Patient Safety Strategies for Gastroenterologists
Keeping patients safe is a significant concern for all gastroenterologists. Some patient safety strategies when performing procedures include conducting a thorough preprocedure patient evaluation, 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.
Conduct a preprocedure evaluation of the patient that includes a review of medical records for underlying medical conditions that may affect care, such as obstructive sleep apnea or airway problems. Elicit any history of problems with sedation, prior surgery, or anesthesia. Perform a focused physical examination and obtain preprocedure laboratory testing if indicated. Review current medications and allergies.
Matching the facility and setting to the patient and procedure can be facilitated by using the American Society of Anesthesiologists (ASA) Physical Status Classification System to assign an ASA 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.
Implement and maintain a comprehensive infection control plan. Include active infection prevention surveillance and meticulous endoscopic reprocessing protocols. Emphasize ongoing education and evidence of competency for the staff involved in the plan.
Follow patient safety guidelines for moderate sedation (conscious sedation). Resources include the following:
- Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018, ASA.
- Statement of Granting Privileges for Administration of Moderate Sedation to Practitioners, ASA.
- Guidelines for Sedation and Anesthesia in GI Endoscopy, American Society of Gastrointestinal Endoscopy (ASGE).
- Guidelines for Safety in the Gastrointestinal Endoscopy Unit, ASGE.
Guidelines include monitoring the following throughout the procedure:
- Blood pressure.
- Ventilatory function by respiratory rate and capnography.
- Oxygen saturation by pulse oximetry.
- Heart rate and function by electrocardiogram.
- Depth of sedation/level of consciousness.
Monitoring equipment alarms should be audible throughout the procedure and not silenced.
The following are additional strategies for moderate sedation (conscious sedation):
- Have a designated individual trained to recognize and respond to airway complications (other than the practitioner performing the procedure) present to monitor the patient throughout the procedure.
- Maintain current ACLS certification (or PALS for pediatric patients) for all practitioners who supervise or administer moderate sedation.
- Adhere to the guidelines indicated for the particular sedative given (for example, propofol).
- Have age-appropriate emergency medications and equipment readily available for patients.
- Ensure appropriate postprocedure observation and monitoring.
Maintain tracking systems for test results and follow-up exams. Tracking test results is a critical patient safety function. Verify that your manual office system or your electronic health record (EHR) 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 EHR, 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 our expert patient safety risk managers at email@example.com or (800) 421-2368 for guidance and assistance in addressing any patient safety risk management concerns.
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 healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.