Outcomes

Quality of Care

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Adverse Health Events Patient Falls Medication Errors Healthcare Associated Infections

Adverse Health Events

   

 

 

INTERPRETATION: Adverse health events are extremely rare medical errors that are serious and often preventable. We are required to report adverse health events to the Minnesota Department of Health. We had three pressure ulcers in the latest time period. Click here for more details.

WHAT WE ARE DOING TO IMPROVE: We are part of a national collaborative to reduce serious safety events through shared learning and analysis.

DATA SOURCE: Safety Learning Reports

BENCHMARK DATA: None available.

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Patient Falls

 

INTERPRETATION: We had no falls that resulted in an injury to the patient in the most recent two quarters.

WHAT WE ARE DOING TO IMPROVE: Children's has a hospital- wide improvement initiative to quickly identify patients who may be at risk for falling and keeping them safe.

DATA SOURCE: Safety Learning Reports

BENCHMARK DATA: Not available

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Medication Errors

 

 

INTERPRETATION: We are currently above our goal for 2011.

WHAT WE ARE DOING TO IMPROVE: We have multiple projects in place to reduce medication errors.

DATA SOURCE: Children's Pharmacy and Safety Reports

BENCHMARK DATA: Not available

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Healthcare Associated Infections

What is a HAI?

HAIs are infections that patients get during the course of receiving treatment for other conditions while in a healthcare setting.

Who is at risk for a HAI?

Any patient in the hospital may be at risk for a HAI. The amount of risk each patient is at depends on the reason for their hospitalization, the type(s) of procedure(s) being performed while they are in the hospital, the patients own immune system, medications they may be on, and the way the infectious agent is transmitted.

Why do we measure HAIs?

Patient safety is our top priority. There are steps that can be taken to help prevent HAIs. Our goal is to see continuous improvement in reducing HAIs. The HAIs being reported were chosen because they are meaningful in pediatrics, they have a national benchmark available for comparison, and are some of the most common HAIs that occur.

What is the most important thing I can do to prevent a HAI?

Prevention of HAIs starts with hand hygiene (washing with soap and water or using an alcohol based hand sanitizer). It is important for everyone entering and leaving a patients room to perform hand hygiene every time. This includes all healthcare workers, as well as patients, family members and other visitors. If you see someone enter your room without performing hand hygiene, it is okay to speak up and ask them to wash their hands.

 

 

 

INTERPRETATION: Children’s had zero CLABSI’s in our Pediatric Intensive Care Units in the most recent quarter.

WHAT WE ARE DOING TO IMPROVE: Children's has implemented central line "bundles" in the Pediatric Intensive Care Unit. "Bundles" are a set of best practices used to prevent infections when inserting and maintaining lines. We monitor adherence to the bundles and provide ongoing education to staff.

DATA SOURCE: Children's Infection Prevention and Control Surveillance Data.

WHAT WE ARE MEASURING: Central line associated bloodstream infections (CLABSIs) in the pediatric intensive care units (PICUs). CLABSIs are measured as a rate of the number of infections per 1000 central line days (a central line day is defined as one patient with a central line in place for one day). Measuring by rates allows us to compare ourselves to other Children's hospitals.

WHY WE ARE MEASURING THIS: Patient safety is our top priority. There are important steps that need to be followed when placing and caring for central lines in order to prevent CLABSIs. Learn about CLABSIs and ways you can help prevent CLABSIs.

HOW DO WE MEASURE THIS: CLABSIs are measured using the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) definitions.

BENCHMARK DATA: "National Healthcare Safety Network (NHSN) Report, Data Summary for 2009, Device-associated Module". Published by the Association for Professionals in Infection Control and Epidemiology, Inc. (Am J Infect Control 2009;37:783-805).

 

 

INTERPRETATION: Children's Central Line Associated Bloodstream Infections (CLABSI) rate is similar to the national average reported for other Neonatal Intensive Care Units. Our ultimate goal is to have zero CLABSI’s.

WHAT WE ARE DOING TO IMPROVE: Children's has implemented central line "bundles" in the Neonatal Intensive Care Unit. "Bundles" are a set of best practices used to prevent infections when inserting and maintaining lines. We monitor adherence to the bundles and provide ongoing education to staff.

DATA SOURCE: Children's Infection Prevention and Control Surveillance Data

WHAT WE ARE MEASURING: Central line associated bloodstream infections (CLABSIs) in the neonatal intensive care units (NICUs). CLABSIs are measured as a rate of the number of infections per 1000 central line days (a central line day is defined as one patient with a central line in place for one day). Measuring by rates allows us to compare ourselves to other Children's hospitals.

WHY WE ARE MEASURING THIS: Patient safety is our top priority. There are important steps that need to be followed when placing and caring for central lines in order to prevent CLABSIs. Learn about CLABSIs and ways you can help prevent CLABSIs.

HOW DO WE MEASURE THIS: CLABSIs are measured using the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) definitions.

BENCHMARK DATA: "National Healthcare Safety Network (NHSN) Report, Data Summary for 2009, Device-associated Module". Published by the Association for Professionals in Infection Control and Epidemiology, Inc. (Am J Infect Control 2009;37:783-805).

 

 

INTERPRETATION: A Ventriculoperitoneal (VP) Shunt procedure is a brain surgery that is done to relieve pressure inside the skull due to excess cerebrospinal fluid. We had three infections in the latest time period. Our ultimate goal is to have zero infections.

WHAT WE ARE DOING TO IMPROVE: A SSI Prevention Committee was established in 2011 and VP Shunt SSI reduction is a focus of this committee.

DATA SOURCE: Children's Infection Prevention and Control Surveillance Data

WHAT WE ARE MEASURING: Surgical Site Infections (SSIs) that develop after a Ventriculoperitoneal Shunt (VP) procedure. VP Shunt SSIs are measured as a rate of the number of infections per 100 procedures (VP shunt insertion and revision procedures). Measuring by rates allows us to compare ourselves to other Children's hospitals.

WHY WE ARE MEASURING THIS: Patient safety is our top priority. There are important steps that need to be followed when performing an operative procedure in order to prevent SSIs. Learn about SSIs and ways you can help prevent SSIs.

HOW DO WE MEASURE THIS: SSIs are measured using the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) definitions. Per the CDC NHSN SSI definitions, there is a 1 year follow-up period for surgical procedures where an implant is left in place, so the most current data available is from 1 year prior to now.

BENCHMARK DATA: "National Healthcare Safety Network (NHSN) report: Data summary for 2006 through 2008, issued December 2009". Published by the Association for Professionals in Infection Control and Epidemiology, Inc. (Am J Infect Control 2009;37:783-805)

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“The nurses at Children's saw that my son got the help he needed, and that I received the reassurance I needed.” Read the full story.