Back to Basics
Deborah M. Nadzam, PhD, FAAN
Practice Leader, Patient Safety Services
Our nation’s economic crisis is affecting all of us. According to a recent Thomson-Reuter survey, nearly half of surveyed hospitals are now operating at a loss. A recent survey of Pennsylvania hospitals found more than 80% are planning reductions in staff and 88% are decreasing capital expenditures. No doubt this trend will roll across the country as all health care organizations struggle with investment losses, decreased admissions, and lower payments for patients enrolled in federal insurance programs. Now more than ever is the time to focus on the basic elements of safe care. Three such basics come to mind: clear communication, infection prevention, and safe medication use.
Fundamental is clear communication—with the patient and with each other. Through dialogue with the patient or a significant other, we learn important details that can help us to make accurate diagnoses, select appropriate treatment modalities, monitor effects of treatment, and prevent harm. The pace of health care today necessitates better communication with each other as well. Regardless of the health care setting, we are caring for sicker patients, with fewer staff, and limited resources. Any knowledge we have about the patient should be shared with each other in writing and during hand-offs of care. When that hand-off is face-to-face, let’s make eye contact with each other as we impart patient information. When telephonic, let’s use phrases such as “Now here is a very critical point to remember…” We are dependent on each other’s time spent with the patient and knowledge about the patient. Let’s use effective methods when communicating with others to emphasize key data.
A second fundamental element of safe care focuses on infection prevention. The growing concern about multidrug-resistant organisms mandates our attention to cleanliness: washing our hands, keeping patients clean and dry, ensuring a well-ventilated and clean environment—basic elements of care professed by Florence Nightingale in 1860. With infections contributing to morbidity, mortality, increased length-of-stay, and costs, our attention to these issues cannot be emphasized enough. When you walk into a patient’s room, look around. Would you want a loved one in that room? That bed? Is the patient in clean, dry clothing? Would you care for your loved one without washing your hands if you just cared for a patient in another room?
Finally, safe medication use necessitates the confirmation of identification—identification of patients and of medications. Medication errors are the most common type of medical error and contribute to 7000 deaths a year, with an estimated $3.5 million to treat drug-related injuries occurring in hospitals (IOM, 2006). How much time does it really take to confirm the patient identification and be certain about the medication being prescribed, prepared, dispensed and administered? The time taken to confirm all elements of identification may save a life. When in doubt, check it out!
Three basic elements of patient care: communication, infection prevention, safe medication use. These are important aspects of care we all learned about in school but in the rush of daily work seem to justify overlooking. In some ways it is unfortunate that it has taken external requirements to remind health care professionals about these fundamentals: The Joint Commission’s NPSGs, CMS’ new payment and non-payment rules, The Leapfrog Group’s adoption of National Quality Forum’s safe practices in contracting principles, and a sundry of state regulations and other payer/purchaser requirements.
Let’s not delude ourselves into thinking that we are now expected to include the patient; perform thorough, timely hand-offs; wash our hands; identify patients; and practice safe medication use because these are the latest “hot” patient safety topics, or because our organization might not be accredited if surveyors witness poor attention to these practices, or may not be paid if these practices aren’t followed. These are fundamental elements of good patient care. External requirements exist because we need to be reminded of them.