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Patient safety is a discipline that emphasizes safety in health care through the prevention, reduction, reporting and analysis of error and other types of unnecessary harm that often lead to adverse patient events. The frequency and magnitude of avoidable adverse events, often known as patient safety incidents, experienced by patients was not well known until the s, when multiple countries reported significant numbers of patients harmed and killed by medical errors.
There is a significant transdisciplinary body of theoretical and research literature that informs the science of patient safety. Millennia ago, Hippocrates recognized the potential for injuries that arise from the well-intentioned actions of healers. Greek healers in the 4th century BC drafted the Hippocratic Oath and pledged to “prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.
However, despite an increasing emphasis on the scientific basis of medical practice in Europe and the United States in the late 19th century, data on adverse outcomes were hard to come by and the various studies commissioned collected mostly anecdotal events. Presenting accounts of anesthetic accidents, the producers stated that, every year, 6, Americans die or experience brain damage related to these mishaps.
The APSF marked the first use of the term “patient safety” in the name of professional reviewing organization. Both organizations were soon expanded as the magnitude of the medical error crisis became known. In the United States, the full magnitude and impact of errors in health care was not appreciated until the s, when several reports brought attention to this issue. The majority of media attention, however, focused on the staggering statistics: from 44, to 98, preventable deaths annually due to medical error in hospitals, 7, preventable deaths related to medication errors alone.
Within 2 weeks of the report’s release, Congress began hearings and President Clinton ordered a government-wide study of the feasibility of implementing the report’s recommendations. However, subsequent reports emphasized the striking prevalence and consequences of medical error. The experience has been similar in other countries. Effective communication is essential for ensuring patient safety.
Communicating starts with the provisioning of available information on any operational site especially in mobile professional services. Communicating continues with the reduction of administrative burden, releasing the operating staff and easing the operational demand by model driven orders, thus enabling adherence to a well executable procedure finalized with a qualified minimum of required feedback.
The use of effective communication among patients and healthcare professionals is critical for achieving a patient’s optimal health outcome. However, scientific patient safety research by Annegret Hannawa , among others, has shown that ineffective communication has the opposite effect as it can lead to severe patient harm. Use of effective communication can aid in the prevention of adverse events, whereas ineffective communication can contribute to these incidences.
There are different modes in which healthcare professionals can work to optimize the safety of patients which include both verbal and nonverbal communication,  as well as the effective use of appropriate communication technologies. Methods of effective verbal and nonverbal communication include treating patients with respect and showing empathy, clearly communicating with patients in a way that best fits their needs, practicing active listening skills, being sensitive with regards to cultural diversity and respecting the privacy and confidentiality rights of the patient.
Some channels are more likely to result in communication errors than others, such as communicating through telephone or email missing nonverbal messages which are an important element of understanding the situation. It is also the responsibility of the provider to know the advantages and limitations of using electronic health records , as they do not convey all information necessary to understanding patient needs. If a health care professional is not practicing these skills, they are not being an effective communicator which may affect patient outcome.
The goal of a healthcare professional is to aid a patient in achieving their optimal health outcome, which entails that the patient’s safety is not at risk. Practice of effective communication plays a large role in promoting and protecting patient safety. During complex situations, communication between health professionals must be at its best. There are several techniques, tools, and strategies used to improve communication.
Any team should have a clear purpose and each member should be aware of their role and be involved accordingly. Strategies such as briefings allow the team to be set on their purpose and ensure that members not only share the goal but also the process they will follow to achieve it.
Debriefing is another useful strategy. Healthcare providers meet to discuss a situation, record what they learned and discuss how it might be better handled.
Closed loop communication is another important technique used to ensure that the message that was sent is received and interpreted by the receiver. SBAR is a structured system designed to help team members communicate about the patient in the most convenient form possible. As is the case in other industries, when there is a mistake or error made people look for someone to blame. This may seem natural, but it creates a blame culture where who is more important than why or how. A just culture , also sometimes known as no blame or no fault , seeks to understand the root causes of an incident rather than just who was involved.
In health care, there is a move towards a patient safety culture. When assessing and analyzing an incident, individuals involved are much more likely to be forthcoming with their own mistakes if they know that their job is not at risk.
From there, root cause analysis can occur. There are often multiple causative factors involved in an adverse or near miss event. After an adverse event occurs, each country has its own way of dealing with the incident.
In Canada, a quality improvement review is primarily used. A quality improvement review is an evaluation that is completed after an adverse event occurs with the intention to both fix the problem, as well as preventing it from happening again.
Healthcare providers have an obligation to disclose any adverse event to their patients because of ethical and professional guidelines. The disclosure of adverse events is important in maintaining trust in the relationship between healthcare provider and patient. It is also important in learning how to avoid these mistakes in the future by conducting quality improvement reviews, or clinical peer review. The simplest definition of a health care error is a preventable adverse effect of care, whether or not it is evident or harmful to the patient.
Errors have been, in part, attributed to:  . The Joint Commission ‘s Annual Report on Quality and Safety found that inadequate communication between healthcare providers, or between providers and the patient and family members, was the root cause of over half the serious adverse events in accredited hospitals. However, hospitals pay in both higher costs for implementation and potentially lower revenues depending on reimbursement scheme due to reduced patient length of stay.
The benefits provided by technological innovations also give rise to serious issues with the introduction of new and previously unseen error types. Handwritten reports or notes, manual order entry, non-standard abbreviations and poor legibility lead to substantial errors and injuries, according to the IOM report. The electronic health record EHR , previously known as the electronic medical record EMR , reduces several types of errors, including those related to prescription drugs, to emergency and preventive care, and to tests and procedures.
Drug Information at the point-of-care and drug dispensing points help in reducing errors. Also, these systems provide recurring alerts to remind clinicians of intervals for preventive care and to track referrals and test results. Clinical guidelines for disease management have a demonstrated benefit when accessible within the electronic record during the process of treating the patient. Still, there may be a weak link because of physicians’ deficiencies in understanding the patient safety features of e.
Portable offline emergency medical record devices have been developed to provide access to health records during widespread or extended infrastructure failure, such as in natural disasters or regional conflicts. These systems’ basic security measures are based on sound identifying electronic tags, in order that the patient details provided in different situations are always reliable.
These systems offer three differently qualified options:. Any of these options may be applied whenever and wherever patient details are required in electronic form Such identifying is essential when the information concerned is critical.
Prescribing errors are the largest identified source of preventable errors in hospitals IOM, ; The IOM estimates that each hospitalized patient, on average, is exposed to one medication error each day.
A standardized, modular technology system that allows a hospital, clinic, or health system record their Incidents that include falls, medication errors, pressure ulcers, near misses, etc.
These systems can be configured to specific workflows and the analytics behind it will allow for reporting and dashboards to help learn from things that have gone wrong and right. Technology induced errors are significant and increasingly more evident in care delivery systems. As such, the term technological iatrogenesis describes this new category of adverse events that are an emergent property resulting from technological innovation creating system and microsystem disturbances.
When these systems are under the increased stresses caused by the diffusion of new technology, unfamiliar and new process errors often result. If not recognized, over time these new errors can collectively lead to catastrophic system failures. The term “e-iatrogenesis”  can be used to describe the local error manifestation.
The sources for these errors include:. Solutions include ongoing changes in design to cope with unique medical settings, supervising overrides from automatic systems, and training and re-training all users.
Evidence-based medicine integrates an individual doctor’s exam and diagnostic skills for a specific patient, with the best available evidence from medical research. The doctor’s expertise includes both diagnostic skills and consideration of individual patient’s rights and preferences in making decisions about his or her care. The clinician uses pertinent clinical research on the accuracy of diagnostic tests and the efficacy and safety of therapy, rehabilitation, and prevention to develop an individual plan of care.
In the United States, over 1, guidelines see example image, right have been developed as a resource for physicians to apply to specific patient presentations. Advantages:  . Drawbacks:  . Community pharmacy practice is making important advances in the quality and safety movement despite the limited number of federal and state regulations that exist and in the absence of national accreditation organizations such as the Joint Commission – a driving force for performance improvement in health care systems.
Community pharmacies are using automated drug dispensing devices robots , computerized drug utilization review tools, and most recently, the ability to receive electronic prescriptions from prescribers to decrease the risk for error and increase the likelihood of delivering high quality of care.
Quality Assurance QA in community practice is a relatively new concept. As of [update] , only 16 states have some form of legislation that regulates QA in community pharmacy practice. While most state QA legislation focuses on error reduction, North Carolina has recently approved legislation  that requires the pharmacy QA program to include error reduction strategies and assessments of the quality of their pharmaceutical care outcomes and pharmacy services.
New technologies facilitate the traceability tools of patients and medications. This is particularly relevant for drugs that are considered high risk and cost. Quality improvement and patient safety is a major concern in the pediatric world of health care.
This next section will focus on quality improvement and patient safety initiatives in inpatient settings. Over the last several years, pediatric groups have partnered to improve general understanding, reporting, process improvement methodologies, and quality of pediatric inpatient care. These collaborations have created a robust program of projects, benchmarking efforts, and research. It has been reported that when pediatric medication errors occur, these patients have a higher rate of death associated with the error than adult patients.
In order to reduce these errors the attention on safety needs to revolve around designing safe systems and processes. Slonim and Pollack point out that safety is critical to reduce medical errors and adverse events. These problems can range from diagnostic and treatment errors to hospital-acquired infections, procedural complications, and failure to prevent problems such as pressure ulcers.
One of the main challenges faced by pediatric safety and quality efforts is that most of the work on patient safety to date has focused on adult patients. In addition, there is no standard nomenclature for pediatric patient safety that is widely used. However, a standard framework for classifying pediatric adverse events that offers flexibility has been introduced. If these large-scale studies are conducted, the findings could generate large-scale intervention studies conducted with a faster life cycle.