Safety really doesn’t happen by accident

Feb. 28, 2017

In November of 2016, ECRI Institute, an independent medical device testing laboratory and investigator of technology-related incidents, announced the launch of its “Top 10 Health Technology Hazards for 2017” list. Produced each year by the organization’s Health Devices Group, the list identifies specific potential sources of danger that warrant heightened attention for the coming year. It also provides a starting point for clinics, care centers, and hospitals alike to establish priorities and implement solutions.

First on the list is infusion errors that can still occur when using large-volume infusion pumps, followed by inadequate cleaning of complex reusable instruments (including duodenoscopes, which have gotten a lot of media attention in the past year), ventilator alarm management, infection risks with heater-cooler devices, undetected opioid-induced respiratory depression, software management oversights, and occupational radiation hazards in hybrid ORs. Automated dispensing cabinet set-up and use errors, surgical stapler misuse and malfunctions, and device failures caused by cleaning products and practices rounded out the list.

Given that research from Johns Hopkins published last May in The BMJ named medical errors as the third-leading cause of death in the United States, it has never been more crucial to discuss causes and remedies on this topic. In that light, HMT asked a roundtable of relevant solutions providers about their latest technology offerings to pinpoint, control, and combat patient safety risks in healthcare settings. We also asked about trends in the HIT patient safety space and the biggest obstacles that users face when trying to keep patients safe while maintaining compliance to a growing number of procedures and regulations.

Integrating safety into the background workflow

By Trey Cook, Vice President and General Manager, Clinical Workflow Solutions, Hill-Rom

There is a growing realization of the lack of time caregivers are able to spend directly with patients. We know the best way to improve patient care and satisfaction is to maximize this time. However, a lot of today’s technology creates additional tasks for caregivers. These extra tasks further reduce a caregiver’s time with patients. This, understandably, creates technology adoption challenges, making change management even more onerous. To put it simply, we believe any technology that exacerbates the cognitive burden of caregivers, instead of being part of the solution, is destined to ultimately fail.

Latest offerings

We are focused on helping clinicians better protect patients by anticipating care. We are specifically focused on helping to improve patient satisfaction and reduce patient falls, two top-of-mind issues for nearly every hospital. By addressing these two challenges, our customers can improve patient outcomes and financial performance.

Our solutions aim to be at the center of the hospital’s clinical information systems, collecting the information that matters about patients and their environments. Through real-time analysis of this information, our solutions are able to identify opportunities to improve care and deliver actionable insights to caregivers and patients.

We recognize technology is change, which is never easy. That is why all of our solutions are supported by clinicians, every step of the way. For example, with our NaviCare Nurse Call solution, we are able to capture a holistic view of the patient environment. Our system captures specific patient needs, caregiver locations on the unit, safety status of devices in the room, and compliance of caregivers to key protocols like rounding, just to name a few. Real-time analysis of this data allows us to notify staff proactively about patients in need of care. Seemingly simple actions like notifying caregivers if their patient’s bed is in an unsafe state or reminding a caregiver that a round is due are examples of turning data into insight that can help caregivers improve patient safety and satisfaction.

Our newest solution is NaviCare Patient Safety, which automates falls protocols to help ensure patients are in a safe state at all times. It achieves this by automatically turning bed safety settings on or off based on patient risk, patient presence, and caregiver location.

For example, upon patient admittance, many hospitals are performing a falls risk assessment on that patient and documenting falls risk in the EMR. If the patient is deemed a falls risk, we pull that data automatically from the EMR and notify our bed. Then, the second the bed detects a patient’s presence and the caregiver is known to be outside the patient room, we automatically set our bed exit alarm and bed status monitoring. If the bed ever enters an unsafe state (e.g., a family member lowers a side rail or physical therapy raises the bed height and forgets to lower it) or the bed exit alarm goes off, we can automatically, in real time, notify the caregiver. And when the caregiver enters the room, all alerts and alarms are silenced so the caregiver can go straight to caring for the patient instead of having to worry about turning off alarms.

We believe this solution is powerful because it is asking nothing additional from caregivers and doesn’t add steps to their workflow. The solution is simply a fail-safe in the background ensuring that, no matter what happens, the patient is being kept in as safe a state as possible as it relates to fall prevention.

It’s more than a numbers game

By Steve Elder, Senior Marketing Manager, STANLEY Healthcare

One of the major trends healthcare organizations are continuing to embrace throughout the HIT patient safety space is a greater and more nuanced use of analytics to not only better understand current performance, but to also develop insights and drive improvement. For example, the integration of business intelligence platforms has helped hospitals uncover a more accurate real-time picture of the location, status, and usage of assets, including performance against par-level targets to ensure patient safety. While the integration of analytics for process analysis will continue to increase, we will also see an evolution toward the integration of predictive analytics—especially in areas such as asset utilization—that enable the hospital to address any potential issues before they happen.

Automated hand hygiene monitoring helps hospitals drive higher compliance levels.

Latest offerings

STANLEY Healthcare’s key solution offering is real-time location of patients, providers, and equipment coupled with analytics to understand the complex interrelationships between these elements. Our solutions touch on patient safety in a number of ways. The ability to access real-time visibility into foundational patient safety tasks such as the storage of sensitive pharmaceuticals and tissues is one of the key features of STANLEY Healthcare’s solutions from which customers drive value. This data has allowed healthcare organizations to automate many of these vital processes, which has simultaneously improved accuracy and enabled doctors and nurses to focus on other areas of patient safety. RTLS solutions also play an important role in ensuring the safe management of mobile medical assets, primarily through the integration with other HIS systems such as pump management systems. By ensuring these devices are not only in the right locations but are also ready for use when needed, our solutions help fulfill a critical patient safety need.

We recently released our integrated Hand Hygiene Compliance Monitoring solution, which is an interesting example of how analytics and automation can impact patient safety on a daily basis. This solution provides organizations with reliable data on when staff wash their hands upon entering or exiting patient rooms, giving hospitals actionable data not only for reporting purposes, but to also inform any actions that could improve hand hygiene throughout the organization. STANLEY Healthcare’s Hand Hygiene Compliance Monitoring solution also makes the data easily accessible and actionable, and is part of the “By Your Side” lifetime customer care commitment that is at the core of all our solutions.

Comprehensive event reporting and analysis all in one

By Andy Weissberg, SVP Marketing Communications, Quantros

Despite some declarations of major success in the effort to make care safer for patients, others would argue that improvement has been minimal at best. As aggregate safety data suggests, the federal dollars applied to improving patient safety have had minimal impact on containing the problem of preventable harm and have not identified collective failure points or rewarded systematic remediation. Short-term government grants, such as the Partnership for Patients’ HEN 2.0 grants, require healthcare organizations to perform tests of change meant to improve care, collect data, and demonstrate measurable improvement—all within a one-year time frame. That favors a human capital and consulting approach.

Hiring temporary staff members to “nag” providers to do the right thing is neither sustainable nor cost effective. Broadly introducing new and innovative safe practices to transform systems is more likely to be successful. Meaningful Use incentives applied to incident reporting systems can be one effective catalyst for aligning around new and innovative priorities. System enhancements to incident reporting must shift away from what is today largely an “intake orientation” that supports reactive reporting of incidents of harm to an outcomes-based orientation centered on the proactive reporting of actions that constitute safe performance.

Latest offerings

Niches that Quantros fills in the HIT patient safety market include:

  • Safety event reporting;
  • Event investigation and root-cause analysis;
  • Tracking patient experience;
  • Adverse event surveillance;
  • Infection surveillance;
  • Infection control; and
  • Safety performance measurement and benchmarking.

The Quantros Safety and Risk Management Solutions Suite (SRM Suite) enables healthcare providers to improve quality and patient safety by providing the information they need to prevent errors, improve outcomes, and reduce risks and costs. SRM offers a single access point for users to manage their safety-related claims, risk management, and event reporting activities. The applications support the reduction of patient safety events via automated alerts, real-time reporting, and sophisticated root-cause analysis. The Quantros SRM Suite includes several modules and applications:

  • Quantros Safety Event Manager: Enables intuitive event reporting, workflow tracking, and robust analytics for advancing safety and mobilizing performance improvement.
  • Quantros Root Cause Analysis: Facilitates investigation of systemic causes of serious reportable events (SREs), never events, and sentinel events. It also offers tools for building and deploying corrective action plans to help improve staff accountability and safety culture.
  • Quantros Safety Surveillance: An automated system that captures events that are not voluntarily reported to your safety event management system through near-time surveillance of billing data.
  • Quantros Feedback Manager: Used to analyze feedback and insights collected from patients, staff, and visitors to measure and improve patient satisfaction.
In the spring of 2016, Quantros launched the newest version of its Quantros Safety Event Manager application (Quantros SEM). A mobile “light” version of the application is also now available as of mid-December 2016. The updated version and mobile application have both further streamlined and made the event reporting process easier and more convenient for clinicians and staff across the enterprise.

The event classification process utilized during the early stages of the event reporting lifecycle is optimized by way of Quantros’ Smart Classification technology, which allows users to enter a simple narrative description of the event and submit it to the system for automatic classification based on comparison to a database of more than 6 million events. Smart Classification truly streamlines the event entry process, significantly reducing event entry time and eliminating some of the traditional usability barriers. It also allows organizations to have a consistent and standardized way of capturing events, which ultimately provides actionable and meaningful data across the organization.

Quantros also upgraded the reporting and analytics capabilities in the new version, enabling risk managers and department leadership to generate quantitative and qualitative analysis of reported events and near misses categorized by patient, type, or severity. Managers can compare performance across departments and other facilities.

In March 2016, Quantros also acquired Comparion Medical Analytics and has since fully integrated its Performance Analytics Solutions into the Quantros Enterprise Solutions Suite. With regards to patient safety, the CareChex Hospital Quality Ratings Analysis and Physician Quality Ratings Analysis modules enable hospitals and health systems to track, measure, and benchmark patient safety and quality performance at a comprehensive level across all service lines for hundreds of diagnoses, procedures, and areas of treatment spanning 37 clinical categories of inpatient and physician office-based care.

It’s all about documentation

By Brenda Hodge, Senior Vice President of Healthcare Marketing, Nuance

Increased tracking and reporting of quality metrics in hospitals is a major trend that is becoming a top-of-mind issue for more and more hospital administrators. Patient safety has always been a concern, but with increasing penalties and denials for hospital-acquired conditions, readmissions, and failure to prove medical necessity, millions of lives and dollars are at stake. What most people don’t realize is that clinical documentation accuracy is central to all of these.

Many doctors don’t realize that how they document is just as important as how they provide care, and clinical documentation is central to demonstrating that they are doing the right thing for patients at the right time. Comprehensive CDI programs and new computer-assisted physician documentation tools help automate this process and arm physicians with the tools they need to easily document care decisions naturally within their workflow, keep information flowing and accurate throughout patient care, protect the patient, and preserve reputations.

Latest offerings

Nuance provides intelligent systems that healthcare professionals use to naturally and accurately capture, improve, and communicate more than 300 million patient stories annually. These solutions deliver high-quality documentation across the clinical care continuum, providing the right information at the right time in order for clinicians to optimize patient care. Using speech recognition, language understanding, EHR integration, clinical documentation improvement, cloud-based image sharing, and coding solutions, Nuance’s clinical approach promotes accuracy from the point of care, which provides many downstream benefits to hospitals and health systems.

Our latest solution is Nuance’s Dragon Medical Advisor, a speech-enabled computer-assisted physician documentation tool that supports physicians at the point of care while they are charting directly into the EHR. If they miss something, the system will advise them on how to adjust for increased specificity. Additionally, Nuance’s complete clinical documentation improvement programs help clinicians spend 50% less time documenting patient care. Documentation of patients is improved with these solutions, which improves patient safety and quality by giving stronger patient narratives to the rest of the care team. The below results demonstrate the benefits:
  • 20% more relevant clinical content captured;
  • Improved capture of severity of illness (SOI) and risk of mortality (ROM) through better documentation in the EHRs;
  • Real-time access to clinical guidelines;
  • Reduced hospital-acquired conditions through quality measures and performance analytics;
  • A compliance rate of 95% to 100% for key quality measures; and
  • A satisfaction rate among clinicians of 98% for Nuance’s CDI programs.

Unifying workflow

By Si Luo, President and CEO, PatientSafe Solutions

PatientSafe Solutions’ PatientTouch platform delivers real-time patient, clinical, and care team data in secure message to speed collaboration and improve safety. The platform unifies communication with clinical workflows in a single smartphone application for the entire frontline care team. Secure messaging, voice, alerts, and nurse calls are integrated with clinical workflows including medication and blood product administration, infant care, specimen collection, patient safety assessments, and more in one user experience. Integrated with the EMR, other clinical systems, and IT infrastructure, PatientTouch delivers relevant patient and clinical data to the right care team member in-message and in-workflow for more efficient, safer care.

Our Positive Patient Identification workflows ensure the seven rights of medication administration, reduction in specimen mislabeling during the collection process, safe blood product handling and administration, and mother-baby-breast milk matching. Results at our partner hospitals include 100% reduction in wrong dose, wrong meds at the point of administration, 100% of transfusions successfully cross-matched, 50% reduction in response times to rapid patient deterioration, and 32% reduction in Hospital Acquired Conditions.

PatientTouch Clinical Inbox

One trend we see is the ongoing search for a technology-enabled solution to meet evidence-based best practices in the domains of nursing-sensitive quality outcomes, high-reliability environments, and safely managing transitions of care.

There is an evolution away from deeply embedded EMR content that is difficult to access and use during the natural flow of care delivery. We are beginning to see an emphasis on real-time systems that facilitate workflow execution and clinical decision support and apply machine learning to point-of-care workflow patterns to continuously grow the body of evidence for what’s working in quality and safety.

The biggest obstacles users face is the lack of workflow-centric user experience design and the industry’s ongoing challenges with true interoperability, though the latter is getting better by the day.

Latest offerings        

PatientSafe is launching enhanced enterprise capabilities and voice communications and additional clinical workflow modules this spring for PatientTouch. The release includes the following:

  • Dynamic user assignment and management

A key addition in 4.1 is the Enterprise Manager, which enables dynamic user assignment management and context-aware care team directory and role-based routing, ensuring that all order notifications, texts, alerts, and nurse calls are sent to the right caregiver at the right time, with the right patient and clinical context.

  • Direct integration to PBX

The platform integrates with EMRs and is interoperable with telephony, ADT, telemetry, and other systems that are part of an organization’s current infrastructure. As an extension to the current platform, Enterprise Manager provides direct integration with, and management of, an organization’s multiple PBX systems and synchronizes user accounts with Active Directory.

  • Superior voice communications

As an Apple Mobility Partner, PatientSafe supports CallKit on iOS 10 for more intuitive call handling within the PatientTouch application. Cisco Fast Lane enables prioritization of critical communications on iOS and ensures high quality of service throughout the hospital.

  • Rounding, Early Warning System (EWS) and sepsis workflows

Adding to current clinical workflows including medication administration, specimen collection, assessments, and nursing documentation, PatientTouch now includes modules for rounding, EWS, and sepsis. The rounding module increases HCAHPS scores by driving more consistent rounding, better nurse-patient communication, and understanding of patient needs. EWS and sepsis workflows are incorporated scheduled vitals collections to help the care team more frequently evaluate the signs of worsening patient condition and take steps to address patient needs and acuity of care needs, reducing hospital-acquired conditions and preventable mortality rates.

This is a long-term solution and improvement for our current and future customers. When clinical communication and workflow are unified, the care experience is transformed, and care teams are able to deliver the best possible results.

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