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Issues Addressed: Diabetes Mellitus & Dining Out, Breastfeeding, Environmentally Sensitive Nursing, BC Lifestyle Guide, Lewin, Burnout, Child Malnutrition in Malawi, Injection Drugs, Childhood Obesity, Nursing Image, New Immigrants, Eating Disorders, Art of Nursing, Child Health, Schizophrenia, Body Image. Issues Addressed: Assault, Orientations, Goddess Power, Anti-Smoking, Healthy Living, Childhood Obesity, Child & Maternal Mortality, Marijuana, Superbugs, KNS Club, Nursing Shortage, Child Safety, Perinatal Drug Use, Alcoholism, Education $$, Nursing History, Asthma, Drinking and Driving, Antibiotic Resistance.
Issues Addressed: Aboriginal Awareness & FASD, Breastfeeding & Work, Childhood Obesity, Healthy Children, Communication with Older Adults, Children & Sports, Harm Reduction and IV Drug Abuse, Stop Violence & Women, SMH ER Rap, Circadian Rhythms & Shiftwork, Complementary Therapies. Issues Addressed: Media Images of Women, Nurse Handover, Nurse Doctor Relationships, High Risk Pregnancy, Hospital Recycling, Online Learning, Violence & Video Games, Childhood Obesity, Smoking, Breast Cancer, Male Nurses, Ecology, Burnout, Nursing Shortage, Nursing Turnover, Drug Use in Patients, Restraints, Organic Food.
Issues Addressed: Tobacco Cessation & Hospitalization, Eating Disorders, Men in Nursing, Environmental Sustainability, Burnout, Gender Inequality, Crisis Prevention, Anti-Smoking, Breastfeeding, Aggression, Mental Illness Stigma, Stop Recreational Marijuana Use, Medication Errors. Some reports estimate 200,000 patient deaths per year as a result of medication errors in hospitals alone. By sharing your story, you will contribute to making healthcare processes safer by increasing awareness of common medical errors.
Patient safety is a new healthcare discipline that emphasizes the preventing, reducing, reporting and analysis of medical error that often leads to adverse healthcare events. Millennia ago, Hippocrates recognized the potential for injuries that arise from the well-intentioned actions of healers. The Department of Health Expert Group in June 2000 estimated that over 850,000 incidents harm National Health Service hospital patients in the United Kingdom each year.
The use of effective communication among patients and healthcare professionals is critical for achieving a patient's optimal health outcome. Methods of effective verbal and nonverbal communication include treating patients with respect and showing empathy, clearly communicating with patients in a way that best fits their needs, practicing active listening skills, being sensitive with regards to cultural diversity and respecting the privacy and confidentiality rights of the patient.[23] To use appropriate communication technology, healthcare professionals must choose which channel of communication is best suited to benefit the patient. The goal of a healthcare professional is to aid a patient in achieving their optimal health outcome, which entails that the patient's safety is not at risk.
As is the case in other industries, when there is a mistake or error made people look for someone to blame. In health care, there is a move towards a patient safety culture.[25] This applies the lessons learned from other industries, such as aviation, marine, and industrial, to a health care setting.
When assessing and analyzing an incident, individuals involved are much more likely to be forthcoming with their own mistakes if they know that their job is not at risk.[26] This allows a much more complete and clear picture to be formed of the facts of an event.
The disclosure of adverse events is important in maintaining trust in the relationship between healthcare provider and patient. The simplest definition of a health care error is a preventable adverse effect of care, whether or not it is evident or harmful to the patient. The Joint Commission's Annual Report on Quality and Safety 2007 found that inadequate communication between healthcare providers, or between providers and the patient and family members, was the root cause of over half the serious adverse events in accredited hospitals.[48] Other leading causes included inadequate assessment of the patient's condition, and poor leadership or training. In the United States, two organizations contribute to one of the world's lowest aviation accident rates.[51] Mandatory accident investigation is carried out by the National Transportation Safety Board, while the Aviation Safety Reporting System receives voluntary reports to identify deficiencies and provide data for planning improvements. A near miss is an unplanned event that did not result in injury, illness, or damage - but had the potential to do so. These systems' basic security measures are based on sound identifying electronic tags, in order that the patient details provided in different situations are always reliable.
Any of these options may be applied whenever and wherever patient details are required in electronic form Such identifying is essential when the information concerned is critical.
Prescribing errors are the largest identified source of preventable errors in hospitals (IOM, 2000; 2007). Technology induced errors are significant and increasingly more evident in care delivery systems.[74] This idiosyncratic and potentially serious problems associated with HIT implementation has recently become a tangible concern for healthcare and information technology professionals. Shortcut or default selections can override non-standard medication regimens for elderly or underweight patients, resulting in toxic doses.
Solutions include ongoing changes in design to cope with unique medical settings, supervising overrides from automatic systems, and training (and re-training) all users. Evidence-based medicine integrates an individual doctor's exam and diagnostic skills for a specific patient, with the best available evidence from medical research.
Evidence-based medicine may reduce adverse events, especially those involving incorrect diagnosis, outdated or risky tests or procedures, or medication overuse. Clinical guidelines provide a common framework for improving communication among clinicians, patients and non-medical purchasers of health care. Errors related to changing shifts or multiple specialists are reduced by a consistent plan of care. Information on the clinical effectiveness of treatments and services can help providers, consumers and purchasers of health care make better use of limited resources. As medical advances become available, doctors and nurses can keep up with new tests and treatments as guidelines are improved. Managed care plans may attempt limit "unnecessary" services to cut the costs of health care, despite evidence that guidelines are not designed for general screening, rather as decision-making tools when an individual practitioner evaluates a specific patient. The medical literature is evolving and often controversial; development of guidelines requires consensus. Implementing guidelines and educating the entire health care team within a facility costs time and resources (which may be recovered by future efficiency and error reduction).
Clinicians may resist evidence-based medicine as a threat to traditional relationships between patients, doctors and other health professionals, since any participant can influence decisions. Failing to follow guidelines might increase the risk of liability or disciplinary action by regulators.
Community pharmacy practice is making important advances in the quality and safety movement despite the limited number of federal and state regulations that exist and in the absence of national accreditation organizations such as the Joint Commission - a driving force for performance improvement in health care systems. Quality improvement and patient safety is a major concern in the pediatric world of health care.
Over the last several years, pediatric groups have partnered to improve general understanding, reporting, process improvement methodologies, and quality of pediatric inpatient care. In order to reduce these errors the attention on safety needs to revolve around designing safe systems and processes. Development: As children mature both cognitively and physically, their needs as consumers of health care goods and services change. Different epidemiology: Most hospitalized children require acute episodic care, not care for chronic conditions as with adult patients.


Demographics: Children are more likely than other groups to live in poverty and experience racial and ethnic disparities in health care.
One of the main challenges faced by pediatric safety and quality efforts is that most of the work on patient safety to date has focused on adult patients. The Agency for Healthcare Research and Quality (AHRQ) is the Federal authority for patient safety and quality of care and has been a leader in pediatric quality and safety. Possible additions to the dataset will address the patient’s condition on admission and increase the understanding of how laboratory and pharmacy utilization impact patient outcomes. While the number of nurses providing patient care is recognized as an inadequate measure of nursing care quality, there is hard evidence that nurse staffing is directly related to patient outcomes.
Scalable: The indicators are applicable to pediatric patients across a broad range of units and hospitals, in both intensive care and general care settings. Feasible: Data collection does not pose undue burden on staff of participating units as the data is available from existing sources, such as the medical record or a quality improvement database, and can be collected in real time.
Valid and reliable: Indicator measurement within and across participating sites is accurate and consistent over time. Pediatric care is complex due to developmental and dependency issues associated with children. A recent increase in work hours and overtime shifts of nurses has been used to compensate for the decrease of registered nurses (RNs).
In the United Kingdom, the National Health Service (NHS) began an ambitious pay for performance initiative in 2004, known as the Quality and Outcomes Framework (QOF).[116] General practitioners agreed to increases in existing income according to performance with respect to 146 quality indicators covering clinical care for 10 chronic diseases, organization of care, and patient experience. A component of this program, known as exception reporting, allows physicians to use criteria to exclude individual patients from the quality calculations that determine physician reimbursement. Payments for better care coordination between home, hospital and offices for patients with chronic illnesses. A set of 10 hospital quality measures which, if reported to CMS, will increase the payments that hospitals receive for each discharge.
Rewards to physicians for improving health outcomes by the use of health information technology in the care of chronically ill Medicare patients. Pay for performance programs often target patients with serious and complex illnesses; such patients commonly interact with multiple healthcare providers and facilities. The Center for Medicare & Medicaid Services (CMS) no longer pay for hospital and caregiver errors, which is has in turn prompted hospitals to focus on patient safety.
The frequency and magnitude of avoidable adverse patient events was not well known until the 1990s, when multiple countries reported staggering numbers of patients harmed and killed by medical errors.
Greek healers in the 4th century BC drafted the Hippocratic Oath and pledged to "prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone."[3] Since then, the directive primum non nocere (“first do no harm) has become a central tenet for contemporary medicine.
The majority of media attention, however, focused on the staggering statistics: from 44,000 to 98,000 preventable deaths annually due to medical error in hospitals, 7,000 preventable deaths related to medication errors alone. Communicating starts with the provisioning of available information on any operational site especially in mobile professional services.
Some channels are more likely to result in communication errors than others, such as communicating through telephone or email (missing nonverbal messages which are an important element of understanding the situation). Healthcare providers meet to discuss a situation, record what they learned and discuss how it might be better handled. This may seem natural, but it creates a blame culture where who is more important than why or how. It is also important in learning how to avoid these mistakes in the future by conducting quality improvement reviews, or clinical peer review. According to the WHO, 50% of medical equipment in developing countries is only partly usable due to lack of skilled operators or parts. The latter system is confidential and provides reports back to stakeholders without regulatory action.
Reporting of near misses by observers is an established error reduction technique in aviation,[54] and has been extended to private industry, traffic safety and fire-rescue services with reductions in accidents and injury.[57] AORN, a US-based professional organization of perioperative registered nurses, has put in effect a voluntary near miss reporting system (SafetyNet[58]), covering medication or transfusion reactions, communication or consent issues, wrong patient or procedures, communication breakdown or technology malfunctions.
It may not be possible to attain maximum safety goals in healthcare without adversely affecting patient care in other ways. An automatic identification check is carried out on each person with tags (primarily patients) entering the area to determine the presented patient in contrast to other patient earlier entered into reach of the used reader. As such, the term technological iatrogenesis describes this new category of adverse events that are an emergent property resulting from technological innovation creating system and microsystem disturbances.[75] Healthcare systems are complex and adaptive, meaning there are many networks and connections working simultaneously to produce certain outcomes. The doctor's expertise includes both diagnostic skills and consideration of individual patient's rights and preferences in making decisions about his or her care. Community pharmacies are using automated drug dispensing devices (robots), computerized drug utilization review tools, and most recently, the ability to receive electronic prescriptions from prescribers to decrease the risk for error and increase the likelihood of delivering high quality of care. As of 2006[update], only 16 states have some form of legislation that regulates QA in community pharmacy practice. This next section will focus on quality improvement and patient safety initiatives in inpatient settings. Slonim and Pollack point out that safety is critical to reduce medical errors and adverse events. Therefore, planning a unified approach to pediatric safety and quality is affected by the fluid nature of childhood development. Even when children can accurately express their needs, they are unlikely to receive the same acknowledgment accorded adult patients. Planning safety and quality initiatives within a framework of "wellness, interrupted by acute conditions or exacerbations," presents distinct challenges and requires a new way of thinking. Children are more dependent on public insurance, such as State Children’s Health Insurance Program (SCHIP) and Medicaid. In addition, there is no standard nomenclature for pediatric patient safety that is widely used.
How these factors impact the specific processes of care is an area of science in which little is known. Logbooks completed by nearly 400 RNs have revealed that about "40 percent of the 5,317 work shifts they logged exceeded twelve hours."[100] Errors by hospital staff nurses are more likely to occur when work shifts extend beyond 12 hours, or they work over 40 hours in one week. A study of 2,600 patients at two hospitals determined that between 26-60% of patients could not understand medication directions, a standard informed consent, or basic health care materials.[106] This mismatch between a clinician's level of communication and a patient's ability to understand can lead to medication errors and adverse outcomes.


Unlike proposed quality incentive programs in the United States, funding for primary care was increased 20% over previous levels.
There was initial concern that exception reporting would allow inappropriate exclusion of patients in whom targets were missed ("gaming").
In April 2005, CMS launched its first value-based purchasing pilot or "demonstration" project- the three-year Medicare Physician Group Practice (PGP) Demonstration.[126] The project involves ten large, multi-specialty physician practices caring for more than 200,000 Medicare fee-for-service beneficiaries.
By the third year of the demonstration, those hospitals that do not meet a threshold on quality will be subject to reductions in payment.
Furthermore, the CDC does not cover costs of certain hospital acquired diagnosis which has saved taxpayers millions of dollars and has forced hospitals to enhance their preventable measure initiatives. Recognizing that healthcare errors impact 1 in every 10 patients around the world, the World Health Organization calls patient safety an endemic concern.[1] Indeed, patient safety has emerged as a distinct healthcare discipline supported by an immature yet developing scientific framework. Within 2 weeks of the report's release, Congress began hearings and President Clinton ordered a government-wide study of the feasibility of implementing the report's recommendations.[12] Initial criticisms of the methodology in the IOM estimates[13] focused on the statistical methods of amplifying low numbers of incidents in the pilot studies to the general population. Communicating continues with the reduction of administrative burden, releasing the operating staff and easing the operational demand by model driven orders, thus enabling adherence to a well executable procedure finalised with a qualified minimum of required feedback.
Use of effective communication can aid in the prevention of adverse events, whereas ineffective communication can contribute to these incidences. It is also the responsibility of the provider to know the advantages and limitations of using electronic health records, as they do not convey all information necessary to understanding patient needs.
Any team should have a clear purpose and each member should be aware of their role and be involved accordingly.[23] To increase the quality of communication between people involved, regular feedback should be provided. Closed loop communication is another important technique used to ensure that the message that was sent is received and interpreted by the receiver. There are often multiple causative factors involved in an adverse or near miss event.[27] It is only after all contributing factors have been identified that effective changes can be made that will prevent a similar incident from occurring. A quality improvement review is an evaluation that is completed after an adverse event occurs with the intention to both fix the problem, as well as preventing it from happening again.[28] The individual provinces and territories have laws on whether it is required to disclose the quality improvement review to the patient.
An example is blood transfusion; in recent years, to reduce the risk of transmissible infection in the blood supply, donors with only a small probability of infection have been excluded. However, hospitals pay in both higher costs for implementation and potentially lower revenues (depending on reimbursement scheme) due to reduced patient length of stay.
When these systems are under the increased stresses caused by the diffusion of new technology, unfamiliar and new process errors often result. The clinician uses pertinent clinical research on the accuracy of diagnostic tests and the efficacy and safety of therapy, rehabilitation, and prevention to develop an individual plan of care.[78] The development of evidence-based recommendations for specific medical conditions, termed clinical practice guidelines or "best practices", has accelerated in the past few years. In addition, because children are dependent on their caregivers, their care must be approved by parents or surrogates during all encounters.
However, a standard framework for classifying pediatric adverse events that offers flexibility has been introduced.[94] Standardization provides consistency between interdisciplinary teams and can facilitate multisite studies.
Thirteen inpatient indicators are recommended for use at the hospital level, and five are designated area indicators. These two indicators of pediatric nursing care quality are sensitive measures of nursing care. Throughout health care providing safe and high quality patient care continues to provide significant challenges.
This allowed practices to invest in extra staff and technology; 90% of general practitioners use the NHS Electronic Prescription Service[citation needed], and up to 50% use electronic health records for the majority of clinical care[citation needed]. Participating practices will phase in quality standards for preventive care and the management of common chronic illnesses such as diabetes. Both organizations were soon expanded as the magnitude of the medical error crisis became known.
However, subsequent reports emphasized the striking prevalence and consequences of medical error.
If ineffective communication contributes to an adverse event, then better and more effective communication skills must be applied in response to achieve optimal outcomes for the patient's safety. AlmostME[59] is another commercially offered solution for near-miss reporting in healthcare.
Also, these systems provide recurring alerts to remind clinicians of intervals for preventive care and to track referrals and test results. If not recognized, over time these new errors can collectively lead to catastrophic system failures.
Professional nurses play a key role in successful pain management, especially among pediatric patients unable to verbally describe pain. Efforts to improve the safety and quality of care are resource intensive and take continued commitment not only by those who deliver care, but also by agencies and foundations that fund this work.
Working back to back shifts, or night shifts, are a common cause of fatigue in hospital staff nurses.
Early analysis showed that substantially increasing physicians' pay based on their success in meeting quality performance measures is successful. Practices meeting these standards will be eligible for rewards from savings due to resulting improvements in patient management. Arnold Epstein of the Harvard School of Public Health commented in an accompanying editorial that pay-for-performance "is fundamentally a social experiment likely to have only modest incremental value."[129] Unintended consequences of some publicly reported hospital quality measures have adversely affected patient care. Many of the tenets of this training have been incorporated into medicine under the guise of Team Stepps, which was introduced by the Agency for Healthcare Research and Quality (AHRQ). Clinical guidelines for disease management have a demonstrated benefit when accessible within the electronic record during the process of treating the patient.[65] Advances in health informatics and widespread adoption of interoperable electronic health records promise access to a patient's records at any health care site. Astute assessment skills are required to intervene successfully and relieve discomfort.33 Maintenance of a patient’s intravenous access is a clear nursing responsibility. Advocates for children’s health care must be at the table when key policy and regulatory issues are discussed. Still, there may be a weak link because of physicians' deficiencies in understanding the patient safety features of e.g.



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