Performing small acts makes a big difference

In the Canadian Adverse Events Study published in the CMAJ in 2004, 7.5 per cent of hospital admissions resulted in adverse events (unintended injury) and 37 per cent of these were judged to be highly preventable. The study estimated that between 9,250 to 23,750 deaths each year were preventable.

The Institute for Healthcare Improvement (IHI), recognizing that patient harm is largely "due to poor systems not bad people," ran the 100,000 Lives campaign for the 18 months from December 2004 to June 2006. With the goal of preventing 100,000 needless patient deaths in hospital, the campaign focused on six evidence-based interventions.

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These interventions were: (1) rapid response teams to respond to acutely deteriorating patients, (2) the prevention of adverse drug events, (3) reliable acute myocardial infarction care (to reduce heart attack deaths), (4) the prevention of surgical site infections (with the appropriate use of antibiotics around surgery), (5) the prevention of ventilator-associated pneumonia, and (6) the prevention of central line infections.

The four keys of ventilator-associated pneumonia prevention were relatively simple: elevating the head of the bed, a daily break from sedative medication, a daily assessment for the readiness to remove ventilation, gastric ulcer prevention and deep vein thrombosis (clotting) prevention.

The campaign was a success. The IHI estimated that 122,300 lives were saved from preventable deaths. Some of these interventions were relatively simple and they were based on what we already knew to be best practices (based on scientific evidence). The impact was significant.

More than 100,000 lives saved. Grandparents, aunts, uncles, parents, children and spouses remained alive and well to enjoy the oft neglected gifts of being alive and being with those they love.

Small things can make a big difference. This applies to you as well. When we think about making a positive change in our lives, we imagine that it would take a huge investment of time, effort or money to make it happen. We can be so intimidated that we can't even begin to bring about a change.

We may only dream, "Maybe next year when I have more time. Maybe someday when I have more will power. Maybe if I win the lottery."

Every big change begins with small incremental change, but it requires some reflection and intention. The relatively small systematic changes made in the hospitals involved in the IHI's 100,000 Lives campaign were scientifically based, carefully planned and standardized.

Think about a small systematic change you can begin this week and incorporate into your daily routine. Ask yourself, "What small simple change can I start today that will have a positive impact on my life?"

Consider first the most important areas of your life. Which areas (i.e. work, family, social, recreational, emotional, physical) need some improvement?

If you're not exercising at all and you would like to start, why not get off the bus a bit further from work or home and start walking an extra 15 minutes each day?

If you or your spouse is feeling neglected, why not set up a weekly date night (with each other not other people). If you are both busy parents and haven't found any time to check in and talk to one another, schedule regular time as a couple-maybe 15 minutes at the end of each day.

If you recognize that you've been more critical and negative about your life and everyone in it, consider beginning each day with positive thoughts-a meditation of appreciation. By reflecting on the good things in your life each morning before you even roll out of bed, you can frame your day in a positive light-even if it is cloudy and overcast outside. For many, this positive outlook can help you see opportunities instead detours throughout the day. You will be primed to see the positive in yourself, your world and others.

Dr. Davidicus Wong is a physician and writer.

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