Courtesy Photo MidMichigan Medical Center-Alpena employees receive training on a Rover, a device that allows staff to access patient records on the go, in this photo provided by the hospital. Pictured from left to right are nurse Joan Peltz, nursing assistant Heather Moldenhauer, nurse Courtney Sauer, and Jerry Hinge, who provided the training.

ALPENA — Changes to hospital policies and procedures and efforts by the employees who implemented those changes are the main reasons MidMichigan Medical Center-Alpena received top marks on the latest round of hospital safety scores from the Leapfrog Group, officials said.

The Alpena hospital’s score from Leapfrog, a national nonprofit that ranks hospitals, has gradually improved over the last seven to eight of the twice-yearly rankings. The hospital earned an A it earlier this month, up from a B in the spring and the C it earned in both 2019 rankings.

“I’m really, really excited that we got an A — that’s just a testament to the hard work and effort of all of our employees at the hospital and focusing on trying to do the right thing for patients,” hospital President Chuck Sherwin said.

Leapfrog’s semiannual report grades hospitals on 27 metrics, including staff handwashing, patient falls, and preventable infections. The hospital scored above average in 19 categories, below average in four categories, and average in two categories.

The hospital improved considerably in its handwashing and ability to treat infections in the urinary tract, according to Leapfrog, but continued to score below average in patient falls and having specially trained doctors to care for patients in its intensive care unit.

The hospital scored average in dangerous bed sores and clostridium difficile infection, also called C. diff, which stems from a bacteria and can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon, according to the Mayo Clinic.

“We have really focused a lot of attention over the last couple of years on patient safety, reducing infection rates, and preventing falls,” Sherwin said. “A lot of what leapfrog looks at is, what are the things that can go wrong in a hospital that can cause more harm to a patient?”

Nationwide, one out of 25 hospital patients develops an infection while in the hospital each year, and a Medicare patient has a one-in-four chance of being injured or dying when admitted to a hospital, Leapfrog says. About 440,000 people die each year from hospital errors, injuries, accidents, and infections.

According to the Leapfrog data, the hospital didn’t have any infections in the blood or surgical site infection after colon surgery.

The hospital also scored a 9.71 for patients who experienced serious breathing problems after surgery. For comparison, the average performing hospital scored a 6.36 for patients who experienced serious breathing problems after surgery and the worst performing hospital scored a 12.99 for those kinds of breathing problems.

Sherwin said Alpena hospital staff monitor handwashing and have done a lot of work to reduce patient falls.

He said Alpena tends to have an older population, which means the hospital’s fall rate can be considerably higher. He also said sick people tend to fall more often than healthy people.

To reduce patient falls, the hospital has implemented “no pass zones,” where hospital employees are not allowed to walk by a room if a call light is on. Employees try to provide extra support for patients in parts of the hospital where they know a patient is likely to fall.

When nurses or other care providers notice a call light is on, they go into the room to see what the patient needs, Sherwin said. If the patient has to go to the bathroom, employees can make sure they don’t get up before employees can help them, because most patient falls occur in the bathroom.

“It’s after they’ve gone to the bathroom and they go stand up and go back to their room — that’s when we find most patients fall,” he said. “The effort is to stay with the patient during that time — people want privacy, but just good communication, good education to the patient of what we’re trying to accomplish.”

With the construction of the new patient tower at the Alpena hospital, Sherwin said hospital leaders are looking at ways to keep cords and tubing off the floor of patient rooms, which could trip patients. He said administrators are also considering floor lighting in patient rooms, so patients can see at night.

The hospital has also made gains, and now scores above average, in its leadership to prevent errors and its communication about medicines.

Sherwin said the hospital now uses computers and barcoding to help reduce medication errors. He estimated about 98% of the hospital’s medication is distributed using the barcoding method, but noted there are times in critical situations where there isn’t the time to use barcoding.

For a patient to receive medicine, Sherwin said, a doctor enters a prescription into a computer, which reduces transcription errors, and sends it to the pharmacist. The pharmacist reviews the order and the pharmacy’s computer notifies the pharmacist if there are any potential interactions between the prescription and patients’ other medications with the medicine.

The pharmacist then prepares the medication and assigns it a barcode. When the medicine is distributed to a patient, Sherwin said, the nurse or physician will scan a barcode on the patient’s wristband. The barcode would alert staff if the medication is not in the computer.

“We have found that’s one of the biggest improvements that we have seen to reduce medication errors,” he said.

In addition to the barcoding, Sherwin said, hospital employees have also improved their communication when a patient is discharged, so patients know what they need to take — and what they don’t need to take — when they leave the hospital.

While Sherwin said he hopes the hospital’s grade will remain an A, he recognized there may be times when the hospital is “waffling” between an A or a B.

“Certainly, our goal will be to remain an A,” he said. “To be realistic, I think we’re going to fluctuate between an A and a B from now on. Hopefully, our days of being a C are over.”