March 2003 • Volume 9 • Number 3 |
BY TONI LAPP
Take note: March 9 15 is Patient Safety Awareness Week. But devoting a mere week to the issue begs the question: Shouldn't every week be patient safety awareness week?
Absolutely, say doctors, nurses and researchers who were interviewed for this story to get their insights on patient safety.
Susan Dovey, Ph.D., M.P.H., of the Robert Graham Center in Washington has made a career of studying ways to make primary care better. She worked on two studies of patient safety that were published in 2002.
"We now have a good understanding of the types of errors that happen in primary care," she says. At the top of the list are communication errors and office management/filing system errors, all boiling down to one point: not having information you need when you need it.
Value of self-assessment
Most recently published was a study Dovey led on error reporting that described a wide range of errors family physicians observe in their practices. What she has learned has been that the act of recording errors led to an examination of office procedures that many participants found enlightening.
Duncan Etches, M.D., of Vancouver, British Columbia, is a prime example. His nurse practitioner noted how difficult it was to locate data relating to patients' diabetes history in their files when his practice participated in a diabetes outcomes study for AAFP's National Network for Family Practice and Primary Care Research (done in collaboration with the Department of Family and Community Medicine at Baylor College of Medicine, Houston). Shortly after, Etches' practice switched to an electronic medical record system -- and the difference was dramatic. "Now such data can be abstracted with a click of a mouse," Etches says.
In fact, the ease of accessing the information allows Etches to run audits on various patient populations. "Most recently we ran an audit to see what our cholesterol control was in patients who had myocardial infarctions," Etches says. "We wanted to see whether we were following guidelines in achieving targets." What he found was that some patients with elevated cholesterol levels were not being treated. As a result, "some of the patients will be contacted," he says.
Systems of care
AAFP Past President Bruce Bagley, M.D., of Albany, N.Y., cites having tried-and-true systems of care as an important safeguard against practice errors.
Checklists should guide the treatment of patients with special needs such as diabetes or asthma, Bagley says. Know what tests patients are supposed to get and when they're supposed to get them.
"It's all about systems and consistency," he says.
Join AAFP's national research network, participate in studies on patient safetyInterested in doing periodic research in your practice to improve patient care and outcomes? Then consider joining the AAFP National Network for Family Practice and Primary Care Research. Through the network, you and your physician colleagues from across the United States can conduct research in such areas as patient safety, as well as in quality improvement, treatment and control of chronic diseases, and screening and prevention. Data collection for two upcoming patient safety studies begins in April. For application materials, contact Tom Stewart at (800) 274-2237, Ext. 3172, or e-mail tstewart@aafp.org. |
But above all, illegible prescriptions are probably the leading preventable cause of errors, says Bagley, whose practice relies on an EMR system.
If you're among the fortunate few doctors who have EMR systems, you already know the benefits -- legible patient records, immediate access to records, instant review of vital signs, printed prescriptions, automated drug-drug and drug-food interaction checking -- the list goes on.
However, the vast majority of physicians -- 95 percent -- do not have EMRs, according to a Jan. 20 article in the Wall Street Journal. So most physicians must work harder to achieve these safety checks.
"Filing, filing, filing"
If your office still uses paper files and those patient charts could talk, what would they say?
Would they describe myriad opportunities for misadventure? Of being misplaced? Of going through several sets of hands en route from clerk to nurse to physician? Would they tell of not having the most current lab reports filed within? Of waiting on your desk for hours until you transcribe notes?
Michael Hartsell, M.D., of Greeneville, Tenn., took part in Dovey's study of computer versus paper error-reporting systems, which was conducted in AAFP's national research network. He says the experience was "eye-opening."
"I'm not sure that I see EMR as the savior for errors, although it is a step in the right direction," he says. Going to an EMR system is not an option for Hartsell because of concerns over the interface with his practice's current billing system.
For Hartsell, the key to a safe practice is "filing, filing, filing." In his efforts to perform continuous quality improvement in his practice, he's asked his partners, nursing staff and clerical staff to report on what they see as safety issues. What they've found is simple: "Each time you introduce another step where someone has to interact with a patient's chart, then there is opportunity for error," Hartsell says.
In another effort to stay ahead of the flow on patients' charts, Hartsell completes all paperwork while in the exam room with the patient. This includes a quick survey of reports, letters, labs and ancillary data for accuracy, currency and authentication.
"The potential for errors occurs in everything you do every day," he says. "Error prevention becomes a mindset. It's something you get up and work on each day."
To learn more about quality initiatives to enhance patient safety, visit http://www.ihi.org. For more on AAFP quality initiatives, go to http://www.aafp.org/quality.xml.
To reach writer Toni Lapp, e-mail tlapp@aafp.org.
FP Report is published by the
AAFP News Department.
Copyright © 2003 by
American Academy of Family Physicians.