Q1 Target Zero Harm: Keeping Our Youngest Patients Safe

Target Zero Harm is on Inside Carilion and in the ePulse every quarter to keep you in the know about the great work that's happening systemwide to keep our patients and team members safe—and how you can help! Check it out and watch for other stories that demonstrate our commitment to quality and patient and staff safety.

Keeping our pediatric patients safe takes an intentional focus on quality and a willingness to adjust to the changing needs of our tiniest patients, who may be only minutes old and a few pounds to adolescents and teens up to age 17.

Not only must we constantly change how we care for our patients as their physical and emotional needs evolve, but we also continuously monitor data, processes and indicators to help reduce falls, infections and other conditions that could potentially cause our pediatric patients harm.

Through increased communication and feedback across our teams, monthly goal tracking and progress reporting, and by regularly celebrating our wins, Carilion Children’s is finding success in building a culture of quality and patient safety that we can sustain.

As a physician and a leader, I’ve had the privilege to both witness and be part of this important work—and I couldn’t be prouder or more excited to share our stories with you in this edition of Target Zero Harm! Thank you for your part in keeping our youngest patients safe. – Linda Keele, MD, FAAP, MAS, Pediatric Quality Officer, Department of Pediatrics and Clinical Advancement and Patient Safety

 A Spotlight On...

There is a lot of information to keep track of when we’re working to protect the health and well-being of our patients. It can be easy to put our efforts into improving some data and processes, losing sight of other work that needs our attention.

Pediatrics is learning the best way to create systems we can sustain for ongoing success is to monitor everything. Even data and processes that don’t require a focus to improve should be monitored.

Here are some highlights of their success.

Our PICU Decreased Unplanned Extubations

In 2021, the PICU had a large increase in unplanned extubations (UEs), which is when the endotracheal tube that removes patients from ventilators comes out accidentally or when not planned. This can lead to longer ICU stays, hospitalizations and sometimes cardiac arrest and death. The rate of UEs was rising to 3.45 per 100 ventilator days. By improving teamwork around high-risk procedures, improving communication and developing a protocol for sedation, the PICU team has successfully decreased their UE rate to 0.66—close to the national benchmark of 0.52. 

Our Pediatric Unit Decreased the Rate of Falls

The Pediatric unit had an increase in falls without injury, so they worked to decrease the incidents of falls—quite the ask in a young, mobile population. By using more visual reminders, such as fall risk signs, yellow wrist bands and yellow room lights; involving families’ help to prevent falls;and implementing an updated fall-risk scoring tool, the unit decreased the rate of falls without injury from 1.36 to 0.94 per 1,000 patient days. And they have prevented falls for almost 10 months in a row!

Our NICU Decreased Bacteremia Rates 

The NICU implemented an aseptic no-touch technique (ANTT) for inserting PIVs (peripheral intravenous lines). Embracing this technique wholeheartedly, the NICU has decreased our pediatric bacteremia rate from 1.5 to 0.87 and has a compliance rate of >85%. The work has been so valuable that the education they created has been shared systemwide. 

Our Outpatient Pediatric Clinics Decreased Vaccine Errors

Our outpatient clinics have been working to decrease vaccine errors and increase hand hygiene compliance.

• Our GI clinic had the highest rate of hand hygiene compliance of all subspecialty clinics in 2023.
• The Rocky Mount pediatric clinic had the highest rate of hand hygiene compliance among general pediatric clinics.
• The Rocky Mount pediatric clinic and the Postal pediatric clinic celebrated one year without a vaccine error.

Milestone celebrations are a big part of Carilion Children's success. Some recent celebrations are pictured here.

More Wins!

Recognition for Supporting Black Maternal Health

CRMH has been recognized for its success in supporting Black maternal health by U.S. News & World Report for Black Maternal Health Week 2024.

U.S. News’ analysis of all High-Performing Maternity Care Hospitals in the U.S. identified just 26 hospitals nationwide achieving excellent outcomes for cesarean section and unexpected newborn complications among Black patients. The news release announcing this award has more information. 

Presentation at VHHA Patient Safety Summit

Kevin Broyles, DO, Medical Director, Emergency Medicine; Mirla Cisneros, Senior Process Improvement Consultant; and Justin Price, MD, Medical Director, Human Factors and former Sepsis Committee Chair’s presentation, "Applying Process Improvement Strategies to Sepsis Care in the Emergency Department" was selected for the recorded presentation at Virginia Hospital and Healthcare Association's Patient Safety Summit in February.

Highlights of the presentation include:

• Sepsis is the leading cause of hospital admission and mortality nationwide and at Carilion.
• With over 70,000 Emergency Department visits annually, CRMH’s sepsis mortality index has lagged behind peers.
• The largest contributor to sepsis mortality is the population with sepsis present on arrival.
• The goal of their work was to improve sepsis outcomes by updating and integrating ED and inpatient sepsis workflows and improve the admission time for patients identified as having septic shock.

2024 Quality Poster Contest Winners

Angela Alderman, Ghislaine Cady, Erika Hamilton, Amanda Hudson, Alicia McAllister-Daniels, Kim Ramsey, Branden Robertson and Pansy Thompson were the winners of this year's Quality Conference poster contest held during National Patient Safety Awareness Week in March for their poster, "When Good Leads Go Bad: An ECG Lead Investigation."

Through innovative teamwork and collaboration, they found a resolution to issues discovered with ECG leads on our tiniest patients.

Several team members were present to receive an award presentation for their work from CEO Nancy Howell Agee. If you missed it, you can watch the award presentation and view all the contest posters.

If you have any questions or content suggestions for Target Zero Harm, contact Shawn Blackwell, CAPS Process Improvement, at sablackwell@carilionclinic.org.