Improving Patient Safety: An Urgent Imperative for All Providers 9/30/19 1 Improving Patient Safety: An Urgent Imperative for All Providers Patrick J. Dunne, MEd, RRT, FAARC Fullerton, CA [email protected]Kentucky Society for Respiratory Care 14 th Annual Educational Symposium Western Kentucky University September 25, 2019 w Bowling Green w KY Disclosure Professional relationship with w Monaghan Medical Corporation w Mylan Pharmaceutical Career-long member/supporter of w AARC (AARConnect) w State affiliates Objectives ✦ State reasons why RTs should actively support and participate in efforts to improve patient safety; ✦ Describe the benefits of using patient-centered protocols, in conjunction with safety checklists, to ensure the delivery of appropriate and safe respiratory care, and ✦ List the prevalence and economic impact of post-operative pulmonary complications and the important role RTs can play to help address this significant patient safety issue.
11
Embed
Improving Patient Safety: An Urgent 9/30/19 Imperative for ... · Improving Patient Safety: An Urgent Imperative for All Providers 9/30/19 6 Patient Safety 2013 Literature search
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Kentucky Society for Respiratory Care14th Annual Educational Symposium
Western Kentucky UniversitySeptember 25, 2019 w Bowling Green w KY
Disclosure
Professional relationship withw Monaghan Medical Corporationw Mylan Pharmaceutical
Career-long member/supporter ofw AARC (AARConnect)w State affiliates
Objectives
✦ State reasons why RTs should actively support and participate in efforts to improve patient safety;
✦ Describe the benefits of using patient-centered protocols, in conjunction with safety checklists, to ensure the delivery of appropriate and safe respiratory care, and
✦ List the prevalence and economic impact of post-operative pulmonary complications and the important role RTs can play to help address this significant patient safety issue.
✦ Literature search 2008 – 2011✦ 210,000 to 400,000 preventable deaths per year✦ Non-lethal harm 10-to-20 fold higher✦ Near misses/non-reported incidents unknown✦ Preventable patient harm/injury an epidemic
Journal of Patient Safety. Vol 9; No 3: September 2013
Patient Safety2013
Established through support of Masimo Foundation for Ethics, Innovation to reduce preventable deaths to ZERO through development of actionable patient safety solutions
Convenes Annual World Patient Safety, Science & Technology Summit; Key feature – Personal Testimonials by family members of victims
AARC an active, engaged Partner
Patient Safety2015
✦ Implements Hospital-Acquired Conditions (HAC) Reduction Program
✦ Reduce payments 1% to worst-performing hospitals (25th percentile)
“The development of at least 1 PPC, even those presumed mild (e.g. atelectasis, need for prolonged oxygen therapy) was associated with significantly increased early post-operative mortality, ICU
admission and prolonged LOS.”
Fernandez-Bustamante, A; et.al. JAMA Surg. Feb 2017
Patient Safety in Respiratory CarePost-operative Pulmonary Complications (PPCs)
Postoperative Pulmonary ComplicationsOverview
✦ Relatively recent area of independent investigationv Typically “we treat it when detected”
✦ Prevalence following general surgery/anesthesiav Overall range: 2% to 40%
v A prophylactic bronchial hygiene technique§ 1970s - “cost-effective” alternative to IPPB
v Slow, deep inhalation followed by breath hold (2 – 6 seconds)
§ Ideally, from FRC to TLC
v IS devices widely used in many/most hospitals
What About Incentive Spirometry?What Does The Evidence Say?
✦ Cochrane Database Systematic Review; Feb 2014v 12 studies with useable data on 1160 subjects
v “There is low quality evidence regarding the effectiveness of incentive spirometry for prevention of postoperative pulmonary complications in patients after upper abdominal surgery.”
Evidence for Incentive Spirometry?Respir Care; March 2018
✦ Published studies: inconsistent methodologies = inconclusive results✦ Lack of patient adherence data major confounder in IS studies✦ Standardized clinical approach for IS lacking
“Until evidence of benefit from well-designed clinical trials becomes available, the routine use of IS in postoperative care is not supported by high levels of
evidence . . .
Given their expertise in working to optimize patients’ postoperative pulmonary outcomes, respiratory therapists can play an integral role in educating providers
about the dearth of evidence supporting IS.”
Patient SafetyOur Responsibility – Our Time
✦ Medical mistakes:
v Are prevalent, harmful, deadly & costly§ An epidemic requiring immediate/continuous action
§ Excellent opportunity for RTs in ALL care settings
v Impact EVERY health care stakeholder§ Patients/family, purchasers, providers, payors
v Are largely preventable§ Demands “mindfulness” in a highly complex environment
§ Require a Culture of Safety
Patient SafetyOur Responsibility – Our Time
“Today’s clinicians have at their disposal some 6,000 drugs and
4,000 medical/surgical procedures to treat more than 13,000 different diseases, symptoms and types of
injuries.
Medicine has become the art of managing extreme complexity.”