The 10th annual adverse health report, put out by the Minnesota Hospital Association, (MHA) was released on Thurs., Jan 23. Initiated by the MHA and the Minnesota Department of Health (MDH) and created through state legislation in 2003, the system is the first in the nation to be built on the National Quality Forum's list of 28 reportable adverse events. The MDH and MHA produce an annual report of adverse events that have occurred in Minnesota hospitals, ambulatory surgery centers and regional treatment centers.
Ninety percent of facilities in the state self-report safety event and medical error information in order to share existing safeguards, identify common safety issues and facilitate new collaborative solutions among hospitals. The reporting is needed by hospitals to become more aware of medical errors, catch those errors, and encourage staff at medical facilities to report these events without fear of reprisal.
Mille Lacs Health System Quality Manager Greg Larson said Minnesota is a leader in this type of self-reporting, and that in some states, reporting facilities and employees are penalized, which defeats the purpose of continuing to improve safety. Adverse events can range from surgical errors to medications to pressure ulcers. “We all place ourselves under scrutiny so that we have greater transparency. We identify what we need to improve, and then develop plans to address those issues,” Larson said.
Mille Lacs Health System had no adverse events in the year 2013.
In 2012, the Senior Care Geriatric Psychiatry Unit applied for and received grant monies, allowing them to purchase infrared motion detectors for their patient rooms that assisted staff in the detection of a pending fall. Utilizing this equipment, along with other fall prevention tools, has reduced the fall rate for this group of patients.
Statewide, falls are an issue for communities in general. Due to an increasingly complex and aging population, falls resulting in serious injury or death continue to challenge both hospitals and communities.
A statewide coalition has been formed to address improving functioning for older adults and sharing fall prevention practices across the community. Models and tools will be tested at three state sites and MLHS in Onamia is one of the sites chosen.
MLHS Senior Care Unit Manager Jane Larson said that there will be collaboration between hospitals, long term care facilities, clinics and the community to share and implement strategies to prevent falls. “We’re happy to be one of the test sites and are already developing screening and education plans to work with various departments here, as well as within the community,” Larson said. Based on what is learned from the test sites, strategies and best practices will be developed and implemented state-wide.
“We are very proud that we had a positive year regarding adverse events here at MLHS,” said MLHS COO Kim Kucera, “and we continue to stretch our goals for patient safety. From surgery to clinical and hospital practices, we are implementing our safe campaigns consistently.” Kucera said that MLHS has also dedicated resources to safety by hiring a full time safety coordinator.
Mille Lacs Health System
Mary Rains: 320-532-2608