Psychiatry - November 2008 - (Page 17)

Adverse Events prolongation of a hospital stay or in diminished function/disability at the time of discharge. Accordingly, severe adverse events would constitute those that result in the death of a patient or permanent or prolonged disability. The Agency for Healthcare Research and Quality (AHRQ) developed a set of patient safety indicators for identifying suspected instances of compromised patient safety based on hospital administrative data.1 These were not pertinent to psychiatry. Among the potential patient safety events of surgical, medical, and obstetric patients, published in Health Affairs in 2003, no psychiatric care indicators are included.2 Although Romano et al2 made a concerted effort to evaluate those ethnic groups and age groups that were most prone to certain safety events, no psychiatric care problems have been identified. Their data only took into consideration general medical, surgical, and obstetric data. Bates et al3 reported in a patient safety forum in 2003 that the highest rate of adverse drug events was on an inpatient psychiatric unit. The authors point to the lack of clear evidence in psychiatry of the nature and types of errors. They call for further investigation in this regard. As Pronovost4 indicates in his report on May 14, 2008, although complications can be measured with reasonable accuracy, the degree of preventability must be estimated accurately too. With psychiatric patients this is not an easy task. The patient’s role in negative developments of treatment is variable, sometimes ambiguous, and at other times, not detectable. Who is to blame when participation in a treatment regimen is greatly affected by a [NOVEMBER] Measuring Adverse Events in Psychiatry by Geetha Jayaram, MD, MBA Psychiatry (Edgemont) 2008;5(11):17–19 easuring and improving quality of care in hospitals is a growing health policy requirement. Outcomes need to be demonstrated, report cards are to be posted on the internet for comparison, data are required to be gathered, and a continuum of clinical practice striving toward measurable goals needs to be demonstrated. Generic screening criteria to identify what constitutes adverse events have not been agreed upon or delineated in psychiatry. For example, hospitals track “sentinel” and other events, among which M mortality and readmission rates for post-surgical complications and postoperative infection rates are included, as well as administration of required medications within a specified duration of a medical event. These generic screening criteria were developed in the early 90s and continue to be widely utilized for evaluating quality of care. Although such parameters exist for measurements in general medicine and surgery, no such standards exist in psychiatry. Adverse events may be defined as unintended injuries caused by medical management resulting in Psychiatry 2008 17

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Psychiatry - November 2008 Editor's Message Editorial Advisory Board Contents PsychRx Letters to the Editor Measuring Adverse Events in Psychiatry Nonsuicidal Self Injury in Adolescents Relative Tolerability of Alzheimer's Disease Treatments Biracial Identity Development and Recommendations in Therapy Depression and Cardiovascular Disease: Just an Urban Legend? Three Risk Management Basics Journal Watch Classified Advertising Information for Authors

Psychiatry - November 2008

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