Quality, safety

P&T update: Pulmonary arterial hypertension
Providence Health Plan (PHP) reviewed utilization data for 2013. The plan continued to
have success in generic trend rates.

Providence leads in excellence once again
From Leapfrog’s high safety marks to other awards, these honors tie directly to the care we give our patients. – Dave Underriner, chief executive, Oregon Region

Patient safety indicators need careful documentation
Vague language or omissions can inflate our complication rates even when the quality of our care is superior. – Alexandra Penney, RN, MPH, clinical project manager, Oregon Region Quality Management and Medical Staff Services

New rules on surgical attire will increase patient safety
From covering all hair to bagging items brought from home, stricter dress rules in the OR can help prevent hospital-acquired infections. – Scott Foster, M.D., executive, Oregon Region Surgery Program

Are you taking the right precautions against bad bugs?
Preventing transmission of multidrug-resistant organisms not only keeps our patients safe, knowing the right precautions is required to keep our accreditation in good standing. – Martha Barstow, RN, director, Regional Infection Prevention and Accreditation

Regional palliative care services now unified
By consolidating our palliative care services into a single organizational structure, we can ease access to our services and provide consistency for our patients, whether they're at home, in a clinic or in the hospital. – James Arp, chief executive, Home and Community Services, and Bill Sherer, executive, Medicine Program

Nearly a year old, PICU is caring for the sickest kids
Providence St. Vincent Medical Center's new pediatric intensive care unit has helped more than 68 critically ill children with conditions ranging from respiratory distress to seizure. – Marie Curley, RN-BC, nurse manager, Providence St. Vincent Medical Center

When time is limited, a new model of hospice care
For patients nearing the end of life, rapid-response care approach eases the way of both patient and family. – Twilla Harrington, RN, clinical educator, Providence Home Services

What Providence’s care (r)evolution means for providers
We’re moving from treating the sick to improving the health of whole communities; from pay-for-service to pay-for-performance; from a collection of hospitals and clinics to a truly integrated network. – Doug Koekkoek, M.D., chief executive, Clinical Services; chief medical officer

CMS updates admissions rules, but compliance still required
A recent time extension applies only to a portion of the new policies, which include the controversial “two-midnight” rule. – Bradley Bryan, M.D., medical director, Regional Utilization Management 

On safety, Providence scores highest
The latest Leapfrog Hospital Safety Scores are out, and I am pleased to share that Providence received more “A” grades than any other health system in our area. – Doug Koekkoek, M.D., chief executive, Clinical Services; chief medical officer

Accreditation update: Moving to high reliability
The Joint Commission surveyed five of our hospitals this past year, and their reports were generally positive. But as hospitals continue to meet or exceed standards, surveyors are now drilling deeper into every aspect of process improvement and patient safety. – Karen Temte Lloyd, RN, BSN, quality management coordinator

Guest column: Miracle drugs in need of miracle
Antibiotic overuse, poor infection prevention, inadequate data mining and the lack of new drugs have created a global crisis. Here’s how we may be able to stop it. – David N. Gilbert, M.D., infectious disease consultant, Providence Portland Medical Center

Providence makes gains in curbing antibiotic overuse
Last year, a new antimicrobial stewardship program was rolled out at all eight Oregon hospitals. The goals: to prevent infection and stop the unnecessary use of antimicrobial agents. – Steve Stoner, Pharm.D., BCPS, FASHP, senior director, Regional Clinical Pharmacy Services

A primer on the new lipid guidelines
In November, the American Heart Association and American College of Cardiology issued new guidelines that will change decades-old treatment practices. PMG’s clinical pharmacy addresses the changes in these FA

Medical staff alert: New CMS admission rules
New documentation is required for inpatient orders, physician certification and the "two-midnight rule." Get details and see a decision tree. – Bradley Bryan, M.D., medical director, Regional Utilization Management

Skilled nursing partnership shrinks readmissions
A novel partnership between Providence Medical Group and selected skilled nursing facilities is easing the way for patients transitioning out of acute care. Learn how this team-based care model works. – Mahnaz Ahmad, M.D., medical director, Providence Geriatric and Long-Term Care Team

Hospitals welcome new quality directors
We’re pleased to announce that Charis Yoder will lead quality and medical staff services at Providence Newberg and Seaside hospitals; Jessica Bailey-Oetker at Milwaukie and Willamette Falls; and Dian Farber at Providence Medford.

Hospital rankings: What do they mean?
Barely a month goes by without a new set of “best hospital” rankings. Recently U.S. News & World Report issued its comparisons, followed by Consumer Reports. We can expect to see more of these lists in the fall and into 2014. We thought it might be helpful to provide some perspective.

Providence Portland to open a NICU by summer 2014
As a natural extension of the maternity care we currently provide, Providence Portland Medical Center will open a level III neonatal intensive care unit to care for the area's most fragile newborns. – John McDonald, M.D., medical director, Providence Women’s and Children’s Program

The worst part of the best job
Sentinel events, safety lapses or malpractice claims haunt clinicians. But errors can be avoided with diligence and a strong culture of safety. – Doug Koekkoek, M.D., chief medical officer, Oregon Region 

Care packages a new approach to common conditions
From total joint replacement, to pregnancy care and coronary artery bypass graft, the Oregon Region is exploring a new way for providers to collaborate on evidence-based models of care. – Doug Koekkoek, M.D., chief medical officer, Oregon Region

Medical home model takes adjustment, brings gains
From seating to workflows to clinical roles, Providence Medical Group's primary care clinics are adopting a new patient-centered approach to care. – Kerry Bonin, MPH, CHES, program manager, primary care redesign, PMG

Measuring quality beyond the hospital
Pay-for-performance measures for coordinated care organizations require a broader perspective – Doug Koekkoek, M.D., chief medical officer, Oregon Region

Providence begins its acute-care transformation
The first phase of an innovative team-based model rolls out at PSVMC this month, marking a leap forward in how we care for patients both in and out of the hospital. – Judith Tatman, RN, BSN, MS, chief nursing officer, Oregon Region

Inpatient, outpatient or observe: Urology
This month’s UM tip sheet focuses on decision making for common urologic procedures including, cystoscopy, TURP, prostatectomy and others. –Bradley Bryan, M.D., medical director, Regional Utilization Management

Closing the gap on zero preventable readmissions
Nationally, readmission rates continue to hover in the 9- to 10-percent ranges for health systems similar to ours in Oregon. How are we doing? – Doug Koekkoek, M.D., chief medical officer, Oregon Region

Bad bug, no drugs. What is CRE?
Bloodstream infections from this deadly "human gut bacteria" may still be rare in Oregon, but their resistance to antibiotics should put us all on alert. – Ronald Dworkin, M.D., medical director, Providence Infectious Disease Consultants-East

PSVMC to open pediatric intensive care unit
Beginning April 29, the PICU will allow Providence St. Vincent Medical Center to care for the community’s most critically ill children. – John V. McDonald, medical director, Regional Women and Children's Program

What do your patients know about fluoridation?
Portland is the only major U.S. city that doesn’t add fluoride to its water supply. Yet despite the public health benefits, misinformation about fluoridation persists. – Molly Melbye, D.D.S., MPH, University of Washington School of Dentistry, and Priscilla Lewis, RN, Providence Community Health Division

Inpatient, outpatient or observe?
This emergency department tip sheet will help decision making for a host of presenting conditions, including chest pain, synocope, asthma, pelvic fracture, COPD, dementia and others. – Bradley Bryan, M.D., medical director, Regional Utilization Management

Oregon Region Pharmacy and Therapeutics Committee updates

Decisions on diabetes, migraine and MS drugs

The evidence on rheumatoid arthritis drugs
The regional pharmacy and therapeutics committee has confirmed that biologic agents are effective for treating rheumatoid arthritis regardless of certain other factors.

Anticoagulant added to drug formulary
Apixaban, or Eliquis, is the third novel anticoagulant added to the region's drug formulary. The factor Xa inhibitor is used to prevent stroke and systemic embolism in patients with nonvalvular atrial fibrillation.

Treating opioid-induced constipation
Methylnaltrexone has been added to Providence’s drug formulary to treat opioid-induced constipation when laxative therapy has failed.