffered a broken bone. The tracking system runs from Oct. 7, 2012, to Oct. 6, 2013. That was down from three serious incidents the year before.
But in addition to looking in-house, hospital staff is trying to exert influence beyond its walls to ensure that Hubbard County residents understand the peril of falling and ways to prevent it.
Fifteen Minnesota hospital patients died last year from hospital errors that encompassed falls, wrong medications, wrong site surgeries and other serious medical errors.
And while St. Joe’s staff meets daily, weekly and monthly to prevent such in-patient mishaps at least one committee is training its sights on the community at large.
Statewide, the number of deaths remained stable- but the number of what health officials call “adverse health events” – declined 18 present from the previous year.
Internally, that still presents a challenge to local hospital staff, which seems to live by the moniker “but for the grace of God go I.”
Preventing all errors is likely impossible, maintains Director of Quality Chris Broeker.
“We’re learning that even falls in the community are an issue and I know now that even Department of Health and groups around the state are looking at fall prevention and to look at it from that perspective, not just falls in hospitals,” Broeker said.
“Can we prevent all falls even outside the hospital?” asked Public Information Specialist Judith Miller. “No. But can we prevent falls in which people get hurt? I think that’s our goal.”
“We assess for injury factors, which is new,” Broeker said of incoming patients. “Someone who is on anticoagulant therapy, someone with osteoporosis,” are very high risk.
Hourly rounding is a new concept at St. Joe’s. That means that patients are thoroughly assessed every hour and know their nurse will be back in an hour to check on them. That doesn’t mean they cannot summon help in the interim, just means that the most they might go unattended is an hour.
Staff visit and round purposefully on each patient, giving them medication, making sure they’ve gone to the bathroom, assessing their pain and reinforcing the mantra that they will be back in an hour.
But it also reinforces in the patient the theory of asking for help when they’re up, not dashing off to the bathroom on their own.
“Often times our falls happen when someone chooses not to ask for help,” Broeker said. “Despite us asking for patients to put their call light on, sometimes they don’t. Asking for help is the most important thing and knowing we’ll be coming back in an hour has been effective for us in helping decrease our falls.”
So patients learn how to summon a nurse before they learn how to change the channels on their TV set. It’s just resetting priorities, the women said.
“Especially when it’s an elderly patient,” Miller said. Families can share their experiences. “We tend to serve an elderly population,” she added. People in a foreign environment may tend to fall out of unfamliarity, stress or a number of factors.
The hospital recently received a Catholic Health Initiatives grant to purchase four lower hospital beds so replacing all the beds will be a future priority. That will prevent many falls, Broeker said. Most falls occur when patients are getting up to the bathroom.
They are reserved for high risk patients after being assessed for risk of falls and risk of injury from falls.
And if a patient is at high risk for falls or may be unreliable, the hospital may even station a staffer in or near their room or station the person near the nurse’s station.
But outside the facility, sidewalks are clean, staff even come out to help patients enter and escort them outside. Wheelchairs are readily assessable.
The safety first initiative is paying off with safety coaches in each unit. It doesn’t focus strictly on falls but also concentrates on medication errors and any possible scenario that could be of detriment to a patient.
All along the way, patients are assessed and re-assed as their conditions change.
If a patient falls the hospital looks at those assessments.
Were they accurate or complete? Then they look at interventions. What strategies were in place? Should any changes have been made? What changes were made? Was education necessary and administered?
“You let patients that were fine at home know that even though they have this IV pull and they’ve had medication” know they could be at risk of falling.
“‘Call for help’ is really the message we want to get across,” Broeker said.