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.
USP <800>: Protecting healthcare workers from hazardous drugs
According to the National Institute for Occupational Safety and Health (NIOSH), approximately 8 million American healthcare workers are potentially exposed to hazardous drugs each year. And in May, the Department of Health and Human Services (HHS) released a report critical of CMS surveyors’ oversight of hospitals’ use of compounded, sterile drugs. The report recommended that surveyors receive proper training on safe compounding practices.
While there have been numerous guidelines and recommendations on how to safely handle, transport, and dispose of potentially harmful chemicals and drugs, none of them have been enforceable. That was until the U.S Pharmacopeial Convention (USP) published its newest chapter on February 1, 2016. With USP General Chapter <800> Hazardous Drugs; Handling in Healthcare Settings, the organization hopes to promote worker safety, patient safety, and environmental protection using evidence-based practices and quality standards.
Chapter <800> covers from the moment a hazardous drug is received at the loading dock all the way through to the medicine’s disposal. Its standards apply to anyone who comes into contact with hazardous drugs: nurses, physicians, pharmacists, pharmacy technicians, loading dock personnel, etc.
And on July 1, 2018 the chapter will become fully enforceable by regulators. With 18 months (as of January) until the chapter goes into effect, what do healthcare facilities need to know about USP <800>?
Patient satisfaction vs. quality: The whys, hows, pros, and cons
There’s been a flood of different measures and metrics in recent years. CMS, Joint Commission, hospital organizations, and vendors each have their own way of calculating a hospital’s ranking and improving patient care.
While hospitals are already expected to conduct certain surveys by various agencies, how often should they conduct their own research? What measures should they use? And how do they use the information they have to drive improvement?
The difference between them
There are two definitions that are used often in conjunction with a hospital’s merit: patient satisfaction and quality of care. Patient satisfaction measures how a patient feels about the care they received. Care quality measures whether the care given was any good.
Janiece Gray, a founding partner of DTA Associates and author of the HCPro book Beyond CAHPS: A Guide to Achieving Patient- and Family-Centered Care, says that it’s important to know the differences between the two measures, as they aren’t always in alignment. She points to her experience with a former chiropractor as an example. She had been going to this person for about two years for a medical issue and from a satisfaction perspective, couldn’t have been happier.
Five ways healthcare systems can help physicians talk about adverse events
For many surgeons and physicians, the hardest thing they will have to do in their medical career is talk to a patient about a medical error.
Although communication and resolution programs are becoming more pervasive throughout healthcare, providing a more structured approach to adverse event discussions, clinicians still struggle when it comes to discussing unintended outcomes with patients and their families. Hospitals and health systems can further complicate the anxiety surrounding these discussions by failing to provide physicians with the necessary support to facilitate open, honest, and effective communication.
In fairness, the discussion around medical errors can be an emotionally charged affair for both physicians and the patient, and one that is nuanced and often cluttered with unresolved or unknown complications. Layered on top of that is a longstanding concern about malpractice lawsuits prompting hospitals and liability insurers to urge physicians to limit their discussions with patients.
As a result, physicians and surgeons struggle to communicate key issues during these conversations. According to a study published in JAMA Surgery in July, the majority surgeons surveyed within the Veterans Administration (VA) health system explained why the event happened, expressed regret and concern for the patient’s welfare, disclosed the event within 24 hours, and discussed steps for future treatment. However, a much smaller portion of surgeons apologized to patients, discussed whether the event was preventable, or discussed how reoccurrences could be avoided.
Since the study was voluntary, the surgeons that participated where among the most comfortable discussing adverse events, says Rani Elwy, PhD, lead author of the study and director of the Center for Information Dissemination and Education Resources (CIDER). Elwy is also an investigator at the Center for Healthcare Organization and Implementation Research (CHOIR) at the VA Health Services Research & Development Resource Center in Boston, and a professor in the Department of Health Law, Policy and Management at Boston University.
High reliability and the impact of 'rescuing' patients
The healthcare industry is transitioning to a new wave of patient safety, according to a group of experts that says high reliability will become a bigger emphasis for healthcare facilities looking to improve quality care.
Amir Ghaferi, MD, MS, assistant professor of surgery and business at the University of Michigan in Ann Arbor and the chief of general surgery at the Ann Arbor Veterans Administration Healthcare System, spoke with Patient Safety Monitor Journal about this transition, which he and several colleagues outlined in an article published in Harvard Business Review (https://hbr.org/2016/08/the-next-wave-of-hospital-innovation-to-make-patients-safer). During the conversation, Ghaferi explained what it means for organizations to be highly reliable and how hospitals are implementing new approaches to facilitate better patient care.
Editor’s note: The following was lightly edited for space and clarity.
Q: In the Harvard Business Review article, you make reference to the Institute of Medicine’s To Err is Human report in 1999 that said as many as 98,000 people die each year from medical errors. A recent report pegged that number at more than 250,000. Has healthcare gotten worse or are we just more aware of these errors?
A: I think the 250,000 number is very controversial. Healthcare is definitely safer and for anyone to say it is less safe than it was in 1999 is incorrect. I don’t think that’s an accurate characterization of healthcare.
Healthcare is definitely more complex now. The systems in which we deliver care are more complex. The patients we are caring for are more complex, and the treatments we have are much more complex. That number [of patient deaths] has not increased by two- to three-fold since that time.
Can predictive analytics push patient safety into the 21st century?
For industries across the country, data has become a key element of operational improvement, and the use of predictive analytics in particular has opened a new opportunity to better utilize a growing repository of data.
But when it comes to predictive analytics, the healthcare industry has lagged behind. Until recently, medical facilities did not have the means to collect and store clinical data. It wasn’t until electronic health records (EHR) became pervasive across the industry that that opportunity to use predictive analytics to improve patient care became a real possibility.
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