Patient Safety Organizations Improve Nursing Care Delivery and Performance on the Frontline.

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FEATURE ARTICLE By Kate ONeill, MSN, RN www.icarequality.org
Nursing and Patient Safety Organizations
Posted on: March 12, 2014
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Nurses are ideally positioned to support PSOs in transforming care and improving patient outcomes. The culture of patient safety, quality, and transparency is central to improving care delivery at every level in the healthcare industry. Overcoming healthcare challenges will require new skills, new technology, innovative thinking and patient voices who demand better. Failure to adopt best practices, care coordination and medical errors in 2011 contributed to $125 billion in excess spending in the U.S. healthcare system.1,2 In 2005, Congress passed The Patient Safety Act that authorized the creation of Patient Safety Organizations (PSOs) to help drive a new culture of "healthcare safety" in the U.S. The PSO serves as a secure environment for nurses, physicians, hospitals and other organizations to voluntarily collect report and share patient safety information to improve clinical practice. Nurses are in an ideal position to support the mission of a PSO to transform care in a non-punitive way, reduce patient harm, and improve patient outcomes. Nurses Key to Improving Care The U.S. healthcare system is undergoing unprecedented change. Patients, providers and policy leaders are coming together to re-design care delivery, expand services, improve patient safety, reduce medical errors, and decrease total cost of care.3 At the same time, professional associations, government agencies, and regulatory bodies are striving to close gaps in care by adopting new technologies, building cultures of safety, creating new care models, and developing collaborative learning programs.2,4,5,6 According to the landmark IOM report, "The Future of Nursing," nurses can play a key role in the healthcare transformation process.7,8 Organizations such as the American Nurses Association , the American Nurses Credentialing Center and its Magnet program have supported and strengthened the mission to improve the nursing profession through education, advanced degrees and certifications.9-11 Central to the transformation process is self-regulation and accountability for a professional clinical practice model (Code of Ethics, ANA).12 Since the era of Florence Nightingale, frontline nurses have provided a bedside "human touch" element that is essential for the delivery of high quality. Thus., "better care" means "safer care" which requires engaging patients, providers, and hospital leaders to support quality and safety initiatives in a learning organization. Overcoming care delivery challenges requires new skills, new technology, and workflow re-engineering. How then, can we leverage our best asset, professional nurses, to deliver evidenced based care that that is cost effective, timely and efficient? The answer just might be a Patient Safety Organization. PSO Overview In 2005, The Patient Safety and Quality Improvement Act (PSIQIA) stipulated the creation of Patient Safety Organizations to improve the quality and safety of U.S. healthcare delivery.13 The law encourages clinicians, nurses and healthcare organizations to voluntarily report and share patient safety information with a PSO without fear of legal discovery. Currently there are 77 federally-approved PSOs registered in the U.S. Many of these PSOs focus on specialty areas such as anesthesia, surgery, pediatrics, etc, or serve certain geographic regions. Other PSOs are engaged in various patient safety work activities and collaborate with hospitals,

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EMS, long-term care, surgical centers, community agencies and practitioner groups around the country. According to AHRQ, staff who work at a PSO must have specific expertise in analyzing patient safety events, and a strong background in identification, analysis, prevention, and reduction or elimination of the risks and hazards associated with the delivery of patient care.13 PSO Activities The main goal for the PSO is to create a secure, non-punitive learning environment where clinicians and organizations can share, collect, aggregate, and analyze patient safety data to support organizational improvement initiatives. The PSO collects and analyzes Patient Safety Work Product (PSWP) which is collected through a secure online reporting portal. The PSO identifies important trends and helps mitigate risks associated with complex patient care delivery systems. The PSO can also recommend strategies to reduce medical errors and educate healthcare professionals about best practices through various communication channels such as alerts and newsletters. Additionally, the PSO can interact with hospitals and healthcare professionals to create a "fair and just" culture of openness and commitment to quality and safety through collaboration and professional accountability.13,14,15 Legal Protection with PSOs The Patient Safety Act13 was specifically designed so healthcare organizations can safely collect and report information to a PSO in a non-punitive way. In order to support openness and transparency, all quality data and safety work activities from a PSO are strictly privileged and confidential, thereby reducing the risk of malpractice or litigation. Hence, The Patient Safety Act grants that the PSWP collected from a PSO may not be subject to discovery or admissibility as evidence in state or federal proceedings.14 With the new Patient Safety Act, PSOs are now able to identify patterns of organizational failures and propose measures to reduce risks and hazards even at the point of care, thereby improving overall care delivery. 2017 Mandatory Reporting to PSOs While reporting to a PSO has been voluntary for the past few years, the U.S. government added a specific rule in the Accountable Care Act (ACA) that now makes it mandatory. Under the ACA rule and in order to participate in the healthcare exchange, any hospital with greater than 50 beds will be required to establish a "patient safety evaluation system." Hospitals and organizations will need to contract with a PSO to be compliant by the beginning of January 2017.16 Benefits of Working with PSOs Both hospitals and providers gain mutual benefits when working with a Patient Safety Organization. Some of the key highlights include:  broad liability protection that encourages sharing of quality data for improving safety.  creation of a learning organization culture that is open and transparent for QI.  organizational commitment to patient safety and raising practice standards.  compliance to the 2017 PSO mandatory reporting guidelines.16 Nursing Champions Partner with PSO The culture of patient safety, quality, and transparency is central to improving care delivery at every level in the organization. Nurses are in an ideal position to work strategically and tactically with PSOs to benefit both patients and providers.

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In 2013, CloseCareGap (CCG) was federally approved by AHRQ as a Patient Safety Organization in order to fill a need in supporting frontline care delivery. Thus, the mission at CCG is to supports bedside nurses by providing tools and education to improve professional practice, engage staff, and to drive change. Many of our core modules are FREE and publically available to help organizations embark in clinical safety activities. CCG is one of only a few national Patient Safety Organizations dedicated to serving frontline nurses, managers and chief nursing officers to improve care delivery and patient safety – a mandate by the original 1999 IOM report. CCG has adopted the CMS Partnership for Patients campaign focusing on the top 10 areas of hospital acquired conditions. The online smart tools help nurse's measure practice performance and turns real-time evidence into action. Additionally, nursing Continued Competency can be validated using CCG tools which provide supporting data for state licensure and professional practice portfolios that embrace a culture of life-long learning. As a PSO, CCG works with inpatient hospitals, long-term care centers, and community nurses to reduce care variations and improve patient outcomes through QI projects that include:  perform real-time peer to peer clinical audit observations;  engage and incent staff to participate in QI projects with "Quality Points";  perform best practice quality audits on CAUTI, CLABSI, VAP, Pressure Ulcers, SSI, etc.;  reduce knowledge gaps through online learning to receive contact hour CE credit; and  view real-time unit, department, and organization dashboards to sustain QI efforts. CCG also works with various Magnet hospital organizations to meet the new 2014 Magnet requirements with a greater emphasis on outcomes, safety, technology, and innovative practice. Using our online smart tools, Magnet facilities can implement real-time Peer Review; collect patient safety data; and build sources of evidence for New Knowledge and Empirical Outcomes (such as NK4EO and NK5EO) to submit as sources of evidence for designation status.17 Overcoming Challenges The culture of patient safety, quality, and transparency is central to improving care delivery at every level in the organization. Overcoming healthcare challenges will require new skills, new technology, innovative thinking and patient voices who demand better. The Patient Safety Act of 2005 authorized the creation of PSOs to improve the quality and safety of the U.S. healthcare system. The PSO serves as a secure environment for nurses, physicians, hospitals, EMS, long term care, and other organizations to voluntarily collect, report and share quality patient safety information. Frontline nurses are in an ideal position to support the mission of PSOs and help make care delivery safer today for a better patient experience tomorrow. ----------------------------------- Kate ONeill, MSN, RN is VP of Quality and Safety at CloseCareGap, Patient Safety Organization, Springfield, Pa. Contact Kate at kate.oneill@icarequality.org or office phone @ 610.505.0996
This article appeared March 12, 3014 in the online edition of ADVANCE http://nursing.advanceweb.com/Magazine/References/Nursing-Patient-Safety-Organizations.aspx

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