EDITOR’S NOTE: Robert Bayly, M.D., explains how the adoption of evidence-based protocols – like electronic medical records (EMRs) – can help avoid many preventable mistakes that are greatly improving patient safety.
As vice president of quality and patient safety at JFK Medical Center in Edison, Robert Bayly, M.D., draws on everything from the latest scientific research and national guidelines to his experience as a critical-care physician to implement programs that protect patients’ well-being during a hospital stay.
During a recent interview with NJ Advance Media, Dr. Bayly discussed the scope of patient-safety issues on a national level and the initiatives that have caused JFK Medical Center to be recognized for its leadership in this area.
Q. It seems that every few weeks there is a news report about a patient-safety issue at a hospital somewhere in the United States, whether it be an infection being spread within the institution or some sort of error that led to a patient receiving the wrong drug or being injured. What is the extent of this problem?
A. In 1999, the Institute of Medicine released a report estimating that 98,000 Americans die each year due to preventable medical mistakes, whether in the hospital setting or elsewhere. That statistic is somewhat dated, but brings the issue into focus. Since then, great strides have been made, but much more remains to be done. More recent reports, using somewhat different criteria, put the number of avoidable deaths even higher. To look at just one aspect of the overall issue, the Centers for Disease Control and Prevention (CDC) reported that in 2011, one patient in 25 acquired an infection while in the hospital. That amounts to roughly 722,000 healthcare-associated infections, or HAIs, and the CDC estimates that 75,000 people with HAIs died during hospitalizations that year, whether due to the HAI itself or another cause.
Q. Those numbers are startling, but what improvements are being made?
A. The numbers are startling, in their own right, because hospitals are thought of as places where an individual heals and recovers, not acquires a new illness or injury. The great majority of patients who are hospitalized do not encounter any of these problems, but more work needs to be done to further reduce the number of infections, injuries and other issues.
Improvements are being made on several fronts, and many are being driven by the adoption of evidence-based protocols that every member of the team follows to prevent a mistake, an injury or the transmission of infection. The use of electronic medical records, or EMRs, helps in this regard, because each member of the care team has access to information about the patient and the care he or she is receiving. These EMRs also have a number of built-in safety features, such as alerts that warn a nurse about a patient’s allergies or that flag a possible drug-drug interaction when a physician wants to add a new drug to the patient’s regimen.
Q. What are some of the other safety issues involved?
A. There are many, but some of the other major ones include preventing falls, avoiding the development of pressure ulcers — commonly referred to as bed sores — and preventing blood clots, particularly in patients who have had major surgery.
Q. JFK Medical Center has been recognized for its leadership in this area. An independent organization, known as The Leapfrog Group, recently awarded JFK Medical Center an “A” for patient safety for the seventh consecutive reporting period. How is this success achieved?
A. A number of programs have been developed to address specific issues, but the main thing is a multidisciplinary approach, in which every member of the care team has a voice, a role and a responsibility. The office Quality and Patient Safety is staffed with talented people, but doesn’t just issue directions to front-line clinical personnel. Everyone who has a role to play in patient care is identified and those people are brought together to review the latest evidence and guidelines and to discuss how to best integrate the science and the guidance. When people know not only what they’re supposed to do, but why and why it matters to patients, they are fully invested and committed. Similarly, when each team member’s knowledge and experience is drawn upon, approaches that reflect the reality of day-to-day care are discovered and, as a result, are very effective.
Q. What are some of the programs that have been implemented to promote patient safety?
A. One example is the closed-loop process for guarding against medication errors. When a physician prescribes a drug for a patient, he or she does so via a computerized physician order entry system. The hospital pharmacy reviews the prescription to ensure that there are no issues with drug-drug interactions, allergies or other potential problems. Robots are used for the actual dispensing and delivery to the correct location, and when the medication reaches the floor, a nurse uses a bar code scan to confirm that it is the right medication, in the right dosage and for the right patient.
Nationally validated protocols are used — specifying why, when and how to insert and remove central lines and catheters, which can be sources of infection. Substantial strides have been made in preventing deep vein thrombosis, or the development of blood clots in the legs. Through the use of a protocol, a nurse first performs a risk assessment on each patient, then preventative measures individualized to each patient are implemented. Similarly, substantial progress has been made in preventing the development of pressure ulcers through a system of risk assessment, simple preventive steps and peer rounding and review.
Q. What can patients and their families do to help avoid some of these problems?
A. The first and most vital step is to ask questions. If being given a medicine, ask what it is and what it is for. Ask about potential side effects and interactions with other drugs. If there is a concern, raise it. In addition to getting information, it’s also important to give information. A patient should make sure the physicians, nurses and others issuing care know about symptoms that are being experienced. These caretakers also should be informed of medical history, medications and anything else that may be relevant. If a patient is gravely ill or has dementia or some other cognitive difficulty, the family or other caregivers have to be the ones who provide this background. Even when patients are fully capable of providing information, however, it’s helpful for the family to be informed and involved. In short, when it comes to patient safety, knowledge truly is power and the more the patient knows, and the more the hospital’s care team knows, the better care can be issued and problems avoided.