Patient Safety Monitor Journal answers your most important patient safety questions and offers field-tested compliance strategies to ensure your patient safety efforts measure up to The Joint Commission.
Looking at the biggest problems with PPE
The failure of workers to comply with PPE guidance is a perennial issue in healthcare. While PPE protects workers from infection and harm, it also plays a key role in patient safety: It keeps employees from accidentally exposing patients to harmful chemicals and bacteria from around the facility. The risk of infection for patients and staff goes up every time someone forgets to wear gloves or enters the building wearing sandals.
“PPE does not remove the hazards; it protects the individual,” said Marjorie Quint-Bouzid, MPA, RN, vice president of patient care services, chief nursing officer, and emergency manager for Fort Washington (Maryland) Medical Center, in an interview with Patient Safety & Quality Healthcare. “Healthcare organizations must continue to attempt to mitigate potential hazardous situations or practices as the first line of defense.”
To learn more about commonly misused PPE, we spoke to two safety experts on the mistakes they see most often.
Dan Scungio, MT (ASCP), SLS, is the laboratory safety officer for the Sentara Healthcare system in Virginia.
1. Lab coats
Misuse: Types of misuse include not wearing coats, wearing a lab coat but not buttoning it up, rolling up the sleeves, wearing a cloth coat (rather than a liquid-resistant material), wearing a waist-length coat (rather than knee-length), and cutting into disposable coats to create coolness/ventilation. Any misuse described will cause a greater risk of exposure to chemicals and blood or body fluids.
Proper use: Lab coats must be worn closed (i.e., snapped) to prevent incidental splash of blood and other potentially infectious material from contacting the worker’s skin. Staff should wear lab coats only in the work area. They should not wear them during meal or rest breaks or in any public areas, such as the cafeteria, lobby, or gift shop. Laboratory workers should wear a traditional knee-length laboratory coat, long-sleeved with knitted cuffs. Lab coats may be reusable (requiring laundry processing) or disposable.
Q&A: What makes a quality EHR?
Editor’s note: A 2016 study published in the Annals of Internal Medicine found that for every hour physicians spend with patients, they spend two hours interfacing with their electronic health records (EHR). A different study found that 14% of physicians have experienced a potential medication error due to their EHR in the past month, and another 14% of physicians said that excessive EHR alerts have caused them to overlook something important.
Despite this, an AMA survey of 1,200 physicians found that 85% believed digital health solutions are an advantage to patient care. Hospitals and healthcare facilities need to be able to implement their EHRs to their full potential—not only to improve care quality, but to make sure it doesn’t suffer.
The following is an edited Q&A about the value of EHRs with Michael Sherling, MD, MBA, co-founder and chief medical officer at Modernizing Medicine, a company that specializes in EHR systems for specialty practices including dermatology, orthopedics, rheumatology, plastic surgery, and ophthalmology.
PSMJ: How many different types of EHR systems are on the market?
Sherling: When we started the company about six years ago, I’d say there were about 600 EHRs on the market. Literally every flavor of ice cream that you could think of.
Some were client-server based (hosted by the practice) and some of them were cloud-based (hosted remotely by the vendor). But what we’re seeing over time is a consolidation. I’d say there’s about 20 to 30 vendors who are likely going to get all of the market share over time from that 300–600. We [Modernizing Medicine] have ourselves about 10,000 providers.
Plan staff activities for National Patient Safety Awareness Week
March 12–18 marks the start of the 2017 National Patient Safety Awareness Week (PSAW). The week is organized by the National Patient Safety Foundation (NPSF) to increase awareness on patient safety issues. The event is aimed at educating and engaging healthcare professionals and the general public through web events, social media, educational programs, and materials.
“The campaign emphasizes that everyone participating in the healthcare system has a role to play in keeping patients safe and free from harm,” said Tejal K. Gandhi, MD, MPH, CPPS, president and CEO of NPSF, in a press release. “Patient Safety Awareness Week is an important annual focus of the campaign and we hope to have record numbers of participants this year.”
While PSAW has been going on for several years, in 2016 it was made part of the NPSF’s United for Patient Safety campaign. Sara Valentin, NPSF assistant vice president of event management and strategy, says the purpose of the campaign is to spread the idea that “every day is patient safety day,” rather than just one week. However, PSAW still has a crucial role in spreading the news and edifying people on quality care and safety.
“Over the years, we feel the week has been very successful in engaging healthcare organizations and their teams in patient safety,” Valentin says. “We are making additional efforts to further engage the public and educate people about patient safety. Since the launch of the new [NPSF] site, we have seen an increase in traffic, and we think that translates into a raising of awareness.”
Quick, cheap, and effective: Oral care makes serious dent in hospital-acquired pneumonia cases
If you work in healthcare, then you’re probably aware that there’s room for improvement. You’re also probably aware of the deluge of strategies, solutions, recommendations, and guidance on enhancing quality and patient safety—all of which require time, money, equipment, metrics, and manpower you may not have. But one patient safety improvement project is as simple—and as cheap—as it gets: having patients brush their teeth to prevent pneumonia. This is done with a regular toothbrush in the morning, in the evening, and after meals.
Multiple hospitals and studies have found that through this simple intervention, they were able to reduce their non-ventilator hospital-acquired pneumonia (NV-HAP) rates by 40% to 60%, sometimes even more. And since hospitals have to pay out of pocket for many hospital-acquired infections (HAI), this program not only improves patient safety, but may improve the bottom line.
Oral care and pneumonia
Although a lot of focus is put on infections caused by devices such as ventilators, central lines, and catheters, those only account for 25% of HAIs. Meanwhile, NV-HAP cases occur in every type of medical unit and are more common than the well-known issues of central line–associated bloodstream infections and catheter-associated urinary tract infections. While NV-HAP carries the same mortality rate as ventilator-associated pneumonia (VAP), only 38% of hospital pneumonia cases fall into the latter category.
The first studies linking improved oral care and pneumonia prevention came out of long-term care facilities in the late 1990s. However, this phenomenon hasn’t been as well researched in other care settings.
PSMJ 2016 index
It was a long year of big changes; some unexpected, some you saw coming miles away. To help you find what you need, we’ve created our annual PSMJ Index of all this year’s articles and links. We hope you find this helpful in the upcoming year and we look forward to keeping you up to date on all things patient safety.
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