Military Might
Today's VA hospitals are models of top-notch care
"There is room for improvement," says Bagian. "We're not perfect, make no mistake about it." But now the drive to enhance safety has become an accepted part of the VA. Caregivers on the front lines turn in a steady flow of ideas, such as requiring that doctors key in the full name rather than the first few letters when ordering a prescription. That minimizes the chance, say, that a patient who needs clonidine, a blood-pressure medicine, will get clozapine, an antipsychotic.
Augustin Martinez simply appreciates that he took his brother's advice. "I was fortunate I was a veteran. Otherwise, I don't know what else I would have done," Martinez says. "I don't think I would be here today."
Small Steps That Made a Difference
These are a few of the changes the VA has put in place to make patients safer.
FALLS
Problem: In older patients, falls were the top cause of injury and the No. 1 cause of deaths resulting from injury.
Solution: Bedside floor mats. Putting the bedside table, call button, and light switch within easy patient reach. Outfitting at-risk patients with hip protectors.
Did it work? In a six-month trial at 31 VA facilities, there were 62 percent fewer major injuries from falls.
INFECTIONS
Problem: Infections caused by an antibiotic-resistant strain of Staphylococcus aureus, largely spread by healthcare workers' hands, were killing patients or making them very ill.
Solution: In 2001, the VA's Pittsburgh Healthcare System mounted a hand hygiene campaign, raising awareness of the need for disinfecting hands and for gloving and using gowns and masks, and making sure such supplies were always at hand. At the same time, infection monitoring was increased.
Did it work? Such infections have been cut 85 percent in the general surgical unit, 50 percent in the surgical ICU.
BLOOD THINNERS
Problem: Delays in follow-up care for discharged patients taking blood thinners such as warfarin, which can cause bleeding complications if patients are not carefully monitored.
Solution: The VA Ann Arbor Healthcare System in Michigan recently required doctors to ensure that these discharged patients are seen within a week in one of its clinics. Their blood levels and medication dosage can be checked, and they can be counseled about diet, because certain foods interfere with blood thinners.
Did it work? It's too early for clinical results, but reportedly all such patients have had follow-ups, lab tests, and counseling within one week of discharge.
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