SaferCare Texas

Author: safercaretexas

COPD and Covid-19: What to Know

The pandemic has changed our way of life, and forced us to establish a new “normal.” There is much dialogue around chronic health conditions at risk for severe illness from Covid-19. Most discussions emphasize diabetes, obesity, and auto-immune disorders, but few mention chronic obstructive pulmonary disease (COPD).

COPD refers to a group of diseases that cause airflow blockage and breathing-related problems. It includes emphysema and chronic bronchitis1. COPD causes airway inflammation, increased mucous production, and weakening of the parts of lungs where gas is exchanged2. We breathe in oxygen and breathe out carbon dioxide. In people with COPD, this process is impaired, producing lower than normal oxygen levels, and higher than normal carbon dioxide levels. As the disease progresses, this results in low energy and somnolence.

What Causes COPD?

 

Air pollutants in the home and workplace, genetic factors and respiratory infections play a role. The most common air pollutant is tobacco smoke-both first and second hand. People should avoid smoking tobacco or inhaling others’ smoke. Also, ensure proper ventilation in indoor spaces. Early COPD detection may slow disease progression.3 

According to the CDC, 140,000 Americans die each year from COPD and 75% of those deaths are attributed to smoking. It is estimated that 15 million currently have COPD, and as many as 12 million have yet to be diagnosed4. 

COPD Symptoms

Diagnosing COPD can be done in your doctor’s office with a special breathing apparatus called a spirometer. Please contact your doctor if you have experienced any of the following symptoms:

Commonly, people with COPD contract pneumonia and other respiratory infections, leading to frequent hospitalizations. These infections cause an increase in the severity of COPD, referred to as a COPD exacerbation. As the symptoms intensify, patients become less tolerant to activity; simple tasks such as walking to the bathroom, tying shoes, and in severe cases, eating expend so much energy that rest periods are necessary. The combination of symptoms can cause dizziness, lethargy, frequent shortness of breath, and others. 

Treatment for COPD exacerbations requiring hospitalizations include antibiotics for the infection, nebulized breathing treatments, and steroids. Steroids and breathing treatments reduce inflammation; however, steroids also reduce the body’s immune response to infection. This vicious cycle ends in death as noted earlier. 

 

How can people with COPD stay safe during the Pandemic?

People with COPD are at increased risk for severe illness from Covid-19. Both ailments affect the respiratory system. People with COPD have chronic difficulty breathing, and therefore should refrain from wearing masks, as per CDC guidelines5.  

To sustain optimal health with COPD, during the pandemic, please follow this advice5:

  1. Stay at home as much as possible. Look into delivery services, or enlist a trusted family member.
  2. Avoid sick people
  3.  Keep your hands clean
  4. Avoid touching your face, especially with unclean hands
  5.  Disinfect frequently used surfaces/objects
  6.  Reduce stress-contact family members via phone/virtual platforms
  7.  Continue your COPD maintenance plan as prescribed by your doctor
  8.     Make sure you maintain a supply of your prescribed medications
  9.    Telemedicine is an innovative way to see your doctor; call if your symptoms begin to worsen
  10.  Avoid COPD exacerbation triggers such as smoking/vaping or other environmental pollutants

References

1.     Aryal, S., Diaz-Guzman, E., & Mannino, D. M. (2014). Influence of sex on chronic obstructive pulmonary disease risk and treatment outcomes. International journal of chronic obstructive pulmonary disease, 9, 1145–1154. https://doi.org/10.2147/COPD.S54476

2. Centers for Disease Control and Prevention. Annual smoking-attributable mortality, years of potential life lost, and productivity losses — United States, 1997–2001. MMWR Morb Mortal Wkly Rep. 2005;54(250):625–628.

3.     Centers for Disease Control and Prevention. National Vital Statistics System detailed mortality data at Wonder Database website. http://wonder.cdc.gov. Accessed July 3, 2019.

4.     Centers for disease control. (2020, February 20). World Life Expectancy. Retrieved November 19, 2020, from https://www.worldlifeexpectancy.com/usa-cause-of-death-by-age-and-gender

5.     National Center for Immunization and Respiratory Diseases (NCIRD) Division of Diseases. (2020, November 12).

National Healthcare Quality Week: Quality does not exist without safety

It’s been a little over 2 months since I joined the HSC and SaferCare Texas family. Wow. Time flies, even during a pandemic. In my new role, I learn something new every day. One of my passions is healthcare quality.  Yes. You read correctly. I love all things quality and safety. 

This week is National Healthcare Quality week. In recognition of this week, the focus of this blog is on quality.  The term quality is often a catchall term. According to Merriam-Webster, definitions of quality include how good or bad something is, a characteristic or feature, high level of value or excellence, and the standard of something as measured against other things of a similar kind. 

In healthcare, when we speak of quality it typically has multiple meanings depending on one’s viewpoint.  My favorite definition of quality is the one that is put forth by the National Academy of Medicine, formerly the Institute of Medicine. Quality is care that is SAFE, TIMELY, EFFECTIVE, EFFICIENT, EQUITABLE and PATIENT-CENTERED (STEEEP).  In this definition, safety serves as the foundation of quality.  In short, quality does not exist without safety.  

The Quality Model

Quality model

Let’s go a little deeper into this.  Did you know that a healthcare organization’s culture impacts the quality of care provided? 

At SaferCare Texas, one of our priorities is providing education to help others make the connection between culture and safety. An organization’s culture is comprised of the collective beliefs, attitudes, perceptions, and values of its leaders and employees. This includes the beliefs, attitudes, perceptions, and values regarding safety. How would you describe your organization’s culture? Did you know that you can measure it?

Measuring Safety Culture

There are many safety culture surveys available for use. But the one that most people are familiar with is the Survey on Patient Safety (SOPS) developed by the Agency for Healthcare Research and Quality (AHRQ). This survey was originally designed for use in hospitals but has been modified for use in other healthcare settings such as primary care. The survey helps healthcare organizations assess safety culture within their own walls.  

Who takes the survey? 

All team members across the organization – providers, nurses, technicians, non-clinical staff, etc. participate. It is a tool to help an organization assess its safety culture strengths and weaknesses. This survey is not a one-and-done survey. In fact, most healthcare organizations ask team members to complete the survey every 12-24 months. By doing so, organizations can re-assess their safety culture, and determine which improvement interventions were successful, and what opportunities remain. Remember, improving safety culture takes years sometimes.

The survey results help identify local or system level quality improvement projects such as improving patient handoffs or improving communication between healthcare providers. These are just a few reasons why regularly assessing culture should be the norm. 

 

Example of Safety Culture

Let me share an example of safety culture from a different healthcare setting.  Medical Transport.  Specifically, flight transport.  Several years ago, a colleague of mine worked as a flight nurse. I was amazed to hear her share stories of safety time-outs that were done if someone on the team felt something was not quite right or referring a case to another agency due to team exhaustion.  It was obvious that the culture of safety was more advanced in this setting.  Later on, I learned that this was due to the connection of the air-based transport team with aviation. Today, more than a decade later, safety precautions like time-outs, are commonly practiced in many healthcare settings.

How to Approach Errors

If you are a leader, do you think your team members feel empowered to come to you with concerns about an unsafe situation or when a mistake occurs? Have you empowered your team to speak up without the fear of repercussions from their colleagues or administration?

How the organization approaches errors is another aspect of organizational culture.  Healthcare has a long tradition of holding individuals accountable for errors or mishaps that happen to patients under their care.  Let’s face it – people are fallible. People make mistakes. Mistakes can contribute to harm to a patient or another team member. However, punishing an individual for a mistake does not solve the problem. One of my favorite quotes on this topic is this:


The single greatest impediment to error prevention in the medical industry is “that we punish people for making mistakes.” 

Dr. Lucian Leape, Harvard School of Public Health

Just or Fair Culture.

In healthcare, people function within systems and use processes designed and put into place by the organization.  A person may make a mistake, but the system or process that they were following is also an issue.  The reality is — there is no such thing as a perfect system, a perfect process, or a perfect human.  Perfection does not exist.  So, when we punish a person for making a mistake and we fail to address the system or process issue, the problem goes unchecked and patients or team members will continue to suffer harm. 

To address this, organizational leaders must shift the focus from errors and outcomes to system design and management of the behavioral choices of team members.  This shift is known as Just or Fair Culture.  Yes. Another aspect of organizational culture.  The concept of Just or Fair Culture is related to systems thinking which emphasizes that mistakes are generally a product of faulty organizational cultures, rather than solely due to the person or persons directly involved. 

Consider the following situation:   

 A nurse working in a busy clinic inadvertently takes the wrong vial of intravenous medication from the dispensing system and administers the drug to a patient. Subsequently, the patient experiences a cardiac arrest.  What is the best way to approach the nurse and investigate the situation?

The investigation revealed that 2 vials of entirely different medications looked alike in shape, size, color, and print and were located right next to each other in the medication dispensing system. This is an accident waiting to happen and it did.  Human error was involved, but the nurse should be consoled and supported by her leader rather than punished. Think about it. In this scenario, the system of medication storage is faulty and in need of improvement. Working within this system, the nurse was set up to fail.  The fix for this issue is improving medication storage.   

medicine

A just culture creates balanced accountability. Creating the need for open and honest reporting with the end goal of cultivating a culture that is focused on continuous learning.  See the image below for a visual.

For more information on Just Culture, please see https://www.justculture.com. 

Finally, did you know that the concept of safety culture originated outside healthcare?   Industries such as aviation and nuclear power plants are known as high reliability organizations (HROs) because they consistently minimize adverse events despite carrying out complex and hazardous work. HROs maintain a commitment to safety at all levels, from frontline providers to managers and executives. This commitment establishes a culture of safety. Key features of HROs include:  

  • acknowledgment of the high-risk nature of an organization’s activities and the determination to achieve consistently safe operations.
  • a blame-free environment where individuals are able to report errors or near misses without fear of reprimand or punishment.
  • encouragement of collaboration across ranks and disciplines to seek solutions to patient safety problems.
  • organizational commitment of resources to address safety concerns.

When you think about it, quality is everyone’s responsibility every day. Quality in healthcare means providing the care the patient needs when the patient needs it, in an affordable, safe, effective manner.  

I encourage you to take some time this week to recognize someone you work with for their efforts to ensure patients receive safe, timely, efficient, effective, equitable and patient-centered care.  

For more information on healthcare quality, register for our upcoming panel discussion on improving healthcare quality through leadership education and making the case for quality and safety embedded in academic programs.  

Author: Tracy Chamblee, PHD, APRN, PCNS-BC, CPHQ, CPPS

Clinical Executive at saferCare Texas

Language brokers: When children control the conversation

hispanic family

As the demographics of the U.S. population change, immigration stands out as a leading factor in this transformation.  Children living in immigrant households represent one group that deserves particular attention in this demographic shift.  A child is said to reside in an immigrant household if he or she is an immigrant or the son or daughter of immigrant parents.  Children in immigrant families make up approximately 25% of the child population in the U.S.1 Of this group, more than 50% are of Hispanic origin.1 For these children, their immigration status or their parents’ status shapes their childhood experience.

One of the most exclusive experiences of an immigrant child’s life is the concept of language brokering.  The idea of language brokering involves the interactions that take place when children in immigrant households have to act as translators for their parents, friends, or relatives.2 These interactions go beyond translating information from an individual’s primary language to English or vice versa. Language brokers assume adult decision-making duties despite being unable to understand the information they are asked to translate. In these scenarios, the language broker(child) is the primary communicator; without them, interaction would be limited/non-existent for both parties.

When children bear the role of language brokers, their responsibilities expand beyond translating everyday exchanges.  A language broker’s duties may include translating phone and in-person conversations, school forms, utility bills, employment applications, and legal documents.  Additionally, they may find themselves in a situation where they may have to translate in a hospital or other medical settings.  This broad range of interactions produces a combination of positive and negative outcomes for them.

Language brokers report an increase in self-esteem, improved academic performance, and feeling accomplished when they translate for others.3,4 But the process is also associated with adverse consequences.  Amongst Hispanic language brokers, the process has been linked to feelings of burden, stress, depression, and alcohol and illicit drug use.5,6,7

In addition to the impact on the child, one must consider the ramifications that language brokering may have when it involves sensitive topics such as medical diagnoses and procedures. Patients with limited English proficiency (LEP) are more likely to receive poor quality treatment, experience more harm, delay seeking medical attention, and report more dissatisfaction with the medical system due to language and communication barriers.8 Thus, it is essential for healthcare systems to provide interpretation services and to make these services accessible to all patients with LEP.

October marks Hispanic Heritage Month and Health Literacy Month. The intersection of these two key events is an ideal time to emphasize that although being a language broker can be an asset, the responsibility of translating, especially in a medical setting, should not fall on a child. In a time when health inequities are at the forefront due to the COVID-19 pandemic, it is worth noting that Hispanics account for approximately 63% of the LEP population.9 Patients with LEP have the right to obtain information and receive care in a linguistic and culturally-sensitive manner. However, a child should not be the person telling his or her mom, “mamá, dice el doctor que te va a operar – mom, the doctor says you’re going to need surgery.”

For additional information on these topics, visit our resources page or feel free to contact us. 

Author

Clara Ramirez, MPH, CPH 

Project Coordinator, Asthma 411

Sources

1. Child Trends. (2018). Immigrant children. https://www.childtrends.org/indicators

/immigrant-children#:~:text=From%201994%20to%202017%2C%20the,and%202.9

%20million%2C%20respectively

2. Tse, L. (1995). Language brokering among latino adolescents: Prevalence, attitudes, and 

school performance. Hispanic Journal of Behavioral Sciences, 17(2), 180-193.

doi:10.1177/07399863950172003

3. Dorner, L., Orellana, M., & Li‐Grining, C. (2007). “I helped my mom,” and it helped me:

            Translating the skills of language brokers into improved standardized test

            scores. American Journal of Education, 113(3), 451-478. doi:10.1086/512740

4. Weisskirch, R. S. (2006). Emotional aspects of language brokering among Mexican American 

            adults. Journal of Multilingual and Multicultural Development, 27(4), 332-343. doi: 

            10.2167/jmmd421.1

5. Kam, J. A., & Lazarevic, V. (2014). The stressful (and not so stressful) nature of language 

            brokering: Identifying when brokering functions as a cultural stressor for latino 

            immigrant children in early adolescence. Journal of Youth and Adolescence, 43(12), 

            1994-2011. doi:10.1007/s10964-013-0061-z

6. Love, J. A., & Buriel, R. (2007). Language brokering, autonomy, parent-child bonding, 

            biculturalism, and depression. Hispanic Journal of Behavioral Sciences, 29(4), 472-491. 

            doi:10.1177/0739986307307229        

7. Weisskirch, R. S. (2013). Family relationships, self-esteem, and self-efficacy among language 

brokering mexican american emerging adults. Journal of Child and Family Studies, 22(8), 1147-1155. doi:10.1007/s10826-012-9678-x

8. Al Shamsi, H., Almutairi, A. G., Al Mashrafi, S., & Al Kalbani, T. (2020). Implications of

            Language Barriers for Healthcare: A Systematic Review. Oman medical journal, 35(2),

e122.doi:10.5001/omj.2020.40

9. Zong, J., & Batalova, J. (2015, July 8). The Limited English Proficient Population in the

United States in 2013. Migration Policy Institute. https://www.migrationpolicy.org/

article/ limited-english-proficient-population-

Sepsis: A Deadly Condition

Sepsis month

During this tumultuous 2020, Covid-19 has captured most headlines and news reports. Everywhere you look there is heavily promoted mitigation strategies such as mask wearing, social distancing, and hand washing on how to reduce transmission of Covid-19. When a new disease infects 6.4 million Americans with over 200,000 associated deaths, one understands why it is a popular topic.1

 

Although Covid-19 has consumed our lives the last 7 months, it doesn’t mean we get to ignore other health issues. For instance, sepsis affects 1.7 million Americans each year and kills 270,000.  Moreover, one in three hospital deaths is sepsis related. Are there equal prevention schemes in place to avoid the pitfalls of sepsis? The answer is yes. 

With September being Sepsis Awareness Month, the CDC is working to raise awareness of sepsis, prevent it, and improve early detection and treatment, and we wanted to join them in this movement. Read below for more information about sepsis. 

What Is Sepsis? 

Unlike Covid-19, sepsis is not a disease; rather it is the body’s response to an infection. When the body responds to a disease, it attempts to preserve life through a chain of events we cannot see. Left untreated, these events can lead to tissue damage, organ failure and death. Sepsis is a life-threatening medical emergency.  Sepsis happens when an infection you already have —in your skin, lungs, urinary tract, or somewhere else—triggers a chain reaction throughout your body. Researchers agree that death and life-limiting conditions is preventable with early sepsis identification and prompt treatment.2

Sepsis Symptoms

Our bodies respond to infections in a variety of ways. One of the most common ways is with fever. Despite the temperature reading, fever associated with chills or feelings of extreme cold are potential signs of sepsis. Other symptoms include an elevated heart rate, shortness of breath, or clammy/sweaty skin1. A trusted family member may notice you are confused, disoriented, or perhaps you have extreme pain or discomfort. Any of these symptoms may indicate sepsis and should trigger an immediate evaluation by a healthcare professional. Remember, sepsis is a medical emergency!

Sepsis Symptoms

Who Is At Risk?

  • People with chronic health conditions
  • People over 65 or younger than 1
  • People with weak immune systems
  • People with long-term blood access lines such as dialysis catheters
  • People unable to take care of their personal needs
  • People who have had sepsis before 

How to Prevent Sepsis

Prevention is always the best treatment plan. Especially during the Covid-19 pandemic, make sure to get your flu vaccine and stay up to date on all other vaccines. Be sure to wash your hands, wrists, nails, and fingers on all sides for 20 seconds after using the restroom, eating, taking out the trash, petting animals, or any other time your hands contact dirty surfaces. Even though we cannot see germs, they are all around us; we unknowingly spread germs to others with our hands. If you have chronic conditions like diabetes, heart failure, or lung disease, make sure you follow your healthcare provider’s disease management instructions and report anything unusual. Lastly, know the signs of sepsis and act on them.3

Author: John Sims, MSN, RN, CNL, Director of SaferCare Texas

References

1. Centers for Disease Control. (2020, August 28). Get ahead of sepsis – know the risks. spot the signs. act fast. | patient safety | cdc. https://www.cdc.gov/patientsafety/features/get-ahead-of-sepsis.html. Retrieved September 18, 2020, from https://www.cdc.gov/patientsafety/features/get-ahead-of-sepsis.html

 

2. Kim, H., & Park, S. (2019). Sepsis: Early recognition and optimized treatment. Tuberculosis and Respiratory Diseases, 82(1), 6. Retrieved September 11, 2020, from https://doi.org/10.4046/trd.2018.0041

 

3.Sepsis is a medical emergency. time matters. (2020, August 27). Centers for Disease Control and Prevention. https://www.cdc.gov/sepsis/what-is-sepsis.html

Health Worker Safety: A Priority for Patient Safety

Patient Safety is a global priority. In recognition of this, the World Health Organization (WHO) established World Patient Safety Day in May 2019 as an annual event.  The objectives of this initiative are: 1) increase public awareness and engagement, 2) enhance global understanding, and 3) spur global solidarity and action to promote patient safety.

The origin of this day is firmly grounded in the fundamental principle of medicine – First, do no harm.

Patient Safety is a relatively young discipline that emerged on the heels of the Institute of Medicine (IOM) report, To Err is Human, which reported 44-98,000 deaths per year were attributed to medical error — adverse events.  Initially, this work was focused on care in the hospital setting. Twenty years later, we now recognize that harm occurs in ALL health care settings, and we also know that most of the harm associated with adverse events is preventable.

It is also reported in the literature, that medical errors in the U.S. are considered the 3rd leading cause of death at 440,000 per year, behind heart disease and cancer. 

Since these reports, we have made great strides to improve patient safety in the U.S., but we still have opportunities to improve.  The focus on patient safety is moving into other health care settings like ambulatory care.  This is the new face of patient safety.

Patient Safety Day 2020

 

This year, the COVID-19 pandemic has brought to light existing issues among health care professionals related to burnout and mental health issues, such as depression and anxiety.  This is a global problem. Issues such as health care associated infections, workplace violence, bullying and harassment, stigma, psychological and emotional disturbances, illness, and even death. Working in a stressful environment increases the likelihood of errors which can lead to patient harm or harm to a fellow team member. 

At SaferCare Texas, our mission is to eliminate preventable harm. We do this through education, advocacy, and by challenging traditional thinking as it relates to quality and safety in any health care setting. This year we want to join World Patient Safety Day 2020 and bring awareness to health care worker safety. This year’s theme is:

Health Worker Safety: A Priority for Patient Safety

You might be thinking, how does health care worker safety impact patient safety?  The truth is if health care workers do not feel safe in their work environment, how can we expect them to keep patients safe. 

Going back a little further, let’s define safety. In my humble opinion, the best definition of safety is: a dynamic non-event.  Think about it.  In order to keep everyone safe, the organizational culture must prioritize safety in the workplace.  To do this, leaders must set the tone and role model that everyone safe is a priority.  Safety is the foundation of the organizational culture.

This year’s World Patient Safety Day slogan is:  Safe healthcare workers, Safe patients. It is very timely. Health care has a long history of being a stressful environment.  I have worked in health care for more than 30 years and have experienced it first-hand.  Let’s face it – we are all humans. We are fallible, and we make mistakes.  However, working in a stressful environment increases the likelihood of errors that can result in harm to a patient or a team member. 

The ongoing experience of health care workers across the globe during this pandemic is a great example – lack of personal protective equipment (PPE).  Imagine working in an environment and not feeling safe.  This is a real issue impacting health care workers every day and can lead to mental health issues such as depression, anxiety, even suicide.   It’s a real problem.  We need to empower health care workers to speak up and voice their concerns about working conditions.

Another important workplace issue is violence, physical assault by patients, caregivers or even team members as well as verbal abuse, harassment, and bullying.  Yes, this happens often in health care and is not acceptable.  Workplace violence also contributes to the mental health issues described above.

Globally, an estimated 264 million people suffer from depression. Depression is one of the leading causes of disability.  And many people who suffer from depression also suffer with symptoms of anxiety.  Mental health issues such as this have a significant economic impact related to lost productivity.  The global estimated cost is $1 trillion/year.  And, in many cases, these issues are preventable.  

This is why psychological safety is so important.  If you are not familiar with the term, psychological safety in the workplace is the belief that you won’t be punished when you make a mistake.  Yes, when you make a mistake. Acknowledging your humanness is the first step.  Because psychological safety in the workplace is so important, the WHO also issued the following Call to Action:  

Speak Up for Healthcare Worker Safety

At SaferCare Texas, we challenge you to be empowered and to empower your colleagues to speak up, let someone know if you do not feel safe in your work environment.  In addition to this, the Institute for Healthcare Improvement (IHI) recently launched a campaign on psychological safety called “Your Psychological Personal Protective Equipment (PPE).  This campaign outlines strategies that both individuals and leaders can do to promote mental health and wellbeing.

You can find more information about IHI’s psychological safety campaign here. 

Author: Tracy Chamblee, PHD, APRN, PCNS-BC, CPHQ, CPPS – Clinical Executive at SaferCare Texas