Facility type shapes safety concerns, policy
Rehab facility takes safety seriously, asks patients
Patient safety is a concern at all health care facilities. However, the issues at a medical clinic are not the same as at an acute care hospital, and neither institution mirrors the concerns of a rehabilitation center.
To help determine the safety concerns of patients at Craig Hospital in Englewood, CO, the safety committee asked Terry Chase, ND, RN, a patient education clinical specialist, to create a survey. She did so, and for two years has distributed it to a representative number of patients at the 70-bed facility for patients with spinal chord and brain injuries. The committee has asked that the survey be distributed annually.
Getting patient feedback
Chase says although she tries to distribute the survey evenly between patients with spinal chord injuries and brain injuries, the cognition and communication problems of the later group make this difficult.
The survey is short, consisting of five questions:
- Do you have any concerns about your safety in any of the following areas: hospital grounds; hospital community areas such as the cafeteria, hallways or gym; therapy areas; patient rooms; other?
- Who would you report safety concerns to if they occurred: doctor; nurse; rehab tech; therapist; housekeeping; don’t know?
- Would you feel comfortable reporting safety concerns?
- What do you consider the greatest safety risk as a patient at Craig Hospital?
- What suggestions do you have to improve or enhance patient safety?
The results of the survey are used to improve patient safety by changing policy, making repairs or additions to physical landscapes and buildings, and through the education of patients and staff.
In question No. 2, most patients said they would report safety concerns to nursing. Therefore, Chase plans to share the information in a newsletter called "Nursing Notes" to congratulate nurses for being the No. 1 contact for patients with safety concerns and to remind them that the patients rely on them for a lot of things including safety.
Both years the survey was taken, patients said that they felt comfortable in reporting safety concerns. When patients are admitted to Craig Hospital, they receive a patient and family orientation handbook that has a section on patient rights and responsibilities. This section covers safety issues. For example, patients have the right to receive care in a safe environment. They also have the responsibility of reporting perceived risks in their care and safety concerns.
Safety and education
For the two years the survey has been used to assess safety, patients reported that their greatest safety risk was falls caused by everything from tripping off the curb outside on the sidewalk while in their wheelchair to falling out of bed and falling during transfers.
The hospital does have a safety committee dedicated to preventing falls. In addition, education about how to handle the wheelchair is part of the spinal chord patient’s rehabilitation process. The physical therapy department provides the education on both an individual and group basis. Chase, who was a patient at Craig Hospital 15 years ago, says that being fearful of falling is common with new spinal chord injury patients. When first in a wheelchair, she was fearful of going on a sidewalk and on driveways that slant.
When a patient is close to being discharged, they attend a session on what to do if they fall out of the wheelchair. In this session, the patient, with the help of the therapist, undergoes a slow, controlled fall and then learns how to get back up.
When answering question five, one patient in the most recent survey suggested that staff install more bubble mirrors on the ceiling at blind intersections in hallways where it is difficult to see someone coming around the corner. Chase went around with the patient who had made the comment picking specific sites that needed to be improved.
While physical safety issues are a top priority at Craig Hospital due to patients’ conditions, safety concerning the distribution of medications is important as well because many patients are prescribed drugs for pain, to control muscle spasms, and for depression. Antidepressants often are given for nerve-related pain as well.
Patients receive a booklet, "Managing Your Medications" and nurses provide one-on-one education each time they distribute medicine. At that time, nurses often ask patients to tell them the reason that they are taking each pill.
In addition, spinal chord injury patients attend a group class on medication safety taught by Chase and at least one pharmacist. Brain injury patients have difficulty with group learning, so this teaching method is not used for these patients.
Before class, a list is printed of all the medications each patient attending the session is taking. Each patient is given his or her list of medications and asked to write, in one word, the reason for taking it.
"Once everyone can identify their medications we use the rest of the class time to discuss the importance of knowing the purpose of your medication and the interaction of drugs with alcohol and herbal products," says Chase.
A good portion of the class covers the dangers of mixing alcohol with certain types of medication.
Safety concerns at Craig Hospital are different from other facilities because patients do not remain in bed but are up and moving around. A lot of their therapy is outside the hospital. Patients go on outings, such as to the local mall. While staff members accompany them, the ratio is not one-to-one. Sometimes the trip is made using public transportation to help assimilate patients back into the community.
Overall, there is a general attention to safety issues by staff at Craig Hospital, says Chase. They are aware and watchful of safety concerns.
For more information about how Craig Hospital addresses safety issues and concerns, contact:
• Terry Chase, ND, RN, Patient Education Clinical Specialist, Craig Hospital, 3425 S. Clarkson St., Englewood, CO 80110. Telephone: (303) 789-8211. E-mail: TMChase@CraigHospital.org.