Quality Outcomes Safety

According to the Agency for Healthcare Research and Quality (AHRQ), every year somewhere between 700,000 and 1,000,000 people in this country have a fall in a hospital. An inpatient who falls has the possibility of sustaining injury such as fractures, lacerations or internal bleeding.

Every patient diagnosed with cancer regardless of age, has a higher chance of falling. The goal of the Fall Prevention Program at Roswell Park is to identify the patient who is at risk to fall, reduce that risk and provide a safe environment. Several interventions to reduce patient falls have been implemented at Roswell Park. They include: a signed safety agreement between patient and nursing staff, a fall risk assessment scale to determine low, moderate and high risk patients, safety interventions that are initiated based on risk category — like bed and chair alarms and door magnets, slipper socks with improved grips for all patients, an educational brochure on preventing falls provided to each patient and a multidisciplinary team huddle performed if a fall event occurs.

Our patient fall data reflects a downward trend from 2011 to 2013. The rate is measured by number of falls per 1,000 inpatient days. The goal is to have the rate lower than the target. We remain lower than the national oncology mean and continue to strive to get our rates even lower.

 

A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or friction. The Pressure Ulcer Prevention Program at Roswell Park focuses on evidence based practices to identify patients at risk and implement prevention strategies for all patients who are identified as being at risk. Major strategies for pressure ulcer prevention include: conducting a pressure ulcer admission assessment for all patients, daily risk assessment on all patients, daily skin inspections, keeping the patient dry and moisturizing the skin, reviewing nutritional factors and assessing hydration and minimizing pressure especially over bony prominences. Patients with limited mobility are especially at risk for the development of pressure ulcers. Every effort is made to continually redistribute the pressure on the skin.

Data is collected daily on pressure ulcer incidence. The rate is measured by the number of pressure ulcers over the number of patient admissions. The goal is to have rates lower than the target. Our rates are lower than the national oncology mean, but we continue to strive for even lower rates.

 

A central line associated blood stream infection (CLABSI) is an infection confirmed by a laboratory test which pinpoints that the infection must be related to a central line. A central line is a long, thin flexible tube that is used to deliver medicines, fluids, nutrients or blood products over a long period of time, eliminating the need to use needles for each application.

At Roswell Park, we have taken note of the national initiatives to decrease CLABSI and have performed better than the national benchmark for the past two and a half years. But this does not mean we have grown complacent. Our infection control team maintains the most current and best practice, leading to the following initiatives over the past few years. We have implemented the use of a biopatch, which is a patch that surrounds the insertion site of the catheter and continually releases antimicrobial protection. In addition, we have implemented a standardized central line insertion kit, which gives the provider everything they need to more safely perform the task of insertion. Also, we have a prompt through the Electronic Medical Record which makes the provider determine the necessity of the central line. Lastly, very recently we have started to use alcohol impregnated caps, which replace the old method of scrubbing the hub of the catheter prior to insertion. Studies have shown a dramatic decrease in CLABSI with this intervention.

 

A Catheter Associated Urinary Tract Infection (CAUTI) is an infection that results from the use of a catheter, which is a device to collect urine from a patient while they are unable to use a toilet. The actual infection is one that involves the organs or structures of the urinary tract itself, (which includes the kidneys, ureters, bladder and urethra). Symptoms of a UTI include burning and/or pain in the lower portion of the abdomen, burning during urination or an increased number in the times the person urinates. According to the Centers for Disease Control and Prevention (CDC), Urinary Tract Infections are the most common health care associated infection.

Roswell Park has performed at or better than the national benchmark in regard to UTIs for the past two and a half years. Our infection control team maintains the most current and best practice, leading to the following initiatives over the past few years. First, we have a bladder screening protocol that monitors both urine removal and the amount that still remains in the bladder. Second, we have taken the time to educate staff to new procedures. Lastly, we have instituted an electronic method that prompts our providers to review the necessity of a catheter on a patient. Removal of an unnecessary catheter helps decrease the risk of acquiring a UTI.

 

As a result of the passage of the Affordable Care Act, one of the requirements that affects Roswell Park and all other PPS Exempt Cancer Centers is a provision that asks for public reporting of quality measures. The Centers for Medicaid and Medicare Services (CMS) have contracted with the American College of Surgeons (ACoS) to act as the intermediary for the collection of the reporting of quality measures for PPS Exempt Hospitals, where Roswell Park is one of 11 hospitals nationwide that fit these criteria. Through this partnership, three measures were identified and have been tracked since October of 2012. Below are the results of the initial measurement. Roswell Park has achieved a perfect score in all three measures, which have been agreed upon by a collection of different groups (The Commission on Cancer, American Society of Clinical Oncology, National Comprehensive Cancer Center Network and the National Quality Forum) as the best evidence based on validated measures to use for this subset of hospitals. View the specifications of these measures in more detail.