Above All Else Do No Harm…

Above All Else Do No Harm…

Mark your calendars for March 13th through the 19th next year. What’s so special about that week other than the promise of upcoming shamrocks and green beer? The second week of March marks the observance of National Patient Safety Week when healthcare organizations of all sizes and disciplines can put up posters, hold special events and webinars and basically spruce up their efforts to make sure their patients – their reason for existing – don’t leave their practice in worse shape than when they arrived.

But really, why just one week a year. Doesn’t patient safety deserve more than just 5 business days of awareness during the doldrums of late winter? Oddly enough, the first-ever “Patient Safety Day” wasn’t observed or recognized by the World Health Organization (WHO) until September 17th, 2019 when they decided to urge people to show their commitment to making healthcare safer. So before then, did we not recognize the need for patient or healthcare safety?

Joking aside, while having “days” to recognize things like patient safety or National “whatever” day is great to help put a spotlight on important issues or group, the fact remains that a topic like patient safety is something that should be TOP OF MIND every single day and during every patient encounter.

“How can I be focused on patient safety all the time,” you might ask? 

The real question is; “How can you afford not to be?”

For the sake of your patient and your practice, patient safety in all its aspects should be the quiet voice that’s in the back of everyone’s mind at the beginning of the shift, throughout every patient intake/encounter, as you walk through the facility, and even as you are engaging with colleagues.

The World Health Organization estimates that nearly 40% of patients experience some form of harm in ambulatory or primary care settings annually. Nearly 80% of these cases are likely preventable. These patient injuries range from major incidents like medication errors and slip and falls to seemingly minor occurrences like poor communication due to language barriers or even exposure to illnesses from lack of proper infection control or even a sick healthcare worker.

What does patient safety involve? There are several aspects, sometimes depending on the healthcare environment. The 2019 goals as set forth by JACHO involve the basics of the following:

  • Proper patient identification
  • Improve staff communication
  • Medication safety
  • Procedure/surgical safety
  • Reduction of nosocomial infections
  • Identify patient safety risks
  • Use alarms (such as equipment/device alerts) safely

But in the non-hospital setting, many of the above are not common issues. Instead, the priority in the outpatient clinical setting is becoming aware of the risks to the patients. What are the problems areas when it comes to patient safety?

A recent survey of over 4300 events by ECRI Institute reported that the top 4 patient safety risks in ambulatory care practices included the following:

  1. Diagnostic testing errors

Patients experienced missed or delayed diagnoses, delayed interventions or duplication of services related to incorrect or errors related to laboratory tests (69%) or imaging tests (21%)

  1. Medication events

Medications errors are the leading cause of malpractice claims in the ambulatory care setting. Most involve administration of “wrong patient/wrong drug” (67%), followed by monitoring errors (16%.)

  1. Patient falls

A problem regardless of the healthcare setting, patient falls occur in the physician practice setting typically due to lack of screening, attention to the patient or poor facility maintenance.

  1. Security Incidents

Workplace violence has become so commonplace that training and drills for preparedness are as necessary as mandatory fire extinguisher training. Disruptive patient and the frequency of verbal threats, even the possibility of disgruntled employees or associated family/friends all create a need for awareness in order to assure greater patient safety.

Recognizing the threat potential is one thing but creating a plan to prevent occurrences is another. How can your organization become proactive about safety?

Start by identifying a practice champion; a staff member who will take the lead and be a positive, hands-on leader to help keep the team engaged in promoting patient safety during all aspects of operations and patient care. Next, work in conjunction with key leaders and team members to identify weak points within your current facility and operations. Be open, honest and frank. You cannot improve if you do not recognize or challenge yourself to create a better, safer environment for the patient.

Consider implementing a process of inspection that can be quantified. Daily, weekly, or monthly inspections of risk areas can immediately reinforce attention to a problem as well as show improvement as the team begins to practice change and address the safety issue. And be sure to engage your entire team on the process. Simply tossing out words like “patient safety” and “Policy” make it just another rule. Having team members become involved in improving the quality of care and reducing the risk of a negative outcome, can be an opportunity to see what talent and ideas reside within your staff.

While promoting safety among your team is of the utmost importance, be sure to also enforce that reporting deficiencies or problems, even “near-misses” will never be punished. Healthcare workers who fear reprisal from reporting errors or patient safety issues will almost always be more reluctant to come forward with concerns or suggestions for improvement.

Finally, be sure that you also educate and involve your patients. Often, patients do not understand why we have certain procedures in place. Things like having them confirm their name or birthdate prior to a medication administration in order to verify the correct patient may seem just like one huge waste or hassle, but in fact, it’s a valuable and proper step in assuring their safety. Letting them know the reason can go a long way to not only engaging the patient but also showing that their safety is as important as their care.

Most importantly for your practice is to understand that patient safety is a never-ending goal. You will never reach a point where you can proudly proclaim that your clinic is 100% compliant or 100% safe. There will always be something to improve; some frayed cord or wet floor that needs to be repaired, some angry patient or ex-boyfriend that must be dealt with, or some stressed out MA who accidentally draws up Ketorolac instead of Kenalog.

Creating an environment where staff are encouraged to be AWARE can at least provide your patients with a better than average opportunity to avoid an accidental injury. All patients should expect that when they come to a medical provider to receive care, they should at least leave the practice no worse than when they arrived. It’s our duty as healthcare workers to ensure that we not only provide the great care, but we do so in an environment that is safe and in a manner that is held to the highest standard.


Patrice Pash, BSN RN