Communication is crucial to safe patient care

Throughout society, whenever there is a problem, you can usually bet that ineffective communication is one of the reasons for it.

The healthcare industry is no different -- communication failures were cited as root causes in approximately 65 percent of all sentinel events reviewed by the Joint Commission on Accreditation of Health Care Organizations since 1995. This is the leading cause for serious adverse events, and a major cause for concern.

So it's no surprise that one of JCAHO's Patient Safety Goals is to improve the effectiveness of communication among caregivers.

[Learn more about Patient Safety Goal #2: Communication" by downloading JCAHO's Frequently Asked Questions sheet on this topic here.]

"Whether it is reading back orders, limiting the use of abbreviations or taking the time to properly 'hand off' patient information to fellow staff and physicians, communication is essential to assuring patient safety," said Karen Long, RN, Vice President and Chief Nursing Officer at Backus Hospital.

At Backus, staff members are expected to:

• Writing down all verbal or telephone orders, and reading them back.
  
• Not use dangerous or unacceptable abbreviations.
  
• Communicate patient information in timely manner, including critical laboratory values.
  
• Follow established protocol for 'hand off' communications.

Peter Shea, MD, Medical Director at Backus, said hospital and medical staff should never underestimate the importance of communication, especially in an increasingly complex healthcare environment with many different clinicians, on various shifts and at multiple locations, involved in patient care.

"Communication must always be a top priority for everyone in our organization," said Mary Bylone, RN, Assistant Vice President, Patient Care Services and Patient Safety Officer. "I cannot stress enough how important this is to the safety of our patients."

Anyone with questions about the National Patient Safety Goals, or suggestions to help Backus improve patient safety, can call Ms. Bylone at 860-889-8331 ext. 2771 or Joe Hughes, Director of Quality Improvement, at 860-889-8331 ext. 2345.

"Time outs" before surgery bolster patient safety

Despite the widespread media attention that wrong site surgeries receive, they are very rare.

The rate, according to a recent study in published in the Archives of Surgery, is 1 in every 112,994 operations.

But that one case can irreparably harm the patient, ruin a hospital's reputation and potentially end a physician's career.

Last year, healthcare institutions reported 84 wrong site or wrong patient surgeries to the Joint Commission on Accreditation of Healthcare Organizations.

"That number might seem small," said Peter Shea, MD, Medical Director at Backus Hospital. "But anything more than zero is unacceptable."

At Backus, just prior to any surgical procedure, medical and nursing personnel conduct a final verification process, which includes a deliberate pause (a "time out").

[Learn more about this by downloading JCAHO's "Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery" here].

In this process, all members of the surgical team stop and confirm the correct patient, procedure and site.

Prior to transporting a patient to their procedure room, the physician marks the site of the procedure with the word "Yes" or with the physician's initials -- a process in which the patient is involved whenever possible.

Once in the procedure room, one member of the team reads the informed consent aloud while anesthesia checks the patient's hospital armband for the name, date of birth and medical record number, and all members of the team actively communicate to confirm that they are performing the right procedure on the right patient in the correct location on the body.

"We must always remain vigilant, and realize how important it is to follow our established patient safety protocols," said Karen Long, Vice President and Chief Nursing Officer at Backus. "The 'time out' process is very important."

Mary Bylone, RN, Assistant Vice President of Patient Care Services and Patient Safety Officer, said it is essential that all members of the surgical team participate in the "time out" process, each and every time.

"Not taking the time to do so can result in a major mistake," Ms. Bylone said.

According to Judi Goldberg, RN, Clinical Educator for Surgical Services, the Surgical and Special Procedures, Patient Safety Process for Patient Identification/Procedure/Site Verification policy and checklist have been used throughout the hospital since February 2000 wherever surgeries and invasive procedures are performed. The policy also requires making sure the correct x-rays, positioning supplies, implants and equipment are available prior to the start of the procedure.

"Patient safety must always be our first priority, and all members of the team are encouraged to speak up if they have concerns," Ms. Goldberg said.

Anyone with questions about the National Patient Safety Goals, or suggestions to help Backus improve patient safety, can call Ms. Bylone at 860-889-8331 ext. 2771 or Joe Hughes, Director of Quality Improvement, at 860-889-8331 ext. 2345.

Patient Safety: "Don't Just Go Through the Motions"

The National Patient Safety Goals typically get plenty of attention when a hospital is scheduled for an accreditation visit or during National Patient Safety Awareness Week.

But constant attention to patient safety is how you can make a real difference for patients, and the hospital as a whole. And you don't have to be a direct patient care provider to have a major impact.

"Providing high quality, safe and efficient patient care is the most important thing that we can do as an organization," said Thomas P. Pipicelli. "Everyone who works at Backus Hospital should know the National Patient Safety Goals, and have an understanding of their own roles in making Backus Hospital the safest possible place for patients."

The Joint Commission on Accreditation of Health Care Organizations (JCAHO) is scheduled to make an accreditation visit at Backus Hospital as early as January 2007, and adherence to the National Patient Safety Goals will be a major focus.

But Peter Shea, MD, Medical Director at Backus, said patient safety should be at the forefront of everyone's minds year-round, at all times, because studies show that mistakes are made when healthcare workers let their guard down, or go on "auto pilot."

Patient safety is most often compromised when a staff member loses focus while doing something they have done successfully a thousand times, he said.

"You can't just go through the motions," Dr. Shea said. "We have to be totally committed to patient safety, every day, and everything else will fall into place."
Over the next several weeks, HospiTell will focus on the importance of each 2006 National Patient Safety Goal, and what the Hospital is doing to adhere to them.

The goals are:

• Improve the accuracy of patient identification.
  
• Improve the effectiveness of communication among caregivers.
  
• Improve the safety of using medications.
  
• Reduce the risk of healthcare-associated infections.
  
• Accurately and completely reconcile medications across the continuum of care.
  
• Reduce the risk of patient harm due to falls.
  

"The National Patient Safety Goals are designed to help organizations like Backus avoid mistakes that compromise patient care," said Karen Long, RN, Vice President and Chief Nursing Officer. "While it is important to adhere to them for compliance purposes, we are committed to them because it is the right thing to do for our patients. That's the bottom line."

Anyone with questions about the National Patient Safety Goals, or suggestions that can help Backus improve patient safety, can call Mary Bylone, RN, Assistant Vice President of Patient Care Services and Patient Safety Officer, at 860-889-8331 ext. 2771 or Joseph Hughes, Director of Quality Improvement, at 860-889-8331 ext. 2345.

Patient identification a key to safety

National Patient Safety Goal #1 is Improving the accuracy of patient identification.

Peter Shea, MD, Medical Director at Backus Hospital, said it is important to not just go through the motions while performing these seemingly routine checks. That is how mistakes can happen, some of which have received very negative national attention and compromised patient safety.

At Backus, strategies to properly identify patients include:

* Use at least two patient identifiers (never the patients room number) whenever taking blood samples or administrating medications or blood products, including the patient's name and either medical record number or birth date.
* Medical personnel ask patients to state their name and then check that against their identification bracelet.

Here are a couple of scenarios in which these strategies are applied:

• An outpatient comes in for blood tests. Just before drawing blood, the lab tech should ask the patient "What is your name?" It is not sufficient to ask, "Are you Mrs. Smith?" Then ask the patient his or her date of birth, and confirm both the name and date of birth before drawing blood.
  
  
• When dealing with a patient in the Critical Care Unit who can't interact because of his or her condition, always confirm the patient's name against the arm band before medication is administered. You must also confirm either the patient's medical record or date of birth with the arm band.
  
  
• The same policies apply for any inpatient or outpatient scenario, whether it is in a health center, X-ray, physical therapy, etc.
  

"Staff should be using two patient identifiers in any of these settings," Dr. Shea said.

Anyone with questions about the National Patient Safety Goals, or suggestions to help Backus improve patient safety, can call Mary Bylone, RN, Assistant Vice President of Patient Care Services and Patient Safety Officer, at 860-889-8331 ext. 2771 or Joe Hughes, Director of Quality Improvement, at 860-889-8331 ext. 2345.

Why "Always" always matters

You're planning a dinner for a special occasion. Will you select the restaurant that usually gets your order right, and sometimes has its signature dessert available?

Your car’s making a disturbing noise. Will you take it to the mechanic who sometimes finds out what's wrong the first time and usually gives you an accurate estimate?

You're juggling your schedule at work and home to make a long-standing appointment with — take your pick: a doctor, a hairdresser, a contractor, your child's teacher. Will you recommend that person to others if he or she sometimes sees you within a reasonable time?

Of course not. When you're the consumer, you have pretty high standards. And you expect them to be met — always.

That's important to keep in mind when thinking about the new inpatient experience survey called HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems). The survey’s second word is “consumer,� and that's exactly how our patients expect to be treated.

Of the 22 patient experience questions (out of 27 in the survey), 14 ask patients to report how frequently certain things occurred during their hospital stay. These items are events that patients have said make a big difference in determining their overall experience.

Here are two typical questions:

• During this hospital stay, how often did nurses treat you with courtesy and respect?
  Never -- Sometimes -- Usually -- Always
  
  
  
• During this hospital stay, how often were your room and bathroom kep clean?
  Never -- Sometimes -- Usually -- Always
  

When the HCAHPS results are publicly reported, only one answer will be used to compare hospitals. You can guess which one: ALWAYS.

Backus — like all good hospitals — has systems and standards in place so that certain things always should happen. Checking patient identifiers is not optional; it's an “always� standard for patient safety. Making sure patients (or their families) understand their medications and discharge instructions is not optional; it’s always important.

Our patients' expectations — to be treated with courtesy and respect, to be informed so they can understand what's happening, to have a restful and safe environment — are hardly unreasonable. When you, or a loved one, is the patient, it's what you always want, too. With the HCAHPS survey, we get a chance to see how we meet those expectations, and how well we live up to our own vision of providing patient-centered care.

Oct. 1: A key date for inpatient surveys

There will be a new name and a new look to Backus Hospital's inpatient surveys starting Oct. 1. The purpose of the surveys remains the same, though: To better understand our patients' perception of their hospital experience, and to use the results to improve.

Starting with the new Fiscal Year, we will switch from Press, Ganey Associates surveys to those designed by the National Research Corporation and the Picker Institute, called NRC+Picker.

Oct. 1 is a very important date in another area of patient surveys, as well: It marks the start of the public survey period for a new national standardized inpatient survey, called HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems).

"Making sure our patients have the best possible hospital experience is why each os us is here," said Keith Fontaine, Vice President, Corporate Communications. "Patient-centered care is not just the job of direct caregivers. We all have important roles to play, because we all share a common purpose: Making Backus a hospital where patients and families know they'll get exceptional care."

We will explore the new inpatient survey and the HCAHPS survey in greater detail in future posts. Here are a few questions and answers you may find helpful at the outset:

• Why change surveys? We've used Press, Ganey for more than five years.
  The short answer is that the Picker survey aligns much better with the HCAHPS questions, which we are required to include at the start of the survey.
  NRC+Picker attempts to measure the quality of patients' experience, asking the extent to which a relevant behavior or process did or did not occur (always, usually, sometimes or never).
  Press, Ganey attempts to measure patients' satisfaction with the care or service they received on a 1-to-5 scale (very poor, poor, fair, good, very good).
  The new national HCAHPS survey uses the experience approach, arguing that this yields less subjective and more actionable results.
  
  
• Give me an example:
  Press Ganey:
  Nurses’ attitude toward your requests:
  1 -- 2 -- 3 -- 4 -- 5
  (very poor, poor, fair, good, very good)
  
  HCAHPS / Picker:
  During this hospital stay, how often did the nurses listen carefully to you?
  Never -- Sometimes -- Usually -- Always
  
  
• Is there a Picker survey philosophy?
  The Picker survey is based on eight "dimensions" of patient-centered care -- items that mattered most to patients. These areas were developed by Harvard and NRC researchers, based on focus groups with more than 8,000 patients, and have been adopted by the Institute of Medicine. The dimensions are: Respect, Coordination, Education, Comfort, Emotional Support, Family/Friends, Transition, and Access.
  

By measuring the frequency of specific behaviors, Picker believes hospitals can more readily know what to act upon to improve the patient experience.