NSUCO - The Visionary Fall 2010

the VISIONARY • Summer/Fall 2010 13 The Institute of Medicine’s 1999 landmark report To Err is Human provided critical insight as to the numbers of patients that die in hospitals as the result of medical errors. Hospitals are not the only setting where patients may encounter a treatment-related injury, and the report does not address those patients that are injured in the course of treatment. Consequently, the rhetorical question becomes: Has patient safety improved in the last 10 years? That issue is debated in a number of forums. It is critical to personalize the issue and consider what each of us does in our course of care to promote the practice of patient safety. A component of improving safe patient care in- cludes actively reviewing the office and clinical practice site for potential sources of injury. There are a number of national patient safety initiatives that can be adopted to make the office setting safer for patients. The first is the adoption of the Universal Protocol―a template to ensure that the provider has a pre-procedure verification process (pa- tient identity and procedure to be performed), marking of the pro- cedure site (right V. left in the case of optical care), and a “time out” immediately prior to beginning the procedure. This is the final verification that the correct patient will have the correct pro- cedure to the correct site. Documentation is often the least-favorite aspect of patient care, yet is the one that if not done timely and fully will have significant repercussion on the practice. Legally speaking, the documenta- tion should reflect the reason for care, services performed and offered, and the plan for future care. It is appropriate to include patient quotes and any comments the patient verbalizes about reluctance or dissatisfaction with a treatment plan. Evidence of coordination of care with other providers also should be included. This step is critical especially if the patient has an emergent con- dition that requires specialty care. Be sure there is a mechanism to ensure closure so the patient does not “fall through” the proverbial cracks. Financially speaking, the billing charges must be supported with appropriate and complete documentation re- flecting the necessity of care and services provided. Do not forget to have patient calls and messages entered into the permanent clinical record. This patient feedback is important and may impact future care. Critically review your practice setting to minimize your particular set of risk exposures. Proparacaine should not be left unattended in the exam room; patients know or learn through the course of treatment that this medication relieves ocular pain. Patients have been known to take this medication from the exam room and self- prescribe. Often these patients suffer corneal damage and com- plicate the course of treatment, and they are reluctant to disclose its use when they return with complications. Patient satisfaction surveys are a gift because they serve as a mechanism to solicit valuable information from the patient’s per- spective. Patients gladly share what is working well along with those areas that represent an opportunity for improvement for the practice. Taking this feedback seriously and responding to the B Y J UDITH R. S ANDS , R.N., M.S.L. R ISK M ANAGEMENT S PECIALIST NSU H EALTH P ROFESSIONS D IVISION B uilding the Patient Safety Culture for You and Your Patients