1. Accountability

2. Quality and Healthcare
Although most patients receive high quality health care, there are still too many who receive substandard care.
The incidence of substandard care:
3-10% of hospital admissions result in some sort of problematic outcome.
1/3 of problematic outcomes result in disability or death.
The incidence of problems in some areas, like medication errors is increasing.

3. Quality and Healthcare cont.
Quality of care is disproportionate across the US.
Health care providers must prevent problematic events.
Facilities must have a system of reporting problematic events - some are reluctant to do so.
Benefits of wide-spread reporting
Other systems could avoid making the same mistake
Analyzing the mistake, thus preventing it from happening again could develop a new routine.
The overall delivery of health care could gradually improve

4. PROBLEMATIC OUTCOMES IN HEALTHCARE HAVE BEEN
CATEGORIZED INTO FOUR BROAD
AREAS

5. Avoidable errors
Include missed diagnoses, errors in interpretation of lab and imaging studies, medication errors, surgical errors, errors in care by all levels of health care providers.
One study found that antibiotics, cardio-vascular agents, gastrointestinal agents, and narcotics were the most common medications to be involved in errors.
28% of the errors were preventable
42% were life-threatening

6. Tonsilitis misdiagnosed as the flu…patient dies
Surgical error…instrument left in patient
Misdiagnosis of breast cancer
Drug error

7. Under Use of Services
Patients do not receive helpful treatments or services due to disinterest, lack of insurance, and discrimination.
Examples of under use of services:
Lack of immunization of individuals.
Relatively poor provision of prenatal care to prevent poor infant outcomes.

8. Discrimination
Disinterest in health care
No Immunizations

9. OVER USE OF SERVICES Over prescribing antibiotics
Inappropriate admissions to hospitals
Use of Emergency Departments for minor illnesses and injuries

10. Over prescribing of anitbiotics!
Use of ER for minor illnesses and injuries!

11. VARIATIONS IN SERVICES
Regional differences in care
Consumers expect that competent care should follow established standards and be delivered equitably, no matter where they live

13. PREVENTION OF PROBLEMS
New and innovative ways to provide updates to health care providers are needed.
Examination of the factors that contribute to errors.
A study showed that human error was a factor in 55% of incidents in an ICU and violations of practice standards were a factor in 28% of the incidents.
Elimination of variation in providing health care.

14. AMERICAN HOSPITAL ASSOCIATION CONSUMER BILL OF RIGHTS
First Right - Considerate and respectful care.
Second Right - The right to “appropriate, current, and understandable information about diagnosis, treatment, and prognosis”.
Exceptions would be in emergencies, when the person is unable to make decisions.
This………………not this!

15. Freedom to discuss procedures and treatments, risks, expected length of recuperation, and reasonable alternatives.
Knowledge of the identity of their health care providers.
Knowledge of financial obligations of care

16. Third Right - The right to make decisions about the plan of care before and during treatment.
Has the right to refuse treatment to extent allowed by law
Know the consequences of refusal of care.
If refusal, has right to know about alternative treatments.

17. The right to be notified of any hospital policies that might affect patient choices.
Fourth Right - The right to advance directives The hospital must tell consumers the extent of the law and hospital policy in regards to any advance directive

18. Fifth right - Consideration of privacy.
Sixth right -Communications and records be held in confidence, except in cases of expected abuse and public health hazards.

19. Seventh right - The right to review records about his/her care and have information explained.
Eighth right - The right within the capability of the facility to provide appropriate and medically indicated care and services.

20. Ninth right - The right to be informed about business relationships that may influence their treatment and care.
Tenth right - The right to either consent or decline participation in research studies.
Eleventh right - The right to continuity of care and the right to be informed of options when hospital care is no longer an option.
Twelfth right - The right to be informed of policies of the hospital and the means of lodging a complaint or grievance.

21. JCAHO
An independent, not-for-profit organization, The Joint Commission accredits and certifies more than 15,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.

22. Mission: To continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations

23. JCAHO Patient Safety Goals

24. Improve the safety of using medications.
Reduce the risk of health care-associated infections
Accurately and completely reconcile medications across the continuum of care.
Barcodes for medication safety
Hand washing for the prevention of infections

25. Reduce the risk of patient harm resulting from falls
Reduce the risk of influenza and pneumococcal disease in institutionalized older adults.

26. Improve the accuracy of patient identification
Improve the effectiveness of communication among caregivers (verbal/telephone orders; standard list of abbreviations)
List of Non-used Abbreviations:
MSO4 MS
QD QID
< >
You must use a leading zero—example: 0.45mg

27. Reduce the risk of surgical fires.
Encourage patients’ active involvement in their own care as a patient safety strategy.

28. Prevent health care-associated pressure ulcers (decubitus ulcers).

29. Improve recognition and response to changes in a patient’s condition.
Patient who lit a cigarette while on oxygen
The organization identifies safety risks inherent in its patient population. (including suicide risks and risks of oxygen therapy)
Improve recognition and response to changes in a patient’s condition.

30. Patient/Consumer Responsibility
The responsibility to provide complete and accurate information about past and present health status.
The responsibility to provide their advance directives
The responsibility to inform health care providers if they will have a problem following the prescribed treatment.

31. The responsibility to understand that other community members have the right to the same care.
The responsibility to provide insurance information and meet their financial obligations.
The responsibility to recognize their behavior and lifestyle choices impact their health status.
We don’t often hear of these responsibilities, but they are every bit as important.

32. Ethically and legally it is an obligation for Health Care providers to be accountable for their competence and knowledge.