- Opioid abuse, diagnostic errors, and poorly designed health IT systems are among the top hazards on ECRI Institute’s 2018 list of patient safety concerns.
Opioid abuse is ranked second this year, up from its seventh-place spot on the 2017 list. While ECRI emphasized opioid administration issues in acute care settings last year, this year the organization stresses that misuse of opioids is a problem that impacts the entire healthcare continuum.
Although the opioid epidemic has brought attention to outpatient prescriptions and illicit drugs, the report states that opioids are also administered in hospitals and emergency departments to treat pain.
“Opioids are a patient safety concern because of the seriousness of the side effects," says Stephanie Uses, PharmD, MJ, JD, patient safety analyst and consultant, ECRI Institute. "We recommend that clinicians carefully assess patients for opioid use disorder and set realistic expectations about pain."
ECRI also suggests that providers use non-opioid medications when possible while taking into account the individual needs, comorbidities, and opioid tolerance of each patient. In addition, organizations can use sedation scales and continuously monitor high-risk patients to better detect opioid-induced respiratory depression.
Providers should also pay close attention to avoiding diagnostic errors - the number one patient safety hazard this year. Errors and delays can lead to care gaps, unnecessary procedures, and patient harm.
“Diagnostic errors are not only common, but they can have serious consequences," says Gail M. Horvath, MSN, RN, CNOR, CRCST, patient safety analyst, ECRI Institute. "A lot of hospital deaths that were attributed to the normal course of disease may have been the result of diagnostic error."
The report points out that diagnostic errors can be challenging to measure because they often go undetected until after the patient leaves the hospital or emergency department.
To combat this issue, ECRI recommends that organizations capture data on diagnostic errors from patient complaints, record reviews, and other sources, and use this data to address gaps.
“Clinical decision support interventions can also be helpful by identifying ordered tests that haven't been done or by flagging incidental findings that require follow-up," adds Horvath.
Diagnostic errors are the result of a combination of cognitive and systemic factors, says ECRI, including miscommunication.
Lack of communication is also the root of poor care coordination, which was ranked third on the list. Insufficient care coordination can lead to medication errors and diagnostic delays.
To alleviate this problem, ECRI states that providers must inform one another of the patient’s condition, regimen, and medical history at every step of the care process.
“Many handoff tools are available to ensure the vital information is communicated and the process is standardized,” said Elizabeth A. Drozd, MS, T (ASCP) SBB, CPPS, senior patient safety analyst, ECRI Institute.
ECRI also recommends that providers use checklists and safety huddles to effectively communicate at every step of a patient’s care. Communication training and leadership support will also be essential in improving care coordination, the report says.
Health IT systems occupy the fifth spot on the list this year. The report acknowledges that a health IT safety program can significantly improve care quality and safety. However, if a health IT system is flawed, or if an organization fails to embrace health IT safety, users may not recognize health IT-related issues, and patients can suffer.
A 2017 study published by ECRI Institute and the Pennsylvania Safety Advisory found that health IT contributed to 889 medication errors recorded in provider reports. These errors included dose omissions and extra doses.
“It is not only how we use [our health IT system] in daily workflow, but also how we use it effectively by optimizing the benefits and reducing the risks,” says Robert C. Giannini, NHA, CHTS-IM/CP, patient safety analyst and consultant, ECRI Institute.
To improve health IT system safety, ECRI advises organizations to integrate health IT into their existing safety programs, collaborate with stakeholders, and promote health IT safety among staff.
Other patient safety concerns on this year’s list include device cleaning and sterilization, patient engagement and health literacy, and management of behavioral health in acute care settings.
ECRI Institute recognizes that these issues may not be most prevalent or severe in every organization, but they encourage organizations to look at this list and develop relevant strategies to improve patient safety across the continuum of care.