ED Accreditation Update: Is your ED ready to comply with patient safety goals? 

Additions target test results, meds, and falls

The newly announced national patient safety goals, which are expected to receive special emphasis at accreditation surveys, require EDs and other departments of the hospital to accurately and completely reconcile medications across the continuum of care.

"I think everyone is recognizing now that medication errors are a significant problem," explains Lowell W. Gerson, PhD, professor of epidemiology in the division of community health sciences at Northeastern Ohio Universities College of Medicine in Rootstown.

During 2005, EDs must develop a process for obtaining and documenting a list of a patient’s current medications upon his or her admission and must involve the patient. As part of this process, ED staff must compare the medications the organization provides to those on the list. The process must be implemented by January 2006. The remainder of the new goals goals take effect Jan. 1, 2005.

A complete list of the patient’s medications must be communicated to the next provider when the ED refers or transfers a patient within or outside the hospital.

Every facility is working on this problem of reconciliation, sources say. One problem at some hospitals is that computers treat medications that a patient receives in the ED as separate from the medications the patient receives as an inpatient, says Robert L. Wears, MD, MS, attending physician at Shands Jacksonville and professor at the University of Florida in Jacksonville.

"Pharmacies and [information technology departments] are trying to produce reconciliation," Wears says.

It’s critical that the problem be examined from a systems perspective vs. making an effort in one or two areas, says Matthew Rice, MD, JD, practicing emergency physician and chief medical officer at Northwest Emergency Physicians, a Team Health affiliate, in Seattle. Rice is on the board of directors of the National Patient Safety Foundation in Washington, DC.

"It’s a problem with the continuum of care," he says. "That’s why [the goal] is phrased that way."

Not only is the problem systemwide, but it is a systems problem, Gerson adds.

"As much as you can take the human being out of the process, the better off you are," he says. EDs need systems with checks, such as physician entered computerized order-entry, bar code checking, and software systems that alert providers to interactions, Gerson notes.

Other additions to the national patient safety goals are:

  • EDs must measure, and if appropriate, take action to improve the timeliness of reporting and receiving critical test results.

Many EDs have a process of reporting panic values, Wears says. "The problem is that most of the definitions of panic values don’t actually cause any panic in anybody," he points out.

Panic values create a number of false alarms in the typical hospital, Wears says. "The danger, when staff members are inundated with false alarms, is that they start to ignore all of the alarms."

Many hospital systems are altering their processes to have multiple persons to check that test results are reported and received in a timely manner, Rice explains. "If you have one person involved, a person can have slips or lapses with bad outcomes based on the failure to identify issues and deal with them," he says.

  • EDs must assess and periodically reassess each patient’s risk for falling, including the risk associated with the patient’s medications, and address any risks.

MacNeal Hospital in Berwyn, IL, has an interdisciplinary falls committee that has been very active over the past year, says Jenny Meziere, RN, BSN, CEN, manager of emergency/trauma and gastrointestinal services. The group has developed an incident report specifically for falls that seeks to identify the cause by asking questions about staffing and unit census, obstacles, lighting, medications given to the patient in the past eight hours, and whether the patient was identified as a fall risk, Meziere says.

"The falls committee then takes these [quality improvement] reports and breaks down what happened and why," she says.

Also, the committee has added a blue armband to patients identified as being at risk for falls, Meziere adds. "This then is a visual clue to everyone that the patient is at risk and needs to be monitored closely," she says. "Even when patients are off their unit having testing, other departments know that the patient is at risk for a fall."

Patients may be at risk of falling due to cognitive impairment or instability, Gerson suggests. Any patients identified at risk should be closely observed and provided with escorts as needed, he says. Also, avoid having slick floors, Gerson adds.

If family members are there, advice them when a patient is at risk of falling, suggests Michelle H. Pelling, MBA, RN, president of The ProPell Group, a Newburg, OR-based consulting firm specializing in continuous Joint Commission accreditation readiness and performance improvement. "If a family member isn’t there, the person may be very vulnerable," she adds.

  • EDs must identify and, at a minimum, annually review a list of look-alike/sound-alike drugs used in the organization and take action to prevent errors involving the interchange of these drugs.

This task is almost impossible, due to the inordinate number of potentially confusing names and sounds, Wears says. "I know our pharmacy looked at it, and before they had gotten through [the drugs starting with] A, they had gotten to 100," he says. "There are probably well over 1,000 conflicts when you look at all the possibilities."

Look-alike drugs are particularly challenging, he says. "When hospitals change supplies or turn to generic drugs, packaging material tends to change appearance," he says.

With all of these new goals, don’t try to address them within your ED only, Pelling advises. "The organization has to have a plan about what they’re going to do, who has what piece, and they must work together collaboratively," she says.

Resource

To access the national patient safety goals, go to www.jcaho.org. Under "Top Spots," click on "national patient safety goals."