The 10 largest patient safety concerns for 2019
Patient safety continues to be a significant area of concern for healthcare organizations. An annual report from research firm ECRI Institute find several areas for potential improvement, but the news is not all good for the healthcare IT industry—several safety issues have direct links to the use of information technology, or could be greatly ameliorated if IT capabilities were better applied in provider environments.
Diagnostic and test result management with EHRs
When diagnoses and test results are not properly communicated or followed up, the potential exists to cause serious patient harm or death. Providers have begun relying on electronic health records systems to help with clinical decision support, to track test results and to flag issues. However, the EHR is only part of the solution. “Technology is just a tool—there’s currently not an algorithm that is going to identify all the key elements and analyze them to give you the correct diagnosis,” says Lorraine Possanza, DPM and program director at the Partnership for Health IT Patient Safety.
Antimicrobial use in physician practices and aging services
“We need to combat antibiotic resistance before the situation gets worse,” says Stephanie Uses, a safety analyst at ECRI Institute. As antibiotic resistance increases, “your treatment options can be limited,” she explains. Perhaps the most significant challenge facing antibiotic stewardship is managing patient expectations, she adds. “Patients expect an antibiotic to help them get better,” she contends.
Burnout and its impact on patient safety
Burnout affects many clinicians, including physicians, nurses, allied healthcare providers and organizational leaders alike. News sources carry numerous stories about providers struggling with burnout, depression and suicidal ideation. Studies show that burnout has a consistent negative relationship with safety and quality. The burdens of currently used electronic health records are imposing increased stress on providers, ECRI and other research has found.
Patient safety concerns surrounding mobile health
Risks of mobile health technology include lack of regulation of new technologies, barriers to ensuring that providers are accurately receiving the data a device collects, and the possibility that a patient is not using the technology correctly or is not using it at all. Many devices are released without Food and Drug Administration testing, and so it is incumbent on providers to ensure the safety and validity of any device they recommend to a patient and be certain the device will work when the patient leaves the healthcare facility.
Reducing discomfort with behavioral health
When working with individuals who have behavioral health needs, “you fear what you don’t know, and fear can make you react defensively,” says Nancy Napolitano, a patient safety analyst at ECRI. This fear can lead providers and staff to behave in ways that fail to meet patients’ needs or even escalate situations, with consequences for patients and staff. In many healthcare settings, behavioral and physical health are siloed; however, people with behavioral health needs are in every setting, and it is not always obvious when an individual has such needs.
Detecting changes in patient conditions
Failure to detect changes in a patient’s condition is an ongoing patient safety concern—problems can arise within a care unit, during transitions of care within a facility, or between one facility and another. “Transitions of care and handoffs are critical times for care delivery, and they’re fraught with danger,” says Mary Rodger, an ECRI senior risk management analyst and consultant. “Passing along and receiving the correct information sets providers up for success.” Staff are not always adequately trained in recognizing changes in a patient’s condition or in responding to an alarm.
Developing and maintaining skills with med devices and equipment
Patient harm can occur if staff are uncomfortable using medical equipment or performing a procedure or are unaccustomed to an organization or care area’s processes. ECRI Institute has received reports of adverse events occurring because a healthcare professional was unfamiliar with equipment, such as infusion pumps and robotic-assisted surgical systems, or lacked competence with procedures and processes, ranging from Foley catheter insertion to management of a hemorrhaging patient after childbirth. Simulation training replicates real-life scenarios and offers an ideal opportunity for health professionals to practice their skills.
Early recognition of sepsis across the continuum
Sepsis can be difficult to detect, but early recognition is vital because sepsis can quickly turn deadly. “We’re in a time rush,” says James Davis, an ECRI senior infection prevention and patient safety analyst. “The challenge is can we intervene quicker to get patients the care they need to prevent shock and death?” In recent years, sepsis has gained attention in acute care—artificial intelligence is being tested as a way to identify patients at risk for sepsis, even before symptoms surface. But as healthcare delivery changes, “we’re moving that early recognition of sepsis outside the hospital as much as possible,” he adds.
Infections from peripherally inserted IV lines
Peripheral intravenous (PIV) catheters are commonly inserted upon admission in case the patient needs IV therapy at a later point. However, PIVs can expose patients to a significant risk of infection—one that is underreported, under-recognized, and often ignored, Davis says. “Any time you break the skin, you’re breaking down the body’s first line of defense against infection. Tracing infections back to the PIV line can be difficult because healthcare workers tend to overestimate their safety. “Staff need to respect putting in that PIV catheter, so that they slow down and treat it with the same reverence as if they were making an incision.”
Standardizing safety efforts across large health systems
Healthcare organizations are becoming megasystems, says Sheila Rossi, a manager at ECRI. “How do organizations internally structure themselves to address patient safety needs?” she asks. Leverage the protections of a patient safety organization, Rossi counsels. As health systems grow and expand across the continuum, it is beneficial to leverage the protections that a PSO affords to all affiliated providers within the health system.