Safer Healthcare Now

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Your Health Care - Be Involved – Patient Safety Tips Campaign

There are five common-sense tips for our patients that form the basis of the Ontario Hospital Association's project Your Health Care - Be Involved. The initiative is guided by the concept of patient empowerment and on the important role patients play at each stage in the care path. Posters and brochures on this important initiative are available at all NHS sites.

Common Sense Tips

  • Be involved in your health care. Speak up if you have questions or concerns about your care
  • Tell a member of your health care team about your past illnesses and your current health condition.
  • Bring all of your medicines with you when you go to the hospital or to a medical appointment
  • Tell a member of your health care team if you have ever had an allergic or bad reaction to any medicine or food.
  • Make sure you know what to do when you go home from the hospital or from your medical appointment.

The Canadian Patient Safety Institute provides leadership in building a foundation where patient safety can advance in Canada. It works with partners in government and healthcare stakeholders to create new opportunities to develop, implement and recognize patient safety innovation within the health system. With endorsement and participation from a growing number of health care agencies across Canada, the Canadian Patient Safety Institute has developed the Safer Healthcare Now initiative to improve healthcare standards across Canada.

NHS Safer Healthcare Now Committee

With the strong foundation laid by the Canadian Patient Safety Institute (CPSI) and the Safer Healthcare Now initiative, here at the NHS a Safer Healthcare Now Committee formed in 2007, with membership representing key clinical areas including Pharmacy, Critical Care, Operative/Peri-Operative, Education, Risk Management/Patient Safety and Infection Prevention and Control.

The CPSI has chosen a number of interventions to improve patient safety across Canada. The mandate of the NHS committee is to ensure that, as an organization, we participate and meet compliance in the following interventions we are currently focusing on:

The aim of these interventions is to improve healthcare delivery by focusing on patients and their safety while they're in our care, with the goal to reduce the number of injuries and deaths related to adverse events, specific to the above initiatives.

Our healthcare teams – Physicians, Clinical Program Leaders, Infection Prevention and Control Co-ordinators, Nurse Educators, Registered Nursing staff and Respiratory Therapists – are integral to ensuring patient safety and evidence-based practice is at the forefront of bedside care.

Safer Healthcare Now Initiatives Underway...

Prevention of Central Line-Associated Bloodstream Infection

Protecting the patient from exposure to any type of environmental bacteria or virus is important all the time, especially when the risk of exposure increases when intravenous (IV) lines are inserted to provide vital medicine and blood or body fluids to the patient.

Many Intensive Care Unit (ICU) patients require a larger access point in their body to deliver IV fluids, so a large central vein, usually in the upper chest, is selected to place the catheter. The central venous catheter is a small plastic tube that remains in the patient, with a hub attachment which allows tubes to be connected for all types of IV and other therapies. There could be three points of access into a central venous line – one which must be a dedicated line for supplying nutrition and the others for medications and blood or other fluids.

Whenever an IV line is created, the risk of infection is greater for the patient. To provide safer patient care, health care professionals at the NHS's three ICU departments (Welland, Niagara Falls and St. Catharines hospitals) are following new stringent protocols when inserting and maintaining central venous catheters.

These protocols are as follows:

  • When the patient is being prepared for a catheter to be inserted, health care professionals must first put on a sterile cap, mask, gown and gloves, as well as goggles.
  • Chlorhexidine skin cleaning liquid is used to clean the patient's skin area where the catheter is to be inserted.
  • A covering of sterile drapes is placed on the patient from head to toe. The catheter is then inserted by the physician.
  • To maintain a sterile environment at the catheter site over several days, the nurse has to protect the IV line from contamination by checking the catheter site daily, changing dressings as necessary and using proper sterile techniques to insert new medications or liquids. It is important that access to the lines be limited since the nutrition IV line will contain a lot of fat, an excellent breeding ground for bacteria.

The new stringent protocols have been in place since late 2006 and staff is anticipating patient data will show a reduction in infection rates. Next steps are to roll out this safer way of starting central IV lines for patients on all Medical and Surgical units as well as Emergency Departments in early 2008.

Medication Reconciliation

Medication Reconciliation is a medication safety initiative, in place to reduce the number of medication errors or adverse events associated with medication use. Many patients coming to hospital for a planned or emergency admission already take prescription or over-the-counter medications. It can be difficult for hospital staff to ensure the right doses and right types of home medications continue to be given to the patient during his/her hospital stay. An example would be a patient on blood pressure medication who brings the pills into the hospital, but doesn't know the name of the medication or the dosage.

To reconcile these home and hospital medications the patient is taking, a new project is underway. It involves creating an individualized comprehensive list of all home medications used by each patient. The list is generated from patient information, as well as confirming info from the community pharmacy and family physician. The list is used to ensure physician admission, transfer and discharge orders are reflective of what the patient currently takes. Since summer 2007, the NHS has been conducting a pilot project at the St. Catharines General Site Pre-Op Assessment Clinic for orthopaedic patients booked for hip or knee surgery and lessons learned from this process will be rolled out throughout clinical areas.

This will become a system-wide initiative, ultimately impacting all patients, both on an inpatient and outpatient basis. The initiative has begun with inpatients, as per the Safer Healthcare Now toolkit. A steering committee will be co-ordinating the process, including education for staff.

Prevention of Surgical Site Infection

It is estimated that in the U.S. and Canada, 40 to 60% of infections occurring after surgery are preventable. Surgical site infections cause longer lengths-of-stay in hospital, increase recovery time for patients, can lead to readmission to hospital, and in rare cases, death. For these reasons, the NHS, along with hospitals everywhere across the province, has refocused efforts on preventing surgical site infections for all surgical patients. In Fall 2007, the NHS began a number of new protocols to be followed for surgical patients, based on the best current evidence of effective ways to reduce surgical site infections. These new guidelines are part of the Safer Healthcare Now initiative.

In most invasive surgeries, antibiotics are administered to the patient, usually before, during or immediately after surgery, to help build up the patient's resistance to infection while his/her body heals. Evidence shows that the time when a surgical patient takes the antibiotic can have an impact on whether or not an infection begins. The new rules now being followed by NHS surgical staff are that antibiotics are to be given in a more timely fashion, before the surgical incision and should be discontinued at appropriate timeframes after surgery.

Another risk area for infection is hair removal before surgery. When hair is removed using a razor, skin may be roughened during the shaving, increasing the potential for bacteria and infection to start. To combat this, a new hair-removal protocol now means only hair-clippers or a lotion depilatory are to be used.

Another basic yet important way of preventing infection for surgical patients is to monitor the patient's body temperature and keep it at a normal level (36 to 38 degrees Celsius) before, during and immediately after surgery. Fluctuations in body temperature can result in fever and infection.

To make sure these new surgical protocols are effective, sophisticated computer software is now in use at the NHS. Staff enter into the patient's electronic health record details on times and types of antibiotics given, lab results after surgery which identify any bacteria in the bloodstream, what type of hair removal product was used, and other key indicators that can be linked to the potential of surgical site infections. The software captures and connects all this information, and collates it for the health care team so they can track trends and make improvements based on evidence.

Orthopaedic surgeons who practice at St. Catharines General Site are now piloting a system to make sure the information loop on surgical site infections is closed. Sometimes a patient will develop infection after he/she is discharged from hospital after surgery. When that patient visits or contacts his/her surgeon and signs of an infection are apparent, the surgeon now reports this information via fax back to the hospital lab. This allows the NHS to trend the rate of post-op infection once the patient leaves the hospital and the team then works together to improve practices, such as the timing of antibiotics.

Education plays a big part in reducing post-op infection. Patients need to be aware of the ways to prevent infection once they get home, such as proper cleaning techniques and dressing changes. The type and timing of education by hospital staff to patients is also tracked on the software, so gaps can be identified and corrected.

Prevention of Ventilator-Associated Pneumonia (VAP)

The incidence of pneumonia in ICU patients on mechanical ventilators to help them breath is noticeably higher than in patients not on ventilators. When a patient cannot use his/her chest muscles to breath and is assisted by a ventilation machine, pneumonia can start in the lower lungs after 48 hours. Preventing Ventilator-Associated Pneumonia (VAP) and deaths from VAP is a top priority for the NHS and new evidence-based care protocols are now in place at our three ICU's.

The main components to reduce mortality for VAP are:

  • Elevate the head of the patient's bed 30 degrees to decrease the risk of aspiration, improve breathing efforts and decrease damage to lower lungs, where pneumonia often starts.
  • Physician, Respiratory Therapist and Registered Nurse carry out a daily assessment to determine if the patient is ready to come off the ventilator. Sedation is also decreased where possible to encourage the patient to use his/her own muscle strength to breath.
  • The NHS is currently in the process of implementing a new protocol to place a feeding tube in the mouth instead of the nose, which will decrease sinus infection and resulting mucus build-up, which drains into the lungs and can cause pneumonia.
  • The NHS is also exploring new types of breathing tubes to insert in the mouth, which provide constant suction to remove collecting mucus, a major source of infection.

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