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SAFETY
BY HEATHER DAVID
Unveiling ECRI's 2024 Top 10 Patient Safety Concerns list
rom integrating new technology
to navigating shifts in care delivery
and mitigating burnout, the
most pressing challenges for healthcare
organizations tend to be multifaceted
problems that demand multifaceted solutions.
For evidence of that, look no
further than the Top 10 Patient Safety
Concerns 2024 list from ECRI. For every
risk on the list, the potential for harm is
often rooted in overlapping failures of
people, process, and technology.
Backed by data and expert insights,
this annual patient safety report from
ECRI and the Institute for Safe Medication
Practices (ISMP) aims to do more
than spotlight concerns demanding immediate
attention. The Top 10 Patient
Safety Concerns list also serves as a
blueprint for action-specifically, for
implementing safety policies that account
for every facet of operations in a
dynamic care setting.
F
ECRI advocates a " total systems
safety " approach adapted from the Institute
for Healthcare Improvement's
National Action Plan to Advance Patient
Safety. Designed to go beyond addressing
individual safety threats, this
strategy aims to ensure consistency,
resiliency, and efficiency throughout an
organization by blending insights from
human factors, systems design engineering,
health equity, and the latest
safety science. The core idea is that
advancing patient and worker safety
requires improvement efforts to account
for four interdependent foundations:
* a culture of safety
* patient engagement
* a healthy work environment
* a commitment to continuous learning
and improvement.
Viewing patient safety through the
lens of such a comprehensive framework
serves to clarify specific risks as well as
potential mitigation strategies.
The following outlines what ECRI has
identified as the top patient safety challenges
for healthcare leaders to address
right now, along with actionable recom20
OR
Manager | May 2024
mendations for each safety concern to
reduce the risk of harm.
1
Challenges transitioning newly
trained clinicians from education
into practice
The pandemic disrupted the traditional
hands-on, in-person educational experiences
of new clinicians. Workforce
shortages compounded the issue.
Without sufficient preparation, support,
and training throughout the transition
into practice, new clinicians can experience
loss of confidence, burnout, and
reduced mindfulness around a culture
of safety. The coalescence of these factors
may lead to a failure to recognize
and rescue patients from preventable
harm or even contribute directly to patient
harm events.
One way to support newly educated
clinicians is fostering partnerships between
academic and healthcare institutions
for hands-on and simulation-based
learning. Another is establishing strong
preceptorship programs to prioritize
training and confidence-building for new
clinicians to meet practice standards.
Leaders might also seek input from patient
and family advisory councils on
how newly trained clinicians can improve
the patient-centered care experience.
2
Workarounds with Barcode Medication
Administration (BCMA)
systems
BCMA systems are vital for preventing
medication errors. However, scanning
or labeling issues may prompt staff to
resort to workarounds that endanger
patient safety. Workarounds for missing
or otherwise unreadable barcodes could
be symptomatic of system configuration
issues or insufficient knowledge or training.
Workarounds might also reflect a
lack of appreciation among the staff for
the safety benefits of BCMA technology.
To prevent the need for workarounds,
convene a multidisciplinary
team to review clinical practices and develop
configurations that support safe
clinical workflow. Collaboration among
clinical leaders and HR partners can
help implement a safety culture for
addressing staff behaviors related to
BCMA workarounds. Meanwhile, establishing
an escalation process ensures
everyone knows what to do if a barcode
will not scan.
3
Barriers to accessing maternal
and perinatal care
Every year in the US, about 1,200 patients
die from pregnancy complications,
and 50,000 experience serious
issues because they can't easily receive
obstetric and reproductive services.
An estimated 2.2 million women
in the US live in " maternity care deserts " -areas
lacking hospitals, birth
centers, OB-GYN providers, or certified
nurse midwives. Another 4.7 million
women face restricted access to care
during pregnancy and childbirth.
Improving access to care is crucial to
address this health equity crisis. Among
other recommendations, ECRI encouragers
caretakers to advocate for public
policies that can help. Consider seeking
board support for proposals such
as extending insurance coverage to 12
months postpartum; reimbursing community
partnerships with midwife and
doula care and maternal home visiting
programs; and developing obstetric
workforces to support care in maternity
care deserts.
4
Unintended consequences of
new technology
New technologies such as digitally mediated
diagnostics and treatment, as
well as machine learning and other
forms of artificial intelligence (AI), are
becoming more routine in healthcare
operations. Although AI has been successfully
used in medical imaging, its
quality depends on the data used to
train the clinical AI application. Unreliable
AI functionality may result in misdiagnoses
or inappropriate care decisions.
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