Partnering with patients for safety

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  • 1. What About the Patient? The Missing Partner in Patient Safety American Society for Quality Quality Management Division Conference Dallas, TX March 5, 2004 Patrice L. Spath
  • 2. Patient Safety in Health Care If not a crisis, certainly a loss of public confidence 2
  • 3. The Public Is Concerned Percent who are “very concerned” In the past 12 months, have you about an error resulting in injury personally suffered personal injury or happening to them or their family… harm that you feel resulted from a medical error? When receiving health care in general 47% When going to a hospital for care 47% 93% When going to a No doctor’s office for care 40% When filling a prescription at a pharmacy 34% 6% When flying on U.S. 1% Don’t know/ commercial airliners 32% Yes Refused When eating food 30%purchased at the supermarket Source: Kaiser Family Foundation / Agency for Healthcare Research and Quality National Survey on Americans as Health Care Consumers: An Update on The Role of Quality Information, December 2000 (Conducted July 31-Oct. 13, 2000)
  • 4. Traditional PerformanceManagement Methods in Health Care Competent physicians and staff Physician credentialing/peer review Staff performance expectations Well-defined systems and processes Notebooks full of policies and procedures The expectation that competent people should be able to it “right” every time Performance measurement and quality improvement activities 4
  • 5. The Result: Alarming Defect Rates Breast cancer Outpatient antibiotics for colds screening (65-69) 1,000,000 Hospital acquired infections 100,000 Hospitalized patients Post-MI injured due to errors 10,000 β-blockersDefects Airline baggage handling Detection & per 1,000 treatment of Adverse drug Anesthesia-relatedmillion 100 events depression fatality rate 10 U.S. Industry Best-in-Class 1 1 2 3 4 5 6 (69%) (31%) (7%) (.6%) (.002%) (.00003%) σ level (% defects)
  • 6. Mistakes Happen Even the most competent professionals can make a mistake 99.9% of the time health care professionals are ‘set up’ to make a mistake. 6
  • 7. National Focus on Patient Safety Institute of Medicine report – “To Err is Human” (Nov. 1999) 44,000-98,000 deaths due to medical errors Annual cost $17B-$29B Federal Mandate and Regulatory Requirements - Presidential directive, Joint Commission on Accreditation of Healthcare Organizations, Centers for Medicare & Medicaid Services, State regulations 7
  • 8. Initial Reactions Distrust the data / challenge the definitions Strengthen traditional methods to create safer systems and practices Physician/staff training Process improvement (RCA / FMEA) Gather and analyze incident data 8
  • 9. Patients – Players in the System “The patient is one of the players in the complex system of health care and yet physicians and other health care professionals often think of them in a passive way as the victims of errors and safety failures.” Joel Mattison, M.D., F.A.C.S, Medical Director, Clinical Resource Management, St. Joseph’s Hospital, Tampa, FL. Author of chapter in “Partnering with Patients to Reduce Medical Errors” (AHA Health Forum, 2004) 9
  • 10. Vigilance Throughout theContinuum of Care The patient is often the only “constant” in the continuum of care. 10
  • 11. Involve Patients & Their Families Patients can help to reduce harmful mistakes 11
  • 12. What Patients are Saying Health care professionals should remember that they are human and will make mistakes. There is no harm in checking with the patient or their family members for a second opinion. And there is no excuse for ignoring or trivializing patient input. Female, 45-years old, Texas. No health care background. Cares for her husband who suffered a stroke and renal failure 10 years ago. 12
  • 13. Patient Power Patients can play an active part in preventing some mistakes if given the correct information and the right tools for the job. Environmental safety Clinical safety 13
  • 14. Another “Pair of Eyes” in theSystem Remind caregivers to confirm their identity Confirm that caregivers know what the doctor ordered Ask caregivers to explain the reason for a test/treatment Verify everyone knows what procedure is being done Alert caregivers to unusual or unexpected events 14
  • 15. Do Patients Want to be Involved? Range of responses Ostrich: “It won’t happen to me. It’s not my job to prevent medical mistakes.” Passive: Wants to know how to prevent mishaps, but won’t act unless caregivers are supportive. Assertive: Deliberately seeks out information on how to prevent mistakes and assumes a proactive role. 15
  • 16. Marking Surgical Sites Study of patient participation in surgery site marking: A surprisingly high number (35%) of patients did not comply with the orthopedist’s request to mark “NO” on the extremity that was not to be operated on, even when patients were told that such a mark was intended to prevent wrong-site surgery. DiGiovanni, C.W., Kang, L., Manuel, J. “Patient Compliance in Avoiding Wrong-Site Surgery.” The Journal of Bone and Joint Surgery (American), 2003, 85:815-819. 16
  • 17. Patients as Safety Partners:A New Role Change attitudes and behaviors of health care consumers Consumers are safety partners in other industries 17
  • 18. Tapping into “Patient Power” Role of organizations and practitioners Open, honest communication Willingness to partner with patients and their families 18
  • 19. Open, Honest Communication Relevant JCAHO Standards RI.3.10 – Patients are given information about their responsibilities while receiving care, treatment, and services. Mechanism for communicating responsibilities to patients, including the responsibility to ask questions PC.6.10 – The patient is educated about: Basic health practices and safety The safe and effective use of medications Safe and effective use of medical equipment or supplies when provided by the organization 19
  • 20. Admit Mistakes Happen “Everyone wants you to have a safe health care experience … here’s what you can do to help.” 20
  • 21. Safety Education Resources for Patients National Patient Safety Foundation ( Joint Commission ( Agency for Healthcare Research and Quality ( Institute for Safe Medication Practices ( American Academy of Orthopaedic Surgeons ( National Council on Patient Information and Education ( The Minnesota Alliance for Patient Safety ( Virginians Improving Patient Care and Safety ( Madison (WI) Patient Safety Collaborative ( Ohio Patient Safety Institute ( AORN Patient Safety First ( Sentara Healthcare (
  • 22. Empower Patients withInformation To serve as safeguards in the system, patients must know what to expect during the health care experience “Your test results will be back within 7 days. If you don’t hear from my office by the end of that time, please contact us.” 22
  • 23. Patient Education ToolsLaparoscopic Cholecystectomy BEFORE ADMISSION BEFORE SURGERY AFTER SURGERYYour doctor will do a Medical An Anesthesiologist will talk with Your physician or the surgicalHistory and Physical and have you you and discuss the type of resident assisting him/her will seesign a form giving him/her anesthesia to be used for your you before you are discharged.permission to do surgery. surgery.A nurse from the Hospitals Day Your blood pressure, pulse, The nurse will monitor your bloodSurgery Unit will call you the day respirations, and temperature will pressure, pulse, breathing, andbefore surgery. They will tell you: be taken when you arrive. temperature frequently. If you•What time to arrive at the An intravenous line will be started have any discomfort, ask yourhospital; in your vein and you will receive nurse for some medication. You•Not to eat or drink anything the an antibiotic. You will be asked to should empty your bladder 4-6night before surgery; empty your bladder 5 to 10 hours after your surgery. If you•What medications to take the minutes before going to surgery. cant empty your bladder or feelnight before or morning of uncomfortable, tell your; Your intravenous line will be•To have someone available to removed when you are drinkingtake you home. enough fluids.Your doctor and Day Surgery You will need to arrive at the You will be reminded to do yournurse at the Hospital will explain hospital 1 ½ hours before your breathing exercises. You canthe procedure to be done and your scheduled surgery. A nurse will begin to drink clear liquids and eatcare after the surgery. You may teach you about leg exercises and when you feel you are ready.need to have some tests done how to cough and take deepbefore your surgery. breaths after surgery.
  • 24. Incorporate Safety Topics intoDisease-Specific Education In the “Diabetes – What You Need to Know” educational booklet safety tips include: Check the label on your insulin bottle to be sure you have the correct type Make sure your insulin syringe and insulin bottle are marked with the same concentration Always read your labels Source: Royal Oak Beaumont Hospital, Royal Oak, MI 24
  • 25. Teach Them What WE Know How do YOU check that things are going right when you or a loved one is receiving medical care? 25
  • 26. Suggestions from a SurgeonAfter he was hospitalized for surgery Make yourself easily and instantly recognizable and not just the patient in “B bed.” Write your name in large letters on a sign and place it by your bed. Keep a small notepad and pencil at your bedside to jot down thoughts that might otherwise be lost during those temporary memory lapses. Joel Mattison, M.D., F.A.C.S, Medical Director, Clinical Resource Management, St. Joseph’s Hospital, Tampa, FL 26
  • 27. Willingness to Partner It’s not enough to have an organizational commitment to patient partnership … patient-caregiver interactions must support this commitment 27
  • 28. What Patients are Saying Health professionals must understand that I am also a member of the team. Members of the team should be accessible to me. Information should be shared with me. I should be part of the process, not a helpless victim. Female, 59-years old, New York City. No health care background. No chronic illness; only occasional interaction with a physician. 28
  • 29. Enabling Attitudes and Actions The Paternalistic The Collaborative Professional Professional Master of knowledge and Shared learning skills Unilateral ownership of Interdependent quality and safety (patient relationship (patient is is dependent) empowered) Individual accountability Collective responsibility Detached Engaged 29
  • 30. How to Stop Patients FromSpeaking Up (more than once) Deliberately change the subject because you are uncomfortable. Fail to clarify the patient’s concern. Offer premature or inappropriate reasons or answers. Cite policy as the reason for an action. Minimize or disregard the patient’s concern with comments such as “Don’t worry; we’ve handled it.” Make promises to do things you don’t or can’t follow through on. Blame or “put down” the organization. 30
  • 31. What Patients are Saying When you’ve got to be there all the time, you don’t want to fall out with any nurse or put any blame on anybody. Obviously, all the nurses stick together. And, hopefully, the same mistake won’t happen again. A person interviewed during a study of patients who had used an infusion pump during a hospital stay (Research conducted in early 2003 by the UK National Patient Safety Agency). 31
  • 32. Safe Havens Patients and their families should know who to contact with concerns or questions (other than the direct caregiver) Patient advocate Customer service department Printed on the patient safety brochure at Royal Oak Beaumont Hospital, Royal Oak, MI: Please tell us if you have questions or concerns about your care. You are welcome to call our customer hotline: 248-551-2273 32
  • 33. Measure Partnership Efforts During safety rounds, ask currently hospitalized patients: Have you noticed the staff asking you to state your name or have they checked your identification band? Have you or your family had a chance to review the information in the patient safety brochure? If you had surgery, were you asked to mark your surgical site? If so, what do you think about that process? Would you feel comfortable asking a doctor if he had washed his/her hands before examining you? 33
  • 34. Safety-Related SurveyQuestions Did the health care worker spend sufficient time reviewing your admission packet? Did you feel appropriately involved in your care? Were you encouraged to ask questions? If there were any unplanned or unanticipated events in your care, were you kept informed in a timely and satisfactory manner? 34
  • 35. A Few Watchwords Commit (organization & individual) Think multiplicity Persist Measure Ogden Nash: When you feel how depressingly slowly you climb, always remember: things take time. 35
  • 36. Everyone Has a Role inHealth Care Safety Senior leaders & quality professionals Physicians & other independent licensed practitioners Nurses & other caregivers Patients & their families 36
  • 37. Resource “Partnering with Patients to Reduce Medical Errors” (Jan. 2004) American Hospital Association ( 37
  • 38. Thank You Be Safe Patrice L. Spath Brown-Spath & Associates Forest Grove, OR Phone: 503-357-9185 Internet: email: 38