Apr 9 2014

Improving safety for patients on warfarin therapy

Orthopaedic Surgery/Anticoagulation Service partnership helps meet National Patient Safety Goals for high-risk medication

A partnership between the Department of Orthopaedic Surgery and the Anticoagulation Service improves patient safety for orthopaedic patients who are on high-risk/high-alert Warfarin therapy.

Brian Kurtz, PharmD, and Shelley Howells, LPN, from Anticoagulation Services, discuss a patient referral.

Post-operative Orthopaedic Surgery joint reconstruction patients typically receive anti-clotting medications such as Warfarin (Coumadin) to prevent deep vein thrombosis (DVT)—blood clots in the calf or thigh. This is a life-saving but high-risk/high-alert medication because staff must closely monitor the therapeutic levels in the blood.

In fact, the Joint Commission has made reducing the likelihood of patient harm associated with anti-clotting medications a National Patient Safety Goal.

Back in 2012, U-M faculty, staff — and most importantly patients — were dissatisfied with the level of management this high-risk population received. So, in January 2013, a multidisciplinary team formed to tackle the issue – as one of the inaugural “Lean – Train the Trainer” Projects under the Michigan Quality Initiative.

Using several lean tools, the team identified tasks within their control that they could change to improve the process to identify and monitor patients—and to get them started in the service.

“After several meetings, we aligned clerical work with clerical staff and significantly reduced the involvement of the clinic/phone triage nurses and Joint Service mid-level providers associated with managing these patients,” says Dorothy Nalepa, administrative manager of the Taubman Center Orthopaedic Surgery Clinic. Read the rest of this entry »

Mar 19 2014

Operating room whiteboards help fight infection

Sometimes the best solutions are right before our eyes

Since the 1960s it has been known that certain procedures — such as hysterectomies and colorectal operations — run a high risk for infections, and that if surgeons use prophylactic antibiotics during these surgeries, infection can be avoided.

Now, the Health System hospitals operating rooms are using electronic whiteboards to inform OR medical staff of each patient’s antibiotic needs.

“We had already put up these giant screens in the ORs to show the patient’s name and procedure, and it occurred to us that we could put the screens to even greater use by adding the specific antibiotic individual patients should receive based on the procedure they are having,” says Mark Pearlman, M.D., professor of obstetrics and gynecology, and head of the OB/Gyn portion of the project. Read the rest of this entry »

Mar 5 2014

Safety Huddles: Sports tactic makes U-M hospitals safer, more efficient

University of Michigan hospitals are using a classic team tactic—huddles—to make things safer and more efficient for patients and staff.

These huddles are safety huddles—daily morning meetings that prep staff on necessary information, including patient admissions and discharges, problems with equipment, medication changes, support services, supplies and more. They run Monday through Friday, from 8:45 a.m. to 9 a.m.—a brisk 15 minutes—right after bed briefing.

Chris Dickinson, M.D., professor of pediatrics and the co-architect of patient safety huddles, leads a morning huddle to help staff make the hospital safer and more efficient for patients and staff.

Although the safety huddles have never been mandatory, “everybody wants to come,” says Scott Marquette, intermediate project manager at U-M C.S. Mott Children’s Hospital and Von Voigtlander Women’s Hospital. A typical meeting includes charge nurses, ambulatory care bed managers, laundry managers, support staff, biomed, Office of Clinical Safety and MCIT (Medical Center Information Technology)—in short, everyone with information to give to others and/or a need to know. Marquette sends information gleaned from the huddle to 190 managers and staff across Children’s and Women’s via email. Staff who want to be added to the email list should email Marquette.

“Like all hospitals, we have safety concerns,” says Chris Dickinson, M.D., professor of pediatrics and the architect, with Marquette, of the safety huddles. “To get people thinking about safety, you really have to change your culture. The safety huddles get people thinking about safety all the time. We talk about all sorts of error prevention strategies.” Read the rest of this entry »

Feb 11 2013

Bringing Hope to UMHS: Clinical Program of the Year

Being without health insurance is like walking a tightrope without a safety net below you. All it takes is one tiny slip to send you into a health crisis.

But for uninsured people in Washtenaw and western Wayne counties, a charity called the Hope Clinic helps keep uninsured patients from falling too far.

For decades, U-M doctors, nurses, staff, medical students and residents have volunteered at Hope’s location in Ypsilanti, helping weave a safety net that has served thousands of people.

Accepting the Program of the Year award for clinical services on behalf of the dozens of UMHS faculty, staff and trainees who have volunteered for the Hope@UMHS program are, from left, Perry Schechtman, Ophthalmology, Heather Pontasch, Dermatology, Julie Brown, Hope Clinic, Trisha Goodridge, Plastic Surgery, Robbi Kupfer, Otolaryngology, Katherine Simpson, Hope Clinic, Seyi Aliu, Plastic Surgery, and Paul Salow, Otolaryngology/Anesthesiology.

Now, Hope has come to UMHS in the form of a specialty clinics held at the Taubman Center and Kellogg Eye Center – a major step made possible through the tireless efforts of faculty, staff and trainees in several specialty departments.

This effort, called Hope@UMHS, has earned the UMHS 2012 Program of the Year recognition – as well as the gratitude of the hundreds of patients who have already been seen there.

The Saturday-morning specialty clinics – - staffed by an all-volunteer team – - help uninsured patients get free access to advanced care that can’t be offered at Hope’s own locations. Read the rest of this entry »

Dec 5 2012

A Trip to El Salvador, A Mission of Thanks

Their parents earn as little as $2 a day selling tacos or doing manual labor. They live in one-room homes made of sheet metal, adobe and cardboard. But for seven days in October, these 12 children received the world-class cardiac care they needed—courtesy of a team headed by the University of Michigan Health System. And a cardiac team in El Salvador can now give similar care to the children in their country.

Gabe Owens, M.D., Ph.D., clinical assistant professor, U-M Congenital Heart Center.

This is the second time the UMHS team has traveled to El Salvador as part of an international collaborative sponsored by Gift of Life International (GOLI). After the team’s visit last year, GOLI and Hospital Bloom asked that they return.

This time, the team trained the Salvadoran surgeons to perform more advanced cardiac surgeries on lesions such as tetralogy of Fallot and atrioventricular septal defects (AVSD). They also continued training on the new echocardiogram machine concentrating on transesophageal echocardiography, trained a newly hired perfusionist, enhanced the skills of the ICU nurses and respiratory therapists as they began taking care of more complex patients, and helped improve communication among the entire pediatric cardiac team.

In addition, they provided training in diagnosis, medical management, cardiac anesthesiology, post-operative cardiac care, intensive care nursing, and discharge planning.

“The goal for the entire international collaborative has been to help El Salvador develop its own sustainable pediatric cardiac surgery program,” says team leader Lisa Beckman, BSN, MSMI, Pediatric Cardio-Thoracic ICU (PCTU). Read the rest of this entry »