At Lakeland Health, the three hospital-based community-owned health system in St. Joseph, Mich., “patient safety with zero harm” is the number one goal enterprise-wide. But as senior clinical and informatics leaders at Lakeland quickly realized a few years back, some 40 percent of unanticipated hospital deaths happen on the general ward, where it's hard to predict which patients to watch closely.
Due to this challenge, coupled with government regulations increasingly focusing on safety and compliance, Lakeland C-suite executives knew the pressure was on to ramp up their protocols so that they could reach their goal of either very minimal errors or best of all, zero patient safety issues. To start, a newfound emphasis was placed on collecting patients’ vital signs, says Arthur Bairagee, chief nursing informatics officer, Lakeland Health.
“When a patient comes in and he or doesn’t feel good, the first thing we will do is take the vital signs. And the vital signs are called just that because we are taking information from the vital organs. So our goal was to get that accurate patient data into the EHR [electronic health record],” Bairagee explains. “We have found throughout my years as a nurse on the floor that transcription errors can happen. So when I am documenting respiration [rates], a normal rate might be 17 or 18 [breaths per minute], but accidently if I record that number as 60, that changes everything. And the same thing goes for blood pressure and the other vital data that goes in. We needed to get the right data into the [Epic] EHR so that we could have a better decision making process for clinicians,” he says.
As Bairagee explains, the approach around vital sign collection at Lakeland had been that the nurse’s assistant would go into every patient room with the vital sign monitor, ask the patient’s name, collect the vital signs, and then write that information down on a piece of paper, while later on going into the EHR to transcribe it. But with that process, since paper was being used, sometimes the patient’s room number or name would get switched, misplaced, or forgotten. Also, just one nurse assistant would collect this information for seven or eight patients, which would take over an hour alone, and then he or she would sit down at the computer to enter in the data. This means that clinicians wouldn’t get that important data until an hour-and-a-half after the collection of the vital signs, rather than immediately. “And one keystroke mishap changes everything,” Bairagee says.
This archaic approach needed to evolve, and that’s why Lakeland clinical and IT leaders decided to deploy the Philips IntelliVue Guardian Solution with automated early warning scoring (EWS) at all three of its hospitals. The solution contains software and clinical decision algorithms, allowing caregivers to accurately obtain vital signs and integrate the validated patient data directly to the EHR. Last year the hospitals did two pilots with the technology and then the entire organization went live with it this past August.
Now, explains Bairagee, when the nursing assistant goes into the patient’s room, he or she is using the system to scan his or her own ID badge barcode, as well as the patient’s arm band barcode, collects the patient’s vital signs, validates the data, and then hits “send.” The data is calculated by the software and then wirelessly uploads into the Guardian system while also giving the nurse assistant a patient “score” back on the screen.
The scoring system assigns a number to each patient, from 1 to 8. A score of 1 to 3 means that the patient is doing OK; a score from 3 to 5 leads to a decision being made by the nurse and nurse assistant on if the vital signs should be taken every two hours going forward; and a score of 6 to 8 is when the nurse could call in a rapid response team, if needed.
This entirely new and improved process has “completely changed the organization’s culture,” attests Bairagee. The nurse assistants feel empowered and engaged, he says, and they are also communicating that data to the nurses, whereas previously they were just entering it into the computer. “And that also has led to complete awareness; before the patient crashes, if he or she does, the nurse is more engaged. And the physicians also come in right away, addressing the patient’s issue early, so that part of the culture has changed as well.”
As a result of this system, Bairagee points to the amount of rapid responses having increased significantly, with the number of cardiac and respiratory arrests decreasing by approximately 56 percent. He adds that while deploying the vital signs system and having the algorithm in the back to display the score certainly has helped, that alone will not save lives. “It does make people aware to do something about it because it’s pointing out where attention should be placed, but you still have to act on it. That culture change doesn’t come in one day, but it will come once you show that data. And here at Lakeland we want to keep up this effort and move toward our goal of zero codes.”