Patient Safety CME Curriculum Patient Safety: The Other Side of the Quality Equation

1
Patient Safety CME CurriculumPatient Safety
The Other Side of the Quality Equation

• Under a Grant from
• The Agency for Healthcare Research and Quality
• Principal Investigator
• Christel Mottur-Pilson, PhD
• Director, Scientific Policy
• ACP-ASIM

2
Patient Safety The Other Side of the Quality
EquationSeven Modules in Ambulatory Care

• Systems
• The influence of systems on the practice of
  medicine.
• Cognitive Capacity
• Coping mechanisms under information overload and
  time pressures
• Communication
• Communication barriers, lack, and unclear
  communication
• Medication Errors
• Uniform dosing, look- and sound-alikes, forcing
  functions

3
Patient Safety The Other Side of the Quality
EquationSeven Modules in Ambulatory Care

• The Role of Patients
• Patients as allies in patient safety
• The Role of Electronics
• Supportive products and processes
• Idealized Office Design
• Medical practice design to support patient safety

4
Logistics

• CME To receive your CME, please fill out the
  usual forms
• Evaluation form
• CME form
• Research Grant Surveys
• Pre-CME assessment of knowledge level
• Post-CME assessment of knowledge level
• Six-month follow up to CME
• Virtual Patient Safety Electronic Community

5
Patient Safety The Other Side of the Quality
Equation

• The Role of Patients
• Patients as Allies in Patient Safety
• This module was developed by
• Elizabeth C. Bernabeo, MPH and Christel
  Mottur-Pilson, Ph.D. for the American College of
  Physicians-American Society of Internal Medicine.
  

6
Presentation Goals

• Understanding the role of patients in preventing
  medical errors
• Examples of how patients interact with all
  systems in health care
• Take home points to help you educate patients in
  your practice

7
The Role of the Patient (1)

• Patients as passive recipients
• Biomedical Model
• Physician-centered interviewing

8
The Role of the Patient (2)

• Patients as active partners in decision-making
• Biopsychosocial Model
• Patient-centered interviewing

9
Patients Play a Role in

• Effective communication
• Compliance
• Preventing medical errors
• Accurate use of electronics
• All systems levels
• Prevention
• Follow-up

10
Effective Communication (1)

• A successful dialogue between patient and
  physician is at the heart of working
  scientifically with patients.
• GL Engel, 1995

11
Effective Communication (2)

• Empowering patients builds trust and leads to
  a more satisfying physician-patient relationship.
• Long lasting, trusting relationships with
  physicians
• Enhanced compliance
• Greater diagnostic accuracy
• Improved health outcomes

12
Effective Communication (3) Patients
Responsibility in the Interview

• Be active, open, and honest
• Speak up with questions or concerns
• Verify orders are understood and legible
• Verify symptoms and concerns with physician

13
Effective Communication (4) Patient Compliance

• 1 of 4 patients does not always follow physician
  advice
• 33 fail to understand orders/too difficult
• 39 disagree with recommendation
• 27 cannot afford treatment
• 20 orders go against personal beliefs

14
Preventing Medication Errors (1)

• 16 of patients have been given the wrong
  medication or wrong dose when filling a
  prescription at a pharmacy
• 88 of medical errors involve the wrong drug or
  the wrong dose

15
Preventing Medication Errors (2)Educate Before
You Medicate

• Verify the medication with the pharmacist and
  make sure it is what the physician ordered
• Verify how/when the medication is to be taken and
  at what dose
• Be aware of what foods or activities to avoid
  while taking the medication

16
Preventing Medication Errors (3) Educate Before
You Medicate

• Inform the physician of all concomitant
  medications, including OTC and herbal supplements
• Verify any potential side effects and what to do
  if they occur
• Inform the physician of any known allergies
• Keep only up to date medications

17
The Use of Electronics

• Increased access to information and support
• Comprehensive Health Enhancement Support System
  (CHESS)
• Potential dangers
• Privacy
• Ethics
• Inaccurate information

18
Systems (1) Patients Not Being Proactive In
Their Care

• More is not always better
• No news is not always good news
• 20 of women over the age of 18 fail to receive a
  PAP test at 3 year intervals
• 44 of adult men and women do not have annual
  dental exams

19
Systems (2) Patients Being Proactive In Their
Care

• Assign a family member or friend to be in charge
  of care
• Seek support
• Research all reasonable options and treatment
  plans
• Seek more than one opinion

20
Systems (3)Agencies Empowering and Educating
Patients

• Center for Healthcare Strategies, Inc. (CHCS)
• Foundation for Accountability (FAACT)
• National Patient Safety Foundation (NPSF)
• The kind of health plan a patient has may
  influence his/her role as a consumer.

21
Systems (4) Agencies Empowering and Educating
Patients

• Journal of the American Medical Association
  (JAMA)
• Agency for Healthcare Research and Quality (AHRQ)
• ACP-ASIM and the Massachusetts Coalition for the
  Prevention of Medical Errors

22
Clinical Trials

• Informed consent
• Voluntary
• Clear understanding of treatment and outcomes
• Payment for continued care after trial

23
Case One

• Test results
• PAP Smear
• 30 year-old woman with 3 children
• Failure to follow up

24
Case One Take Home Points

• What are some take home points from Case One?
• Patient role in systems failures
• Assertiveness
• Follow-up with test results

25
Case Two

• Patient with psoriasis
• Presentation for worsening disease
• Prescription of topical steroids

26
Case Two Take Home Points

• What are the important take home points from Case
  Two?
• Failed communication
• Compliance

27
Case Three

• 30-year-old patient presents with bronchitis
• The wrong chart is pulled
• Physician mistakenly prescribes Bactrim to
  patient with known allergy to sulfas

28
Case Three Take Home Points

• What are the take home points from Case Three?
• Verify information
• Inform physician of allergies
• Inform pharmacist of allergies
• Coordinate all information between pharmacies and
  medical offices, particularly if they are new

29
Case Four

• 25 year-old patient experiencing a sore throat
  and fever
• Uses internet to diagnose condition- without
  physician guidance
• Takes old medication to alleviate symptoms
• Condition worsens

30
Case Four Take Home Points

• What are the take home points from Case Four?
• Outdated medications
• Use of internet to self-diagnose and treat

31
Case Five

• Elderly patient eligible for clinical trial
• Health care professional other than physician
  handles consent process

32
Case Five Take Home Points

• What are the important take home points from case
  five?
• Informed consent
• Barriers to treatment
• Assign a family member to care

33
Case Six

• 59 year-old patient with hypertension and DM
• Physician adds new ACE inhibitor
• Patient takes the pill twice a day instead of
  once
• Becomes dizzy and suffers a syncopal episode

34
Case Six Take Home Points

• What are the important take home points from case
  six?
• Compliance

35
Case Seven

• 50 year-old woman
• Insomnia
• Lack of appetite
• Feeling overheated, at times
• Mood swings

36
Case Seven Take Home Points

• What are the important take home points for case
  seven?
• Seek second opinion
• Talking with physicians

37
Conclusions

• CHCS, FAACT, and NPSF focus on patients in the
  design and delivery of health care
• AHRQ, JAMA, and the MA Coalition for Preventing
  Medical Errors provide tips for empowering
  patients
• Caveat
• Diverse ethnic patients may not identify with the
  roles presented in this module.

38
Patient Safety Interactive Learning Community
(PSILC)

• Program Information Updates
• All Seven Modules
• Refresher Exercises
• Email Discussion Groups

• http//www.acponline.org/ptsafety

39
Refresher Exercises

• http//www.acponline.org/ptsafety