Preventing five million injuries will require hospital-inspired initiatives, efforts

Nurse Leader Insider, February 12, 2007

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The Institute for Healthcare Improvement's (IHI) new Five Million Lives campaign's initiatives combine no-nonsense clinical steps with big-picture moves to present a broad range of options for hospitals to reduce harm from injuries.

The IHI laid out the following six new interventions for hospitals during its National Forum on December 12, 2006:

  • Prevent Methicillin-resistant Staphylococcus aureus (MRSA) infection by implementing scientifically-proven infection control practices throughout the hospital
  • Reduce harm from high-alert medications starting with a focus on anticoagulants, sedatives, narcotics, and insulin
  • Reduce surgical complications by implementing the changes in care recommended by the Surgical Care Improvement Project (SCIP)
  • Prevent pressure ulcers by using science-based guidelines for prevention of this serious and common complication
  • Deliver reliable, evidence-based care for congestive heart failure to reduce readmissions
  • Get boards involved by defining and spreading new and leveraged processes for hospital boards of directors so they can become more effective in accelerating the improvement of care

Each initiative offers its own challenges for hospitals, and the IHI admits that the overall goal of five million lives is ambitious. IHI President Don Berwick, MD, told the assembled crowd during the National Forum that reaching five million would require efforts beyond the six new initiatives outlined.

"This would be the biggest impact on patient safety certainly in the modern history of healthcare," he said during a December 12, 2006, press conference.

Many hospitals are already working on these initiatives, according to Berwick. The SCIP recommendations are already in place in about 500 hospitals, and there are several examples of hospitals that have tackled other initiatives (e.g., pressure ulcer prevention).

Many of the new initiatives are extensions of the procedures and practices introduced in the 100,000 Lives campaign, according to Berwick.

For example, the new high-alert medication initiative has roots in the 100,000 Lives medication reconciliation initiative, and the MRSA prevention initiative is an offshoot of central-line-infection prevention.

Linking the initiatives with other efforts
The initiatives selected are meant to complement other patient safety efforts in healthcare, such as The Joint Commission's National Patient Safety Goals and National Quality Forum (NQF) Safe Practices, according to IHI Vice President Joe McCannon. A matrix comparing the campaign's initiatives with other patient safety requirements and recommendations is available on the IHI's Web site (

Source: Briefings on Patient Safety, February 2007, HCPro, Inc.

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