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The Big Picture Experts agree that patient safety is a broad concept, but one that must be addressed. By Laura Thill Editor’s Note: The participation of those in the following articles does not constitute an endorsement of the sponsor’s products or services. The concept of patient safety is huge - so huge, in fact, it can be difficult to evaluate its impact on the quality and cost of patient care. "Patient safety is a very broad topic, one that encompasses quality, infection prevention, risk management [and more]," says Gina Pugliese, vice president of Premier’s Safety Institute. "It can be characterized as overuse, underuse, misuse or errors in patient care. Who [in a hospital] is responsible for safety depends on the facility." And, patient safety cannot be considered in a vacuum, she adds. "At Premier, we look at more than just the patient’s safety," she says. "When we talk about patient safety, we have to consider worker safety as well. So, with regard to fall prevention, we have to think about the staff who must lift the [fallen] patient. Also, [issues] such as latex allergies affect both patient and worker safety as well." At MedAssets, Janelle Johnson, executive director, laboratory division and outreach services, supply chain systems, agrees that patient safety is an umbrella term that applies to a number of issues, including falls, medication errors, wrong-site surgery, surgical-site infections, pressure ulcers and hospital-associated infections. It is impossible to estimate the cost of patient safety, she notes. "Any product or service used to treat, control or prevent any of [the above] conditions can impact the cost of providing safe care," she says. "Every hospital is different relative to what it [must] spend to improve patient safety. But one thing is certain: The additional cost of treating, or responding to, avoidable events far outweighs the cost of preventing them." This is a tremendous incentive for hospitals to invest in products, services and educational programs that can help improve patient outcomes, she adds. "Healthcare providers need to move [away from] focusing on the cost of products and [look at] their clinical performance [and ability] to reduce harmful events and the overall cost of care," says Johnson. She says MedAssets can help its members achieve this by:
To err is human - and sometimes inevitable in a hospital setting, notes Elizabeth Duthie, RN, MA, director of patient safety, New York University Hospitals Center. "Error can occur in so many places," she says. "In healthcare, we tend to try to intercept errors before they occur." As a result, the biggest challenge often is showing the staff that their efforts to prevent errors have paid off, she notes. Hospital clinicians and workers must take many steps to ensure that one or two errors are prevented. "When so many people take, say, eight steps [every day] to intercept errors, and then see that only one error has been prevented," they may get frustrated, she says. "It can be difficult to get them to understand the necessity of these safety steps if they can’t see the value." Eliminating much of the redundancy in safety steps is one way to get them to commit to the system, she adds. One way to reduce the number of steps it takes to prevent errors, and to reduce the opportunity for human error, is through automation. Hospitals are busy, notes Pugliese. "There are a lot of things going on, and people get distracted and make mistakes," she says. "We need automated systems to maintain checks and balances, and to override errors, such as a wrong dose medication." Premier offers its members several such patient safety software tools, including the following:
"We need [tools] to increase reliability in order to do things correctly," she adds. Redesign the system While they may not appreciate the redundancy in safety steps, hospital workers do appreciate the need to eliminate errors in healthcare settings, says Duthie. "People’s attitudes toward patient safety are changing," she says. There definitely is less tolerance for unsafe conditions, she states. "Our staff has a greater awareness of safety, and they can see what it takes to create a safer [environment]." In fact, many healthcare workers and clinicians now understand the need to "redesign the system" in order to prevent unnecessary errors, Duthie continues. "Workflow processes must support efficiency. [For example], nurses easily can do a cognitive flip of milligrams and milliliters. To eliminate [the potential for] error, hospitals are getting rid of bottles and, instead, sending exact doses to the nurses. Now you’re in the safety zone!" It’s true, this approach may add work for the pharmacy, but it’s much more efficient and safer for the nurses, she adds. Other errors, which also can be prevented by redesigning the system, include look-alike drugs (e.g., different vials of medicine often look similar) and confusing orders, she points out. Pugliese agrees that clinicians and administrators need to redesign hospital processes and systems to intercept errors, rather than point fingers once an error has occurred. She describes one member hospital that developed a system to ensure all incoming heart patients received an aspirin. "The hospital had aspirin available for all incoming patients," she says. If the patient did not have a heart-related condition, the hospital simply threw out the aspirin. "Still, it had a system to prevent overlooking incoming heart patients," she points out. "We need to recognize that many errors are due to poor design of the [hospital’s] system," she continues. Too often, "the tendency is to place blame for an error, rather than consider the conditions leading up to that error. But, we should learn from, and improve on, errors - not punish people. Otherwise, no one will report near-misses or mistakes." Sidebar 1: Costly Mistakes The cost of preventing errors is nothing compared to the cost of the error itself, note experts. People make mistakes. But, increasingly, healthcare workers see the need to reduce any opportunity for patient errors. Not only are patients’ lives at risk, but the economic impact of error is immense. In fact, in an effort to facilitate patient safety and reduce the cost of errors, Medicare is scheduled to stop payments to hospitals for care provided to treat eight preventable injuries: urinary tract infections from catheters, bloodstream infections from catheters, falls, bedsores or pressure ulcers, objects left in surgery patients, blood incompatibility, mediastinitis (a post-heart-surgery infection) and air embolism. The Centers for Disease Control and Prevention provides statistics highlighting the cost of errors: Healthcare-associated infections
Sidebar 2: Preventing Falls in Healthcare Settings Novation addresses need for fall prevention tools As of October 1, 2008, the Centers for Medicare and Medicaid Services (CMS) is scheduled to stop payments to hospitals for care provided to treat eight preventable injuries, including falls. In an effort to improve patient safety and help prepare hospitals for the CMS mandate, Novation offers its members several resources to address fall prevention. Available since November 2006, the program includes resource guidance on implementing fall management programs, as well as online links to fall-assessment tools and a sample protocol of John Hopkins Hospital’s policy on fall risk assessment. "In my opinion, falls often occur [in hospitals and long-term-care facilities] when patients are not oriented to their rooms and when there is a lack of communication between staff and patients," says Juliann Helsel, RN, senior clinical manager, Novation. "For instance, an incontinent patient may get up to use the bathroom, and [his or her] call light may not be working. "Many elderly patients are on medication, which can leave them dizzy and confused, and at higher risk for falls," she continues. "[Caregivers] must assess what types of medication they are giving, and when they are giving it. It calls for good communication, [as well as] orienting the patient and the patient’s family to fall prevention protocols." Helsel suggests some basic ways to reduce the risk of elderly patient falls in healthcare settings:
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