Using Patient Safety Week to report on rising risks

Photo courtesy of ECRI.

Journalists can use Patient Safety Awareness Week (March 13-19) as an opportunity to question officials at local hospitals and nursing homes about what’s happened with their risk-reduction programs in the past two years. U.S. hospitals and nursing homes lost ground during COVID-19 in their efforts to prevent harm to patients such as catheter-related infections, government data shows.

This article highlights a few resources for journalists seeking to use Patient Safety Awareness Week as a news peg.

The Association for Professionals

The Association for Professionals in Infection Control and Epidemiology (APIC) recently issued a report with detailed recommendations for strengthening patient-safety measures. “Especially troubling to APIC is how many preventable infections were transmitted inside hospitals during COVID because that resilience was not built into our healthcare system,” Linda Dickey, R.N., M.P.H., C.I.C., F.A. P.I.C., the president of the group, said in a statement.

Devin Jopp, Ed.D., M.S., chief executive officer of APIC, stressed the need to prepare for crises, allowing infection prevention and control (IPC) procedures to remain in place even during surges in hospital demand. “I won’t sugarcoat it; fortifying our nation’s IPC infrastructure isn’t free, but the cost of ill-preparedness in lives and dollars is incalculable,” Jopp said in a statement.

Top CMS officials

Top officials from the Centers for Medicare and Medicaid Services (CMS) and the CDC called for a renewed effort to prevent people from suffering harm in hospitals and nursing homes. Instead of imposing more burdens on medical staff, leaders in health care need to “provide them with more tools and an environment built on a strong foundation of wellness and on instilling and rewarding a culture of safety,” wrote Lee A. Fleisher, M.D., the chief medical officer for CMS, and co-authors in their Feb. 12 article, “Health Care Safety during the Pandemic and Beyond — Building a System That Ensures Resilience.”

“We believe the pandemic and the breakdown it has caused present an opportunity and an obligation to reevaluate health care safety with an eye toward building a more resilient health care delivery system, capable not only of achieving safer routine care but also of maintaining high safety levels in times of crisis,” they added.

ECRI

The nonprofit group ECRI intends to release  a special report on patient-safety threats on March 14 , offering suggestions, resources and systems-based approaches for reducing these risks.

The Collaborative Healthcare Patient Safety Organization

The Collaborative Healthcare Patient Safety Organization (CHPSO) will hold a series of events, exploring issues such as racial inequities in maternal care and reducing risks for prescription drugs. 

Missing data, an unclear picture

In its report, ACIP explained why there will be a gap in knowledge about how many health care-associated infections (HAIs) occurred during the pandemic. 

In 2020, CMS  granted a waiver to relieve facilities of mandatory reporting of HAIs to ease the administrative burden on medical staff responding to the pandemic. Per the waiver, CMS did not count data from January 1, 2020, through June 30, 2020, for measuring performance or payment programs. This is data used by the CDC’s National Healthcare Safety Network (NHSN) in monitoring how well medical staff work to prevent infections among patients. 

The “waiver may mean that the true impact of COVID-19 on HAI development during the first pandemic period will never be elucidated,” APIC noted in its report. 

Still, the findings available show reversal in positive recent trends to lower incidence of HAIs. There have been significant efforts in recent years to prevent infections in U.S. health care, with some notable results, Fleisher said in an audio interview included with The New England Journal of Medicine article.

“When we put our attention on it, we saw improvements over time,” Fleisher said about efforts to reduce the number of infections acquired in medical settings.

Central-line–associated bloodstream infections in U.S. hospitals, for example, had decreased by 31% in the five years preceding the pandemic, CMS’ Fleisher and co-authors noted in their article. 

Central lines or central venous catheters, are akin to the intravenous catheters (also known as IVs) that are used frequently to provide medicine or fluids, according to a CDC explainer. IVs are placed near the skin’s surface, usually on the arm or hand, for short periods of time. In contrast, central lines are used in intensive care units. They access a major vein that is close to the heart and may remain in place for weeks or months, with this long use increasing risk for infection.

 The previous “promising trend” of reduced central-line-associated bloodstream infections was almost totally reversed by a 28% increase in the second quarter of 2020, as compared with the second quarter of 2019, Fleisher and co-authors wrote, citing CDC data.

Data submitted to CMS’ quality reporting programs during the second quarter of 2020 also showed worrying trends, with skilled nursing facilities showing rates of falls causing major injury increasing by 17.4% and rates of pressure ulcers or bedsores increasing by 41.8%

In the view of Fleisher and co-authors, the strains on U.S. health care during the pandemic affected routine safety practices.

“Overworked clinicians have often had no time for safety rounds, safety audits or error reporting. Supply-chain disruptions reduced access to personal protective equipment, putting both patients and health care workers at risk,” they wrote. “Standard safeguards, such as checklists, quickly became inadequate.”

The other authors of this article were Michelle Schreiber, M.D. of CMS and Denise Cardo, M.D., and Arjun Srinivasan, M.D., both of the CDC.

Other resources for covering Patient Safety Awareness Week include the Institute for Healthcare Improvement and the Center for Patient Safety.

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