The Protecting 5 Million Lives from Harm campaign

AORN Journal, May, 2007 by Suzanne C. Beyea

In December 2006, Don Berwick, president and chief executive officer of the Institute for Healthcare Improvement (IHI), announced a new campaign: Protecting 5 Million Lives from Harm. (1) This initiative builds on the IHI's earlier programs titled the 100,000 Lives (2) and the Six by Seven (3) campaigns. All of these efforts focus on creating an infrastructure that can be used and reused to improve clinical care by addressing the variability in health care systems and minimizing the risks associated with medical errors.

Building on the experience and success of the earlier campaigns, the Protecting 5 Million Lives Campaign addresses preventable medical harm. (4) Medical harm is defined by the IHI as

   unintended physical injury resulting
   from or contributed to by medical care
   (including the absence of indicated
   medical treatment) that requires additional
   monitoring, treatment or hospitalization,
   or results in death. (5)

The IHI hopes to prevent five million incidents of harm in a 24-month period (ie, from December 2006 to December 2008) and to enroll at least 4,000 hospitals and their surrounding communities in this endeavor. (2)

This new campaign includes the six original interventions of the 100,000 Lives Campaign, which are

* deploying rapid response teams;

* delivering evidence-based care for acute myocardial infarction in a consistent, reliable fashion;

* implementing medication reconciliation;

* preventing catheter-related central line infections;

* preventing surgical site infections; and

* preventing ventilator-associated pneumonia. (2)

The Protecting 5 Million Lives Campaign also includes new interventions designed to

* prevent pressure ulcers,

* reduce methicillin-resistant Staphylococcus aureus infections,

* reduce harm from high-alert medications,

* reduce surgical complications,

* provide reliable care for heart failure patients, and

* involve a hospital's board of directors in supporting quality and safety initiatives. (5)

The goal of preventing five million episodes of medical harm in the next two years is formulated on the premise that an estimated 15 million incidents of medical harm occur each year in the United States. (1) The IHI's ambitious goal is consistent with its previous efforts to reduce harm and injury by improving the reliability of health care. Progress toward this goal will be measured by data collected from a representative sample of participating hospitals. (2)

RESOURCES

To help health care facilities implement and promote the campaign, the IHI web site provides access to several support resources at http://www.IHI.org /ihi/programs/campaign/campaign.htm?tba ID=6. For example, health care providers can access checklists, articles, posters, annotated bibliographies, PowerPoint presentations, and various guides to help implement the campaign and to sustain improvements. The IHI web site also provides many intervention-specific materials including a starter" kit for each of the interventions. The starter kits provide a summary of the evidence, strategies for implementing the interventions, and instructions on how to monitor a facility's progress toward achieving the outcome measures. These free resources are provided to help facilitate an organization's efforts related to the campaign.

PREVENTING PATIENT HARM

Gaining an understanding of the errors that occur is an important step toward the goal of eliminating similar episodes of harm. The IHI has modified the National Coordinating Council for Medical Error Reporting and Prevention (NCC MERP) Index (6) to help identify the types of errors that commonly occur. The NCC MERP index classifies patient harm from "E" to "I" using the following categories.

* Category E: The patient experienced temporary harm that required intervention.

* Category F: The patient experienced temporary harm that required initial or prolonged hospitalization.

* Category G: The patient experienced permanent harm.

* Category H: The patient experienced harm that required life-sustaining intervention.

* Category I: The patient died as a result of the harm.

The IHI will monitor all incidents of harm categorized as E through I both in the aggregate and within each category during the two-year campaign.

Obviously, preventing all types of harm is important when caring for patients. An individual perioperative nurse, however, might question what role he or she can take to help reduce harm and save lives. If a nurse works in a health care organization that has joined this campaign, he or she will be encouraged to participate in the activities of the campaign. If the facility in which a nurse works has not joined the campaign, it still is important to pursue ways to help prevent patient injury and harm.

A PERIOPERATIVE FOCUS

The Protecting 5 Million Lives Campaign lists key areas of focus specific to perioperative clinicians. These include interventions to prevent or reduce pressure ulcers and to identify and improve practices related to high-risk medications, as well as other interventions.