Medication errors. The Agency for Healthcare Research and Quality calls medication errors "one of the most common types of inpatient errors," as nearly 5 percent of hospitalized patients are affected by adverse drug events annually. New evidence uncovered in 2015 shows that medication errors are not just a problem for inpatients: They abound during surgeries as well.
In fact, medication errors occur in some form in nearly half of all surgeries, according to research from Massachusetts General Hospital published in October. Mistakes in labeling, incorrect dosage, neglecting to treat a problem indicated by a patient's vital signs, and documentation errors were the medication errors that occurred most frequently.
"We definitely have room for improvement in preventing perioperative medication errors, and now that we understand the types of errors that are being made and their frequencies, we can begin to develop targeted strategies to prevent them," said Karen Nanji, MD, lead author of the study.
Diagnostic errors. Diagnostic errors were thrust into the spotlight late in 2015 thanks to an Institute of Medicine report titled "Improving Diagnosis in Health Care." The report asserts that diagnostic errors account for 6 to 17 percent of hospital adverse events and roughly 10 percent of patient deaths, indicating definite room for improvement in this space.
"The report launched an important conversation about a serious patient safety issue with broad impact across the continuum of care," Tejal Gandhi, MD, president and CEO of the National Patient Safety Foundation, wrote in a December blog.
The new year provides an opportunity for hospitals to focus efforts to improve this serious patient safety issue. The IOM report outlines several possible solutions to remedying diagnostic errors, including partnering with patients and their families, as well as fostering teamwork between and among healthcare providers.
Discharge practices to post-acute, home care. Hospital discharge can be a critical moment in a patient's care. A study from the early 2000s found nearly 20 percent of patients experience an adverse event within three weeks of discharge, and many of those events could be prevented.
This important safety issue necessitates more attention in 2016 thanks to the launch of the Comprehensive Care for Joint Replacement model in April. The CCJR will make hospitals responsible for the care quality and cost of joint replacement patients for a full 90 days post-discharge, giving hospitals a financial incentive to focus on this important patient safety issue.
Workplace safety. It is hospitals' duties to keep patients safe, but some experts argue patients cannot be safe unless healthcare workers feel safe themselves.
"If healthcare providers are safe, then we will have safer patients," says Deborah Grubbe, a healthcare consultant with DuPont Sustainable Solutions. "Because healthcare providers won't have to focus on their own safety and thinking they'll get hurt, [they'll] be able to spend all their energy and alertness in providing good care for the patient."
This sentiment applies to a myriad of worker safety issues, from needlestick injuries to injuries from lifting patients to fear of being assaulted by a patient.
Unfortunately, these staff safety issues are still a problem moving into 2016. To that end, the U.S. Department of Labor's Occupational Safety & Health Administration launched a webpage in December 2015 providing information and strategies for healthcare workplace violence awareness and prevention.
Hospital facility safety. Issues with hospitals' facilities can sometimes put patient safety at risk. Several times in 2015, the safety of hospital patients was compromised or nearly compromised because of building or maintenance problems. For instance, a Florida Agency for Healthcare Administration report released in April cited one Florida hospital's handling of a sewage leak as a patient safety issue, including its failure to ensure the sewage was cleaned up properly and failure to conduct an infection control risk assessment. The investigators also reported finding live rats above the affected ceiling tiles and air conditioning supply vents leaking condensation over food prep tables.
Legionnaires' disease is another issue tied to the structure of a hospital, as Legionella outbreaks "are commonly associated with buildings or structures that have complex water systems, like…hospitals," according to the CDC.
In 2015, several organizations from the healthcare, construction and engineering industries formed a task force to create uniform guidelines for the heating, ventilation and air condition of operating rooms, sterile processing departments and endoscope procedure rooms to ensure patient safety.
In light of these issues and events, hospitals may wish to consider re-evaluating the maintenance protocols for their facilities to ensure patient safety this year.
Reprocessing issues. The issues surrounding certain medical scopes and their link to infections resurged in 2015 and are sure to carry over in to 2016 as healthcare providers hone best practices to prevent further scope-related incidents. In fact, the ECRI Institute listed "inadequate cleaning of flexible endoscopes before disinfection" and the resulting risk of infection at the top of its 2016 Top 10 Health Technology Hazards list.
Experts have emphasized the importance of using the right tools and following protocol to the letter to prevent infection, while some hospitals have begun culturing scopes after reprocessing to check for bacteria. Meanwhile, some members of an FDA advisory panel recommended mandatory sterilization of duodenoscopes to prevent spread of infection.
Sepsis. According to the CDC, more than 1 million cases of sepsis occur each year, and up to half of people who get sepsis will die, making it the ninth leading cause of disease-related deaths. While sepsis is not a new patient safety concern, it gets a new spotlight for 2016 thanks to CMS: The agency added the Severe Sepsis and Septic Shock Early Management Bundle to the fiscal year 2016 Inpatient Prospective Payment System Final Rule.
"What's driven much of CMS' response to sepsis is the gradual increase in sepsis across the nation," Edward O. Blews III, MD, assistant professor of infectious disease and associate medical director of hospital epidemiology at Loma Linda (Calif.) University Medical Center, said in a December webinar on sepsis protocols.
Hospitals that meet compliance with the sepsis early management bundle can help lower sepsis mortality as well as costs associated with treating sepsis (which, according to Mike Abrams, president and CEO of the Ohio Hospital Association, can reach anywhere from $22,000 to $57,000 per case).
"Super" superbugs. Superbugs — defined by Brian K. Coombes, PhD, of McMaster University in Ontario as bacteria that cannot be treated using two or more antibiotics — continue to pose a threat to patients, and they appear to be getting stronger: A CDC report published in December revealed a particularly dangerous set of CRE strains is cause for public health concern in the U.S. "Newly described resistance in Enterobacteriaceae…highlight[s] the continued urgency to delay the spread of CRE," the report reads.
The strains have been named the "phantom menace" by some scientists, and they aren't the only superbugs infectious disease specialists and healthcare providers will be keeping an eye on in 2016 — researchers in China published data on a bacteria found in pigs, broiler chickens and humans that contains a gene that makes it resistant to all forms of antibiotics, including "last resort" drugs used to beat the toughest antimicrobial resistant bugs. The gene responsible for resistance is called mcr-1, and has also been identified in Denmark. The gene has been found in E. coli and Klebsiella pneumoniae bacteria, according to the Chinese study.
Small steps — like boosting the focus on antibiotic stewardship — can be taken this year to help combat the spread of these surreal-sounding organisms.
The cyber-insecurity of medical devices. In July 2015, the U.S. Food and Drug Administration issued an official warning to hospitals asking they reconsider using the Hospira Symbiq Infusion System, a computerized pump that is widely used to deliver general infusion therapy, after it became apparent that with some ease, hackers could remotely access the device and alter dosages.
But experts have been sounding the alarm on the cybersecurity of medical devices for some time now. In 2011, Jay Radcliffe, senior security consultant and researcher for security data and analytics company Rapid7, wowed audiences at the Def Con hacking conference in Las Vegas when he hacked his own Medtronic insulin pump.
Cybersecurity concerns have graduated from a health IT-specific worry to one that carries patient safety risks serious enough to be on everyone's radar. Many medical devices connect to and operate on hospital networks that are already rife with vulnerabilities, and even if the goal isn't to hurt patients who may be connected to the devices, hackers can hopscotch onto the network from the device's entry point, gathering protected health information and exploiting vulnerable data.
In the next year, there will likely be some organized pushes to secure those devices — or at least a push to put manufacturer, federal and healthcare providers' feet to the fire to start drumming up solutions.
Going transparent with quality data. Most health systems query patients about their experiences and satisfaction with physicians during their hospital stays. But few opt to put those ratings online for all to see, although there's reason to believe the practice can improve patient safety.
"When everyone — physicians, patients, institutions, and the press — is privy to data on performance, physicians will develop a greater sense of accountability to deliver quality care," Ashish K. Jha, MD, a patient safety researcher at Harvard University's School of Public Health in Cambridge, Mass., wrote in a post on Harvard Business Review in October.
Aggregated ratings can be helpful learning tools for reviewing individual employee performance, and they also incentivize medical staff to double check their work and pay more attention to areas where slip-ups can impact their ratings, and ultimately the safety of those in their care. At some institutions, ratings are displayed internally, enabling side-by-side comparisons that might produce insights into best practices or encourage a healthy sense of competition.
In the future, this kind of openness could become a necessity for hospitals and health systems who want to compete in a market with an increasing focus on transparency.
In addition to fostering quality improvement, facilitating this kind of feedback and discussion has the capacity to highlight low points in patient care of which administration may not have previously been aware.
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