We have long been discussing the vital role
nurses have in patient care and in 2011 we held a CRICO-sponsored
symposium at Harvard Medical School to explore this topic. In honor of
National Nurses Week, we wanted to share this video that voices some of
the attendee's thoughts from that day. Add your voice to the
conversation here.
Wednesday, May 8, 2013
Tuesday, May 7, 2013
Tuesday, April 30, 2013
Mr. Rogers Would Have Been Proud
By Jock Hoffman, CRICO
Original Source, Strategies for Patient Safety
For those of us left only to watch in horror on Marathon Monday, heeding Fred Roger’s advice
to “look for the helpers” gave us countless selfless acts to observe.
Many of those spectators and race participants who rushed to the aid of
the bombing victims were “off duty” physicians and nurses. Even though
many had never experienced similar circumstances, their instincts and
bravery saved lives and reduced injury severity. To all of you who
instantly engaged your dedication and training to literally begin
Boston’s healing process, and to all who put in extra hours and extra
shifts to care for the flood of victims, thank you.
Certainly no one who jumped in to help was thinking about their own risks, but it is worth noting that legal and insurance “Good Samaritan” protections are in place. Doctors and nurses in Massachusetts (and other states) who perform emergency aid in the immediate aftermath of an accident, natural disaster, or crime, are protected from malpractice liability (unless their actions are wanton or reckless). In addition, Massachusetts law allows hospitals to temporarily employ clinicians credentialed elsewhere in order to safely manage extraordinary events. And for a bit more reassurance, at least for CRICO-insured physicians, their medical professional liability coverage follows them wherever they practice within the scope of their license. In concert, these protections support those people who act heroically without hesitation—as we all saw on April 15th when we looked for the helpers.
Certainly no one who jumped in to help was thinking about their own risks, but it is worth noting that legal and insurance “Good Samaritan” protections are in place. Doctors and nurses in Massachusetts (and other states) who perform emergency aid in the immediate aftermath of an accident, natural disaster, or crime, are protected from malpractice liability (unless their actions are wanton or reckless). In addition, Massachusetts law allows hospitals to temporarily employ clinicians credentialed elsewhere in order to safely manage extraordinary events. And for a bit more reassurance, at least for CRICO-insured physicians, their medical professional liability coverage follows them wherever they practice within the scope of their license. In concert, these protections support those people who act heroically without hesitation—as we all saw on April 15th when we looked for the helpers.
Additional Reading
Tuesday, April 23, 2013
It wasn't luck: it was training
Using multiple scenarios that simulate an active ED setting, including an unstable patient at triage, a patient with deterioration in the ED, patients with abnormalities not addressed at discharge, and patient hand-offs, the curriculum is designed to improve providers’ ability to:
- recognize barriers to gathering and integrating complete information;
- use a designated method (e.g., SBAR, IPASS) for receiving and transferring complete information; and
- lower the barriers for speaking up, by consistent use of agreed upon communication prompts, (e.g., triggers to identify and respond to unstable patients, physician-nurse huddles, and discharge timeouts with reconciliation of abnormal vital signs).
Thursday, March 28, 2013
A Bad Err Day
By Jock Hoffman, CRICO
We can assume that health care providers make fewer mistakes on those days when they are not overly busy, easily distracted, constantly being interrupted,
stressed, or dealing with personal issues, a leaky water heater, or
their car’s check engine light. You know those days, right?
Of course, health care providers generally do function safely and effectively under challenging conditions. From the relative “quiet” of a private practice to the more frenetic pace of EDs, L&D units, ORs, understaffed labs, and overbooked imaging suites, health care delivery is carried out in an environment that would likely immobilize many non-health care professionals. Physicians and nurses, however, learn how to filter out numerous everyday distractions and navigate around routine diversions without compromising their vigilance to the patient’s care and safety.
Almost all of the time.
But even those of you who thrive amidst organized chaos can become preoccupied with a nagging concern, take on one task too many, or let down your guard. Of course, this is when you are most vulnerable to making errors, or to not catching your mistakes quickly enough to rescue the situation. This is when you need an extra ounce of vigilance to prevent patient harm and, perhaps, an allegation of malpractice.
So what throws you off your game?
Original Source, Strategies for Patient Safety
Of course, health care providers generally do function safely and effectively under challenging conditions. From the relative “quiet” of a private practice to the more frenetic pace of EDs, L&D units, ORs, understaffed labs, and overbooked imaging suites, health care delivery is carried out in an environment that would likely immobilize many non-health care professionals. Physicians and nurses, however, learn how to filter out numerous everyday distractions and navigate around routine diversions without compromising their vigilance to the patient’s care and safety.
Almost all of the time.
But even those of you who thrive amidst organized chaos can become preoccupied with a nagging concern, take on one task too many, or let down your guard. Of course, this is when you are most vulnerable to making errors, or to not catching your mistakes quickly enough to rescue the situation. This is when you need an extra ounce of vigilance to prevent patient harm and, perhaps, an allegation of malpractice.
So what throws you off your game?
- A new piece of equipment, new software, a new form to be filled out?
- A schedule snafu, a change in team members, a workplace dispute?
- A patient who reminds you of a loved one…or resembles a crabby neighbor?
- The day before or after vacation, or the first or last day of being on service?
- A pending malpractice case or a near miss?
- Traffic, a fight with your spouse, too many meetings?
- Something in the mirror that doesn’t look right, or a new and undiagnosed pain or ailment?
ADDITIONAL READING
- Side tracks on the safety express. Interruptions lead to errors and unfinished… Wait, what was I doing?
- Distractions in OR Make Errors More Likely
Original Source, Strategies for Patient Safety
Tuesday, March 26, 2013
Could you miss a colorectal cancer? Our data shows many do.
Test your own knowledge by taking our private quiz. The scenario below is taken from a CRICO closed malpractice case. The case outcome with the application of CRICO's decision support tools, appears at the end of this quiz.
Take the quiz on the CRICO website.
How did you do? Leave a comment here and let us know how you did.
Wednesday, February 27, 2013
Build a Better EMR
By Jock Hoffman, CRICO
For all the good they promise for health care, electronic medical records (EMRs) have yet to demonstrate a profound impact on patient safety. Health care providers who resist or merely tolerate paperless systems are unlikely to capitalize on secondary components that could alert them to hidden risks. But even for clinicians who embrace their EMR, the benefit of reducing errors, and by extension patient harm, remains elusive. Nevertheless, patient safety experts see enormous potential in both the point-of-care opportunities for avoiding errors and the broader value of data aggregated from appropriately designed systems.
Today, the EMR that some envision may be mere fantasy, but physicians, patient safety experts, and patients need to put forward ideas that will enable designers to meet that potential. Ideally, an EMR should help the clinician in the office or at the bedside focus on the immediate concern while keeping him or her fully apprised of the patient’s history. And rather than dictate the diagnostic process or care plan, an EMR should support the clinician’s decision-making:
Certainly that is a tall order. Commercial vendors need to see a return on investment; providers want ease of use; and, more and more, patients expect to be engaged with both their physician and their medical information. CRICO and its constituents have stepped up the challenge through a provocative video and a series of demonstration projects currently underway that should influence this evolving technology. But we expect that the best ideas will come from everyday EMR users who want a better EMR in their future.
Original Source, Strategies for Patient Safety
For all the good they promise for health care, electronic medical records (EMRs) have yet to demonstrate a profound impact on patient safety. Health care providers who resist or merely tolerate paperless systems are unlikely to capitalize on secondary components that could alert them to hidden risks. But even for clinicians who embrace their EMR, the benefit of reducing errors, and by extension patient harm, remains elusive. Nevertheless, patient safety experts see enormous potential in both the point-of-care opportunities for avoiding errors and the broader value of data aggregated from appropriately designed systems.
Today, the EMR that some envision may be mere fantasy, but physicians, patient safety experts, and patients need to put forward ideas that will enable designers to meet that potential. Ideally, an EMR should help the clinician in the office or at the bedside focus on the immediate concern while keeping him or her fully apprised of the patient’s history. And rather than dictate the diagnostic process or care plan, an EMR should support the clinician’s decision-making:
- linking to evidence-based guidelines and protocols
- identifying potential risks
- ensuring that critical patient information is communicated, received, and acted upon
Certainly that is a tall order. Commercial vendors need to see a return on investment; providers want ease of use; and, more and more, patients expect to be engaged with both their physician and their medical information. CRICO and its constituents have stepped up the challenge through a provocative video and a series of demonstration projects currently underway that should influence this evolving technology. But we expect that the best ideas will come from everyday EMR users who want a better EMR in their future.
Additional Material
Original Source, Strategies for Patient Safety
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