Quality and Safety Business Line

2015 - 6 December - Quality Improvement
Steven J. Martin, PharmD, BCPS, FCCP, FCCM
This article discusses the activities and initiatives of the Quality and Safety Business Line.
 
The Quality and Safety Business Line has been busy over the course of 2015. The ICU Liberation Task Force will conclude its work by the Society of Critical Care Medicine’s (SCCM) 2016 Congress, and a transition to a quality improvement initiative, funded in part through a grant from the Gordon and Betty Moore Foundation, has begun. The ICU Liberation ABCDEF Bundle Improvement Collaborative is teaming with 76 U.S. (67 adult and nine pediatric) hospital intensive care units committed to improving outcomes for patients and families by reliably implementing the newly modified bundle. In-person learning and virtual learning sessions have been ongoing to allow providers to share tips when implementing these new bundles. A session titled “ABCDEF Bundle Improvement Collaborative: Is the Sum Greater Than the Parts?” will take place at Congress 2016.
 
In addition to the collaborative, SCCM held a simulation-based conference at Vanderbilt University Medical Center. The conference included an opportunity for learners to interface with actors while practicing cognitive and pain assessments along with early mobility. This one of a kind course stimulated learners to return to their hospitals to implement the ABCDEF bundle to improve care for patients and families.
 
The Surviving Sepsis Campaign (SSC) has also benefited from Moore Foundation grant funding.  The Foundation-funded Sepsis on the Wards Collaborative has concluded. Results of the collaborative will be published and a session is planned at the SCCM Congress in 2016. The SSC is completing its work reviewing newly available research in order to update the clinical practice guideline which to date has more than 5 million views.

A successful sepsis conference was held at the end of September, bringing together numerous experts in the care of patients with sepsis.

The Sepsis Definitions Task Force has completed work and will be publishing results to be shared at the SCCM Congress. This is a joint effort with the European Society of Intensive Care Medicine (ESICM).

There is continued work with the Sepsis in Resource Limited Nations Task Force, which is a collaboration between ESICM and SCCM. A pilot project is planned in Gitwe, Rwanda, and through collaboration with the local ministry of health and local research support a program of education and early intervention will be conducted in 2016. 

It is well recognized that alarm and alert fatigue is an ongoing issue within intensive care units. The Gordon and Betty Moore Foundation has provided a grant to consider all published research in this area for a manuscript with presentation at the SCCM Congress in 2017. This initiative is being spearheaded by Sandra L. Kane-Gill, PharmD, MS, FCCM, and Bradford Winters, MD, PhD, FCCM.

Telemedicine in the intensive care unit (tele-ICU) uses remote monitoring and communication systems to connect critically ill patients with expert critical care practitioners in different geographic locations. The SCCM Tele-ICU Committee has recently completed a survey of the global use of telemedicine, and a paper is in development describing the results of the data collected.

The Quality and Safety Committee provided input to the federal government on behalf of SCCM on glucose meter use in the intensive care unit. Most glucose meters are not FDA approved for use in critically ill patients, yet off-label use commonly exists, and insulin administration as well as other therapeutic interventions are made based on these handheld device measurements.

Catheter-associated urinary tract infections (CAUTIs) commonly occur in critically ill patients, and complications associated with CAUTIs result in increased length of stay, patient discomfort, excess healthcare costs, and can lead to increased mortality. Many cases of CAUTIs may be preventable. To address this problem, the Health Research & Educational Trust (HRET), through a contract with the Agency for Healthcare Research and Quality (AHRQ), led a quality improvement collaborative to implement the Comprehensive Unit-based Safety Program (CUSP) and CAUTI prevention practices in hospital units. SCCM participated in this effort by providing subject matter experts for a large cohort in the Southeastern United States. The results of this initiative will be discussed at the 2016 Congress.