Registered nurse Mary Dowling describes keys to the success of Memorial Sloan Kettering's hand hygiene program for clinicians.
Memorial Sloan Kettering’s Quality of Care Initiative (QCI) was created in 2005 under the leadership of former Physician-in-Chief Robert Wittes. Its mission is continuous quality improvement across the full spectrum of care and includes:
- Establishment of evidence-based care and process standards
- Implementation of quality metrics for these standards
- Measurement of performance metrics for key domains reflecting care quality
- Commitment to continuous performance improvement
Integral to the QCI are six committees and programs in which physicians, nurses, allied healthcare personnel, and patient advisors work together to recommend improvements in the delivery of care. The QCI aims to maintain a leadership position in the national effort to define, measure, and research quality care, and to publicize these efforts to interested audiences.
Every clinical department within Memorial Sloan Kettering has a Quality Assessment Committee charged with developing and implementing a continuous monitoring system to evaluate patient care, treatment, and safety.
Reporting to Improve Safety and Quality (RISQ)™ is a system developed at Memorial Sloan Kettering that enables staff to report actual events as well as events that have the potential to cause harm, but are caught and corrected before they reach the patient (near-misses).
All RISQ™ reports are reviewed by managers, quality assessment staff, and patient safety staff. More than 20 reading groups, which are composed of a diverse group of clinical staff, review RISQ™ reports to identify themes and potential gaps or problems. From these groups, many performance improvement teams are formed, which then feed information back to clinicians, senior leadership, and the executive board. Numerous changes have been implemented as a result of these efforts.
Memorial Sloan Kettering’s proactive approach to patient safety has resulted in a system for reporting events and implementing improvements based on RISQ™ reports. Initiatives include measures for infection control and having nurses assess patients for the risk for falling and implementing specific interventions (such as alert bracelets) as needed.
As part of our strategy for encouraging patient involvement in their own care, patients and families are encouraged to ask safety-related questions and monitor and report observations about specific patient safety initiatives, such as hand-hygiene practices and reducing falls.
A Patient Safety Advisory Committee, consisting of patients, caregivers, and Memorial Sloan Kettering staff, meets monthly to develop, plan, and evaluate patient safety initiatives.
Prevention of healthcare-associated infections (HAIs) represents one of the major safety initiatives at Memorial Sloan Kettering. The Infection Control Program involves the design, implementation, and documentation of practices and procedures that are known to prevent infections from occurring and to record and confine those that do occur.
Through grant funds and institutional support, we engage in research defining rates, risks, interventions, and resource utilization for an array of nosocomial infections, such as central venous catheter infection rates, resource utilization in multi-drug resistant bacteria, and analysis of the use of copper as an antibacterial agent in the hospital setting.
The program manages critical data and information (including surveillance of healthcare-associated infections), sets and recommends policies and procedures, intervenes directly to interrupt the transmission of infectious diseases, is involved in facility construction and design, and educates and trains healthcare workers, patients, and visitors.
A hand-washing initiative developed by the inpatient nursing program has improved hand-hygiene compliance among our clinicians. Since its implementation across all patient care settings within Memorial Sloan Kettering in 2010, we have sustained a 96 to 98 percent compliance rate.
In collaboration with the Microbiology Laboratory, a facility to determine “molecular fingerprints” using pulsed field gel electrophoresis (PFGE) was established in 1999. This facility determines the molecular typing characteristics of drug-resistant bacteria facilitating outbreak investigation and control.
At Memorial Sloan Kettering we conduct comprehensive quarterly patient satisfaction surveys to help us understand patients’ perceptions of their experiences here and identify issues we may need to address.
By routinely measuring the perceptions of our patients, we embrace them as essential participants in defining, assessing, and enhancing the quality of care that we provide.