The identified systematic reviews reached similar conclusions, with two of the reviews determining that use of aspirin has a lower bleeding relative risk than other pharmacologic options. Other studies found no difference in bleeding risk between aspirin and other therapies. Implementation An important consideration when establishing the appropriateness and potential efficacy of aspirin following major orthopedic surgery is the patient risk profile. While 24 of the 27 included studies determined aspirin is safe and as effective, if not more effective, than other prophylaxis methods, a potential confounding or even misleading factor is the risk stratification of patients. In almost 50 percent of studies, some degree of patient risk stratification occurred. Key findings • Use of aspirin following major orthopedic surgery was generally found to be of similar effectivenessas other agents. • An overwhelming majority of studiesconcluded that aspirin has a lower bleeding risk rate than other pharmacologic agents, which, combined with its lower cost, makes it an appealing option for VTE prophylaxis, particularly in low- risk patients. • More prospective randomized controlled trials are needed to directly compare the effectiveness of aspirin with other prophylactic methods across patient risk levels. Cross-cutting patient safety topics/practices Over the last decade, there have been more quality and safety improvement efforts in healthcare than ever before, with programs funded by Federal grants, State agencies, and privately run organizations. Despite these efforts, reliably safe healthcare has remained somewhat elusive as adverse events continue to occur. A more recent trend in healthcare quality improvement has been focused on building high reliability organizations (HROs). HROs are described as organizations that operate in complex environments while maintaining high levels of safety for extended periods of time. HROs also have strong leaders who are committed to safety. Leaders are key to instilling a commitment to safety in all members of the organization to create a positive safety culture, where staff continually scan and monitor their environment to identify and correct even minor deviations that could lead to unsafe conditions. When a deviation in safety processes or practices is observed, staff speak up or take action to contain the problem and/or resolve the issue. In the event that an adverse event or near miss does occur, incidents are reported without fear of blame or punishment. In addition, HROs rely on process improvement tools to systematically solve safety issues, including reliable assessments of the problem’s scope (e.g., isolated to a unit or organization-wide), identification of root causes associated with the problem, and application of the most appropriate solutions.
While a great deal can be learned through the study of HROs, it can be difficult to articulate the exact steps to achieve high reliability, as many different paths can be taken. Moreover, what works in one organization does not always work in another, as demonstrated by the many conflicting results found within the healthcare quality and patient safety literature. To increase the reliability of healthcare quality, it is also necessary to understand the context in which improvement practices are applied. Any pre-existing norms, processes, resources, or quality improvement initiatives will influence how new practices are viewed and adopted, and the degree to which they achieve their intended result(s). A wide range of contextual factors can impact performance. Four specific cross-cutting patient safety practices will be reviewed in this section: (1) patient and family engagement, (2) safety culture, (3) cultural competency, and (4) teamwork and team training. Patient and family engagement Traditionally, patient safety management has been the sole responsibility of the healthcare provider, but in recent decades, new approaches to patient safety include actively engaging patients and/or patients’ families and caregivers. While there is no standard definition, patient and family engagement (PFE) is commonly defined as the desire and capability to actively choose to participate in care in a way that is uniquely appropriate to the individual, in cooperation with a healthcare provider or institution, for the purposes of maximizing outcomes or improving care experiences. This makes sense because patient- centeredness is a vital aspect of healthcare, and patients are uniquely positioned to provide information throughout an entire course of care. Patient and family engagement can be conceptualized in two primary ways: (1) as an overarching principle that is applicable to many patient safety practices and (2) as a specific component of another particular patient safety practice. 130 Some strategies to encourage adoption of patient and family engagement patient safety practices include: • Patient and family advisory councils, boards, and committees • Team-based care • Interventions to support medication safety • Structured communication for patients, families, and primary care providers • Teach-back • Warm handoffs As patient and family engagement is still an emerging patient safety practice there is little if any published research that provides comprehensive insight into its relationship to patient safety. Because such studies are limited, healthcare providers may find it difficult to apply appropriate guidelines and implement effective patient and family interventions in their current practice.
Patient safety in primary care continues to evolve, and so do the practices used to engage patients and families in their care. Strategies are needed to help patients and families understand the role of PFE in their safety. Healthcare providers also need to understand the importance of engaging patients in their care. In order to accomplish this, stakeholders should become more involved in the process to address the following: (1) building consensus on the definition and guidelines for implementing patient and family engagement, whether it is through an independent intervention or as part of another intervention within an existing PSP; (2) widening the research scope for patient and family engagement and patient safety; and (3) addressing priority areas for implementing patient and family engagement. Safety culture Many patient safety practices are available to reduce harms, but these practices sometimes fail to achieve their intended results. Even when implemented properly, contextual factors and organizational characteristics can reduce their effectiveness. For example, the patient safety culture can affect the degree to which patient safety practices are adhered to, or not. Patient safety culture, which is part of the overall culture, has been described as the beliefs, values, and norms that are shared by healthcare practitioners and other staff throughout the organization that influence their actions and behaviors. Patient safety culture helps inform staff about the behaviors that are acceptable, are worthy of praise, or are punishable (formally and/or informally) by the organization. A positive patient safety culture can be characterized as one where: • Safety has been articulated as an organizational priority • Staff work as a team to accomplish their tasks and reduce error • There is open communication and transparency in discussing near-misses and adverse events • There is an emphasis on learning from mistakes Leaders in healthcare quality improvement have recognized the importance of safety culture and encouraged its measurement. Several safety culture survey instruments have been developed, and research has established their psychometric properties. For instance, AHRQ sponsored the development of Surveys on Patient Safety Culture™ (SOPS™) in multiple healthcare settings, such as hospital, medical office, nursing home, community pharmacy, and ambulatory surgery center. As part of this program, survey instruments and support materials are available, as are voluntary databases to which users can voluntarily submit data from patient safety culture surveys. These, as well as other safety culture surveys (e.g., Safety Attitudes Questionnaire) reliably measure multiple dimensions of safety culture, including teamwork, safety climate, communication, and error reporting.
109
Powered by FlippingBook