Safety at Nationwide Children's
Nationwide Children’s measures and trends several key metrics for both patient and staff events. Every event is assigned a team to investigate and learn to prevent future events.
How Do We Know if We’re Improving?
Nationwide Children's measures and trends several key metrics for both patient and staff events. Every event is assigned a team to thoroughly investigate with the purpose of learning to prevent future similar events. Please continue reading for information on serious safety events, health care acquired conditions and employee safety events.
What Is a Serious Safety Event*?
One metric to track performance and progress on our mission to zero harm is the serious safety event rate (SSER). Nationwide Children’s defines a serious safety event (SSE) as a variation from expected practice or care delivery that, following a thorough peer review investigation, is determined to likely have resulted in a significant safety event. Significant safety events result in moderate to severe harm or death. When we suspect an SSE may have occurred, we mobilize all our resources to understand what happened, why it happened, if there was variation from expected practice and if the variation likely resulted in harm. By studying what happened and why, we can best determine how to prevent a similar event from happening again.
The SSER is the number of SSEs per 10,000 adjusted patient days. By keeping track of our rate of serious safety events, we can make sure we are improving the safety of our patients. The goal is to eliminate all serious safety events. That is the basis of our Zero Hero patient safety program. Since the inception of Zero Hero, Nationwide Children’s has lengthened the stretch of days without an SSE from an average of one event per quarter, to a record high stretch in 2022 and 2023 with 600+ days without an SSE. 2022 was the first year at Nationwide Children’s without a single SSE!
How Do We Measure Serious Safety Events?
Each month we record the number of SSEs that have occurred, if any. This number is divided by patient days to normalize the data for patient volume fluctuations and so we can compare to other hospitals. We use the average rate for that month plus the previous 11 months to get a 12-month rolling average.
The below SSER graph demonstrates the significant reduction in serious safety events at Nationwide Children’s over the past decade. The early rise in SSER reflects increased reporting of events by staff coincident with the launch of the Zero Hero safety program.
What About Health Care Acquired Conditions (HACs)?
Health care acquired conditions (HACs) are undesirable conditions that a patient develops while in the hospital being treated for something else. Examples of HACs include: adverse drug events (ADE), catheter associated urinary tract infections (CAUTI), central line associated blood stream infections (CLABSI) and surgical site infections (SSI). Nationwide Children’s is focused on reducing HACs as most, but not all HACs, are preventable.
How Is Nationwide Children’s Performing in HAC Reduction Efforts?
What Is the Project and Why Is It Important?
An adverse drug event (ADE), or drug error, is an injury resulting from the use of any drug.
- Adverse drug events can have a negative effect on a patient’s recovery.
- Improving is part of providing a safe healing environment.
- We continue to strive to reduce the number of ADEs to zero.
- All ADEs are placed on a nine-point clinical severity scale on the seriousness of the error. To review the severity scale, click here.
- Below is a graph which shows the number of ADEs for severity 6-9.
How Are We Doing?
What Are We Doing to Improve?
- We concentrate on providing the right medication, to the right patient, at the right time.
- We have advanced technical processes in place to ensure errors do not occur.
- Feedback is key. We continually provide information and education to our staff about medication errors.
How Can Patients and Families Help?
- Patients and families play an important role in verifying home medications with their medical team to lessen the likelihood of medication errors.
- If you suspect your child is having an adverse reaction to a medication, please immediately let their caregiver know.
What Is the Project and Why Is It Important?
A surgical site infection (SSI) is an issue (complication) resulting from surgery. An infection may develop following any kind of surgery. SSIs can happen when germs get in the surgical wound. We take the prevention of these infections very seriously for many reasons.
- SSIs cause complications in recovery.
- SSIs may cause delayed healing resulting in a longer hospital stay for patients.
- Some SSIs involve the skin only while others are serious and involve the tissues under the skin and organs.
We measure SSIs for surgeries involving the heart, back and brain.
How Are We Doing?
Below is a graph that shows the number of SSIs that have occurred over the last few years.
What Are We Doing to Improve?
- We have a detailed prevention program focused on cleanliness and proper antibiotic administration.
- We continuously audit surgery best practices to ensure our staff follows them (compliance).
How Can Patients and Families Help?
- Good hand washing is very important. Washing hands correctly and often is the best way to prevent the spread of germs.
- Do not touch the surgical wound or dressings after your child’s surgery.
- If you see our staff not cleaning their hands before and after caring for your child, please speak up and remind them to wash their hands. Don’t be shy!
- Knowledge is key. Before you go home, make sure you know how to care for your child’s wound. Be sure to ask questions.
What is the project and why is it important?
A central line associated blood stream infection (CLABSI) occurs when germs enter the blood stream through a central line catheter and cause a patient to become sick.
A central line catheter is a small plastic tube that is placed into the blood vessels near the heart. It may be used to deliver important medications, food and other nutrition. It may also be used to draw blood for testing or to monitor blood pressure.
How are we doing?
What are we doing to improve?
- We continue to implement the best care practices and investigate and implement new prevention techniques.
- We have dedicated infection prevention champions on each unit who work with staff every day to promote the best care.
- Good hand washing (hygiene) is extremely important to prevent infection. We promote and monitor hand hygiene among our staff.
How can patients and families help?
- Good hand washing is very important. Washing hands correctly and often is the best way to prevent the spread of germs.
- Ensure you do not touch the catheter or tubing while your child has a central line in place.
- If you see our staff not cleaning their hands or wearing gloves prior to using the line, or changing dressings on the line, please speak up and remind them to wash their hands. Don’t be shy!
What Is the Project and Why Is It Important?
A CAUTI is an infection of the urinary tract caused by a tube (urinary catheter) that has been placed to drain urine from the bladder. There are a variety of complications that can occur if a patient has a CAUTI and can contribute to a longer hospital stay. These infections are preventable.
How Are We Doing?
What Are We Doing to Improve?
- We monitor catheter use constantly to ensure that they are in place only if needed.
- We confirm that proper catheter maintenance occurs by regularly checking (auditing) our staff.
- We ensure there is sterile equipment when inserting and maintaining the catheters.
- We promote hand hygiene every day.
How Can Patients and Families Help?
- If you see our staff not cleaning their hands before or after caring for your child, or handling their catheter, please speak up and remind them to wash their hands. Don’t be shy!
Hand Hygiene – a Common Way to Prevent Many Healthcare Acquired Conditions
Hands are the main pathways of spreading germs during health care. Hand hygiene, or hand washing, is therefore a simple, yet very effective way to avoid the spread of harmful germs to prevent health care associated infections. At Nationwide Children's Hospital, we do hand hygiene audits to observe staff cleaning their hands before and after entering a patient’s room and before and after touching the patient and any of their belongings or equipment. Prior to 2021, the audits were not secretive. In 2021, we changed the audit methodology to a blinded audit, meaning staff were not able to tell when they were being observed for hand hygiene audits. We believe the drop in compliance, seen below on the graph of compliance over the past several years, was likely our actual compliance all along. We have reinforced expectations for hand hygiene and focused efforts and strategies to improve compliance with our team in the past two years. We now consistently have compliance between 90-100% and still maintain our blinded audit methodology.
Serious Safety Event
The designation of a Serious Safety Event (SSE) is not an analysis, a determination, an admission, or even a suggestion, that any healthcare provider was negligent or deviated from the applicable “standard of care” as that term is defined under Ohio law governing medical claims, or that the healthcare provider’s conduct in any way caused or contributed to legally cognizable damages. Rather, designation of a particular event/condition as an SSE means that the Hospital has determined that the event/condition is one that may be amenable to reduction and/or elimination through the implementation of additional interventions, actions, and/or related quality improvement initiatives. The qualification of an event as a “serious safety event” is based upon a retrospective review of the event and its potential to be instructive in improving the quality of healthcare services provided at the Hospital with the aspiration that steps may be taken to prevent the same or similar events in the future.
Preventable Harm Definition
Nationwide Children’s Hospital’s Preventable Harm Index is a classification system designed to track similar occurrences with the goal to eliminate each class of occurrence. We have chosen to classify these occurrences as “harm” and “preventable” as a call to action for Children’s healthcare community. It is designed to change the thinking that these occurrences are expected complications and, to instead, see them as a challenge that we need to work to reduce and to ultimately eliminate. Designation of “Preventable Harm” does not mean the occurrence in question was necessarily preventable at the time, which is often impossible to determine. We, instead, focus on the opportunity to improve patient care and, therefore, define harm as “preventable” in order to create the opportunity to eliminate classes of “harm” and get to ZERO.