In 2003, the Cleveland Clinic was one of the first healthcare organizations to convert to an electronic medical record – beginning with its family health centers – and this world-class institution has been paving the way for patient safety improvements ever since.
Today, the Cleveland Clinic’s EMR connects all facets of the organization, virtually eliminating the risk for lost information and making it easier to meet The Joint Commission’s National Patient Safety Goals.
What’s more, the coordination of care is greatly enhanced as the entire healthcare team can access patient records simultaneously, which greatly improves communication in a seamless process for healthcare providers.
Certainly, the EMR is the foundation for every patient safety program, but what separates the Cleveland Clinic from so many other organizations are the protocols and practices that extend from – and enhance – the EMR proper.
Here are just a few of the patient safety features at the Cleveland Clinic:
- A Just Culture: The Cleveland Clinic is committed to a just culture of safety in which employees are encouraged to come forward when they or others make mistakes, allowing the organization the opportunity to improve the care it delivers and prevent potential errors.
- Safety Event Reporting System: Cleveland Clinic’s online Safety Event Reporting System (SERS) allows any employee to report a near miss, process problem, or a patient event. An event is anything that occurs in the hospital or outpatient setting that caused or has the potential to cause a medical error or injury. Employees are encouraged to report events even if they did not cause harm to the patient because "near misses" provide opportunities to identify flaws in the system and to implement changes before they impact patients.
- Executive Leadership Safety Walk Rounds: Walk rounds offer Cleveland Clinic executives insight into the care process and help identify potential harm to the next patient – which can then be preempted. Walk round are comprised of representatives from the Quality & Patient Safety Institute, unit/area management, and Cleveland Clinic senior executives. Teams walk each unit/area on a monthly basis. Walk rounds not only demonstrate senior leadership’s commitment to patient safety, but also facilitate an ongoing relationship with the clinical units, facilitates a non-punitive just culture of safety, and encourages the reporting of safety opportunities.
- Flu Vaccine Program: The Cleveland Clinic offers all employees an annual flu vaccine to protect its employees, patients, and visitors against the disease.
- Hand Hygiene: The Cleveland Clinic is part of a growing number of hospitals that monitors hand hygiene among employees as part of a comprehensive program to keep patients safe. Alcohol-based hand sanitizers are located through the organization’s facilities to protect the health of patients, visitors, and employees.
- Latex-Safe Environment: The Cleveland Clinic has instituted a latex-free environment, reducing direct exposure to highly allergenic latex sources.
- Patient Involvement: The Cleveland Clinic has implemented several programs to encourage patients to get involved with their care, including a video, “Be a Part of Your Care,” that patients can watch in their hospital rooms. The goal of these programs is to encourage patients to voice their medication or safety concerns.
While the Cleveland Clinic’s patient safety protocols and practices should be considered for adoption by all healthcare organizations, they are not – by any means – the only activities worth pursuing. In fact, the Agency for Healthcare Research and Quality offers five additional evidence-based protocols and practices for preventing adverse events and preventable patient harm.
- CLABSI Prevention: To prevent central line-associated blood stream infections, take these five steps every time a central venous catheter is inserted: wash your hands, use full-barrier precautions, clean the skin with chlorhexidine, avoid femoral lines, and remove unnecessary lines. A study at more than 100 hospitals showed that this practice reduced CLABSIs to zero.
- Hospital Discharge Protocol: Ensuring medication reconciliation and scheduling of follow-up medical appointments at the time of discharge can reduce potentially preventable readmissions by 30%. AHRQ suggests creating a simple, easy-to-understand discharge plan for each patient that contains a medication schedule, a record of all upcoming medical appointments, and names and phone numbers of whom to call if a problem arises.
- Venous Thromboembolism Prevention: Hospital-acquired venous thromboembolism (VTE) is the most common cause of preventable hospital deaths, but it can be prevented by using an evidence-based guide to create a VTE protocol. This free guide explains how to take essential first steps, lay out the evidence and identify best practices, analyze care delivery, track performance with metrics, layer interventions, and continue to improve.
- Blood Thinner Education: Patients who have had surgery often leave the hospital with a new prescription for a blood thinner to keep them from developing dangerous blood clots. However, if used incorrectly, blood thinners can cause uncontrollable bleeding and are among the top causes of adverse drug events. A free 10-minute patient education video and companion 24-page booklet from clotcare.com, both in English and Spanish, can help patients understand what to expect when taking these medicines.
- Reduce Staff Fatigue: Evidence shows that acute and chronically fatigued medical residents and other staff are more likely to make mistakes. To that end, ensure that residents get ample sleep and adhere to 80-hour work-week limits. For more practices related to reducing staff fatigue, check out, “Resident Duty Hours: Enhancing Sleep, Supervision, and Safety.”
Patient safety is an ongoing effort that never allows a healthcare organization to relax or believe that it has done enough. There is always more that can be done to reduce preventable patient harm. Even if your patient safety program is delivering outstanding results, the protocols and practices listed here are worthy of consideration.