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per Florida Statutes, Section 381.0011 authority (DOH/Disease Control/Epidemiology TAG 340-1-13). Slide 61 “An Ounce of Prevention is Worth A Pound of Cure.” -Benjamin Franklin Benjamin Franklin was accurate in his proclamation, “An ounce of prevention is worth a pound of cure.” 40 It's a New Day in Public Health FDOH Medical Errors: A Public Health Perspective Learner Course Guide Slide 62 AVOIDING PREVENTIVE ERRORS There are a number of precautions everyone should follow each day to avoid accident and injury to staff as well as patients: • Fire safety - Know how to use a fire extinguisher • Use of safety-type sharps containers - An overfilled sharps container is an accident waiting to happen for the curious child whose mother is temporary distracted • Environmental safety - Pick up items which may present risk for falls • Hand washing should be a routine habit for the prevention of spread of infection. Slide 63 AVOIDING PREVENTIVE ERRORS Another method for avoiding injury which can be prevented is assisting patients in avoiding the development of chronic disease: • Ask patients about physical activity, stress levels • Counsel patients on illness prevention • Talk about healthy eating habits 41 It's a New Day in Public Health FDOH Medical Errors: A Public Health Perspective Learner Course Guide Slide 64 OTHER ERRORS Failure of communication Equipment Malfunction Failure of communication and equipment malfunction are those errors which commonly fall under the category of Other Errors. Slide 65 FAILURE OF COMMUNICATION There are a number communication points at which medical error is more subject to occur: ‒ patient/family clinician, office/clinic staff members ‒ the communication chain ‒ primary care hospital ‒ handoff communications ‒ missing reports There are a number of communication points at which medical error is more subject to occur. Special attention should be offered to these areas to ensure smooth and accurate information flow processes. Structured handoffs, proactive sharing of patient information, improved feedback and standardized processes for information handling may assist in the prevention of error. Slide 66 Equipment Malfunction Occasionally, equipment failure will result in medical error. Users should ensure they follow manufacturer’s directions for use and are attentive for indicators that equipment is not functioning properly. Sterilization of equipment, improperly performed, may result in cross-contamination leading to the transmission of infectious agents and the spread of disease such as Hepatitis C, HIV and TB. 42 It's a New Day in Public Health FDOH Medical Errors: A Public Health Perspective Learner Course Guide Slide 67 Equipment It is important that weight/other scales which require annual calibration be evaluated on a regular basis to ensure readings are consistent and accurate (Marsteller, Hsiao, Underwood, Woodward & Barr, 2010). Slide 68 INFORMED CONSENT The document a patient signs to verify engagement in communication with a health care provider about a proposed medical treatment. The process of informed consent is applicable to all medical care decisions where one or more alternatives exist. Slide 69 INFORMED CONSENT Requires discussion about: – The patient’s role – The clinical issue and suggested treatment – Available alternatives – Associated risk and benefits – Uncertainties Requires assessment of: – The patient’s understanding of the information – The patient’s treatment preference (consent) A complete informed consent process consists of seven elements: 1. Discussion about the patient’s role in the decision-making process 2. Describing the clinical issue and suggested treatment 3. Discussing alternatives to the suggested treatment 4. Discussing risk and benefits associated with the suggested treatment and comparing them with the risks and benefits of alternative treatments 5. Discussion of related uncertainties 6. Assessing the patient’s understanding of the information provided 7. Eliciting the patient’s treatment preference (consent) 43 It's a New Day in Public Health FDOH Medical Errors: A Public Health Perspective Learner Course Guide Slide 70 1,057 audio-recorded informed consent process encounters examined In an examination of the informed decision-making process in 1,057 audio recorded outpatient encounters in the offices of primary care physicians and surgeons, regarding mostly low-risk decisions, only 9% were deemed to contain all the elements of complete informed decision-making. The most common element missing was an explicit assessment of patient understanding. However, risks and benefits, and their associated uncertainties were also commonly not included in the discussions. Slide 71 Case Study Discussion Multiple studies have shown that most patients are unable to recall or do not understand most of the information that is presented to them in the informed consent process. Lower levels of education are consistently associated with being less likely to recall information in the informed consent process. Older age and low level health literacy has been associated with being less likely to recall informed consent information. Patients with cognitive dysfunction are particularly vulnerable in the informed consent process. 44 It's a New Day in Public Health FDOH Medical Errors: A Public Health Perspective Learner Course Guide Slide 72 PREVENTION OF OTHER ERRORS ‒ Simplifying informed consent forms ‒ Providing supplemental written materials ‒ Using decision aids ‒ Using video educational tools ‒ Using interactive computer-based educational tools ‒ Having structured discussions ‒ Using “repeat back” methods (Cordasco, 2013) Methods for improving the informed consent process Multiple potential methods have been proposed for improving the informed consent process. These methods include: Providing patients with supplemental written materials, in simplified language, has been found to result in higher patient recall of informed consent information. Decision aids have been found to improve knowledge scores by an average of 15%, improve patients’ participation in decision making, resulting in lower decisional conflict, and increased accuracy of risk perceptions (Cordasco, 2013). Slide 73 SPECIAL VULNERABILITY POPULATIONS Pediatric Patients Older Adults Limited Health Literacy/English There are populations which are considered ‘vulnerable’ to medical errors. Those populations require extra vigilance in the provision of care. 45 It's a New Day in Public Health FDOH Medical Errors: A Public Health Perspective Learner Course Guide Slide 74 Special Vulnerability Populations PEDIATRIC PATIENTS ‒ Physiological characteristics ‒ Developmental issues ‒ Dependence on others The pediatric population is at increased vulnerability of medical errors due to physiological characteristics, developmental issues and dependence on others. Pediatric medications require weight dosing and careful consideration of dosing frequency; errors may occur when physicians/ pharmacists convert dosage from pounds (for adults) to kilograms (for children). They may also occur due to misplaced decimal points in the drug dosage order. Slide 75 Special Vulnerability Populations OLDER ADULTS ‒ Physiological changes of aging process ‒ Visual and auditory decline ‒ Chronic disease ‒ Risk for falls As the most frequent users of medications, older adults are at substantial risk for medical errors. Physiological changes which are associated with the normal aging process disrupt or change the body’s ability to absorb, metabolize and excrete drugs. Visual and auditory decline frequently affect communication. Development of chronic disease such as arthritis or postural hypotension may create functional limitations and lead to falls. 46 It's a New Day in Public Health FDOH Medical Errors: A Public Health Perspective Learner Course Guide Slide 76 Special Vulnerability Populations Individuals with Limited Health Literacy or Limited English