Tips for Patient Safety

The wrong diagnosis. The wrong procedure. The wrong eye. Ophthalmology is not exempt from problems with patient safety, said speakers at an AAO 2016 symposium on Sunday about improving safety in the clinic and the OR.

The World Health Organization (WHO) estimates that 1 in 10 patients is affected by medical errors. Diagnosis, communications, prescribing, and surgery are the “leading problem areas,” said Richard L. Abbott, MD, and they often overlap. And Phillip L. Custer, MD, reminded attendees that problems often can be tracked back to how information is “received, reviewed, and relayed.”       

Speakers offered the following tips.

Check and check again. In the high-volume setting of Aravind Eye Hospitals, “Safety errors are often related to work process and patient flow, and most problems have had to do with wrong documentation,” said R.D. Ravindran, MD. Physicians and staff now employ multiple checklists and cross-check such basics as patient identity, IOL power, and IOL design at every turn.  

Be responsive. “We have come up with solutions as we have encountered problems,” Dr. Ravindran said. For instance, one recent error—an eye block delivered to the wrong eye—led the Aravind team to institute a new practice of double-marking the patient’s face, both above and below the eye that should receive the block.

Be transparent. Physicians often have difficulty in sharing their medical errors, several speakers noted. “We need a culture of open discussion,” said Purnima S. Patel, MD. As part of that, she quoted the advice from surgeon and author Atul Gawande, MD: “When a mistake occurs, ‘Explore, do not ignore.’”

Dr. Patel also noted that observation—being observed by and observing other surgeons—can help prevent errors. “It’s part of the learning process that should continue after training.”

Involve office staff. “Our office procedures need to be as rigorous as our surgical ones,” Dr. Custer said. Because investigations of errors often uncover underlying patterns of failure in office procedures as well as surgical procedures, he recommended enlisting the help of the office staff and soliciting ideas from them. “You will be amazed at how engaged they will become. They don’t want to see patients get hurt.”

Involve patients. Any patient safety initiative needs to incorporate the “perspectives of patients and their families,” said Ivo Kocur, MD, MBA. “There should be protocols and checklists for patients as well as surgeons.”

This point was driven home by Bertil Damato, MD, PhD, who has developed a patient bill of rights based on clinical experience and research. For instance, inadequate communication may leave patients unsure as to when (or even whether) they should return for follow-up—a potentially fatal lapse in Dr. Damato’s field of ocular oncology.

Resources. The IRIS Registry is expected to help physicians improve by benchmarking performance. Visit aao.org for information on the IRIS Registry, as well as a surgical checklist, Preferred Practice Patterns, and Ophthalmic Technology Assessments. For information about global initiatives, see the WHO website. You also can go online for the Institute of Medicine’s reports on patient safety.—Jean Shaw

Financial disclosures. Dr. Abbott: MacRegen: O,C; Santen, Inc.: C. Dr. Custer: Johnson & Johnson: O; Pfizer, Inc.: O. Dr. Damato: AURA Biosciences: C; Impact Genetics: C. Dr. Kocur: None. Dr. Patel: None. Dr. Ravindran: None.

Disclosure key. C = Consultant/Advisor; E = Employee; L = Speakers bureau; O = Equity owner; P = Patents/Royalty; S = Grant support.