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Sunday, September 26, 2010
Title: Using An Electronic Medical Documentation System to Track Patient Safety Initiatives
Discipline: Childbearing (CB)
Learning Objectives:
Submission Description:- Identify three adverse events that were monitored.
- Identify an adverse event that decreased over the period of monitoring.
- Identify the technology that allowed large volumes of data to reviewed and analyzed.
Background
In 1999, the Institute of Medicine released its landmark paper, To Err Is Human: Building a Safer Health System. Patient safety has become an issue of major importance for health care professionals, hospitals, accrediting agencies, and the public. Atlantic Health initiated the Obstetric Quality and Safety Committee in 2006. This committee instituted many patient safety initiatives such as emergency simulation team training, multi-disciplinary education, and the implementation of a comprehensive electronic documentation system with clinical decision support.
The United States Department of Health and Human Services identified the effective use of health information technology as a national priority. (2005) An important function is the collection of information about occurrences. The use of a comprehensive electronic medical record is critical to patient safety and the reduction of liability. (Weinstein, 2005). Electronic documentation systems can promote patient safety through the prevention of errors and adverse event surveillance. Data storage, organization, and retrieval is more efficient than paper based systems. This can facilitate retrospective analysis of adverse events and outcomes. (McCartney,2006)
The development of reliable and reproducible quality measures is critical to address patient safety in Obstetrics ( Pearlman, 2006). Quality Measures must be meaningful in order to reduce errors and increase safety. The rate of cesarean birth does not necessarily reflect the safety of care delivered in a given institution. Pearlman suggests that the monitoring of adverse outcomes is a more relevant indicator. At Yale-New Haven Hospital, an obstetric specific adverse outcome index was developed. The introduction of patient safety initiatives with simultaneous tracking of adverse outcomes demonstrated a significant reduction in adverse events. (Pettker, et al. 2009)
In 2009, as part of continuing efforts in patient safety, Atlantic Health joined the New Jersey Perinatal Collaborative. As part of the collaborative process, Atlantic Health is monitoring a variety of obstetric adverse events as a means to improve patient safety.
RESULTS
Perinatal events monitored include elective singleton induction prior to 39 weeks gestation which was 20% in the first quarter of 2008 and reduced to 0.5% in the first quarter of 2009. Similarly, elective cesarean sections prior to 39 weeks gestation declined from 47% to 20%. Unanticipated admissions to the NICU at 35 weeks gestation or older went from 5.6% to 4.9%. Apgar scores of less than 7 at 5 minutes were reduced from 1.3% to 0.9 %. We have had no term intrapartum or neonatal deaths. Blood transfusions declined from 1.2% to 0.3%. Third and fourth degree lacerations declined from 3.7% to 2.4%. We are currently monitoring episodes of uterine tachysystole on oxytocin and planning to implement an initiative to reduce frequency of episodes.
CONCLUSIONS
Our ability to monitor this large volume of data is related to our electronic documentation system’s ability to provide us with an organized and easily accessible data base. The ability to trend data has been an effective tool to foster clinical improvement and promote patient safety.
In 1999, the Institute of Medicine released its landmark paper, To Err Is Human: Building a Safer Health System. Patient safety has become an issue of major importance for health care professionals, hospitals, accrediting agencies, and the public. Atlantic Health initiated the Obstetric Quality and Safety Committee in 2006. This committee instituted many patient safety initiatives such as emergency simulation team training, multi-disciplinary education, and the implementation of a comprehensive electronic documentation system with clinical decision support.
The United States Department of Health and Human Services identified the effective use of health information technology as a national priority. (2005) An important function is the collection of information about occurrences. The use of a comprehensive electronic medical record is critical to patient safety and the reduction of liability. (Weinstein, 2005). Electronic documentation systems can promote patient safety through the prevention of errors and adverse event surveillance. Data storage, organization, and retrieval is more efficient than paper based systems. This can facilitate retrospective analysis of adverse events and outcomes. (McCartney,2006)
The development of reliable and reproducible quality measures is critical to address patient safety in Obstetrics ( Pearlman, 2006). Quality Measures must be meaningful in order to reduce errors and increase safety. The rate of cesarean birth does not necessarily reflect the safety of care delivered in a given institution. Pearlman suggests that the monitoring of adverse outcomes is a more relevant indicator. At Yale-New Haven Hospital, an obstetric specific adverse outcome index was developed. The introduction of patient safety initiatives with simultaneous tracking of adverse outcomes demonstrated a significant reduction in adverse events. (Pettker, et al. 2009)
In 2009, as part of continuing efforts in patient safety, Atlantic Health joined the New Jersey Perinatal Collaborative. As part of the collaborative process, Atlantic Health is monitoring a variety of obstetric adverse events as a means to improve patient safety.
RESULTS
Perinatal events monitored include elective singleton induction prior to 39 weeks gestation which was 20% in the first quarter of 2008 and reduced to 0.5% in the first quarter of 2009. Similarly, elective cesarean sections prior to 39 weeks gestation declined from 47% to 20%. Unanticipated admissions to the NICU at 35 weeks gestation or older went from 5.6% to 4.9%. Apgar scores of less than 7 at 5 minutes were reduced from 1.3% to 0.9 %. We have had no term intrapartum or neonatal deaths. Blood transfusions declined from 1.2% to 0.3%. Third and fourth degree lacerations declined from 3.7% to 2.4%. We are currently monitoring episodes of uterine tachysystole on oxytocin and planning to implement an initiative to reduce frequency of episodes.
CONCLUSIONS
Our ability to monitor this large volume of data is related to our electronic documentation system’s ability to provide us with an organized and easily accessible data base. The ability to trend data has been an effective tool to foster clinical improvement and promote patient safety.
