Preventing medical mishaps

San Francisco

- Whether one works in a private office or hospital outpatient setting, agree that maximizing patient safety in procedural dermatology demands taking nothing for granted.

In the private office setting, patient safety starts with teaching one’s staff to acknowledge every instruction the dermatologist gives, says Scott M. Dinehart, M.D., clinical professor of dermatology, University of Arkansas for the Medical Sciences.

"When you ask your staff to do something, they should repeat that back to you," as airline flight controllers and pilots do.

"If you just hear a ‘yes,’ you don't know exactly if they understood. But if you told the nurse to give an injection of 10 mg per ml of Kenalog (triamcinolone, Bristol-Myers Squibb), and they repeat back, ‘yes, I will give that injection of 10 mg per ml of Kenalog,’ it’s different than just saying ‘yes.’

"The whole idea is to close the loop with communications. This also works well with patients," Dr. Dinehart tells Dermatology Times.

Medical notation

Similarly, he says the Medical Board of California has identified ambiguous medical notation as one of them most common preventable problems in American healthcare.

Accordingly, Dr. Dinehart says, "Certain abbreviations aren’t accepted anymore. But I find that many physicians are still using them, not only in hospital records, but also in their prescriptions."

Examples of prohibited shorthand include "u" for units, and the greater than or less than symbols, along with drug abbreviations and "Qday." Each item's meeting should be spelled out completely to avoid misinterpretation, he says.

Proactive approach

In the hospital setting, says Philip Bailin, M.D., program director, dermatologic surgery and cutaneous oncology, Cleveland Clinic, Cleveland, "The days of name and blame are ending," as they are being supplanted by a spirit of awareness and a proactive approach to preventing medical mishaps.

Nowhere is this more evident than in the Joint Commission’s recently unveiled National Patient Safety Goals.

Of 13 goals total, the two that apply most directly to dermatology are those dealing with patient identification and communication among caregivers, Dr. Bailin says.

In the former area, he says, "Every patient must have two identifiers at the time of the procedure." These could include name, date of birth, Social Security number, medical record number address and more.

Somewhat similarly, he says the Joint Commission’s new Universal Protocol includes everything from handwashing before interacting with patients to taking an oral pre-procedure "timeout" to verify among staff members involved not only what procedure is about to be done, but also that all needed supplies are present.

Identifying problems

In procedural dermatology, Dr. Balin says that occasionally, "Scalpels fall. Needles slip. What can go wrong will. So, the idea of this safety movement is to identify these problems and develop a framework for avoiding them."

Although the Joint Commission’s hospital outpatient guidelines don’t apply to private offices, he says that one day, "they will extend, to some degree, to every private office. So start preparing now." DT

Disclosure:

Drs. Dinehart and Bailin report no relevant financial interests.

For more information:

www.aad.org

www.jointcommission.org