The top five safety risks in ambulatory care are diagnostic testing errors, medication safety events, falls, HIPAA violations and security incidents, according to a new ECRI Institute analysis.
Plymouth Meeting, Pa.-based ECRI Institute, a non-profit patient safety organization, reviewed 4,355 events reported by ambulatory care centers, community health centers and physician practices between December 2017 and November 2018. Almost 50 percent of events involved diagnostic testing errors, while 25 percent were related to medication safety and the remainder involved falls, security and safety and privacy-related risks.
Here are the five key safety challenges and ECRI-recommended solutions:
1. Diagnostic testing errors: The majority of errors were related to lab tests. ECRI recommends implementing decision support tools for providers and monitoring test tracking and follow-up processes.
2. Medication safety events: Two-thirds of medication safety events were categorized as wrong drug, wrong patient or wrong time. Medication errors are often the result of a series of failures within the organization. Solutions include standardized medication management procedures and new reporting and management policies for safety events.
3. Falls: About 800,000 people are hospitalized with a fall-related injury per year, with 50 percent of the events ECRI analyzed occurring in an exam or waiting room. Solutions include screening for falls and proactively identifying high-risk patients.
4. HIPAA violations: Misunderstanding Health Insurance Portability and Accountability Act privacy and security rules led to more than 350 HIPAA-related events reported to ECRI. The majority involved accidental disclosure of patients' protected health information. Due to inadequate detail regarding current practices, the ECRI did not give HIPAA-related recommendations.
5. Security and safety incidents: Most events involved verbal threats or disruptive behavior by patients or visitors. Solutions include staff education and training on violent situations, along with monthly security and safety surveillance rounds.
Regarding safe patient care as a whole, ECRI recommended creating a strong, nonpunitive culture of safety that encourages patient safety event reporting.