Application of Quality and Safety Concepts

Introduction
In the US, healthcare safety isn’t up to the mark, as it ought to be. Figures from a couple of important research works reveal that between 44,000 and 98,000 individuals lose their lives per annum within healthcare settings owing to preventable clinical errors. Even if one uses the lower figure, preventable clinical mistakes within healthcare facilities surpass mortality attributed to feared risks like motor accidents, AIDS and breast cancer. The term ‘clinical error’ may be described as non-completion of an action according to plan or employing the wrong plan for accomplishing an objective. The issues which mostly crop up whilst delivering healthcare services to patients include wrong transfusions, adverse medication related events, operation-related injury, wrong-site operations, mistaking patient identity, suicide, pressure ulcers, restraint-linked loss of life or injury, falls, and burns. Error cases that have the gravest consequences will most probably transpire in ICUs (intensive care units), emergency rooms, and operation theatres (IOM, 1999).
Ordinary people hold the view that technological advancement means improved efficacy, safety, expenses and quality of health care services delivered. But there are some who feel that these very same advancements can give rise to adverse events and clinical errors. Considering the fact that several million healthcare practitioners worldwide utilize almost 5,000 kinds of clinical tools and equipment, such device-linked issues are unavoidable. Even with the above challenges, mistakes and inefficiencies persist within the healthcare domain owing to the low-key technology utilized by the sector for management. Most healthcare systems across the globe continue to stick to a pen-and-paper system, including those in developed nations such as America. This is an obstacle on the medical science path as well as gives rise to regression due to the waste caused by it. Besides patients paying the price through adverse health events and inconvenience, there is also an increase in litigation and administrative costs on account of such mistakes and inefficiencies (Amit, 2019). Of particular concern is: patient information exchange when patients are shifted between departments or hospitals. Conventionally-performed record sharing of patients is ineffective and time-consuming, as well as puts patient data in jeopardy (i.e., risk of data leaks and loss of confidentiality/ privacy). Inefficient or partial information interchange may be highly dangerous if the patient requires complex or emergency treatment.
Hence, this paper holds that the sole means of addressing the above-mentioned medical problems is through the utilization of more, advanced technology for delivering an all-inclusive healthcare experience to allow diverse entities participating in the healthcare process (namely physicians, patients, and healthcare insurance and scheme providers) to exchange patient data in a secure and timely manner.
Brief literature review
Federico and Alotaibi (2017) state that ever since the IOM (Institute of Medicine) report was published, health IT (HIT) is being created and implemented at a quicker pace, with varying levels of evidence regarding health IT’s effect on the safety of patients. The report analyzed existing scientific proofs regarding the influence of diverse HITs on patient safety result improvements. It was concluded that HIT gives rise to patient safety improvements through decreasing clinical errors and adverse reactions to medication, in addition to improving adherence to clinical practice guidelines. Furthermore, it was concluded that HIT constitutes a key instrument when it comes to improving the safety and quality of healthcare. Hospitals and other healthcare facilities must selectively choose technologies for investment, since research works reveal that certain technologies have only limited evidence when it comes to improving the safety outcomes of patients.
Sittig and Singh’s (2016) study indicates that HIT is capable of bringing about patient safety improvements, though its adoption has resulted in unintentional outcomes and fresh safety-related concerns. One of the major challenges to improvement of HIT-enabled hospital system safety is: development of effective, reasonable approaches for the measurement of safety concerns where HIT intersects with patient safety. As a solution to the basic methodological and theoretical gaps that are associated with the definition and measurement of HIT-linked patient safety, the authors put forward a novel framework labeled HITS (HIT Safety) measurement, for offering a theoretical basis for HIT- linked patient safety improvement, measurement, and monitoring. This framework abides by sociotechnical as well as CQI (Continuous Quality Improvement) strategies and demands novel measurement tasks and measures for dealing with safety concerns.
Feldman, Hayes, and Buchalter’s (2018) article titled “Health Information Technology in Healthcare Quality and Patient Safety: Literature Review” assumed the form of a review of literature for identifying peer-reviewed texts dealing with actual HIT employment in the areas of patient safety and healthcare quality. The authors classified 41 research works through the use of inductive thematic studies with open coding. They utilized 3 pre-established groups, namely, prevention, action, and identification. Coding helped create 3 more groups, namely, challenges, location, and outcomes. This research aimed at providing a basis to comprehend where to concentrate HIT linked human and financial resources, in addition to expectations for HIT implementation for patient safety and healthcare quality, since the above two areas are beginning to adopt HIT for preventing preventable events, taking action in case of inevitable problems, and identifying preventable events prior to their development into actual problems. Hospitals considering HIT utilization in this domain are usually uncertain of where to concentrate human and financial resources.
Description of the situation from a theoretical perspective
HIT has been conceptualized to cover information technology articles and associated nomological networks that encompass systems promoting the healthcare goal, including CDSS (clinical decision support systems), EHR/ EMR (electronic health/ medical records), CPOE (computerized physician order entry), PCHR (personally-controlled health record which can be accessed by patients as well as their doctors in different ways), (Halamka, Mandl, & Tang, 2008) admin support functional systems, and other information management IT systems. HIT may be distinguished from general IT on account of its particular focus and possibly more inflexible and limiting standards and framework. AST (Adaptive Structuration Theory) improves IT analysis, especially in case of new adoption. Based on the 1984 Structuration Theory of Gidden, Poole and DeSanctis (1994) came up with alterations concentrating on intra-organizational social structure and how organizational members’ interactions are impacted by, and impact, IT utilization. Contrary to AST’s social structure emphasis, the TTF (Task Technology Fit) theory revolves around whether or not IT is properly devised for suiting the activity carried out by the IU (individual user). AST is frequently employed for addressing group-level events, but the focus of TTF is the individual. Patient care seldom forms an individual domain; a group encompassing physicians, nursing staff, other practitioners, administrators, technicians, and, most importantly, the patient engage in information interchange, making decision, and acting on the basis of those decisions. Therefore, AST may be applicable to HIT analysis. Additionally, TTF may help study the linkages between each aforementioned player and the HIT system they interact with. It is believed that the above models are especially well-suited to HIT analysis (Weigel, Hall, & Landrum, 2009).
Explanation of the synthesized literature findings.
Health Information Technology for Prevention of Quality and Safety Events
HIT to prevent safety and quality events entails HIT utilization for avoiding the occurrence of safety and quality events. Computerized notifications and alarms can help offer key data to support efficient, safe clinical decision-making. These notifications within the context of EHRs form a standard procedure in HIT employment for preventing likely patient safety and missed quality events. For instance, immunization notifications have resulted in a twelve percent growth in vaccination administration among healthy children and a twenty-two percent growth in that for ailing children. Further, medication notifications have been linked to a twenty-two percent decline in drug prescription errors. Lastly, soft stops may offer vital details on a likely patient safety or care quality problem. While they can proffer alternatives, they generally only need users to allow the notification to proceed.
Meanwhile, hard-stops check users from proceeding with interventions or orders which would possibly prove lethal to patients. Moreover, they can enable process continuance, though only in the event that the user takes major necessary action, like calling or consulting with specialists (e.g., pharmacists). In certain instances, a soft stop can be overruled or neglected on account of problems like alert fatigue, ineffective interface design, and weak implementation. A hard stop, if properly planned, has proven more effective in altering a less-safe plan or avoiding a possibly hazardous intervention.
Health Information Technology for Identification of Quality and Safety Events
HIT in identifying safety and quality events entails HIT which is utilized for the identification of safety and quality events at the time of their occurrence. Healthcare insurance providers have been pressurizing healthcare systems progressively to decrease healthcare service provision costs and bring about improvements in patient health results. Such pressure can exist via hierarchical reimbursement arrangements, profiting systems that satisfy or surpass certain performance benchmarks. Increased pressure on the part of payers assumes the shape of non-reimbursed care decided by payers as being unneeded or beyond “standard care.” HIT may help isolate EHR patient populations for whom this reimbursement may be below the anticipated figure. An example to take into account is hospitalization duration for any given medical procedure. Though HIT application may help furnish dashboards and reports valuable in decision-making corresponding to reimbursement practices and trends for hospitalization durations for that particular diagnosis, carefully considering unintentional consequences is imperative. For instance, when decreasing hospitalization duration, unintentional re-hospitalization is a key measure to follow.
Health Information Technology for Action in Quality and Safety Events
HIT for safety and quality event-related action entails HIT utilization for the purpose of acting on safety and quality events after they have already transpired. That is, such actions which were recorded in research works, taken owing to an event. HIT for action is different from HIT for preventive purposes in the following manner: action-focused HIT is a response associated directly with an article-reported event while prevention-focused HIT has been reported by the article to be a preemptive procedure, before an event occurs.
Owing to their standardization, a number of medical care pathways exist, including sepsis, lending themselves to medical decision support. In spite of almost twenty years of advancement in the field of early care of sepsis, its results remain poor, with sepsis continuing to be a major cause of global mortality and accounting for considerable mortality and morbidity. Considering this, an increasing national impetus exists to enhance early sepsis detection and treatment to improve results. Sepsis patients have been counted among the most critical patients hospitalized, with their chances of survival being largely reliant on prompt administration of important interventions and subsequent swift assessment of and action on intervention outcomes. A few examples are intravenous antibiotic administration and administration of intravenous fluids aggressively within a single hour. An example of intervention evaluation would be measurement of distinct lab and physical values which offer key details on patient reaction. Too frequently, clinicians encounter too much information which, though all relevant, might prove irrelevant to the problem they are attempting to address. For instance, a wide range of laboratory test results may be presented, though in actual clinical practice, only three to four tests actually guide the clinical decision. The challenge resides in distinguishing between the noise (i.e., unnecessary data for that moment) and the signal (vital for that moment). HIT solutions like dashboards may help guarantee the placement of necessary information in a favorable viewing position, with non-vital information relegated to a secondary position (e.g., on drill down, possibly).
Identification of the clinical or health care problem (Intervention and implementation)
The solution put forward for dealing with the growth in rate of preventable clinical errors has been described below and encompasses the application of;
Electronic physician’s orders and E-prescribing
CPOE (computerized physician/doctor order entry) involves utilization of computer-based or electronic support for entering doctor’s orders, which include those related to drugs, via a mobile device or computer. CPOE systems were initially targeted at improving medicine order safety. However, the latest systems also permit electronic lab test, consultation, and clinical procedure ordering. CPOEs are often incorporated into CDS (clinical decision support) systems that function in the form of an instrument for preventing errors by means of guiding prescribers on preferred medication dosage, administration frequency, and administration route. Furthermore, certain CPOE systems possess the added feature of pointing out patient allergies and medicine-lab or medicine-medicine interactions to prescribers; more complex systems are even capable of prompting prescribing physicians towards interventions which ought to be administered/prescribed on the basis of clinical guideline recommendations (e.g., venous thromboembolism prophylaxis). According to a meta-analysis aimed at the assessment of CPOE efficacy in decreasing adverse drug events and drug errors within healthcare settings, CPOE adoption along with CDS led to a significant decline in adverse drug reactions (RR: 0.47; 95% CI 0.35 to 0.60) and drug errors (RR:0.46; 95% CI 0.31 to 0.71). Likewise, research works carried out within the context of community-centered outpatient facilities revealed similar outcomes with regard to reduction of drug errors. Analysis of hard-stop utilization in the form of a measure for error and force function prevention within CPOE systems indicates its effectiveness in altering prescribing errors. But hard stop usage led to clinically significant delays in treatment.
Clinical decision support (CDS)
CDS offers healthcare providers patient-specific and other data which aims at improving provider decision-making and has been logically filtered and put forward before providers at the right time. CDS encompasses a variety of instruments aimed at improving clinical workflow and decision-making. Some examples of the instruments covered under CDS are reminders, warnings, and signals to patients and their healthcare providers, clinical practice guidelines, illness-specific order sets, documentation templates, diagnostic and investigation support, and personalized patient clinical summaries. According to conclusions arrived at by a Cochrane systematic review, the utilization of on-screen doctor reminders caused small to moderate improvements in the areas of compliance with the process, lab ordering, clinical results, drug ordering, and immunization.
Retained surgical items prevention technology
A variety of technologies have been utilized for the purpose of enhancing retained surgical item (RSI) prevention, including: RFID (radiofrequency) and bar coding surgical item tagging. A systematic study revealed as many as three research works which have carried out an assessment of the technologies that were targeted at the prevention of RSI. Of these, one research work assumed the shape of an RCT (randomized control trial) addressing barcode-aided sponge count technology usage; study findings revealed no control group-intervention group difference; however, the time taken for carrying out the count turned out appreciably longer during the intervention. A second research work delved into assessing surgical items’ RFID tagging; its outcomes were statistically insignificant. At present, no adequate clinical evidence exists in support of or in opposition to the utilization of this technology. Such technologies shouldn’t be considered for use as a separate, detached procedure. Rather, it should only accompany manual counts, on account of a number of reasons including costs, wand technique using RFID and RF systems, and confusion with previous non-tagged devices.
Remote patient monitoring
Research works attempting to assess community-based telemonitoring or remote monitoring of patients have revealed that it enhances patient results for distinct chronic ailments such as stroke, heart failure, stroke, asthma, elevated blood pressure, and chronic obstructive pulmonary disease. PDMS (patient data management systems) automatically retrieve information from bedside clinical devices such as patient monitors, ventilators, and intravenous pumps). The information is then synopsized and restructured for facilitating its interpretation by healthcare practitioners.
Evaluation using an appropriate research instrument
Further, assessment can be carried out based on systematic monitoring of the main indicators of patient care service quality, which includes those that are affected by digitalization. Monitoring can help identify the undesired changes which stakeholders such as governmental entities are capable of influencing via policies. Digital healthcare services are highly diverse in their types. The term ‘monitoring’ may be described as “the continuous process of collecting and analyzing data to compare how well an intervention is being implemented against expected results”. Therefore, this involves “the routine collection, review and analysis of data, either generated by digital systems or purposively collected, which measure implementation fidelity and progress towards achieving intervention objectives”. The content of, and part played by, assessment as well as monitoring alters when an intervention develops further. The process of monitoring may be perceived to be a process of checking whether or not the evaluation-established ‘right thing’ is being properly done. While some interventions may continue to be ‘right’, they may fail at effecting the desired or anticipated outcomes and advantages if they aren’t appropriately applied or adopted. Thus, the process of monitoring can lead to the healthcare sector and its employees doing things in a better way, thereby resulting in better performance whilst the 2016 WHO report does recognize the linkage between monitoring and assessment, it frames the former slightly more “internally”, with the latter being considered more “externally”.
Summary of the case
There is a need for healthcare institutions to cultivate a “culture of safety” in order for their processes and employees to concentrate on bringing about improvements in patient care safety and reliability. Safety ought to be explicitly recognized as an institutional objective, demonstrated through robust leadership by clinicians, governing entities, and management. This implies incorporation of various adequately-understood safety rules like working condition and job planning keeping safety in mind; ensuring healthcare providers refrain from relying on memory; and standardization and simplification of processes, instruments, and supplies. Additionally, systems to constantly monitor patient safety need to be developed and financed appropriately.
The process of medication offers an example of improved system implementation giving rise to improved human performance. Drug errors are currently occurring often in healthcare facilities; in spite of this, a number of facilities haven’t been availing themselves of established safety improvement systems like computerized drug order entry, and aren’t actively considering novel safety systems. Further, patients themselves can be the source of major safety checks within a majority of healthcare organizations. They ought to be familiar with the drugs prescribed/administered to them, what they look like, and associated side effects. In the event of discrepancies in medication or side effects, the prescribing physician ought to be notified. Hence, technology implementation is essential to decreasing easily-preventable clinical errors.
Bibliography
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