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Making patients part of the safety effort; tip sheet helps reduce medical errors
Teach patients how to be their own best advocates for safety
While medical errors are not a new phenomenon, they suddenly are becoming high profile due to government reports, media coverage, and standards to improve patient safety by such accrediting agencies as the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations.
According to the Agency for Healthcare Research and Quality in Rockville, MD, more people die from medical errors than from motor vehicle accidents, breast cancer, or AIDS. These mistakes occur in all areas of health care, including medication errors, surgical mishaps, incorrect diagnosis, equipment problems, and confusion with lab reports.
To help reverse these statistics, health care facilities are working on ways in which to partner with patients to create the safest care experience. To determine the best way to teach patients how to be part of the safety team, a committee was formed at the University of Washington Medical Center in Seattle. This committee developed a tool that can be used in any clinical area throughout the institution.
"The overall objective of the committee was to create a tool that would clearly help patients understand what their role is in the partnership to create a safe care experience," says Cezanne Garcia, MPH, CHES, manager of patient and family education services at the University of Washington Medical Center.
Staff selected to sit on the committee looked at such issues as communication and advocacy, infection control, specific treatment procedures, access to medical records, medication, falls, pain management, and how to deal with a medical error if it happens.
The educational piece the committee created gives patients tips about being involved in their care, about how family members and friends can help with their care, how they can help prevent the spread of infection, what they should know about their medications and medical record, and how to respond if a medical error should occur.
During the process of creating this tool, several issues that impact patient safety became apparent. For example, people do not all have the same definition of patient safety. Some think of fall prevention while others think of patient safety as wearing seat belts.
When the first draft of the patient safety tip sheet was complete, eight consumers were asked to evaluate it. During the open-ended dialogue about the piece, it became apparent that they all had a different perspective of patient safety, says Garcia. "It wasn’t until they had read the tool that they understood what patient safety was," she says.
Empowering patients to speak up
Another issue that surfaced through discussion with consumers is that they did not always feel comfortable following some of the instructions to help create a safe environment. For example, several consumers told the surveyors that they would be uncomfortable asking their physician to wash his or her hands before providing care.
Therefore, the committee changed the copy and instructed patients to ask everyone to wash their hands, visitors and health care providers alike. In that way, they would become used to the practice.
Another barrier to patients or family members fully becoming a part of the safety team is the reluctance to question or challenge a health care worker who is in charge of their care, says Garcia. Patients and family members might feel vulnerable, she says.
In addition, while it is possible to coach patients to speak up to prevent medical errors, there is no control over how they convey the information to staff. Often, patients are under extreme stress and discomfort.
Also, the issue may not always be a safety factor, but staff need to be appreciative when the information is offered and not brush the patient off. "I think there is a lot of legwork that needs to be done with staff. We need to create a climate where our staff responds positively when patients and families draw attention to key issues," says Garcia.
In a self-study module created for nursing staff at Baptist Health South Florida titled "Promoting a Culture of Patient Safety," nurses are told that it is through open, ongoing communication and education that patients can be incorporated into health care decisions. "Teaching patients and family members to observe, question, and assist in the proper manner can contribute to the patient’s care in a safe, effective way," the manual reads.
The manual lists several key aspects of education that will promote a culture of safety that:
• includes the active involvement of the patient and family;
• instructs the patient to provide all information including prescribed medications, over-the-counter medications, herbals, and alternative therapies being used;
• informs the patient to provide information about allergies and adverse reactions;
• informs patients to ask questions in the hospital, in the physician’s office, and at the pharmacy to be sure they understand prescriptions;
• informs patients to ask questions about their treatment plan to be sure they understand what will be done;
• provides patients with written information;
• teaches patients about their condition and helping them to be knowledgeable about their health, history, and medications;
• teaches patients to follow instructions on medications or other treatments to obtain the desired outcome.
Safety starts at admission
Providing instruction for patients on how to participate in their safety begins upon admission to one of the hospitals within the Baptist Health system. At that time, patients are given a patient safety tip sheet that covers a variety of issues, including medication safety, and the prevention of infections and falls, says Geri Schimmel, RN, MS, educational consultant at Baptist Health South Florida and co-author of the self-study module. (See samples of tip sheet, Page 1 and Page 2.)
Safety is further promoted through instruction. Patients are given information on all the medications the physician prescribes while they are in the hospital. It is not uncommon for either the patient or a family member to question a new medication if he or she has not received instructions, which is what the tip sheet advises him or her to do, she says.
Physical therapy not only teaches patient safety in the hospital environment but also about preventing falls at home.
In addition, the nurse that coordinates the patient’s care also can ask for multidisciplinary screenings to help with educational needs. For example, if the nurse determines that a patient’s family needs some additional instruction on diet he or she can ask for a consult with the dietitian. It is not the nurse who is assessing and teaching on diet, but the nurse contacts the discipline with the expertise.
Education ultimately does work to create the safest care experience, agrees Garcia. For example, teaching patients how to prepare for surgery creates a safer surgical experience, she says. Yet patients need to understand their part in promoting safety and that is the new focus.
The most difficult part of the patient safety tip sheet to create was the section on responding to medical errors, says Garcia.
"In an ideal setup there is a straightforward acknowledgement and admission of error, but if we talk to our risk managers, they want more caution," she says.
The guidelines currently read:
• Ask for a full explanation of the error;
• Expect an open discussion;
• Ask about how your error will affect your health status;
• If you feel your questions are not being answered, ask to talk to our patient relation staff to assist you in finding answers to your questions;
• If you have suggestions on how to prevent errors, share them with your care provider or our patient relation staff.
For more information about creating tip sheets on patient safety, contact:
• Cezanne Garcia, MPH, CHES, Manager, Patient and Family Education Services, University of Washington Medical Center, 1959 Pacific St. N.E., Box 358126, Seattle, WA 98195. Telephone: (206) 598-8424. E-mail: email@example.com.
• Geri Schimmel, RN, MS, Educational Consultant, Education Services, Baptist Health South Florida, 8900 N. Kendall Drive, Miami, FL 33176-2197. Telephone: (305) 273-2510. E-mail: firstname.lastname@example.org.