Patient Safety in Clinical Practice

Patient safety has become an everyday terminology in the healthcare sector. This is due to the growing attention that the concept is garnering not only from the patients and their families but also from policymakers and the healthcare sector itself. In the clinical practice, the improvement of patient safety necessitates mechanisms for reporting and assessing events as well as the prevention of errors before they occur. A number of effective instruments have been developed to help clinicians prevent the occurrence of adverse events. Clinical decision support systems (CDSS), for instance, for instance, systems used to key in medication order, can help in the prevention of the occurrence of many medical errors. Reminder systems that are computer-based can aid healthcare practitioners to adhere to care protocols.

Computer-assisted diagnosis and management programs can enhance the process used in making clinical decisions at care sites. Improvement of patient safety not only depends on systems but also on timely access to clinical data, for instance, laboratory and radiology examination results. Access to timely information can aid in minimizing redundancy, and permit a more proficient decision making. Clinical practice that has patient safety as one of its objectives needs to incorporate new research findings into everyday clinical – that is, evidence-based practice. Unfortunately, the integration of new research results into clinical practice usually takes a long time – an average of seventeen years (Sanders & Cook, 2007) whereas the integration of newer technologies takes on average between four and six years. Travis and Ryan argue that “actionable knowledge representation through the use of information systems holds promise for better connecting clinical research and patient care practices,” (2004, p. 17).

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Impact of Patient Safety across the Care Continuum

The concept of patient safety has a profound impact on the care continuum. Patient safety can determine if a patient lives or dies. Medical errors that result either from commission or omission errors have been known to cause premature death or severe health conditions that could easily have been avoided. Apart from the loss of lives or worsening of the quality of life, medical errors increase the total costs incurred by patients and their families as well as healthcare organizations. A patient who suffers due to medical errors may lose his productive capability and hence his ability to earn a living for the family. Medical errors increase the expenditures of a family due to increased hospital visits, more costly treatments, and longer hospital stays. Kohn, Corrigan and Donaldson argue that, “medical errors have been estimated to result in total costs of between $17 billion and $29 billion per year in hospitals nationwide,” (2000, p. 40). Healthcare organizations and their employees also suffer as a result of medical errors. For one, they lose the trust patients and their families once had in them. In addition, healthcare practitioners may suffer from lower morale and job satisfaction levels that may result from feelings of guilt and the knowledge that a life could have been saved if only they were more attentive and less negligent. In cases where patients and their families choose to file a lawsuit, healthcare organizations lose money in form of legal fees as well as negative public image. Patient safety therefore has a significant impact on the entire healthcare system and the society as a whole.

Illness/Wellness Trajectory

Many people tend to interpret the feeling of wellness based on illness. That is, a person may think that he is well simply because he has no physical signs to tell him otherwise. However, it should be noted that wellness and illness have many degrees. Therefore even if a person lacks physical symptoms of an illness, he/she may still have emotional instability brought about by feelings of depression, stress, boredom an frustration to mention but a few. Such a person is indeed not well even if his physical body is alright. Moreover, emotional instability often lays the foundation for physical illnesses, if left unattended. The two extremes of the wellness/illness trajectory are immature death on the one end and high-level wellness on the other end. Both wellness and immature death come about as a result of our actions. Negative habits such as smoking, excessive drinking, not going for regular medical check ups, and medical errors can lead to immature death. On the other hand, concern for one’s physical, psychological, emotional, spiritual, and social health can lead to high-level wellness. However, this does not mean that a person who is on the wellness end of the continuum does not get ill or die. Such people accept that death and some illnesses are natural phenomena and therefore do their best to prepare for such events (Travis & Ryan, 2004). On the illness/wellness continuum, I believe am on the wellness side.

Historical Background of Patient Safety

Patient safety is a concept that has been around for ages. Debates surrounding patient safety have been documented as early as the 1950s when Beecher and Todd published a paper titled, “A Study of the Deaths Associated with Anesthesia and Surgery”. However, during this time, the emphasis was mainly on medical errors that resulted from incorrect administration of anesthesia and wrongful surgical procedures. It was also during this time that the Anesthesia Patient Safety Foundation (APSF) was formed to address the mortality problem. The awareness of the high rates of avoidable deaths inspired a rigorous attention on research into anesthesia and surgery. As a result, standardization and safety controls were developed for anesthetic instruments, monitoring and tubing circuits. These incidents provide an early illustration of the issue of patient safety in the healthcare system as well as the methods that were used to tackle the problem particularly as it pertained to adverse events that could easily have been avoided. A major lesson that was learned from the anesthesia investigation and examination of premature death is that a scientific platform is important for illustrating which modifications were important in enhancing patient care (Byers and White, 2004).

The concept of patient safety gained momentum during the 1995-1996 years due to the rising cases of medical errors across different healthcare organizations. The Annenberg Conference on Patient Safety was held and the National Patient Safety Foundation (NPSF) was created during this period. The Advisory Commission on Consumer Protection and Quality in the Healthcare Industry was also formed by the then President Bill Clinton so as to tackle the problem of patient safety and quality of care provided to patients. It is widely acknowledged that the concept of patient safety attracted the greatest attention from people of all walks of life following the release of a report by the Institute of Medicine titled “To Err is Human: Building a Safer Health System”. This report gave the hard facts concerning the issue of patient safety and medical errors. The report’s statistics are now widely cited in major publications, journal articles, and books – that as low as 48,000 and as high as 98,000 Americans die every year due to medical errors. This figure is even higher than the number of deaths resulting from serious health conditions such as HIV/AIDS. Following the report’s startling revelations, patient safety has garnered the attention it deserves from healthcare organizations, patients, patients’ families, governments, and policymakers. Much has improved in healthcare organizations including the use of technologies in medical operations, and the restructuring of healthcare organizations’ structures and processes in an effort to minimize the opportunities for medical errors (Byers & White, 2004).

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Patient Safety Adaptation

The improvement of patient safety in healthcare organizations must start with the establishment of standards that support it. Standards guide the healthcare practitioners in their daily practice and have a great potential of reducing medical errors and enhancing the safety and quality of patient care. However, the establishment of effective standards necessitates committed leadership and healthy relationships between the leaders and the employees of an organization. It is therefore a great challenge that a healthcare organization needs to overcome so as to enhance the welfare of patients. In order to overcome the challenge, healthcare organizations can use some strategies that include: the provision of financial, material, and human resources necessary for patient safety; the creation of a patient safety culture by the organization’s management; the provision of practical educational prospects that will teach the healthcare practitioners how to implement the standards; the establishment of efficient communication mechanisms that support the adaptation, design and application of the standards; the implementation of a system to measure the performance and the usefulness of the standards; the implementation of evidence-based mechanisms that continuously improve the standards; and the encouragement of professionals to dispute the standards that seem unsuitable or threat the safety of patients (Travis & Ryan, 2004). The establishment and implementation of these standards in healthcare organizations would go a long way in enhancing patient safety.

Patient Safety and Leadership

Leadership plays an important role in patient safety. Senior leaders have both the duty and the power to make patient safety a premeditated priority in the healthcare organization. If this is to happen, the leadership must be attentive to the concept. First and foremost, the leaders should incorporate patient safety as one of the key objectives of the organization. The leaders should instill the concept into their employees and make them understand that patient safety is a part of their job descriptions. Making the case in favor of patient safety can also be used as a strategy by the leaders. This can be accomplished for instance by discussing the occurrence and impact of medical errors in the organization and emphasizing the gap in clinical practice (Larson, 2002). Upholding patient safety requires healthcare organizations to adopt a new paradigm of care that views patient safety as one of the organization’s key values. This cannot be achieved without an organizational culture of patient safety.

A culture of patient safety is one of the most difficult yet the most important measures an organization can take. The culture of patient safety should be ingrained in any healthcare system. This culture is characterized by organizations’ values, beliefs, blame-free environment and leadership that are centered on promoting attitudes of patient safety among the practitioners as well as measures that address potential and actual risks in different healthcare settings. A blame-free environment is one which recognizes that humans are bound to make mistakes. Such an environment encourages physicians and other healthcare practitioners to report the occurrence of adverse events so that the most effective and immediate remedy can be found. Leaders of healthcare organizations provide the resources needed to enhance patient safety such as adequate and competent staff as well as technical infrastructure. Leaders also encourage an organizational culture of patient safety by actively engaging in activities that promote patient safety (Larson, 2002).

Teaching Patient Safety

There is a need to focus on the competency development of quality and safety, capacity building in nursing education programs, the faculty and nursing shortages, and implementation of new methods of being at par with an ever-evolving health care environment. One of the key purposes of putting in place quality and safety competencies in nursing education is to narrow the gap between the theory and practice of nursing. This can be achieved through training and development of education programs that emphasize on patient safety. Indeed, such curricular emphasis should start from as early as undergraduate and graduate programs to continuing education programs. Training programs should make sure that there are increased opportunities for interdisciplinary training. In this era, medical and health care is increasingly being provided by interdisciplinary and multidisciplinary teams. Unfortunately, the training offered by healthcare organizations tends to focus on individual healthcare workers rather than on teams. Medical errors can occur when there is lack of coordination and information sharing among the team members. Such challenges cannot easily be avoided unless medical teams are trained on how to effectively and safely deliver care to patients (Kohn, Corrigan & Donaldson, 2000).

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Enhancing patient safety also necessitates the understanding of systems theory so as to effectively assess the major elements that contribute to medical errors. Education programs focusing on patient safety should include instruction that impart knowledge of working as teams, sharing of information, utilization of information technology, quality assessment, and communication with patients about medical errors. Such programs should also incorporate knowledge from other relevant fields such as cognitive psychology and statistics so as to minimize the risks of errors. Most importantly, education and training programs should stress on better communication across all disciplines. This is crucial in cases where team members are located in one place, but more so where members of the core team may not be in one physical location, for instance, a team offering home care. Such educational and training efforts would go a long way in promoting patient safety by minimizing the probabilities of medical errors (Kohn, Corrigan & Donaldson, 2000).

Patient Safety Advocacy

Since the peak of the concept of patient safety in the mid-1990s, there has been a mushrooming of patient safety advocates across the United States. These advocates have permeated the healthcare system at every level, from the healthcare organizations’ board of directors to employees and policymakers. Nevertheless, the greatest portion of patient safety advocates is made up of patients or families and friends of victims of medical errors – a mother who has lost a child, wives left widows, husbands left widowers, and children who have lost a parent at the hand of negligent healthcare practitioners. This portion of the patient safety advocates has had the most significant impact on the issue of patient safety and has led to the restructuring of healthcare organizations that is currently going all for the sake of patient safety. The advocates often hold meetings, speak to policymakers and government officials and mobilize communities to demand safer and high quality patient care. All this is done through their heartbreaking and horrifying stories of their loved ones who either died or were disabled by the healthcare system. The advocates are driven by the need to share their grief and suffering but also by the need to stop the adverse yet avoidable events from occurring again (DerGurahian, 2009). Patient safety advocates have indeed been created by the healthcare system and without their influence the changes that are now taking place in the healthcare system would never have happened.

Patient Safety and Communication

Communication is a key element in clinical practice and more so for patient safety. Communication has often been cited as a leading cause of medical errors and also an effective tool in reducing medical errors. The major aspects of communication necessary for patient safety include: communication with patients, communication between healthcare workers of all levels, communication among different departments and team communication. In Germany, studies of adverse events in healthcare organizations reveal that 15% of all adverse events occur as a result of communication problems (Sanders & Cook, 2007). Communication, both oral and non-oral, has a great potential of enhancing the safety and quality of patients care through longer consultations with the patients and caregivers as well as detailed sharing of information among the concerned departments/practitioners.

Unfortunately, majority of healthcare workers pay little attention to effective communication. Some practitioners consult with patients when they are in a hurry while others do not care to obtain full information from the patients before the diagnosis. In this era of diversity, communication in healthcare organizations is even more important. This is because of differences in cultural beliefs and languages which result when the healthcare practitioners and the patients are from different cultural background. For an effective communication to exist between the different players of healthcare, an effective relationship must be established with the patients. This will ensure that patients trust their healthcare practitioners enough to provide all medical details needed for correct diagnosis and treatment. The use of interpreters and cultural competency of healthcare workers are just some of the strategies that healthcare organizations can use to enhance communication and ultimately improve the quality of care and safety of patients (Sanders & Cook, 2007).

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Related Research Article

The related research article is titled “An Educational Intervention to Enhance Nurse Leaders’ Perceptions of Patient Safety Culture,” by Ginsburg, Norton, Casebeer and Lewis (2005). The main aim of the study was to develop a training intervention and assess its impact on the perception of patient safety culture by nurse leaders. The researchers used a sample of 356 nurse leaders in clinical settings from two Canadian hospitals. A quasi-experimental design was used by the researchers in which the participants were classified into two groups namely: the study group and the control group. Those in the study group took part in two patient safety workshops that lasted for six months. All the participants were then required to complete surveys that measured the culture of patient safety and leadership for improvement both before the workshop and four months after the end of the second workshop.

The effect of the intervention on patient safety culture was analyzed using ANOVA and paired t-tests while the effect of the intervention on leadership was analyzed using regression analysis. Ginsburg et al. (2005) found that there was a statistically significant increase in the valuing safety variable among the study group after the intervention workshop and a significantly significant decrease in the state of safety variable among the control group. Regarding leadership for improvement, the researchers found a significant relation with workshop participation only for the fear of repercussions variable. They concluded that although support from senior leadership is important in advocating for patient safety in an organization, the understanding of how such support can be inspired requires more research.

The research article by Ginsburg et al. (2005) is related to the concept of patient safety because it addresses two of the major factors that promote patient safety in a healthcare organization: leadership and training intervention. Leadership is important in steering the entire organization and healthcare workforce towards a patient safety culture. Training intervention on the other hand helps to instill in healthcare workers the knowledge and skills necessary in preventing medical errors. Such an intervention helps to bring the grave issue of patient safety to the limelight. As a result, it helps in narrowing the wide gap between theory and practice in clinical practice.

Reference List

Byers, J.F., & White, S. (2004). Patient safety: principles and practice. New York: Springer Publishing Company.

DerGurahian, J. (2009). From tragedy to advocacy. Modern Healthcare, 39(36), 1-3.

Ginsburg, L., Norton, P.G., Casebeer, A., & Lewis, S. (2005). An educational intervention to enhance nurse leaders’ perceptions of patient safety culture. Health Services Research, 40(4), 997-1020.

Kohn, L.T., Corrigan, J., & Donaldson, M.S. (2000). To err is human: building a safer health system. Washington, D.C.: National Academies Press.

Larson, E. (2002). Measuring, monitoring, and reducing medical harm from a systems perspective: a medical director’s personal reflections. Academy of Medicine, 77, 993-1000.

Sanders, J., & Cook, G. (2007). ABC of patient safety. New York: Blackwell Publishing.

Travis, J.W., & Ryan, R.S. (2004). Wellness Index: A Self-Assessment of Health and Vitality. London: Celestial Arts.

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