Strategies for improving safety through patient and family involvement in care
Institutions create ways to achieve latest National Patient Safety Goals
In order to successfully meet the requirements of many of the National Patient Safety Goals for hospitals, educational initiatives must be created and applied.
This is especially true of a goal added in 2007:
Goal 13 states: "Encourage patients' active involvement in their own care as a patient safety strategy."
Goal 13A states: "Define and communicate the means for patients and their families to report concerns about safety and encourage them to do so."
"In order for patients and families to do this, they have to know that involvement is wanted and they have to understand how to go about it so that is where education comes in," says Richard J. Croteau, MD, executive director for patient safety initiatives at The Joint Commission in Oak Brook, IL.
Croteau explains that organizations are required to provide ways for patients and families to express their concerns about safety. In addition, they must go beyond giving patients permission to discuss concerns and actively encourage them to do so.
"The general message is there are a lot of ways to do this, and it is probably a good idea to have more than one way in an organization," adds Croteau.
Part of the education process is to help patients and families become more observant and know when to speak up. (To learn more about the types of things in which to teach patients to be more actively involved see information on "Speak Up" campaign below.)
Joint Commission tells patients to "Speak Up" Materials give instruction on patient involvement "Speak Up" is a program offered by The Joint Commission in Oak Brook Terrace, IL, which features brochures, posters, and buttons on a variety of patient safety topics. The acronym stands for the following:
"The whole campaign is about patient involvement and it provides materials for health care organizations to use if they wish; it is not required. They can develop their own or there are other products they can purchase," says Richard J. Croteau, MD, executive director for patient safety initiatives at The Joint Commission. For more information: www.jointcommission.org. |
In addition to educating patients and families, it is important to educate health care professionals as well as they must not only accept patient involvement but encourage it, says Croteau.
In anticipation of Goal 13 being implemented in 2007, Annette Mercurio, MPH, CHES, manager of patient, family, and community education at City of Hope National Medical Center in Duarte, CA, was asked by the vice president of patient care services and vice president for quality and safety to take the lead on addressing the goal.
So she established a "Patient and Family Partnership in Safety" performance improvement team. The team consists of several patients, along with a cross-section of staff, such as a patient advocate, nurse, and social worker.
To identify strategies for partnering with patients the team is in the process of conducting 300 surveys. The survey results also will serve as a baseline for measuring the institution's progress on Goal 13A, determining whether patients know how to report their concerns about safety.
Also the team revised a booklet titled "Be a Partner in Safe Patient Care." This booklet, written in English and Spanish, addresses multiple National Patient Safety Goals, such as improving the accuracy of patient identification by encouraging patients to show their armband to care providers and reducing the risk of health care-associated infections by encouraging patients to ask their care providers if they've washed their hands.
The new improved booklet includes explicit statements about how patients can communicate concerns about their safety.
Another project with the communications department involves identifying tools to remind patients and family members of their key role in preventing falls, reducing risk of infection, having staff use two identifiers, and using medications safely. "We're considering tent cards for patient rooms," says Mercurio.
While many tools have been devised to educate patients, Mercurio says handing a booklet to patients or having videos available is never enough.
"We've worked to encourage care providers to talk with patients about their role in safe patient care. To prompt that discussion we included a pre-printed section on our patient and family education flow sheet that requires documentation that the patient's role as a partner in safe patient care was discussed and that the patient's understanding was assessed," she explains.
Prompting participation
Staff members at the University of Minnesota Medical Center, Fairview in Minneapolis always involve patients in the site marking for invasive procedures; thus the safety precaution becomes routine.
Also staff wear buttons that state: "Ask me if I have washed my hands" and posters with a similar message can be found throughout the medical center.
"What we are doing is getting patients used to being involved and we are getting our staff used to being asked if they are doing the things they need to do to keep patients safe," says Susan Noaker, PhD, LP, senior director of quality and patient safety.
Currently, a brochure provides information on how to report concerns, and patients and family members can contact patient relations, a nurse manager, a physician or enter their concerns on The Joint Commission web site. Also, an employee position at the hospital is dedicated to soliciting patient concerns. This employee visits patients and asks if they have worries about their safety.
In the near future, patients will have access to kiosks that will allow them to enter safety concerns into a web-based tool.
Noaker says the University of Minnesota Medical Center provides information on its safety performance to patients and families so they are more aware of the issues. "We are being very transparent, not only with our staff, but patient and families, about our hospital performance — whether that has to do with national patient safety goals or a patient safety initiative we have initiated," says Noaker.
To educate staff, a series of three eight-hour classes have been implemented called "A Leader's Role in Patient Safety." Lessons from other industries are viewed in light of how they apply to health care. Also, research is reviewed that shows the frequency of human errors, even though providers are well-intended caregivers.
A campaign to encourage patients and family members to partner with health care professionals at Vanderbilt University Hospital and Clinics in Nashville, TN, is called "Asking is the Answer." To prompt people to ask the right questions, posters focusing on safety goals are tacked up all over the medical center with a fresh message every three months, says Terrell Smith, MSN, RN, director of patient/family-centered care.
The posters have been designed for a quick read based on research about how much information can be read on a poster while someone is walking past it.
Along with these posters, Vanderbilt developed a video that plays on a continuous loop on a TV system that also is safety related. It reinforces the safety messages introduced on the posters, such as asking providers to wash their hands.
At Ohio State University Medical Center in Columbus patients' rights and responsibilities, as well as information on how to partner in their health care, are posted on the web site and printed in the visitor guide. There also are many handouts available to patients on how to partner in patient safety.
In addition, nurse managers encourage patients to call them if they have concerns. They provide patients and families with a card that has the contact information, says Diane Moyer, MS, RN, program manager of consumer health education at Ohio State University Medical Center.
The accreditation committee or safety committee usually makes recommendations on how to meet patient safety goals based upon suggestions from a task force. The task force reviews where the medical center currently is pertaining to a goal and comes up with ways to move forward, says Moyer.
Pinpointing the best strategy
The process for meeting patient safety goals is similar at Northwestern Memorial Hospital in Chicago, where a team was created to figure out the right strategy for the organization, says Cynthia Barnard, MBA, MSJS, CPHQ, director of quality strategies.
Barnard says a team is formed as soon as a new goal is clarified by The Joint Commission and there usually is at least six months lead time.
To help meet the goal to encourage patients' active involvement, a team created a pamphlet that explains how the organization wants to work with patients on patient safety goals. The information is given according to the acronym PARTNER.
The P is for "provide information," and there are details on what health care providers at Northwestern Memorial would like to know, such as what medications a patient is taking. The A is for "ask questions," and the R for "review information," such as the treatment plan.
The T is for "tests and treatment," encouraging patients to make sure they ask questions so they understand what their tests and treatment are for and that they participate in marking the surgery site. The N stands for "notify," something they are asked to do if they have safety concerns. The E is for "engaging a friend or family member" to help make decisions and provide oversight of safety issues. The R prompts patients to "recognize their risk for falls."
Barnard says there are a few things listed at the end of the document patients need to be sure they have when they leave the hospital. This includes discharge instructions with diet guidelines and instruction sheets such as details on wound care. There also is a medication record that can be carried in a person's wallet.
Mercurio says when National Patient Safety Goals are discussed amongst members of the patient safety team at City of Hope Medical Center she makes sure patient education/partnership strategies are considered whenever possible. Also, she includes partnership with patients and families in safety on the agenda of the patient and family education committee.
"Patient education is all about partnering with patients and their families to improve the outcomes of care. We know that patients who are informed and actively involved in their own care are likely to experience optimal outcomes —including safe care," explains Mercurio.
Sources
For more information, contact:
- Cynthia Barnard, MBA, MSJS, CPHQ, director, quality strategies, Northwestern Memorial Hospital, 676 St. Clair #700, Chicago, IL 60611. Phone: (312) 926-4822. E-mail: [email protected].
- Annette Mercurio, MPH, CHES, manager, patient, family, and community education, City of Hope National Medical Center, 1500 East Duarte Rd, Duarte, CA 91010-0269. Phone: (626) 301-8926. E-mail: [email protected].
- Diane C. Moyer, MS, RN, program manager, consumer health education, Ohio State University Medical Center, 660 Ackerman Road, Room 667, P.O. Box 183110, Columbus, OH 43218-3110. Phone: (614) 293-3191. E-mail: [email protected].
- Susan Noaker, PhD, LP, senior director of quality and patient safety, University of Minnesota Medical Center, Fairview, 2450 Riverside Ave., Minneapolis, MN 55454. Phone: (612) 273-6992. E-mail: [email protected].
- Terrell Smith, MSN, RN, director, patient/family-centered care, Vanderbilt University Hospital and Clinics, Hospital Administration, AA-1204 Medical center North, Nashville, TN 37232-2102. Phone: (615) 322-3454. E-mail: Terrell.[email protected].
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