5.1 Patient safety and clinical risk.pptx

This is new subject in B.Sc. Nursing program. The occurrence of adverse events due to unsafe care is likely amongst the leading causes of death and disability in the world.
Investment in reducing patient harm can lead to significant savings and better patient outcomes.

1. Patient Safety and Clinical Risk

2. INTRODUCTION The occurrence of adverse events due to unsafe care is likely amongst the leading causes of death and disability in the world. Investment in reducing patient harm can lead to significant savings and better patient outcomes.

3. PATIENT SAFETY As the health care systems have evolved with complexity, it has led to rising patient harm in the facilities. This has led to patient safety as an emerging health care discipline. Patient safety aims to reduce and prevent risks, errors and harm that occur to patients during provision of health care. It is based on learning from errors and adverse events, and continually improving upon it. To ensure successful implementation of patient safety strategies; clear policies, leadership capacity, data to drive safety improvements, skilled health care professionals and effective involvement of patients in their care, are all needed.

4. Causes of Patient Harm The increasing complexity of health care systems can cause harm when human complacency is factored in. Medical error refers to the failure of planed action to be completed as intended. Medical errors can occur anywhere in healthcare system-from hospitals to nursing homes, to pharmacies.

5. TYPES OF ERROR ERROR DESCRIPTION Near-miss An incidence about to happen, but did not occur by chance. Sentinel events An unexpected occurrence involving death or serious physical or psychological injury. Medication errors It is a preventable event that may cause or lead to inappropriate medication use Adverse events It is an incident in which harm resulted to a person receiving health care. This could include infections, physical harm, etc.

6. Several medical practices and risks associated with health care are emerging as major challenges for patient safety. Medical complexity (e.g. complicated technologies, prolonged hospital stay) Health-care associated infections Unsafe surgical care procedures Unsafe injection practices Diagnostic errors Unsafe transfusion practices Radiation errors Sepsis Venous thromboembolism (blood clots)

7. Medication errors Prescribing errors (Incorrect selection of drugs) Omission errors (Missing a scheduled drug dose) Improper dosing errors (Incorrect quantity of drug prescribed) Wrong dose errors (Incorrect quantity of drug administered)Improper administration technique errors Wrong drug preparation errors Fragmented care errors (Due to lack of communication between prescribing physician and other professionals)

8. Human factors Variations in healthcare provider training and experience Fatigue or depression in healthcare provider Failure to acknowledge seriousness of medical errors Anxiety or stress System failures Unsafe communication Disconnected reporting systems in a health care facility Monitoring environment and design factors Infrastructure failure

9. CAUSES OF MEDICATION ERRORS Lack of knowledge: Nurses who lack complete information on drug prescription, its various generic and brand names, its side effects, or on how drugs work can make errors. Incomplete patient information: Nurses should always cross-check with physicians or another nurse in case they lack information about patient's allergies towards certain mediation, or other medication already being taken by the patient. Environment and distraction: Nurses could be chronically overworked that can lead to exhaustion and reduced efficiency. In addition, environmental factors such as lack of proper lighting, heat or cold, etc. can lead to distractions. Memory lapse: Distractions or overworking can also cause nurses to forget information, such as allergies of a patient Systematic problems: Medication errors can also be caused due to systematic problems such as mislabelling medication, placing similar-named medicines in proximity, etc.

10. RELATIONSHIP BETWEEN PATIENT AND INFORMATICS (HEALTHCARE INFORMATIONTECHNOLOGY (HIT) Healthcare information technology (HIT) is defined as the application of information processing involving both computer hardware and software that deals with storage, retrieval, sharing and use of health care information, data, and knowledge for communication and decision making. It includes various technologies from simple charts, to more advanced decision support that integrates with medical technology. Health Information Technology is an important tool to improve the healthcare safety as well as quality, and it improves patient safety by: Reducing medication errors Reducing adverse drug reactions Improving compliance to practice guidelines

11. HIT and Patient Safety HIT presents several opportunities for improving and transforming healthcare: Reducing medical errors Improving clinical outcomes Facilitating care coordination Improving practice efficiencies Tracking data

12. Components of HIT that help enhance patient safety are listed here. (1)Clinical Decision Support (CDS) Clinical decision support provides patient-specific information to the health care provider, which is intended to enhance the health care quality. The information is rationally processed and presented to the health care provider at suitable time. CDS includes a wide range of tools such as alerts, notification, clinical guidelines, diagnostic tools, condition-specific order sets, and reminders for patients and health care provider, etc. These tools help to enhance decision making and clinical workflow by improving adherence to the process, laboratory and medication ordering.

13. (2)Electronic Physician's Entry and E-Prescribing Computerized physician order entry (CPOE) entails the use of electronic support to enter physician orders and medication on a computer device. This not only allows to improve medication orders, but also allows electronic ordering of tests, procedures and consultation. Computerized entries, when integrated with clinical decision support system (CDS), help to prevent clinical errors as they guide through proper administration of doses.

14. (3)Electronic Sign-out and Hand-off Tools Medication errors can be prevented using bar-coded medication administration systems, which are electronic systems that integrate electronic medication administration records with bar code technology. This would ensure that the right patient receives the right medication at the right time. The bar-coded systems also have varying level of sophistication.

15. (4)Patient Electronic Portals A patient portal is a secure online application that provides patients access to their personal health information and two-way electronic communication with their care provider using a computer or a mobile device. These portals have proven to improve outcomes of preventive care, disease awareness and self-management.

16. (5)Telemedicine Telemedicine is defined as the use of telecommunication technologies to facilitate communication from patient to health care provider, or from one heath care provider to another. The communication can be real-time (using video-conferencing technologies) or asynchronous transmission of patient's clinical information. Medical devices or personal mobile devices may be used to track patients' health remotely. Telemedicine provides this health information collected remotely, which is further used to monitor patients, track or change their behaviour . Synchronous telemedicine refers to virtual, real-time visits using 2-way audio/video communication between a healthcare provider and a patient. Several studies show that telemedicine is as effective as face-to-face care with regard to specific clinical outcomes. E-Consultation is electronic communication between patient's clinician and a specialist using a secure platform to discuss sensitive information. This reduces wait times, though there is limited evidence regarding efficacy and safety of e-consults.

17. (6)Remote Patient Monitoring Telemonitoring, i.e., remote patient monitoring, can be used when there are challenges to healthcare accessibility. It helps improve patient outcomes for certain chronic conditions such as stroke, asthma, hypertension, etc. The Patient Data Management System (PDMS) can automatically retrieve data from medical equipments (e.g. ventilator, patient monitor, etc.) and is further used for interpretation by the health care provider. PDMS data integrated with CDS (Clinical Decision Support) and EMR (Electronic Medical Record) can help improvement in clinical outcomes and reduce the risk of errors.

18. (7)Electronic Incident Reporting Electronic incident reporting systems are web-based systems that allow healthcare providers to voluntary report safety events that occured with them or were observed by them. These systems can be integrated with electronic health record (EHR) to automate detection of adverse events. (8)Electronic Health Records EHR helps reduce errors pertaining to prescription drugs, emergency and prescriptive care as well as to tests and procedures. EHRs are accessible from anywhere.

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