Becker's Clinical Quality & Infection Control

12 INFECTION CONTROL & PATIENT SAFETY Most patient family members hesitant to express safety concerns By Megan Knowles T he majority — 50-70 percent — of family members with a loved one in an intensive care unit said they were hesitant to voice their concerns about common care situations with safe- ty implications, a study published in BMJ Quality and Safety found. Here are six things to know: 1. Clinician-researchers at Beth Israel Deaconess Medical Center in Boston surveyed family members and patients with recent ICU experiences about how willing they felt to discuss care concerns with medical providers. "Speaking up is a key component of safety culture, yet our study — the first to our knowledge to address this issue — re- vealed substantial challenges for patients and families speaking up during an ICU stay," said co-lead author Sigall Bell, MD. "In the ICU setting in particular, families — who are also among the most vigilant stakeholders — may hold key information clinicians may have overlooked, and may be the first to detect a change in clinical status." 2. Using a questionnaire developed by a multidisciplinary group of experts in patient advisory and care quality, the researchers surveyed 105 families of patients admitted to an urban academic hospital's ICU from July 2014 to February 2015. ey also sur- veyed a panel of 1,050 participants with recent ICU experience via the internet. 3. Although nearly two-thirds of ICU patients and families report- ed feeling very comfortable discussing medications, only about one-third of respondents said they felt very comfortable discuss- ing hand hygiene or disagreements about aggressiveness of care desired by patients/families versus care clinicians proposed. 4. Only half of survey respondents felt very comfortable asking clinicians to clarify confusing or conflicting information or rais- ing concerns about a possible error. 5. e most frequently cited reasons for that hesitancy included fear of being labeled a "troublemaker," not knowing whom to talk to, and knowing the medical team was busy. 6. "We were surprised not knowing [whom] to talk to about concerns — a readily actionable issue — was among the most highly cited barriers," Dr. Bell said. "Our results highlight the need to explicitly support patients and families to speak up in real time about perceived errors. Hesitancy to do so represents a real safety gap." e findings point to low-cost opportunities to improve patient and family outcomes. As a first step to improving outcomes, hospital leaders can implement systematic instructions about whom to contact with concerns, culturally reframe speaking up in a more positive way and ensure clinicians listen to patients and families when they do speak up, the researchers suggest. n This Maryland hospital wants physicians to discuss gun safety with patients By Harrison Cook H ospital officials at Parole, Md.-based Anne Arundel Medi- cal Center view gun violence as a public health crisis and want physicians to hold nonjudgmental talks about gun safety with their patients, according to the Capital Gazette. "We have a moral obligation to address this problem," David Moller, MD, chief of clinical and organizational ethics at Anne Arundel Medical Center, told Capital Gazette. "Because it is so contentious and so divisive, it's going to take sustained moral courage to build a lasting initiative to address and resolve." Officials discussed the issue with about 100 hospital em- ployees and community members during a July 26 panel discussion, although physician talking points and literature for patients are still under development. The idea of physicians talking about gun safety with patients emerged after Anne Arundel physicians treated survivors of the Capital Gazette newsroom shooting in June, where five employ- ees were killed. Barry Meisenberg, MD, director of medicine at Anne Arundel, categorizes the hospital's planned discussions as harm reduc- tion, which is not the same as gun control. "This is not political advocacy, but rather patient advocacy," Dr. Meisenberg told the Capital Gazette. n New hand hygiene data collection process uses Google By Anuja Vaidya R esearchers from University of Louisville (Ky.) School of Public Health and Information Sciences, University of Louisville School of Medicine and New York City-based Lenox Hill Hospital developed a new hand hygiene data collec- tion process and an automated reporting engine, according to a study published in American Journal of Infection Control. The researchers' process involves a three-step approach: • Creating a data collection form using Google Forms • Transferring data from the form to a spreadsheet using Google Spreadsheets • Creating an automated, cloud-based analytics platform for report generation using R and RStudio Shiny software "This data collection and automated analytics engine provides an easy-to-use environment for evaluating hand hygiene data; it also provides rapid feedback to healthcare workers," re- searchers concluded. n

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