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Facility defined patients’ role in safety
In its recent initiative to minimize medical errors, William Beaumont Hospital in Royal Oak, MI, has made its patients "Partners in Safety." That’s the name of the new program, which was launched in 2002. "We knew it was the right thing to do," says Kay Beauregard, RN, MSA, director of hospital accreditation and nursing quality.
"It’s not unusual to open a paper or a journal that tells patients what they should do to prevent medical errors. The community was seeing it in the lay press — Protect yourself from infection when you go to the hospital!’ Save yourself from medical error!’ We wanted our patients to know that we firmly supported their active role, that we appreciated their questions, and that we felt it was of value in preventing errors," she says.
Before Beaumont could put the patient in patient safety,’ it first needed to change the overall culture of the organization. That effort began in 2000. "This involved the creation of a learning environment, so we could learn from our medical errors, and the creation of a nonpunitive environment, so people would, in fact, report errors or potential errors," Beauregard notes.
It was in 2002 that the Beaumont staff seriously addressed the question, "How can our patients be partners with us? First, we had to define what we felt the patient’s role was in safety," she says. The facility put together a brochure for patients, You and Your Caregivers: Partners in Safety. "It tells the patient that safety is a top priority and that they play an important role in safety efforts. Basically, it says, Please help your caregivers give you the care you expect.’"
The brochure provides an itemized list of things patients can do to enable the staff to provide safe care. The list was developed from a number of sources, including the Joint Commission on Accreditation of Healthcare Organizations and the National Patient Safety Foundation, as well as a review of the literature. "We took what was out there and put it in a format that was comfortable to our culture," Beauregard says.
The brochure is divided into several key areas:
• Patients are encouraged to ask questions and share their concerns. To facilitate this process, patients are told to bring a family member or friend with them whenever possible. Patients should feel free to ask questions about what a medication is for, what test is going to be performed, or why something is being done. Customer hotlines also are provided.
• Patients are told to pay attention to the care they are receiving. Patients are informed about the wristband ID they received and told to make sure their nurse or physician checks the band before administering any medication or treatment. Surgical patients should be sure the physician marks the area to be operated on and to ask questions about it. Health care workers should introduce them-selves when they enter the room; patients should look for their name badges. It’s OK to ask anyone who touches you whether they have washed their hands. Patients should tell the nurse or physician if something doesn’t seem quite right.
• Patients should know what meds they are taking and why. Patients are told to carry a list of all meds they are taking, including herbals and over-the-counter drugs. They should tell physicians and nurses about any allergies or side effects. They are told staff expect them to ask questions about meds.
• Patients should educate themselves about their diagnosis, treatment plan, and medical tests. Patients are encouraged to ask their physician or nurse for information about their condition; they should make sure all the information they need is written down. Patients should be sure they know how to use any equipment needed for home care.
• Patients should be part of all decisions about their treatment. Patients should share all information about their condition, including special needs, with their caregivers. They should provide details about their medical history, as well as the symptoms they are having. Patients should be sure to understand the information they receive and ask questions as often as needed.
Implementation involved distribution of the brochure through several different venues. "We put it into all patients’ information packets they received when admitted," Beauregard adds. "Also, our chief of medical staff sent it out to all our physicians with the message, This is our approach; we support it; we encourage our patients to ask questions.’" The brochures also were distributed via community education programs, which reach 15,000 to 25,000 community members a year. "We felt this was a good opportunity to give them a brochure, so when they do have to interact with our facility or another facility, they can be safer," she explains. The brochures also were stocked in the waiting rooms.
Of course, seeing that the nursing staff were on board was critical. "We left it to the nursing departmental leaders to deliver the message — to make sure every employee received the brochure and discussed it at their various meetings," Beauregard says. During these meetings, nurses were asked questions such as, "How will you react if a patient questions the meds you are giving them, or if you are asked if you washed your hands?"
"What we want them to do is say thank you, and then answer the question," she notes. "They need to understand why patients are our partners."
Another vehicle for disseminating the key messages at Beaumont is the executive patient safety rounds, which include a hospital administrator, a medical administrator, and department directors, who talk to staff about patient safety issues. "During those rounds, they also talk to patients, so here we again demonstrate how to involve patients in safety," Beauregard observes.
Surveys conducted by Beaumont indicate that progress has been made, but she asserts, "We still have a way to go with it." The number of patients and family members who say they received the written materials has gone up from 50% to 70% during the past two years. "Even though we provide a packet for all patients, the managers feel some of those brochures are not being actively read, so we are continually looking for new strategies," Beauregard observes. What might those strategies be? "We’re looking at more and better ways to provide information to patients, considering options such as putting it on a closed-circuit TV system," she says.
"We’re also looking at translating the brochure into different languages. This is very important; one of the biggest obstacles to patient questions and learning properly about their diagnoses are cultural barriers." Currently, Beauregard is considering translating the brochure into Arabic, Spanish, Russian, and Ukrainian.
For more information, contact:
• Kay Beauregard,RN, MSA, Director of Hospital Accreditation and Nursing Quality, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI 48073. Telephone: (248) 551-094. E-mail: email@example.com.
OSHA delays enforcement of TB standard to July
The Occupational Safety and Health Administration (OSHA) will delay until July 1, 2004, enforcement of the general industry respiratory standard for health care providers and other employers required to protect workers from potential exposure to tuberculosis. Employers required to protect against TB were subject to a separate standard while a 1997 proposed rule for TB protection was being considered; however, OSHA recently decided to withdraw its proposed rule and begin applying the general industry standard.
The delay will allow affected employers six months to make the changes necessary to comply with the general industry standard, which includes more stringent requirements, including mandatory annual fit-testing.
The OSHA announcement can be found at www.osha.gov/ under "OSHA News."