The week of March 14th through March 20th was Patient Safety Awareness Week, a time when nationally all healthcare agencies and facilities encourage everyone to learn more about healthcare safety. There has been real progress made in the area of patient safety, but unfortunately, medical harm is still a cause of significant patient mortality world-wide. The World Health Organization (WHO) estimates that 134 million adverse events occur each year in unsafe hospitals world-wide in low to middle-income countries resulting in 2.6 million deaths. The WHO has reported that a large portion of these events are preventable.
Here in the US two agencies are integral in working to combat unsafe patient care conditions, The Institute for Healthcare Improvement (IHI) and the Agency for Healthcare Research and Quality ( AHRQ). The IHI has launched a national safety initiative called Safer Together, A National Action Plan to Advance Patient Safety. The AHRQ has developed and launched a national scorecard that looks at trends in conditions that occurred in hospitals, these conditions are referred to as HACs, hospital-acquired conditions which can include hospital-associated infections, adverse drug events, falls, and surgical site infections.
The AHRQ has reported some encouraging findings regarding HACs and patient safety from analyzing HAC data from 2014 through 2017 which showed that HACs fell by 13%, saving over 20,000 lives in the US and saving over 7 billion dollars in healthcare costs.
How does having a Patient Advocate improve a patient’s safety?
The IHI defines a patient advocate as a “supporter, believer, sponsor, promoter, campaigner, backer or spokesperson.” They go on to say that this person can be a friend, family member, or a paid professional who assists patients and families in “making sense” of their healthcare options and treatments. The primary focus of the patient advocate is the patient and their needs, but patient advocates also see themselves as partners in the healthcare team. The patient advocate also enhances the patient-clinician communication process which can result in better patient outcomes and safety. The patient advocate “partners” with the client, empowering them on their healthcare journey, which can include the management of chronic disease, the management of a new diagnosis, or a transition in care.
The patient advocate also assists their clients and their families in working through healthcare challenges that may include medication management and education, the ordering of medical equipment, and handling medical insurance issues. A key role of the patient advocate is to ensure that patients understand their plan of care, treatment options, and field any questions that they may have. Everyday, patient advocates may find themselves accompanying a client to a physician visit or to a diagnostic test as well as calling physicians for appointments and treatments.
A day in the life of a Nurse Patient Advocate - a case study.
As a nurse patient advocate, I have encountered many patients and assisted them with a variety of healthcare needs. Recently, I encountered an extremely complicated client with serious co-morbidities that involved major organ systems, which included the renal, gastrointestinal, and cardiac systems. This client has experienced a number of highs and lows through his complicated healthcare journey that began two years ago. As his nurse advocate, I have coordinated a number of services which have included scheduling and accompanying him to medical appointments, coordinating the communication of physician specialists, and medication education and management.
Despite the number of medical specialists and treatments that are coordinated to operationalize this client’s care, my role as the care “quarter-back” has been integral in making sure that all the clinicians are on the “same page” with care changes, which include treatment changes and medication changes to prevent any unsafe patient outcomes.
Avoiding “Near Misses” or Adverse Events
One of the most important benefits I have provided to this client in the past two years has been the avoidance of “near miss” events. A “near miss” event has been defined in healthcare as an occurrence that may have resulted in patient harm but did not occur because of the timely intervention of a healthcare provider or advocate.
Listed are some of the examples where harm or a fatal outcome could have occurred with this client but was avoided:
Recognizing that the client was taking too high a dose of a blood-thinner medication and facilitating the timely transfer of the client to an acute care facility from a rehabilitation facility when he developed signs of internal bleeding.
Collaborating with the medical team in getting timely diagnostic tests when needed when the client was experiencing extreme pain and discomfort, which was an indicator of advanced disease which required a medication change.
Clarifying the correct dosage of a cardiac medication that was causing the client’s blood pressure to become labile and drop to dangerously low levels.
Coordinating communication “huddle” calls with the physician specialists to avoid treatment, diagnostic, and medication errors.
Calling the emergency squad to the home when the client showed signs of change of mental status and was admitted to the hospital for a possible stroke.
Overall, my role as an advocate for this client is to ensure that his care plan is being carried out safely as ordered by his care team, that the communication among the care providers is in place, and that the client’s wishes are respected and adhered to.
Most of the clinicians I have worked with are appreciative of the role I provide for the client and they embrace having me as part of the care team. In the case mentioned above, the specialists on the case often appreciated the notes I provided during office visits which included a medical history, recent lab work results, and a list of current medication. It truly makes the appointment go very smoothly, provides the physicians with the client data they need, and makes the client feel comfortable during the visit.
Our own CEO/Founder, Lorie Gardner, is a community educator for the organization Campaign Zero - Families for Patient Safety. We encourage you to go to the website to check the many checklists available that are vital if you require hospitalization or surgery. They are invaluable and worth having on hand for an emergency! https://campaignzero.org/about/.