Babithas Notes on unit-5 Health/Nursing Informatics Technology
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The document discusses patient safety in healthcare. It provides definitions of patient safety and discusses some key facts: - An estimated 134 million adverse events worldwide result in 2.6 million deaths annually, especially in low- and middle-income countries. Medical errors are among the most common adverse events. - Investments in patient safety can improve outcomes and save costs by preventing unnecessary harm and treatment expenditures. - Common adverse events include medication errors, healthcare-associated infections, surgical complications, diagnostic errors, and radiation errors. - Patient safety is enhanced through risk management, which identifies risks, analyzes their causes and impacts, evaluates their severity, and develops treatment plans to control, transfer, or avoid risks.
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Risk Management Process
3. Analyze Risks: contd.
• Risk Score (R) = Likelihood (L) x Severity Impact (S)
• Likelihood assessment (L) [5] Likelihood scoring is based on the expertise,
knowledge and actual experience of the group scoring the likelihood. In
assessing likelihood, it is important to consider the nature of the risk.
• Severity of impact indicates the impact of harm to service users, employees,
service provision, environment or the organization. The scoring ranges from 1
(Negligible impact) to 5 (Extreme impact).](https://image.slidesharecdn.com/unit5-231215115616-3892397b/85/Babithas-Notes-on-unit-5-Health-Nursing-Informatics-Technology-22-320.jpg)
Babithas Notes on unit-5 Health/Nursing Informatics Technology
- 1. Patient Safety & Clinical Risk Babitha K Devu, RN, RM, M.Sc (N), MBA Assistant Professor, SMVD College of Nursing, J & K Research Scholar, Ph.D (N), Amity University, Gurugram
- 2. 2 Patient Safety in the World • “First, do no harm,” the principle of non-maleficence, is the fundamental principle to ensuring safety and quality of care. • Patient safety is defined as the prevention of errors and adverse effects associated with healthcare. • Available evidence suggests hospitalizations in low- and middle-income countries lead annually to 134 million adverse events, contributing to 2.6 million deaths. • About 134 million adverse events worldwide give rise to 2.6 million deaths every year. • Estimates indicate that in high-income countries, about 1 in 10 patients is harmed while receiving hospital care. • Many medical practices and care-associated risks are becoming major challenges for patient safety and contribute significantly to the burden of harm due to unsafe care.
- 3. 3 Patient Safety in the World • The Organisation of Economic Co-operation and Development (OECD) has estimated that adverse events engender 15% of hospital expenditures and activities. • For all these reasons, investments in patient safety are necessary to improve patient outcomes and to obtain financial savings which could be reinvested in healthcare. • Prevention expenditures are lower than treatment ones and they add important value to the national healthcare systems.
- 4. 4 Most Frequent Adverse Events • A medication error is an unintended failure in the drug treatment procedure which could harm the patient. Medication errors can affect all steps of the medication process and can cause adverse events most often relating to prescribing, dispensing, storage, preparation, and administration. • Healthcare-associated infections are the infections that occur in patients under care, in hospitals or in another healthcare facilities. • Unsafe surgical procedures cause complications for up to 25% of patients. Each year almost 7 million surgical patients are affected by a complication and about 1 million die. • Unsafe injections can transmit infections such as HIV and hepatitis B and C, endangering both patients and healthcare workers. The global impact is very pronounced, especially in low- and middle-income countries where it is estimated that about 9.2 million disability-adjusted life years (DALYs) were lost in the 2000s.
- 5. 5 Most Frequent Adverse Events • A diagnostic error is the failure to identify the nature of an illness in an accurate and timely manner and occurs in about 5% of adult outpatients. • Venous thromboembolism is one of the most common and preventable causes of patient harm and represents about one third of the complications attributed to hospitalization. This issue has a significant impact both in the high-income countries, where 3.9 million cases are estimated to occur yearly, and in low- and middle-income countries, which see about 6 million cases each year. • Radiation errors include cases of overexposure to radiation and cases of wrong- patient and wrong-site identification. Each year, more than 3.6 billion X-ray examinations are performed worldwide, of which 10% are performed on children. • Unsafe transfusion practices expose patients to the risk of adverse transfusion reactions and transmission of infections. Data on adverse transfusion reactions from a group of 21 countries show an average incidence of 8.7 serious reactions per 100 000 distributed blood components.
- 6. 6 Definition – Patient Safety • The WHO defines Patient safety is defined as “the absence of preventable harm to a patient and reduction of risk of unnecessary harm associated with health care to an acceptable minimum.“ • It is to decrease the risk of preventable damage associated with the healthcare to an acceptable minimum limit.
- 7. 7 Relationship between Patient Safety & Informatics • In 1999 the Institute of Medicine’s (IOM) released report “To err is human” called for developing and testing new technologies to reduce medical error, and the subsequent 2001 report “crossing the quality chiasm” called for using information technology as a key in transforming and changing the healthcare environment to achieve better and safer care. • Electronic physician’s orders and E-prescribing. Computerized physician order entry entails the use of electronic or computer support to enter physician orders including medication orders using a computer or mobile device platform. • It usually integrated with a clinical decision support system (CDS), which acts as an error prevention tool through guiding the prescriber on the preferred drug doses, route, and frequency of administration. • In addition, some CPOE systems may have the feature of prompting the prescriber to any patient allergies, drug-drug or drug-lab interactions or with sophisticated systems it might prompt the prescriber towards interventions that should be prescribed based on clinical guideline recommendation example venous thromboembolism prophylaxis)
- 8. 8 Relationship between Patient Safety & Informatics • Clinical decision support:Clinical decision support provides the health care professional with information and patient-specific information. • This information is intended to enhance the decision of the healthcare provider and is rationally filtered and presented to the healthcare professional at appropriate times. Clinical decision support includes a range of tools to enhance decision-making and the clinical workflow. • These tools include notifications, alerts and reminders to care providers and patients, clinical guidelines, condition-specific order sets, patient specific clinical summaries, documentation templates, investigation and diagnostic support, among other tools. • Electronic sign-out and hand-off tools: Sign-out / “hand-over” communication relates to the process of passing patient-specific information from one caregiver to another, from one team of caregivers to the next, or from caregivers to the patient and family for ensuring patient care continuity and safety. • Breakdown in handover of patient information has been found to be one of the leading root causes of sentinel events
- 9. 9 Relationship between Patient Safety & Informatics • Electronic sign-out applications are tools used as standalone or integrated with the electronic medical record to ensure a structured transfer of patient information during healthcare provider handoffs. • Bar code medication administration: Bar code medication administration systems are electronic systems that integrate electronic medication administration records with bar code technology. These systems are intended to prevent medication error by ensuring that the right patient receives the right medication at the right time. • Smart pumps: Smart pumps are intravenous infusion pumps that are equipped with medication error-prevention software. This software alerts the operator when the infusion setting is set outside of pre-configured safety limits. • Automated medication dispensing technology: Automated dispensing cabinets (ADC) are electronic drug cabinets that store medication at the point of care with controlled dispensing and tracking of medication distribution.
- 10. 10 Relationship between Patient Safety & Informatics • Retained surgical items prevention technology: There are various technologies that are used to enhance the prevention of retained surgical items which include: bar coding and radiofrequency (RFID) tagging of surgical items. • Patient electronic portals: A patient portal is a secure online application that provides patients access to their personal health information and 2-way electronic communication with their care provider using a computer or a mobile device. • Telemedicine: Telemedicine is defined as the use of telecommunication technologies to facilitate patient to provider or provider to provider communication. Communication maybe synchronous with real-time 2-way video communication or asynchronous transmission of patient clinical information. In addition to communication, telemedicine may provide health information that is collected remotely from medical devices or personal mobile devices. This information may be used to monitor patients, track or change their behavior.
- 11. 11 Relationship between Patient Safety & Informatics • Electronic incident reporting: Electronic incident reporting systems are web- based systems that allow healthcare providers who are involved in safety events to voluntarily report such incidents. Such systems can be integrated with the electronic health record (EHR) to enable abstraction of data and automated detection of adverse events through trigger tools. Electronic incident reporting systems potentially have the following advantages; standardize reporting structure, standardize incident action workflow, rapid identification of serious incidents and trigger events, while automating data entry and analysis.
- 13. 13 Risk Management • Risk Management is a process of identifying factors that provide excellent, efficient, effective and safe patient care. The aim of risk management is to ensure variety of risks are identified and assessed at an early stage along with ensuring best way of managing, controlling or reducing their effect. The main purposes/functions are • Enhance patient safety • Minimize occurrence of errors • Improve safety of the employees • Enhance safety of the visitors • Reduce financial lose • Formulate plan to manage risk • Protect resources • Protection of patient’s records • Identification and fixing of deficiencies in system.
- 14. 14 Functions of Risk Management • Risk is an integral part of human activities, both in living and working environments. • First of all, it is necessary to embed the two activities of “risk assessment” and “investigation of adverse events” in the organizational processes of health systems. • Both activities may provide reasons for study and research, or be linked to organizational objectives such as patient safety, cost containment or, compliance with regulatory obligations. • The assessment of risk as an organizational function should permeate both the choices of clinicians and managers, if we accept that patient safety is an essential goal of health organizations. • The analysis of adverse events could be an activity entrusted to specialists in the investigation of accidents, or shared between both the frontline and the bottom end as an integral part of the risk assessment process, if it is meant and used for organizational development.
- 15. 15 Functions of Risk Management The functions are divided into three:- • Protection of Patient’s Records • Use of contingency plans • Identification and fixing of deficiencies in system
- 16. 16 Components of Risk Management • Education & Training Risk management plans need to detail employee training requirements which should include new employee orientation, ongoing and in- service training, annual review and competency validation, and event-specific training. • Patient & Family Grievances To promote patient satisfaction and reduce the likelihood of litigation, procedures for documenting and responding to patient and family complaints should be described in the Risk Management Plan. Response times, staff responsibilities, and prescribed actions need to be articulated and communicated. • Purpose, Goals, & Metrics Risk management plans should clearly define the purpose and benefits of the healthcare risk management plan. Specific goals to reduce liability claims, sentinel events, near misses, and the overall cost of the organization’s risk should also be well-articulated. Additionally, reporting on quantifiable and actionable data should be detailed and mandated by the plan.
- 17. 17 Components of Risk Management • Communication Plan While it is critical that the healthcare risk management team promote open and spontaneous dialogue, information about how to communicate about risk and with whom should be provided in the healthcare risk management plan. • Contingency Plans Risk management plans also need to include contingency preparation for adverse system-wide failures and catastrophic situations such as malfunctioning EHR systems, security breaches, and cyber attacks. The plan needs to include emergency preparedness for things like disease outbreaks, long-term power loss, and terror attacks or mass shootings. • Reporting Protocols Every healthcare organization must have a quick and easy-to-use, system for documenting, classifying, and tracking possible risks and adverse events. These systems must include protocols for mandatory reporting. • Response & Mitigation Plans for healthcare risk must also include collaborative systems for responding to reported risks and events including acute response, follow-up, reporting, and repeat failure prevention.
- 18. 18 Risk Management Process • Five Basic Steps of Risk Management: The five basic steps of risk management are outlined below and also in • Step 1: Establish the context • Step 2: Identify risks • Step 3: Analyze risks • Step 4: Evaluate risks • Step 5: Treat/Manage Risks
- 19. 19 Risk Management Process 1. Establish the context: Context is very important in risk identification and management. ICU (Intensive care unit), O.R(Operation room), E.R (Emergency room), blood transfusion services, CCU (coronary care unit), medication management including medication administration are contextually high priority areas for risk management in relation to patient care.
- 20. 20 Risk Management Process 2. Identify Risks: Risk identification is the process whereby the healthcare professional and the healthcare employees become aware of the risks in the health care services and environment. Sources of risk identification a. Discussions with department chiefs, managers and staff b. Patient Tracer Activity (Tracing the journey of a patient from admission till discharge) c. Retrospective screening of patient records d. Reports of accreditation bodies e. Incident reporting system & sentinel events f. Healthcare associated infections (HAI) reports g. Executive committee reports h. Facility management & safety committee report i. Patient complaints and satisfaction survey results j. Specialized committee reports (such as Morbidity and mortality committee, medication management and use, Infection control, blood utilization.
- 21. 21 Risk Management Process 3. Analyze Risks: Risk analysis is about developing an understanding of the risks identified. • It includes Level of the risk or Risk score, finding Underlying causes and Existing control measures. • Existing controls: When examining the existing control measures, consideration should be given to their adequacy, method of implementation and level of effectiveness in minimizing risk to the lowest reasonably practicable level. These include all measures put in place to eliminate or reduce the risk and may include Policies, procedures, protocols, guideline, Alarms and beeps, Engineering controls etc. • Root Cause Analysis (RCA) represents a systematic approach to identifying the underlying causes of adverse occurrences so that effective steps can be taken to modify processes and prevent future losses. Brain storming with a team of relevant and informed people still remains the best method to do Root cause analysis.
- 22. 22 Risk Management Process 3. Analyze Risks: contd. • Risk Score (R) = Likelihood (L) x Severity Impact (S) • Likelihood assessment (L) [5] Likelihood scoring is based on the expertise, knowledge and actual experience of the group scoring the likelihood. In assessing likelihood, it is important to consider the nature of the risk. • Severity of impact indicates the impact of harm to service users, employees, service provision, environment or the organization. The scoring ranges from 1 (Negligible impact) to 5 (Extreme impact).
- 23. 23 Risk Management Process 4. Evaluate Risks: The purpose of risk evaluation is to prioritize the risks based on risk analysis score and to decide which risks require treatment and the mode of treatment. Like Negligible, Minor, Moderate, Major, and Extreme. 4. b. Accepting the Risk: Accepting a risk does not imply that the risk is insignificant. 5. Risk Treatment: (Also known as Risk reduction, Risk mitigation): The decisions in risk treatment should be consistent with the defined internal, external and risk management contexts and taking account of the service objectives and goals. Risk treatment plan should have: • Proposed actions • Resource requirements • Person/s responsible for action • Timeframes (Dates for actions to be completed and date for review.) Risk can be treated in three ways as given below
- 24. 24 Risk Management Process Controlling the Risk: The most effective methods of risk control are those which redesign the systems and processes so that the potential for an adverse outcome is reduced. Other methods of controlling the risk include reducing the likelihood of the risk and/or reducing the severity of the impact of the risk. Transferring the risk: Transferring the risk involves another party bearing or sharing some part of the risk through contractual terms, insurance, outsourcing, joint ventures, etc. Avoiding the risk: This is achieved by either deciding not to proceed with the activity that contains an unacceptable risk, choosing an alternate more acceptable activity.
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