In this section :
- Hospital harm is everyone’s concern
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Hospital Harm Improvement Resource
- How to Use the Hospital Harm Measure for Improvement
- Learning from Harm
- General Patient Safety Quality Improvement and Measurement Resources
- Hypoglycemia: Introduction
- Aspiration Pneumonia: Introduction
- Delirium: Introduction
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Infusion, Transfusion and Injection Complications: Introduction
- Infusion, Transfusion and Injection Complications: Discharge Abstract Database
- Infusion, Transfusion and Injection Complications: Importance to Patients and Families
- Infusion, Transfusion and Injection Complications: Clinical and System Reviews, Incident Analyses
- Infusion, Transfusion and Injection Complications: Measures
- Infusion, Transfusion and Injection Complications: Success Stories
- Infusion, Transfusion and Injection Complications: References
- Medication Incidents: Introduction
- Obstetric Hemorrhage: Introduction
- Patient Trauma: Introduction
- Pneumonia: Introduction
- Pneumothorax: Introduction
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Post Procedural Infections: Introduction
- Post Procedural Infections: Discharge Abstract Database
- Post Procedural Infections: Importance to Patients and Families
- Post Procedural Infections: Clinical and Systems Reviews, Incident Analyses
- Post Procedural Infections: Measures
- Post Procedural Infections: Success Stories
- Post Procedural Infections: References
- Pressure Ulcer: Introduction
- Sepsis: Introduction
- UTI: Introduction
- Venous Thromboembolism: Introduction
- Wound Disruption: Introduction
- Obstetric Trauma: Introduction
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Procedure-Associated Shock: Introduction
- Procedure-Associated Shock: Discharge Abstract Database
- Procedure-Associated Shock: Importance to Patients and Families
- Procedure-Associated Shock: Clinical and System Review, Incident Analysis
- Procedure-Associated Shock: Measures
- Procedure-Associated Shock: Success Stories
- Procedure-Associated Shock: References
- Selected Serious Events: Introduction
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Electrolyte and Fluid Imbalance: Introduction
- Electrolyte and Fluid Imbalance: Discharge Abstract Database
- Electrolyte and Fluid Imbalance: Importance to Patients and Families
- Electrolyte and Fluid Imbalance: Clinical and System Reviews, Incident Analyses
- Electrolyte and Fluid Imbalance: Measures
- Electrolyte and Fluid Imbalance: Success Stories
- Electrolyte and Fluid Imbalance: References
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Anemia – Hemorrhage (Health Care / Medication Associated Condition): Introduction
- Anemia – Hemorrhage (Health Care / Medication Associated Condition): Discharge Abstract Database
- Anemia – Hemorrhage (Health Care / Medication Associated Condition): Importance to Patients and Families
- Anemia – Hemorrhage (Health Care / Medication Associated Condition): Clinical and System Reviews, Incident Analyses
- Anemia – Hemorrhage (Health Care / Medication Associated Condition): Measures
- Anemia – Hemorrhage (Health Care / Medication Associated Condition): Success Stories
- Anemia – Hemorrhage (Health Care / Medication Associated Condition): References
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Anemia – Hemorrhage (Procedure-Associated Conditions): Introduction
- Anemia – Hemorrhage (Procedure-Associated Conditions): Discharge Abstract Database
- Anemia – Hemorrhage (Procedure-Associated Conditions): Importance to Patients and Families
- Anemia – Hemorrhage (Procedure-Associated Conditions): Clinical and System Reviews, Incident Analyses
- Anemia – Hemorrhage (Procedure-Associated Conditions): Measures
- Anemia – Hemorrhage (Procedure-Associated Conditions): Success Stories
- Anemia – Hemorrhage (Procedure-Associated Conditions): References
- Birth Trauma: Introduction
- Device Failure: Introduction
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Infections due to Clostridium difficile, MRSA or VRE: Introduction
- Infections due to Clostridium difficile, MRSA or VRE: Discharge Abstract Database
- Infections due to Clostridium difficile, MRSA or VRE: Importance to Patients and Families
- Infections due to Clostridium difficile, MRSA or VRE: Surveillance, Outbreak Management
- Infections due to Clostridium difficile, MRSA or VRE: Clinical and System Reviews, Incident Analyses
- Infections due to Clostridium difficile, MRSA or VRE: Measures
- Infections due to Clostridium difficile, MRSA or VRE: Success Stories
- Infections due to Clostridium difficile, MRSA or VRE: References
- Laceration: Introduction
- Retained Foreign Body: Introduction
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Viral Gastroenteritis: Introduction
- Viral Gastroenteritis: Discharge Abstract Database
- Viral Gastroenteritis: Importance to Patients and Families
- Viral Gastroenteritis: Surveillance, Outbreak Management
- Viral Gastroenteritis: Clinical and System Reviews, Incident Analyses
- Viral Gastroenteritis: Measures
- Viral Gastroenteritis: Success Stories
- Viral Gastroenteritis: References
Obstetric Trauma: Success Stories
British Columbia Patient Safety & Quality Council-Quality Award Winner (2009)
Managing Obstetrical Risk Efficiently (MOREOB) in Northern Health
The MOREOB program launched in 2006, is a comprehensive patient safety, professional development and performance improvement program for hospital caregivers and administrators providing obstetrical care in Northern Health.
Over the past four years, health care providers and administrators working in obstetrics have come together as a cohesive team with a shared passion and goal for putting patient safety first. Ninety-three per cent of Northern Health obstetrical healthcare providers (including physicians, midwives, nurses and administrators) are participating in the program. Evaluation of the program has found a growth in leadership capacity with safe patient care at the core. Activities within the program include environmental scans, patient satisfaction surveys, staying current with new evidence and best practices, participating in workshops, and competency drills. The program structure is based on proven principles of High Reliability Organizations, including:
- Patient safety is the priority and everyone's responsibility.
- Communication is highly valued.
- Operations are a team effort.
- Hierarchy disappears in an emergency.
- Emergencies are rehearsed.
Reviews with all types of health care providers are routinely held. The MOREOB program's Annual Cultural Assessment for 2009 revealed that the participants had an improved sense of work culture, including: open communication with respect to patients and general knowledge; valuing each other's knowledge-base and skills sets; and an improved sense of teamwork. An improvement in staff retention and recruitment has been seen in all sectors.
Statistical information from the B.C. Perinatal Health Program database shows improved statistics on the number of: labour inductions, mothers who received an epidural, intermittently listening to the unborn baby's heart during labour (auscultation), number of Caesarean-section deliveries, and newborns with cord blood gases after delivery.
Changes and efforts that were made to achieve these outcomes and spread the initiative included the following:
- promoting the annual program components of the MOREOB program for all participants;
- monthly regional obstetrical rounds via videoconference;
- development of a Regional Perinatal Council, including quality;
- practice working groups;
- growing communities of practice;
- design of a template to support Council development for other disciplines, such as critical care, emergency care and long-term care; and
- annual planning conference for core team leaders. (BC Patient Safety & Quality Council, 2009)