Patient safety continues to be a paramount issue in healthcare institutions across the globe, as it carries the risk of avoidable patient fatalities and injury. Progress has been made to enhance patient safety and the standard of care since the Institute of Medicine’s influential report, ‘To Err Is Human,’ was published in 1999 (Johnson et al., 2016). However, despite these endeavors, obstacles continue to endure. The present recommendation pertains to a specific patient safety concern identified during the Vila Health simulation exercise: the scenario involving the Patient Identification Error. The matter at hand necessitates immediate consideration, as neglecting to resolve it would entail substantial hazards for patients, staff, and the institution in its entirety. This paper aims to analyze the patient safety imperative, assess the associated risks, investigate the function of regulatory agencies, deliberate on the obligations of a patient safety officer, and suggest best practices supported by evidence to mitigate the identified threat.
Health Care Safety Imperative
The healthcare safety imperative is crucial for fixing the Patient Identification Error problem in the Vila Health simulation. This mistake could put patients’ health at risk because it leads to the wrong labeling of patients. To help leaders understand clearly, it is important to give a thorough account of what happened, including how the patient was mistakenly identified (Allen, 2015). The healthcare safety imperative stresses how important it is to correctly identify patients to avoid bad results. Not dealing with this threat could have very bad results, putting patients in danger and lowering the level of care overall.
The Patient Identification Error that has not yet been fixed poses a big threat to patients, workers, and the company. The healthcare safety imperative stresses the importance of correctly identifying patients to avoid bad things happening. In this case, not dealing with the threat could lead to wrong diagnoses, bad treatments, and delays in important steps that could put patients at great risk (Allen, 2015). The necessity stresses the importance of strong ways to identify patients so that safe, high-quality care can be given. Regulatory agencies, like The Joint Commission, keep an eye on problems related to patient safety (Wickersham & Basey, 2016). This makes it even more important to deal with the threat immediately to stay compliant and lessen the possible effects.
Regulatory agencies have a big impact on how companies handle patient safety, especially when it comes to the Patient Identification Error. The Joint Commission’s National Patient Safety Goals (NPSGs) spell out specific rules meant to make patients safer (Joint Commission, 2021). Looking at these rules gives you ideas on what steps need to be taken to successfully deal with the threat that has been identified. Regulatory agencies affect businesses because they set rules that they must follow. If they do not, they may face fines and damage to their image. When healthcare organizations set up best practices for reporting and investigations, they need to follow regulatory advice. The Patient Identification Error could seriously affect patients, employees, and the organization if it is not fixed (Kemper et al., 2013). These effects could include decreased patient safety, legal problems, and damage to the institution’s image. Dealing with the threat aligns with the need for healthcare safety and what regulators expect. This shows that the resolve to give safe, high-quality care is stronger than ever.
Role of the Patient Safety Officer
Patient safety officers are very important when implementing patient safety plans in healthcare settings, especially when fixing problems like the Patient Identification Error (Joint Commission, 2021). Their job includes keeping an eye on creating and implementing plans to improve patient safety measures.
The patient safety worker has more than one job to do in the case of the Patient Identification Error. They need to work with other departments to set up good patient identification processes so that everyone in the organization follows the same rules (Smith et al., 2020). This means that the methods for identifying patients must be constantly watched, evaluated, and made better. The officer is also in charge of planning training programs for staff, stressing the importance of accuracy, confirmation, and communication when identifying patients.
My responsibility as the patient safety officer requires me to spearhead an interdisciplinary effort to rectify the Patient Identification Error in this particular case (Smith et al., 2020). As part of this process, I will work together with administrators, healthcare personnel, and IT experts to develop and execute thorough solutions. Staff will receive timely feedback to encourage continuous improvement once audits and feedback systems are set up to examine the effectiveness of patient identification methods.
The research by Smith et al. (2020) is one example from the literature that shows how important it is to work together to solve patient safety problems. The importance of forming interdisciplinary teams to address patient identification mistakes in healthcare facilities was highlighted in their study. The importance of stakeholder collaboration in creating and executing effective patient safety plans is illustrated by this case.
The patient safety officer assumes the role of a catalyst for change, promoting a culture of safety and alertness among the personnel (Smith et al., 2020). By utilizing literature examples and implementing best practices, the officer can substantially contribute to reducing Patient Identification Errors, aligning with the primary objective of delivering safe and high-quality healthcare.
Evidence-Based Best Practice Tools
To fix the Patient Identification Error, it is suggested to use a complete five-point plan that includes tools and methods shown to work best. Barcoding technology has been shown to increase accuracy and decrease mistakes, which makes it an important part of the plan. It is suggested that barcoding technology be used to accurately identify patients and lower the chance of mistakes during different stages of care, like giving medications and collecting samples (Smith et al., 2020). Staff training programs are another important part of the plan since ongoing training has been shown to cut down on mistakes made when identifying patients. It is suggested that all healthcare workers involved in identifying patients get regular training programs that stress the importance of correct verification and discussion throughout the care process.
Furthermore, the plan supports the implementation of routine audits and feedback systems. Consistent audits, substantiated by empirical evidence, have demonstrated efficacy in detecting and rectifying concerns about errors in patient identification (Smith et al., 2020). This strategy aims to establish a methodical framework for assessing the efficacy of patient identification procedures, while ensuring that personnel receive prompt feedback on audit results to promote ongoing enhancements. The plan heavily relies on standardized patient identification protocols, widely acknowledged as a best practice for improving accuracy. The proposal recommends the establishment and execution of standardized protocols to identify patients throughout all departments, to promote uniform compliance and reduce the occurrence of discrepancies and mistakes.
Lastly, the plan stresses how important it is to share and learn from incidents. Setting up a strong incident reporting system encourages employees to report mistakes and helps the company learn. The plan suggests setting up a full incident reporting system to get staff to report any patient identification mistakes. To keep improving patient safety, it is very important to use reported incidents to learn how to improve processes and stop mistakes from happening again (World Health Organization, n.d.). By adding these best practices based on evidence to the five-point plan, the organization can proactively deal with the Patient Identification Error. They can think about how to handle incidents, do rounding for ongoing assessment, find mistakes through audits, report incidents for ongoing learning, and ensure that best practices fit seamlessly into existing workflows.
Conclusion
Ultimately, prioritizing the resolution of the Patient Identification Error is of utmost importance to safeguard patient well-being and uphold the standard of care in healthcare institutions. The need for healthcare safety emphasizes the importance of establishing efficient solutions to reduce the dangers connected with misidentification. Neglecting this danger may result in significant consequences, jeopardizing the well-being of patients and the organization’s credibility. The suggested five-point strategy, based on proven and reliable methods, highlights the use of barcoding technology, continuous staff education, frequent evaluations, uniform procedures, and reporting of incidents. These strategies jointly contribute to a holistic approach to lower and finally eradicate the Patient Identification Error (World Health Organization, n.d.). Healthcare companies can uphold their commitment to patient safety and consistently improve the quality of care by adhering to regulatory expectations, promoting a culture of safety, and utilizing evidence-based methods. The success of this campaign hinges on collective endeavors, unwavering dedication to ongoing enhancement, and a diligent emphasis on adopting optimal methodologies in patient identification procedures.
References
Allen, G. (2015). Infection prevention: A patient safety imperative for the perioperative setting. AORN Journal, 101(5), 508–510.
Johnson, J. K., Haskell, H. W., & Barach, P. R. (2016). Case studies in patient safety. Jones & Bartlett Learning.
Joint Commission. (2021). National patient safety goals. https://www.jointco mmission.org/standards/national-patient-safety goals/
Kemper, C., Blackburn, C., Doyle, J. A., & Hyman, D. (2013). Engaging patients and families in system level improvement: A safety imperative. Nursing Administration Quarterly, 37(3), 203– 215.
Smith, A. B., Kean, E. A., Malloy, P., Lappin, S. L., & Mullan, P. B. (2020). A multidisciplinary approach to reducing patient identification errors in a hospital setting. Journal of Patient Safety, 16(4), e247-e251. doi:10.1097/PTS.0000000000000595
Wickersham, M. E., & Basey, S. (2016). Is accreditation sufficient? A case study and argument for transparency when government regulatory authority is delegated. Journal of Health and Human Services Administration, 39(2), 245–282.
World Health Organization. (n.d.). Patient safety. https://www.who.int/patientsafety/en/
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