QUALITY IMPROVEMENT INITIATIVES  

• Porter Medical Center Fall Prevention
  
  Goal: To reduce harm from inpatient falls by decreasing the number of falls.
  
  Porter Hospital has been successful at maintaining a low rates of falls for our inpatients. There are many factors which may increase a patient’s’risk of a fall during an inpatient stay. Being in an unfamiliar environment, medical equipment, illness and medications are a few examples of factors that increase a patient’s risk.
  
  At Porter Hospital we have increased the frequency in which we review a patients’ risk factors for falls. As an inpatient, situations change frequently. An assessment had only been done upon admission for fall risk. These risk factors are now reviewed daily to determine potential of a fall. We anticipate there will be a further decrease in our fall numbers for 2008.
  
  The team that reviewed this process also developed a trigger to remind the nursing staff of those patients at increased risk. The falling star symbol is a visual reminder for staff not assigned to the patient of that patient’s risk for fall. The diligence of the nursing staff’s increased surveillance is key to reducing falls.
  
  
• Safety in Anticoagulation Therapy
  
  Anticoagulants (blood thinners) are given to patients who are at risk for formation of blood clots which can result in life threatening medical conditions. They are commonly used as a preventative for patients in the hospital undergoing surgery or having mobility issues due to their illness.
  
  Achieving a safe and therapeutic dose is key in preventing bleeding complications. So much so that JCAHO (Joint Commission) expects all hospitals to implement steps to reduce likelihood of harm from anticoagulation therapy by 2009.
  
  In an effort to assure safe delivery of anticoagulation therapy at Porter, we have assembled an interdisciplinary team of clinical staff including pharmacists, nurses and doctors to develop specialized protocols. Using current standards of care, this group will exam our practices and update the way we order, administer and monitor anticoagulation therapy.
  
  As an additional safety net, this team is also investigating implementing a mechanism for certain patients to have access to “at home” testing to assure continued safe therapy after discharge.
  

• Porter Medical Center Bedside Communication
  Goal: To improve the level of communication among patient, patient’s family and nursing staff regarding the patient’s healthcare issues. This process will effect a higher level of professional nursing practice at the bedside by giving the nurse complete information shared by both their peer and the patient.
  
  Porter Hospital’s Medical/Surgical unit has developed a team to focus on Transforming Care at the Bedside. After educational seminars provided by the Institute of Healthcare Improvement, a team of dedicated Nursing staff, Administrator and managers have collaborated to develop this positive process change.
  
  Historically, at the end of each shift, nurses gather behind a closed door and give a report to the oncoming shift. In the new process, the “on” coming nurse and the nurse “going off” duty go to the patient’s bedside. After obtaining patient approval, the nurse with patient input, explain events that took place during the last shift for that patient. The communication could include information regarding goals, medications, upcoming diagnostic tests or procedures. Patients have an opportunity to add, question and learn during this time.
  
  This new method of reporting was started in December 2007. We started with a few patients and are expanding it to include all patients that wish to participate on the Medical/Surgical unit. Patients who have been surveyed have responded positively. Most say that it gives them a sense of security knowing what is “going on”.  

Quality Improvement Contact Information

Diane Haughney, Perf. Improvement/Risk Mgt. Department
Porter Hospital
115 Porter Drive
Middlebury, VT 05753
802 388-5609

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