• Patient Safety Studies
  Both epidemiologic studies and randomized trials have shown that many Surgical Site Infections (SSIs) are preventable with appropriately timed antibiotic prophylaxis. Unfortunately, errors in antibiotic prophylaxis timing are extremely common with error rates reported to be between 35 - 40%. Since this problem is common and the consequences of the error so grave, identifying methods to assist hospitals in improving antibiotic timing is a high priority. Florida Hospital is participating in the baseline data collection for the TRAPE project. This project is under the combined efforts of the Society of Healthcare Epidemiology of America, JCAHO and the Centers for Disease Control and Prevention.
• Clinical Best Practice
  Clinical Best Practice = Improved Quality and Safety
  
  Clinical Best Practice ("CBP") goals are to reduce process variation, improve quality, and preserve resources through prudent utilization. CBP pathways and order sets result from systematic medical literature reviews and physician consensus to assess its validity and application to a specific patient population. CBP is based on

Evidence-Based Medicine ("EBM"). EBM is a fundamental change in how medical problems are solved. In contrast to the traditional paradigm of medical practice observation, intuition, authority and theory are insufficient grounds to define standards of care. EBM recognizes the complexity of healthcare and places a hierarchy on decision making. CBP also acknowledges physician preferences and patient values through understanding potential risks and benefits with their decisions.

From a safety perspective, legibility, consistency, appropriate dosing of medication, optimum medication and patient knowledge have a powerful potential to improve understanding and reduce errors. Reduction of process variation through clinical order sets and pathways that are based on EBM establishes a consistent standard of care, high reliability and quality.

• Patient Safety Initiatives
  
  Florida Hospital values and continually strives for improvements in patient safety. Across the Florida Hospital system, our hospitals are engaged in the pursuit of improvements in patient and clinical quality. In addition to implementation of the JCAHO National Patient Safety goals, we have an active process that monitors patient safety across all areas. Our patient safety team has members from leadership, patient care, laboratory, pharmacy, radiology, environment of care, risk management and infection control. We closely monitor key indicators related to patient, visitor, employee and environmental safety. Some of these are patient falls, bloodstream infections, medication event reporting, visitor safety, water and air quality, and immunization. We strive to think safety-always- for-everyone.

• National Quality Forum 30 Safe Practices
  
  The National Quality Forum (NQF) is a diverse group of stakeholders with the purpose of driving organizations to adopt evidenced based best practices to reduce the risk of harm to patients.

The NQF report lists 30 healthcare practices derived from a report by the Agency for Healthcare Research and Quality’s University of California, San Francisco Stanford University Evidenced-Based Practice Center, The Leapfrog Group’s three safety “leaps”, NQF Steering Committee and members, and health professional specialty societies responding to NQF’s open call for suggested safety practices.

The practices are organized in five categories for improving patient safety:

Creating a culture of safety
Matching healthcare needs with service delivery capability
Promote information transfer and clear communication
Adapting safe practices in specific clinical care settings or for specific processes of care; and
Increasing safe medication use

We are conducting a gap analysis of the NQF’s 30 safe practices to make recommendations for future implementation.

Once the gaps have been identified, action plans will be developed to address the gaps.

1. Create a healthcare culture of safety.
2. For designated high-risk, elective surgical procedures or other specified care, patients should be clearly informed of the likely reduced risk of an adverse outcome at treatment facilities that have demonstrated superior outcomes and should be referred to such facilities in accordance with the patient’s stated preference
3. Specify an explicit protocol to be used to ensure an adequate level of nursing care based on the institution’s usual patient mix and the experience and training of its nursing staff
4. All patients in general intensive care units (both adult and pediatric) should be managed by physicians having specific training and certification in critical care medicine (critical care certified)
5. Pharmacists should actively participate in the medication-use process, including, at a minimum, being available for consultation with prescribers on medication ordering, interpretation and review of medication orders, preparation of medications, dispensing of medications, and administration and monitoring of medications.
6. Verbal (including telephone orders) should be recorded whenever possible and immediately read back to the prescriber, i.e. a healthcare provider receiving a verbal order should read or repeat back the information the prescriber conveys in order to verify the accuracy of what was heard.
7. Use only standardized abbreviations and dose designations.
8. Patient care summaries or other similar records should not be prepared from memory.
9. Ensure that care information, especially changes in orders and new diagnostic information, is transmitted in a timely and clearly understandable form to all of the patient’s healthcare providers/professional who need that information to provide care.
10. Ask each patient or legal surrogate to recount what he or she has been told during the informed consent discussion.
11. Ensure that written documentation of the patient’s preference for life-sustaining treatments is prominently displayed in his or her chart.
12. Implement a computerized prescriber order entry system.
13. Implement a standardized protocol to prevent the mislabeling of radiographs.
14. Implement standardized protocols to prevent the occurrence of wrong-site procedures or wrong-patient procedures.
15. Evaluate each patient undergoing elective surgery for risk of an acute ischemic cardiac event during surgery, and provide prophylactic treatment of high-risk patients with beta-blockers.
16. Evaluate each patient upon admission, and regularly thereafter, for the risk of developing pressure ulcers. This evaluation should be repeated at regular intervals during care. Clinically appropriate preventive methods should be implemented consequent to the evaluation.
17. Evaluate each patient upon admission, and regularly thereafter, for the risk of developing deep vein thrombosis / venous thromboembolism (DVT/VTE). Utilize clinically appropriate methods to prevent DVT/VTE.
18. Utilize dedicated anti-thrombotic (anticoagulation) services that facilitate coordinated care management.
19. Upon admission, and regularly thereafter, evaluate each patient for the risk of aspiration.
20. Adhere to effective methods of preventing central venous catheter-related blood stream infections.
21. Evaluate each pre-operative patient in light of his or her planned surgical procedure for the risk of surgical site infection (SSI), and implement appropriate antibiotic prophylaxis and other preventive measures based on that evaluation.
22. Utilize validated protocols to evaluate patients who are at risk for contrast media-induced renal failure, and utilize a clinically appropriate method for reducing risk of renal injury based on the patient’s kidney function evaluation.
23. Evaluate each patient upon admission, and periodically thereafter, for risk of malnutrition. Employ clinically appropriate strategies to prevent malnutrition.
24. Whenever a pneumatic tourniquet is used, evaluate the patient for risk of ischemic and/or thrombotic complication and utilize appropriate prophylactic measures.