during psychiatric hospitalization. This can occur because their behavioral symptoms limit their sound cognition, or it can result from power imbalances between staff and patients that are characterized, for example, as the voice of the patient being minimized by providers because of mental illness stigma (Shields et al., 2018; Svensson, 2022). Medicaid 1115 Waivers and Profits Section 1115 of the Social Security Act is a recent clarification of the regulations affecting Medicaid managed care organizations. It changed the mental disease exclusion that did not provide Medicaid payments to mental health facilities with 16 or more beds (Shields et al., 2018). With this change, states may now use Medicaid funds in facilities that treat mental disease. Accordingly, researchers have identified this change as one of the factors contributing to the dramatic increase in for-profit behavioral and substance abuse facilities from 2010 to 2016. In this six-year period, for-profit beds increased by 48%. Researchers argue that for-profit entities earn big profits because of this change and that this can be a negative factor in the quality and safety of patient care in these facilities. According to Shields and colleagues, for-profit facilities could potentially have motivations that can be misaligned with patient safety. For example, in the quest for preserving profits, psychiatric hospitals can cut corners in a variety of ways that negatively impact patient safety. This can manifest in several practices, for example, sending treatment staff home—unpaid—when the hospital census drops too low. This can negatively affect provider morale because their employment is full-time conditional, that is, conditioned on a certain patient census. Lowered provider morale is associated with lower quality and safety of patient care. Other cost-cutting measures can be noninvestment in evidence-based care and patient safety education as well as less hiring of appropriate numbers of qualified providers, thus clinically underpreparing and overburdening existing psychiatric staff (Shields et al., 2018). Frustrated, overburdened providers working in the for-profit model of care can—unfortunately—put patients at risk. Ignoring burned-out providers can be a critical mistake behavioral health leaders make (Svensson, 2022). In fact, Universal Health Services, the largest U.S.-based chain of for-profit psychiatric hospitals, has been involved in numerous federal and local investigations that allege neglect, abuse, and fraud, meanwhile boasting profit margins of more than 20% for inpatient psychiatric care
across 350 acute care hospitals. Furthermore, research suggests that while these same dynamics can exist in not-for-profit facilities, the overall evidence indicates that for-profit entities have more safety violations (Shields et al., 2018). Accreditation and Regulation’s Role in Patient Safety The Joint Commission regulates, monitors, and accredits more than 80% of U.S.-based psychiatric facilities and hospitals. Patient safety standards for psychiatric inpatient care are created and maintained by The Joint Commission; however, these standards apply to (Shields et al., 2018):
● Processes of seclusion and restraint ● Suicide screening and assessment ● Access to ligature points ● Translation services
Researchers expressed concern that The Joint Commission, while encouraging facilities to identify their policies for investigating sentinel events—including voluntary reporting of adverse safety events—did not provide policy or language that addressed either trauma-informed care or the importance of safety culture. Shields and colleagues (2018) argued that this exemplified leadership falling short of the needed regulatory guidance and monitoring, practices that ought to be expected from The Joint Commission. Unfortunately, states do not often create regulatory standards that exceed those of The Joint Commission or the Center for Medicare and Medicaid Services. Researchers argue that states are deficient in their regulatory patient safety mandate and are in need of systematic, evidence- based improvements (Frogner et al., 2020). Because of this, researchers have examined the regulatory role of states, which create licensing rules that inpatient facilities must follow. In a sample of six states, research demonstrated that rules varied considerably from state to state, with a mélange of regulations that appear somewhat ambivalent— in practice—toward standards to ensure patient safety. Regulators cannot be complacent and at the same time call for patient safety. For example, for the six states sampled by Shields and colleagues (2018), there was “limited information describing states’ trend analyses of critical incidents, which suggests that states do not systematically track and publicly report aggregated rates of complaints . . . furthermore, states differ in their transparency with critical incidents and regulatory violations” (p. 1857).
IMPACT ON HEALTHCARE PROFESSIONALS
Clinicians involved in errors that harm their patients also suffer psychologically and thus are referred to as the second victims of medical mistakes (Burlison et al., 2017). In addition to guilt, sleep disturbance, and depression, second victims lose self-confidence, question their self-worth, are anxious about committing future errors, and are vulnerable to burnout and job dissatisfaction (Schwappach & Boluarte, 2008). A correlation has been found between poor well- being of healthcare professionals and worse patient safety. Additionally, researchers concluded that this phenomenon is so critical that programming to support second victims for their own well-being and the safety of patients that they serve (Jung et al., 2022) is needed. The following excerpt from a newsletter of the Institute for Safe Medication Practices (2011) portrays how a medical error had tragic consequence for a second victim. It was with immeasurable sadness that we learned a veteran pediatric nurse had taken her own life in the aftermath of a fatal medication error. The nurse, Kimberly, age 50, committed suicide on April 3, 2011, just 7 months after making a mathematical error that resulted in an overdose of calcium chloride and the subsequent
death of a critically ill infant. According to media reports, after investigation of the event, hospital leaders made a difficult decision to terminate Kimberly’s employment after 27 years of service for undisclosed reasons, including factors not directly associated with the event. To satisfy state licensing disciplinary actions, Kimberly agreed to pay a fine and accepted a four-year probation that included medication administration supervision at any future nursing job. Just before her death, she had aced an advanced cardiac life support certification examination to qualify for a flight nurse position. But according to media reports, this and countless other efforts produced no job offers, increasing her isolation, despair, and depression. As a testament to her long- standing compassionate and competent nursing care, many patients and families who received care from Kimberly attended her memorial service to honor her. Patient safety programming and research appears to be robust globally; however, scholars argue that efforts to manage the aftermath of adverse patient events appear to be trailing behind.
EliteLearning.com/Counselor
Book Code: PCUS1525
Page 64
Powered by FlippingBook