Must Reads, Patient Safety

5 Equations for Improved Patient Safety and Care Articles PPAHS have been reading the week of June 18, 2018

Articles PPAHS have been reading the week of June 18, 2018 emphasize these equations for patient safety.

#1 Equation for Patient Safety: Nurses = Patient Safety

The RAFAELA system uses daily data on patients’ care needs and the workload per nurse. It was developed in Finland in the 1990’s to help plan for better nursing staffing allocation than a simple nurse:patient ratio.

A recent study in Finland found that increased nursing workload was related to a decrese in patient safety and an increase in patient mortality.

Writes Bradley T. Truax, MD in “More on Nursing Workload and Patient Safety”:

[Researchers] found that when workload/nurse was above the assumed optimal level, the adjusted odds for a patient safety incident were 1.24 times that of the assumed optimal level.  But when it was below the assumed optimal level the adjusted odds were 0.79. Similarly, when workload/nurse was above the assumed optimal level, the adjusted odds for patient mortality were 1.43 and when it was below the assumed optimal level the adjusted odds were 0.78.

Essentially, that meant that the odds for a patient safety incident were 10% to 30% higher, and for patient mortality about 40% higher, if the nurse workload as measured by the RAFAELA system was above the assumed optimal level. If OPC/nurse was below the level, the odds for a patient safety incident and for mortality were approximately 25% lower.

Nurses = Patient Safety Click To Tweet

#2 Equation for Patient Safety: Doctor Bias = Impedes Patient Care

A survey of 115 ED physicians at the Johns Hopkins Health System found that a “significant number of emergency department (ED) physicians have “low regard” for patients with substance abuse disorders (SUDs) who present with pain.”

The lead study author, Cecelia Mendiola, a fourth-year medical student in the Department of Medicine at Johns Hopkins Bayview Medical Center cautioned that there may be many factors affected patient care:

Unconscious and conscious biases as well as stigma may be part of the story; there are a lot of other factors that can make interactions with these patients challenging, including limited time and limited resources to help patients with complex social situations.

Doctor Bias = Impedes Patient Care Click To Tweet

#3 Equation for Patient Safety: Recognizing Dangerous Abbreviations, Symbols and Dose Designations = Improved Patient Safety

Abbreviations, symbols and dose designations may cause patient safety issues. To help alleviate this ISMP Canada reaffirmed these dangers in “Rearming the ‘Do Not Use: Dangerous Abbreviations, Symbols and Dose Designations’ List” saying:

Abbreviations are commonly used in healthcare to communicate information. However abbreviations, as well as symbols and dose designations, are only helpful when their intended meaning is fully understood by all persons who will be deciphering the information and when there is no potential for misinterpretation. The use of shortcuts when writing medication orders can result in unrecognized or misconstrued abbreviations leading to mistakes during the reading, interpretation, and processing of prescriptions. Certain abbreviations in particular appear to be more error-prone, and the resultant errors may lead to serious or even fatal outcomes.

Recognizing Dangerous Abbreviations, Symbols and Dose Designations = Improved #PatientSafety Click To Tweet

#4 Equation for Patient Safety: Young Adult Deaths = 1 in 5 are Opioid Related

Researchers recently found that 1 in every 5 young adult deaths in the United States is opioid-related.

Dr. Tara Gomes, a scientist in the Li Ka Shing Knowledge Institute of St. Michael’s, commented on the broad implications of the study:

Despite the amount of attention that has been placed on this public health issue, we are increasingly seeing the devastating impact that early loss of life from opioids is having across the United States. In the absence of a multidisciplinary approach to this issue that combines access to treatment, harm reduction and education, this crisis will impact the U.S. for generations.

Young Adult Deaths = 1 in 5 are Opioid Related Click To Tweet

#5 Equation for Patient Safety: Monitoring = Saving Lives

Narcotics can be dangerous, which is why the Physician-Patient Alliance for Health & Safety recommends that all patients receiving opioids be continuously electronically monitored.

Thanks to a pulse oximeter that a doctor sent home helped save the life of his patient:

Amanda had taken a prescription narcotic as outlined by her doctor, Dr. Michael Catten, but he had her do one more thing. Dr. Catten sent Amanda home with a pulse oximeter, a device doctor’s offices and hospitals use to measure the oxygen in a patient’s blood. That’s because of something that had happened to a previous patient named Parker Stewart. He was 21 years old when he died right after a tonsillectomy, and the autopsy said he died of respiratory depression.

So Dr. Catten looked into it further.

“The problem with narcotics is it stunts their desire to breathe. It helps with the pain, but a person doesn’t feel the urge to breathe,” he explained.

Monitoring = Saving Lives Click To Tweet

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