Medication Safety Survey

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Medication safety is of critical importance to patient safety. As frontline nurses play a vital role in ensuring medication safety, this survey of nurses presented by HarrisInteractive and McKesson gives critical insight into the state of patient safety.

Saúde e medicina Negócios

Executive Summary

June 2005

FRONTLINE NURSES’ PERCEPTIONS
O F T H E S TAT E O F PAT I E N T S A F E T Y

SURVEY CONDUCTED BY SPONSORED BY

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A SPECIAL S U P P L E H E N T TO THE H/HTIHGS CENTEH REPOUT ETY i ! . : i, . - w , ; , • • ' • ' i l POLICY DELIBERATIOI VIRGINIA A. SHARPE On the cover: Hospital, by Frank Moore, 1992. Oil on wood with frame and attach- ments. 49" X 58" overall. Private Collection, Italy. Courtesy Sperone Westwater, New York. This is the final report of a two-year Hastings Center research project that was launched in response to the landmark 1999 report from the Institute of Medicine, To Err Is Human, and the extraordinary attention that policymakers at the federal, state, regulatory, and institutional lev- els are devoting to patient safety. It seeks to foster clearer and better dis- cussion of the ethical concerns that are integral to the development and implementation of sound and effec- tive policies to address the problem of medical error. It is intended for policymakers, patient safety advocates, health care administrators, clinicians, lawyers, ethicists, educators, and oth- ers involved in designing and maintaining safety policies and practices within health care institutions. Among the topics discussed in the report: H the values, principles, and per- ceived obligations underlying patient safety efforts; • the historical and continuing tensions between "individual" and "system" accountability, between error "reporting" to oversight agencies and error "disclosure" to patients and families, and between aggregate safety improvement and the rights and welfare of individual patients; • the practical implications for patient safety of defming "respon- sibility" retrospectively, as praise or blame for past events, or prospec- tively, as it relates to professional obligations and goals for the fu- ture; S the shortcomings of tort liability as a means of building institutional cultures of safety, learning from error, supporting truth telling as a professional obligation, or ad- equately compensating patients and families, contrasted with alter- native models of dispute resolu- tion, including mediation and no- fault liability; SB the needs of patients, families, and clinicians affected by harmful errors and how these needs may be addressed within systems approaches to patient safety; and SI the potential conflicts berween the protection of patient privacy required by the Health Insurance Portability and Accountability Act and efforts to use patient data for the purposes of safety improvement, and how these conflicts may be resolved. Although this report is the work of the project's principal investigator, not a statement of consensus, it draws from the insights of the interdiscipli- nary group of experts convened by The Hastings Center to make sense of the complex phenomenon of patient safety reform. Working group mem- bers brought their experience as people who had suffered from devastat- ing medical harms and as institutional leaders galvanized to reform by tragic events in their own health care institutions. They br.

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2 8 5 L e a r n I n g o b j e c t I v e s C H A P T E R 1 0 Q U A L I T Y M A N A G E M E N T I N T H E P H Y S I C I A N P R A C T I C E Quality and reliability are system properties. —W. Edwards Deming ➤ Articulate the nature of performance management. ➤ Describe the approaches to performance improvement. ➤ Appreciate the impact of variation on performance. ➤ Discuss the components of the Triple Aim. ➤ Describe process improvement. In t r o d u c t I o n One of the most important issues to address in the medical practice is the quality and safety of the care provided to patients. The Institute of Medicine (IOM 2001), a presti- gious branch of the National Institutes of Health, stated in its landmark report Crossing the Quality Chasm: A New Health System for the 21st Century, “In its current form, habits, and environment, American health care is incapable of providing the public with the quality health care it expects and deserves.” C o p y r i g h t 2 0 1 7 . H e a l t h A d m i n i s t r a t i o n P r e s s . A l l r i g h t s r e s e r v e d . M a y n o t b e r e p r o d u c e d i n a n y f o r m w i t h o u t p e r m i s s i o n f r o m t h e p u b l i s h e r , e x c e p t f a i r u s e s p e r m i t t e d u n d e r U . S . o r a p p l i c a b l e c o p y r i g h t l a w . EBSCO Publishing : eBook Academic Collection (EBSCOhost) - printed on 4/16/2020 7:48 PM via SUNY CANTON AN: 1839064 ; Wagner, Stephen L..; Fundamentals of Medical Practice Management Account: s8846236.main.ehost F u n d a m e n t a l s o f M e d i c a l P r a c t i c e M a n a g e m e n t2 8 6 Another historic IOM (2000) report, To Err Is Human: Building a Safer Health System, indicated that a shocking number of people—an estimated 44,000 to 98,000 per year—are harmed by the healthcare system. A more recent study found that this number has increased since publication of the 2000 IOM report despite substantial efforts to improve. Medical errors have now become the third leading cause of death in the United States (Makary and Daniel 2016). The complexity of medical service and the inconsistency with which these services are delivered, not to mention the fragmented nature of the system, have led to a number of quality concerns (Mosadeghrad 2014), including a lack of systematic approaches to care delivery and quality improvement. Efforts to improve quality in the medical profession have a long tradition of focusing on individual performance versus system performance. Exhibit 10.1 illustrates the potential flaw in this thinking. The bell-shaped curve, P-1, represents the overall performance of any given system. Curve P-2 illustrates an improved system of performance where the median performance is moved from M-1 to M-2. If an organization seeks to improve by only focusing on the low performers, it experiences only a small improvement, shown as I-1. By improving th ...

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