News Briefs
February 1, 2000 5 minutes read
News Briefs
Health care goes to the finals for Baldrige Award
Of the 52 organizations that applied for the 1999 Malcolm Baldrige National Quality Award, one health care organization was selected to receive a site visit.
It was the first time not-for-profit health and educational institutions were eligible to apply, and 25 organizations applied within the newly approved category. Kathleen Hearald-Marlowe, chair of the Baldrige Award’s panel of judges and manager of quality at Exxon Research and Engineering Co., observes, "You do not have to win the Baldrige Award to be a winner."
The process of writing the application, in combination with the post-submission feedback, is "a great way for an organization to assess its performance system and marshal improvements guided by feedback from a topnotch set of outside experts," she says. Two health care organizations were among the 18 semifinalists selected by the judges to go on to the consensus evaluation.
The winners are:
1. (Manufacturing) STMicroelectronics Inc. — Region Americas, Carrollton, TX.
2. (Service) BI, Minneapolis.
3. (Service) The Ritz-Carlton Hotel Co., L.L.C., Atlanta.
4. (Small business/Manufacturing) Sunny Fresh Foods, Monticello, MN.
For the 2000 awards, eligibility determination forms (the first step of applying) are due April 6, 2000; and the 2000 award applications are due May 31.
To obtain a copy of the latest criteria, download it from the Baldrige National Quality Program’s Web site: www.quality.nist.gov; call (301) 975-2036; or mail requests to Customer Service, Malcolm Baldrige National Quality Award, NIST/NQP, 100 Bureau Drive, Stop 1020, Gaithersburg, MD 20899-1020.
Multidisciplinary system improves drug error reports
When Methodist Medical Center (MMC) in Dallas addressed medication errors, the seemingly obvious objective of error reduction proved unrealistic. The QI team realized that, first, it had to get a better handle on the extent of the problem. MMC was no different than most institutions in that drug errors were severely underreported. The quality of data from the existing report process was inadequate to prevent repeats.
The revised goals aimed at the more basic solutions of higher report rates and more useful error data. The team also determined that MMC needed a standard definition of "medication error" and wider availability of the database housing report results. An additional goal — and perhaps the most challenging — was to remove the perceived and actual punitive aspects of error reporting.
The team membership included representatives from pharmacy, quality assurance, and nursing staffs. The medical and legal staffs provided consultation. With interdisciplinary representation came access to a richer knowledge base. In fact, the team found the nursing literature to be the most helpful in designing the new occurrence report.
Features of the report include:
• Incident description detailing where and why the mistake happened.
• Point of origin in the drug administration system.
• Error details that describe the incident and tell where and why it happened.
• Data elements laid out by field for easy input to the database.
The fear factor was the target of all-out staff education efforts. Nurses learned, for example, that reports bearing their names do not end up in their employee files.
The result of the initiative is the availability of good data for use in targeted drug error prevention processes. Within the first year, occurrence reports increased 60%. Incomplete reports decreased 60%. The data are now available to multiple departments from the centralized database. For details, see: DeJong D, Brookins LH, Odgers L. Multidisciplinary redesign of a medication error reporting system. Hosp Pharm 1998; 33:1,372-1,377. (For additional approaches to safe drug administration in hospitals, see "Consumer anxiety runs high about meds problems during hospital stays," QI/TQM, December 1999, p. 137.)
Cardiac death rates fall 60% since 1950
Here’s an encouraging note for dedicated clinicians and QI specialists. The Centers for Disease Control and Prevention (CDC) reports that age-adjusted death rates from heart diseases and strokes have steadily decreased after hitting a peak in 1950. According to the Atlanta-based CDC, the decline represents one of the most important public health achievements of the 20th century.
The heart diseases included in the study are coronary artery and rheumatic disease, as well as hypertension problems. Among the factors credited for the achievement are a decline in cigarette smoking by adults aged 18-plus, from 42% in 1965 to 25% in 1995.
Also cited are lower mean blood pressure and cholesterol levels and better rates of hypertension control and treatment. The report mentions that improved medical care for diagnosing and treating heart disease and stroke have led to lower fatality rates, longer survival times, and shorter hospital stays.
But lest we gloat too much, the report also describes emerging challenges for the new century. The prevalence of obesity is up in all age groups. Racial and ethnic disparities in morbidity and treatment persist. Finally, the aging population and growing numbers of survivors of life-threatening cardiovascular conditions pose concerns about lingering disability and diminished quality of life.
For further details, see Cardiovascular Health Branch, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Decline in deaths from heart disease and stroke — United States, 1900-1999. MMWR 1999; 48(30):649-655.
Evidence mounts for proper antibiotics use
The Centers for Disease Control and Prevention in Atlanta released new findings from its ongoing surveillance of antibiotic-resistant strains of strep bacteria, i.e., Streptococcus pneumoniae, the leading cause of bacterial pneumonia, meningitis, and otitis media in the United States. The report says, "the prevalence of S. pneumoniae that was not susceptible to penicillin varied among geographic regions and among hospitals within a geographic region."
The study covers sites in seven locations: The metropolitan areas of San Francisco; Atlanta; Baltimore; Minneapolis-St. Paul; Portland, OR; five urban counties in Tennessee, and the state of Connecticut. Altogether, the regions represent a population of 16 million. The report primarily concerns bacterial strains that were intermediately receptive to penicillin or resistant. It labels those as penicillin-nonsusceptible.
To find predictors of resistant infections, the study assessed demographic characteristics of patient populations. The analysis evaluated hospitals with a high proportion of pediatric cases and African-American patients. Those characteristics did not make significant differences.
However, geography apparently makes a difference. Here’s the proportion of penicillin-nonsusceptible strains found in the hospitals by region: California, 15%; Connecticut, 18%; Georgia, 35%; Maryland, 15%; Minnesota, 22%; Oregon, 18%; and Tennessee, 38%. The study observes that "despite the overall increase, the prevalence of resistance varies regionally. Resistance also varies substantially by hospital within a region, even in regions where overall resistance is low. Clinical guidelines can improve management of clinical syndromes commonly attributable to pneumococcal infections."
For further information, check the Centers for Disease Control and Prevention, Geographic variation in penicillin resistance in Streptococcus pneumoniae — selected sites, United States, 1997. MMWR 1999; 48(30):656-661. (See "Weaning physicians to generic antibiotics" in QI/TQM March 1999, p. 34.)
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