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Jewish Healthcare Foundation

2014 Fine Awards Honor Teamwork Excellence in Infection Control, Pain Management

November 13, 2014

Pittsburgh, PA — The Jewish Healthcare Foundation (JHF), in partnership with The Fine Foundation, announced the winning teams for the 2014 Fine Awards for Teamwork Excellence in Health Care on November 12. Now in its seventh year, the Fine Awards for Teamwork Excellence in Health Care encourage essential teamwork in developing systems, tools, and programs that better serve patients and families by spotlighting those who have made a difference.

Following an open request for applications to healthcare providers in western Pennsylvania a panel of fifteen distinguished healthcare professionals evaluated submissions and selected winners for 2014. The award ceremony, held at the Carnegie Museum of Art in Oakland, was emceed by KDKA TV's Jon Burnett, with opening remarks by Milton Fine, chairman of The Fine Foundation.

The 2014 awards honor healthcare teams that elevated the level of care and disseminated their best practices beyond a single unit or department on one or both of two key quality measures: infection control and pain management.

According to the most recent CDC (Centers for Disease Control and Prevention) prevalence survey, about 1 in 25 hospitalized patients get a healthcare-associated infection (HAI), which can be mild to devastating, with about 75,000 hospital patients with infections dying each year as a result[i].

"The recent Ebola outbreak in Africa, and isolated cases in the U.S.," noted JHF President and CEO Karen Wolk Feinstein, PhD, "has raised public awareness of the need to control infection, but this certainly is not a new issue — healthcare-associated infections (HAIs) have been a major threat to patient safety since there was health care."

"We do, however, know that most HAIs can be prevented through strict adherence to evidence-based practices — JHF's Pittsburgh Regional Health Initiative (a regional health improvement collaborative that is an operating arm of the Foundation) has demonstrated that quite successfully in a number of settings. Progress has been made in HAI prevention; but, as the CDC statistics show, there is still much room for improvement."

The second area of focus, pain management, was selected because of the ubiquity of pain. One in four Americans lives with pain, some only for brief periods (e.g., following injury or around surgery), some chronically. The Institute of Medicine (IOM) reports[ii] that 100 million Americans suffer from chronic pain. "The prevalence of chronic pain," notes the IOM report, "is growing and likely to continue to do so."

"Infection control," noted Mr. Fine in his November 12 opening remarks, "prevents unnecessary pain, expense, and death.  Pain management relieves suffering, and it gives patients hope and a greater measure of control of their lives.  Both processes relieve the anguish of patients' families and caregivers.

"Working together with the energy, the creativity, and the enthusiasm that we celebrate this evening," concluded Mr. Fine, "we can reach clarity, sanity, and effectiveness in our health care.  The values that drive your work will inspire others; and your leadership will move us toward a better healthcare system.  Thank you for all that you have done and will do." 

Platinum Award (Two $25,000 Team Prizes)

Allegheny Health Network's Allegheny Valley Hospital (AVH) is one of two teams who received a Platinum Award for their initiative "Eliminating Hospital-Acquired Clostridium Difficile." In recent years there has been a reduction in most HAIs nationwide — but not in clostridium difficile infection (CDI), where its incidence in hospitalized patients has nearly doubled from 2001-2010[iii]. People who are most at-risk for CDI include older adults and patients who receive antibiotics while receiving medical care (when a patient takes antibiotics, "good" bacteria that protect against infection are destroyed for a time. CDI is usually spread by contact with contaminated surfaces).

In 2009, AVH — whose CDI rate was above the national average —declared CDI reduction a priority quality objective. A multidisciplinary team developed a comprehensive CDI Prevention Plan, which is updated on an ongoing basis to reflect changes in best practices and internal findings. The CDI prevention program has enabled AVH to reduce their CDI rate by more than 82% since the program was put into place. AVH continues to demonstrate sustainability by maintaining a rate of less than 3% — well below the national average — for the last three consecutive years.

The VA Pittsburgh Healthcare System (VAPHS) also took home a Platinum Award. Their initiative, "Regional Anesthesia and Pain Prevention for Joint Replacement," put into place completely revamped policies and procedures for anesthesia, surgery, and recovery for VAPHS joint replacement patients.

Before 2011 VAPHS knee and hip replacement patients would receive general anesthesia, which has a number of risks and side effects. Under the leadership of Dr. Brian Williams, anesthesia care processes were restructured to render regional anesthesia (associated with less post-operative pain and nausea, and a lower incidence of blood clots and other side effects), comprised of spinal and/or nerve block anesthesia, as the primary anesthetic technique.  Key also was the integration of the best-practices "WAKE Score" and "STOP-BANG SCORE" into anesthesia care plans. The resulting Regional Anesthesia/Acute Pain Medicine Service has resulted in sustained patterns of lower associated morbidity (by 36%) and mortality (by 72%).

This is the third Fine Award that VA Pittsburgh Healthcare System has earned.

Gold Award ($15,000 Team Prize)

The Gold Award went to St. Clair Hospital for their "Surgical Site Infection Prevention" program. Surgical site infections (SSIs) following surgical procedures are a frequent cause of morbidity, and — like other HAIs — have been shown to increase length of stay, readmission rates, and even mortality. According to the CDC, about one to three out of every 100 patients who have surgery will develop an infection at the surgical site.

In FY2010, St. Clair Hospital's SSI rates for hip and knee replacement surgeries were above the CDC's National Healthcare Safety Network (CDC's HAI tracking system) pooled means, spurring St. Clair to action. The St. Clair Hospital team developed a multi-faceted program comprised of protocols for both pre-operative optimization and intra-operative standardization. St. Clair Hospital's Surgical Site Infection Prevention program has resulted in an 87% reduction in the SSI rate for total hip replacement and a 53% reduction in the SSI rate for knee replacement, since the program began, with rates now below the pooled means.

This is the third Fine Award that St. Clair Hospital has earned.

Silver Award ($10,000 Team Prize)

Children's Hospital of Pittsburgh of UPMC received the Silver Award for "Creating a Culture of Excellence in Central Line Care." A central line is a tube placed in a large vein as a means for administering medication. When not properly inserted or kept clean, they can become a conduit for germs to enter the body and can cause deadly infections in the blood stream.

The immature immune systems of patients in a neonatal ICU (NICU) puts them at higher risk for developing an infection. In 2009, Children's Hospital noted an upward trend in the incidence of CLABSIs in their NICU. NICU leadership felt they could drastically reduce their incidence through compliance with evidence-based best practices — and they did.

The Children's Hospital team partnered with 16 other NICUs across the country to develop a quality improvement collaborative aimed at decreasing CLABSIs. Best practices were developed — including hand hygiene, central line insertion, central line care and maintenance, and more — and they implemented a "full immersion" approach to staff, patient, and family education. As a result of this initiative, CLABSIs in the NICU have been significantly decreased (about 0.5 per 1,000 line days) for almost three consecutive years. Children's has also rolled the program out to the cardiac ICU and pediatric ICU, both of which have also been able to decrease and sustain low levels of CLABSI.

Bronze Award ($5,000 Team Prize)

The Bronze Award went to Allegheny Health Network's Saint Vincent Hospital  for "Improving Safe Use of Opioid Therapy."  

The use of patient-controlled analgesia, or PCA, in hospitals to manage post-operative and other pain is fairly common. However, PCA-related adverse events (such as opioid toxicity) can occur, with potentially fatal outcomes. Naloxone is often used to reduce the incidence of opioid-induced side effects.

In order to improve the safety of opioids administered with PCA, Saint Vincent Hospital revised the PCA and Adult Pain ordersets, which include a standard regimen as well as a regimen for patients at high risk of opioid toxicity, such as elderly patients or those with sleep apnea. The revised PCA orderset also provided the opportunity to design a specialized regimen for patients who are opioid-tolerant. The Adult Pain Orderset eliminates therapeutic duplication, and is mandatory for all orders for opioids for pain. Institution-wide communication methods were (and continue to be) used to educate the large number of healthcare professionals and staff. Saint Vincent Hospital was able to reduce the naloxone administration rate for patients on PCA by 76% a year after implementing the orderset.

Other 2014 Fine Award finalists included AHN Forbes Hospital, Excela Health, The Bone and Joint Center-Magee Womens Hospital of UPMC, UPMC McKeesport, and UPMC St. Margaret.

About the Fine Awards

The Fine Awards for Teamwork Excellence in Health Care was established in 2008. More than $500,000 has been awarded in recognition of frontline healthcare teams who dedicate time and attention to overcoming challenges and delivering superior patient care, who are not only saving lives, but are also making the systems within which they work more effective and compassionate.

Visit the JHF website to view videos for each of the 2014 winners, as well as videos for past recipients of the Fine Award for Teamwork Excellence in Health Care.

CONTACT:  To schedule interviews with Karen Wolk Feinstein, Milton Fine, or Fine Award winners, contact Laurie Gottlieb, JHF chief communications officer, at 412-594-2583 or email gottlieb@jhf.org.

[i] Magill SS, Edwards JR, Bamberg W, et al. Multistate Point-Prevalence Survey of Health Care–Associated Infections. N Engl J Med 2014;370:1198-208

[ii] Institute of Medicine Report from the Committee on Advancing Pain Research, Care, and Education: Relieving Pain in America, A Blueprint for Transforming Prevention, Care, Education and Research. The National Academies Press, 2011.

[iii] Reveles KR, Lee GC, Boyd NK, Frei CR. The rise in Clostridium difficile infection incidence among hospitalized adults in the United States: 2001-2010. Am J Infection Control 2014;42:1028-32

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