Dr. Terri Ashmeade brings patient safety to the forefront of medical training, and has the data to back it up [Multimedia]

This story is part of a series highlighting faculty who are shining examples of quality and compassionate patient care and patient safety. Every day, these health care providers put their patients first. In the process, they create successful models of advanced care focused on empathy, safety, technology and evidenced-based medicine, models that carry through everything they do – into their practice, their teaching, their research, their community outreach, and into the USF Physicians Group.

Neonatal intensive care units (NICU) have some of our most vulnerable patients, babies in need of expert critical care. Because every interaction, every touch, with these newborns must be precise, with little margin for error, these NICUs must be a paragon of optimum patient safety.

Terri Ashmeade, MD, embraces every aspect of that realm. She is associate professor of pediatrics in the USF Health Morsani College of Medicine and medical director for the NICU at Tampa General Hospital. She is also the newly named Chief Quality Officer for USF Health. Her experience in NICUs and her active roles in defining best standards for patient safety helped pave the way for the new position, a job that aims to elevate quality care and patient safety across USF’s hospital partners and inpatient and outpatient facilities.

Dr. Terri Ashmeade directs the Muma NICU at TGH and leads patient safety for USF Health.

Dr. Terri Ashmeade directs the Muma NICU at TGH and leads patient safety for USF Health.

What defines a health care provider’s best approach to care, the one thing that ensures the best outcome for patients? Dr. Ashmeade boils it down to one word: data.

“In order to improve we need data,” said Dr. Ashmeade, adding that data rules in the TGH NICU environment. “Measurement is very important and we try to measure everything, from how long it took us to take a baby from the delivery room to the NICU to the temperature in the delivery room and how that temperature relates to the baby’s progress.

“As Chief Quality Officer, I’ll be able to help others understand our data, get the data they don’t have, understand it, use it to help us improve, and then measure our improvements along the way.”

Dr. Ashmeade said she realizes that patient safety can seem vague for a lot of us, a term that can bring to mind obvious scenarios of incorrect prescriptions and surgical procedures. But true patient safety is more than just preventing accidents.

“The most obvious forms of patient safety are what we hear in the news – a patient has an operation on the wrong body part or a patient gets a medication they weren’t prescribed,” Dr. Ashmeade said. “But there are many more subtle things that can go wrong. People who come into a hospital and get an infection related to a catheter or the overuse of medical treatments and X-rays, for example. It’s the more subtle things we do for patients, or don’t do for patients, that we need to pay attention to.”

Terri Ashmeade leads in patient safety from Tampa General Hospital's NICU and USF Health's Morsani College of Medicine.

Nurses and residents review daily progress of babies in the Muma NICU with Dr. Ashmeade.

Enhanced training for resident physicians and incorporating safety into the medical school curriculum are a couple of the ways Dr. Ashmeade aims to fill the pipeline with health care providers who are proficient in patient safety, which will improve patient outcomes.

“When I was a medical student we rarely heard the words ‘patient safety’,” she said. “We all assumed the care we were delivering was safe and thought that, if we were smart and if we were careful, all our patients would get the best care possible. But since then we’ve learned that, even with the best effort and the best intentions, we’re human beings and we can make mistakes and we can miss things. Learning about the science of patient safety and the science of quality improvement will help move us to the next level. At USF Health, we will train our medical students, nursing students, pharmacy students and public health students from the beginning so it becomes part of their everyday work and not something that’s an extra or an additional task. It has to be engrained.”

Building teams that center their efforts round safety will likely be the most effective approach. But that comes with a caveat: humans are reluctant to change habits and assume they already have good practices. And that’s where data steps in again.

“It’s hard to be measured; it can be shocking at first,” Dr. Ashmeade said. “Sometimes we have difficulty believing the numbers. So, my job will be to make sure I have the numbers right so people can trust them and use them effectively to improve. The first step is getting used to measuring our performance and being OK with ‘this is where I am’ whether we’re at the top or middle or bottom. Knowing where you are on that scale is critical, and data drives that.”

There are many tools for building that data, but Dr. Ashmeade noted that USF Health’s transition to Epic electronic health record system will be instrumental in tracking true improvement.

“With our EPIC implementation, we’ll be able to pull good data out,” she said. “I’ve used Epic for a long time at Tampa General so I know it’s a good system and will help us move forward in terms of collecting information on our patients, monitoring and tracking their progress and helping us improve safety across the board.”

Good data is what sparked Dr. Ashmeade’s drive for optimum patient safety and care, like that found in the NICU.

“When I became medical director of the NICU, it was the first time I really felt driven to understand what types of outcomes my patients were having,” she said. “And for the first time I had data I could look at that compared our performance to that of other similar neonatal units across the country and across the world. When I looked at those numbers, I saw that we were doing OK but weren’t at the top yet. That’s when I started training in quality improvement and patient safety to learn the techniques I could implement in the NICU to make changes that could get us to the top.”

Terri Ashmeade leads in patient safety from Tampa General Hospital's NICU and USF Health's Morsani College of Medicine.

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The delivery room and NICU at TGH are more than sources of data for Dr. Ashmeade. They are daily reminders for why she is so ambitious for the best patient outcomes possible.

“Patient safety is a huge part of neonatology, especially in that delivery room when there are so many things that have to happen within in a very short period of time,” she said.

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“We’re more like an orchestrated event or a dance. Before we go into a delivery we have what we call a huddle and decide who is going to do what in the room. Who is going make sure the baby is warm, who is going make sure the baby is breathing, who is going make sure the baby’s heart rate is appropriate. So when we get to the delivery room, we’re ready to go. We have specific places where we’re supposed to stand. There are specific communication strategies we use in those critical periods of the baby’s delivery. We don’t talk much, but when there is communication it’s very directed and specific so we are sure those specific steps take place at 30 seconds, at one minute, at one minute 30 seconds after birth. It’s really exciting when it all comes together but the fact is that it must all come together. It has to, for the baby’s sake.”

Terri Ashmeade leads in patient safety from Tampa General Hospital's NICU and USF Health's Morsani College of Medicine.

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“The best things happen to me every day,” she said. “I get to be present when babies are born. I get to be present for their first breath. I get to help them along, fragile babies, sick babies who might not make it, help them along their path. And then I have the pleasure of seeing their mom and dad, who weren’t sure if they we going to be able to take their baby home, actually take their baby home. I have the best job in the world.”

 

Photos and multimedia story by Sandra C. Roa, USF Health Office of Communications.