Safety in the Physician’s Office

Hospitals may be the focal point of most patient safety efforts, but the doctor’s office needs attention too.

Of every 1,000 outpatients taking a prescription medication, 90 will seek medical attention because of a drug complication, according to Mary Pittman, Dr. P.H. (doctor of public health), president of the Health Research and Educational Trust, a Chicago-based organization affiliated with the American Hospital Association. And lost test results create a risk to patient safety and quality of care, even more so than drug interactions or office-based surgery, according to a study by the Medical Group Management Association (MGMA) and COPIC, a Colorado-based, physician-sponsored malpractice insurer that insures about 75 percent of the eligible physicians practicing in Colorado.

“The task of improving patient safety is shared by all health care settings, but medical practices must take responsibility for learning from each other and keeping their processes current,” says Terry Hammons, M.D., MGMA senior fellow. And they can start by taking a good, hard look at their own practices.

To help them do that, the Health Research and Educational Trust, MGMA and the Institute for Safe Medication Practices released in October 2006 a Web-based self-assessment tool, aptly called the Physician Practice Patient Safety Assessment ( The tool allows medical practices to evaluate daily processes that affect patient safety. Practices that complete the assessment receive a workbook designed to help them identify problem areas and pathways to improvement. For a small fee, practices can submit their data online and receive data analysis and benchmarking information.

The self-assessment tool allows practices to evaluate their effectiveness and minimize risk across multiple locations in the following areas:

  • Medications (i.e., appropriate medication history, prescribing, storage, labeling, purchasing, dispensing of samples and administration of vaccines).
  • Handoffs and transitions of patients between clinicians or locations (proper procedures for care coordination to track patients and their clinical information).
  • Surgery and invasive procedures (patient safety issues relating to ambulatory surgery, especially sedation and anesthesia).
  • Personnel qualifications and competency (appropriately assessing the qualifications of caregivers).
  • Patient education and communication (actions that practices can take to help patients understand and carry out their responsibilities).
  • Practice management and culture (administrative procedures to create a culture of safety).

Sample questions
Here are some sample assessment questions from the tool:

Is a complete medication history (including over-the-counter medications, vitamins and herbal products) obtained and documented on every patient during each office visit?

Are patients provided with an up-to-date list of all medications they are receiving upon leaving the practice or other encounter (e.g., on a wallet reference card)?

Handoffs and transitions
Are the results of laboratory, pathology and imaging tests communicated to the patient in a timely manner (24 to 48 hours), and does the practice confirm and document that the patient received the results? Are patients notified of all laboratory, pathology and imaging test results, including those that are negative, whether or not they require further clinical action?

When a patient for which the practice has responsibility is discharged from a hospital or other facility, does the practice have a system that confirms the discharge information and enter it into the patient record?

Surgery/anesthesia and sedation/invasive procedures
Has the practice identified and communicated surgical and other invasive procedures that could be performed on site to all clinicians?

Do two staff members and the patient confirm and document the site of any surgical or invasive procedure before the procedure is begun?

Does the practice maintain a system to periodically (at least annually) assess nursing and support staff competency that is appropriate for the services and procedures they perform?

Does the practice maintain a system to periodically (at least annually) assess physician competency that is appropriate for the services and procedures they perform?

Patient education/communication
Are patients assessed for their financial and physical ability to obtain prescriptions and medical supplies at the time of their office visit or when provided a prescription over the phone?

Are patients routinely asked to repeat back what they hear to help the clinician clarify any instructions?

It is likely that every practice that completes the self assessment will find some areas that need improvement, according to the authors of the tool. But that shouldn’t stop them from getting a head start in improving safety and reducing the risk of harmful adverse events and future potential malpractice liability.”