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How to overcome barriers to recognition
By the time the general public hears about an impaired clinician, whether it’s a nurse, technician, or physician, it is often too late to head an incident involving that clinician off at the pass-whether that incident is a medical error, diversion of medication, or something even worse, like the technician recently accused of inadvertently exposing thousands of patients to hepatitis C.
But the healthcare industry is well aware that impaired clinicians exist, and it has methods for addressing, confronting, and helping these medical professionals. Where are the industry’s gaps to success in preventing this far too common occurrence? BOAQ recently sat down with Jill Pollock, RN, LMFT, administrator of Loma Linda University Behavioral Medicine Center and frequent lecturer on chemical dependency recognition and intervention, to discuss this topic.
It takes a case as shocking as the hepatitis C outbreak in New Hampshire to bring a topic like this to light, she says.
“I think it’s difficult for people in healthcare to wrap their heads around it,” says Pollock. “What do you think one of our biggest barriers is to recognition of addiction and confronting it? If I can get people to talk just a little bit, we start hearing how there is a fear that confronting someone’s addiction could ruin someone’s life.”
For many healthcare professionals, the thinking is backward, she says–they’re focused on saving a coworker’s career. But we have a professional responsibility to our patients, our loved ones, and the public in general.
“What happens if someone drives impaired and kills someone in a car crash? Would you worry about their professional life?” says Pollock. “Or if your facility has an outbreak of hepatitis C?”
After talking with audiences about the possible outcomes of not confronting versus trying to help the impaired professional, she has found that the best tactic is to bring in personal, relatable example scenarios. “If someone is diverting drugs, then that patient, that mother or father, son or daughter, husband or wife, is not getting their pain medications,” she says. “Or, alternately, is being cared for by an impaired nurse. I try to bring it home to something we can all relate to.”
Who would you want taking care of your loved one? Pollock asks. Would you be comfortable with a caregiver who is impaired or thinking about where to find his or her next fix?
A new Senate bill would limit the amount of opioids a patient can initially receive for acute pain. If passed, physicians could only prescribe seven days’ worth of opioids when first treating a patient’s condition.
The bill was put forward by Senators John McCain (R-Ariz.) and Kirsten Gillibrand (D-N.Y.) as a way to prevent opioid addiction. The limit is backed up by medical literature and is there are nine states with similar opioid laws in place.
“Our legislation builds on the important steps taken by Arizona Governor Doug Ducey last fall to tackle a root cause of this epidemic by limiting the supply of an initial opioid prescription for acute pain to seven days. We have a long way to go to end the scourge of drugs across our communities, but this legislation is an important step forward in preventing people from getting hooked on these deadly drugs,” said McCain in a press release.
“Too many lives have been destroyed, too many families have been torn apart, and too many communities all over New York are suffering because of this tragic epidemic. I am proud to join with Senator McCain in this urgent fight against the overprescription of opioids, and I look forward to seeing it pass through the Senate as quickly as possible,” said Gillibrand in a press release.
The toolkit aims to prevent patient misidentification through the use of health information technology.
Patient misidentification is a big and likely underreported problem for hospitals and health systems, as well as for patients.
The consequences can be significant. ECRI Institute research shows that 9% of patient misidentification events lead to temporary or permanent harm or death.
That’s why the ECRI Institute and a stakeholder collaborative it convened, the Partnership for Health IT Patient Safety, has launched a new patient identification resource to help prevent patient misidentification through the use of health information technology.
ECRI is a Pennsylvania-based nonprofit that works to improve the safety, quality, and cost-effectiveness of patient care.
The toolkit divides its recommendations into two sections:
- Attributes addresses “the information-gathering aspects of patient identification, including the fields and the formats that are available to accommodate acquisition of required information.”
- Technology addresses “new technologies to improve identification and ways to leverage existing technologies for safe patient identification.”
The World Health Organization (WHO) last week announced its new global initiative, which seeks to halve the rate of medication-related errors by 2022. The Global Patient Safety Challenge on Medication Safety will combat medication errors by
- Addressing weakness and flaws in how drugs are prescribed, distributed, and consumed
- Providing education on safer and more effective prescribing habits and methods
- Increasing patient and provider awareness on the dangers of medication errors
“Most harm arises from systems failures in the way care is organized and coordinated,” the WHO wrote in a press release. “Especially when multiple health providers are involved in a patient’s care. An organizational culture that routinely implements best practices and that avoids blame when mistakes are made is the best environment for safe care.”
In the U.S alone, 1.3 million people are injured annually due to medication errors. Worldwide, med errors cause at least one death per day and cost an estimated $43 billion annually (1% of global health expenditures). Rates of medication-related adverse events are similar regardless of whether one is in a high-, middle-, or low-income nation. However, in less wealthy nations, the impact of these events are about twice as much in terms of the number of years of healthy life lost.
“We all expect to be helped, not harmed, when we take medication,” said Dr. Margaret Chan, WHO director-general, in the press release. “Apart from the human cost, medication errors place an enormous and unnecessary strain on health budgets. Preventing errors saves money and saves lives.”
A new study published in the Journal of the American Medical Association found that patients are less likely to die if they are treated on the same day as a surprise Joint Commission survey. During a survey week, patients had a 1.5% better chance of survival within 30 days of admissions, as compared those treated three weeks before or after the survey. At teaching hospitals, the presence of surveyors caused a 5.9% decrease in fatalities.
Researchers suspect that when they know they’re being watched, physicians work extra hard to provide quality care and follow standards.
“This study highlights that there is potential for us to learn what is going on during those weeks that is associated with better patient outcomes,” Vineet Arora, a researcher at University of Chicago Medicine who wasn’t involved in the study, told Reuters. “The question is whether it is due to a concerted effort on the part of the hospitals to follow safe practices or whether there is something else going on.”
The study was conducted by Harvard Medical School and Harvard T.H. Chan School of Public Health researchers. They analyzed Medicare admissions data from 1,984 surveyed hospitals, with more than 1,462,000 patients admitted in the three weeks before and after a survey and 245,000 during.
The Joint Commission’s newest Quick Safety edition shines a light on MRI safety programs. The report says that vigilance is needed because the electromagnetic fields used during the MRI process can cause harm. Examples include risks such as:
- Heating flesh and tissue
- Inducing electrical currents
- Displacing implants and medical devices
- Disrupting patient monitoring equipment
- Turning metal objects into projectiles
Quick Safety 31 gives suggestions and advice on implementing a MRI safety program and can be viewed here.
The ECRI Institute has published its 2017 list of top patient safety hazards and concerns. The Institute publishes the list to highlight and educate healthcare workers on various dangers affecting patients. The list includes guidance on how to effectively respond to these concerns, along with implementing priorities and corrective action plans. This year the list includes:
1. Information Management in electronic health records (EHR)
2. Unrecognized patient deterioration (UPD)
3. Implementation and use of clinical decision support
4. Test result reporting and follow-up
5. Antimicrobial stewardship
6. Patient identification
7. Opioid administration and monitoring in acute care
8. Behavioral health issues in non-behavioral-health settings
9. Management of new oral anticoagulants
10. Inadequate organization systems or processes to improve safety and quality
“The 10 patient safety concerns listed in our report are very real,” Catherine Pusey, RN, ECRI associate director told HealthLeaders. “They are causing harm (often serious harm) to real people.”
The proper use and timely access to EHRs for patient information management was the main concern this year, Lorraine B. Possanza, program director for ECRI’s Partnership for Health IT Patient Safety said in a press release. She says the vast storehouses of patient data now available to physicians have created new challenges.
“The object is still for people to have the information that they need to make the best clinical decision,” she wrote. “Health information needs to be clear, accurate, up-to-date, readily available, and easily accessible.”
The second concern, UPD, has recently been the subject of increased training, education, better clinical protocols, and public awareness campaigns. However, despite faster recognition and response, UPD is still a major concern.
“People have seen how well the campaigns have worked for stroke and STEMI and how much they’ve improved outcomes,” Patricia N. Neumann, RN, ECRI senior patient safety analyst and consultant told HealthLeaders. “What if those same principles could be applied to other conditions that require fast recognition and management? We could have a big impact on improving outcomes.”
Read more at HealthLeaders Media
The Agency of Healthcare Research and Quality (AHRQ) reports that the number of patients sent to the emergency department (ED) for suicidal thoughts has doubled. As of 2013, 1% of all ED visits are related to suicide ideation, which is up from 0.4% in 2006. This is an average increase of 12% annually.
Of the 1% brought in for suicidal thoughts, more than 71% were admitted to the same hospital or transferred to another facility. ED patients with suicidal thoughts often had these behavioral health conditions:
- Mood disorders
- Substance-related disorders
- Alcohol-related disorders
- Anxiety disorders
- Schizophrenia and other psychotic disorders
Visit HealthLeaders Media for more details. And read more on our previous coverage of suicide ideation and prevention.
The Joint Commission today published its newest Sentinel Event Alert (SEA), which addresses the role of leadership in creating a culture of safety, namely that leaders’ first priority is being held accountable for the safety of patients and staff. Leaders are expected to find flaws and gaps in the care process and ensure that they are resolved.
The SEA comes with an infographic on the “11 Tenets of a Safety Culture.”
In the March issue of Perspectives, The Joint Commission announced that it had added 2016’s sentinel event data to its database. There were 824 sentinel events reported to The Joint Commission between January 1 and December 31, 2016. And 81% of those events were submitted voluntarily by the organization that experienced them. The most often reported events were:
- Unintended retention of a foreign object – 120
- Wrong patient, wrong site, or wrong procedure – 104
- Falls – 92
- Suicide – 87
- Delay in treatment – 54
- Other unanticipated events – 47
- Operative/postoperative complication – 45
- Medication error – 33
- Criminal event – 32
- Perinatal death/injury – 23
Readers should note that less than 2% of all sentinel events are reported to The Joint Commission, and these numbers can’t show the actual frequency of these events.
“In 2016 the trend for the most frequently reported sentinel events continued to be unintended retention of foreign objects, ‘wrong-patient, wrong-site, wrong procedure’ events, patient falls, patient suicides, and delays in treatment,” wrote Gerard M. Castro, PhD, MPH, Joint Commission project director, in Perspectives. “These are not new problems to health care, which indicates that organizations continue to struggle with how to prevent them.