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Rethink your facility's procedures to help improve ICU safety

Nurse Leader Weekly, July 22, 2005

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Improving safety in the intensive care unit (ICU) is a critical but challenging goal. During the seventh annual National Patient Safety Foundation Congress, Lisa Schilling, RN, MPHc, director of VHA's Transformation of the ICU national collaborative, told attendees that improvement can be accomplished by rethinking how we care for patients. Instead of focusing on specific best practices, the seminar examined how to structure your team to adopt and implement new, better practices to reduce infections and save lives.

Making improvements is critical, said Schilling. By studying your organization's current practices, measuring effectiveness, and developing new strategies based on proven methods, you can achieve life-saving results.

However, change is difficult. Although benchmarking, dense tool books, and incentive systems have some effect, nothing has created sustained improvements in the ICU, said Schilling. The goal of the Transformation in the ICU program was to create a new way of thinking about safety improvement.

After measuring your performance, build a team to redesign your process. Start small when implementing a new procedure; measure the improvement and then spread innovations that work throughout the unit.

Start with leadership because buy-in from the top levels in the hospital trickles down to create a focus on safety improvement, said Schilling.

By strictly following ventilators, catheters, and head elevation procedures, you greatly reduce the prospects of infection in the ICU, said Schilling. In fact, Schilling said the participating ICUs showed an 18% reduction in mortality rate, an 11% reduction in the average length of stay for an ICU patient, and a 41% reduction in ventilator-related pneumonia.

Staff trainer

You can use the following questions as a fun scavenger hunt to help familiarize your staff with the location of critical safety equipment.
1. List the location of the fire extinguisher(s) in your department.
2. What is the safety officer's middle name?
3. Where is the oxygen shut-off in your department (if any)? Who shuts it off in an emergency?
4. Collect a blank sticker used to document that preventive maintenance has been completed.
5. Make a copy of the confidentiality statement signed annually by each employee.
6. What is printed on the back of your photo identification?
7. Locate the evacuation route in your department. What do you use to exit?
8. How long do you have to complete an incident report? (Hint: The policy is in the admin policy book.)
9. Where is the command center set up during a disaster? (Hint: The emergency management plan has this info.)
10. Where is the employee health office?
11. Who is the director of infection control?
12. Find the patient handbook. What does it say about wristbands?
 
 
Source: Adapted from Briefings on Patient Safety (July 2005), published by HCPro, Inc.

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