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Transcript of Exceptional Care. Remarkable Services. Extraordinary Grady. IMIA International Conference on Medical...
Exceptional Care. Remarkable Services. Extraordinary Grady.
IMIA International Conference on Medical Interpreting“Pioneering Healthy Alliances”
Boston, MassachusettsOct. 5 – 7, 2007
COMMUNICATION -KEY TO PATIENT SAFETY
Exceptional Care. Remarkable Services. Extraordinary Grady.
Presented by:
Sandra Sanchez, M.S.,
Director, Multi-Cultural Affairs
Grady Health System, Atlanta
and
Linda Joyce, M.S.,
Language Access Consultant
Interpreter
Exceptional Care. Remarkable Services. Extraordinary Grady.
Objectives of the Presentation
Understand patient safety issuesRecognize the relevance of language and
culture in patient safetyDiscuss some of the strategies that have
worked Show how collaborating will lead to better
health outcomes for all, including culturally and linguistically diverse patients
Exceptional Care. Remarkable Services. Extraordinary Grady.
Patient Safety Definitions
Adverse Event/ Occurrence:
Any unintended harm to the patient by an act of commission or omission rather than by the underlying disease or condition of the patient.
Near Miss/Close call:
A potential injury that did not happen to the patient.Sentinel Event:
An unanticipated death or major loss of function, not related to the natural course of the patient’s illness or underlying condition.
Exceptional Care. Remarkable Services. Extraordinary Grady.
Why the focus on patient safety?
Joint Commission, Dec., 2006
Exceptional Care. Remarkable Services. Extraordinary Grady.
Is it safe to go to the hospital?
An average of 195,000 people in the USA died due to potentially preventable, in-hospital medical errors in each of the years 2000, 2001 and 2002, according to a 2004 study of 37 million patient records
HealthGrades Patient Safety in American Hospital Study
Exceptional Care. Remarkable Services. Extraordinary Grady.
Joint Commission - Dec. 2006
Exceptional Care. Remarkable Services. Extraordinary Grady.
2007 National Patient Safety Goals
Patient IdentificationImprove communicationMedication SafetyReconcile MedicationsPatient involvementFocused risk assessment
Exceptional Care. Remarkable Services. Extraordinary Grady.
“Effective Communication”
U. S. Department of Health and Human Services initiative to strengthen language access
Along with the Office of Civil Rights, collaborating with hospital associations in nine states
Assessment includes looking at the needs of small, rural hospitals
Exceptional Care. Remarkable Services. Extraordinary Grady.
WHO (World Health Organization) Patient Safety Solutions Patient identificationCommunicationAssuring medication accuracyLook-alike, sound-alike medication
names
Exceptional Care. Remarkable Services. Extraordinary Grady.
We are part of a mosaic: There are more than 6 categories for race and about 2.5% of
the population identified themselves as having 2 or more races About 12% of the US population is foreign born About 18% of the US population speak a language other than
English at home (Approx. 47 million) About 8.1% of the population 5 Years and Over Speak
English Less Than “Very Well” (Approx. 21 million) US Census Bureau
Federal and Accreditation Mandates
Exceptional Care. Remarkable Services. Extraordinary Grady.
Language and culture 101
Basic considerations to improve patient safety
Primary/preferred LanguageCultural BackgroundHealth Literacy Levels
Exceptional Care. Remarkable Services. Extraordinary Grady.
Cases to consider
10 month old baby with iron-deficiency anemia
3-year old child with abdominal painGirl falling from bicycle“Intoxicado”HysterectomyHmong child with epilepsy
Exceptional Care. Remarkable Services. Extraordinary Grady.
Your real time examples
Experiences that you have had in your health care setting where communication has been, or could have been the cause of incidents
Experiences where cultural considerations have led, or could have led to incidents
Exceptional Care. Remarkable Services. Extraordinary Grady.
“Language proficiency and adverse events in U.S. hospitals: a pilot study”
Adverse events involving some physical harm Almost half (49.1%) of LEP patients vs.Almost a third (29.5%) of patients who speak English Patients with moderate temporary harm to death:46.8% of the LEP vs. 24.4% of English speaking
patientsCommunication errors:52.4% of the LEPs vs. 35.9% of the English speaking patients
Joint Commission - Chandra Divi, Richard G. Koss, Stephen P. Schmaltz and Jerod M. Loeb
Exceptional Care. Remarkable Services. Extraordinary Grady.
Adverse event type characteristics for English speaking and LEP patients
Adverse event characteristic English speaking N (%) Limited English proficient N (%) P-value
CommunicationCommunication 299 (35.9) 130 (52.4) <0.001
Inaccurate/incomplete information 132 (15.9) 39 (15.5) 0.44
Questionable advice/interpretation 29 (3.5) 28 (11.2) 0.002
Questionable consent process 10 (1.2) 7 (2.8) 0.33
Questionable disclosure process 7 (0.8) 8 (3.2) 0.042
Questionable documentation 171 (20.6) 59 (23.5) 0.77
Questionable assessment of patient needs 53 (6.4) 37 (14.7) <0.001
Patient managementPatient management 467 (56.1) 133 (53.0) 0.12
Questionable delegation 14 (1.7) 10 (4.0) 0.69
Questionable tracking and follow-up 182 (21.9) 61 (24.3) 0.30
Questionable use of resources 257 (30.9) 60 (23.9) 0.18
Clinical performanceClinical performance 154 (18.5) 36 (14.3) 0.47
Correct diagnosis questionable intervention 152 (18.3) 32 (12.8) 0.77
Joint Commission – C.Divi et al.
Exceptional Care. Remarkable Services. Extraordinary Grady.
Hospitals, Language and Culture: A Snapshot of the Nation
Quality controlled translationsQualified interpreters and cultural brokersEducation on cultural competencyAvoid stereotypingDiscuss impact of language and culture on patient
safety Expand Joint Commission Nat’l Safety GoalsBetter data and research effect of language and
culture in adverse eventsJoint commission - Wilson-Stokes
Exceptional Care. Remarkable Services. Extraordinary Grady.
CLAS, OCR and The Joint Commission Effective and understandable communication Written information in patient’s language Interpretation and translation services Staff competence (Qualified interpreters and translators) Cultural, linguistic and learning needs Records of communication with patients Patient involvement Hospitals provide services in accordance to laws and
regulations Patients with comparable needs receive same standard of
care
Exceptional Care. Remarkable Services. Extraordinary Grady.
Grady Health SystemDepartment of Multicultural Affairs
Language Interpretive Services (LIS) Qualified professional interpreters and translators Continuous education sessions for interpreters Language Proficiency Assessments
Multicultural Programs Outreach and education Community Partnerships Cultural Competency Training
International Medical Center (IMC) Primary care – Patient centered (one-stop shop) Bilingual and culturally sensitive staff and providers Education in waiting room
Exceptional Care. Remarkable Services. Extraordinary Grady.
Interdepartmental Collaboration at Grady Health System
Patient SafetyRisk ManagementCustomer service / Patient Advocacy Training and Development Nurse Residency ProgramFacilities ManagementPublic Relations Human Resources
Exceptional Care. Remarkable Services. Extraordinary Grady.
The Goal: Patient-centered careAssessing language and cultural needsListening to the patientAsking the patient what they are doing to
address their health issuesInvolving the patient and families at all
transitionsUsing “teach-back” or “show-back”
techniques
Exceptional Care. Remarkable Services. Extraordinary Grady.
What can we do together?
What can health care systems do to include language and culture in its patient safety plan?
What can language service departments do?
What can interpreters do?What can providers and patients do?
Exceptional Care. Remarkable Services. Extraordinary Grady.
Conclusions
Language and culture have to be considered to achieve all the National Patient Safety Goals for 2007.
Organizational collaboration is key to preventing communication errors.
To reduce the risks to patient safety related to language and cultural barriers, always: Use qualified medical interpreters Collect data on preferred language Document use of medical interpreters Confirm understanding with “teach back” or “show back” approach Learn about practices and customs of the patient population in the
service area Attend cultural competency trainings when possible
Exceptional Care. Remarkable Services. Extraordinary Grady.
References
www.jointcommission.org Hospitals, Language and Culture: A Snapshot of the Nation What did the doctor say? Improving Health Literacy to Protect Patient
Safety National Patient Safety Goals
www.LEP.gov www.omhrc.gov
National Standards for Culturally and Linguistically Appropriate Services
www.census.gov www.hhs.gov/ocr www.publimed.org
Exceptional Care. Remarkable Services. Extraordinary Grady.
Thank You!