Friday, December 11, 2009

Patients Play Key Role In Quality Movement

To Err Is Human Blog Series Logo

This post is part of our two-week series commemorating the 10-year anniversary of the seminal IOM Report "To Err Is Human." To see all posts in the series, please click here.

Teamwork has become a standard of care in many U.S. hospitals since the IOM released its landmark report on medical errors, says nurse researcher Kathleen Stevens at The University of Texas Health Science Center at San Antonio.

That team often includes nurses, doctors and other health professionals who work together to both check for errors and provide the highest standard of care, Stevens says. But she says that more and more hospitals are starting to involve patients and family members in the final effort to raise the bar on quality.

For example, nurses on a neonatal intensive care unit often provide one-on-one care for tiny babies. But the mother is often at the bedside for hours and in some cases is the first line of defense against an error or complication, Stevens says. If the mother notices the baby seems to be showing signs of distress, she can press a button on the side of the bed and call for a rapid response team.

That team examines the baby right away and can start treatment that prevents the condition from worsening. Such rapid response teams used to be called by health care workers, and often by the nurse, says Stevens. But in the wake of the IOM report, many hospitals shifted to a team approach to providing quality of care.

Instead of being left out, patients and families now are often brought onto that team and asked to provide a final safety check, Stevens says. After all, a mother who is caring for her premature baby in the intensive care unit is probably more acutely aware of even tiny signs of distress and might be able to sound an alarm at a much earlier stage.

Since the IOM issued its report in 1999, hospitals have been searching for ways to reduce errors and improve the quality of care from administration on down to actual bedside care. For example, Stevens has INQRI funding to learn if training nurses to reduce workarounds – temporary “band-aid” solutions to recurring glitches in patient care – can create a team culture that values removing the underlying causes of those glitches. For example, rather than squirting out the extra medication in a syringe when the pharmacy prepares too large a dose, the nurse can alert her team that they need to collaborate with the pharmacy to prevent such errors from recurring.

But Stevens says that one of the most dramatic changes of the past decade has been the way that some hospitals have given family members and patients more authority to sound an alert, which might prevent an error or lead to better care.

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