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Roxborough Memorial Hospital is one of only 24 hospitals in the
state honored to receive a prestigious HAPAchievement Award from
the Hospital and Health system Association of Pennsylvania for
2007. Roxboroughs award-winning entry,
was submitted by
Dr. Sally Lane,
the hospitals medical director. Dr. Lane accepted the award at
HAPs annual
Leadership Summit luncheon in
on May 14.
This
years HAP achievement awards were selected from among 113
entries evaluated by a 19-judge panel representing the public
and private sectors, health care and business organizations, the
media, and for-profit and non-profit entities.
In
2003, the Joint Commission for Accreditation of Health Care
Organizations (JCAHO) introduced a list of prohibited
abbreviations to its National Patient Safety Goals initiative.
The mandated list included many abbreviations that had been in
common usage by physicians and other healthcare professionals
for decades when writing and administering medication orders and
dosages for patients.
Based
on extensive research data that identified specific
abbreviations with high potential for misinterpretation and,
therefore, medication errors, the JCAHO mandated in 2004 that
all of its accredited organizations must produce a list of Do
Not Use Abbreviations (DNUA). They would also have to achieve
100 percent compliance with that initiative by the end of that
calendar year.
The
need for alternative notations to replace the existing
abbreviations was evident, said Dr. Lane, a practicing
oncologist. However, the process of substituting new and
perhaps more time-intensive processes for long-established
habits would be an enormous challenge for many organizations,
including our own.
Taking on that challenge, Roxboroughs quality assurance,
medical, nursing and pharmacy staffs first came together to
review a list of 113 DNUAs identified by the pharmacy
department in a random review of 300 physician orders within the
hospital.
From
the original list, 10 DNUAs were chosen to be eliminated first
because the study showed that they were the most commonly used.
The
team then began a multi-faceted education process, producing
prominent displays of the DNUA list on nursing units; inserting
the list on bright fluorescent pages inserted into
patient charts; and
publishing the list in both pharmacy and medical staff
newsletters. One particularly unique approach was the
establishment of a JCAHO
Jeopardy game based on the popular TV show where doctors
were asked to identify commonly-used abbreviations when they
were given hint phrases.
All
of those efforts began to produce results. Progress in
eliminating use of the DNUAs in the hospital was tracked
monthly, and the compliance rate for orders showed dramatic
improvement. From a low base compliance rate of 53 percent in
April 2004, the monthly rate has been uniformly above 90 percent
since October 2004.
Based on our experience, we believe that significant change can
be accomplished through a comprehensive and unwavering focus on
this issue, said Dr. Lane. We are pleased with the progress we
have made, and we believe that other institutions can
successfully adopt similar strategies to ours, tailoring the
individual portions of our program to their own hospital and
medical staff cultures.
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