Tenet Nurse

Consumers have taken a more active role in their health care decisions, seeking quality and cost information. Tenet has worked diligently to ensure that our hospitals meet these expectations. As a knowledge-driven organization, Tenet uses data to support patient care excellence. Quantifying nurses’ impact have on patient care is critical to improving patient satisfaction, patient safety and quality of care.

The Commitment to Quality program at Tenet has two major goals: 1) to provide patients with high-quality, care and 2) to operate its hospital facilities safely and efficiently. Today, Tenet’s leaders have dedicated themselves to making the issue of quality the number one priority. Our chief nursing officers are implementing actions and principles designed to further improve the standard of quality of care at Tenet hospitals. To this end, the company’s executive nursing leadership is investing significant time and corporate resources into the development of formal, enterprise-wide evidence-based nursing practices dedicated to excellence in patient outcomes. Nurses at Tenet facilities can continue to grow their passion and commitment to caring for patients and their caregivers. Patients can benefit from the caring excellence of nurses at Tenet, as nurses focus on quality and service, practice and leadership development, and as they are recognized for their success.

Nurse Sensitive Core Measures

We have implemented processes that strive for excellence in nursing practice and patient outcomes. These processes are vital to our overall corporate goals to improve all aspects of patient care. The Corporate Office of the Vice President works directly with our chief nursing officers to improve core measures. Our composite core measures improved 13.2 percent from 2005 to the fourth quarter 2008. According to the CMS Hospital Compare Web site, which displays the public reports for core measures, Tenet exceeds the national average of nurse-sensitive core measures by 1.4 percent in the second quarter of 2009.

Core Measures

Nurses play a key role in impacting patient outcomes, especially the nurse-sensitive measures. For all indicators provided at the time of discharge, Tenet’s composite compliance rate is 96.2 percent for all core measure patient discharges in 2009. According to the CMS Hospital Compare Web site for the second quarter 2009, Tenet exceeds the national average for all core measures by 1.0 percent.

Infection Prevention

Tenet has participated in the Institute for Health Care Improvement’s 5 Million Lives Campaign and then later the 100 Million Lives Campaign, which were international efforts to improve patient safety by implementing evidence-based care.

In 2006 our Infection Preventionists with the support of our chief nursing officers, implemented evidence-based practices to reduce the incidence of hospital-acquired infections (CVBSI) such as ventilator-acquired pneumonia (VAP), urinary catheter associated (CAUTI) and central line bloodstream associated infections across our hospitals. Evidence-based practices were identified and implemented for these three types of device-associated hospital acquired infections. Among the practices implemented were the 30° elevation of the head-of-the-bed and frequent oral care with chlorhexidine impregnated mouth swabs for the reduction of VAP. These two evidence-based practices among others have resulted in a 65 percent reduction of VAP across the company in the last four years and the achievement of zero infections at 74 percent of all Tenet hospitals in fourth quarter 2008. For central line-associated infections, the company made available standardized central line that included a bacterial resistant patch to be placed around the insertion site. Additionally an emphasis on cleaning needleless access device ports and adding a mask for use during the dressing change were implemented. As a result, we have seen a 38 percent reduction in the incidence of CLBSIs in the last four years. For CAUTI practices, hospitals were asked to implement practices to reduce the use of urinary catheters (i.e., medical staff approved protocols that allow the nurse to remove the urinary catheter based on approved decision making algorithm). As a result, we have seen a dramatic reduction in the CAUTI rate as evidenced by 46.6 percent of our hospitals achieving zero CAUTIs in December 2009 as compared to 2006.

National Patient Safety Goals

In 2005, Tenet set the expectation that all hospitals would participate in the Institute for Health Care Improvement’s campaign to save 100,000 lives. This campaign was intended to save lives by implementing best practices to improve patient outcomes. In 2006, 18 of Tenet’s facilities participated in a Robert Wood Johnson Foundation grant to establish Rapid Response Teams (RRTs). Our early results indicated a 7.6 percent reduction in overall in-patient mortality rates from 2006. Since that time we have implemented RRTs throughout our company and continue to see the reduction in overall in-patient mortality. The registered nurse plays a key role in rapid triage assessment and protocol-based interventions to prevent further physical deterioration of the patient. These clinical improvement initiatives have significantly decreased “Failure to Rescue” indicators and contributed to a 0.08 percent decrease in mortality rates across the company since 2006.

Falls (Adults and Pediatric)

Reducing fall rates for hospitalized patients remain a key initiative for our chief nursing officers. In 2006 we introduced an evidence-based falls assessment tool, standardized the communication of high-risk and educated members of the health care team on their role in falls prevention. In 2007 we revised our evidence-based falls assessment tool for adults to include the use of high-risk medications and introduced evidence-based falls risk assessment tool for the pediatric population. Each hospital is required to adopt a comprehensive, aggressive falls program including a post-fall assessment on every fall, a designated falls champion and falls metrics on the our internal dashboard to measure outcomes. The composite falls rate for all adult inpatient units across the company continues to decline. Since 2007 our adult inpatient fall rate has been reduced by 0.94 percent. Across our company we have implemented hourly rounding, which has reduced the incidence of falls as well as several other patient safety issues. Tenet’s goal is to eliminate falls in all patient populations.

Pressure Ulcer Prevention

Prevention of hospital-acquired pressure ulcers is also an important chief nursing officer quality indicator. In 2007, the CNOs used more than $50 million dollars of capitol allocations to invest in new bed frames and bed surfaces. In partnership with our group purchasing vendor Broadlane, Inc., our wound team nursing staff has implemented an evidence-based practice specialty bed algorithm which our frontline nursing staff use to select the appropriate mattress for high-risk patients. To address the new “present on admission” indicator of pressure ulcers, we conducted education with all frontline staff regarding the initial assessment and documentation of pressure ulcers present at the time of admission. The assessment indicates the need for preventive skin interventions or active treatment of a pressure area. Research indicates that the national average for hospital-acquired skin breakdown is 6.7% and that the most recent best practice is less than 1.6 percent. We continue to monitor our patient outcomes related to hospital-acquired pressure ulcers with the goal of having a “zero tolerance.”

Perinatal Program Improvements

The mission of our perinatal program is to improve the quality and delivery of perinatal health for all women and newborns. The primary goals of the perinatal program are:

• Improve maternal and perinatal health outcomes by developing and implementing perinatal quality improvement programs
• Provide education and training related to perinatal standards of care for all professional staff nurses
• Make recommendations for development of evidence-based protocols and guidelines

Currently our Perinatal initiatives boost mandatory participation in the Association of Women’s Health, Obstetric and Neonatal (AWHONN) fetal monitoring workshops, monthly OB and NICU leadership teleconferences, a comprehensive shoulder dystocia toolkit, evidenced-based practices related to hot topics, standardized documentation forms and our monthly web-based Perinatal Education Series. Through our OB and NICU leadership teams we expect to complete the implementation of several new enterprise-wide programs that will improve the safety of our maternal and newborn patients. These programs include OB medication safety, care and management of the late preterm infant, OB hemorrhage, utilization of Oxytocin and elective induction criteria.

Click here to view a PDF of the 2009 Patient Care Services Annual Report