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Safety for Patients and Healthcare Workers Starts With Culture

Radgia Cook, Associate Director Global Leader, Healthcare Quality and Safety
Kim Pardini-Kiely, Associate Director Clinical and Operational Excellence and Innovation Services

Patient safety is always a top priority for healthcare organizations. However, the COVID-19 pandemic has added complexity and significant operational pressures that include maintaining adequate staffing and delivering patient care effectively amid burgeoning demand. It’s magnified existing safety issues and introduced new risks, such as the shortage of personal protective equipment (PPE). Now more than ever it is important to have a strong organizational focus on patient and organizational safety.

Healthcare organizations should help ensure patient safety by establishing a corresponding culture. Culture embodies the values, beliefs and norms of the organization and includes behaviors and attitudes. A positive safety culture can impact both patient and employee safety and overall organizational performance.

Typically, it takes years to establish such a culture. However, organizational changes in response to a crisis like the pandemic can speed up the process dramatically — which is why now is an ideal time to establish a strong culture of safety.

Conduct surveys

One of the most effective ways to evaluate and measure culture and commitment to patient safety is to conduct surveys. Annual surveys, for example, can help management identify trends that measure the impact of patient safety interventions on their culture. Surveys also provide data to benchmark a healthcare organization’s culture against those of similar organizations.

Build high reliability

Healthcare is a high-risk industry that requires a commitment to the principles of high reliability to reduce the risks of patient harm. High reliability organizations (HROs) in healthcare adhere to five basic principles:

  1. Obsess over continually improving operations.
  2. Accept that healthcare processes are complex and can’t always be simplified.
  3. Constantly look for failures.
  4. Maintain deference to expertise.
  5. Practice resilience.

Perform internal audits

Internal audit should be a strategic partner to the leadership team, providing value-added service in support of the organization’s goals and objectives. Internal auditors can reinforce the importance of patient safety through various audits, including program audits.

Beyond a patient safety program audit, audit plans should consider other patient safety topics:

Sentinel events

Healthcare organizations should gain a baseline understanding of its overall patient safety sentinel event program, any adverse events and reporting processes. They also should evaluate current processes for collecting, aggregating and reporting patient safety information to determine the existence and effectiveness of internal controls for ensuring reported patient safety data is accurate, complete and compliant with policy requirements. Determining the adequacy of remediation plans and whether ongoing monitoring is in place is also a must.

Auditing of patient safety events supports the goals of early detection, identification of risks and timely implementation of corrective action plans.

Quality and patient safety outcomes

The accuracy of publicly reported outcomes and other comparative data must be validated because the data is used for comparing the performance of organizations.

Implementation of the Medicare pay-for-performance program and value-based purchasing goes further by linking payment to quality. Organizations should assess the key controls within data collection and reporting systems to evaluate the quality, integrity, availability and preservation of data for reporting quality outcomes. They should also evaluate the effectiveness of corrective action plans to reduce the incidence of hospital-acquired conditions.

Supply chain

Adequate access to supplies, pharmaceuticals and equipment is essential to maintaining the health and safety of workers and patients. A supply chain resiliency plan supports a risk-mitigation strategy and should include measures for a stockpile reserve of at least 45 days to ensure availability.

The pandemic created an increased demand for medical supplies such as disinfectants, PPE, ventilators and vaccines. Before the pandemic, these items were readily available from regular suppliers. But the rate at which the virus spread across the globe created an immediate and overwhelming demand for supplies that quickly led to critical shortages.

Healthcare providers found themselves competing with new and nontraditional buyers almost overnight, which drove product scarcity and price increases. Existing and new suppliers invested in efforts to retool and refocus to fill the gaps. But those efforts still lagged demand, which threatened reliability and availability of downstream components and other supplies.

The supply shortage put intense pressure on healthcare organizations to vet and set up new suppliers and rapidly approve substitute products. Hospital systems had to rethink their supply planning and replenishment processes and ensure their master data management and supplier risk controls were in place, effective and being followed. The pandemic exposed the breadth of the impact that supply chains have on a wide range of hospital operations.

Medical device preventive maintenance

Relying on the pandemic-related 1135 waiver of the Social Security Act to delay medical device preventive maintenance can lead to patient safety issues. Healthcare facilities must have a plan to catch up on all waived preventive maintenance, especially for high-risk devices such as ventilators. The plan should include auditing the high-risk medical device preventive maintenance activities for timeliness and comprehensiveness and establishing protocols for device maintenance — critical to preventing disease spread to both patients and staff.

Daily rounding

During the COVID-19 public health crisis, many healthcare workers have experienced high levels of stress and burnout. Rounding in patient care areas is a powerful vehicle for ensuring real-time issue identification and problem-solving.

Rounding that pairs nursing supervisors with clinical leaders is a constructive strategy to keep staff informed. Issues identified during rounds should be tracked and trended to ensure sustainable solutions are implemented and monitored for effectiveness.

Continued communication for both staff and patients is critical and should include all policy changes such as how to access services, requirements for visiting, how to maintain social distancing while in the healthcare setting, and how the organization has implemented evidence-based practices.

Drug diversion

The COVID-19 pandemic has unfortunately reversed prior successes in reducing opioid overdoses and deaths. High stress, isolation, job loss, and the reduced availability of and patients’ reluctance to obtain safe, medication-assisted treatment have all greatly contributed to this downslide.

Also, the previous focus on drug diversion prevention and detection and opioid prescribing patterns was overshadowed by the need to respond to the pandemic. Patient safety risks related to drug diversion are:

  • Caregiver impairment
  • Ineffective pain management because a controlled substance is diverted and not administered
  • Transmission of healthcare-associated infections due to medication tampering

Enhancements in drug diversion monitoring tools and analytics allow organizations to pinpoint and investigate anomalous practitioner behavior efficiently. Integration of automated dispensing cabinets, electronic medical records and timekeeping systems help provide management with a clear picture of practices that may indicate diversion. Successful implementation of these tools relies on education and ownership of monitoring, investigation and reporting processes.

Getting to a culture of safety

Many aspects of healthcare operations create a culture of safety that can be audited. A systematic and disciplined approach can help organizations accomplish their safety goals through a comprehensive review of patient safety risks, developing management action plans and monitoring the effectiveness of improvement efforts.

Patient safety is both a goal and a journey that is well worth the investment of time and resources.

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