(See endnote 43, an extremely valuable document) (See Chapter 6, “Environmental and Occupational Injury Control”)

Health care is a high-hazard and high-risk industry for patients and staff. The Office of Inspector General of the US Department of Health and Human Services in 2010 stated that poor hospital care contributed to the deaths of an estimated 180,000 patients in Medicare each year. (The report of the numbers of patients dying each year from poor hospital care varies with the group doing the studies. The Institute of Medicine report in 1999 suggests that 98,000 Americans die each year.)

The healthcare industry has the second largest number of injuries and illnesses to employees in the country. The number of non-fatal injuries and illnesses requiring time away from work has increased among healthcare workers.

Patient Safety

Patients are people who typically are debilitated, may be confused, physically disabled, weak from being in bed, disoriented, and very young or older, and face numerous other problems related to their disease, the medicine they take, and the normal problems faced by all people within a residential environment. There is a considerable concern about falls and resulting injuries as a result of the above conditions. In addition, there are numerous other safety considerations including: events related to medication; events related to patient care; events related to surgery or other procedures; and events related to infections.

Overall, adverse events to Medicare patients in 62% of cases required prolonged hospital stays. Permanent harm was found in 5% of patients. The need for life-sustaining intervention occurred 27% of the time, while the event contributed to the death of the patient 10% of the time.

Medication problems contributed about 31% of the total adverse events that occurred to the patients. Patient care including falls with injuries contributed 28% of the adverse events. Surgery or other procedures contributed 26% of the adverse events. Infections of all types contributed 15% of the adverse events to patients. In addition, there were temporary harmful events the result of which did not cause any type of permanent damage to the patient. It was felt that 60% of the infections could have been prevented, 50% of the medication problems could have been avoided, 51% of patient care problems could have been prevented, and 17% of surgery and other procedure problems could have been avoided. (See endnote 41.)

There are several categories considered to be serious reportable events including those related to surgery, devices, patient protection, patient care management, and environmental and criminal situations. The environmental events include electric shock while receiving care at a facility, the wrong gas being delivered to a patient or contaminated with toxic substances, burns received at the facility, falls with injuries at the facility, and death or serious disability from the use of restraints or bed rails.

Unfortunately, in many institutions safety is the concern of a special committee rather than senior leadership of the institution. Because of this lack of high-level involvement, the issues related to patient safety do not receive the amount of time and control that is necessary for a successful program.

Best Practices in Patient Safety (See Best Practices in Employee Safety below)

  • • Senior leadership including chief executive officers, executives reporting to them, senior clinical administrators, and the Board of Trustees must be involved deeply in patient safety and establish goals and objectives for the entire institution and for specific departments in the reduction of medical errors, infection problems, environmental and safety problems, and other areas of patient and employee safety.
  • • At periodic intervals (such as 3 months, 6 months, and 1 year), each of the results of the work being done to achieve goals and objectives to resolve patient care problems should be evaluated and a determination should be made on how to redirect the program if necessary.
  • • Develop and implement a hospital incident reporting program and if one exists, evaluate how it is working and the results of the various reports being analyzed individually and en masse.
  • • Evaluate the hospital communications program to make sure that the proper individuals are being kept informed of all necessary information related to potential patient care problems and existing patient care problems.
  • • Carefully evaluate the amount of time that various members of staff have to work on a continuous basis since fatigue is one of the contributors to poor patient care and potential accidents.
  • • Place on the agenda of all senior executive meetings an update and discussion of patient safety problems, measurements, and trends, techniques being utilized to reduce safety problems, and the results.
  • • Encourage all frontline staff members to offer suggestions on how best to improve patient safety and reward them accordingly.
  • • Involve physicians to help resolve patient safety problems since most of the work is typically performed by nurses, pharmacists, and other allied health professionals.
  • • Involve patients and families in the work of the care team to help prevent patient care problems.
  • • Senior administrative staff should make unannounced rounds on a periodic basis to present a presence to the staff members and help enforce the concept of the necessity for excellence in patient care and avoidance of medical errors, infection problems, and environmental and safety problems.
  • • Since 80% of medical errors or adverse events are due to the system which has been established for a particular technique or treatment being used, all systems must be examined in depth by experts in that particular field in order to determine weak spots and how to correct them and institute the necessary procedures and tools to make this happen.
  • • All tests, medications, procedures, and information must be given at the appropriate time and meet quality control standards set up by experts within the particular field.
  • • Continuously provide short-term continuing education programs to all employees in their respective areas to keep them current on new practices and procedures and advise them of the types of patient safety problems that are occurring and how to resolve them.
  • • Avoid patient and treatment mix-up by immediately identifying the patient with an identification bracelet, including use of barcodes, with the understanding that staff will check the bracelet at least twice before performing any type of procedure or providing medications or other treatments.
  • • Design tubing connections so they cannot fit into the wrong ports.
  • • Patients or caregivers must provide a list of currently used medications and potential adverse reactions at time of entry into the patient care system. Before leaving, the patients or caregivers are given a list of medications given at the hospital and those to take home or prescriptions for them plus instructions on their use.
  • • Monitor very closely all patients given anticoagulation therapy and make necessary adjustments when shown to be necessary by blood work or symptoms.
  • • Establish an infection control team with a highly trained nursing specialist, physician, and other essential people including environmental health practitioners to conduct routine and when necessary special studies to determine potential sources of infection, prevention, and control throughout the entire institution. The team should work closely with local, state, and federal health authorities to deal with current infection problems and to prevent potential infection problems.
  • • Perform appropriate hand-washing techniques to prevent the spread of infection. Alcohol- based gels may be used by the staff and visitors in all patient care areas. All staff members must use the gel before and after taking care of the patient. (See endnote 19 for a comprehensive discussion of hand washing.)
  • • All staff members must use gloves, masks, eye protection, and gowns when dealing with infections or potential infections.
  • • Specialized staff members need to be highly trained in utilizing central venous lines, urinary catheters, ventilators, and other techniques which may be needed to prevent healthcare- associated infection.
  • • Patient falls must be prevented by lowering the beds as much as possible, utilizing bed rails, giving extra care to individuals who are at high risk for falling, and ensuring that the high-risk condition is noted on their wristband.
  • • Prevent pressure ulcers when patients spend extended amounts of time in bed by frequently changing their position in bed, cleaning the skin and drying it well, and using specialized pressure-relieving medical beds or other devices.
  • • Manage the most critical patients in the intensive care units by providing highly skilled doctors and nurses 24 hours a day.
  • • Provide a computerized system for physician orders and prescriptions to be written electronically to improve accuracy and help prevent errors because of handwriting legibility.
  • • All medications for patients must be double checked to make sure that the correct medication and the proper dosage is given to the correct individual. The time of providing the medication is also very important to avoid an error by giving the patient too little or too much over a specific period of time.
  • • Move patients safely when either adjusting them in bed or taking them for tests or other procedures. Provide adequate staff to do this to prevent injury to the patient and the staff member.
  • • As part of proper monitoring of patients, make sure that all treatments and medications are properly identified to the patient or caregiver and presented in a timely manner.
  • • Managers and administrators should give close supervision to all nursing personnel and other staff members to ensure that they provide adequate and timely care without endangering the patient.
  • • Ensure that there is a constant flow of effective communications among all caregivers of the patient so that everyone is working toward a common goal.
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