Keywords

nonpunitive, patient safety, rapid problem solving, real-time reporting, root cause

 

Authors

  1. Hatfield, Elaine MPM, RN
  2. Quinn, Christine MSN, RN
  3. Orme, Clifton MBA, FACHE
  4. Thompson, Debra MSN, RN
  5. Kurth, Marty MPM, RN

Abstract

LifeCare Hospitals of Pittsburgh is a 155-bed freestanding, Acute Long Term Care Hospital, one of 333 nationwide. Patients with complex care needs who are recovering from acute events, postsurgical interventions, and multiple comorbidities stay an average of 25 days. Like other hospitals, reducing medication errors is a focus of the quality improvement program. Provision of a safe environment is tantamount to achieving quality patient outcomes. Creative solutions to the problem of medication errors are needed. Healthcare executives need effective strategies to engage care providers in solving problems in the course of work and in a nonpunitive environment. Over the period of 1 year, medication errors reaching patients at LifeCare decreased by 50% through culture changes, rapid learning cycles, and strong support from the hospital's leaders.