Hospital Hope Scenario; Mrs. Jackson a 73 year old widow mother of two adult daughters grandmother of four and great-grandma to three children was admitted to Hospital Hope a typical suburban hospital viewed by the community as a good hospital. As a newly admitted patient Mrs. Jackson had no reason to suspect either that nearly one in every 20 hospitalized patients in the US each year develops a hospital-acquired infection or that central-line-associated blood-stream infections (CLABSIs) are among the most deadly types of hospital-acquired infections with a mortality rate of 12-25% as reported by the Centers for Disease Control and Prevention (CDC) (2011c).

Mrs. Jackson was active in her community, volunteered at the local library, and enjoyed sharing blooms from her showcase flower garden. She was proactive in maintaining her health through regular activity, such as walking and water aerobics, and by healthy eating. She had not been a hospitalized patient since an abdominal hysterectomy 20 years previously.

Hospital Hope Scenario

Mrs. Jackson did have a well-documented, Grade 6, systolic heart murmur stemming from a childhood illness. She had been asymptomatic her entire life until recently when she experienced two episodes of ‘passing out’ with only minimal exertion. She was admitted to Hospital Hope for diagnosis and treatment and soon scheduled for an aortic valve replacement. The surgery was uneventful and Mrs. Jackson was admitted to the Surgical Intensive Care Unit (SICU) for recovery and post-operative care. Hospital Hope Scenario

During her eight-day SICU stay, Mrs. Jackson, who had a 10 year history of type 2 diabetes, developed hospital-acquired pneumonia, experienced three episodes of hypoglycemia (including one blood glucose level of 39 mg/dL), and developed a CLABSI requiring removal and re-insertion of her central line. Her recovery was slow and her two daughters, one a nurse educator and the other a lawyer, were at her bedside as often as SICU visiting hours allowed. They were eager to help in their mother’s recovery by assisting her with bathing, feeding, and ambulation. However, the doctors and nurses appeared to be reluctant to involve them in their mother’s daily plan of care. After eight days in the SICU and 5 days in the step-down unit, Mrs. Jackson was discharged to an extended care facility for continued recovery and rehabilitation and eventually returned to her home. Hospital Hope Scenario

Mrs. Jackson survived hospitalization without permanent injury despite experiencing three preventable conditions during her hospital stay, namely pneumonia, a central line infection, and episodes of hypoglycemia, all of which could have been prevented if established, evidence-based care had been practiced. Her story did not make headlines; her case did not get anyone’s attention. Yet she was harmed in not one, but three instances. The costs associated with her care, in terms of dollars, psychological stress to Mrs. Jackson and her family, and the discomfort

In the Hospital Hope scenario what do you think was the most important factor that led to the change in practice in the SICU?,

If you worked in a facility that needed a practice change what framework would you use and why?

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