Measuring Patient Care

Safety

Patient safety is at the core of Dana-Farber's mission and vision and the Institute has been a leader in advancing safe practices and reducing the risk of medical error. We believe that health care organizations need to learn from accidental errors and injuries, in order to make care safer. Read more about Dana-Farber's patient safety research and initiatives.

• Hand hygiene

  Learn why and how Dana-Farber encourages and measures hand hygiene.

Safety systems

The Longitudinal Medical Record (LMR) is a Web-based electronic health record used at Dana-Farber and across the Partners healthcare system. Dana-Farber clinicians use the LMR to maintain patient records, order tests and medications, review results, and share critical medical information with other clinicians.

The medication safety features include the ability to avoiding potentially dangerous drug interactions and the ordering of unnecessary drugs and tests. Together, these features help to ensure safety, quality, and efficiency.

The "closed loop of medication" process

Dana-Farber is working toward implementing a fully electronic system for recording and tracking medication, from initial order to delivery.

Our goal is to create a "closed loop of medication" that uses bar coding to follow an order from the point it is entered into the system, through preparation and dispensing by the pharmacy, to administration by a nurse.

All patients now receive identification wristbands printed with a bar code. Products used to prepare chemotherapy agents and other medications at Dana-Farber's pharmacies are also bar coded and recorded in a computer system programmed to catch errors.

When the system is fully operational, nurses will be able to scan the code on a patient's wristband with a hand-held scanner, calling up an electronic medication record on a laptop computer. They will then scan the label on the medication container. The system will alert them if a mismatch has occurred.

Serious reportable events

Serious reportable events (SREs) are a group of 28 types of incidents that can affect hospitalized patients. These events, defined by a group of health care organizations called the National Quality Forum, include:

• Surgical events (e.g. operation on the wrong patient or body part)
• Care management events (e.g. serious medication errors or pressure ulcers)
• Events associated with malfunction of medical devices, environmental events (e.g. burns, falls, electronic shocks)
• Criminal events.

Although these events are rare, many are serious and they are often, though not always, preventable.

Dana-Farber reports SREs to the Massachusetts Department of Public Health and Board of Registration in Medicine.

Dana-Farber response to serious reportable event

• Medication error with death/disability
• Patient had serious allergic reaction and recovered fully

Key findings:
 

• Patient had history of possible sensitivity to drug
• Skin testing done a year earlier was negative for allergic reaction

Lessons learned and actions to prevent future events:

• Allergists now document all patients with completed chemotherapy desensitization protocols directly into the patient's electronic medical record that automatically links to Dana-Farber's pharmacy order entry system
• Frontline staff members have been alerted to the incident and instructed to enter suspected allergies into the electronic medical record.

Safety culture survey

Dana-Farber conducted an employee survey in 2007 to assess our patient safety culture. The safety culture of an organization tells us about employees' perceptions and judgments about the quality of communication, teamwork, collaboration, and fairness.

Understanding our safety culture can help us to compare ourselves against national benchmarks, to identify strengths and weaknesses, and to create a baseline against which we can measure improvements. Clinical staff participated in the survey, using a tool developed by the US Agency for Healthcare Research and Quality.

Dana-Farber met or exceeded national benchmark performance of other teaching hospitals in 14 of 19 areas. Our results were particularly strong in response to questions about organizational learning, supervisor/manager expectations and actions promoting patient safety, and management support for patient safety.

Our responses also showed opportunities for improvement in management of the volume and complexity of patients in our clinical areas, and in the need to communicate more effectively with staff members about safety incidents and to share the results of improvement efforts. We are actively addressing these concerns.

Standard care delivered reliably

High-performing organizations standardize the way they do things. If there is one best way to deliver care for a certain disease or condition, then that approach should be done the same way, every time. In fact, standardization of care captures best practice and helps clinicians recognize when a customized approach is needed.

Dana-Farber clinicians developed and use common templates for delivering care. These treatment plans are incorporated in our electronic medication ordering systems, and they are updated regularly, based on the latest available research. This approach ensures that the best care is delivered the same way every time.