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New Ebola Training Modules Will Help Safeguard Patients, Providers, and the Public

Your body is covered from head to toe in protective equipment, and it’s 115 degrees Fahrenheit inside your outfit. Your hands sweat under two pairs of gloves. An ill-fitting hood creeps down your forehead and nearly covers your eyes, but you cannot touch your head to shift it back up. To top it off, the exterior of your protective garb is partially covered with bodily fluids from a patient with Ebola.

The time comes to leave the patient’s room without leaving a trace of the virus on you or carrying it outside the room. You are anxious and tired but careful to follow infection-control protocols as you remove a disposable face shield, hood, mask, booties and other garb. Yet as you do, a piece of hair falls down over your eyes. In a split second and without thinking, you brush it back, and an infected glove glances across a misty eye. The virus is in you.

In a health care world where infection control methods are part of daily practice, Ebola requires a new level of vigilance. Even scrupulous health care providers could get infected without the proper training and support on how to put on and take off personal protective equipment, or PPE.

The new Ebola protection guidelines for PPE use issued this month by the U.S. Centers for Disease Control and Prevention are a critical step in protecting patients, health care professionals and populations in the United States and abroad. Highlights of these new guidelines include leaving no skin exposed and requiring a trained observer to actively help the health care provider to follow the protocols for donning and removing their protective equipment. Because there is very little that one can do to prevent infection after exposure to this unforgiving virus, it is essential that clinicians know this guidance inside and out, become competent in putting on and removing PPE and have a “buddy” to coach them to ensure that they adhere to each and every step.

But like many clinical guidelines, following them is like following the directions for assembling an IKEA chair. They need to be translated into something that providers can easily absorb, that points out the most important steps and provides guidance for implementing them in real time, under real-world constraints. We need to create systems that help health care workers to follow these guidelines, and clinicians need to practice until they are competent. Health care workers also need to know how to respond in those instances when something doesn’t go according to plan.

With that in mind, the CDC asked the Johns Hopkins’ Armstrong Institute for Patient Safety and Quality to convene a team to produce a series of interactive, online training programs on following the new PPE guidelines. Released this afternoon, the videos provide guidance for putting on and removing PPE and allow users to select training specific to the type of respirator and body covering that they will be wearing. Another video module, which guides trained observers on how to be effective in their roles, will be available in days. The free course will also be available on iTunes U.Read More »New Ebola Training Modules Will Help Safeguard Patients, Providers, and the Public

Part II: ISO clinician leaders in patient safety and quality

studentsI recently gave a talk to the American Medical Student Association. The energy in the room was palpable. The students were excited, passionate and hopeful. We spoke about the urgent need to reduce preventable harm and to enhance value, and we discussed that they will need to be the ones to lead these efforts.

Yet, in speaking with them, I had to confront the sad reality that most of them will graduate ill-prepared to lead the improvements of quality and safety our health care system needs. They no doubt will know chemistry, biology and physiology, but they may not know about human factors, implementation science or performance measurement—the language of quality improvement. They will know orthopedics and genetics but they won't know teamwork and systems engineering. They likely know about German scientist Rudolph Virchow, the father of cell theory, yet they do not know John Kotter, the father of change theory whose model for leading change is highly effective and widely used. Without a doubt, these students will need to lead change.

Read More »Part II: ISO clinician leaders in patient safety and quality

ISO clinician leaders in patient safety and quality

SimulationWANTED: Clinicians for long-term relationship to lead unit and department safety efforts. Must be passionate about improving patient outcomes and value, have skills needed to lead these efforts, and enjoy working as part of a team.

Dr. Martin Luther King, Jr., in pushing the civil rights agenda, spoke of the "fierce urgency of now." Recent news reports highlight the fierce urgency of now in health care. The U.S leads the developed world in preventable deaths, as preventable harm continues unabated, insurance premiums have increased 9 percent while GDP remains flat, and investments in health care are crowding out investments in other important areas such as K-12 education. The fierce urgency to improve health care value not only impacts patients and health care providers, but all of society.

There are two main reasons why progress in improving safety and quality has been slow and difficult. The first is the field has largely run away from science, seeking quick fixes rather than deep understanding, focusing on what we do rather than the results we produce. The second reason is that health care lacks the capacity (infrastructure with skilled people) to improve quality and value. Because we have treated patient safety and quality as a project rather than a way of life, we have failed to create the necessary infrastructure to support the needed quality efforts.

If we are to improve quality, we will need to create an infrastructure to support patient safety. It is not surprising that most of the published literature in quality and safety comes from units (such as intensive-care units) that have dedicated physician and nurse leaders; there is someone in place to closely manage the work. Research and experience shows that units with dedicated physician leaders have lower costs, higher quality and better patient satisfaction.

Read More »ISO clinician leaders in patient safety and quality