McKesson : Six Patient Safety Lessons for Health Care Providers

Patient care is getting safer as providers across the country deploy a number of tactics to keep the patient safety arrow heading in the right direction.

For example, the number of hospital-acquired conditions (HACs) dropped to a rate of 115 per 1,000 discharges in 2015 from 121 per 1,000 discharges in 2013 and 2014, according to the latest available data from the Agency for Healthcare Research and Quality. The HAC rate was 145 per 1,000 discharges in 2010, when AHRQ began calculating the data. HACs include:

• Adverse drug events
• Catheter-associated urinary tract infections
• Central line-associated bloodstream infections
• Falls
• Obstetric adverse events
• Pressure ulcers
• Surgical site infections
• Ventilator-associated pneumonias
• Venous thromboembolisms

'We estimate that nearly 125,000 fewer patients died in the hospital as a result of HACs and that approximately $28 billion in health care costs were saved from 2010 to 2015 due to the reductions in HACs,' AHRQ said.

Whether the positive patient safety trend continues likely will depend on providers identifying new patient safety risks and taking the appropriate actions to mitigate those risks. Six recent studies and reports highlight some of those new risks and suggest ways to keep patients as safe as possible.

1. Good patient engagement has a major positive impact on quality of care

That's the majority opinion of 555 provider organization executives surveyed by NEJM Catalyst. In its survey, 59 percent of the executives said good patient engagement has a major impact on the quality of care with another 31 percent saying it had a moderate impact. That's a higher percentage than executives who said good patient engagement had a major or moderate impact on the cost of care or provider engagement.

The top tactic for embedding patient engagement in care delivery was the use of care teams exclusively devoted to complex patient cases, cited by 63 percent of the executives. That should work as long as the care teams avoid the communication pitfalls identified above.

2. Patient engagement can have a role in preventing surgical site infections

That's according to a study in the journal Antimicrobial Resistance and Infection Control. In the study, a panel of infection control experts made nine recommendations to encourage patients to be actively involved in preventing their own surgical site infections (SSIs) after medical procedures. Among them:

• Be screened and treated for antibiotic-resistant bacteria before surgery
• Quit smoking four weeks or longer before surgery
• Adhere to proper hand hygiene practices after surgery
• Follow proper wound care practices after surgery

'Patient engagement in preventing SSI might be an effective and useful strategy adding to the already existent surgical site care bundles,' the study concluded.

3. Improving communication among patient care teams impacts patient safety

A study by VitalSmarts, a leadership training company, identified five communication challenges among patient care teams that the firm described as 'pervasive and destructive.' The study, based on a survey of more than 1,200 doctors, nurses and other staff, cited the following behaviors as having a material impact on patient safety:

• Poor initiative
• Difficult peers
• Failure to hold others accountable
• Unresponsive physicians
• Managers who play favorites

'You can adhere to strict checklists, surgical pauses and other safety tools, but if people can't talk about behavioral lapses in how those tools are used, they lose their effectiveness,' the study said.

4. Greater use of technology can mitigate the 'weekend effect'

That's the lesson from a research letter than appeared in JAMA Surgery. Researchers studied the impact of specific health information technologies on the length of stay of patients who had three types of urgent or emergent general surgical procedures on weekends at hospitals in Florida in 2011. The procedures were to remove a gallbladder, remove an appendix or repair a hernia. Patients who did not experience the weekend effect were more likely treated at hospitals with:

• High-speed EHR connectivity
• Electronic operating room scheduling systems
• Computerized physician order entry systems
• Electronic bed management systems

'These data illustrate an important relationship that may exist between EHR systems and temporal care disparities in non-elective surgical settings' the researcher said.

5. Adjusting psychiatric medications could reduce fall risk for elderly patients

That's the takeaway from a study in the journal Social Science and Medicine. In the study, researchers looked at the connection between depressive symptoms in people over the age of 65 and their risk of falling. They found that even a moderate increase in depression was associated with a 30 percent increase in the chances of falling over the next two years. When the use of psychiatric medication decreased the symptoms of depression, the association with falling over went away.

'Many interventions to prevent falls are expensive and time-intensive, but this is a simple and inexpensive matter of encouraging continued use of psychiatric medication while improving monitoring of fall risk and adjusting medication appropriately,' the researchers said.

6. Properly cleaning floors in patient rooms can reduce source of infection-causing bacteria

If patients they touch the floor, they may pick up unwanted bacteria and an antibiotic-resistant infection. That's the lesson from a study in the American Journal of Infection Control. In the study, researchers answered their own question with a resounding yes. They tested two spots on the floors in each of 159 patient rooms at five hospitals in Cleveland.

The researchers found that the floors in the rooms frequently were contaminated with Clostridium difficile, methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. They also found that high-touch items like medical devices, personal belongings and linens often were in direct contact with the floors, providing a method of transferring the bacteria to the patient.

'It would be reasonable to educate health care personnel and patients that they should avoid placing high-touch objects on the floor when possible,' the researchers said.

Whether it's improved communication, engagement, technology, medication adherence or cleanliness, providers have a number of new paths to follow to make care safer for patients.

Related: Learn about McKesson's patient and clinical care solutions