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North Country Regional Hospital serves as mentor for Institute for Healthcare Improvement

On Dec. 14, 2004, the Institute for Healthcare Improvement launched the 100,000 Lives Campaign.

The goal was to recruit hospital to commit to preventing that many deaths during the next 18 months by adopting six procedures proven to lessen dangers for patients.

Participating in the December 2004 conference in Orlando, Fla., were representatives of North Country Health Services -- President and CEO Jim Hanko, Dr. Christopher Anderson, Dr. Bill Muller and Dr. Maria Stanton.

They said, 'We signed us up,'" said Joe Dahlby, NCHS vice president of nursing.

Now, NCHS is a mentor organization for the IHI 100,000 Lives Campaign. Nancy Mickleburg, RN of North Country Regional Hospital Intensive Care Unit, one of the people responsible for the success of the campaign here, was a presenter at the national IHI conference in Atlanta, Ga., last week.

"Based on the scientific evidence presented at the IHI 2004 annual forum by Dr. Don Berwick, the four NCRH medical staff leaders who attended and I were readily compelled to sign up right then and there," said Hanko. "We knew the medical and nursing staffs back home in Bemidji would support the initiatives, and that we had the capacity to see them through."

NCRH was the 16th hospital to sign on the 100,000 Lives Campaign, and now, 3,103 are on board, Dahlby said.

Berwick announced last week that the 100,000 Lives Campaign had exceeded the goal by saving an estimated 122,342 lives. He said in a press release that the final number was arrived at by calculating the number of expected deaths at participating hospitals and subtracting the observed deaths, adjusting for changes in patient volume and risk. He said the "most pessimistic" estimate of lives saved during the 18-month period was 115,363 and the "most optimistic" estimate was 148,758.

Dahlby said the program was based on evidence of procedures that reduced risk of such potentially lethal conditions as central-line and surgical-site infections, ventilator-associated pneumonia and acute myocardial infarction (heart attack).

Some of the practices are fairly simple, such as keeping the head of the bed elevated for people on ventilators and quickly administering aspirin and beta-blockers for heart attack. Rapid response teams give extra attention to patients at the first sign of decline. Patients can also help by keeping a list of the medications they regularly take, said Wendy Gullicksrud, director of NCHS patient safety and infection control.

"People are on more and more meds," she said. "We have a sheet with space for 15 meds and some need two sheets."

This issue will become even more important as baby boomers age, Dahlby said.

To prevent surgical-site infections, the procedure is now to give the appropriate antibiotic an hour prior to the incision, said Jana Bromenshenkel, NCHS director of quality care services. Previously, administering pre-operation antibiotic was up to the discretion of the physician, she said. And, instead of shaving the incision site, which can result in nicks, special clippers remove hair safely.

"Any time you adversely affect the integrity of the skin you're open for infection," Dahlby said.

NCRH received IHI recognition at the midpoint of the 100,000 Lives Campaign for the success of the rapid response efforts. As a mentor hospital, NCRH is on the IHI Web site so other hospitals can contact staff for conferences, consultations and sharing information.

"Just the awareness it brought about is critical," said Shannon Westhoff, NCHS marketing specialist.

"Bottom line, this is something North Country can be very proud of," said Dahlby.