Efficacy of clinical laboratory: Therapeutic TAT,safety, and medical errors

Health care services rely on continued technological advances and management of the operational systems for optimum reduction of medical errors. Significant gains in health care outcomes as indicated by recorded increases in life expectancies have been achieved due to the availability and application of technological advances for medical services. The inadequacies in the application of these systems for maximum benefit of the health care systems have however been the subject of recent publications dealing with patient safety and medical errors [1], [2], [3], [4]. Estimates by the Institute of Medicine (IOM) indicate that approximately 44,000–98,000 deaths occur each year as a consequence of inadequate safety and failure to prevent errors in the health care system. This puts medical errors in the top four leading causes of deaths per the IOM report. Other studies in the USA states of Colorado, Utah, and New York suggest that medical errors occur in 2–4% of hospitalizations. The paper by Raab et al. denoted a 6.7% discrepancy between original report and secondary case review, and 5% of the discrepancies have modest to significant effect on patient care [Raab SS, Grzybicki DM, Zarbo RJ, Meier FA, Geyer SJ, Jensen C. Anatomic pathology databases and patient safety. Arch Pathol Lab Med 2005;129:459–66]. This presentation focuses on the health care safety and medical errors relative to clinical laboratory. The impact of laboratory operations with resultant delays in test turn around times (TAT) and other laboratory errors on the health care services are presented. The role of governmental (US Department of Health and Human Services) and non-governmental regulatory agencies (CAP, AACC, IFCC, CLSI, etc) in mitigating these clinical laboratory errors is discussed. The use of payment system as a mechanism for improving the quality of laboratory services is also presented to illustrate the checks and balance systems aimed at reduction of medical errors. The presentation will conclude with the recommendation that majority of the clinical laboratory delays in turn around time and other errors can be prevented with appropriate analytical systems and operational processes under the overall guidance of the right regulatory agencies.     

The Ascension Health Experience: Maximizing the Chief Nursing Officer Role in a Large, Multihospital System to Advance Patient Care Quality and Safety

Ascension Health is the largest Catholic and nonprofit health system in the United States, encompassing 70 acute care hospitals organized into 34 health ministries. Consistent with its distributed leadership model, Ascension Health has created a Chief Nursing Officer (CNO) Advisory Council to provide strategic direction and thought leadership on major system-level initiatives that impact quality, safety, operational performance, nursing leadership, and patient care delivery. The council fosters systemwide CNO engagement and dialogue through a unique structure of regional CNO work teams called "pods," each of which is chaired by a member of the council. This communication structure has facilitated consensus on major system initiatives at Ascension Health related to clinical goals, patient safety, nursing leadership, and systemwide capital investments. This article describes the history, structure, goals, processes, and successes of the CNO Advisory Council shared governance model.     

The American Organization of Nurse Executives System CNE Task Force: A Work in Progress

Health care is a complex industry, consequently requiring a diverse group of health care executives leading initiatives for efficiency and effectiveness in patient care delivery. Value-based purchasing and pay for performance are at the top of the list for indicators of success, and many hospitals are merging into health care systems. The role of the system chief nurse executive is an evolving role to lead health care systems in clinical, operational, patient safety, and patient satisfaction processes and outcomes. The American Organization of Nurse Executives, being the voice for nursing leadership, convened a group of system chief nurse executives to address the role, function, and competencies needed for this significant and emerging role in health care. This article describes the role statement and system chief nurse executive competencies needed for success in the role. In addition, the next steps for addressing the needs of this group will be outlined in this article.     

Simulation-based learning for patient safety: The development of the Tag Team Patient Safety Simulation methodology for nursing education

BackgroundSince the ground-breaking report ‘To Err is Human: Building a Safer Health Care System’ was published nearly two decades ago, patient safety has become an international healthcare priority. Universities are charged with the responsibility of preparing the future nursing workforce to practise in accordance with relevant patient safety standards. Consequently, simulation-based learning is increasingly used for developing the technical and non-technical skills graduates require to provide safe patient care.AimTag Team Patient Safety Simulation is a pragmatic group-based approach that enhances nursing students’ knowledge and skills in the provision of safe patient care. The aim of this paper is to describe the Tag Team Patient Safety Simulation methodology and illustrate its key features with reference to a medication safety scenario.MethodsInformed by the National Safety and Quality Health Service Standards and the Patient Safety Competency Framework for Nursing Students, Tag Team Patient Safety Simulation methodology actively engage large numbers of nursing students in critical conversations around every day clinical encounters which can compromise patient safety.ConclusionTag Team Patient Safety Simulation is a novel simulation methodology that enhances nursing students’ skills and knowledge, fosters critical conversations, and has the potential to enhance students’ resilience and capacity to speak up for safe patient care.     

Patient Safety: A Curriculum for Teaching Patient Safety in Emergency Medicine

The last decade has witnessed a growing awareness of medical error and the inadequacies of our health care delivery systems. The Harvard Practice Study and subsequent Institute of Medicine Reports brought national attention to long-overlooked problems with health care quality and patient safety. The Committee on Quality of Health Care in America challenged professional societies to develop curriculums on patient safety and adopt patient safety teaching into their training and certification requirements. The Patient Safety Task Force of the Society for Academic Emergency Medicine (SAEM) was charged with that mission. The curriculum presented here offers an approach to teaching patient safety in emergency medicine.     

High reliability and implications for nursing leaders

Aim  To review high reliability theory and discuss its implications for the nursing leader.
Background  A high reliability organization (HRO) is considered that which has measurable near perfect performance for quality and safety.
Evaluation  The author has reviewed the literature, discussed research findings that contribute to improving reliability in health care organizations, and makes five recommendations for how nursing leaders can create high reliability organizations.
Key issues  Health care is not a safe industry and unintended patient harm occurs at epidemic levels. Health care can learn from high reliability theory and practice developed in other high-risk industries.
Conclusions  Viewed by HRO standards, unintended patient injury in health care is excessively high and quality is distressingly low. HRO theory and practice can be successfully applied in health care using advanced interdisciplinary teamwork training and deliberate process design techniques.
Implications for nursing management  Nursing has a primary leadership function for ensuring patient safety and achieving high quality in health care organizations. Learning HRO theory and methods for achieving high reliability is a foremost opportunity for nursing leaders.     

Health information technology and nursing

OVERVIEW: Health information technology (HIT) is a central aspect of current U.S. government efforts to reduce costs and improve the efficiency and safety of the health care system. A federal push to implement and enhance electronic health records (EHRs) has been supported by billions of dollars earmarked in the Health Information Technology for Economic and Clinical Health Act, passed as part of the 2009 American Recovery and Reinvestment Act. The goal has been to lay the groundwork for a HIT system that enables a more reliable exchange of information among practitioners and patients and significant improvements in the way care is delivered.But what does this really mean for nurses? This article is the first in a series on HIT and nursing and will examine the federal policies behind efforts to expand the use of this technology as well as the implications for nurses. Subsequent articles will take a closer look at the use of EHRs to improve patient safety and quality of care, and the important role nurses are playing-and could play-in this system-wide initiative.     

The environmental impact of health care: implications for infusion nursing

Health care provision is a dangerous business. Health professionals recognize the potential for miscommunication, medication errors, and other possible threats to patient safety. Less evident are the hazards to the environment inherent in the everyday practice of patient care. This article addresses 3 areas of practice in which infusion nurses can make a positive impact on the environment: preferable intravenous (IV) supply purchasing, proper management of electronic equipment (including purchasing, servicing, and disposal), and appropriate medication use and disposal practices. The article aims to inform IV nurses of the alarming environmental effects that the health care industry has on the environment and to suggest a clear, direct course of action to improve our environmental impact.     

Patient Participation: Current Knowledge and Applicability to Patient Safety

Patient participation is increasingly recognized as a key component in the redesign of health care processes and is advocated as a means to improve patient safety. The concept has been successfully applied to various areas of patient care, such as decision making and the management of chronic diseases. We review the origins of patient participation, discuss the published evidence on its efficacy, and summarize the factors influencing its implementation. Patient-related factors, such as acceptance of the new patient role, lack of medical knowledge, lack of confidence, comorbidity, and various sociodemographic parameters, all affect willingness to participate in the health care process. Among health care workers, the acceptance and promotion of patient participation are influenced by other issues, including the desire to maintain control, lack of time, personal beliefs, type of illness, and training in patient-caregiver relationships. Social status, specialty, ethnic origin, and the stakes involved also influence patient and health care worker acceptance. The London Declaration, endorsed by the World Health Organization World Alliance for Patient Safety, calls for a greater role for patients to improve the safety of health care worldwide. Patient participation in hand hygiene promotion among staff to prevent health care—associated infection is discussed as an illustrative example. A conceptual model including key factors that influence participation and invite patients to contribute to error prevention is proposed. Further research is essential to establish key determinants for the success of patient participation in reducing medical errors and in improving patient safety.Patient participation is a complex concept and arises from the widespread consumer movement of the 1960s that affirmed the consumer''s right to safety, the right to be informed, the right to choose, and the right to be heard.¹ During the past few years, patient participation has been increasingly recognized as a key component in the redesign of health care processes and successfully applied to some aspects of patient care, notably the decision-making process and the treatment of chronic illness. Recently, increasing patient participation has been recommended to improve patient safety. The World Health Organization (WHO) World Alliance for Patient Safety is actively highlighting the role that patients and their families could play in the improvement of health care.² However, this field of patient participation has not been widely researched thus far.We review the underlying principles and the efficacy of patient participation in decision making and self-treatment of chronic illness, as well as the potential obstacles to implementation. Building on these principles, we develop a conceptual framework for patient participation. Finally, we suggest that patient participation could be useful to improve quality of care and prevent medical errors and propose an agenda for research.     

Transitioning the older adult in the ambulatory care setting

Transitions between care settings are periods of vulnerability for patients. This is especially true for older adults, for whom comorbidities and functional impairments can increase the complexity of care and the need for multiple caregivers can compromise safety. Poor care transitions can result in costly hospital admissions. For this reason, leading health care organizations have initiated programs to improve the quality of transitions; however, to date, the ambulatory surgical setting has not been a focus of these initiatives. The ambulatory setting serves an increasingly complex patient population and provides the majority of elective surgeries, and adapting some of the transition tools that have been tested in other settings will benefit health care providers and patients in the ambulatory setting. Identifying periods of transition and risk, implementing electronic health records across all phases of patient care, and using evidence-based tools at each transitional stage can optimize the quality and safety of patient care.     

Patient safety and quality of care: the role of the health care assistant

The role of the Health Care Assistant emerged primarily to support the professional nurse and to undertake perceived 'non-nursing' duties under the direction and supervision of qualified nurses. Health Care Assistants are employed in a variety of clinical settings and carry out a range of tasks and procedures. While they represent a substantial proportion of the health care workforce, the growth of their role has taken place without regulation, clear boundaries, or systematic education and training. This has raised serious concerns, especially with regard to the issues of patient safety and quality of care. For health professionals, regulations, role clarity and validated education and training are key elements of ensuring the safety of the public. This paper explores these issues with regard to the Health Care Assistant role and finds them wanting.     

Special considerations for the geriatric population

Health care providers can be the eyes and ears of patient safety when it comes to medication administration. Simply asking questions about the medication and dose can avert a drug-drug interaction or save the patient's life. When caring for the older adult, question if the drug is right for this patient; if the dose is correct or if it has been adjusted to start at a lower dose; if the patient has renal or kidney dysfunctions that may further affect dosing; and if the patient has been thoroughly assessed for swallowing, cognitive, and physical disorders [22]. Remember that confusion may be an early sign of an adverse drug event. Health care providers can be the first line of defense in reducing adverse medication events in the older adult.     

Advancing interprofessional patient safety education for medical,nursing, and pharmacy learners during clinical rotations

Clinical errors are common and can lead to adverse events and patient death. Health professionals must work within interprofessional teams to provide safe and effective care to patients, yet current curricula is lacking with regards to interprofessional education and patient safety. We describe the development and implementation of an interprofessional course aimed at medical, nursing, and pharmacy learners during their clinical training at a large academic medical centre. The course objectives were based on core competencies for interprofessional education and patient safety. The course was offered as recurring three 1-hour sessions, including case-based discussions and a mock root cause analysis. Forty-three students attended at least one session over a 7-month period. We performed a cross-sectional survey of participants to assess readiness for interprofessional learning and a before and after comparison of patient safety knowledge. All students reported a high level of readiness for interprofessional learning, indicating an interest in interprofessional opportunities. In general, understanding and knowledge of the four competency domains in patient safety was low before the course and 100% of students reported an increase in knowledge in these domains after participating in the course.     

Patient trust and patient safety for low-priority patients: A randomized controlled trial pilot study in the prehospital chain of care

BackgroundPatients who call for an ambulance but only have primary care needs do not always get appropriate care. The starting point in this study is that such patients should be assigned to as basic of care as possible, while maintaining high levels of patient trust and patient safety.AimTo evaluate patient trust and patient safety among low-priority ambulance patients referred to care at either the Community Health Centre (CHC) or the Emergency Department (ED).MethodsThis randomized controlled trial pilot study compared the level of patient trust and patient safety among low-priority ambulance patients who were randomized into two groups: CHC (n = 105) or ED (n = 83).ResultsThere was a high level of trust in the care received, regardless of whether the patient received care at CHC or ED. Overall 31% fulfilled one or more of the given criteria for potentially jeopardizing patient safety.ConclusionPatient selection for the trial indicated a potential limit in patient safety. There was a high level of trust in the care received regardless of whether the patient received care. The accuracy of patient selection for the new care model needs to be further improved with the intention to enhance patient safety even further.     

Four elements of a successful quality program. Alignment, collaboration, evidence-based practice, and excellence

The nurse's role in quality improvement and assurance is well established, but this is particularly true as hospitals engage in a culture of patient safety and view quality-related activities as important "safety checks." The role of the nurse in ensuring quality related to patient care and safety cannot be overstated. The achievement of quality and safety in patient care is the result of caregivers doing the right thing the right way the first time. Nurses serve as a critical link to the best quality health care organizations have to offer. This article describes four elements of a successful quality program in a large tertiary health care setting (alignment, collaboration, evidence-based practice, and excellence) and makes the connection between quality and safety in the provision of exemplary patient care. Three examples are provided that show how nurses and other members of the health care team grouped together as a governing council for quality (Performance Improvement Council) and at the bedside as direct caregivers in ensuring patient safety and quality patient care.     

Barriers to the implementation of patient safety initiatives

Since release of the Institute of Medicine Report "To Err is Human:Building a Safer Health System" in 1999, a huge effort has been expended on error-related clinically applied research and on the implementation of new standards and practices related to quality improvement and patient safety. Nonetheless, measurable improvements in the quality of delivered care and reductions in medical errors have been variable and modest in most cases. Multiple barriers to the implementation of patient safety and error reduction initiatives have been identified in the literature. The greater part of this article is devoted to three fundamental barriers: physicians' intolerance for uncertainty, health professionals' fears, and an organizational structure and culture that are incongruent with increasing patient safety.     

Patient identification: the foundation for a culture of patient safety

Patients, consumer advocacy groups, and regulatory and accrediting bodies have spoken out about the importance of patient safety in the health care environment. Understandably, patient safety is a leading concern for both consumers and health care providers. These efforts have encouraged health care organizations and providers to review and revise, as necessary, routine practices that contribute to a culture of patient safety and avoid medical errors. This article outlines the process and outcome of a performance improvement initiative to develop a standard patient identification policy.     

Strategies for Enhancing Perioperative Safety: Promoting Joy and Meaning in the Workforce

Workforce safety is a precondition of patient safety, and safety from both physical and psychological harm in the workplace is the foundation for an environment in which joy and meaning can exist. Achieving joy and meaning in the workplace allows health care workers to continuously improve the care they provide. This requires an environment in which disrespectful and harmful behaviors are not tolerated or ignored. Health care leaders have an obligation to create workplace cultures that are characterized by respect, transparency, accountability, learning, and quality care. Evidence suggests, however, that health care settings are rife with disrespectful behavior, poor teamwork, and unsafe working conditions. Solutions for addressing workplace safety problems include defining core values, tasking leaders to act as role models, and committing to becoming a high-reliability organization.     

Patient satisfaction with nursing care: a concept analysis within a nursing framework

Title.  Patient satisfaction with nursing care: a concept analysis within a nursing framework.
Background.  Patient satisfaction is an important indicator of quality of care, and healthcare facilities are interested in maintaining high levels of satisfaction in order to stay competitive in the healthcare market. Nursing care has a prominent role in patient satisfaction. Using a nursing model to measure patient satisfaction with nursing care helps define and clarify this concept.
Data sources.  Rodgers' evolutionary method of concept analysis provided the framework for this analysis. Data were retrieved from the Cumulative Index of Nursing and Allied Health Literature and MEDLINE databases and the ABI/INFORM global business database. The literature search used the keywords patient satisfaction, nursing care and hospital. The sample included 44 papers published in English, between 1998 and 2007.
Results.  Cox's Interaction Model of Client Health Behavior was used to analyse the concept of patient satisfaction with nursing care. The attributes leading to the health outcome of patient satisfaction with nursing care were categorized as affective support, health information, decisional control and professional/technical competencies. Antecedents embodied the uniqueness of the patient in terms of demographic data, social influence, previous healthcare experiences, environmental resources, intrinsic motivation, cognitive appraisal and affective response. Consequences of achieving patient satisfaction with nursing care included greater market share of healthcare finances, compliance with healthcare regimens and better health outcomes.
Conclusion.  The meaning of patient satisfaction continues to evolve. Using a nursing model to measure patient satisfaction with nursing care delineates the concept from other measures of patient satisfaction.