Safety Bytes

EHR Final White Paper

Electronic health records (EHR) have significant potential to improve safety, but can also make existing risks greater, or introduce new ones. The WPSC recently commissioned a study of these issues; the product (a literature review and report written by two University of Washington graduate students in the Health Informatics and Health Information Management program, Harshada Pradhan and Julia Stokes) has identified major contributing factors, manifestations, and mitigation strategies.

For example, incorrect use of an EHR, while frequently attributed to inexperience, is actually often exhibited by experienced users: some of the contributing factors are time constraints and system design flaws, resulting in workarounds. The full report is available in the For Providers & Others and the Member Resource Library sections of the web site.

Read the entire White Paper by clicking here.

Honoring Choices: Advance Care Planning & Directives

By Jessica Martinson

Director of Clinical Education and Professional Development, Washington State Medical AssociationMedical Association

Honoring Choice Pacific Northwest is an advanced care planning implementation program that aims to inspire conversations about the type of care people want if faced with a life threatening illness. This joint initiative of the Washington State Hospital Association and the Washington State Medical Association seeks to ensure that everyone in Washington State will receive care that honors personal values and goals at the end of life.

Through this initiative, physicians, hospitals and other health care providers can access the necessary training and resources for discussing, recording and honoring people’s wishes at the end of their life. Our patients can also get the tools they need to make informed care choices and to talk to their families and health care providers about their end of life wishes. Resources are available at www.honoringchoicespnw.org.

Patients’ access to lab test reports: how does this affect patient safety?

by Rosalee Allan
Sr. Vice President/Chief Operations Officer, Pathology Associates Medical Laboratory

As part of an ongoing effort to empower patients to be informed partners with their health care providers, the Department of Health and Human Services (HHS) has taken action to give patients a means of direct access to their completed laboratory test reports. “The right to access personal health information is a cornerstone of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule,” said Secretary Kathleen Sebelius. “Information like lab results can empower patients to track their health progress, make decisions with their health care professionals, and adhere to important treatment plans.”

These changes give patients the option to obtain test reports directly from the lab, while strong protections for privacy are maintained. Another trend is access to one’s results via patient portals. These are typically provided by their physicians, hospital systems or by the laboratories that performed the test. You may know these under names such as MyChart from Epic, FollowMyHealth, Cerner Patient Portal, and NextMD.

This is a significant change over how lab results were historically delivered. Previously, they were reported only to the ordering provider or other health care providers cc’d by the practitioner. The provider would review the results, interpret the information, evaluate the results from the context of all the other information they had on the patient, make a diagnosis, and design a treatment plan. Then the patient would be contacted.

Today, patients may have access to their test results before the health care provider who ordered the test does. Is this good for patient safety? One could argue that the patient now has more control and can speed up the path to diagnosis or treatment by becoming more educated about the results and escalating any concerns. Physicians are under pressure to review charts promptly, as they could have patients pressing for immediate action. A counterargument would be that patients might become confused and frustrated trying to interpret lab results that were designed to be read and interpreted by providers: lab results are not typically printed in a consumer-friendly format and it is very possible that a consumer can interpret the results incorrectly. With immediate access to results, patients could take action inappropriately by researching on the internet or taking advice from others.

One resource that is available that helps to bridge this gap is Lab Tests Online [http://labtestsonline.org/]. The site is produced by the American Association of Clinical Chemistry (AACC) and is the result of a collaboration of professional societies representing the laboratory community. The site has been designed to help patients or family caregivers to better understand the many tests that are part of routine care as well as diagnosis and treatment of a broad range of conditions and diseases.

The Shared Decision Making Gap

Randal Moseley, MD, FACP, FHM
Quality Medical Director, Confluence Health

When making health care decisions, patients are often faced with two extremes. One approach is simply asking patients to make care choices based on their own ideas of care. This assumes a patient understands their condition and has obtained good information about their choices. The other common option is to completely defer to the advice of the care provider. This assumes the care provider fully understands a patient’s values and lifestyle. Both of these traditional options have significant drawbacks. Somewhere between these two extremes lies the option of informed shared decision making. Care providers should routinely make evidence-based care information available to patients in a way that is engaging and easy to understand. Once this information is understood, a useful discussion of how care options play into a patient’s value system and lifestyle can take place. However in practice, achieving this middle road is very difficult. The biggest problem is that quality tools to help inform patients in this way are not commonly available. There has been some progress by a few institutions to fill this gap. But this gap remains alarmingly large for most common care decisions. It is the duty of the healthcare profession to fill this gap, and dedicating resources for this work should receive high priority in all healthcare systems. Find more information and resources on shared decision making at
http://www.informedmedicaldecisions.org/what-is-shared-decision-making/

Health Literacy

Dr. Kate Brostoff
Senior Medical Director at CHPW

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Only 12% of adults in the US have proficient health literacy. Over a third of US adults have difficulty with common health tasks, such as following directions on a prescription drug label or adhering to a childhood immunization schedule using a standard chart. Limited health literacy affects adults in all racial and ethnic groups and across socio-economic class. To improve health outcomes, patients have to be engaged and feel that they have a voice in making decisions about their care. In order to do that we, as providers of care, have to be sure they understand what we are communicating. Here are a few tips from the Health Literate Care Model:

• Approach all patients as if they are at risk of not understanding health information.
• Employ a range of strategies for clear communication (pictures, videos, etc).
• Confirm patients’ understanding (ask open-ended questions or use the teach-back method).

Additional resources and best practices for health communication can be found at http://health.gov/communication/default.asp.

The Power of Patient Stories

Cat Mazzawy
Patient Safety Officer, Group Health Cooperative

Stories have the ability to cut through the clutter of everyday detail to connect what we do to our higher purpose. A patient story is a brief message about the patient experience—the safety, quality, and service of the care we provide. Patient stories provide opportunities to learn from and improve a care experience that did not go well and to celebrate care experiences that delighted our patients. If we talk about the patient experience every day, we are more likely to remain focused on it. Here are a few tips for telling a good patient story:

1. Talk about what you know, such as a personal experience with a patient or as a patient
2. Use specific detail and names whenever possible
3. Introduce your story with what the key take away message is
4. Keep the story short
5. Conclude your story with reinforcing the key message.

Consider starting any meeting that has an agenda with a patient story!

Using Antibiotics Wisely: the best weapon in the fight against “Super Bugs”

Amber Theel BSN MBA CPHQ CPHRM
Executive Director Patient Safety, Operations Lead Partnership for Patients, Washington State Hospital Association

Antibiotics are the only drug where use in one patient can affect the drug’s effectiveness in another. According to the Centers for Disease Control, each year in the United States at least two million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections.

Patients can play an important role in preventing “super bugs” by understanding when antibiotics are most appropriate. Remember: antibiotics cure bacterial infections, not viral infections such as colds or flu; most coughs and bronchitis; sore throats that are not caused by strep; or runny noses. Your health care providers work hard to prevent the spread of serious bacterial illnesses through diligent hand hygiene, isolation of infected patients, and cleaning of the environment.

Patients and providers can work together to preserve the availability of effective antibiotics. Taking an antibiotic when it is not needed can lead to the development of antibiotic resistance. When resistance develops, antibiotics may not be able to stop future infections. Every time someone takes an antibiotic they don’t need, they increase their risk of developing a resistant infection in the future. Learn more about what patients can do to ensure antibiotics are only used when necessary at http://www.cdc.gov/getsmart/community/index.html.

Informed Decision-making

Informed decision-making is one of the best ways we can be engaged patients and advocates, and this is especially true when it comes to major decisions such as considering a move to a long-term care facility for yourself or a loved one. Among other helpful resources, the experts at WPSC member organization Washington Health Care Association have put together a guide to use in choosing a skilled nursing facility. This guide includes questions to ask and things to look for that can provide an indication of a given facility’s focus on quality and patient safety. Visit their site to learn more.

Lessons From Community Coalitions

Here is a great little article from Qualis Health. The bullets of key learnings may seem fundamental but they are profound.

Three years ago, there were only a few community-based efforts in our nation that focused on improving the safe and effective movement of patients between settings and reducing hospital readmissions. Now there are hundreds of such initiatives underway, and Qualis Health is pleased to have helped facilitate the formation and progress of many care transitions-focused community coalitions throughout Idaho and Washington.

Key learnings from our region include:

• Any provider or group of providers can initiate the formation of a coalition.
• Coalitions are most effective when they include not just the “usual” medical providers, but all stakeholders involved with patients and families in any aspect of their healthcare journey.
• Coalitions offer a forum for competing organizations to find common ground so they can work together.
• Transparency and collective energy move the group far beyond initial expectations.
• Different care settings can learn a lot from each other.
• Tracking data over time helps coalitions identify opportunities for improvement and provide feedback about the effectiveness of interventions.
• Community coalitions can share their journeys with neighboring communities and foster improvement across the state.

Safety on the Gun Range/Safety in Health Care

Miriam Marcus-Smith, RN, MHA
Washington Patient Safety Coalition Director

I will say right off that I am not a proponent of carrying a firearm. However, I recently was at a shooting range and observed some things that struck me as very applicable to safety. The group next to us was comprised of a mom, dad, and two girls (ages 10 and 11). The parents were thoroughly and carefully instructing the girls on proper handling of their size-appropriate rifles and all safety equipment (eye and ear protection). They made sure the girls obeyed all safety rules and guidelines and practiced them over and over. They never took their eyes off the girls and stepped in when necessary to correct or guide them.

Lesson: if you really believe in the cause (gun use and gun safety), start them young! Don’t wait until they are old enough to go out and get their own weapons to start learning safe handling and use.

If you believe in patient safety, start them young also, early in their professional education! Don’t wait until they are out there in the field to teach them the basics of safety and quality improvement. Start in nursing, pharmacy, medical school, or before. Teach them how dangerous their weapons are: at the gun range the weapons are literally that. In the health care setting, our weapons are our knowledge, decisions, and procedures. We must teach our providers that these are potentially life-threatening weapons and must be treated with utmost respect.