ECRI's 2017 Top 10 Patient Safety Concerns

Ken Terry

March 15, 2017

For the second year in a row, health information technology (IT) tops the list of patient safety concerns in the ECRI Institute's Top 10 Patient Safety Concerns for Healthcare Organizations . This year, the number-one concern is health information management in electronic health records (EHRs). The third most pressing concern, implementation and use of clinical decision support, is also IT-related.

As in past years, the ECRI Institute derived its list of healthcare safety issues from data gathered by patient safety organizations (PSOs), concerns raised by healthcare provider organizations, and the judgment of experts. ECRI has been collecting data of its own and from partner PSOs and has published safety lists since 2009.

The complete 2017 list is as follows:

1. Information management in EHRs

2. Unrecognized patient deterioration

3. Implementation and use of clinical decision support

4. Test result reporting and follow-up

5. Antimicrobial stewardship

6. Patient identification

7. Opioid administration and monitoring in acute care

8. Behavioral health issues in nonbehavioral-health settings

9. Management of new oral anticoagulants

10. Inadequate organization systems or process to improve safety and quality

The Details

To address the safety threats of EHRs, ECRI urges IT and information management professionals and "clinical engineers" to participate in healthcare organizations' patient safety, quality, and risk-management programs. Users should also understand their EHRs' "capabilities and potential problems" and should report their concerns about safety issues, the report says.

In a recent study in the Journal of the American Medical Informatics Association, Texas informatics researchers identified 245 EHR-related safety concerns at a large tertiary-care hospital over an 8-month period. These safety issues comprised 7% of the concerns discussed in the hospital's "safety huddles."

Regarding patient deterioration, the ECRI report noted that "concerted efforts have enabled speedier recognition of and response to stroke and heart attack" in the past few decades. The report says that other conditions such as sepsis, some maternal conditions, and serious postsurgical complications now "need the same type of prompt recognition and attention in order for the patient to have a good outcome."

ECRI assails suboptimal use of clinical decision support (CDS) tools, which it says can result in patient harm. Oversight by a multidisciplinary team and training of end-users in the proper use of CDS could improve the situation, the report says. Also, it urges organizations to monitor the effectiveness and appropriateness of CDS alerts.

The problems in test reporting and follow-up can be traced to the complexity of the test ordering and reporting process and the fragmentation of work that this often leads to, the report says. ECRI suggests that organizations analyze their test-reporting systems and monitor their effectiveness in triggering appropriate follow-up.

Holding clinicians accountable for their prescribing behavior is the key to antimicrobial stewardship, the report says. "Organizations can also educate patients, family members, and the general public about antimicrobial stewardship," notes ECRI.

Of 7613 safety events related to patient identification ECRI analyzed, about 9% resulted in patient injury, including two deaths. Patient identification initiatives should engage clinical and nonclinical staff and should ask staff to identify barriers to a safe identification process, the report says. In addition, electronic displays, patient identification bands, and bar-code systems can be used to support this process.

Opioid administration errors, like other kinds of medication errors, are often related to organizational culture and workload, the report notes. Best practices can be implemented for processes that include patient identification, medication purchasing, label, dispensing, use of bar-code medical administration systems, and independent double-checks.

Behavioral health issues may go unrecognized in acute care settings, resulting in the patients' needs not being met, the report notes. ECRI urges healthcare organizations to have all patients assessed so providers can determine their behavioral health needs. Staff should also be trained to recognize early signs of behavioral health issues and how to respond to them.

Since 2010, four new oral anticoagulants have been approved. An ECRI analysis of safety events involving these agents showed that about a third of those events resulted in patient harm. Standardized order sets should specify doses for these medications based on indication, the report says. Clinical decision support can also be used to alert practitioners to duplication of therapy and track alert responses.

Despite numerous studies that show a link between error prevention and a culture of safety, many organizations still have "inadequate organization systems or process to improve safety and quality," the report says. ECRI emphasizes the importance of proactive strategies to examine processes, identify what can go wrong, and improve the process to make it less vulnerable to error. Healthcare leaders should also support a "just culture" that emphasizes learning rather than blaming, the report concludes.

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