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Enhancing patient safety education for paramedics with the IHI Open School - Prehospital Research Support Site HomeWell-nighResources Links Forum Contact Us Menu HomeWell-nighResources Links Forum Contact Us Enhancing patient safety education for paramedics with the IHI Open School Enhancing patient safety education for paramedics with the IHI Open Schoolby Alan Batt. Last modified: 22/02/16 Print PDFThis vendible originally appeared in Canadian Paramedicine Introduction Every year, thousands of patients die and millions are harmed by medical superintendency provision (1). Paramedics superintendency for patients in dynamic, and challenging environments every day, which creates conditions that are platonic for mistakes to occur and for harm to be caused as a result. Remember, paramedics provide superintendency equal to the fundamental principles of medical values – the paramedic should first do no harm (non-maleficence – primum non nocere). Harm is specified by the World Health Organisation as “an outcome that negatively affects the patient’s health and/or quality of life, impairment of structure or function of the soul and/or any deleterious effect welling there from” (a). Harm (utilising this definition) includes disease transmission, injury (intentional or accidental), suffering, powerlessness and death. Patient safety in the prehospital setting A review by Bigham et al. in Canada demonstrated a paucity of research surrounding the issue of patient safety in the prehospital setting (2). This is unfortunately reflective of the level of research conducted into patient safety in the prehospital setting wideness the globe (3). In the hospital setting, an evidence-based estimate of patient harm unscientific that the true number of premature deaths associated with preventable harm to patients was unscientific at increasingly than 400,000 per year in the USA (4). With an wrongheaded event rate in Emergency Departments of over 52% documented in the Institute of Medicine’s To Err is Human: Building a Safer Health System Report in 1999 (1), it isn’t unreasonable to seem a similar, if not higher, rate of wrongheaded event occurrence in the prehospital setting (5). Unfortunately, the true number of patients harmed in the prehospital setting is not known. Ambulance services must take towardly steps to ensure the risk of harm occurring to patients is mitigated in so far as is reasonable. For instance, the hands off time during a resuscitation struggle may not be recorded, but has a serious impact on morbidity and mortality. Any interruption in chest compressions greater than 10 seconds compromises myocardial function (6) and thus should be considered an wrongheaded event, but unless the service in question utilizes CPR feedback and performs individual specimen review of every cardiac arrest, this wrongheaded event will never be identified. A number of authors have studied the skills of Paramedics to perform drug calculations, and the results have not been favourable. Hubble et al. found that of the 109 paramedics studied, the stereotype score achieved on an viewing of medication doses was 51% (SD 27.4) (7). IV infusion rate problems were correct in 68.8% of cases. Only 4.5% of percentage-based medication infusions were calculated correctly. They moreover found that scores were lower in paramedics who were qualified longer, and higher in those with college-level education. LeBlanc et al. found that paramedics scored lower in medication numbering verism during stressful simulated scenarios (8). Considering that many prehospital scenes and events that paramedics shepherd are stressful by their very nature, this zone requires remoter research to determine the weightier approaches to minimising risk to patients. A study by Lammers et al. revealed similar findings, where 46% of crews gave an incorrect dose of a medication during a paediatric simulation (9). These findings suggest a very real risk to patients. Implementation of clinical/incident reporting systems in the prehospital setting has been proven to indulge for identification of near-miss events, permitting for changes to be made to the system prior to harm stuff caused to a patient (10). A Canadian national reporting mechanism has been put in place where information on wrongheaded events is shared wideness the country. Incident reporting is however only the initial step in mitigating harm (11), and all incidents warrant some level of spare investigation. Outcomes from these investigations can be used to inform changes in educational approaches, clinical practices and organizational processes to modernize patient safety.Increasinglyimportantly, the priority of patient safety education needs to be reflected in the educational standards. The Canadian National Occupational Competency Profiles (b) (NOCP) identify that patient safety competencies are required in educational content, but the details of those competencies are not explicitly outlined. Groups involved in paramedic education in Canada do however recognise patient safety as a key competency for both seasoned practitioners and individuals new to the profession. Enhancing education The Institute for HealthcareResurgenceoffers a series of online patient safety and quality resurgence lessons that paramedic educators can hands incorporate into their paramedic curricula in order to enhance and supplement education on patient safety. These courses are self-ruling for students, residents, and professors of all health professions, and misogynist by subscription to health professionals. This ensures probity of wangle to patient safety education to all healthcare students. Educators can incorporate the materials from these courses, or alternatively require students to undertake the courses independently online on the IHI Open School website and then use classroom time to self-mastery group activities aligned to the learning objectives. In PS100: Introduction to Patient Safety, students learn why knowledge of patient safety is hair-trigger for everyone involved in health superintendency today. The lesson covers the human and financial toll of medical error and wrongheaded events. It moreover explains why vituperation is rarely an towardly or helpful response to error. Students will moreover be presented with four essential behaviours that any health superintendency professional can prefer right yonder to modernize the safety of patients. PS101: Fundamentals of Patient Safety provides an overview of the key concepts in the field of patient safety. The lesson details the relationship between error and harm, and how unsafe conditions and human error lead to harm utilising the ‘Swiss cheese’ model. When patient safety issues occur it is uncommon for any single event to be wholly responsible. It is far increasingly likely that a series of seemingly minor events all happen consecutively and/or meantime so that at one time, all the ‘holes’ line up and a serious event happens (c). Students will learn how to classify variegated types of unsafe acts that humans commit, including error, and how the types of unsafe acts relate to harm. Considering that human factors worth for virtually 60% of all errors (d), educating student paramedics and practicing paramedics on the impact of human factors on patient safety is paramount in reducing the risk to patients in the prehospital setting. PS102: Human Factors and Safety provides an introduction to the field of “human factors”: how to incorporate knowledge of human behaviour, expressly human frailty, in the diamond of unscratched systems. Students will explore specimen studies to analyse the human factors issues involved in health superintendency situations, and learn how to use human factors principles to diamond safer systems of superintendency – including the most constructive strategies to prevent errors and mitigate their effects. The impact that technology can have in reducing errors – or potentially creating new errors is moreover discussed.Constructiveteamwork and liaison is essential in reducing the risk to patients. In PS103: Teamwork and Communication, students are introduced to what makes an constructive team. Through specimen studies from health superintendency and elsewhere, they will analyse the effects of teamwork and liaison on safety.Liaisontools, such as briefings, SBAR, and the use of hair-trigger language are covered. This undertow can be a useful segue to introduction of prehospital handover tools such as IMIST-AMBO which are used at transition in superintendency (12) – when errors are most likely to occur. The goal of root rationalization wringer (RCA) is to learn from wrongheaded events and prevent them from happening in the future. This is the focus of PS104: RootRationalizationand Systems Analysis. The lessons in this undertow explain RCA in detail, using specimen studies and examples from both industry and health care. Conducting a root rationalization wringer is an platonic opportunity to have paramedic students work in groups, as these are normally conducted in group settings. The UK NHS National Patient Safety Agency for example, provide a RootRationalizationAnalysis Investigation Tool resource, as do the Joint Commission and several other organisations. Communicating with patients without wrongheaded events can be difficult for health superintendency professionals. PS105: Communicating with Patients afterWrongheadedEvents teaches students what to say to a patient, and how to say it, immediately without such an event occurs. Students will moreover imbricate how to construct an constructive restoration that can help restore the trust between the caregiver and the patient without an wrongheaded event. Within the prehospital setting, the culture of self-reporting is not well-established, mainly due to fears of disciplinary action, and a “blame culture” existing. A study by Jennings and Stella in 2010 identified seven themes as barriers to incident notification in an ambulance service in Australia (11). Burden of reporting Fear of disciplinary whoopee Fear of potential litigation Fear of breaches of confidentiality Fear of embarrassment Concern that ‘nothing would change’ plane if the incident was reported Lack of familiarity with process and impact of ‘blame culture’ The final patient safety course, PS106: Introduction to the Culture of Safety, encourages students to dismantle the ‘blame culture’ and instead foster a ‘culture of safety’ in their workplace. This is an environment that encourages people to speak up well-nigh safety concerns, makes it unscratched to talk well-nigh mistakes and errors, and encourages learning from these events. IHI Open SchoolInstallmentAn IHI Open SchoolInstallmentis a face-to-face, multi-disciplinary group that can be established amongst groups of student paramedics, and within EMS systems and paramedic services. Their purpose is to bring together healthcare professionals with a shared interest in learning well-nigh quality resurgence and improving superintendency for patients. This is an platonic forum in which to undertake patient safety discussions, collaborative exercises and IHI Open School courses. A installment allows students, sense and practicing paramedics to interact and help each other proceeds skills to modernize care, network with peers, connect with faculty, and succeed scholarly activities such as publishing and presenting patient safety and quality resurgence research. The installment can moreover provide an informal opportunity to train other healthcare staff and involve patients in the patient safety education process. The role of installment leaders is an platonic opportunity to encourage student paramedics to proceeds leadership experience, and to take a formal role in advocating for patient safety topics and initiatives in their institution. This leadership structure can take the form of a workbench structure, unappetizing structure, multi-campus model or a dual leadership model, details of which are outlined in the IHI Open SchoolInstallmentLeader Toolkit.Senseshould provide an newsy role to the installment and its leaders, encouraging its growth and development. Some suggested IHIInstallmentactivities are outlined below. Review IHI Open School online courses, or discuss specimen studies focused on prehospital patient safety issues. Invite guest speakers to share their knowledge, such as faculty, other healthcare professionals, patients, organisations, and safety/quality resurgence personnel. Join local patient safety and public health sensation campaigns. Organise patient safety clinical learning events such as simulation scenarios. Undertake patient education activities. For remoter information on establishing an IHI Open School Chapter, visit http://www.ihi.org/education/IHIOpenSchool/Chapters/Pages/default.aspx Disclaimer: The views and opinions expressed in this vendible are those of the tragedian and do not necessarily reflect the official policy or position of any employer or organisation. The tragedian is an IHI Open SchoolInstallmentleader (unpaid, voluntary position). Keywords – paramedic, safety, patient, harm, education, IHI Cite this vendible as: Alan Batt.(22/02/16) "Enhancing patient safety education for paramedics with the IHI Open School" in Prehospital Research Support Site, misogynist at http://prehospitalresearch.eu/?p=6171. Accessed 01/10/18. References (non-PubMed) a. World Health Organisation. Patient Safety [Internet]. Patient Safety. 2004.Misogynistfrom: http://www.who.int/patientsafety/about/en/ b. Paramedic Association of Canada. National Occupational Competency Profile for Paramedics. 2011. c. Carthey J, Clarke J. Implementing Human Factors in Healthcare [Internet]. London; 2010.Misogynistfrom: http://www.patientsafetyfirst.nhs.uk/ashx/Asset.ashx?path=/Intervention-support/Human Factors How-to Guide v1.2.pdf d. Van Cott H. Human errors, their causes, and reduction. In: Bogner M, editor. Human error in medicine. Hillsdale, NJ: Lawrence Erlbaum Associates; 1994. p. 21–2. References   1. PMID: 25077248. Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That’s increasingly than die from motor vehicle accidents, breast cancer, or AIDS–three causes that receive far increasingly public attention. Indeed, increasingly people die annually from medication errors th […]   2. Bigham BL1, Buick JE, Brooks SC, Morrison M, Shojania KG, Morrison LJ. Patient safety in emergency medical services: a systematic review of the literature. Prehosp Emerg Care. 2012 Jan-Mar;16(1):20-35. PMID: 22128905. Preventable harm from medical superintendency has been extensively documented in the inpatient setting. Emergency medical services (EMS) providers superintendency for patients in dynamic and challenging environments; prehospital emergency superintendency is a field that represents an zone of upper risk for errors and harm, but has r […]   3. O’Connor RE1, Slovis CM, Hunt RC, Pirrallo RG, Sayre MR. Eliminating errors in emergency medical services: realities and recommendations. Prehosp Emerg Care. 2002 Jan-Mar;6(1):107-13. PMID: 11789638. Errors in health superintendency can have serious consequences, not only for patients but for society as a whole, given the considerable national expenditures required to write these errors. Because of the number of patients treated and the vigilance of emergency situations, eliminating errors should be a prior […]   4. James JT1. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf. 2013 Sep;9(3):122-8. PMID: 23860193. Based on 1984 data ripened from reviews of medical records of patients treated in New York hospitals, the Institute of Medicine unscientific that up to 98,000 Americans die each year from medical errors. The understructure of this estimate is nearly 3 decades old; herein, an updated estimate is ripened from […]   5. Robinson K1. “To err is human…” patient safety initiatives for EMS. J Emerg Nurs. 2002 Feb;28(1):47-8. PMID: 11830735.   6. Yu T1, Weil MH, Tang W, Sun S, Klouche K, Povoas H, Bisera J.Wrongheadedoutcomes of interrupted precordial pinch during streamlined defibrillation. Circulation. 2002 Jul 16;106(3):368-72. PMID: 12119255. Current versions of streamlined external defibrillators (AEDs) require frequent stopping of chest pinch for rhythm analyses and topics charging. The present study was undertaken to evaluate the effects of these interruptions during the operation of AEDs. […]   7. Hubble MW1, Paschal KR, Sanders TA. Medication numbering skills of practicing paramedics. Prehosp Emerg Care. 2000 Jul-Sep;4(3):253-60. PMID: 10895922. To assess the medication numbering skills among a group of practicing paramedics, the types of computations they find most difficult, and the relationship between drug numbering skills and various demographic characteristics. […]   8. LeBlanc VR1, MacDonald RD, McArthur B, King K, Lepine T. Paramedic performance in gingerly drug dosages pursuit stressful scenarios in a human patient simulator. Prehosp Emerg Care. 2005 Oct-Dec;9(4):439-44. PMID: 16263679. Paramedics squatter many stressors in their work environment. Studies have shown that stress can have a negative effect on the psychological well-being of health professionals. However, there is little published research regarding the effects of stress on the cognitive skills necessary for optimal patie […]   9. Lammers R, Willoughby-Byrwa M, Fales W. Medication errors in prehospital management of simulated pediatric anaphylaxis. Prehosp Emerg Care. 2014 Apr-Jun;18(2):295-304. PMID: 24401046. Systematic evaluation of the performances of prehospital providers during very pediatric anaphylaxis cases has never been reported. Epinephrine medication errors in pediatric resuscitation are common, but the root causes of these errors are not fully understood. […]   10. Jennings PA1, Stella J. Barriers to incident notification in a regional prehospital setting. Emerg Med J. 2011 Jun;28(6):526-9. PMID: 20581408. The identification and monitoring of hair-trigger incidents or wrongheaded events and error reporting is a relatively new zone of study in the prehospital setting. In 2005, we commenced a prospective descriptive study of the implementation of aHair-triggerIncident Monitoring process in a rural/regional pre-ho […]   11. Frey B1, Schwappach D.Hair-triggerincident monitoring in paediatric and sultana hair-trigger care: from reporting to improved patient outcomes? Curr Opin Crit Care. 2010 Dec;16(6):649-53. PMID: 20930624.Hair-triggerincident reporting vacated does not necessarily modernize patient safety or plane patient outcomes. Substantial resurgence has been made by focusing on the remoter two steps of hair-trigger incident monitoring, that is, the wringer of hair-trigger incidents and implementation of system changes. The sy […]   12. Iedema R1, Ball C, Daly B, Young J, Green T, Middleton PM, Foster-Curry C, Jones M, Hoy S, Comerford D.Diamondand trial of a new ambulance-to-emergency department handover protocol: ‘IMIST-AMBO’. BMJ Qual Saf. 2012 Aug;21(8):627-33. PMID: 22626739. Information communicated by ambulance paramedics to Emergency Department (ED) staff during handover of patients has been found to be inconsistent and incomplete, and yet has major implications for patients’ subsequent hospital treatment and trajectory of care. […] The pursuit two tabs transpiration content below.BioLatest Posts Alan BattParamedic, educator, researcher Alan is a hair-trigger superintendency paramedic, paramedic educator and prehospital researcher, currently working virtually the world as an educator and researcher. He has previously worked and studied wideness Europe, North America and the Middle East. He holds a Graduate Certificate in IntensiveSuperintendencyParamedic Studies, and an MSc inHair-triggerCare. His main interests are in superintendency of the elderly, end-of-life care, patient safety, professionalism (including role and identity), and paramedic education. Latest posts by Alan Batt (see all)Self-rulingaccess: Resuscitation Today Vol 3 Issue 2 - 27/06/16Self-rulingCPD at the Emergency Services Show - 23/05/16Superintendencyat the Scene – Research for Ambulance Services - 17/05/16 Canadian Paramedicine Feb/Mar 2016 – OpenWangleIssue - 11/04/16 Eat, sleep and be healthy – a paramedic’s guide to healthier shift work - 10/04/16 Tags: education, paramedic, patient safety, safety Leave a Reply Cancel reply Search & Translate Translate Site: Search Site: Get weekly email updates! Cast Your Vote Does your training institution utilise simulation for prehospital education? No, but planning to No Yes, occassionally Yes, regularly View Results  Loading ... 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