Clinical governance report SA - Clinical effectiveness and safety

The “Best Care… Always!” campaign – a new approach to infection prevention

Netcare continues to apply an internationally accepted methodology for reporting overall Healthcare Associated Infections (HCAIs). The number of patients developing HCAIs in Netcare’s hospitals has decreased to 2.06 patients per 1 000 patient days for the year ended 30 September 2009, compared to 2.33 patients per 1 000 patient days in the prior year.

Netcare will be playing an active role on a representative national task team in driving the “Best Care…Always!” campaign. It is a patient health and safety initiative to support southern African healthcare organisations implement specific, internationally recognised, evidence-based interventions in patient care. Our mission is to support and drive the implementation of best care for every patient, always.

The campaign is modelled on the successful “100 000 Lives” campaign, championed by the Institute for Healthcare Improvement in the USA, and the Canadian “Safer Healthcare Now” initiative.

The initial focus is on intensive care units, targeting five interventions to significantly reduce the morbidity and mortality of patients in acute care hospitals, to:

• Prevent ventilator-associated pneumonias (VAP);
• Prevent surgical site infections (SSI);
• Prevent central line (catheter related) bloodstream infections (CLI);
• Prevent catheter-associated urinary tract infections (CA UTI); and
• Promote antibiotic stewardship in intensive care units.

The campaign is being rolled out in all Netcare intensive care units in collaboration with the physicians working in these units. We anticipate being able to report improvements in patient outcomes in the following year.

Incident management

Our incident management system aims to drive best practice initiatives to reduce adverse events and outcomes. For example, improvement targets are set in all of management’s balanced scorecards for the various risk factors that are inevitably present in healthcare environments. All reported incidents are captured and monitored on the Incident Management Reporting System, a central database.

Theatre incidents

In 2008, we recorded a total of 0.07 wrong procedures per 1 000 theatre cases. Following a drive to reinforce “surgical pause”, which is a final check in the operating room before the patient is anaesthetised, we have reduced the incidence to 0.03 per 1 000 theatre cases during 2009.

Medication errors

Medication errors of 1.81 per 1 000 patient days in 2008 have been reduced to 1.34 per 1 000 patient days for 2009. Medication errors leading to adverse outcomes were 0.03 per 1 000 patient days.

Falls

Patient falls decreased significantly from 1.03 per 1 000 patient days (2008) to 0.8 per 1 000 patient days in 2009. Falls leading to adverse outcomes were 0.07 per 1 000 patient days.

Mortality

The World Health Organisation considers hospital death rates to be one of the most important quality measures of a healthcare system. Netcare’s average crude mortality rate¹ has remained stable at around 1.1% of total inpatient admissions. This compares favourably with international benchmarks:

• 1.0% to 3.0% – Department of Health, USA; and
• 3.4% to 13.6% – various National Health Service (NHS) Trust hospitals, with the average for England being 8.5%.

1 Crude mortality rate equates to the total number of inpatient deaths divided by the total number of inpatient admissions.