Incorporating Patient Engagement into Patient Safety Initiatives

Alongside clinical imperatives, strong patient engagement can supplement patient safety initiatives in the hospital.

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Ensuring patient safety is a vital part of medical care and a key component of a quality healthcare experience. As healthcare professionals work to deliver care free of medical error, they are also recognizing the tremendous role patient engagement can play in driving patient safety initiatives.

Healthcare professionals face calls to reduce patient safety issues on both a financial and moral basis.

Medicare reimbursement rates for hospitals hinge on reducing the number of adverse patient safety events.  Patient safety performance accounts for 25 percent of an organization’s score within the 2018 Hospital Value-Based Purchasing Program scoring system, while another 25 percent depends on getting high marks for quality patient experiences.

These measures assess six dimensions of patient safety, including the rates of several different high-risk infections. When a hospital exceeds a certain threshold for infection occurrence rates, their Medicare reimbursement rates suffer.

In 2015, one in 25 patients experienced some form of hospital-acquired infection on any given day, according to statistics from the Centers for Disease Control (CDC).

A 2016 article published in the British Medical Journal found that medical errors are the third leading cause of death in the US, and a separate study published in the Journal of Patient Safety found that 440,000 lives are lost annually to medical error.

According to the National Patient Safety Foundation, adverse patient safety events can include:

  • Diagnostic errors
  • Hospital- and organization-acquired infections
  • Falls
  • Medication errors
  • Preventable hospital readmissions
  • Wrong-site surgery

Providers certainly face an obligation to adhere to standards of care aimed at reducing these patient safety issues. Patient safety checklists can make sure that providers don’t leave surgical equipment inside a patient, and can aid clinical staff in communicating accurately about where a patient will receive surgery.

But patients can also play a role in reducing the risk of a patient safety event. The key is ensuring providers engage patients in those responsibilities.

Healthcare organizations must create a culture of safety that incorporates the patient as a care team member and encourages patient activation.

The organization can also engage patients by creating access to health data, improving patient-provider communication, and empowering family caregivers to play a role in patient safety.

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Empowering patients as safety partners

The current healthcare landscape is pushing patients to take more responsibility for their own health, including activating patients in patient safety.

Patients can act as a second layer of defense and may even catch potential mistakes from their providers. Patients can also prompt providers to engage in safer behaviors and communicate with providers about medical issues that could prevent a potential a safety event.

However, research has indicated that patients are often apprehensive about providing their input, according to the Agency for Healthcare Research and Quality (AHRQ) national patient safety goals.

Patients generally trust their doctors and nurses and are hesitant to raise a concern that could appear confrontational. For example, patients may be wary about asking a provider if she has washed her hands before an exam.

Overcoming patient apprehensions will require a healthcare organization to create a stronger culture of safety that underscores patient participation in care. Healthcare organizations should make their plans to support better patient safety clear through marketing materials, such as posters and brochures.

Providers may wish to consider using available materials from The Joint Commission’s Speak Up Initiative, which was started in 2010 to help encourage patients to play a role in patient safety. The initiative offers numerous brochures for providers to offer patients to empower them.

Providers should also actively encourage patients to ask questions, suggests the AHRQ Patient Safety Network. The Network developed a list of questions patients should ask before, during, and after the healthcare encounter. Topping the list of 10 questions every patients should know include:

  • What is this test for?
  • How many times have you done this procedure?
  • When will I get the results?
  • Why do I need this treatment?
  • Are there any alternatives?
  • What are the possible complications?
  • Which hospital is best for my needs?
  • How do you spell the name of that drug?
  • Are there any side effects?
  • Will this medicine interact with medicines that I’m already taking?

These prompts offer an opportunity for patient education as well as provider reflection. When a patient asks “will this medicine interact with other pills I’m already taking?” a provider must take a closer look at the medication list. This second check may reveal a potential medication error that can be avoided.

Creating a culture of safety built around patient involvement will not work if an organization does not communicate these roles to their patients. Meaningful patient-provider communication about patient safety, in-office marketing strategies, and patient outreach will be essential to spread the message of patient involvement.

Additionally, organizations that build their patient safety strategies alongside their patients will see more success. AHRQ suggests a patient and family advisory council meeting dedicated to tackling patient safety issues.

These advisory meetings will reveal which issues are most pressing to patients and their families, which strategies are most feasible for targeted patient populations, and how to develop effective best practices for engaging patients.

Engaging patients with access to health data

Inaccurate medical data can have a serious and negative impact on patient safety.  While there are numerous data analytics and data governance efforts intended to help ensure the reliability and accuracy of patient health data, patient engagement is another important piece of the puzzle.

Patients who have access to their own health data can serve as an extra check for data accuracy. A patient with patient portal access can ensure that his or her data is correct and up to date. If there is an error, the patient can contact her doctor and request a change.

Tools that allow patients to flag medical errors on their own can make this process more efficient. Most patient portals only allow patients to view their health data, but not to mark errors or create their own patient notes.

A piloted OpenNotes feature that did allow patients to flag errors showed some potential, according to a 2016 study published in BMJ Quality and Safety.

Researchers introduced the patient feedback tool to 41 physicians who had already adopted OpenNotes. About 44 percent of participating patients looked at their physician notes during the one-year test period. Eight percent of those patients used the feedback function.

Of the patients who used the feedback function, 23 percent reported safety concerns, usually pertaining to medication errors or incorrect pre-existing health conditions. Sixty-four percent of feedback reports were categorized as confirmed or possible concerns. Eventually, 57 percent of the reports resulted in actual changes to the medical record.

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Developing meaningful patient-provider communication

Fostering meaningful patient-provider communication, especially between patients and their nurses, will ensure a provider is alerted to a certain patient need, which in turn may reduce the likelihood of adverse patient safety events.

Patient experience experts recommend that nurses conduct regular rounding in patient rooms to identify and fulfill patient needs. This is a part of creating a positive patient experience, free from fear and avoidable harm.

“The way that we approach improvement for patient experience measures is to reframe it,” according to Deirdre Mylod, PhD, Executive Director of the Institute for Innovation and Senior VP of Research and Analytics at Press Ganey. “The exercise is not to make consumers happy. The exercise is to reduce patient suffering.”

Reducing patient suffering requires healthcare professionals to be attentive. For example, nurses checking in on patients and judiciously using nurse call buttons might prevent a patient from getting up to use the bathroom alone, in turn preventing a fall.

Nurses who are attentive and who leverage strong communication channels are better equipped to meet patient needs.

Nurses are busy and cannot spend all day at every patient’s bedside, but technology can connect them to patient calls.

While traditional call buttons play a valuable communication role, bedside tablets can enhance nurse call buttons and in turn help nurses deliver better patient services.

A 2015 study found that a bedside tablet call button tool that utilizes short phrases and pictures improves both nurse and patient satisfaction .

A positive rapport between patient and provider can also make a patient feel more comfortable while playing her part in patient safety.

Patients with a good relationship with their providers may be more likely to ask a provider to clarify the necessity of a certain procedure or mention when they feel their safety might be compromised.

Using education to activate family caregivers

Family members can support patient safety efforts to prevent falls, check data accuracy to forestall medical errors, and deliver quality at-home care to prevent hospital readmissions, according to Jill Harrison, PhD, director of research at patient-centered care group Planetree.

“When a patient is in the hospital, they need an extra set of eyes and ears to understand things,” Harrison explained in a previous interview. “Having a family member by their bedside after surgery is one of the greatest things a family member can do in terms of safety.”

Planetree has created a family caregiver engagement program that equips family members with the skills and knowledge necessary to support patient care and safety.

Providers should identify a family leader at the bedside and ensure a caregiver will take the lead upon hospital discharge, the organization advocates.

Educating those individuals about at-home care procedures or warning signs of complications may be able to prevent common issues leading to readmissions, such as falls or infections.

“By and large, we are discharging patients into the care of family members,” Harrison stated. “If they are not trained, aware, and educated, patients are likely to end up back in the hospital.”

Intermountain Healthcare has also established an efficient family engagement and education program that has yielded positive clinical quality outcomes.

The program calls for appointing one family caregiver who is given a badge and put in charge of certain simple tasks. These tasks include helping with breathing exercises, assisting with activity, giving help using the bathroom, measuring urine output, or keeping track of how much a patient eats and drinks.

Family caregivers record this information on a checklist kept on the back of the exam room door, and then nurses transcribe that information into the patient chart.

This is a low-cost solution that eases nurses’ clinical burdens and puts more control in the hands of patients and their families.

“The vast majority of families like to have something to do and they like to participate in patient care. They're often the most motivated member of the care team,” program lead Michelle Van De Graaff, RN, said in a statement.

“We've found that families not only want to promote healing, but patients benefit from someone who knows their preferences, and the result is, the rate of readmissions is reduced after patients are discharged from the hospital,” Van De Graaff added.

Putting some of the patient safety responsibility in the hands of the family caregiver can ensure that fewer issues fall through the cracks, reducing adverse hospital events and the likelihood of hospital readmission.

There are numerous approaches to improving patient safety efforts, and while some strategies do hinge on provider expertise, others require strong patient engagement. Activating patients as members of the patient safety team, creating patient access to health data, and leaning on meaningful patient-provider communication strategies will help to create a safer environment for patients.

When organizations effectively educate and engage family caregivers, providers have an additional partner in protecting against patient safety issues.

As the healthcare industry continues to incorporate patients into the care team, providers will see emerging uses for patient engagement. Integrating patient engagement efforts into patient safety efforts will ideally improve healthcare quality and experience.

This article was originally published on February 23, 2018.


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