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23 10 Top Patient Safety Issues for 2018 By Anuja Vaidya, Brian Zimmerman and Mackenzie Bean T he Becker's Clinical Leadership & Infection Control editorial team chose the following 10 patient safety issues for providers to pri- oritize in 2018, presented below in no particular order, based on news, study findings and trends reported in the past year. 1. Disparate EHRs. While EHR adoption continues to increase among healthcare providers, interoperability remains a challenge. A KLAS Re- search report released in October shows only 14 percent of 420 survey respondents at hospitals and clinics indicated they have "deep interop- erability" when sharing data among different EHRs. is figure is up 6 percent from a year prior. Disparate EHRs can negatively affect patient care. A lack of interop- erability may mean providers are not getting the whole picture when it comes to their patients' conditions. Information management in EHRs topped ECRI Institute's annual list of top patient safety concerns for healthcare organizations. One of the most concerning ways poor interoperability affects patient care is medication reconciliation. If physicians are unaware of all the medications a patient is taking, they may unknowingly prescribe a drug that can negatively interact with an- other medication. e College of Healthcare Information Management Executives Foundation polled 120 hospital CIOs, CMIOs, directors of informatics and other hospital administrators in February 2017, and found 74.8 percent listed incomplete and inaccurate medication data as a top concern. Lack of EHR interoperability also makes effective patient care harder in times of crisis or during natural disasters. Consider when Hurricane Harvey hit Texas hospitals in August; data exchange between unaffiliated facilities was difficult in the storm's aermath, Wired reported. Poor interoperability complicated the care process for displaced patients who sought treatment at hospitals that did not have access to their medical records. 2. Hand hygiene. A lack of proper hand hygiene compliance was direct- ly linked to numerous infections and death in 2017. In July, state health officials identified poor infection control practices at West Columbia, S.C.-based Vitality Medical Center, where six knee pain patients were sickened with Staphylococcus aureus infections in December 2016. e health officials noted improper protocols, such as not conducting proper hand hygiene practices or wear sterile gloves when performing knee injections, led to the spread of infection at the clinic. However, a number of studies published in 2017 found evidence some interventions can help improve hand hygiene compliance. Supplying patients with handheld signs to remind physicians to wash their hands can help improve provider hand hygiene compliance, according to a study published in the American Journal of Infection Control. Noncon- ventional methods have also been successful at improving hand hygiene compliance rates. A study published in the American Journal of Infection Control showed text messaging via smartphones can significantly in- crease hand hygiene adherence among healthcare workers. 3. Nurse-patient ratios. Inadequate staffing at healthcare facilities can greatly hamper patient care. A study published in the International Jour- nal of Nursing Studies showed every extra patient on a nurse's caseload increased mortality rates by 7 percent. Another study published in the Annals of Intensive Care found intensive care unit patients exposed to a high workload-to-nurse ratio for one or more days had lower risk-ad- justed odds of survival to hospital discharge compared to patients exposed to normal ratios. In May, Rep. Jan Schakowsky, D-Ill., and Sen. Sherrod Brown, D-Ohio, reintroduced the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act in the House. e bill "sets minimum nurse-to- patient staffing requirements for direct-care registered nurses, requires a study of staffing requirements for direct care licensed practice nurses, and provides whistleblower protections." Individual states have also taken up the mantle of requiring minimum staffing ratios in healthcare facilities. As of September 2015, 14 states had enacted legislation or adopted regulations around nurse staffing ratios, according to the Agency for Healthcare Research and Quality. In 2017, Michigan legislators introduced a bill that would require hospitals to keep open records of nurse-patient ratios, develop staffing plans and ban mandatory nurse overtime. 4. Drug and medical supply shortages. Supply chain issues represent- ed a major obstacle for healthcare providers in 2017, with shortages of drugs and medical supplies expected to continue in 2018. In May, many hospitals were forced to delay major operations and chemother- apy treatments due to a nationwide shortage of sodium bicarbonate solution. Mobile, Ala.-based Providence Hospital had to postpone seven scheduled open heart surgeries aer a patient needed 35 of the hospital's remaining 175 sodium bicarbonate vials. While Pfizer — the drug's primary supplier — sent Providence Hospital an emergency supply, the hospital still faced a shortage in the following weeks and months. Hospitals across the U.S. are also battling drug and medical supply short- ages caused, in part, by lower production levels at manufacturing plants in Puerto Rico, which lost power aer Hurricane Maria made landfall in late September 2017. Puerto Rico, which houses more than 80 drug and med- ical device plants, produces nearly 10 percent of the U.S.'s medications. e most notable shortage to hit hospitals was small saline bags, which were already in low supply before the hurricane made landfall. In October, FDA commissioner Scott Gottlieb, MD, said hospitals nationwide could see a shortage of about 40 drugs and medical devices due to manufacturing disruptions on the island. "Some of these prod- ucts are critical to Americans," Dr. Gottlieb told the House Energy and Commerce Committee's Subcommittee on Health. "A loss of access could have significant public health consequences." 5. Quality reporting. CMS Administrator Seema Verma acknowledged issues with the agency's current quality reporting system during a speech at the Health Care Payment Learning and Action Network Fall Summit in October 2017. "ere are many steps involved in submitting them, taking time away from patients," she said. "Moreover, it's not clear whether all of these measures are actually improving patient care." Sponsored by: