MedTeams project saves $16 million nationally
Try these proven error-reducing ideas in your ED
An innovative program to reduce medication errors by applying behavioral science techniques has resulted in savings of $16 million so far for the 10 hospital emergency departments involved. Preliminary results for the MedTeams project show an 80% drop in errors and a 50% reduction in risk management cases.
Here are several MedTeams concepts that have been proved to reduce errors:
• Checkbacks. Pilots and flight crews use the "checkbacks" system to ensure effective communication and minimize errors, explains Dallas Peak, MD, FACEP, clinical assistant professor of emergency medicine at Methodist Hospital in Indianapolis and a physician investigator for MedTeams. "In MedTeams training, we stress that all verbal orders are to be acknowledged verbatim. This will minimize the possibility for errors," he says. "The order-giver has a chance to hear what was said and correct a mis-statement, while the order-receiver ensures the accuracy of what he or she heard."
Repeat orders aloud to avert errors
At the emergency department at Madigan Army Medical Center in Tacoma, WA, the nurse is required to repeat the order out loud so it’s clear what the physician actually wanted, notes Matthew Rice, MD, FACEP, medical corps chief at the department of emergency medicine. "We have had several cases where bad or less-than-ideal outcomes or medication errors were avoided because of the checkbacks," he reports.
• The two-challenge rule. "This is one of the most effective empowerment tools I’ve ever seen," says Peak. "Whenever a team member questions a decision, that team member has a responsibility to seek resolution. In fact, they may seek two challenges, first with the person who is directing them, and then take it to a superior."
The two-challenge rule encourages a permissive atmosphere, notes Rice. "If even the newest, least empowered people see something wrong, they have permission and an actual responsibility to challenge that in a professional way," he says. "At that point, they will either correct a potential error or be educated as to why they were mistaken, so they are a better provider."
Empowering those who perceive problems
"The whole point is to move the welfare of the mission or the patient onto the whole team," says Robert Simon, EdD, chief scientist for the crew performance group at Dynamics Research Corp. in Andover, MA.
The key to this concept is that the responsibility lies with the person who perceives the problem, says Peak. "They are empowered to supersede rank or traditional hierarchy in order to resolve the issue," he explains.
• Cross-monitoring. This is a powerful mechanism to reduce the error rate, advises Simon. "A nurse in a busy ED asked a physician, can a patient with NSAID allergy take Aleve? The attending physician answered yes, but another nurse asserted that Aleve is NSAID. By doing that, a potential injurious dose was avoided," he says.
As many as half the serious adverse events in EDs can be caught by someone who is in the area, says Simon.
• Advocacy and assertion. If a resident physician routinely orders IVs for intermediate patients, a nurse may question the practice, Simon explains. "The nurse may state that it increases the patient’s length of stay, increases the cost, makes patients uncomfortable, and possibly also causes complications," he says. "After a discussion, the physician modifies his practice of routinely ordering IVs.
"The idea, however, is not to berate or correct another provider in front of a patient," Simon says. "If that occurs, the provider needs to explain, When you reprimand me in front of patients, I lose credibility, and we are not performing effectively as a team.’"
For more information about MedTeams, contact Robert Simon, EdD, CPE, chief scientist, crew performance group, Dynamics Research Corp., 60 Frontage Rd., Andover, MA 01810. Telephone: (978) 475-9090, ext. 1316. Fax: (978) 474-9059. Internet: http://teams.drc.com/html/medteams.html
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