Quality and Safety

At Lawrence General Hospital, providing our patients with safe, efficient and high-quality health care is not only our priority, but our mission as your community health care provider.

We have summarized positive outcomes from several recent tasks our team has implemented to enhance patient safety. For a full review of these outcomes, please click here.

Quality

Lawrence General has an entire department leading our focus on quality care outcomes and performance improvement. And the Quality team is backed up by all employees, as they contribute to this important work every day. We submit our performance data to a number of state and national oversight agencies annually and engage daily in quality and safety improvement work.

• Accredited by The Joint Commission for high standards in both quality and safety
• Assessed annually by The Leapfrog Group using key performance indicators
• Verified Level III Trauma Center by the American College of Surgeons
• Only hospital in Massachusetts accredited by American College of Cardiology in four additional areas:
  • Cardiac Catheterization
  • Chest Pain
  • Heart Failure
  • HeartCare Center of Excellence
• Accredited Bariatric Surgery program by the American College of Surgeons
• Named a Breast Imaging Center of Excellence by the American College of Radiology
• Approved as a Community Cancer Program by the American College of Surgeons Commission on Cancer

Patient Safety

Lawrence General takes a proactive approach when it comes to improving patient safety. In addition to the existing infrastructure, our Quality and Safety team has implemented several new tools to monitor and improve safety, including a new safety event incident and "good catch" reporting and tracking system to help us address issues, respond, and learn from them.

COVID-19 Patient Care, Safety

To protect our patients, visitors, and staff from COVID-19, Lawrence General has taken the following steps in making our facilities and environment of care safer:

• Added new chemical systems to create negative pressure rooms that "pull" air out of the patient care environment. this reduces the potential for COVID-19 transmission.
• Installed new ultraviolet disinfection lights in our operating rooms, Emergency Center, and patient floors. The ultraviolet light kills bacteria and viruses.
• Increased cleaning frequency of our satellite locations using new electromagnetic air cannons for disinfecting.

Daily Safety Huddles

Daily Safety Huddles take place on all shifts in all departments, as well as house wide leadership Safety Huddles each morning. These huddles allow for staff to identify any patient safety concerns they have, so challenges can be addressed quickly and collaboratively. Leadership Safety Huddles prioritize concerns and identify potential trends and process problems.

Electronic Health Record (EMR), One Patient, One Record

Lawrence General’s Electronic Health Record (EMR) went live on May 1, 2019 and work continues with optimization. Overall, the system has served as a major resource in helping clinicians provide safer care to patients. The system also provides decision support, alerting the prescriber to potential medication allergies, improper dosing, etc. Training is underway on the integrated business intelligence solution, Business and Clinical Analytics (BCA), which enables the visualization and use of data to drive operational efficiency, maximize financial performance, and most importantly, improve patient outcomes. The EMR also improves Computerized Physician Order Entry (CPOE) which eliminates poor handwriting interpretation and potential errors.

Medication Safety

Several strategies have been implemented to improve medication safety and reduce the potential for medication related errors. These include:

• Bedside Electronic Medication Bar Code Scanning on inpatient units improves medication safety, ensuring patients get the right medication, the right dose, the right route and at the right time.
• Utilizing Intravenous "Smart” Pumps that rescue potential for intravenous infusion errors.
• Implementing a new Night Shift Pharmacy Technician role. As a result, the number of times that nurses must leave their unit to pick up medications in the hospital pharmacy on the night shift has been reduced. Critical, time-sensitive medications are quickly delivered to the units by the pharmacy technician, reducing order-to-administration time and delays in care.
• The night shift pharmacist has significantly fewer interruptions, which will help reduce the potential of adverse medication events.

Safer Maternity Care

The Lawrence General Hospital Laborist Program was implemented in the fall of 2019 with a vision and commitment that every expectant mother will receive consistent, reliable, quality medical care from an experienced physician.

• A Laborist is an obstetric and gynecologic hospitalist whose duties are 100% inpatient care, primarily care of patients on the Labor and Delivery unit, but also may include emergent care in the Emergency Center, including gynecologic surgery.
• The Laborist program was implemented to improve patient safety and quality, allowing for the presence of an experienced board-certified Obstetrician/Gynecologist who is immediately available 24 hours a day, 365 days a year. This immediate availability and continuous presence provide supervision of labor with the aim of early identification of abnormal labor, prevention of poor maternal and fetal outcomes, and management of obstetric emergencies.
• The Laborist program has been very effective. The Lawrence General Labor and Delivery unit has a unique structure where the Laborists support the family medicine extended privileges family practice physicians and residency program. The Laborist program has improved patient safety, quality and maternal and fetal outcomes at Lawrence General, a hospital located in a city with a high-risk OB population.

Reducing Patient Falls

The hospital’s overall patient fall rate and falls with injury rate have come down steadily due to a number of interventions:

• All patients have a fall risk nursing assessment performed daily
• Patient’s with high fall risk are discussed at unit-based Safety Huddles each shift
• More “walkers” were purchased
• Increased use of “gait” belts, which is an assistive device to help safely transfer a person from a bed to a wheelchair, assist with sitting and standing, and help with walking around. It is secured around the waist to allow a caregiver to grasp the belt to assist in lifting or moving a person
• Using bed and chair alarms that alert caregivers when a patient is attempting to stand
• Utilizing Patient Safety Observers for very high fall risk patients
• Discuss patients at high risk for falls at unit-based Safety Huddles (every day, every shift)

Reducing Hospital-Acquired Pressure Injuries

A hospital-acquired pressure injury (formerly known as a pressure ulcer) is a localized injury to the skin and/or underlying tissue during an inpatient hospital stay. Under the leadership of the Lawrence General’s certified Wound Ostomy Continence Nurse, Lawrence General nurses have implemented several interventions to reduce the potential for a pressure injury, these include the following:

• Replaced all inpatient bed mattresses with new pressure-reducing mattresses
• Implemented a Pressure injury intervention and incontinence nursing treatment “bundles”
• Educated nurses on pressure injury recognition and documentation at Nursing Skills Days
• Implemented comprehensive nurse driven skincare protocols
• Educated physicians about pressure injuries at Medical Grand Rounds
• Discuss patients at high risk for pressure injury at unit-based Safety Huddles (every day, every shift)

Implementation of Rapid Response Nurse Role

To improve patient care, Lawrence General nurses proposed a rapid response (RR) nurse position as an adjunct to the Rapid Response Team. The hospital has hired two RR nurses experienced in critical care. Unencumbered with a patient assignment, the RR nurse is available for patients exhibiting early signs of deterioration to prevent respiratory or cardiac arrest events. The RR nurse also serves as a resource and educator to other nurses for patients with chest tubes, central lines, and non-invasive ventilation.

With implementation of the RR nurse role, Lawrence General expects a decrease in response times for code blues, rapid response calls, strokes and a decrease in door-to-balloon time for percutaneous coronary intervention (PCI) patients. Improved code and rapid response documentation are also expected.

The RR nurse role could potentially lead to fewer rapid response calls and codes outside of the ICU, as the RR nurse will be available as a consult to all nurses at any early warning sign or change in clinical condition. To decrease ICU patient re-admissions, the RR nurse will also be responsible for assessing patients transferred from the ICU.

New Safety Event Reporting System

In March 2019, Lawrence General implemented the best-of-breed RL Solutions electronic safety event reporting system which allows for clinicians to easily enter patient safety events or near misses. A safety event system is the backbone of the patient safety program because it allows for analysis of the events so trends and patterns can be identified and appropriate actions can be taken to resolve.

Convenient Patient Surveys

Effective January 2020, Lawrence General upgraded its patient survey operations for more timely and convenient survey completions. Now, each patient receives a brief survey on their phone, by text, email, or U.S. mail just a few days after being discharged. We use this valuable feedback to improve the patient experience for everyone.