Special Section: Health Care Reform

IHI 5M Lives Campaign

Transforming health care in Oregon

The initiatives and the presentations

Deliver reliable, evidence-based care for congestive heart failure to reduce readmissions. Mid-Columbia Medical Center, The Dalles.

Sue Lydic, Legacy Health System

Deploy Rapid Response Teams at the first sign of patient decline and before catastrophic cardiac or respiratory event. Legacy Health System.

Prevent surgical site infections by following a series of steps, including reliable, timely administration of correct perioperative antibiotics. Willamette Falls Hospital, Oregon City.

Reduce surgical complications by reliably implementing the changes in care recommended by the Surgical Care Improvement Project (SCIP). Legacy Health System and Legacy Good Samaritan Hospital, Portland.

Get boards on board by defining and spreading new and leveraged processes for hospital boards of directors, so they can become far more effective in accelerating the improvement of care. Mountain View Hospital, Madras.

Get boards on board. Salem Hospital.

Deliver reliable, evidence-based care for acute myocardial infarction (AMI) to prevent deaths from heart attack. Tillamook County General Hospital.

Care for AMI. Rogue Valley Medical Center, Medford.

Prevent ventilator-associated pneumonia (VAP) by implementing a series of interdependent, scientifically grounded steps. Sky Lakes Medical Center, Klamath Falls.

Cindy Hiday, Adventist Medical Center

Prevent VAP. Adventist Medical Center, Portland.

Prevent Methicillin-Resistant Staphylococcus Aureus (MRSA) infection by reliably implementing scientifically proven infection control practices throughout the hospital. Southern Coos Hospital, Bandon.

Prevent MRSA. Portland Veterans Administration Medical Center.

Prevent pressure ulcers by reliably using science-based guidelines for prevention of this serious and common complication. Providence Milwaukie.

Prevent pressure ulcers. Kaiser Sunnyside Medical Center, Clackamas.

Prevent central line infections by implementing a series of interdependent, scientifically grounded steps. Grand Ronde Hospital, La Grande.

Prevent central line infections. Providence St. Vincent Medical Center, Portland.

Reduce harm from high-alert medications starting with a focus on anticoagulants, sedatives, narcotics, and insulin. Three Rivers Community Hospital, Grants Pass.

Prevent Adverse Drug Events by implementing medication reconciliation. Portland Veterans Administration Medical Center.

On May 8 in Portland, representatives of 18 Oregon hospitals shared their care-improvement projects May 8 at the Oregon 5M Lives Network’s “Transforming Health Care in Oregon” conference.

Here are a few of their stories:

Solving with (fairly) simple solutions

Willamette Falls Hospital in Oregon City took on surgical site infections, with financial assistance from CareOregon’s Care Support and System Innovation (CSSI) program.

The hospital is small, so finances are always tight, and as a community hospital, it has a high profile, said Terry Wynkoop, RN, Director of Perioperative Services.

“Our reputation is on the line every time we do surgery,” he said.

The physician response to improvement efforts, while simple on the surface, took “a lot of arm twisting,” Wynkoop said, especially because most physicians are independent of the hospital.

Among the steps: A form is filled out before the surgical patient arrives at Willamette Falls. This helps enforce an evidence-based protocol to infuse antibiotics one hour before surgery.

Before, compliance with the protocol was 48 percent. Now it’s 98 percent, Wynkoop said. The form also gives the pharmacy department time and opportunity to review the type and effectiveness of antibiotics for each surgical patient.

Getting the front line involved

Legacy Health System faced the challenge of making changes in a five-hospital system that shares policies and procedures, documentation, and standards of care. With financing from CSSI to mine data to measure outcomes, Legacy addressed surgical complications.

“It’s easy, within that integrated system, to think that high-level planning works,” said Cheryl Purvis, RN, BSN.

But that was not the case

“What we heard from physicians and nurses was, ‘This makes no sense. This is not how we work,” she said.

So they changed the process so that people from the front lines are involved. And that has made the difference.

“It’s exciting to get our physicians involved looking at the evidence,” Purvis said.

Getting buy in

Sky Lakes Medical Center in Klamath Falls addressed ventilator-associated pneumonia. The project included setting up processes and education about procedures proven to reduce such pneumonia.

Critical to overcoming the challenges were continuous education and communication with nurses, respiratory therapy staff and physicians, and between shifts, said Robyn Ewing, RN, BSN, critical care unit staff nurse.

“Education and feedback brings buy in and accountability, she said.

Speaking a common language

CSSI funding trained the project team in the “Plan, Do, Study, Act” (PDSA) process of quality improvement.

While valuable for the trained staff, the PDSA model wasn’t getting through to the rest of the hospital staff, said Carolyn Kozik, RN. So the team adapted PDSA principles specifically for the project.

“We created a set of questions to answer, in language that made sense to the participants,” she said. “It helped focus the group.”