Patient Safety
• Advanced Medical Technology
• Campus and Facilities Security
Kuakini places great importance on patient care and patient safety. Proper training of staff, patients and their families; the acquisition of the latest medical equipment and technology; development of new medical procedures for diagnostic and treatment; and heightened campus and facilities security are major ways that Kuakini focuses on the safety and comfort of its patients. A critical component for ensuring patient quality is maintaining a safe environment for all patients. Kuakini maintains an organization-wide Patient Safety Program and all employees are responsible to create a safe environment for its patients and residents.
The Patient Safety Program is designed to improve patient safety and reduce risks to patients and residents through effective medical/health care error reduction processes and an environment that supports the identification and reduction of risks to patients and residents. Kuakini has an internal response system that focuses on timely reporting and the initiation of actions to reduce risks to patients, residents and other customers.
Kuakini also follows regulations mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) that governs privacy, security, and electronic transaction standards for health care information.
The safety of health care delivery is enhanced by the involvement of the patients, residents, and in certain cases the patient's/resident's family, as partners in the health care process. Kuakini's caregivers clearly identify for patients/residents and families what their responsibilities are and educate them accordingly. Specific attention is directed at educating patients/residents and families about their role in helping facilitate the safe delivery of care. Patients and their families are encouraged to ask questions in order to fully understand the procedures and outcomes of the services they will receive.
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Advanced Medical Technology
Kuakini Health System has many examples of technological devices that enhance patient safety. Kuakini has recently 
begun the process of installing a comprehensive computer network and integrated software applications for electronic medical records that will assist in reducing medication errors. By eliminating paper records and manual order entry, Kuakini will dramatically reduce the risk of medication errors. Computerized Physician Order Entry (CPOE) is an automated clinical system that allows physicians to enter orders for diagnosis, treatment and medications with significantly improved accuracy over manual entry. CPOE systems give physicians the ability to instantly share a medication order with all key health care providers in the medication related loop and eliminates the possibility of misunderstanding and errors due to bad handwriting or misrouting of orders. In addition, the CPOE provides a rules-based database that can caution physicians on any adverse effects and contraindications to the patients and potential overdosing based on the ordered drugs and clinical information on the patient in the electronic medical record (EMR).
Kuakini's Imaging Services Department utilizes the latest, filmless, digital imaging equipment that eliminates the need for retaking images, reduces the amount of time a patient is exposed to X-rays and reduces the dosage of radiation exposure. Also, the all-digital imaging equipment eliminates the use of X-ray film and cinefilm which means an environmentally friendly operation. Kuakini is one of a few medical centers in the United States with all-digital imaging equipment and a comprehensive PACS (Picture Archiving and Communications System) to archive the images for clinical and research use.
In the Radiation Therapy Department, Kuakini has a dual energy Clinac 2100C Linear Accelerator that can be positioned for convenient setup of asymmetric fields using a multi-leaf collimator. This allows the Radiation Therapist to "shape" the laser that the Linear Accelerator emits. By shaping the laser into the exact shape necessary, no "healthy" tissue is treated by an accidental overlap. Certain procedures are supplemented with cerrobend blocks, however, these procedures are longer and can take up to four hours per visit.
In April 2002, Radiation Therapy began treating patients diagnosed with cancer using Intensity Modulated Radiation Therapy(IMRT). Kuakini is the first hospital in Honolulu to use IMRT; a state-of-the-art cancer treatment that delivers radiation in a much more conformal and targeted way than is possible with conventional radiation therapy. IMRT uses small rapidly treated beam segments delivering radiation doses directly to the target while sparing normal surrounding healthy tissue. By reducing the radiation dose to healthy tissue, IMRT may reduce side effects in comparison to conventional radiation therapy. It may also allow treatment using higher doses in selected cases by its ability to avoid radiation exposure to non-cancerous areas.
The Sterile Processing Department uses a special surgical instrument sterilizer that uses gas plasma generated by the application of radio frequency energy to vaporized hydrogen peroxide. Microorganisms and highly resistant bacterial spores are killed, leaving only oxygen and water vapor as a by-product. The Sterrad system is also much safer and faster than the widely used ethylene oxide sterilizers and takes about one hour to sterilize instruments compared to the 12 to 18 hour process using ethylene oxide. This sterilization technology is also friendlier to the environment.
Surgical Services provides a number of high-tech procedures for specific surgical cases. Kuakini offers a special procedure to treat liver tumors called Radio frequency Thermal Ablation(RTA). RTA is the latest procedure in the treatment of liver tumors and was first used in Hawaii at Kuakini. Approved by the FDA in 1997, RTA is non-resectional, which means removal of the organ or cutting out the tumor is not necessary. RTA can be accomplished under local anesthesia and on an outpatient basis under percutaneous (external ultrasound for guidance and no incision) methods. This procedure takes less than 15 minutes for each session.
Another advanced procedure is Bariatric Surgery using 3-D visualization and laparoscopic devices to perform surgery on morbidly obese patients. This procedure was offered for the first time in Hawaii by Kuakini.
Kuakini has a centralized robotic drug distribution system that automates the storage, retrieval and dispensing of unit dose, bar coded inpatient medications. The robotic system is call the ROBOT-Rx and was the first of its kind in a private hospital in Hawaii. It is widely recognized in the health care industry for its accuracy in the prevention of medication errors. To date, the ROBOT-Rx sites in the United States have dispensed more than 45 million doses without an error. Using bar codes, which link patients and patient orders to medications, the robot not only automates the dispensing of medications, but also handles checking, crediting, stocking and inventory control for the Pharmacy department.
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Campus and Facilities Security
Kuakini enforces a security lockdown by limiting access to all facilities on campus after visiting hours. During the late evening and early morning hours, all persons must check in with the centrally located Security Kiosk and present identification. Access to Hale Kuakini and Hale Pulama Mau Buildings are limited to the entrance adjacent to the Emergency Room and the HPM main entrance. A trained in-house security staff provides a secure environment on Kuakini's campus. Emergency phones located in several key locations can be used to reach security as well as using any in-house telephone by dialing "0" for the operator.
All physicians, volunteers, vendors, and employees are required to wear identification badges at all times while on duty on Kuakini's property. This security measure is intended to keep unauthorized personnel out of patient-sensitive and limited access areas. Security officers are available 24 hours a day to accompany anyone to their destination on campus if they should feel the need for assistance.
Patients and residents are fitted with yellow wristbands if there is a possibility that they may become disoriented and get lost in the facilities or leave the campus. Kuakini personnel are required to call the Nursing Supervisor on duty and security staff if a patient with a yellow wristband is seen outside the patient care areas.
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