Safety Perspective for Using Dressings and Devices: Reducing Sentinel Events, Improving Quality Outcomes & Avoiding Litigation

From The Clinical Editor

By Diane Krasner PhD, RN, CWCN, CWS, MAPWCA, FAAN

Introduction

The push towards safety by regulators and payers reflects the evidence that safe healthcare practices have numerous benefits – from reducing sentinel events to improving quality outcomes and helping to avoid litigation (1, 2, 3, 4). The wound care community has been slow to adopt the safety mantra . . . but the time has come to put your “safety lenses” on and to view wound prevention and treatment as a safety issue.

A culture of safety is a concept that applies at an organizational level, a wound team level and an individual level. Reflect on how your practice addresses safety prevention and outcomes on all three levels. Identify ways that “safe thinking” can be introduced in your practice with outcome measures such as:

• Reducing the incidence of certain types of wounds (e.g. avoidable pressure ulcers, avoidable skin tears)
• Decreasing wound recurrence rates (e.g. venous ulcers, diabetic foot ulcers)
• Decreasing amputation rates related to diabetes
• Decreasing pain experienced by people with wounds

Review the use of dressings and devices in your practice with your “safety lenses” on. Ask yourself the following five questions:

1. Do you follow the manufacturer’s recommendations for the use of dressings and devices?
2. Do you have guidelines for products/devices use in your facility?
3. Are Material Safety Data Sheets (MSDS) on file with the appropriate office in your organization for all wound products utilized, including samples?
4. Has your staff been appropriately trained on the use of dressings and devices?
5. Do all prescribers of dressings and devices know their prescriber responsibilities?

Familiarize Yourself With the Safety Literature

The lessons from the safety world have import for the wound care world. For over 30 years, certain healthcare specialties have had a focus of safety (OR, ID, HBOT). Excellent resources for plugging in to the vast safety literature in a meaningful way for wound care are available from The Joint Commission and the Institute of Healthcare Improvement (IHI).

Two outstanding safety books are well worth reading:

Why Hospitals Should Fly: The Ultimate Flight Plan to Patient Safety and Quality Care
by John J. Nance, JD

The Checklist Manifesto: How to Get Things Right
by Atul Gawande, MD

These are two great starting points for beginning your safety journey. Here are two quotes to entice you:

From Donald M. Berwick MD, MPH on Why Hospitals Should Fly

"This book is a tour de force, and no one but John Nance could have written it. He, alone, masters in one mind the fields of aviation, health care safety, medical malpractice law, organizational psychology, media communication, and as if that were not enough, the art of fine writing. Only he could have made sophisticated, scientifically disciplined instruction about the nature and roots of safety into a page-turner... This book should be required reading for anyone willing to face the facts about what it will take for health care to be as safe as it truly can be."

From The Checklist Manifesto:

"Checklists seem to provide protection against such failures. They remind us of the minimum necessary steps and make them explicit. They not only offer the possibility of verification, but also instill a kind of discipline of higher performance. Which is precisely what happened with vital signs – though it was not doctors who deserved the credit. The routine recording of the four vital signs did not become the norm in Western Hospitals until the 1960s, when nurses embraced the idea (p. 36)."

Conclusion

As we focus on safety and quality wound care outcomes in the months and years to come, healthcare professionals can also continue to rely on WoundSource: The Wound Product Sourcebook and its companion website WoundSource.com for current and reliable information on products and services related to wound and skin care. Apply this information, read the literature, and review the use of dressings and devices in your practice as you strive to nurture the culture of safety in wound care.

Wishing you a safe journey,

Diane L. Krasner

Clinical Editor

References

1. To Err is Human: Building a Safer Health System. Institute of Medicine. National Academy Press, Washington, D.C., 2000.
2. Crossing the Quality Chasm: A New Health System for the 21st Century. Institute of Medicine. National Academy Press, Washington, D.C., 2001.
3. Nance JD. Why Hospitals Should Fly: The Ultimate Flight Plan to Patient Safety and Quality Care. Second River Healthcare Press, Bozeman, MT, 2008
4. Atul Gawande. The Checklist Manifesto: How to Get Things Right. Metropolitan Books, Henry Holt & Company, New York, 2009.

About The Author
Diane Krasner PhD, RN, CWCN, CWS, MAPWCA, FAAN is a certified wound specialist, a Fellow of the American Academy of Nursing, a Master of the American Professional Wound Care Association, a Wound & Skin Care Consultant, and serves on a variety of editorial and managerial boards for prestigious wound care organizations.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.