Improvements at Norton Women’s & Children’s Hospital

Improvements at Norton Women’s & Children’s Hospital include not only the physical appearance and expanded space of the hospital, but also quality outcomes for our patients. We are most proud of our improvements in these three areas: length of stay for neonatal abstinence syndrome; HCAHPS – responsiveness domain; and deep and organ space C-section surgical site infections.


The length of stay for babies with neonatal abstinence syndrome has decreased consistently over the past five years. In 2016, it was 19 days, down from a high of 40 days in 2011.


The Neonatal Intensive Care Unit has a special nursing unit for these infants, who are born to mothers who abused addictive opioid drugs during pregnancy. The unit was designed by nursing staff to provide care for infants experiencing various levels of opiate withdrawal. Nurses were educated on the use of a scoring tool to determine the infants’ progress. The infants’ symptoms provide direction about which medications should be used. The objective information from reliable scoring helps decrease length of stay and ensures the infants get the appropriate care and medication for their symptoms.


Nursing coordinates the interdisciplinary support team to provide the best healing environment for these patients. Focused training, specific environment, medical protocols and a supportive interdisciplinary team have led to the significantly decreased lengths of stay for these patients.


Improvement in HCAHPS scores as related to the “Responsiveness” domain also significantly improved, as shown in the chart below. This was due in part to several initiatives, including bedside shift report; a PVA development seminar; phones available for all patient care associates; a consistent unit coordinator assigned to the desk; and nurse leader rounding.


Improvement in surgical site infections for deep and organ space C-sections has been demonstrated. From 2011 through 2014, surgical site infections numbered from 21 to 37. To decrease infections, an intervention bundle was developed, implemented and closely monitored. With the initiation of the bundle, infections decreased to 8 in 2015, and a low of 5 in 2016.


The bundle included:

  • Antibiotic administration within one hour of incision time
  • Abdominal chlorhexidine preparation on admission and in the operating room
  • A betadine preparation prior to delivery
  • Educating the patient on surgical site infection prevention


Accountability for bundle compliance was established through feedback loops to care providers.


2016 HCAHPS — responsiveness domain

Surgical site infections for deep and organ space C-sections

Norton Children’s Hospital “Journey to Zero”

Norton Children’s Hospital has made great progress on its “Journey to Zero.” The number of children who experienced harm in 2016 is 60 percent lower than in 2013. That’s a difference of about 200 children.


Many factors have contributed to the success of the hospital’s Journey to Zero:

  • In 2012, Norton Children’s Hospital became the first hospital in the Norton Healthcare system to start daily safety calls.
  • More than 2,500 staff, leaders and physicians have been trained in error-prevention strategies.
  • All clinical areas have had training in high-reliability principles.
  • A new root cause analysis process called CARE Review, a three-step model to assess ways to prevent harm, has been implemented.
  • Norton Children’s Hospital is the first hospital in the Norton Healthcare system to use the zero table to display harm events.


Hospital-acquired conditions at Norton Children’s Hospital • Phase 1

CAUTI: Catheter-associated urinary tract infection

CLABSI: Central line-associated bloodstream infection

SSI: Surgical site infection

VTE: Venous thromboembolism


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Norton Audubon Hospital:

  • Has brought value to our patients
  • Is a major part of our “1” team
  • Elevated “Up” its nursing practice
  • Will continue to take ownership of “myAudubon” in 2017