Safety Success Stories
Nurse-driven safety initiatives
Summa Health System’s goal was to reduce safety events by 80% within the first
2 years of our comprehensive focus on a culture of safety. Summa has defined a serious
safety event as any deviation in care that causes moderate to severe harm to a patient.
We are proud to report an 82% reduction of serious safety events within 18 months.
Here are a few of our nurse-driven safety initiatives that have been implemented
within the Summa Health System:
Improved care of critical care patients requiring insulin
Lisa Ray, BSN, RN, staff nurse on one of Summa’s intensive care unit
(ICU) floors recognized the need for better glucose control of patients in the ICU.
She reviewed current literature on insulin drip procedures and identified the need
for incorporating a new target blood glucose level for ICU patients. With stakeholder
support of Summa physicians, pharmacists, administration and nursing, Lisa received
approval to conduct a trial in her 26-bed trauma surgical ICU. Because of the success
of the trial, it was extended to all ICU units. Six months prior to the trial, 9
out of 12 ICU patients on insulin drip experienced hypoglycemic episodes. Following
the 6-month trial, 28 patients were without hypoglycemic episodes because of the
new target blood glucose level.
Simulations offer real-life scenarios. Simulations are a safe
and effective way to learn from both successes and mistakes. When faced with similar
circumstances on a patient, practicing on a manikin allows nurses to know what to
do, as well as to perform appropriately. Carol Kridler, MSN, RN, CCRN, a staff development
instructor in critical care, is a co-leader in developing a program where nurses
face real-life situations in a simulated environment. Working with Scott Atkinson,
coordinator of the Virtual Care Simulation Lab, Carol provides simulations of clinical
situations based on computer learning modules from The American Association of Critical
Care Nurses Essentials of Critical Care Orientation (ECCO).
The focal point is several manikins, which talk, blink and breathe; have a pulse;
and can mimic a real patient. Nurses can learn to assist with the insertion of a
breathing tube or chest tube; practice inserting an IV or bladder catheter; change
a dressing; or assist with a birth. Carol and Scott have worked with several of
the manikin manufacturer’s programs to ensure nurses have the most realistic
simulations incorporating Summa’s policies and practices.
One critical care scenario coaches nurses to recognize when a Code STEMI (ST-Elevation
Myocardial Infarction) should be called. In another, nurses learn how to assist
with placing an artificial airway or rapidly assess symptoms of a trauma patient.
The work of Carol and Scott was recognized by the National Nursing Staff Development
Organization (currently the Association for Nursing Professional Development) with
an award for Excellence in the use of Educational Technology.
Safer labor and delivery for mother and baby. Pitocin is often
administered to induce labor by speeding up contractions. However, overusing the
drug can be harmful to mother and child. Too many contractions can cause the blood
flow to be cut off to babies and can cause mothers to bleed too much after delivery.
Summa Akron City Hospital's perinatal safety team has implemented practices to improve
the safe administration of pitocin, which has led to improved outcomes in labor
and delivery. As a result, Summa has earned the 21012 Ohio Patient Safety institute
Best Practice Award for improving the safety of labor augmentation and induction.
The policy on pitocin is part of an overall effort at Summa to improve the safety
of deliveries by implementing the “bundle” criteria for the induction
and augmentation of labor. Implementing the bundle criteria at Summa is a nurse-driven
initiative and has resulted in better care, as well as healthier mothers and babies.
The implementation of bundling includes:
- Development of a perinatal safety team that recommends practice
changes to Obstetrics Operations and Departmental committees;
- Development of an induction scheduling and consent form; and
- A “hard-stop” process to block inappropriate deliveries
at less than 39 weeks.
Uterine tachysystole, or too many contractions from the administration of oxytocin,
has become an area of excellence for Summa Women’s Health Services. A collaborative
multidisciplinary team developed an oxytocin administration algorithm chart to emphasize
policy and the evidence with color-coded directions. The chart is posted at each
Reducing hospital-associated infections. Nurses at Summa Akron
City and St. Thomas Hospitals implemented evidence-based measures – or bundles
– to prevent hospital-associated infections (HAIs). Caregivers washing their
hands as they enter and exit a patient’s room is the first and most important
step to prevent HAIs. Catheter Associated Urinary Tract Infections (CAUTI) and Central-Line
Associated Bloodstream Infections (CLABSI) are two of the most common HAIs.
A team of Summa nurses met to address The Joint Commission’s National Patient
Safety Goal of Prevention of CAUTIs. A nurse-driven protocol for CAUTI prevention
was developed to remove a catheter as soon as possible. The nurse protocol included
criteria for continuing to use a catheter, criteria for removal by a nurse and post-catheter
assessment. Nurses also developed criteria to justify the placement of a catheter
if ordered by a doctor within the electronic medical record. Nurses receive online
education as well as practical pointers developed by the CAUTI Prevention Committee.
Quality care goes beyond the spoken word. Quality healthcare
depends on communication. That is a challenge for Summa’s Family Medicine
Center and Labor and Delivery as both units care for a number of patients of Limited
English Proficiency (LEP) who don’t speak or undertstand the English language.
An example is the refugee populations of Burmese and Nepalese communities that have
been resettled to Akron, Ohio, where Summa Health System’s main campuses are
A lack of communication can potentially compromise safety and quality of care. In
Women’s Health, for example, there are challenges when an LEP patient arrives
in labor and delivery in an emergency situation. Critical information is needed
before an interpreter can be contacted.
Some issues that arise when treating a LEP patient include:
- Safety. Patients with the same first and last names as well
as the same birth dates.
- Language. Few interpreters, patients with no written language
and a variance in understanding/reading their native language.
- Culture. Health and religious beliefs, diet, work ethic, gender
roles, etc, including appropriate physical contact such as when shaking hands; making
eye contact with a patient; and interpreting body language.
- Access. Transportation, limited insurance.
To help overcome the language barrier in emergency situations, Carol Clevenger,
BSN, RN, created translation notebooks to care for Spanish- and Nepalese-speaking
patients. The notebooks contain common phrases used in a labor-and-delivery situation
and picture to assist in improving patient-nurse communication.
Plans are underway for additional notebooks to address Arabic- and Congo-speaking
refugee populations that will soon arrive in the Akron area. The goal is to create
an atmosphere where expectant mothers can deliver in a safe and comfortable environment
despite the language barrier, making sure LEP populations have a good care experience.
As a result, these patients will likely continue to come back for treatment.
Technology strengthens patient care. Knowledge-Based Charting
(KBC) done on portable computers (workstations on wheels or WOWs) outside each patient
room at Summa Akron City Hospital means no more paper charting for nurses.
The benefits of KBC, compared with the paper-based system, include:
New hope for traumatic brain injury patients.
- Consistent charting
- Better continuity of care
- Clinical decision support software to help with risk assessments
- More detailed reporting
- No handwriting or legibility issues
- Vital signs are inputted directly into the system
A grant from
The Adam Williams Foundation has placed Summa Akron City Hospital at the forefront
of a national movement in neurocritical care, which states to not have a predetermined
destiny for patients with traumatic brain injuries (TBIs).
In 2012, training and implementation of new equipment began, including: seven pupilometers
to provide objective pupilary assessments; a hypothermia device; and bispectral
index monitor to assess the condition of a sedated patient. This technology has
allowed critical care nurses to receive more objective information about the condition
of a TBI patient, leading to better informed care.
Breastfeeding initiative. In 2009, nurses at Summa Akron City
Hospital’s maternity unit decided to stop providing kits for new mothers that
included baby formula packets. Instead, the nurses concentrated on teaching new
mothers to breastfeed their newborns.
By encouraging and supporting new mothers to meet their breastfeeding goals, Summa
is helping to keep babies safer and healthier. Formula-fed babies have been found
to be at an increased risk of obesity, sudden infant death syndrome and other conditions.
Nurses teach new mothers on how to properly breastfeed; lactation consultants are
available for additional guidance.
As a result, Summa Akron City Hospital has become a leader among hospitals in Ohio
with its breastfeeding initiative, winning a maternity care best practices award
from the Ohio Lactation Consultant Conference. Only hospitals that don’t distribute
formula packets can earn this award. In addition, Summa Akron City Hospital received
a grant from National Initiative for Children's Healthcare Quality (NICHQ) –
1 of 90 in the country and 6 in Ohio – to help improve breastfeeding practices.
Summa Akron City Hospital is pursuing a "Baby Friendly Hospital" designation. This
is an international award from the World Health Organization, given to hospitals
that achieve the Ten Steps to Successful Breastfeeding, which include the elimination
of formula packets.
Read more about this initiative.
Continuing the tradition of helping overcome substance abuse.
Summa St. Thomas Hospital has a tradition of helping patients overcome substance
abuse. In 1939, Sister Mary Ignatia, hospital registrar, and Robert Smith, M.D.
(Dr. Bob), collaborated to admit to the hospital patients who were suffering from
alcoholism in order to receive treatment. At that time, alcohol was not yet classified
as a disease.
The tradition continues today at Summa St. Thomas Hospital’s Ignatia Hall,
a 14-bed, specialized detoxification unit. Patients come to the detoxification unit
on a voluntary basis. Nurses receive ongoing education about how to assess and treat
patients by two attending physicians. Nurses are educated on how to screen new patients.