Case managers play key role in patient safety
Biggest areas: Transcription, self-administration
By virtue of their direct involvement in the transition of patients from one care setting or service line to another, case managers are uniquely positioned to play a key role in preventing medical errors.
Such is the conclusion of panelists on a recent Webcast at NursingCenter.com, "Practice Errors: Creating a Culture of Safety." The panel was lead by Lucian Leape, MD, PhD, of the Department of Health Policy and Management at Harvard Medical School of Public Health in Boston. Leape is the nation’s leading expert on hospital deaths and adverse drug events caused by medical errors. In congressional testimony in 1997, he estimated that up to 1 million people a year are injured by errors in medical treatment and that 120,000 people in the United States die each year as a result of medical errors.
Leape said that nurses can be instrumental in moving the field of health care away from an individual blame-and-punishment mode to systematic safety management.
From the standpoint that they are the ones responsible for "overseeing the holistic needs and care of the individuals they serve, as well as coordinating timely and beneficial clinical outcomes along the care continuum," case managers can play a critical role in preventing medical errors, says Sandi Lowery, president of the Case Management Society of America in Little Rock, AR. "It is the [case manager’s] duty to report any medical errors, not because he or she is a health professional but because those errors can become barriers to good outcomes."
Depending on their particular job function, case managers can play a significant part in preventing medical errors, agrees Judy Homa-Lowry, RN, MS, CPHQ, president of Homa-Lowry Healthcare Consulting in Canton, MI. "If you are dealing with case managers who tend to be more from a social work background or who are more involved in discharge management and reimbursement than in continuum of care [issues], then they obviously cannot be as instrumental."
John Borg, RN, MS, senior vice president for clinical and community services in Valley Health System in Winchester, VA, says that case managers at his facility "have prevented hundreds of medical errors. When it comes to medical errors, the two biggest areas — and they are huge — are transcription and self-administration, taking the wrong combination of pills or taking the pills at the wrong time. Those two probably account for 85% to 90% [of medical errors]."
Valley Health’s patient base is made up primarily of elderly people. "We go through their houses and medicine cabinets and get every nondated and nonprescription drug out of there," he says.
If keeping tabs on patients’ meds is an effective way of limiting medical errors, then so is having a team in place that can oversee what is taking place within the patient’s course of treatment. Like Leape, who stresses the importance of having systems in place that encourage teamwork, automation, and error reporting, Homa-Lowry suggests forming a medical errors’ team of case managers and other health care workers. The team could serve not only as an effective monitoring mechanism in locating the cause of any errors but could also be instrumental in coming up with ways of reducing those errors in the future. "If a problem exists, it’s important to be aware of what precipitated it. Was it caused by a nursing error, or was it brought about by the [poor] legibility of the doctor’s prescription form? As long as the emphasis is on looking at the systems and processes rather than on punitive actions, it can be very valuable." She notes that fear of reprisal often prevents workers from reporting errors in medication and related mistakes.
Having a team in place could be equally beneficial from the standpoint of damage control. With the large number of new medications coming down the pipeline, it becomes increasingly harder to keep track. "When I was coming out of school, we were not allowed to give insulin [shots] unless we checked with another nurse first. Now you don’t have that," says Homa-Lowry, who notes that fellow team members could be responsible for providing valuable doublechecks.
In the last analysis, awareness, perhaps more than any other single factor, plays a paramount role in preventing costly and potentially fatal medical errors. To help ensure that it is providing quality care, University Hospital at the University of Colorado Health Services Center in Denver has put in place a series of competency-based education programs that spotlight issues ranging from reviewing patients’ course of treatment, to making sure that the patients are receiving the appropriate medication.
For more information, contact:
Judy Homa-Lowry, RN, MS, CPHO, President, Homa-Lowry Healthcare Consulting, Canton, MI. Telephone: (734) 459-9333.
Sandi Lowery, President, Case Management Society of America, Little Rock, AR. Telephone: (501) 225-2229.
John Borg, RN, MS, Senior Vice President, Clinical and Community Services, Valley Health System, Winchester, VA. Telephone: (540) 722-8030.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content