Patient Safety Concerns for 2020 – Part 2

photo up close stethoscope - patient safety concernsNo one wants their healthcare to make them sicker. And no medical professional wants their patients to get sicker under their care. However, there are some common, potentially dangerous patient safety concerns that you should know about. It was just Patient Safety Awareness Week – a good time to think about patient safety. Although we are all facing the very scary COVID-19 pandemic, this post focuses on the top 10 patient safety concerns identified by ECRI. This recently published list, put together before the COVID-19 outbreak, identifies risks compiled from 3.2 million reports of healthcare events that caused patient harm.

Today’s blog post covers ECRI’s patient safety concerns 6-10. For information on the top 5 safety risks, read last week’s blog post here.

6. Lack of safety standards across organizations.

You may have seen news reports about healthcare organizations merging and consolidating, an ever-increasing practice. In fact, in 2018, healthcare organizations announced 90 mergers and acquisitions, including larger hospitals merging with smaller hospitals, ambulatory care centers and/or long-term care facilities.

What’s the issue and what can organizations do?

Smaller, once-independent healthcare organizations may not have the same safety framework and standards of a larger hospital. As one would expect, each setting likely has their own culture, processes and resources related to patient safety. But, to provide safe, effective care in all corners of the organization, a newly merged organization needs a standardized culture of safety that is “emphasized, implemented, and supported in smaller sites just as they are in the larger parent organizations.”

What can you do?

No medication, procedure or test is risk free, no matter where the patient is treated. However, you can take steps to reduce your risk of patient safety hazards. Read these blog posts to learn more:

7. Patient matching discrepancies in Electronic Health Records.

photo blackboard sign about technical issues - patient safety concernsMost hospitals and medical practices use Electronic Health Records (EHRs) and other digital technologies. Of course, when EHRs contain mistakes, patients can be harmed, or even killed. “Patient matching” involves having the right patient information in the right patient file. However, EHRs can contain patient names that are either outright wrong or contain spelling errors or other mistaken patient identifiers. Additionally, one patient’s records can contain information related to another patient.

What is the impact of improper patient matching?

When there are matching errors, EHRs contain mistakes that can cause significant patient harm. For example, patients may receive the wrong medications or undergo unnecessary testing based on misinformation in their EHR. Conversely, they may miss medications and/or testing they need. And, the danger is amplified when misinformation spreads throughout the entire health information exchange.

How can organizations improve this issue?

The ECRI report recommends organizations apply strong active identification matching practices to all their digital health technologies, including EHRs, to allow for a “flow of correct patient information across the continuum of care.”

What can you do?

First, never assume your EHRs are accurate. Review your records through online portals when possible. And ask your doctor to print out appointment notes before you leave the office. Read them over and notify the office if you notice mistakes. For more information, read: The Pros and Cons of Electronic Health Records.

8. Improper use of antibiotics.

colorful pills spread on table - patient safety concernsI’m sure you’ve heard this before – as a society, we take too many antibiotics, which puts us all at risk of dangerous antibiotic-resistant superbugs. Despite an increased focus on this issue, patients still take unnecessary antibiotics, including taking them when there is no indication, or taking them longer than needed, or taking the wrong dosage.

How do patients get unnecessary antibiotics?

There are several ways in which patients get antibiotics they don’t need. Sometimes, patients insist on getting a prescription for antibiotics. And unfortunately, sometimes doctors prescribe them when they’re not needed. Moreover, many unnecessary antibiotics are prescribed in long-term care organizations, urgent care centers, and dentist offices. For instance, in 2014, 45.7% of urgent care patients received antibiotics for respiratory issues that did not require antibiotics.

Why is this a concern?

Antibiotics can cause patient harm, particularly in hospital patients. Therefore, patients should use antibiotics only as needed. Moreover, the overuse of antibiotics has led to the rise of antibiotic-resistant superbugs that don’t respond to treatment. In fact, some experts speculate that antibiotic-resistant superbugs may kill more people than cancer in the coming decades.

What can healthcare organizations do?

The ECRI report recommends that healthcare organizations evaluate their antimicrobial stewardship programs to ensure all providers follow current guidelines.

What can you do?

You can do your part! Don’t insist on antibiotics. And if you do need them, take them as directed. For more detailed information, read this blog post: Are Antibiotics Helpful or Harmful? What You Need to Know.

9. Medication errors due to overrides of automated dispensing cabinets

photo woman in hospital taking pill - patient safety concernsMost hospitals and many other healthcare facilities use “smart” automated dispensing cabinets (ADCs) to dispense medications. Although ADCs have greatly improved medication safety, they’re not perfect. Unfortunately, it’s usually easy for healthcare workers to override the system, allowing them to dispense medications without a pharmacist review. This can lead dangerous, even deadly, medication errors as patients can receive the wrong medication or the wrong dosage.

Why do these cabinets allow overrides?

Overrides can save lives when patients need medications in emergency situations, leaving no time to consult a pharmacist. However, nurses and other medical staff use the override capabilities in non-emergency situations as well.

What can healthcare organizations do to reduce risk?

The ECRI report recommends a medication safety committee determine which medications should be stored in each ADC, based on the patients’ needs in each location. Additionally, the report suggests analyzing prior overrides, requiring a medication order before removing any medications from an ADC, and using technology-based safeguards.

What should you do?

Importantly, realize that medication errors are common in hospitals and other in-patient settings. Therefore, patients and families must pay attention to medications. Keep a list of medications needed and note a description of each pill. If a staff member presents a pill that doesn’t look familiar, speak up! For more recommendations on reducing your risk of medication errors, read these blog posts:

10. Fragmentation of care.

photo two doctors talking - patient safety concernsWhen patients have more than one doctor treating them, it’s important for every doctor on the “team” to understand each patient’s history, diagnoses, testing, medications, treatments, etc. Unfortunately, seeing multiple doctors can lead to fragmented care, which can impede communication among providers and interfere with care coordination.

What’s the impact of fragmented care?

Patients can suffer when healthcare is fragmented. Potential problems include hospital readmissions, missed or delayed diagnoses, medication errors, and unnecessary tests and procedures.

When are care coordination issues more likely?

There are a few scenarios in which care is more likely to be fragmented. First, patients with multiple chronic condition may experience care coordination issues as they may visit up to 16 different doctors in a year. That’s a lot of care to be coordinated! With this many doctors involved, it’s easy to see how information can slip through the cracks.

Additionally, when patients receive care at urgent care centers and other retail clinics, the information is often not communicated with the patients’ primary care doctors.

And don’t think your doctors are coordinating your care because they all work in the same healthcare system. Care fragmentation can occur within one healthcare system or between several healthcare systems.

What can healthcare organizations do?

Unsurprisingly, the ECRI report suggests that healthcare organizations devise strategies to collaborate and share information on shared patients. They also suggest organizations engage patients to ensure that important information is shared.

What can you do?

Primarily, never assume that each doctor on your team knows about the care you receive from other doctors. You must be the captain of your ship. Engage in the process!

Take detailed notes in a notebook at every appointment – including diagnoses, treatments, test results, and other important information. If a doctor recommends you see a specialist, write down your doctor’s specific reasons for the referral. Bring this notebook, along with any pertinent test information (e.g. MRI scans) with you to every appointment and share the material with each doctor.

And of course, if you visit a retail clinic or urgent care center, let your doctor know why you went and what diagnosis and treatment recommendations you received.

To learn more, read these blog posts:


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