7 Health Care Safety Practices that Could Save Your Life
By: Source: AARP Bulletin Today Date Posted: 2003-08-07 10:44:09
Until now, patients haven't been able to do much about the medical mistakes that result in an estimated 180,000 deaths each year in the U.S. That's primarily because shortsighted medical care has been tough to recognize.
Enter a report commissioned by a small federal agency, the Agency for Healthcare Research and Quality (AHRQ), which takes a big step toward reducing deadly medical mistakes by alerting both health care professionals and the public to critical safety practices. Still, there's a long way to go before such errors are significantly reduced, experts say.
The report "is a very good starting point, and it's the cornerstone of our work," says Laura Blum, project director with the National Quality Forum, a nonprofit membership organization focused on developing and implementing a national strategy for health care quality improvement. The forum, which counts AARP as a member, expects to release consumer-focused health safety practices next summer.
The AHRQ report, which ranked top safety practices after reviewing more than 70 hospital-related practices, is geared toward clinicians. However, "each item listed has relevancy for consumers," Blum says. Many of the practices are associated with conditions or procedures common among older Americans.
What's notable about the leading safety practices is the under-use of them by doctors and hospitals. Most are inexpensive strategies that would save lives, suffering and money if used more widely, and patients and their families should demand that health care providers follow these guidelines.
Dr. David Gaba, professor of anesthesia at Stanford University School of Medicine, recommends that "patients ask providers about what they are doing or what their institutions are doing to deal with their safety." Gaba is a patient safety researcher who served on the report's advisory panel.
Here are the critical safety practices to keep in mind:
1. Prevent debilitating blood clots with fitted elastic stockings, aspirin and other blood-thinning agents that substantially decrease the risk of blood clots for patients undergoing total knee or hip replacements and for older patients facing general surgery. Blood clots commonly occur in hospitalized patients—particularly among older and high-risk patients—resulting in stroke, paralysis or even death. Ischemic stroke and acute spinal injury sufferers are also susceptible to dangerous clotting. Though blood clots occur frequently in hospitalized patients, low-cost measures to prevent clots remain underused or incorrectly used. Drugs such as warfarin or heparin also can reduce clotting.
2. Reduce the risk of cardiac complication during surgery with beta blockers. Heart attacks and other cardiac problems are common complications for patients undergoing heart-related surgery, occurring in more than a quarter of such patients. Almost 60 percent of those suffering such an event in surgery die, while survivors face prolonged hospitalization and higher medical costs. Beta-blockers, drugs that decrease the heart's activity, can substantially reduce cardiac risk to high-risk patients when given to patients in conjunction with surgery. Research suggests additional benefits to older patients, including a need for less pain medication. If you're facing such surgery, ask your doctor about beta-blockers. Less than a third of high-risk patients undergoing vascular surgery receive beta-blockers. Patients with intermediate risk may benefit from beta-blockers when undergoing non-cardiac surgery.
3. Prevent infections during catheter insertion. Here's how: Insist that clinicians reduce the risk of infection by simply wearing sterile gloves, long-sleeved gowns, a full-size drape and non-sterile mask when inserting central line catheters. Problem is, catheter inserters usually wear only sterile gloves and small drapes. Common and important devices in treating critically ill and other hospital patients, central venous catheters are associated with serious complications such as bloodstream infection, impacting more than 200,000 patients yearly.
4. Prevent infections via antibiotics prior to surgery. A common complication for surgery patients is infection along or near an incision site. As many as 5 percent of patients undergoing thoracic and orthopedic surgery get them, and up to 20 percent of patients undergoing gynecologic or intra-abdominal surgeries get such infections. Administering a brief course of antibiotics shortly before an operation significantly reduces such infections. While a common preventive strategy, the dose, timing of administration or duration of antibiotics is wrong in 25 percent to 50 percent of cases. If done properly, this low-cost approach can substantially stave off infection.
5. Stop ventilator-associated pneumonia, a leading cause of death and disease for intensive care unit patients. Spit collects at the base of the throat of patients on breathing machines, and bacteria build up. If the bacteria-laden saliva is not vacuumed or drained, the ventilator-dependent patient breathes it in and develops pneumonia. Low-cost specialized tubes can remove the secretions, but are not common practice in hospitals. Family members can request specialized tubes to prevent ventilator-dependent loved ones from contracting pneumonia.
6. Prevent pressure ulcers in older patients. Pressure ulcers are common complications and causes of morbidity in older hospital or nursing home residents. These bedsores occur in about 13 percent of nursing home residents, and they can cost $4,000 to $40,000 to treat. A range of specially designed, moderate-cost mattresses, including those with pads made from sheepskin or elastic polymers, can prevent pressure sores better than standard hospital mattresses.
7. Reduce bad reactions to blood-thinning drugs. Real-time dose monitoring is a challenge to patients taking blood-thinning drugs, such as heparin and warfarin. Low doses don't prevent the blood clotting and heart fibrillation the medication is designed to control, while high doses can cause bleeding complications. Like diabetics monitoring blood sugar levels, patients on blood-thinners can self-monitor heparin and warfarin doses to prevent complications. Unlike diabetic monitoring kits, devices to monitor anticoagulants are expensive and not covered by insurance. They cost about $1,000, with additional costs for cartridges. As a result, they are underused by patients and by providers. However, research shows that they are cost-effective, as they reduce complications.
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