5 Tips for Improving Patient Safety

Tip #1 - Follow These 5 Keys to Reduce Harms from Opioids

ECRI Institute recently released the 2016 Top 10 Patient Safety Concerns for Healthcare Organizations. Of ECRI's top 10 patient safety concerns, inadequate monitoring for respiratory depression has the greatest likelihood of preventable harm. This occurs when the patient receives opioids and is not monitored effectively and sufficiently. ECRI says that inadequate monitoring for respiratory depression in patients receiving opioids poses the greatest risk to patients and assigned it a risk map of 80.

In an interview with ECRI's Patient Safety Analyst, Stephanie Uses, PharmD, MJ, JD, five keys to reducing harms from opioids are discussed.

Tip #2 - Monitor Patients Receiving Opioids with Capnography

On the sixth death anniversary of 18-year old Amanda Abbiehl, July 17, 2016, the motto of A Promise to Amanda Foundation – "Capnography Saves Lives" – is increasingly being realized.

The following organizations have this year endorsed the use of capnography monitoring:

• Association of periOperative Registered Nurses (AORN) – "the perioperative RN should monitor exhaled CO2 (ie, end-tidal CO2 [EtCO2]) by capnography in addition to SpO2 by pulse oximetry during moderate sedation/analgesia procedures."
• Association for Radiologic and Imaging Nursing (ARIN) – "ARIN endorses the routine use of capnography for all patients who receive moderate sedation/analgesia during procedures in the imaging environment. This technology provides the critical information necessary to detect respiratory depression, hypoventilation, and apnea, thus allowing the timely initiation of appropriate interventions to rescue the individual patient. Capnography use is associated with improved patient outcomes. Capnography should be used at all times, regardless of whether sedation is administered by an anesthesia provider or a registered nurse credentialed to administer moderate sedation/analgesia medications."
• American Academy of Pediatrics (AAP) and American Academy of Pediatric Dentistry (AAPD) – The lead guideline author Charles J. Coté, MD, explained that the updated guidelines contain two major changes, "The first has been to add capnography monitoring of children who are deeply sedated and to encourage capnography for children who are moderately sedated. Capnography measures expired carbon dioxide to ensure airway patency and gas exchange."

Tip #3 - Learn from St. Joseph's/Candler Health System's More Than 10 Years Being 'Event Free'

St. Joseph's/Candler Health System (SJ/C) has experienced more than ten years of patient safety. Moreover, although a human life should never be measures in dollars and cents, SJ/C calculated that over the 5-year period from 2002 to 2007, SJ/C:

• Saved $4 million — estimated potential expenses averted (not including potential litigation costs).
• Had a 5-year return on investment of $2.5 million.

To better understand how SJ/C did this, PPAHS interviewed Harold Oglesby, RRT, Manager, The Center for Pulmonary Health at SJ/C.

Tip #4 - Use Higher Safety Standards to Reduce Exposure to Liability Claims

The death of Joan Rivers provides a learning opportunity to prevent other patient deaths from occurring.  In "Medical standards of care and the Joan Rivers death," differing standards of medical care recommended by The American Association for Accreditation of Ambulatory Surgery Facilities ("AAAASF") and American Society of Anesthesiologists ("ASA").

Using a higher standard of care may reduce exposure to liability claims.

Tip #5 - Recognize the Signs of Respiratory Compromise

Key medical and healthcare stakeholders launched the Respiratory Compromise Institute to drive actionable solutions that increase education about and reduce the incidence of respiratory compromise in inpatient hospital settings.

Tim Morris, MD, President of NAMDRC and Chair of the Institute's Clinical Advisory Committee, explained the necessity of recognizing Respiratory Compromise:

"Preventing or mitigating decompensation is critical because nearly any patient could be at risk and succumbing quickly to Respiratory Compromise. One minute you have a patient who is doing fine and within a few minutes the patient rapidly deteriorates to a dangerous point of no return. In many cases, if we could detect this deterioration earlier, we could prevent the need for massive intervention."

About Physician-Patient Alliance for Health & Safety

Physician-Patient Alliance for Health & Safety is a non-profit 501(c)(3) whose mission is to promote safer clinical practices and standards for patients through collaboration among healthcare experts, professionals, scientific researchers, and others, in order to improve health care delivery. For more information, please go to www.ppahs.org.