13/10/2015. Sidra Medical & Research Center. Objectives. A Data Driven Safety Culture. Learning Healthcare System

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1 Objectives Sidra Medical & Research Center Building a Data Driven Safety Culture October 6 th 2015 Describe a model Learning Healthcare System Review the role of Health Information Technology in Patient Safety Implementing a Culture of Safety Describe a framework for a Data Driven Safety Culture guides for Electronic Health Records Julio C. Silva, MD, MPH A Data Driven Safety Culture Learning Healthcare System Providers Caring for Patients Safety Culture Data Driven Culture Electronic Health Records Data Driven Safety Culture Learning Healthcare System Enabling a Culture of Safety Providers Caring for Patients Electronic Health Records Information, Decision-Support Creation of Protocols, Guidelines Regional and National Public Health and Disease Registries Standards for Prevention and Treatment Biomedical and Clinical Research Improving Safety with Information Technology Reduce the rate of errors in three ways: Preventing errors and adverse events by Improving communication, Making knowledge more readily accessible, Requiring key pieces of information (such as the dose of a drug), and assisting with calculations Assisting with monitoring Providing decision support Facilitating a more rapid response after an adverse event has occurred Tracking and providing feedbackabout adverse events Do Advanced Electronic Medical Records (EMR) make patient care safer? Findings: Advanced EMR adoption leads to: 27% decline in all (aggregated) events 30% decline in medication events 25% decline in complication of procedure, test, or treatment Hydari, Telang, Marella: Saving Patient Ryan Can Hospital IT Make Patients Safer? Bates, David W., and AtulA. Gawande Improving Safety with Information Technology. New England Journal of Medicine348 (25):

2 Culture: What is it? Culture Organizational Safety Culture A set of shared assumptions that guide what happens in organizations by defining appropriate behavior for various situations. Represents the collective values, beliefs and principles of organizational members Data Driven (Informed) Culture Recognizes data as a strategic asset and puts processes and systems in place that allow them to access and analyze the right data to inform decision-making processes and drive actionable results. Sociotechnical Context and Culture Sociotechnical context means that it is not just the hardware and software required to run the EHR application that factor into creating and maintaining an up-to-date, accurate medical record, but also the workflow processes, people, policies, and other social and organizational factors. Understanding the risks of any EHR system requires: Knowledge of who uses the EHR How the organization influences use of the EHR In a culture of safety, people are not merely encouraged to work toward change; they take action when it is needed. Senior leaders must drive the culture change Demonstrating their own commitment to safety Message about safety must be consistent and sustained Enable staff to openly share safety information 2

3 Institute for Healthcare Improvement Conduct Patient Safety Leadership Rounds Create a Reporting System Designate a Patient Safety Officer Reenact Real Adverse Events from Your Hospital Involve Patients in Safety Initiatives Relay Safety Reports at Shift Changes Appoint a Safety Champion for Every Unit Simulate Possible Adverse Events Conduct Safety Briefings Create an Adverse Event Response Team Conduct Patient Safety Leadership Rounds Get a commitment from senior executives for an hour every week. The rounds may be rescheduled but never canceled. Keep discussions focused on safety; don t dilute the safety message Involve all the senior executives in the organization, not just the chief executive officer. Communicate with managers so they understand why senior executives are visiting their departments. Make sure that senior executives follow up and provide feedback to staff about issues raised. Institute regular safety briefings. Prior to leaving the unit, have executive summarize the issues and ask staff to prioritize 2 to 3 items to be addressed. Reenact Real Adverse Events from Your Hospital Urge everyone involved in the event including physicians to contribute to telling the story. Allow people who are deeply uncomfortable to observe rather than participate. Encourage patients to participate; they can add tremendously to the message. Consider taking several real events and combining them into one fictional event with made-up names and dates. Record a skit version story, with staff volunteers as actors. Involve Patients in Safety Initiatives Invite patients and families to take part in multidisciplinary rounds and ask for their comments. Include patients and families as partners to monitor for compliance with safe practices (e.g., they can make sure no one administers medication without verifying the patient identification). Establish a practice of stopping and re-verifying a medication, test, or intervention any time a patient or family member asks whether it is correct. Recruit patients and family members to patient safety committees Simulate Possible Adverse Events Consider simulations excellent debriefing opportunities for people involved in adverse events or near misses. Use an empty patient room for simulations it costs little and often already has the relevant equipment. Framework for Data Driven Safety Culture 3

4 SAFER (Guides) National Coordinator for Health IT (ONC) sponsored the development of the (SAFER) guides which were released in 2014 Self-assessment guides that help organizations The SAFER guides, address: Two foundational aspects of EHR implementation and use Three areas of the computing infrastructure Four clinically focused, error-prone processes proactively detect and reduce patient safety risks associated with EHRs Foundational guides: Organizational Responsibilities Recommendations related to activities, processes, and tasks that people must carry out to ensure safe and effective EHR implementation and use. High Priority Practices Recommendations determined to be high risk and high priority. This guide can be used by organizations to help them assess where they should concentratetheir EHR safety improvement efforts. Recommendations: Foundational Organizational Responsibility Communication mechanisms ensure that EHR users learn of EHR changes promptly, and users are able to give feedback on related safety concerns. The highest-level decision makers (e.g., boards of directors or owners of physician practices) are committed to promoting a culture of safety that incorporates the safety and safe use of EHRs High Priority Information required to accurately identify the patient is clearly displayed on screens and printouts. Clinicians are able to override computer-generated clinical interventions when they deem necessary. Computing infrastructure Contingency Planning Recommendations for preparations that should be completed before the EHR experiences a hardware, software, or power failure. System Interfaces Recommendations for processes that enable the physical and logical connection of different hardware devices and software so they can share information. System Configuration Recommendations related to the physical environment in which the EHR will operate, as well as the infrastructure required to run the EHR. Recommendations: Computing infrastructure Contingency Planning Staff are trained and tested on downtime and recovery procedures. Patient data and software application configurations critical to the organization s operations are backed up. System Interfaces At the time of any major system change or upgrade that affects an interface, the organization implements procedures to evaluate whether users on both sides of the interface correctly understand and use information that moves over the interface. Security procedures, including role-based access, are established for managing and monitoring key designated aspects of interfaces and data exchange. System Configuration The EHR is configured to ensure EHR users work in the live production version, and do not confuse it with training, test, and read-only backup versions. The organization has processes and methods in place to monitor the effects of key configuration settings to ensure they are working as intended. 4

5 Clinically focused, error-prone processes Patient Identification Recommendations for creating new patient records in the EHR and patient registration and retrieval of information on existing patients. Computerized Provider Order Entry with Decision Support Recommendations for electronic ordering of medications and diagnostic tests and point-of-care clinical decision support. Test Results Reporting and Follow-up Recommendations regarding delivery of test results to the appropriate providers. Clinician Communication Recommendations regarding consultations or referrals, discharge-related communications, and patient-related messaging between clinicians. Recommendations: Clinically Focused Patient Identification Users are warned when they attempt to create a new record for a patient (or look up a patient) whose first and last name are the same as another patient. The organization has a process to assign a temporary unique patient ID (which is later merged into a permanent ID) in the event that either the patient registration system is unavailable or the patient is not able to provide the required information Computerized Provider Order Entry with Decision Support Evidence-based order sets are available in the EHR for common tasks/conditions and are updated regularly. Corollary (or consequent) orders are automatically suggested when appropriate and the orders are linked together, so that changes are reflected when the original order is rescheduled, renewed, or discontinued. Recommendations: Clinically Focused Test Results Reporting and Follow-up Written policies specify unambiguous responsibility for test result follow-up with a shared understanding of that responsibility among all involved in providing follow-up care. The EHR has the capability for the clinician to set reminders for future tasks to facilitate test result follow-up. Clinician Communication Clinicians are able to electronically access current patient and clinician contact information (e.g., address, telephone and fax numbers, etc.) and identify clinicians currently involved in a patient s care. Both EHR design and organizational policy facilitate clear identification of clinicians who are responsible for action or follow-up in response to a message. Guides Guides Summary 5

6 Sociotechnical Context and Culture and SAFER Our Mission: Sociotechnical context: Policies Social and organizational factors Hardware and software required to run Workflow processes People 6