Concordia News - Patient Safety Culture - May 2009

Published by Hamish Brown

Handovers, Shift Changes and Transitions
Communication, team culture, handovers and lack of information have previously been identified as key reoccurring problems that increase the likelihood of hospital errors. The latest (2009) data from 622 US hospitals shows that this is still a major issue. Here are five improvement suggestions: 

  • Communicate Interactively - allow and promote questions between giver and receiver of information
  • Communicate up-to-date information - regarding care, treatment, services, condition, and recent or anticipated changes
  • Limit interruptions - to avoid losing or skewing information shared
  • Allow sufficient time - to complete the hand over
  • Require a verification process - repeat-back or read-back as appropriate
  • Ensure that the receiver of information has the opportunity to review relevant historical data

 

Walk Arounds
In a project supported by Kaiser Permanente's Garfield Memorial Fund, executives, department managers, nurses, physicians, technicians and clerks participated in hospital walk arounds.
Six months later responses from participating front line staff reported:

  • 86% said they had a better understanding of patient safety
  • 64% said something had been done differently in their area related to patient safety
  • 29% indicated that reporting or discussion of errors and near misses had increased since the walk around
  • 68%said they had had conversations with coworkers or managers regarding the patient safety walk around
  • 86% of managers said that new patient safety initiatives or other changes had been made as a result of input from staff and physicians.

 

May's Quote

 

Beat the Winter Blues!!
Welcome to all new recipients of our Newsletter...for you and others who are grumbling about the "crisis", the cold weather and whatever else, here's some wisdom from Herbert Benson, M.D., director emeritus of the Benson-Henry Institute for Mind Body Medicine (Boston), and Peg Baim, the institute's clinical director of training: Harvard Business Review April 6 2009.

Managing Stress and Counteracting Its Effects
Engage in an activity that calmly engages you, such as yoga, knitting, or going for a walk. Visiting an art museum counts; visiting a Web site does not. Similarly, watching TV is out. But looking intently and meditatively at a painting in your home or office may be an effective way for you to dial down the stress.

Benson and Baim especially recommend meditation to activate what they call the relaxation response. All you need is a quiet place and 10 to 20 minutes during which you repeat a word, sound, phrase, or gesture. When everyday thoughts intrude, as they inevitably will, calmly disregard them and refocus on the repetitive activity.

(To learn more about the relaxation response, go to the Benson-Henry Institute for Mind Body Medicine Web site at www.mbmi.org.)

All the best,

Concordia