In my encounters with nearly 65 patient safety officers (PSOs) since becoming the Patient Safety Liaison (PSL) for the Northeast Region of Pennsylvania, there is one common theme: the need to collaborate and share in ongoing education about patient safety. Patient safety is influenced by many issues in healthcare, including human factors, high-tech equipment and devices, and often dangerous medications and/or procedures. Complex systems of healthcare delivery demand the use of evidence-based practices and standardization in order to achieve the best clinical outcomes. Ongoing education is necessary to support patient safety.
The Pennsylvania Patient Safety Authority recognizes that responsibilities and internal support vary for PSOs. The Authority is engaged in ongoing efforts to collaboratively identify and address PSOs’ educational needs. Through the PSL program, the Authority continued its efforts with two recent educational offerings.
2009 Patient Safety Officer Foundation Education Program
In early 2009, PSOs in the Northeast Region were offered a patient safety foundation education course. Eleven PSOs who were either new to their role or who desired more information about patient safety attended this program. Of the participants, eight were from ambulatory surgical facilities (ASFs) and three were from hospitals.
The learning objectives of this program included PSOs being able to recall key elements of Chapter 3 of the MCARE Act of 2002; recognize their role, responsibility, and scope; identify the components and framework of a patient safety infrastructure; identify how to develop and implement a patient safety plan; and recognize patient safety challenges.
A key item of discussion was event reporting—specifically, event determination. This is not unique to this particular group, as other PSOs often struggle with categorizing events that they report to the Authority. During this particular session, the group had the opportunity to work through various scenarios and collectively decide its respective event classification. In some scenarios, there was debate and controversy over each person’s interpretation of the criteria used to distinguish a Serious Event and an Incident. But, working through the scenarios aided the PSOs’ interpretations. One participant said this experience helped her learn “the different ways people report events and how to determine the type of event.” Another participant expressed interest in additional programs dedicated solely to event reporting.
PSOs from ASFs, who represented the majority of participants at the program, discussed appropriate patient selection for services at an ASF. No clear guidelines identify patient comorbidities or other specific criteria that would help to determine which setting is the most appropriate for outpatient surgery.1 Patient selection is typically determined through medical screenings performed by the surgeon in consultation with the referring physician and the anesthesia practitioner. All participating PSOs agreed that comprehensive preoperative screening measures capture critical information that can help to determine whether a patient is appropriate for the ASF setting. For example, if a patient presents to an ASF with an exacerbation of an existing medical condition that predisposes him or her to harm, that case is aborted and the patient is transported to a local hospital for care and treatment.
All participating PSOs identified communication among all providers and patients as a key factor in ensuring a good patient safety program. An example discussed by the group was correct-site surgery protocols. Each person in the operating room (OR) plays a part to ensure not only the correct patient, correct procedure, and correct site, but to identify potential complications, procure necessary equipment, and monitor to ensure proper recovery management. The benefits of using forcing functions such as time-out checklists were discussed by the group. Some participants have enhanced their existing OR checklists to include the World Health Organization’s (WHO) Surgical Safety Checklist. (Information on the WHO Surgical Safety Checklist and accompanying correct-site surgery information can be accessed via the Authority)
The 2009 Patient Safety Officer Foundation Education Program was well received. The Authority replicated the program for the South Central region in June and will take it to other regions in conjunction with the expansion of the PSL program. The Authority will also build on this success to address more in-depth topics of interest to PSOs.
MRSA Education Program for Ambulatory Surgery Centers
An objective of the PSL program is to develop and conduct educational programs dedicated to the needs of specific care settings. One of the first Northeast regional sessions involved PSOs of ASFs.
The ASFs of the Northeast Region comprise approximately 50% of all medical facilities in that region. Although ASFs share some of the same patient safety challenges that hospitals and other medical facilities encounter, ASFs are unique in many ways. Most are separate and distinct from a hospital setting. ASF procedures and surgeries are performed on low-risk patients who do not require the more extensive resources available in a hospital setting. In order to obtain/maintain licensure, ASFs must comply with state standards that differ from state standards for hospitals (e.g., limit of four hours of operating time).2 In addition, ASFs are accredited by different voluntary regulatory bodies. While hospitals are accredited by the Joint Commission, the majority of ASFs are accredited by the Accreditation Association for Ambulatory Health Care.
During my visits with PSOs of ASFs, they voiced interest about methicillin-resistant staphylococcus aureus (MRSA). Each PSO understands the core infection prevention elements for MRSA, but all are continually looking at best practices for surveillance. Regarding patients’ infectious disease status, some PSOs commented about inconsistent cooperation from other care settings that transferred patients to ASFs for care. Others requested additional education about elements of Act 52 of 2007. As a result, the Authority conducted a MRSA education program for ASFs on April 7, 2009. The program addressed clinical features, mode of transmission, infection prevention strategies, recognition of high-risk patients, surveillance measures, infection control practices, and elements of Act 52.
PSOs from 62% of ASFs in the Northeast participated in this program. PSOs represented various types of ASFs (e.g., single procedure versus multiple procedure settings). Overall participant response was quite positive (satisfaction rating of 98%). Evaluation comments reflected that current knowledge was reinforced, and additional education was provided about items such as the availability of rapid MRSA testing and recommendations from the Centers for Disease Control and Prevention (CDC). The education prompted some PSOs to say that they will modify facility policies as a result. Another attendee from the Southeast Region, who accompanied a PSO from her sister facility in the Northeast Region, asked when the Authority would be hiring a PSL for, and have functions like this in, the Southeast Region.
Toward the conclusion of the program, the attendees had the opportunity to participate in a limited open forum about shared issues. One PSO was from a facility in which a malignant hyperthermia event had resolved successfully. The PSO offered to share this experience so that others could learn from it. Another PSO offered to share her facility’s medication reconciliation process, including policy and forms. Yet another was willing to share preoperative assessment forms.
PSOs also offered topics of interest for future programs, including correct-site surgery, team building, medication reconciliation, and preoperative screening/assessment. (See the March 2009 Pennsylvania Patient Safety Advisory for articles on the first and last topics.) All participants were referred to the Authority’s Web site (http://www.patientsafetyauthority.org) to access existing information about these topics and others and were encouraged to provide feedback about their usefulness. PSOs were likewise encouraged to comment on entries to the Authority’s Time-Out in the OR Competition (entries were reprinted in the March 2009 Advisory).
The Authority’s PSL program will continue to communicate with all the medical facilities in the Northeast Region to both identify and respond to their patient safety needs and initiatives. These and future Authority-sponsored educational programs will offer continuing education hours for Pennsylvania professional nurses. The programs shared in this article are among many being planned for the Northeast and other regions throughout the Commonwealth. Those individuals within the Commonwealth who have an interest in learning about future programs should contact the Authority.
The Authority is in the process of broadening the reach of the PSL program beyond the Northeast Region. Two new PSLs will soon engage healthcare facilities within their respective regions of Pennsylvania (see listings under Authority staff on the Advisory masthead page). Within the next year, it is anticipated that the program will grow to encompass three more regions of the Commonwealth and provide medical facilities with guidance and education relative to their patient safety needs.
- Patient screening and assessment in ambulatory surgical facilities. Pa Patient Saf Advis [online] 2009 Mar [cited 2009 Apr 27]. Available from Internet: http://www.patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2009/mar6(1)/Pages/03.aspx.
- The Pennsylvania Code, Chapter 551.21, § 1005.10, Licensure and general operating standards, Section I, (c), (A)., Amended October 1999, Criteria for Ambulatory Surgery [online]. [cited 2009 May 18]. Available from Internet: http://www.pacode.com/secure/data/028/chapter551/chap551toc.html.