It's National Nurses Week...nurses are in
integral part of a patient's health care team and vital to quality
health care. We salute you today and everyday for your dedication to
patient safety. Share your stories of great nurses you have worked with or have cared for you or a loved one.
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.
An efficient and effective ED team doesn’t
happen by luck: it happens as a result of integrated team training. That
is why we are dedicated to working with ED personnel across the CRICO
system to enhance their teamwork and communication skills that are
critical to keeping ED patients safe. 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).
To learn more about ED team training, visit 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?
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?
Many adverse events stem from seemingly small missteps in the
patient’s care. Self awareness of what might set you up for a
substandard performance is an important step in developing strategies to
compensate and perhaps avoid those little mistakes that can have big
consequences.
Could you miss a colorectal cancer? Our data
show many do. Test your skills with our short private quiz that is based
on a closed malpractice case.
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.
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
Behind the scenes, an EMR designed to reduce the risk of patient harm
should enable health care leaders and researchers to mine the database
for trends that signal the need for education, training, or systems
adjustments.
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.
While Obamacare is the ultimate political Frisbee, a different set
of laws—about breast cancer screening —may soon have physicians’ heads
spinning.
To date, five states1 have enacted some form of legal requirement that the significant percentage2
of women with dense breasts be apprised of the limitations of
radiographic mammography and informed of alternate or adjunct imaging
options. Now, in addition to having to help patients navigate
conflicting studies about the when of screening, providers also have to
guide patients through the how. Even in states (including Massachusetts)
where such laws are not in place, physicians should be prepared to
address this emerging aspect of breast care with an eye toward patient
safety.
Radiologists and primary care physicians (PCPs) are trying to
determine what to write and what to say to patients that is both legally
compliant and reflective of appropriate care. The biggest challenge is
the lack
of clinical evidence that screening alternatives for women with dense
breasts, i.e., whole breast ultrasound and MRI, are beneficial.
Providers have to convey to patients both sides of the potential consequences
of additional screening without increasing their own risk of being
deemed liable for a missed or delayed breast cancer diagnosis.
Given that patients—especially women who have a screening
mammogram—have increased access to their medical records and reports,
radiologists and PCPs will do well to coordinate their breast density
messaging. Wording
the information about density in the mammogram report to help the PCP
frame the patient discussion (about screening options) will reduce
tension between providers. Along with the foundation of evidence-based
care, clearly documenting what was discussed, and the patient’s
expressed plan (if any) for subsequent imaging will be a strong defense
for PCPs whose standard of care is later questioned.
While the breast density issue has received considerable attention,
malpractice cases related to breast cancer more frequently involve the
mismanagement of symptomatic patients than insufficient screening.3
Capturing and updating patient and family histories, and following
breast complaints to resolution will best position physicians to provide
optimal care that can be defended against allegations of diagnostic
missteps. To that end, CRICO’s Breast Care Management Algorithm offers PCPs a clear course of best practices that balance evidence-based care with practical risk management recommendations.
It's National Nurses Week...nurses are in
integral part of a patient's health care team and vital to quality
health care. We salute you today and everyday for your dedication to
patient safety.
