Author's note: This column is intended for educational purposes only. It aims to highlight gaps in health knowledge, provide support and empower organizations to guide their members in creating effective health and wellness programs.

When we talk about patient safety, we often think of preventing errors. But safety should not begin with avoiding mistakes. It should begin earlier — with quality — moving the conversation beyond “mistakes happen” toward quality systems thinking.

PATIENT SAFETY VERSUS QUALITY

Much is said and written about patient safety. However, we must not lose sight of the big picture — quality, which is the foundation for safety. The “5 rights of medication administration” (right patient, right drug, right dose, right route and right time) is a foundational safety framework used to reduce errors and ensure patient safety, but it is not foolproof. A quality system goes beyond this standard by acknowledging knowledge gaps and inconsistencies that extend beyond the “5 rights,” such as:

• Incomplete medication reconciliation at hospital or clinic.
• Delay in treatment.
• Communication breakdowns.
• System failures, including inadequate storage, incorrect labeling, knowledge, competency and training gaps.

• Multiple medications prescribed by varying providers resulting in adverse side effects.
• Use of over-the-counter medications and supplements that were not disclosed at the time of treatment.

Safety is not a separate department in a hospital. It is the natural outcome of systems that are designed for quality care. As a nurse, patient and family member with hospital experience, I have seen dozens of “near misses” from a lack of quality systems.

When quality is present:

• Staff are professionally trained.

• Workflows are clear.
• Communication is structured, not haphazard.
• Equipment is well maintained.
• Staffing is adequate.
• Leadership actively listens to and addresses patient and staff concerns.

When quality erodes:

• Shortcuts appear.
• Fatigue increases.
• Communication breaks down.
• Hostility rises.

• Errors become more likely.

When a health care environment becomes rushed, reactive or adversarial, quality suffers. When quality suffers, safety is next. In a rapidly growing community like Baldwin County, quality systems must grow just as quickly. Quality processes and staffing must expand, not just buildings, developments and roads. Patient safety is not built in moments of crisis. It is built quietly every day in how systems are designed, how training and communication take place and in civility.

WHAT IS PATIENT SAFETY?

Patient safety is a buzzword used by health care organizations to protect patients from errors, injuries, accidents and infections. Many hospitals are good at keeping patients safe. Some are not. Upward of 250,000 people die every year from preventable errors in hospitals. In addition to tragic deaths, patients can experience dangerous complications resulting in slower and more difficult recovery and higher health care costs. Staying informed, something faith and civic groups can help with, is necessary to protect individuals from hidden dangers. One valuable tool available is the Leapfrog Hospital Safety Grade, a group that provides individuals with data on hospital safety records.

HOW PATIENTS CONTRIBUTE TO QUALITY:

• Patients can guide quality by keeping an updated medication list and knowing and understanding their medications, side effects and schedule.
• Asking informed questions to ensure they understand what is being said.
• Clarifying discharge instructions before leaving the hospital.
• Bringing an advocate with them to hospital admission, ER or clinic visits.
• Reporting concerns respectfully and conducting themselves civilly. Quality care is not passive — it is collaborative.

Every community depends on health care systems that are strong enough to meet demand without sacrificing quality care. It is up to all of us to help make that a reality.

HEALTH MINUTE

A recent study published in the Cochrane Library, based on their database of systematic reviews, explains how substituting advanced practice nurses (APNs) for physicians in hospital settings can improve access to care for patients who may otherwise face significant wait times. The rationale states that demand for health services has increased due to an ageing population, more complex healthcare needs, comorbidities, and rising healthcare costs. This further acknowledges the need, as discussed in recent op-eds, for faith and civic groups to become involved in their members’ health and wellness, as well as the need for health care to move away from the traditional “sick” health care system. This review was from 80 studies involving over 28,000 patients seen in hospital settings.

Dr. Cheryl Christy is a Baldwin County resident and registered nurse with nearly 30 years of experience. She holds master's degrees in nursing education and nursing practice and a doctorate in nursing practice. She is a member of Sigma Theta Tau, Phi Pi Chapter, a certified lay counselor and the author of "Voices for Healthcare," a health care blog.

Read her previous column titled "Root causes of disease: A new health care perspective" on www.GulfCoastMedia.com.