11 patient safety innovations to know

Patient safety is always at the forefront of healthcare delivery. Here are 11 innovations positively affecting patient safety today.

The fight against superbugs. Multidrug resistant bacteria, or superbugs, infect around 2 million people annually and result in around 23,000 deaths per year, according to the CDC.1 Hospitals spend around $2 billion per year treating patients with multidrug-resistant infections, a Health Services Research study found, and infections such as Clostridium difficile add $4,617 to each case.2 Healthcare delivery organizations take a multipronged approach to combatting superbugs. For now, the focus is on preventing the spread of drug-resistant bacteria by using antimicrobial products and disinfectants to remove pathogens from commonly touched surfaces in patient rooms.

While some of these products have been around for decades, many researchers are working on new means of disinfection. At the University of Alberta in Canada, researchers compared pure-compressed sodium chloride surfaces with antimicrobial copper and stainless steel, and found the salt was able to kill a Methicillin-resistant Staphylococcus aureus culture 20 to 30 times faster than the other materials.3 The salt surface also reduced MRSA levels by 85 percent in 20 seconds; by one minute, the MRSA level dropped 94 percent.

Another study published in the March 2019 issue of The Journal of Hospital Infection examined how sink drain devices can reduce multidrug-resistant Pseudomonas aeruginosa infections.4 The researchers replaced drain siphons in an intensive care unit with devices that applied heat and electromechanical vibration to disinfect the draining fluid. After replacing the drains, colonization among the ICU patients dropped from 8.3 per 1,000 admitted patients to zero in one ICU unit and from 2.7 to 0.5 per 1,000 admitted patients in a second group of ICU units.

Stepping up antibiotic stewardship. The overuse of antibiotics is fueling the rise in superbugs. A 2018 study published in eLife found the increase in antibiotic resistance is closely linked to occasional antibiotic use by many people.5 Researchers discovered 34 percent of people received antibiotics in 2011, with 10 percent of the population using 57 percent of the antibiotics.

Reducing unnecessary antibiotic prescriptions is top of mind for all hospitals, but implementing an antibiotic stewardship program can be daunting. Many healthcare organizations are turning to clinical decision support technologies to help accelerate these antibiotic stewardship efforts. VigiLanz offers surveillance and reporting platforms that can perform automated antibiotic dosing with clinical surveillance and issue drug interaction alerts. The technology also provides leaders with helpful data into antibiotic prescription patterns for a specific unit or physician.

ED adverse event prevention. Adverse events in the emergency department are a challenge for healthcare organizations and detrimental to patient care. A study published in the Annals of Emergency Medicine examined 62 urban EDs in 20 states and found an adverse event rate of 4.1 per 100 patients, as well as a near miss rate of 5.4 per 100 patients.6 Researchers deemed all of the near misses and 37 percent of the adverse events preventable, which leaves room for innovation, and health IT companies have developed solutions to fill the gaps.

A 2019 study in the Journal of Patient Safety examined a monitoring system that combines two reporting methods and five trigger tool methods for capturing adverse events.7 The researchers gathered results from an academic medical center ED, which included 69,327 adult non-trauma patients. There were 285 adverse events, and the reporting method identified 77.2 percent of them; the trigger tools identified 26 percent. The remaining 3.2 percent were detected using both the reporting method and trigger tools.

Leveraging the EHR to provide better patient care. As EHR usability has evolved, physicians and nurses can now use the patient records to improve care delivery and safety. When all the patient's data is documented correctly, clinicians have pertinent information available to make informed decisions at the point of care. EHR notes are more legible than handwritten notes, and alerts can prevent clinicians from administering medications in problematic combinations or medications that will induce allergic reactions. For example, the VigiLanz Platform is designed as a real-time automated monitoring system that can alert clinicians about drug mismatches, preventions and reportable infections based on EHR data.

In the future, adding genomic information to the patient's record will allow for faster, targeted care delivery. Genomic information has already proven beneficial for cancer patients, as oncologists can now match chemo and other cancer therapies based on the patient's genes and specific tumor. Similar data can influence other types of medications administered for chronic disease management and specialty care.

Blockchain for physician credentialing. Proper physician credentialing is a crucial process for healthcare organizations to verify that physicians are qualified to provide safe and accurate care. However, this process requires a lot of information gathering and a long approval process that can delay physicians' practice. Healthcare organizations, including hospitals and physician networks, must obtain the physician's education, licensure and regulatory history, among other references, before the clinician can perform cases. Blockchain is one solution to speed the process and ensure accuracy, according to PwC. When information is inserted onto the blockchain's distributed ledger, the appropriate certification parties can make updates in real time and share the information with the right organizations, including payers, within days.

Blockchain could save weeks or months of waiting for physicians, who submit around 18 applications for credentialing per year. The National Association of Medical Staff Services reports physician credentialing takes around 120 days on average.8 CMS reports 52 percent of providers in their Medicare Advantage online directory contained inaccuracies. Blockchain would keep all verified provider data in one spot. Five organizations, including Spectrum Health and WellCare, have already signed on to physician credentialing via blockchain in partnership with Hashed Health.9

Improved internal communications. Disjointed communication systems in healthcare organizations can lead to patient harm or mortality. Researchers examined malpractice claims between 2009 and 2013, and found 37 percent cited miscommunication as a contributing factor in high-severity injury cases.10 There were 7,149 cases that included instances of facts, figures or findings that weren't properly communicated between providers with dire consequences, and more than half of the cases involved miscommunication between two or more providers.

The Joint Commission estimates around 80 percent of serious medical errors involve miscommunication between providers during patient transfers. Health IT companies now seek to mitigate these challenges with real-time updates in patient records, alerting the entire care team when the patient's condition or care plan changes. Platforms such as Spok Care Connect can be used to break down clinical barriers between organizations by offering a streamlined communication system that integrates into existing workflows within the EHR. These types of solutions are designed to securely share important patient information, make handoffs more efficient and reduce preventable harm.

Proactive pathogen detection. The earlier clinicians identify infections, the easier they are to treat. Healthcare-associated infections are responsible for about 1.7 million infections and 99,000 deaths each year, according to the CDC.11 Several companies have found innovative ways of detecting harmful pathogens in healthcare settings before patients become infected. For example, continuous air sampling and monitoring systems such as the RAPID Reader System from PathogenALERT examines and detects pathogens in real time and then texts or emails results.

Not all infections are preventable, however. When patients do contract an infection, technology such as BD's MedMined Surveillance Advisor mines data to discover clinically relevant pathogen changes so providers can pinpoint emerging infection trends and eliminate outbreaks. Wolters Kluwer Health's POC Advisor, a clinical intelligence platform, also aggregates data for early issue detection and prevention.

Machine learning to identify and treat sepsis sooner. Every year nearly 1.7 million adults develop sepsis and about 270,000 people die from the condition, according to the CDC.12 Sepsis remains a critical challenge for hospitals nationwide, but some, such as Massachusetts General Hospital in Boston, use predictive modeling to better inform sepsis treatment decisions.

Mass General teamed up with researchers from the Massachusetts Institute of Technology in Cambridge to develop a predictive modeling system based on records from nearly 186,000 patients treated in the Mass General ER from 2014-16.13 The researchers used data from 130,200 records to train the machine learning model, which uses more than 24 clinical factors to assess whether patients could benefit from receiving vasopressors in the ER. During testing, researchers found the model was able to predict vasopressor need correctly 80 to 90 percent of the time.

North Oaks Health System in Hammond, La., also uses a predictive modeling tool to identify sepsis risk by monitoring 80 data points in a patient's medical record.14 After the patient arrives in the ER, the tool examines the patient's health information every 15 minutes to determine sepsis risk. If the patient reaches a critical threshold, the tool alerts clinicians. As a result of the tool, patients with sepsis symptoms now receive antibiotics an average of 30 minutes sooner, and sepsis mortality at North Oaks dropped by 18 percent within a year of implementing the tool.

Safe waste management. Hospitals produce around 5.9 million tons of medical waste per year, equaling around 33 pounds of medical waste per staffed bed per day. The medical waste includes sharps, biohazard material, trace chemo and pharmaceuticals. According to an Associated Press study, researchers identified pharmaceuticals in drinking water serving around 41 million Americans, which puts communities at risk.15 Companies including Stericycle have created innovative ways to dispose of medical and pharmaceutical waste across the spectrum, from hazardous waste to recyclables, sharps and electronic waste, which includes privacy protected information.

Healthcare organizations are also working with patients for safe disposal of controlled substances with medication disposal kiosks at retail pharmacies and long-term care facilities, providing envelops to patients so they can mail back unused medications to prevent pill diversion.

High-tech hand hygiene systems. Proper hand hygiene is a simple way to prevent the spread of bacteria in a hospital, but that's easier said than done. Just washing hands with soap and water may reduce deaths related to diarrhea by up to 50 percent, and a group of London-based researchers estimated routine hand-washing could prevent around 1 million deaths per year.16 Lax hand hygiene compliance also fuels the spread of HAIs. Hospitals now rely on several methods, including digital monitoring, to ensure hand hygiene compliance. Technology such as the SwipeSense System, which is a smart alcohol rub dispenser with a sensor that can tell whether providers comply with hand hygiene best practices when entering or exiting a room, can improve hand hygiene. The company also provides individual dispensers hospital staff can wear and use at the point of service.

Safer opioid prescribing. Nearly 218,000 people have died from overdoses linked to prescription opioids between 1999 and 2017, according to the CDC.17 Of the 70,237 drug overdose deaths that occurred in the U.S. in 2017, 47,600 involved opioids. To counter this increasing rate of overdose deaths, many hospitals are adopting innovative approaches to promote safer opioid prescribing.

Charlotte, N.C.-based Atrium Health developed an EHR alert system that can assess a patient's history with controlled substances to better prevent high-risk opioid prescriptions. The system identified patients with evidence-based risk factors for opioid abuse, misuse or diversion and alerts the provider in the EHR before they write a potentially unsafe prescription. Atrium Health prevented more than 23,000 high-risk prescriptions systemwide within the first two years of implementing the alert system.

References:

1. Centers for Disease Control and Prevention. "Antibiotic / Antimicrobial Resistance (AR / AMR)" U.S. Department of Health & Human Services. Accessed: May 9, 2019.

2. Johnston, Kenton J., Thorpe, Kenneth E., Jacob, Jesse T., Murphy, David J. "The incremental cost of infections associated with multidrug-resistant organisms in the inpatient hospital setting—A national estimate." Wiley Online Library: March 2019. doi.org/10.1111/1475-6773.13135

3. Hingston, Michael. "Can Salted Doorknobs Prevent Superbug Infections?" The Atlantic: March 2017. Accessed: May 9, 2019.

4. De Jonge, E, et al. "Effects of a disinfection device on colonization of sink drains and patients during a prolonged outbreak of multidrug-resistant Pseudomonas aeruginosa in an intensive care unit." Journal of Hospital Infection, Vol. 102, 1, 70-74. doi.org/10.1016/j.jhin.2019.01.003

5. Olesen, Scott W. et al. "The distribution of antibiotic use and its association with antibiotic resistance." eLife: December 2018. Accessed: May 2019.

6. Camargo Jr., Carlos, et a.. "Safety Climate and Medical Errors in 62 US Emergency Departments." Annals of Emergency Medicine, Vol. 60: 5, November 2012. Pp. 555-563.

7. Lee WH, et al. "Comparing the Outcomes of Reporting and Trigger Tool Methods to Capture Adverse Events in the Emergency Department." J Patient Saf Mar; 15(1): 61-68 doi:10.1097/PTS.0000000000000341

8. Gaffney A. "Here's how blockchain could accelerate credentialing." PwC Oct. 2018.

9. Jasper K. "5 healthcare groups sign up for blockchain credentialing." Ledger Insights, Accessed: May 9, 2019.

10. Kern C. "Healthcare Miscommunication Costs 2,000 Lives And $1.7 Billion." Health IT Outcomes: Feb. 2016. Accessed: May 9, 2019.

11. Centers for Disease Control and Prevention. "HAI Data." U.S. Department of Health and Human Services. Oct. 2018. Accessed: May 9, 2019.

12. Centers for Disease Control and Prevention. "Sepsis: Data & Reports." U.S. Department of Health and Human Services. Aug. 2013. Accessed: May 9, 2019.

13. Matheson R. "Machine-learning system could aid critical decisions in sepsis care." MIT News: Nov. 2018.

14. Practice Greenhealth. https://practicegreenhealth.org/topics/waste/waste-0 Accessed: May 9, 2019

15. Associated Press Study "Pharmawater I" – 2015.

16. Centers for Disease Control and Prevention. "Hygiene Fast Facts: Information on Water-related Hygiene." U.S. Department of Health and Human Services. July 2019. Accessed: May 9, 2019.
17. Centers for Disease Control and Prevention. "Prescription Opioid Data." U.S. Department of Health and Human Services. Dec. 2018. Accessed May 9, 2019.

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