Patient Safety Strategies for Gastroenterologists
Keeping patients safe is a significant concern for all medical specialties. Some patient safety strategies for gastroenterologists include selecting the appropriate facility, providing clear preprocedure instructions, maintaining infection control standards, following appropriate guidelines for sedation, and having adequate test results and follow-up exam tracking systems in place.
Matching the facility and setting to the patient and procedure can be facilitated by assigning an ASA score (the American Society of Anesthesiologists’ risk score) to each patient and selecting the appropriate setting for the procedure based on the patient’s score. 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 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.
Support and maintain meticulous endoscopic reprocessing protocols that are part of a comprehensive infection control plan. Include active infection prevention surveillance in the plan, and emphasize ongoing education and evidence of competency of the staff involved in the plan.
Follow patient safety guidelines for moderate sedation (conscious sedation). For example, use the “Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists,” published by the American Society of Anesthesiologists (ASA), (Anesthesiology. 2002;96:1004–17) and the ASA’s “Statement on Granting Privileges for Administration of Moderate Sedation to Practitioners Who Are Not Anesthesia Professionals” (amended March 22, 2016). AHRQ has also published “Guidelines for Safety in the Gastrointestinal Endoscopy Unit” that addresses this issue.
Guidelines include monitoring:
- Blood pressure.
- Respiratory rate.
- Oxygen saturation by pulse oximetry, including alarms.
- Electrocardiographic monitoring.
- Depth of sedation.
Additional strategies for moderate sedation (conscious sedation) include:
- Following the guidelines indicated for the particular sedative given (for example, propofol).
- Ensuring appropriate postprocedure observation and monitoring.
- Maintaining current ACLS certification (or PALS for pediatric patients) for all practitioners who supervise or administer moderate sedation.
- Having emergency medications and equipment readily available.
- Having a designated individual (other than the practitioner performing the procedure) present to monitor the patient throughout the procedure.
Practices should maintain tracking systems for test results and follow-up exams. 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.
Like test result tracking, a patient reminder system should be used to ensure that patients are monitored for reexamination or follow up. Maintain a reminder system so that letters can be generated and sent at appropriate intervals. If a patient who meets the risk criteria fails to respond to reminders, help the individual make an informed decision by providing education about the risks of ignoring treatment recommendations. File all documentation in the medical record.
Contact The Doctors Company Patient Safety Risk Management Department for guidance and assistance in addressing any patient safety risk management concerns.