Whether you are hospitalized for an illness or a scheduled procedure – it’s safe to say, the sooner you can leave the hospital, the better. No one wants an extended stay in the hospital. While researching patient safety issues, we came across this insightful article from Becker’s Hospital Review. It outlines the top 10 patient safety issues for 2018.
This is an abridged version. Read the full article.
#1 Disparate EHRs (Electronic Health Records). While EHR adoption continues to increase among healthcare providers, poor interoperability or the inability to share electronic health records among unaffiliated healthcare facilities is still very much an issue.
One of the most concerning ways poor interoperability affects patient care is medication reconciliation. If physicians are unaware of all the medications a patient is taking, they may unknowingly prescribe a drug that can negatively interact with another medication. A 2017 poll of 120 hospital administrators revealed that 74.8 percent listed incomplete and inaccurate medication data as a top concern.
Lack of EHR interoperability also effects patient care during a crisis or natural disasters. When Hurricane Harvey hit Texas, poor interoperability complicated the care process for displaced patients who sought treatment at hospitals that did not have access to their medical records.
#2 Hand hygiene. A lack of proper hand hygiene compliance was directly linked to numerous infections and deaths in 2017. In July, state health officials identified poor infection control practices at a South Carolina Medical Center, where six knee pain patients were sickened with Staphylococcus aureus infections. The health officials noted improper protocols, such as not conducting proper hand hygiene practices or not wearing sterile gloves when performing knee injections.
#3 Nurse-patient ratios. Inadequate staffing at healthcare facilities can greatly hamper patient care. A study published in the International Journal of Nursing Studies showed every extra patient on a nurse’s caseload increased mortality rates by 7 percent.
In May, lawmakers reintroduced the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act in the House. The bill “sets minimum nurse-to-patient staffing requirements for direct-care registered nurses, requires a study of staffing requirements for direct care licensed practice nurses, and provides whistle-blower protections.”
#4 Drug and medical supply shortages. Supply chain issues represented a major obstacle for healthcare providers in 2017, with shortages of drugs and medical supplies expected to continue in 2018. In May, many hospitals were forced to delay major operations and chemotherapy treatments due to a nationwide shortage of sodium bicarbonate solution.
Hospitals across the U.S. are also battling drug and medical supply shortages caused, in part, by lower production levels at manufacturing plants in Puerto Rico, which lost power after Hurricane Maria in September 2017. Puerto Rico, which houses more than 80 drug and medical device plants, produces nearly 10 percent of the U.S.’s medications.
#5 Quality reporting. Centers for Medicare & Medicaid Administrator Seema Verma acknowledged issues with the agency’s current quality reporting system during a speech at the Health Care Payment Learning and Action Network Fall Summit in October 2017. “There are many steps involved in submitting them, taking time away from patients,” she said. “Moreover, it’s not clear whether all of these measures are actually improving patient care.”
Last fall, the agency rolled out the “Meaningful Measures” initiative, which aims to reduce the regulatory hurdles associated with quality reporting. CMS plans to simplify the measures hospitals and physicians must report on, zeroing in on the most important measures to improve care quality and patient outcomes. The agency also launched “Patients Over Paperwork”, an initiative aimed at identifying unnecessary burdens and inefficiencies that prevent healthcare providers from spending time with patients.
#6 Resurgent diseases. The U.S. saw several historic outbreaks of vaccine-preventable viruses in 2017 amid waning immunity and low vaccine adherence in certain pockets of the country. Minnesota experienced its largest measles outbreak since 1990, lasting 4 months with 79 measles cases and 22 hospitalizations. Sixty-four of the cases occurred among the Somali Minnesotan community. Immunization rates among this population declined in recent years due to the spread of misinformation regarding vaccine safety.
Scarlet fever is also re-emerging in certain parts of the world for reasons unknown to health officials, Vox reported. England and Wales saw three times the amount of scarlet fever cases in 2014 compared to the year before. Vietnam, South Korea, Hong Kong and China have also reported significant increases in scarlet fever cases since 2009.
#7 Mergers and acquisitions. Hospital mergers, acquisitions and divestitures cause various changes in an organization’s culture, leadership, equipment and operating environment that can pose a threat to patient care. A 2015 op-ed published by researchers from Johns Hopkins Medicine argued hospital consolidation and reduced healthcare competition limits patient choice, hinders innovation that leads to better care and reduces hospitals’ incentive to improve quality ratings.
On the other hand, transactions that help to increase competition and diversify markets can also improve healthcare quality and services. Research from the Robert Wood Johnson Foundation shows patients living in competitive healthcare markets exhibit better health outcomes and lower mortality rates than those who live in areas with less healthcare competition.
#8 Physician burnout. Fifty-one percent of physicians experienced frequent or constant feelings of burnout in 2017, compared to just 40 percent in 2013, according to an annual survey. A major source of burnout stems from the large amount of data entry and clerical work physicians must complete daily. On average, physicians spend 50 percent of their work day entering data into EHRs and completing clerical work. Just 27 percent of their day is spent interacting with patients. Even when physicians do engage in patient encounters, 37 percent of the visit is spent on EHR documentation or desk work.
#9 Antibiotic resistance. The ongoing evolution of antibiotic resistance continues to be a major patient safety issue for hospitals around the world in 2018.
In February 2017, the World Health Organization ranked the world’s 12 most-dangerous superbugs. Topping the list were three strains of bacteria resistant to the last resort antibiotic carbapenem. U.S. health officials will closely monitor several drug-resistant hospital-acquired infections in 2018, including, carbapenem-Enterobacteriaceae (CRE), which can sometimes be resistant to all available antibiotics.
CRE cause an estimated 9,300 infections and 600 deaths every year in the U.S. Infection control leaders are looking to organizations like the CDC, the National Quality Forum and the Society for Healthcare Epidemiology of America for tools to improve antibiotic stewardship and curb resistance.
#10 Opioid epidemic. The nation’s ongoing opioid addiction and overdose crisis presents numerous challenges for healthcare organizations, including drug diversion, rising rates of overdose deaths and secondary exposure to deadly synthetic opioids like fentanyl among frontline providers caring for overdose patients.
A June 2017 study cited prolonged opioid use as the most common complication among surgery patients who were not previously exposed to opioids.
Over prescribing is so serious, some physician leaders argued hospitals should be penalized for opioid addiction if the condition develops as a result of hospital-based care. Amid this environment, some leading health systems are taking serious efforts to reduce opioid use in their facilities. Some have pledged to cut opioid prescriptions by as much as 40 percent by the end of 2018. Healthcare leaders will be watching these types of initiatives closely in the coming year.
Casey & Devoti is a St. Louis-based personal injury law firm. Together Partners Matt Casey and Matt Devoti have nearly 40 years of trial experience. They handle a variety of personal injury matters, including: car, truck and train accidents, victims of impaired and distracted driving, medical malpractice and birth injuries, product liability, slips/trips/falls, elder care and sexual abuse, Workers’ Compensation, and wrongful death. Matt and Matt proudly serve clients throughout metropolitan St. Louis, southeastern Missouri and southern Illinois. If you or a loved one have been injured by the negligence of another, call the office today for a free, no-obligation consultation: (314) 421-0763.
