Non-CAH award recipient - Mary Lanning Memorial Hospital
Read more about Mary Lanning's quality improvement activities.

CAH award recipient - St. Francis Memorial Hospital
Read more about St. Francis Memorial Hospital quality improvement activities.

Read about the other applicants
Non-CAH applicants
CAH

Overview

Mary Lanning Memorial Hospital (MLMH), is a 157-bed, JCAHO accredited, regional referral hospital located in rural Nebraska. MLMH has an average daily census of 77 and yearly inpatient admissions of 6,461 (2004). The regional health industry has a primary and secondary service area that draws users of the system of care from an approximately 32,000 square miles area that stretches into Kansas.

As an agency, MLMH has been progressive in its leadership role in quality of care issues both within the state and nationally. The Hospital has participated in all peer-review research projects conducted by CIMRO of Nebraska, formerly, the Sunderbruch Corporation. Nationally, the Hospital was recognized as the Nebraska state leader in preventing surgical wound infection and joined 52 others nationwide to participate in the National Surgical Site Infection Prevention Collaborative to test ways to reduce surgical site infections.

In addition, MLMH was the first hospital in Nebraska to commit to and participate in the national reporting mechanisms for quality indicators and most recently was named an award finalist for the 2004 American Hospital Association’s Quest for Quality Prize. The Quest for Quality Prize, first presented in 2002, is to honor hospital leadership and innovation in patient care quality, safety and commitment.

Philosophically, the promotion of quality and patient safety started with the Hospital’s Board of Trustees. The Trustees’ aim was to create a healthcare environment that supports, in both words and actions, error identification and offers solutions to prevent errors from recurring, while minimizing individual blame. MLMH's Strategic Plan designated a priority goal "To continue to identify and implement patient safety initiatives that will positively affect care delivery while minimizing patient safety errors, defects, and sentinel events, and striving for zero defects". With this goal in mind, the hospital charted a course to improve our medication administration process.

Historically, MLMH’s medication error rate has been below the national error rate. In 2003, our reported medication error rate was 10 errors per 10,000 doses compared to the national reported error rate of 30 errors per 10,000 doses. We recognize that one error can prove to be one too many. In 2000, a sentinel event occurred as a result of a medication error that led to severe brain damage and ultimately death of one of our patients. This event reinforced the need for a standardized medication administration process.

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Introduction
In the past medicine has been referred to as both "art" and "science". Successful practitioners of medicine (those with the best outcomes) have used the most reliable and up-to-date medical information (science) along with the art of knowing the family and culture, together with their own judgement and intuition.

Far too often physicians have relied on their personal intuition and medical view over what science has proven are the "best standards of care." These individual medical views, while usually producing a successful outcome, give a great deal of latitude in providing the patient's care, sometimes to the detriment of the outcome. Consequently, this care can also vary greatly from one physician to another. Further, without standards of care, it makes it far more difficult for support staff to order supplies correctly, give consistently good care, or answer patient's questions.

At the worst, it leads to bad outcomes. It also can lead to support staff making far more judgements as to "good" and "bad" doctors because they attach the physician’s reputation to these outcomes over time.

Our physicians and nurses recognize that evidence-based medicine is here to stay and with good reason. While implementing evidence-based medicine faces political, economical, control and leadership issues the benefit of improved outcomes far outweighs those costs and inconveniences.

Our facility has tackled these issues, and as a result of the projects outlined here, our community receives better care with proven outcomes and our medical staff has now taken ownership of evidence-based medicine—the greatest outcome of all.

Overview:

This project could come under the heading of several of the categories listed in the criteria for the award, but we feel that it fits best under the Process Management category involving performance and quality improvement.

The quality issue that we have worked on, and are continuing to work on, involves the integration of evidence-based best practices for different diagnoses into the fabric of our healthcare delivery system, both at the hospital and clinic level. This involves the use of eight guidelines for eight diagnoses for inpatients at St. Francis Memorial Hospital and implementation of CIMRO of Nebraska’s clinical guidelines for diabetes disease management in the Dinklage Medical Clinic. The eight guidelines were developed by the Southeast Rural Physician Association (SERPA). We are also participating in the Rural Health Outreach Grant by delivering the Targeting Lifestyle Changes to area diabetes patients.

The delivery of quality healthcare is an ongoing strategic initiative of our hospital and clinic, as well as our retirement center (where we are implementing Quality First, a quality improvement program of the American Association of Homes and Services for the Aging), and is a core value of our system. Assuring that our patients have access to the best medical treatment available every time that they come in contact with our system and can count on consistent, excellent care, regardless of the practitioner providing that care is critical to our vision to be the first choice for healthcare in our region.

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