Patient safety rounds help problem reporting

One of the most successful Patient and Family Advisory Council (PFAC) efforts at Dana-Farber Cancer Institute in Boston is the practice of "patient safety rounds," in which PFAC members and hospital staff make rounds on hospital units to inquire about any problems that may endanger patients.

Deborah Duncombe, MHP, is risk manager at Dana-Farber. She explains that the patient safety rounds are based on an infection control model of proactive surveillance for nosocomial infections. With PFAC's encouragement, the hospital began the patient safety rounds to get a better idea of what might be compromising patient safety.

"Patients know what is going on out there, and they know that there are more patient safety issues than what comes across your desk every day as the risk manager," she says. "Incident reports don't really tell us what is going on out there."

Duncombe leads the interdisciplinary team making the rounds, which always include a PFAC member. The team visits the unit and talks to any staffer they run into, asking, "Has anything happened today or recently that you think is an obstacle in providing safe patient care?"

The questions asked during the round are crucial to getting the right information, Duncombe says. People tend to think in narrow terms and only report specific medical problems if they are not prompted correctly. As the rounding went on, Duncombe developed more teaser questions to get at the big picture. These are some of the most effective:

  • "So where do you think you will make your next mistake?"
  • "What interrupts you? How do you control it?"
  • "Do you have any standard work-arounds?"

Champion on unit improves results

Mary-Dana Gershanoff, a former breast cancer patient at Dana-Farber and a PFAC member, was involved with a recent Dana-Farber's study of how PFAC helped improve patient safety. She says one of most important findings was that including a staffer who is particularly interested in improving patient safety in each unit, a PFAC initiative, led to better results.

In one unit, adding a champion to the unit nearly doubled reports during patient safety rounds from 59 concerns in 11 rounds to 107 reports in 12 rounds.

"Having that one person on the unit who really believes in the cause encourages other people to speak up," she says. "It's amazing how much more you can achieve when one just person working on that unit is excited about the work."


For more information on organizing a patient and family advisory council, contact:

  • Deborah Duncombe, MPH, Risk Manager, Dana-Farber Cancer Institute, 44 Binney St., Boston, MA 02115. Telephone: (617) 632-3253.