Connecting patient safety and
When SARS claimed 44 lives in Ontario in 2003—even though no one died at the Brant Community Healthcare System—it significantly changed the way care was delivered.
SARS convinced the Board of Directors that oversees the Brantford General, a 300+ bed acute care centre in southern Ontario and the Willett, an ambulatory health centre providing urgent care in the nearby town of Paris, Ontario, to establish patient safety as one of the organizations corporate priorities.
“Patient safety and infection prevention practices are inter- connected and directly linked to quality of care, there is no doubt,” says Jim Hornell, President and CEO. “To truly achieve the great outcomes we want for our patients, staff, physicians and volunteers demands synergy between patient safety initiatives and infection prevention and control practices. Like the lyrics in the song say, ‘You can’t have one without the other.’”
For starters, Board members devote 25 per cent of their meeting agendas to patient safety. Staff, with a comprehensive project plan designed to build a safety culture of openness, empowerment and monitoring, set about to spread the message from the boardroom to bedside.
One of the first computerized bedside medication verification systems in Canada, a best possible medication history program, and a ‘no blame, no shame’ incident reporting system were launched. Simultaneously, a decision support analysis team was formed to measure results of the initiatives and provide information to educate staff.
“A culture of openness, transparency and reporting resulted in our incidence reporting rates shooting up more than 500 per cent,” explains Lina Rinaldi, Vice President, Patient Services said. “We began to see change happening throughout the organization.”
During SARS the hospital had no infectious disease specialists on staff; now they employ two physicians that collaborate with staff. Monthly reports highlighting the latest hospital infection rates are circulated and areas where improvements can be made are followed up.
Critical to the success of preventing transmission of infectious diseases is the collaboration between the Infection Prevention and Control department and the environmental service aides.
“Our environmental service aides continually upgrade their skills,” explains Sandra Comand, Manager, Infection Prevention & Control. “They take their jobs very seriously and were involved in researching new hand wash stations for our hospital entrances and consolidating our general purpose cleaning products. They are at the frontline and have a wealth of knowledge.”
Canada’s first multi- discipline, fully automated hospital laboratory opened in February and according to Don Manning, Director, Laboratory & Diagnostic Imaging, “Robotics minimizes handling and risk to patient samples. Physicians receive the results as much as 40 per cent faster and have confidence knowing that any abnormal results were automatically re-tested for verification.”
In recent years hospitals have recognized the importance hand washing has on patient safety and infection prevention. ‘Doctor Doctor’, a hospital band produced a music video ‘I Want To Wash My Hands’, to the song ‘I Want To Hold Your Hand’ featuring staff, physicians, volunteers- even Ontario Minister of Health Deb Matthews and Walter Gretzky- dancing and washing their hands. The video has scored over 30,000 hits on YouTube and health-care organizations around the globe are clamouring to use it. A medical school will host a flashmob set to the video to promote hand hygiene in downtown Singapore!
Hornell says, “The hand wash video demonstrates that we can have some fun when it comes to the serious matter of patient safety and infection prevention.”
C.difficile, VRE and MRSA rates are consistently low virtually right across the board and well within provincial guidelines. Bedside medication verification rates are over 80 per cent and some units are achieving 100 per cent. Meanwhile, medication reconciliation compliance has increased from 57 per cent upon implementation to over 80 per cent, with many units continually scoring as high as 90 to 100 per cent. Data also shows that the best possible medication history program is working: errors in patients’ medication profiles decreased 42 per cent in nine months.
Other notable achievements include the Quality Healthcare Workplace Award presented by the Ontario Hospital Association and the Ministry of Health to the Board- who began the journey on patient safety and infection prevention. Last December, the Hospital Standardized Mortality Ratio (HSMR) from the Canadian Institute for Health Information (CIHI) identified the Brant Community Healthcare System has the lowest number of deaths of inpatients compared to all hospitals in Canada.
Hornell, the hospitals’ champion to improve patient safety and infection prevention, is thrilled with the progress and says, “Our best practices have definitely produced changes for the better. We seem to be an island to ourselves protected from outbreaks that unfortunately challenge neighbouring centres.” When Deb Matthews, Minister of Health visited the hospital earlier this year she praised staff, saying, “Brant Community Healthcare System- you are the safest hospital in Canada.”