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10 top patient safety issues for 2016 By Dr.Mahboob Khan Phd

Hospitals are charged with the dual task of keeping patients well while also

keeping patients safe. The two are inextricably linked, as patient safety concerns

often tie directly into patient health concerns — hand hygiene, transitions of

care and medication errors are a few such concerns that come to mind.

Retrospectively, 2014 provided some lessons in patient safety issues. The Ebola

outbreak shed light on the country's unpreparedness for handling infection

outbreaks after two nurses contracted the virus while caring for an infected

patient, and meaningful use guidelines are ramping up requirements for patient

involvement in their care.

Looking prospectively, these concerns, and many others, will flow into the next

calendar year. Some of the patient safety issues are long established, and will

remain in the forefront of healthcare's mind for years to come. Here, in no

particular order, are 10 important patient safety issues for providers to consider

in the upcoming year.

Healthcare-associated infections. HAIs have long plagued healthcare

facilities, both clinically and financially. Protocol including hand hygiene and

antimicrobial stewardship play directly into the rate and prevalence of HAIs,

and all three are continuously deemed patient safety concerns. According to the

CDC, one in every 25 patients will contract an HAI during a hospital stay, and

treating such infections costs the healthcare industry upwards of $9.8 billion, by

some estimates.

Antibiotic resistance. Given current prescribing practices, the lack of new

antibiotic development and the speed with which pathogens are developing

resistance to certain drugs, a scenario in which antibiotics are rendered useless

may be sooner than many realize. The Centers for Disease Control and

Prevention estimate 2 million people contract an infection by bacteria that are

resistant to antibiotics each year, and 23,000 people die as a direct result of this

infection.Since the 1940s, the beginning of the "Golden Age of Antibiotics,"

society has leaned on antibiotics as a go-to fix, regardless of whether they could

actually cure the ailment at hand. Clinicians also have adopted a preemptive,

precautionary attitude, prescribing antibiotics to protect themselves in the event

a patient does develop an infection. Antimicrobial stewardship programs can

play a key role in transforming antibiotic prescribing practices to reduce both

the use of antibiotics and pathogens' ability to develop resistance to such

organisms.

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Personal protective equipment protocol. 2014 saw the largest Ebola virus

outbreak to date. As of Nov. 16, the World Health Organization reported 5,420

deaths in eight countries attributed to the virus. Although the overwhelming

majority of the outbreak was contained in West Africa, the United States cared

for seven Ebola patients through November; five of whom were travelled back

to the country from West Africa and two of whom contracted the virus in the

U.S., marking the first Ebola transmissions in the country. The two patients who

contracted Ebola in the U.S. were nurses caring for the U.S.'s first imported

Ebola patient. It is suggested the virus was contracted through lack of or

inadequate PPE protocol, sparking controversy and a reexamination of such

guidelines. The WHO and the Centers for Disease Control and Prevention

issued guidelines for donning and removing PPE, and hospitals are bolstering

their infection control tactics. Additionally, nursing unions such as National

Nurses United are going on strike, demanding better protective gear and safety

precautions and increased education and training on treating patients with Ebola

or other infectious diseases.

Hand hygiene. The first line of defense against infections remains one of the

least-used tactics. Despite the relative easiness of washing hands, hand hygiene

compliance rates simply remain too low. "Hand hygiene has well-documented

ties to patient safety, yet median hand hygiene compliance is still only 40

percent, meaning healthcare workers clean their hands less than half the time

they enter patient rooms," says Jason Burnham, associate director of patient care

solutions of Halyard Health, a global medical technology company spun-out of

Kimberly Clark Health Care.

Financial incentives are pushing healthcare providers to explore different

avenues by which to increase hand hygiene. "With CMS penalties for infections

adding to the cost of poor quality in 2015, hospitals across the country are

exploring electronic monitoring as a way to create rapid improvement and

individual accountability where manual audits and observations have not

succeeded in improving behavior in this fundamental of patient care."

Hospitals and health systems have implemented hand hygiene intervention and

conducted studies to determine when clinicians achieve optimal hand hygiene

compliance. But the fact remains that clinicians just aren't washing their hands

enough.

Health IT issues. The proliferation of health IT has been both a blessing and a

curse in the patient safety sphere. At its core, health IT is meant to quicken

processes, aggregate and analyze data and eventually improve outcomes.

However, implementation of IT has been rocky, and the scope of technology's

reach is shorter than anticipated, creating an environment conducive to human

error and patient safety mistakes.

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"We believe there is a lot of promise for health IT to improve quality and safety,

but new technology generally also brings new problems,"I reiterate. "The job

now is to enhance the technology, so we are using it in optimal ways to improve

communication within and between teams, improve timeliness of care, and

create meaningful data for monitoring and evaluation."

Medication errors. The Institute of Medicine has estimated nearly 1.5 million

Americans experience an adverse event due to a medication error each year,

costing the health system nearly $3.5 billion in extra costs. The Mayo Clinic

suggests medication errors are largely communication errors, be it between

patient and provider, provider and pharmacist or pharmacist and patient. This is

one arena in which health IT can offer a proven solution. A recent study at

Boston Children's Hospital found medication errors fell by 58 percent when an

electronic reconciliation tool was implemented. Innovations and adaptations

such as electronic tools may begin to help cut down the incidences of this

adverse event.

Workforce safety. Clinicians can't treat others if they themselves are not well.

The NPSF believes ensuring safety of the workforce and in the workplace is a

prerequisite for patient safety. This includes both the physical and psychological

safety of healthcare employees. "The Occupational Safety and Health

Administration reports that hospitals and health settings are among the most

hazardous workplaces in the country, with high rates of injury such as

musculoskeletal problems and needlestick injuries," I think. "We also know that

there are intense pressures in healthcare, and disruptive behaviors, disrespect

and even violence against health workers is all too common. We believe these

issues have a direct impact on patient safety because workers can only perform

at their best when in an environment of physical and psychological safety."

Transitions of care. The healthcare spectrum is a string of transitions, whether

it is a physical transfer or just a change of physician. "Our communication

around patient care is critical in that we must communicate exact information at

each change of care to provide the next caregiver with the necessary

information to start care without having to read the chart from the beginning or

until the personnel can assess the patient themselves," I reiterate .Health IT has

also stepped up to the plate to deliver technologies and solutions to address care

transitions, such as remote patient monitoring, wireless data aggregation and

analysis and electronic data sharing.As I think , the clearer communication

channels are, the better care patients will receive as they move through the

healthcare spectrum.

Diagnostic errors. In addition to the severe issues they cause patients,

diagnostic errors are both the most common and the most costly form of

medical malpractice claims. A 2013 study from Johns Hopkins Medical Center

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in Baltimore found nearly 8 percent of medical malpractice payouts exceeding

$1 million from 2004 to 2010, the majority of which were due to misdiagnoses.

I think , says diagnostic errors are largely an issue in radiology due to

substandard operating models. "To date, there is still no established set of

standard best practices that radiologists, patients, health systems and payers can

use to gauge the quality of radiology services,"I think. "What is needed, at the

very least, is a better clinical operating system that ensures routing of images to

the right subspecialty and a consistent practice of blinded peer reviews. This

will significantly increase quality of care, reduce costs and enable radiologists

to practice at the top of their license."

Diagnostic errors were a key issue at NPSF's Patient Safety Awareness Week

2014, I reiterate, saying such errors may be more prevalent than people initially

realize. These errors can result from a number of combined forces, including

failure to order appropriate tests and a lack of patient engagement. She says it is

a complex error, but even missed communications, such as not following up on

a test or a patient not realizing how important a test is, could lead to a diagnostic

misstep.

Patient engagement. Patients are becoming consumers of healthcare, and the

industry has to shift to meet this new demand. By involving patients in their

treatment plans and processes, they become allies in their care and can serve as

another layer of defense against many safety issues. The more minds tuned into

an issue, the better the outcome.

"NPSF has been a strong advocate for increased patient engagement in

healthcare at all levels," I think. "This is an extremely complex issue with many

corresponding challenges — for example, health literacy and ensuring that

patients are given materials and information in a way that they can understand

it. There needs to be considerable education and training of health professionals,

as well as the creation of shared decision making tools. But there is great

promise to improving patient safety by having patients more directly involved."