ELLSWORTH — It may be as simple as removing little-used medications or reorganizing a crash cart, but it could have a big effect on patient safety. That’s the hope of staff at Northern Light hospitals, including Maine Coast and Blue Hill, who are in the midst of implementing new protocols aimed at reducing errors.
Behind heart disease and cancer, medical errors are the third leading cause of death in the United States, according to a 2016 Johns Hopkins study analyzing medical death rate data over an eight-year period.
The errors are not necessarily because doctors are bad at their jobs, researchers argue, but because there are systemic issues, such as poorly coordinated care, fragmented insurance networks, the absence or underuse of safety nets and other protocols that undermine patients’ safety.
“About two years ago, we started looking at different programs for patient safety within hospitals,” said Daryl Boucher, vice president of nursing and patient care services, in a video released by Northern Light earlier this year. “As a system, we didn’t have a standardized way to really develop safety programs. Each member organization was doing their own thing.”
Staff got together and developed lists for each department in which patient injuries happen most frequently and examined how they happen, prioritizing those lists and trying to figure out “what’s the highest risk event that could happen here.”
The teams are using a program developed by Johns Hopkins known as Comprehensive Unit Based Safety Program, or “CUSP.”
“It’s really staff-driven,” said Emily Tolman, director of patient engagement for the organization. “The focus is on reducing patient harm.”
There are a lot of different parts to CUSP, but staff at Northern Light emphasized that one of its strengths is that it brings together staff from disciplines across the hospital and involves those on the frontlines of care, such as nurses and technicians, who have a lot of contact with patients.
At Northern Light AR Gould Hospital in Presque Isle, for instance, one of the potential problems staff identified was the “crash carts,” the wheeled carts with materials, drugs and devices used in emergencies.
“When staff were responding to a code on the floor [as opposed to in the emergency department], they were having a hard time finding different items because their carts were organized differently,” said Certified Nursing Assistant Natasha Tompkins.
“We had three of our own crash carts, which were built by [emergency department] nurses,” said Registered Nurse Jill Codrey. “They were effective for the ED staff, but if we were going to a code or an emergency outside of the ER taking our crash cart, other staff coming to help … they didn’t know where any of our stuff was located.”
That could mean time delays in a situation in which seconds can be crucial.
So, the team got together with other departments to reorganize the carts together and reuse medications that weren’t being utilized that often.
The new system also has meant introducing checklists in some areas, similar to those used in the aviation industry, to help prevent accidents.
“Every time a patient has a procedure there’s a time out and a checklist,” said Deb Sanford, vice president for nursing and patient care services.
“Every time a patient gets a central line there’s a time out and a checklist.” A hand off between one shift and another? Checklist. Although that doesn’t mean there’s a checklist for everything.
“We try to balance the checklist with making sure everything gets done,” said Sanford. “What we don’t want to do is build a bunch of checklists … so people don’t use critical thinking.”
“This is so different than the way safety used to be approached in hospitals,” said Dr. Julius Cuong Pham, in a video from Johns Hopkins explaining the program. “Traditionally, it was top-down pressure … it was hard to communicate up the ladder.”
“We mostly accepted that certain harms were inevitable, and we could not really make an impact on them,” said Registered Nurse Rhonda Wyskiel.
“The idea with CUSP is that you roll it out and it just becomes the culture of the organization,” said Boucher.