New patient safety goal: Involve your patients
New patient safety goal: Involve your patients
Another new goal targets patient suicides
ED managers could be impacted by one newly announced National Patient Safety Goal and an extension of an existing goal, says Richard Croteau, MD, executive director for patient safety initiatives at the International Center for Patient Safety at the Joint Commission on Accreditation of Healthcare Organizations. The new Goal, 15/ 15A, states:
"The organization identifies safety risks inherent in its patient population. The organization identifies patients at risk for suicide. [Applicable to psychiatric hospitals and patients being treated for emotional or behavioral disorders in general hospitals.]"
The extension is for Goal 13/13A, which previously did not apply to hospitals. It reads:
"Encourage patients' active involvement in their own care as a patient safety strategy. Define and communicate the means for patients and their families to report concerns about safety and encourage them to do so."
In terms of the new goal, says Croteau, "the requirement is that these patients be assessed for risk of suicide, and based on that assessment, that appropriate precautions be taken." Usually, he says, these precautions involve continuous observation and checking for any kind of contraband, such as pills or knives.
Richard Bukata, MD, FACEP, medical director of the ED at San Gabriel Valley Medical Center in Sierra Madre, CA, responds: "I think we do that now. If people come in with some indication there has been self-harm — they've taken some pills, or cut their wrists — all those patients are assumed to be suicidal."
In those cases, he says, after the physicians evaluate them, there often will be a consult from the psychiatric evaluation team. "We often have a guard placed by the room so they cannot elope or leave before it is determined whether they are a danger to themselves."
As for Goal 13, "The patient needs to be advised as to how they can express concerns about their safety," Croteau explains. "If they observe anything they think is unsafe, they need to be able to report that, so the ED needs to provide those means and encourage them to do it."
He suggests that the triage nurse might say, if appropriate, something like this: "Here at 'St. X Hospital,' we are very concerned about safety. We want everyone and anyone to be alert and to help us keep everyone safe — including you." Accordingly, Croteau continues, the patient can be advised that if they see something that doesn't look right or appears hazardous, they should tell the first nurse or doctor they see. "You don't want the patient to feel you are transferring the responsibility for their safety to them, but you should state your philosophy of safety and engage the patient and family as part of that philosophy," he emphasizes.
The family's involvement is especially important if the patient is unconscious, adds Croteau. "It could be a significant other, a close friend — whoever they want by their side as an advocate," he says.
But, warns Bukata, "The devil's in the details. How are you supposed to comply?" For example, he notes, one possibility might be to have signs all over the ED saying, "If you see something that's not safe, talk to your nurse."
Sources
For more information on the 2007 National Patient Safety Goals, contact:
• Richard Bukata, MD, FACEP, Medical Director, Emergency Department, San Gabriel Valley Medical Center, 227 W. Orange Grove Ave., Sierra Madre, CA 91024. Phone: (626) 836-3700. Fax: (626) 836-3702. E-mail: [email protected].
• Richard Croteau, MD, Executive Director for Patient Safety Initiatives, Joint Commission International Center for Patient Safety, Phone: (401) 855-0281.
ED managers could be impacted by one newly announced National Patient Safety Goal and an extension of an existing goal, says Richard Croteau, MD, executive director for patient safety initiatives at the International Center for Patient Safety at the Joint Commission on Accreditation of Healthcare Organizations.Subscribe Now for Access
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