Patient Safety

What are we measuring?

Pressure injury (also called pressure ulcer, decubitus ulcer, or bedsore) is the breakdown of skin and underlying tissue that develops from prolonged pressure over bony areas of the body or under medical devices. Patients who have medical conditions that limit their movement or cause them to spend most of their time in a bed or chair are at higher risk for this type of injury. Other risk factors for pressure injury include incontinence, poor nutritional status, and medical conditions that affect blood flow.

Although some pressure injuries may occur despite our best efforts to prevent them, pressure injuries are often preventable and can be used an indicator of quality of care. We monitor the occurrence of pressure injuries in our hospitals to identify opportunities to improve our care for patients.

How are we performing?

What are we doing to improve?

Pressure injury prevention begins with a thorough assessment of the skin and an assessment of risk for pressure injuries when you are admitted to the hospital and each day while you remain in the hospital. Based on those assessments, care teams develop a care plan that includes appropriate interventions such as assisting with turning and repositioning frequently or consulting a nutrition expert if needed. We may also use devices to cushion bony areas and special beds that help to reduce pressure and shear on the skin.

We strive to identify pressure injuries at the earliest signs of skin breakdown and to classify them correctly so the appropriate treatment can be provided. Our nurses are provided education and training on pressure injury staging and prevention. We also have specially trained wound experts who provide consultation and assist with the prevention, staging, documentation, and treatment of pressure injuries. When a pressure injury occurs, a multidisciplinary team comes together to discuss factors that contributed to the injury and ways in which it can be avoided in the future. Those lessons learned are then shared with the patient’s care team.

How can you help?

You can help prevent pressure injuries by shifting your weight and repositioning yourself frequently or at least once an hour, if you are able. Ask your caregivers for help if you have difficulty moving by yourself and let them know if anything hurts or is uncomfortable. Other things you can do include taking good care of your skin, maintaining good nutrition and fluid intake, quitting smoking, and staying physically active.

What are we measuring?

Falls in the hospital are one of the most common adverse events that patients may experience. Fall rates vary across different care areas, but it is estimated that a fall in the hospital occurs in about 2-3% of all hospitalizations. Factors that increase the risk for falling include medication side effects, difficulty with walking and making transfers, medical conditions or treatments that cause dizziness, weakness, or confusion, being in an unfamiliar setting, and lack of physical activity. Falls that result in an injury can keep patients in the hospital longer and can increase the risk of poor outcomes, particularly among older adults. For this reason, fall prevention is a top priority at Davie Medical Center. We monitor the occurrence and rate of falls and falls with injury in our hospitals to identify opportunities to improve our fall prevention program and reduce patient falls.

How are we performing?

What are we doing to improve?

Wake Forest Baptist Health formed a system-wide multidisciplinary Fall Prevention Committee with sub-committees at each hospital campus leading efforts to reduce falls and falls with injury. In 2018, we implemented a new Fall Prevention Program that includes the following fall prevention strategies:

• Universal fall prevention strategies to create a safe environment and reduce accidental falls for all patients, including:
  
  • Orienting the patient and family to the room and care environment.
  • Placing the call button and frequently needed items within easy reach.
  • Ensuring adequate lighting and keeping the room free of clutter.
    
  • Making sure the bed is in low position with wheels locked.
  • Checking on patients frequently to assist with any needs, like going to the bathroom.
  • Providing non-skid footwear for patients to wear when out of bed or walking.
  • Monitoring for medication side effects.
• Nurses assess each patient’s risk for falls on admission and regularly throughout the hospital stay. Patients at high risk for falls are also assessed for their risk for injury and are asked to wear a yellow armband to help caregivers easily recognize who may need fall protective measures.
• The care team works with each patient to create an individualized care plan to prevent falls, which may include use of assistive devices, close monitoring and assistance with mobility, use of bed or chair alarms, and referral to physical therapy.
• The care team also communicates about high fall risk patients during safety huddles and provides education to patients and their families about fall prevention measures.

In addition, Wake Forest Baptist continues to research and develop new ways to improve our care and reduce patient falls. Our safety team, nursing leaders and unit staff review each fall to identify trends and to look for gaps in care and opportunities for improvement. We are piloting an electronic tool to help predict the patient’s risk for falling while in the hospital. We are also piloting an activity and mobility initiative aimed at improving patients’ ability to function safely more independently.

How can you help?

When you are admitted to the hospital, your nurse will talk with you about your risk for falling while in the hospital. Based on your risk, he or she will work with you to create a fall prevention plan to keep you safe. Here are some things that you can do to partner with your care team to keep you safe:

• Tell your care team about any recent falls you have had.
  
• Work with your caregivers to keep the things you need within easy reach, like the phone, your glasses, and especially the call button.
• Get up slowly to prevent dizziness.
• Use your assistive device when you get up and use grab bars in the bathroom.
• Wear your non-skid footwear at all times when you get up from the bed or chair.
• Keep your yellow armband on at all times so your caregivers will be mindful of your risk for falls.
• Follow your scheduled mobility and toileting plans. Being active keeps you strong. Regular planned trips to the bathroom can avoid the need to get up and go urgently.
• Call for help when you need to get up or go to the bathroom.
• Allow your caregivers to stay within arm’s reach while you use the bathroom and pause for help when you are finished. They will give you privacy while remaining close by.

What are we measuring?

Hospitals and other healthcare facilities dispense and administer hundreds of thousands of medications every day. Given the high volume and the complex nature of medication management systems, medication delivery can be high-risk and prone to errors. When medication errors reach patients they can cause harm to patients and families that can often be prevented. At Davie Medical Center, we are committed to providing safe medication administration.

We monitor the occurrence of serious safety events related to medication errors in our hospitals to identify opportunities to improve our care for patients and to prevent future events from occurring. We also measure the processes we have in place to prevent medication errors, including Computerized Physician Order Entry (CPOE) and bar code medication administration (BCMA).

How are we performing?

What are we doing to improve?

At Wake Forest Baptist, we have a robust medication management system that reflects industry best practices to ensure medication safety. We adhere to all accreditation and regulatory standards, and we implement strategies to reduce the risk of medication errors. We also monitor the effectiveness of our medication management system to continuously improve when opportunities are identified.

 

Here are some of the medication safety practices we have in place that are known to be effective in preventing medication errors:

• Medication Reconciliation is a safety strategy that involves comparing the list of medications the health care provider currently has with the list of medications the patient is currently taking.
• Providers use our Computerized Physician Order Entry (CPOE) system to order medications instead of writing out prescriptions by hand. Our system also provides tools to support clinical decisions at the point order entry – checking for allergies, drug interactions, proper dosage – and alerts the provider of potential safety concerns.
• Nurses use bar code medication administration (BCMA) to scan medications and the patient’s ID bracelet before giving medications to make sure the patient is receiving the correct medications at the right dose and time.
• A multidisciplinary team reviews all medication related events and conducts an analysis of all serious safety events related to medications. We use the information from those processes to make improvements in our system to prevent similar events from happening again.

How can you help?

Taking an active role in your healthcare plan is one of the best ways to partner with your care team to reduce the risk for medication errors. Knowledge and clear communication are your best defense. Learn about the medications you take and keep an updated list, including any over the counter medications or supplements. Tell your healthcare provider about any side effects that you experience and always ask questions or share any concerns you have. Be an active participant in the medication reconciliation process, which should be done at transitions of care (such as being admitted or discharged from the hospital), when new medications are ordered, or current medication orders are changed or discontinued. Although having your medication packages can help to share correct information about your medications, you should not bring home medications into the hospital or take them while in the hospital unless your doctor has written an order to do so. Even then, home medications should only be given by medical staff.

What are we measuring?

A blood transfusion is a common, potentially life-saving practice in healthcare settings in which donated blood or blood components are given to a patient to replace blood or blood components that are too low. This procedure can replace blood lost from injury, during surgery, or from medical conditions that affect blood and blood components. 

The healthcare industry works hard to ensure the safety of blood donated and used in transfusions. Healthcare providers take precautions to deliver blood transfusions safely, but there is some risk for complications. At Davie Medical Center, we have a comprehensive system in place to ensure that blood and blood products are given safely to reduce the risk of adverse reactions and complications.

We monitor the occurrence of serious safety events related to the administration of blood products in our hospitals to identify opportunities to improve our care for patients and to prevent events from occurring.

How are we performing?

What are we doing to improve?

Safe administration of blood products requires multiple steps:

• Proper informed consent for transfusion
• Correct orders placed by the provider for the patient
• Collection of a blood specimen for type and crossmatch
• Obtaining the correct blood products from the Blood Bank
• Accurate identification of the patient prior to administration
  
• Correct administration of the blood products
• Appropriate patient monitoring and documentation

We update our policies and practice guidelines regularly to ensure that we adhere to all accreditation and regulatory requirements and to implement best practices for patient safety. We use bar code scanning technology to ensure that the patient is receiving the correct blood product. We audit processes in the steps listed above to monitor their effectiveness and to make improvements when needed. On the rare occasion that an adverse event happens related to a blood transfusion, a multidisciplinary team reviews the event and conducts an analysis to identify the causes and make improvements in our system to prevent a similar event from recurring.

How can you help?

If you need a blood transfusion, understanding the reasons, the potential risks and benefits, and the steps in the procedure can help you make decisions with your care team about your treatment and can help to keep you safe.

Here are some things you need to know and should discuss with your healthcare provider:

• There are many reasons that you might need a blood transfusion, such as a major surgery, an injury that causes blood loss, or a medical condition that prevents your body from making blood or blood components. It is important to know the reason your provider recommends a blood transfusion and if there are any alternative treatments.
• Your permission is needed for a blood transfusion, and you have the right to refuse. Before you make the decision, talk to your provider about the benefits and potential risks and outcomes.
• Blood transfusions are typically given in the hospital or in an outpatient clinic or doctor’s office. The transfusion can take between one and four hours, depending on what type of blood component you receive and how much is needed.
• Most transfusions are needed somewhat immediately and use blood donated by other people, but you may be able to bank your own blood before a planned surgery. In some cases, blood transfusions are given emergently in life-threatening situations with special precautions for safety.
• Blood is made up of several different parts, or components, which include red and white cells, platelets, and plasma. A transfusion can provide all of these parts, which is called whole blood, but more likely your provider will order a transfusion for only the parts of blood that you need.
• Your blood will be tested before a transfusion to determine the type (A, B, O, or AB) and whether you blood is Rh positive or Rh negative. The donated blood used for the transfusion must be compatible with your blood, otherwise antibodies in your blood will cause problems. Please tell your care team if you have had a reaction to a blood transfusion in the past.
• When your blood is tested, your nurse will place a special Blood Bank identification band on your arm, which is used to make sure that you receive the correct blood.
• Before a transfusion, your nurse will: 1) make sure you have adequate intravenous (IV) access to deliver the blood transfusion, 2) check your patient identification and verify that the blood is the correct type and product ordered for you by your provider, and 3) check your blood pressure, temperature, pulse, and respiratory rate.
  
• During the transfusion, your nurse will recheck your vital signs within 15 minutes of starting the transfusion and at the end of the transfusion and will monitor for any complications or signs of a reaction.
• Most people do not have any reaction or complications from a transfusion. Mild complications, like allergic reactions, can occur, and rarely severe ones can occur during the transfusion or even many days or weeks after. Please tell your nurse or your healthcare provider immediately if you develop:
  
  • Fast heartbeat
  • Itching, rash or hives
  • Cold and clammy skin, fever or chills
  • Headache or dizziness
  • Nausea or vomiting
  • Trouble breathing
  • Chest or back pain
  • Dark or reddish urine
    
    • After the transfusion, your nurse will care for your IV site and continue to monitor your condition closely. He or she may draw a blood sample to test for improvement in your blood counts. Because reactions to blood transfusions can happen at unexpected times, it is important for you to call your healthcare provider right away, or notify your nurse if you are still in the hospital, if you develop any of the above signs of a reaction in the days immediately following a blood transfusion.

What are we measuring?

Whether performed in the hospital or at an outpatient center, planned or emergent, providing safe surgical care is essential to keeping our promise to keep you safe. 

Undergoing surgery has some inherent risks and complications can occur, which may lead to a longer stay in the hospital, higher costs of care, and risk for poor outcomes. Some complications may be more common, like infection after surgery, others are quite rare. Regardless, we strive to prevent avoidable complications and adverse events and reduce the risk of all types of complications associated with surgery.

We monitor the number and rate of surgical complications that occur in our hospitals, some of which are reported and compared nationally on Care Compare. We monitor the number and rate of surgery related patient safety indicators (PSI) as defined by the Agency for Healthcare Research and Quality (AHRQ) and compare our performance nationally. We also monitor the number and rate of serious adverse or safety events, such as a retained foreign object, to identify opportunities to improve our care for patients and to prevent events from recurring.

How are we performing?

What are we doing to improve?

Wake Forest Baptist Medical Center Surgical Services implemented a program called WakeWings. The program is driven by the philosophy that every patient at Wake Forest Baptist Medical Center reliably receives patient-centered, safe and compassionate care of the highest quality. We provide this care by holding ourselves accountable for expert teamwork, technical excellence and adherence to policy, procedures and checklists, and by continuous data-driven improvements to our knowledge and skill. Staff attend a WakeWings training program with a focus on Crew Resource Management, which is a combination of teamwork, communication behaviors, and safety tools to support those behaviors.

Here are a few of the tools that are used as part of the WakeWings program:

• Checklists are used to remind and guide staff through important process steps before, during and after the surgical procedure.
• Handoff tools are used to communicate important information during transitions in care.
• Time Out tools are used to confirm with the patient the planned surgical procedure, including the correct site and side, if applicable, and that the care team has all of the necessary equipment to perform the procedure.

We update our policies and practice guidelines frequently to ensure that we adhere to all accreditation and regulatory requirements and to implement best practices for patient safety. We follow a strict procedure to count sponges and surgical tools in the operating room before and after each surgical procedure. Adverse surgical events are reported and reviewed by a multidisciplinary team to identify opportunities to improve our safety practices and to prevent events from recurring.

How can you help?

Taking an active role in your healthcare plan is one of the best ways to partner with your care team to reduce your risk for surgical complications. Knowing what to expect before, during and after your surgery can help to ease some of the concerns you may have. Following your recommended care plan closely will help to minimize the risk of complications, such as infection or blood clots. It may also help to be aware of some of the specific safety measures that you will participate in as part of your care:

• Identification and Procedure Verification: You will be asked to confirm information such as your name and date of birth, and the type and location of your surgery several times as you go to different places during the surgery process. This is for your safety.
• Procedural Time Out: A final safety check is performed right before the start of your surgery to make sure that the team agrees that they have everything needed to perform your surgery safely.
• Prevention of Infections: Carefully follow any instructions you are given to clean your skin before your surgery, and DO NOT shave the area where the surgeon will operate. Shaving increases the chance of wound infection. Depending on the type of surgery you are having, it may be important for you to breathe deeply and cough after surgery to keep your lungs clear. Again depending on the type of surgery you are having, your provider may order an antibiotic for you before, during, or after surgery, 
• Prevention of Blood Clots: During your surgery, you may have special equipment placed on your legs or feet to keep blood moving in your legs. If it takes a while to get back on your feet after your surgery, you may need to wear the equipment until you can become active again. Your care team will encourage you to be active as soon as you are able, because it promotes healing and reduces your risk for blood clots.

What are we measuring?

Magnetic resonance imaging (MRI) is a diagnostic test that uses a magnetic field, radio wave signals, and a computer to create highly detailed images of the organs and tissues in your body. Metal can interfere with the magnetic field used to create an MRI image and can cause a safety hazard. The magnetic field may damage electronic items, such as implanted electronic medical devices, and cause them to malfunction. We monitor the number and rate of serious safety events related to MRI that occur in our hospitals to identify opportunities to improve our care for patients and to prevent events from occurring.

How are we performing?

What are we doing to improve?

We update our policies and practice guidelines regularly to ensure that we adhere to all accreditation and regulatory requirements and to implement best practices for patient safety. Safety zones around the MRI equipment are clearly defined and marked with signs to show patients, visitors, and staff where they may be exposed to a magnetic field. Access is restricted in areas with the highest exposure to the magnetic field. We screen patients and hospital staff for implanted metal or electronic medical devices before they are allowed to enter the restricted safety zones. Staff who operate or work around the MRI scanner receive education and training in magnetic field safety. Adverse events related to MRI are reported and reviewed by a multidisciplinary team to identify opportunities to improve our safety practices and to prevent events from recurring.

How can you help?

If you have metal-containing objects or implanted medical devices in your body, we need to know about them before your test. Certain implanted objects may require additional scheduling arrangements and special instructions. Some tests require the use of contrast material to show certain organs or structures more clearly. Please tell your doctor and MRI technologist if you:

• Are allergic to any medication. The contrast material used for a contrast MRI does not contain iodine, but be sure to tell your doctor if you are allergic to the MRI dye.
• Are or may be pregnant.
• Have any metal implanted in your body, including an intrauterine device (IUD), stents, pacemakers, artificial limbs or cochlear implants.
• Wear any medicine patches.
• Become nervous in confined spaces. You may require medication to help you relax during the test.