ASQ Quality Report

Business Wire, Oct 14, 2008

From Hand Washing to Handheld Devices: Hospitals Examine Error Prevention Methods

MILWAUKEE -- A new survey of healthcare quality professionals by the American Society for Quality (ASQ) examines specific solutions that U.S. hospitals and patients can take to prevent medical errors. On Oct. 1, Medicare stopped paying hospitals for a list of so-called "never events"--medical errors that are preventable, clearly identifiable, and serious in their consequences for patients.

As part of a Quarterly Quality Report on Healthcare never events www.asq.org/quality-report/reports/200810.html, ASQ distributed a survey to healthcare quality practitioners. One hundred and eighty respondents weighed in on three key topics: 1) procedures that hospitals should do more of to reduce medical errors; 2.) technologies designed to reduce medical errors; and 3.) steps that patients can take.

Survey findings: following procedures

Procedural drills used to error-proof medical care ranked high in the survey and include:

* Use of pre- and post-operative checklists

* Marking surgical sites on the patient's body prior to surgery

* Requiring verbal confirmation to double-check on phone orders for medications

* Train staff on proper hand-washing procedures

"Hand washing is still the most important thing that anyone can do to prevent hospital-acquired conditions," said James M. Levett, M.D., a cardiothoracic and vascular surgeon who chairs the ASQ Healthcare Division. Dr. Levett believes healthcare in general is getting better in its hand-washing practices, but there is room for improvement, and constant reinforcement is still needed.

The survey's highest ranking procedure is benchmarking--or doing more to learn from other healthcare providers about successful practices for protecting patients from medical errors while they are in the hospital's care. Another procedure that makes the list is rapid response teams, which intervene to identify unstable patients and prevent them from lapsing into a condition that requires expensive and risky intensive care.

John Harrison, a hospital surveyor who serves as treasurer of ASQ's Healthcare Division, believes that these types of procedures should be 'givens' within hospitals. "If healthcare organizations are not doing these basic kinds of procedures, they're not following community standards."

Technology as a prescription

Another major thrust in current efforts to improve patient safety focuses on employing technology to reduce errors. The ASQ survey ranked in order of importance the following list of promising technologies that are beginning to take root in U.S. hospitals:

1. Computerized physician order entry systems (helps hospitals avoid illegibility and transcription errors)

2. Automated process checklists

3. IV smart pumps and computerized adverse drug event monitoring

4. Barcodes/scanners that help identify medications

5. Electronic patient records

6. RFID (radio frequency patient identifications systems that cross reference to medical charts and order entry technology)

7. PDAs (personal digital assistant or handheld computer used by physicians for patient care)

8. Spectroscopy (optical device that recognizes medications within 30 seconds through their unique fluorescence fingerprints)

Respondents agree that Computer Physician Order Entry (CPOE) systems should be a top priority for hospitals. When a physician uses CPOE to order medications, it becomes nearly impossible to order a wrong dose; the medication is uniquely spelled out to avoid misspelling. And when the order is read and interpreted by the next person down the line, it is typed and easy to read, eliminating the frequent problem of undecipherable handwriting. Harrison notes that technologies like CPOE are crucial to reducing human error.

"How many businesses do you go into right now that don't use barcodes?" he asks. "How many times do you go out to any retail store and they don't scan your purchase? The technology is not new, and yet, healthcare has not used it. There is so much technology out there healthcare can use--it's unbelievable we're so slow in adopting it."

Proactive Patients

Survey respondents also ranked in order of importance some key steps that patients themselves can take to help prevent medical errors when they are hospitalized. They include:

1. Bring and keep lists of all medications you take

2. Ask physicians/staff to wash hands

3. Choose a hospital with a good track record

4. Ask a physician if you have doubts or questions

5. Get results of any test or procedure in writing

6. Have a loved one accompany you and stay with you

7. Mark yourself with an indelible marker on the spot where you are to have surgery

"Bringing a list of your own medications is the one thing that stands out clearly for me," states Harrison. He points out that when the patient has this information, it facilitates the medication reconciliation process that takes place upon hospital admission and again at discharge.

While Levett agrees that a certain level of patient assertiveness is helpful, he believes there is a limit to the benefits of patient involvement in prevention of medical errors. "It's much more important to have professionals who know what they're doing, and to back them up by the procedures and technologies that will help to ensure delivery of care according to the highest recognized standards," he said.