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Safe practices will be the standard of care
Communication, pharmacists, outcomes targeted
The National Quality Forum (NQF) has approved four additional "safe practices" that should be used universally in applicable health care settings to reduce the risk of harm. These four include three that affect the outpatient surgical area.
"If the National Quality Forum is saying these are very important for safe patient care, we all have to be very aware," says Sharon Tolhurst, RN, MBA, CNOR, chair of the Denver-based Ambulatory Surgery Specialty Assembly at the Association of periOperative Registered Nurses (AORN). Patient safety has grown to be a significant national issue, she points out. "The public is becoming more and more aware and is asking the right questions," says Tolhurst, who is the associate chief nursing officer at Sarasota (FL) Memorial Health Care System.
Also, the Joint Commission on Accreditation of Healthcare Organizations and Health and Human Services have liaison positions with the NQF, so these recommendations could be incorporated into their survey processes, sources point out.
Althea R. Dunscombe, RN, PhD, CRNFA, staff nurse and RN first assistant with The Cleveland Clinic in Naples, FL, says, "I do see these eventually being incorporated into standards of care and, yes, courts, insurers, and others will hold practitioners to these." Dunscombe also is chief executive officer, RNFA program director, and first assistant for Professional Assistants PRN, a consulting firm that educates nurses wanting to assume the role of RN first assistant.
The NQF’s additional safe practices include the following:
• Ensure that care information, especially changes in orders and new diagnostic information, is transmitted in a timely and clearly understandable form to all of the patient’s current health care providers/health care professionals who need that information to provide care.
This is a universal problem in inpatient as well as outpatient centers, according to Dorothy M. Fogg, RN, BSN, MA, perioperative nursing specialist at the Center for Nursing Practice at the AORN. Communication is the key, Fogg says.
"There is no way to make a universal protocol, and individual facilities must work out a system to obtain this information prior to surgery, and surgery is not started until they have it," she says.
Also, programs must comply with the Health Insurance Portability and Accountability Act privacy regulations, sources say.
Hold meetings once or twice a year with the surgeons’ office staff to work out methods to resolve these issues, Fogg says. "This goes a long way in improving communication," she says.
• Pharmacists should actively participate in the medication-use process, including, at a minimum, being available for consultation with prescribers on medication ordering, interpretation and review of medication orders, preparation of medications, dispensing of medications, and administration and monitoring of medications.
Pharmacists typically are not on site at ambulatory facilities, she says. The pharmacist is involved in setting up the formulary and medication supply, she adds. "We would suggest that the individual facility work with one or more pharmacists on a consultative basis and that pharmacy assistance be available by various means," Fogg says.
• For designated, high-risk, elective surgical procedures or other specified care, patients should be informed clearly of the likely reduced risk of an adverse outcome at treatment facilities that have demonstrated superior outcomes, and referred to such facilities in accordance with the patient’s stated preference.
Physicians already are inclined to send their patients or take their patients to facilities that have good outcomes, because with the malpractice insurance crisis, they are seeking good outcomes for their patients’ and their own benefit, Tolhurst points out.
However, at this point, there is no universally accepted method for ranking outpatient surgery programs in terms of outcomes, says F. Dean Griffen, MD, FACS, chairman of the American College of Surgeons Committee on Patient Safety and Medical Professional Liability. "If a ranking system for same-day surgery centers evolves, it will likely effect only larger municipalities, and overall quality will likely improve," Griffen says.
In the meantime, expect your patients to research more on the Internet, Tolhurst predicts. "Outcomes will be out there, and they can make a more informed decision with their physicians," she says. Tolhurst doesn’t oppose such a system.
"If you have a facility that demonstrates the outcomes that should be there, and managers feel that they are superior, they should be letting people know that," she says.
For more information on patient safety, contact:
• Althea R. Dunscombe, RN, PhD, CRNFA, The Cleveland Clinic, Naples, FL. E-mail: ADunscombe@aol.com.
• F. Dean Griffen, MD, FACS, Highland Clinic, 1455 E. Bert Kouns, Shreveport, LA 71105. Telephone: (318) 798-4546. Fax: (318) 798-4412.
• Sharon Tolhurst, RN, MBA, CNOR, Associate Chief Nursing Officer, Sarasota Memorial Health Care System, 1700 S. Tamiami Trail, Sarasota, FL 34239. E-mail: Sharonemail@example.com. Telephone: (941) 917-1910. Fax: (941) 917-6868.