Haunted by Hospital-Acquired Conditions?

Since October 1, 2008, the Centers for Medicare and Medicaid Services (CMS) have held hospitals responsible for preventing hospital-acquired conditions (HACs). Some hospitals have focused on detecting conditions that are present on admission. Others have addressed the complex issues surrounding prevention of injury. But, given the competition for resources during tight economic times, many hospitals are unable to provide adequate resources to achieve their goals in both areas.

When more information about the impact of HACs becomes known, the degree and intensity of focus placed on preventing these conditions may change. Until then, hospitals will continue to do what they can to address the risks associated with HACs and introduce performance improvement efforts to reduce their impact.

Increasing the awareness of HACs and their impact on patients and the hospital is an important step toward focusing on HAC risk reduction. Presenting needed information on HACs in a creative way can set it apart from “routine” education. As Halloween approaches, consider adopting a “Haunted Ward” for in-service education.

Haunting a “ward” – either a classroom, out-of-use patient room, or other set-up – encourages staff to learn serious lessons in a fun setting. In a mock patient setting, dummies can be set up for failure to provide a scavenger hunt for risks factors for HACs. Consider the following “tricks” for targeting HACs.

Foreign Object Retained After Surgery

• Abdominal x-ray on the viewer with an obvious instrument
• Time-out documentation filled in incorrectly, surgical counts incomplete

Air Embolism

• Open ports on CVCs or PICC lines, or large air bubbles in IV tubing

Blood Incompatibility

• Blue blood hung on an IV pole that does not match a blood bracelet
• Unit past “administer by” time
• Blood slip does not include one of the two required signatures
• Patient vital sign record shows temp of 102

Stage III and IV Pressure Ulcers

• “Admission” mannequin shows red area on coccyx
• Band-Aid over red areas on heels
• Absence of pressure relief mattress
• Patient incontinent with pumpkin orange urine

Falls and Trauma

• Fractures
• Mannequin positioned with one leg shorter than the other
• Intracranial Injuries
• Mannequin shows unequal pupils and notes showing neurological assessment
• Burns
• Red area immediately in contact with heating pad
• Electric Shock
• Mannequin/skeleton soaking in a therapy tub with an electrical appliance in hand (radio, hair dryer)

Catheter-Associated Urinary Tract Infection (UTI)

• Foley bag positioned with dependent loops

Vascular Catheter-Associated Infection

• “Creepy” fluid under clear bandage at insertion site
• Label date exceeds policy for change frequency
• Catheter inserted in groin
• Poorly secured/protected catheter and tubing

Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)

• Mannequin with a knee immobilizer using CPM machine as a foot stool instead of intended use

No educational approach can guarantee results, but entertaining illustrations can help to communicate key messages about important topics like HACs. Using a light-hearted but thorough approach, like a “Haunted Ward,” can bring home important lessons in a way that is fun and memorable.