Enhancing Patient Safety

Enhancing Patient Safety

Patient Safety

Is the avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from the processes of healthcare. These events include errors, deviations, and accidents. Safety emerges from the interactions among the components of the system; it does not reside in a single person, device, or department. Patient safety is a subset of healthcare quality. Quality of care is the extent to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

The concepts of quality and safety are a continuum. There is no uniform agreement on their differences in the larger healthcare community. Some view safety as a subset of quality; most agree that quality care must be founded on safe care.

Quality Assurance is the formal and systematic monitoring and reviewing of medical care delivery and outcome; designing activities to improve healthcare and to overcome identified deficiencies in providers, facilities, or support systems; and the carrying out of follow up steps or procedures to ensure that actions have been effective and no new problems have been introduced. In the context of anesthesia, quality can be thought of as a balance between providing the patient a healing experience with the least possible pain and discomfort, optimal conditions for surgery, smooth flow of patient care for the organization, and absolutely no injury or unwanted complication caused by the anesthetic.

The concepts of patient safety, quality assurance, and risk management (the clinical and administrative activities undertaken to identify, evaluate, and reduce the risk of injury to patients, staff, and visitors, and to identify, evaluate, and reduce the risk of loss to the organization itself) are related but have important distinctions. Patient safety is focused on prevention of injury. Quality assurance generally deals with the broader spectrum of quality, including the success of treatments. Risk management historically was directed at managing the aftermath of adverse outcomes, especially to manage legal issues, malpractice, and avoidance of financial loss for insurers. But modern risk management is focused on proactive patient safety, based on the principle that prevention of injuries via error reduction and system improvements reduces the adverse events from malpractice.

Practical Elements for the Practitioner for Producing Safe, High-Quality Patient Care

Safety demands that each individual, as well as an organization, make preventing any injury or harm to the patient the highest priority. For the individual clinician, a continual commitment to safe practice includes avoidance of unnecessary risk taking, almost unending anticipation of what might go wrong, projection of actions in anticipation of failure and, above all, mindfulness, (better notice the unexpected in the making and halt its development). Being patient centered includes placing the patient's needs above all others, especially protecting the patient from harm.

Although vigilance cannot be relied on solely to protect the patient from harm, it remains the strongest under-pinning of safety in anesthesia. This means that the anesthesia provider must maintain alertness and be aware of, compensate for, and counteract the forces working against vigilance. This, too, requires mindfulness about the state of one's own vigilance. Fatigue and sleep deprivation are probably the most common causes of lapses in vigilance.

Anesthetists must identify and integrate into the larger system of care in which they operate. Safe care depends on the effective work of many others working as a team, and understanding their constraints and processes can go far toward creating an environment of safety.

Although teamwork can be seen as a subset of working within a system of care, it also includes specific practices for optimizing safety.

The failure to adequately prepare for anesthesia administration often con-tributes to anesthesia critical incidents. Preparation encompasses a large set of issues, including complete preoperative assessment (see Preoperative Assessment and Planning in module 3); ensuring availability of emergency drugs, equipment, and supplies; checking out the function of equipment (look session IV); and ensuring communication path-ways in the event of an emergency.

Preoperative assessment and planning involves evaluation of the patient and development of the anesthesia plan that includes the anesthetic technique, the requirements for monitoring, and the plans for postoperative care, all of which must be consistent with the wishes of the patient and the needs of the surgeon, and the re-sources of the facility. The evaluation must be thorough and appropriate for the procedure and the patient; most especially, it must include a systematic evaluation of co-morbidities or other factors that might lead to adverse outcomes. Even in healthy patients, there may be conditions that can lead to adverse events, such as difficult airway access, family history of relevant disease, or the recent use of nonprescription or illicit drugs

Because failure to monitor is so often associated with adverse outcomes, this issue deserves special attention.

Attention to the organized arrangement of supplies and drugs, especially adherence to consistent labeling of drugs, and establishing and adhering to local standards are examples. Care to keep intravenous cannula and monitoring cables orderly ensuring reasonable lighting, and reducing clutter, noise, and distractions are general, sound, safety practices.

Care in the safe use and sterility of all anesthesia systems is essential.

Adherence to carefully timed protocols for antibiotic administration in the perioperative interval reduces postoperative wound infection. Surgical wound infection rates are increased 3-fold by hypothermia.