Deploying 5 Million Lives Campaign across Iowa
Building on the success of its nationwide 100,000 Lives Campaign to reduce
preventable deaths in U.S. hospitals, the Institute for Healthcare Improvement
(IHI) launched the 5 Million Lives Campaign (5M Campaign) to protect
patients from 5 million instances of medical harm over a two-year period: December 2006
to December 2008.
The 5M Campaign challenges American hospitals
to adopt 12 changes in care that save lives and reduce
patient injuries. IHI research indicates an estimated
15 million incidents of medical harm occur in U.S.
hospitals each year. Applying that methodology to
Iowa means an estimated 145,000 incidents of harm
occur within the 367,000 annual
hospital admissions in Iowa.
IHC is the Iowa field office
or "node" for the 5M Campaign,
working to convene participation
from all 117 Iowa community
hospitals, share success stories and techniques to
deploy campaign initiatives in an "all teach, all learn"
environment, and track adoption of best practices.
Iowa is one of only seven states in the nation to
achieve 100 percent campaign participation.
IHC developed seven clusters of associated
campaign initiatives and established specific
Iowa goals for each. Reporting on each measure
is rigorously tracked, as hospitals work toward
deploying relevant best practices in their facility.
IHC provides hospitals with ongoing
education, and we're pleased to report
steady progress toward deployment
on each measure. Generally, hospitals
in the state have tripled their full
implementation of these initiatives
over the past 18 months.
Together, IHC and IHI hope to equip Iowa
providers to prevent more than 48,000 incidents of
medical harm by December 2008.
Six interventions from the
100,000 Lives Campaign:
- Deploy rapid response
teams at the first sign of
patient decline
- Deliver reliable,
evidence-based care for
acute myocardial infarction
to prevent deaths from
heart attack
- Prevent adverse drug
events by implementing
medication reconciliation
- Prevent central line
infections by implementing
a series of interdependent,
scientifically grounded steps
- Prevent surgical site
infections by reliably
delivering the correct
perioperative antibiotics at
the proper time
- Prevent ventilatorassociated
pneumonia
by implementing a series of
interdependent, scientifically
grounded steps
New interventions targeted at harm:
- Prevent harm from
high-alert medications,
starting with a focus on
anticoagulants, sedatives,
narcotics and insulin
- Reduce surgical
complications by reliably
implementing all changes
recommended by the
Surgical Care Improvement
Project
- Prevent pressure ulcers
by reliably using sciencebased
prevention guidelines
- Reduce methicillinresistant
staphylococcus
aureus (MRSA) infection
by reliably implementing
scientifically proven
infection control practices
- Deliver reliable,
evidence-based care for
congestive heart failure, to
avoid readmissions
- Get Boards on board by
defining and spreading
the best-known leveraged
processes for hospital
boards of directors, so
they can more effectively
accelerate organizational
progress toward
safe care
Simple steps prevent ventilator-associated pneumonia at Mercy Medical Center
Patients in critical care often need the help of a ventilator to breathe.
However, this lifesaving device brings with it the danger of ventilator-associated
pneumonia (VAP)-a serious, potentially fatal lung infection. Following a series
of interdependent, scientifically-grounded steps called the "Ventilator Bundle" can
greatly reduce VAP risk.
"Anytime you have a foreign object in the body, you have increased risk of
delivering bacteria into the patient's system," explains Monica Gordon,
RN, clinical safety coordinator for Mercy Medical Center in Des Moines.
"When a patient is intubated, there is a direct route for bacteria to travel
through the tube into the patient's lungs. The Ventilator Bundle helps us
assure that the right care is given to all intubated patients all the time.
Performing daily weaning trials and elevating the head of bed unless
contraindicated are two key components of the bundle."
Mercy began implementing the Ventilator Bundle as part of a
critical care patient safety project in one of the hospital's four critical
care units in 2004, and rolled it out to the remaining units in 2005.
A multi-disciplinary team including physicians, nurses, respiratory
therapists, physical therapists, pharmacists, pastoral care staff, social
workers and dieticians collaborate on daily rounds to ensure an appropriate plan of care is established
for each patient.
"Nurses learned that a 30 degree bed elevation is higher than we think, and we monitor this
through regular auditing at the patient's bedside. We collaborated with respiratory therapists to
evaluate the patient every day to determine if he or she can be taken off the ventilator," Gordon says.
"The Ventilator Bundle has done a great service to our patients and has changed my practice for
the better," says Heather McClain, RN, in the Mercy Intensive Care Unit. "When a patient comes to us
intubated or when we intubate a patient in the unit, I now have a clear vision of all the important details
involved in the change of their plan of care."
Mercy measures VAP by the number of days any patient is on a respirator (device days), because
Gordon says the longer a ventilator tube is in a patient's throat, the higher the risk of getting infection.
The hospital averages 100 ventilator days per month among its four adult critical care units, and has
experienced no VAPs in 11 of the past 18 months. The coronary care unit hasn't had a VAP since
March 2005.
"Most VAPs are preventable, so we look at every VAP very closely to determine if anything should
have been done differently. Each one means a lot to us and we want to learn from it," Gordon says.
"Anytime you can avoid infection and unnecessary antibiotics, it is a huge health benefit for patients.
It also decreases the length of hospital stays, which saves both the hospital and the patient money."
New interventions targeted at harm: