10 patient safety issues plaguing healthcare in 2018

Published
  • March 14 2018, 4:00am EDT

Healthcare organizations use IT to address key safety challenges

Patient safety organization ECRI Institute has released its annual report on patient safety concerns for healthcare organizations. The annual list is intended to help organizations in their efforts to proactively identify and respond to threats to patient safety. “Use this list as a starting point for conducting patient safety discussions and setting priorities,” the company advises. In many cases, increased use of healthcare IT can have an impact on improving communication and coordination of care.

Diagnostic errors

Diagnostic errors are common, and miscommunication also is contributing factor, but often not the only one. These errors are the result of cognitive or systemic problems, or a combination of both factors. Errors also are difficult to measure and learn from because they may go undetected until after the patient leaves. Sources for capturing data on errors and near misses include the event-reporting system, malpractice and payment claims, patient complaints and surveys, autopsies and record reviews. Better use of IT can help reduce these mistakes.

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Opioid safety

The opioid epidemic has raised awareness of potential dangers related to outpatient prescriptions and illicit drugs. “It’s a patient safety concern because of the seriousness of the side effects,” says Stephanie Uses, a patient safety analyst at ECRI. Strategies include use of nonpharmacological modalities and non-opioid pain medications, accounting for individual needs, opioid tolerance and comorbidities. Continuous monitoring of high-risk patients by via prescription monitoring systems can help detect respiratory depression.

Internal care coordination

Poorly coordinated care puts patients at risk for medication errors, lack of follow-up care and diagnostic delays. Various technology tools, such as checklists, and safety huddles can help ensure providers are communicating with each other effectively at every stage of treatment.

Workarounds

Workarounds are pervasive in the industry and occur when staff members bend work rules to circumvent or temporarily fix a perceived barrier or system flaw. Staff should be encouraged to speak up about workarounds in a non-punitive environment. Analysis of processes prone to workarounds can identify mismatches between scripted and actual practices. As workarounds often occur with technology, organizations should ensure an ongoing maintenance plan is in place for the technology to perform reliably.

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IT support for safety programs

Health information technology can play a strong role in a safety program, but success depends on users recognizing, reacting to and reporting health IT-related events for analysis and action. If staff members fail to recognize health IT issues when they emerge, they may not know how to intervene. IT safety should be integrated into the existing safety program and the organization’s culture.

Behavioral health

When acute care patient behavioral health needs go unmet, issues such as self-harm or violence toward others, leaving against medical advice, poor behavioral health outcomes or interference with care of the acute medical condition can result. Strategies include addressing behavioral health needs of all patients, training staff on how to work with persons with behavioral issues, and conducting drills on de-escalating a crisis. Hospital should have relationships with behaviorists, psychiatrists, treatment programs, teaching programs and law enforcement.

Emergency preparedness

Hospitals faced a number of significant emergencies during the past year, such as major hurricanes, wildfires, mass shootings and ransomware attacks, altering day-to-day operations. “Obviously, preparing is a whole lot better than having to recover,” says Patricia Neumann, a senior patient safety analyst at ECRI Institute.

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Device cleaning

Failure to follow proper cleaning, disinfecting and sterilization protocol at any point can result in a compromised device and devastating effects for patients. “Once you have an outbreak, everything needs to be examined,” says Scott Lucas, director of accident and forensic investigation at ECRI. “This is a lot less stressful to do before we have bioburden and contaminants showing up in our trays.”

Patient engagement and health literacy

Providers should involve patients and families in identifying, planning and testing health literacy and patient engagement initiatives. Experts recommend taking “universal precautions” for health literacy, which is making all materials and discussions easy to understand. Bedside rounds, daily goal sheets and patient coaching can keep the patient engaged. Partnering with community groups can help tackle social determinants of health.

Leadership engagement

Having leaders invested in safety is essential to success of the program. Engagement must be on the intellectual and emotional levels. “The c-suite and the board, as a result of persuasion, have to be willing to listen,” says Carol Clark, patient safety analyst at ECRI. “It all starts with emotional and intellectual engagement. Without leadership investment, options for patient safety projects are limited.”

The full report, available here, offers expert perspectives and links to additional guidance.