Safety First Proactive Approaches to Patient Safety Rosalind

Safety First: Proactive Approaches to Patient Safety Rosalind K. Lett, MLS, AHIP Knowledge Cartel

o. Let’s start with a tale about a clinical trial… Rosalind K. Lett, MLS, AHIP Knowledge Cartel

The Clinical Trial o Healthy research volunteer o Incomplete literature search doesn’t reveal relative adverse drug effects o Woman dies due to involvement in clinical trial Rosalind K. Lett, MLS, AHIP Knowledge Cartel

Why did this happen? Possible failures include… o Researcher overconfident about research skills o Inaccessibility of librarians o Incomplete search methodology o Researcher didn’t know what he didn’t know o Researcher didn't’ t realize the value of the librarian. Rosalind K. Lett, MLS, AHIP Knowledge Cartel

Why, why? o Researcher was pressured, tired, interrupted o Missed cues in the literature reviews o No double-check of results with the experts o Lack of awareness of library services o Lack of full text availability Rosalind K. Lett, MLS, AHIP Knowledge Cartel

What impact did this clinical trial have on medical libraries o It gave us a case to site when we attempt to justify our value & …. It helps us confidently explain why it’s critical that medical librarians be included in patient safety issues and committees. Rosalind K. Lett, MLS, AHIP Knowledge Cartel

Closing the Chasm o“Between the health care we have and the health care we could have lies not just a gap, but a chasm” IOM, “Crossing the Quality Chasm” (2001) Rosalind K. Lett, MLS, AHIP Knowledge Cartel

An organization totally in-sync with patient safety. What’s it look like? o A place with no needless: o Deaths o Pain o Delays o Helplessness o Waste o Medication Errors o Misdiagnosis Rosalind K. Lett, MLS, AHIP Knowledge Cartel

An In-Sync Health Care Organization o Collaborative Environment o Patient Focused o Great Place to Work o Plentiful Financial Resources (especially for the library) o Big Picture Thinking Rosalind K. Lett, MLS, AHIP Knowledge Cartel

What is Big Picture Thinking? o. It’s a process of taking a step back and evaluating all of the potential issues that may make a proposed project difficult to make a reality. Rosalind K. Lett, MLS, AHIP Knowledge Cartel

What does BIG PICTURE THINKING DO? o Moves Us From the Immaterial to the Important. o Moves Us From Apathy To Action! o Moves Us from Fear to Fantasizing about the possibilities! Rosalind K. Lett, MLS, AHIP Knowledge Cartel

Where is our greatest potential to facilitate Big Picture Thinking? o Breaking down complex problems involves helping health care providers see the connectedness of the “big picture” and not just their part o Recurring problems or those that have been made worse by past attempts to fix them o Problems where solutions are not obvious Rosalind K. Lett, MLS, AHIP Knowledge Cartel

So…. What does that have to do with me? o “ONLY by changing how we interact can shared visions, shared understanding, and new capacities for coordinated action be established; ” o Senge (1994) as quoted in Ray Rosalind K. Lett, MLS, AHIP Knowledge Cartel

How can medical librarians impact patient safety? o Help find new ways of looking at things o Encourage information/knowledge sharing to minimize uninformed decisions o Drive desire to seek deeper understanding of complex situations o Open doors to collective thinking and partnerships Rosalind K. Lett, MLS, AHIP Knowledge Cartel

More Impact o Facilitate integration of library services and expertise into the hospital o Disseminate innovations through understanding of a learning environment Rosalind K. Lett, MLS, AHIP Knowledge Cartel

Are you making an impact? o Is your library interconnected? o Can you identify the key stakeholders to partner with? o Do you have a personal mastery of “the big picture? ” o Do you routinely have dialogues with other departments, (IT, physicians and/or administration)? Rosalind K. Lett, MLS, AHIP Knowledge Cartel

Are you actively involved in preventing medication errors? o Patient Information o Patient Education o Consumer Health Information o Drug Information Rosalind K. Lett, MLS, AHIP Knowledge Cartel

Health literacy is a issue that affects patient safety o 90+ Million American suffer from low health literacy o Inadequate literacy increases hospitalization by 50% o JAMA study reveals 39% of patients could not understand simple instructions on a pill bottle. Rosalind K. Lett, MLS, AHIP Knowledge Cartel

Are You Promoting Health Information Literacy? ü Recognize health ü Evaluate the quality information need ü Identify likely information sources ü Search the information sources to retrieve relevant information of the information ü Use the information to make good health decisions Rosalind K. Lett MLS, AHIP Knowledge Cartel

Challenges of Health Information Literacy? o English Literacy Levels o Unreliable Resources o Evaluation Skills Rosalind K. Lett, MLS, AHIP Knowledge Cartel

English Literacy Levels o Most health materials are written at the 10 th grade level or above o In the U. S. , approx. 48% of adults read at or below the 8 th grade reading level Rosalind K. Lett, MLS, AHIP Knowledge Cartel

Unreliable Resources People tend to: o Search independently rather than seek advice about web sites to use o Trust in most or all information found on the web o Don’t know when they’re seeing wrong or misleading health information on the web Rosalind K. Lett, MLS, AHIP Knowledge Cartel

Bad News o. Online information greatly impacts peoples’ health choices Rosalind K. Lett, MLS, AHIP Knowledge Cartel

Evaluation Skills o Few people check “about us” sections, disclaimers or disclosure statements. o People usually chose one of the first results displayed by the search engine. o Most people don’t remember which websites they retrieved information from Rosalind K. Lett, MLS, AHIP Knowledge Cartel

How Can Medical Librarians Address These Challenges? o Identify quality health education materials o o written at varying literacy levels, in various formats and in other languages. Limit use of medical jargon. Direct consumers/patients to trusted health education web sites. Instruct consumers/patients to evaluate health education materials for authority, bias, and currency. Explain information and instructions clearly. Rosalind K. Lett, MLS, AHIP Knowledge Cartel

Tips - Explaining Information and Instructions Clearly o Repeat o Provide Examples o Be Specific o Back up with written/visual instructions o Ask about learning preference Rosalind K. Lett, MLS, AHIP Knowledge Cartel

Before/After “Plain Language” Before o The Dietary Guidelines for Americans recommends a half hour or more of moderate physical activity on most days, preferably every day. The activity can include brisk walking, calisthenics, home care, gardening, moderate sports exercise, and dancing. After o Do at least 30 minutes of exercise, like brisk walking, most days of the week. Rosalind K. Lett, MLS, AHIP Knowledge Cartel

How can you support patient education? o Suggest lay level materials for patients o Inform patients of their right to ask questions and expect answers o Listen to what patients are saying and refer them to health care providers o Facilitate patients understanding of medical conditions, procedures, and their options for care Rosalind K. Lett, MLS, AHIP Knowledge Cartel

Become an active & visible participant or supporter of: o Pharmacy & Therapeutics Committee o Standardization Committee o Patient Safety Committee o Institutional Review Boards o Quality Committee o Medication Safety Committee Rosalind K. Lett, MLS, AHIP Knowledge Cartel

50% of Rx Drugs are not being taken correctly o This leads to serious medical complications, hospitalization, additional medicines, loss of work, and sometimes death, o It’s Not the Patient’s Fault o This is why patients need accurate and easy-to-understand information about managing their treatment. Rosalind K. Lett, MLS, AHIP Knowledge Cartel

What proactive approaches can medical librarians take: o Develop patient safety awareness programs o Partner – Public Library, Community o Assist consumers in understanding what patient safety is about from several perspectives. Rosalind K. Lett, MLS, AHIP Knowledge Cartel

Focus on Preventing Medication Errors o Develop a monthly newsletter on preventing medical errors o Proactively supply the hospital staff with the latest literature related to medication safety Rosalind K. Lett, MLS, AHIP Knowledge Cartel

Use JCAHO Standards to Support Patient Safety o Leverage accreditation standards (medication management) o Develop routine evaluations of the literature n n Keep it short Select the best information Insert clip art to attract attention Discuss recurring themes Rosalind K. Lett, MLS, AHIP Knowledge Cartel

Internal Review Boards o Become a member of the IRB (internal review board) o Have a contingency plan to insure continued support o Provide comprehensive searches, articles, filtering and citations o Provide as much info as possible to support meeting discussions Rosalind K. Lett, MLS, AHIP Knowledge Cartel

PDA’s o Use PDA’s to enhance patient safety through better communication and documentation o Advocate for PDA use in clinical environments o Provide assistance in establishing patient safety criteria Rosalind K. Lett, MLS, AHIP Knowledge Cartel

Patient Safety Forums o Use National Medical Librarian’s Month or Nat'l Library Week to develop day long patient safety forums o Have speakers present talks to support adopting a culture of safety o Develop patient safety handouts and information about ways the library supports patient safety o Distribute handouts at all types of meetings, and venues Rosalind K. Lett, MLS, AHIP Knowledge Cartel

Library Presentations o Make presentations at hospital wide meetings of knowledge-based information sources of value to those involved in patient safety o Conduct live demonstrations using examples specific to a variety of patient safety issues o Informally answer questions, provide take home points Rosalind K. Lett, MLS, AHIP Knowledge Cartel

Help Develop Patient and Employee Safety Fairs o Fire Safety o Occupational Safety o Security (identity theft) o Back Safety o Needle stick o Medication Information Tables o Feature patient education & consumer health information, books, journal, videos, Rosalind K. Lett, MLS, AHIP Knowledge Cartel

Other Proactive Ideas o Work with your informatics team to develop patient portals o Develop evidence-based search strategy website on top diseases seen by hospitalist and other groups o Work closely with Patient Safety and/or Medication Safety Committee, Performance Improvement Staff, & Medical Affairs, Rosalind K. Lett, MLS, AHIP Knowledge Cartel

More Proactive Ideas o Become the clinical librarian for patient safety o Learn the language and concepts of safety (patients, visitors, staff) o Exploit current awareness tools o Selectively, push full text information to committee members o Track library efforts to support patient safety. Rosalind K. Lett, MLS, AHIP Knowledge Cartel

Brainstorming & Strategizing o. How can you impact Patient Safety when you return to your institutions? Rosalind K. Lett, MLS, AHIP Knowledge Cartel

The End…… Rosalind K. Lett, MLS, AHIP Knowledge Cartel