Innovation Spotlight: New York Hospitals Are Improving Health, Enhancing Quality, and Reducing Costs.

Oneida Healthcare Reduces Central-Line Associated Bloodstream Infection

Central-line associated bloodstream infection (CLABSI) is the costliest healthcare-associated infection, roughly $46,000 per instance, and can lead to prolonged hospital stays and mortality. However, most cases are preventable. Striving to diminish CLABSI, Oneida Healthcare created a task force to evaluate its processes related to central lines.

Using current evidence-based and best practice guidelines, Oneida Healthcare’s multidisciplinary task force conducted a complete review of patients with reported CLABSI and reviewed vascular access policies, procedures, practices and equipment. A vascular access audit tool was created and the infection prevention nurse, nurse educator and vascular access nurse initiated regular rounds on all applicable patients. They observed practices, corrected deficiencies and problem-solved at the bedside. The task force met bi-monthly to review audits and evaluate policies. They then reviewed and collated the information obtained from rounds and created a cause-and-effect document. This helped the team identify short- and long-term goals with respect to reaching a target of zero.

Since creation of the task force, central line insertion kits and standardized antiseptic have been instituted for all intravenous therapy. The intensive care unit has been without a CLABSI since 2008; the medical/surgical unit has been without CLABSI since 2012.

For more information, contact Jeanne T. Miller, RN, BSN, CIC, Manager, Infection Prevention/

Employee Health, Oneida Healthcare, at (315) 363-6000, ext. 1338 or at jemiller@oneidahealthcare.org.

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Cohen Children’s Medical Center Addresses Needs of Children with Neurobehavioral Disorders

Providing quality care to children with neurobehavioral disorders can be a challenge for providers. These patients require specialized treatment processes to ensure the best outcomes. Hoping to address the unique needs of this population, Cohen Children’s Medical Center (a member of Northwell Health), created the BEE MindfulTM program.

BEE Mindful includes an interactive educational module designed to provide staff with a visual and auditory depiction of how a child with a neurobehavioral disorder hears and sees. It also includes a pediatric neurobehavioral assessment tool (PNAT) which allows staff to identify a child’s unique needs with appropriate, safe, quality interventions of care. This ensures that patients with special needs can be cared for in a manner that is safe and specific to their care requirements. The program alerts all team members to be mindful of the individual needs of each child prior to interaction.

After the program was implemented, length of hospitalization decreased by two days, bringing it below the national average. Use of physical restraints in general pediatric medical-surgical units decreased 63%. The annual cost avoidance due to the program is $437,000.

For more information, contact Jennifer L. Simonetti, RN, MSN, CPN, Assistant Director, Nursing, Magnet Program, at (718) 470-3249 or at jsimonet@northwell.edu or Sharon Goodman, RN, MA, CPNP, Assistant Director, Nursing, Pediatric Service Line, at (718) 470-3178 or at sgoodman3@northwell.edu.

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University of Vermont Health Network – Champlain Valley Physicians Hospital Battles Malnutrition

Studies estimate that nearly one out of five pediatric patients and one out of three adult patients aged 60 and older are malnourished. Malnourished patients often experience longer lengths of stay, higher rates of complications, mortality and increased costs. The University of Vermont Health Network – Champlain Valley Physicians Hospital (UVM Health Network – CVPH) formed a malnutrition steering committee to combat malnourishment.

UVM Health Network – CVPH’s malnutrition steering committee implemented best practice guidelines through a phased approach, focusing on screening for malnutrition characteristics: weight loss, appetite, functional grip strength, fluid accumulation, muscle loss and fat loss. Findings are used to create a patient-centered care plan and treatment. Hand dynamometers were introduced to measure grip strength and clinical staff were educated on screening standards with improved electronic medical record integration. Physician, nursing and nutrition staff were educated on screening techniques and assessment.

From 2013 to 2017, readmissions of medically malnourished patients decreased from 32.6% to 17.7%. Malnutrition diagnoses increased from 109 to 744. Length of stay was reduced from 20.4 days to 14.5 days. Dietician capture rate improved from 52.7% to a peak 82.4%. Capture of the acute care malnourished population improved, from 25.4% to 39.3% at admission and from 30.8% to 57.8% during stay.

For more information, contact Eric Gadway, RN, BXN, CMSRN, ONC, Supervisor, Clinical Operations, CVPH, at (518) 562-7765 or at egadway@cvph.org, or Shey Lawrence Schnell, MHA, RD, Director, Food and Nutrition Services, CVPH, at (518) 562-7717 or at sschnell@cvph.org.

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Wyoming County Community Health System Decreases Medication Errors

Medication-related complications due to error are a serious concern for hospitals dedicated to maintaining patient safety. These preventable errors can increase the length of stay for patients and healthcare costs for the hospital. Aiming to reduce instances of medication error, Wyoming County Community Health System (WCCHS) began a robust reporting process.

In 2012, WCCHS began reporting each incident of medication error to the Quality Board of Managers. Each incident is investigated and shared with nursing, providers, and pharmacy. This is key, as medication errors are not solely a nursing issue. Errors are reviewed by each department manager with frontline staff, as well as in monthly department-specific meetings. The event is then routed to “Shed Med,” a specialized committee that discusses and brainstorms causes and solutions. In this non-punitive process, each medication error is used as an educational opportunity for improvement to encourage the reporting of errors among staff.

WCCHS staff have an increased sense of responsibility and accountability. The hospital went from 63 medication errors in 2013 to just 16 in 2017.

For more information, contact LuAnne Roberts, BSHA, Coordinator, Quality and Risk Management, Wyoming County Community Health System, at (585) 786-8940, ext. 4877 or at lroberts@wcchs.net.

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Erie County Medical Center Reduces Geropsychiatric Falls

It is commonly known that senior patients are at risk of falling due to physiological factors; however, geriatric patients can also face psychiatric risks of falling brought on by confusion, use of psychotropic medications, and electroconvulsive therapy. In 2016, Erie County Medical Center (ECMC) began a falls reduction improvement program to focus on preventing geropsychiatric falls.

A multidisciplinary team was created to proactively identify patients at high risk for falls and a geriatric medical team was established to work closely with them to address risks. Occupational therapy staff scheduled conditioning groups and physical therapy on the unit to help reduce falls. A “Fall Patrol” was also established, in which a direct care staff member was assigned to three high-risk patients each shift. Assignment to the Fall Patrol is rotated among staff and a fall huddle is conducted during shift changes to review at-risk patients and identify the three patients for Fall Patrol for the next shift.

Two years after beginning its initiative, ECMC reduced geropsychiatric falls by 56%. Additionally, a culture of mindfulness, urgency, and heightened awareness was established among hospital staff when addressing fall prevention.

For more information, contact Matthew P. Warne, AAS, RN, Team Leader, Erie County Medical Center, at (716) 898-4776 or at mwarne@ecmc.edu or Jillian Brown, MSW, RN-BC, Clinical Manager, Behavioral Health, at (716) 898-5817 or at jbrown4@ecmc.edu.

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