Keys to Patient Safety
Gastroenterology
As the first medical professional liability insurer to establish a patient safety department, The Doctors Company remains the leader in developing innovative tools that can help you reduce risk and keep your patients safe.
Match the facility and setting to the patient and procedure.
Assign an ASA score (the American Society of Anesthesiologists’ risk score) to each patient and select the appropriate setting for the procedure based on the score and procedure. For example, a patient with an ASA score of IV would not be an appropriate candidate for an endoscopic procedure in an office setting. Be aware of each facility’s staff credentials and its capabilities and limitations.
Provide clear preprocedure instructions.
Provide patients with clearly written preprocedure instructions, including the need for NPO status. Document in the medical record that all critical information, like NPO status, has been confirmed with the patient.
Follow patient safety guidelines for moderate sedation (conscious sedation).
The American Society of Anesthesiologists has published “Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists” (Anesthesiology 2002; 96;1004–17) and “Statement on Granting Privileges for Administration of Moderate Sedation to Practitioners Who Are Not Anesthesia Professionals” (amended October 18, 2006). Become familiar with these guidelines, which include monitoring:
- blood pressure;
- respiratory rate;
- oxygen saturation by pulse oximetry, including alarms;
- electrocardiographic monitoring;
- depth of sedation; and
- capnography—for those patients whose ventilation cannot be directly monitored.
In addition:
- Follow the guidelines indicated for the particular sedative given (i.e., propofol).
- Ensure appropriate postprocedure observation and monitoring.
- Maintain current ACLS certification (PALS if pediatric patients) for all practitioners who supervise or administer moderate sedation.
- Have emergency medications and equipment readily available.
- Have a designated individual (other than the practitioner performing the procedure) present to monitor the patient throughout the procedure.
Maintain a mechanism for results tracking and notification.
Tracking test results is a critical patient safety function. Verify that your office system will alert you if a result or report is not received. Holding the chart and relying solely on a follow-up appointment are not recommended solutions. A task list generated by an electronic medical record, a specimen log, or a copy of the requisition or order form—any of which can be checked periodically—provides a reliable safety net. When you review the report or results, verify that the correct test was performed and the correct results were returned. Advise patients that they will be contacted regarding every test or procedure and that they should contact the office if they do not receive results in a reasonable time frame. Do not encourage the “no news is good news” approach.
Maintain a reminder system for follow-up exams.
Certain patients, based on the results of the most recent exam or other history, are encouraged to have a re-exam or to follow up within a certain time frame. Maintain a reminder system so that reminder letters can be generated and sent at appropriate intervals. If a patient who meets the “risk criteria” fails to respond to reminders, help the patient make an informed decision by providing an explanation of why failing to have the recommended exam places him or her at risk.
By Susan L. Marr, MSA, CPHRM, Patient Safety/Risk Management Account Executive.
J8039G 7/11
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.