It’s a peaceful scene: The patient appears to be sleeping soundly. A visitor sits at his bedside quietly reading a book. Nurses come and go without disturbing the patient, who looks calm and rested.
It may also be a dangerous scene.
Health care providers often sedate patients in an effort to make them comfortable and reduce their anxiety. Unfortunately, oversedating the patient is a real risk. Oversedation has been linked to several harm events, including adverse drug events (ADEs), delirium, falls, airway safety events, venous thromboembolism (VTE), and ventilator-associated events (VAEs).
The Indiana Hospital Association (IHA) is partnering with the American Hospital Association’s Health Research and Educational Trust (AHA/HRET) on the UP Campaign, which was designed to simplify safe care and streamline interventions, reduce multiple forms of harm with simple easy-to-accomplish activities, and consolidate basic interventions that cut across several topics to decrease harm. The WAKE UP component of the campaign focuses on appropriate sedation management, which ultimately allows for early mobilization, reduction of delirium, decreased risk of respiratory compromise, and shortened length of stay.
A SIMPLE STEP
As hospitals continue to focus on improving patient safety, the number of helpful resources and safe practices grows every day. In fact, caregivers can easily become overwhelmed with new tasks and responsibilities. That’s why the UP Campaign emphasizes the need for simple, easy-to-accomplish activities.
The leaders at Clark Memorial Hospital in Jeffersonville can attest to the effectiveness of this approach. A small change in procedure has had a big impact on the hospital’s efforts to prevent VAEs.
“We’d been doing the work everyone is doing: deep suctioning every six hours, turning patients every two hours, and so on,” said Chassidy Bibb, director of critical care. “But last January, we also told our aides we wanted them to focus on oral care and getting patients up. We returned the rest of the work to the RNs.”
The simple change has paid off: Since February 2017, Clark Memorial has had a ventilator-associated condition rate per 1,000 ventilator days of 0.
“We didn’t see the bang for the buck at first, but now we do,” Bibb said.
CHECKS AND BALANCES
In addition to redefining roles, Clark Memorial has emphasized communication and collaboration among caregivers.
“Our staff is really good at watching the patients,” said Scott Yates, director of respiratory therapy services. “They don’t hesitate to say, ‘We have the potential for a VAE; what’s going on?’ They have really bought into what we do, and we have a strong system of checks and balances.”
Yates noted that it’s not just the frontline staff who have bought in to the system. Leadership also has been instrumental in the team’s success.
“We have strong backing from our medical director, Dr. Rahel Teferra. She’s very patient-centered and has helped us tremendously,” Yates said.
Bibb pointed out that it’s important to communicate with all employees when it comes to patient safety. She first learned about the UP Campaign at the Indiana Patient Safety Center’s Patient Safety Summit last June.
“We’ve hung up the UP Campaign posters around the hospital,” she said. “They’re very catchy, and they’re great resources for our staff.”
IHA is hosting a four-part WAKE UP webinar series to help hospitals with appropriate opioid and sedation management to reduce unnecessary sleepiness and sedation. The first webinar was held Jan. 23, and the remaining webinars will be Feb. 20, March 6, and March 20. For more information or to view past webinars, please visit IHAconnect.org.