SaferCare Texas

Category: Patient Safety

Geriatrics and Patient Safety

By Dr. Kate Taylor, DNP, FNP-C, CPPS, FNAP

According to Uptodate.com, a widely used resource for healthcare professionals, 90,000 older adults die in the US as a result of injury. If you look up injuries and older adults on the general web, you find a lot of information about falls. Falls account for over half of the injuries of older adults. The Centers for Disease Control provides great detail about fall prevention. In this blog, you will get a few take-home tips addressing home safety with older adults.

Why do older adults get injured? Older adults have injuries due to physical disability, cognitive impairment, and increased risk of isolation or problems with communication. Older adults also depend more on others for everyday living activities, which puts them at higher risk for injury.

The finances of older adults continue to be affected. The poverty rate is declining over the past 50 years, but 10% of the elderly population still live at or below the poverty line. Blacks and Hispanics have a higher rate of poverty. Your healthcare provider needs to screen older adults with financial and social resources as it directly impacts health status and well-being.

Lastly, social isolation affects patient safety in the home as well. Older adults have increased social isolation due to functional limitations, and a lack of relatives, friends, or organizations. This can mean that older adults experience higher rates of depression, anxiety, disability, and self-rated poor health. Again, your healthcare provider needs to screen for these things.

There are abundant preventable home safety concerns. Let’s tackle a few of them today.

Each year, more than 90% of exposures reported to the local poison control centers occur in the home!

 

Source: AAPCC

 

Be prepared: Have a number available for text 797979

  • Practice safe storage habits: Medications, cleaning supplies, pesticides, button batteries, oils (such as tiki torch oil), personal care products, and chemicals
  • Read and follow labels and directions
  • Prepare food safely: Prepare, cook, and store

Choking is a big safety concern!

 

  • Eat foods with minimal choking risk such as ground meat, soup, Jello, applesauce, fish, and chocolate
  • Avoid foods with high choking risk such as steak, hard candy, popcorn, white bread, hot dogs, cake and milk, dry crackers, and chicken with bones

Carbon monoxide poisoning harms!

 

Source: EnPro Learning System

 

  • Never try to heat your home with your stove, oven, or grill since these can give off carbon monoxide.
  • Make sure there is a carbon monoxide detector near all bedrooms, and be sure to test and replace the battery twice a year.

Elder abuse is sad but true and occurs in 1 in 10 adults over the age of 60.

There are many types of abuse of older adults, but the most common is financial abuse that can occur from the following:

  • Financial neglect: The older adult’s bills such as utility, personal, or property taxes are not getting paid.
  • Financial exploitation: Misuse of finances by the use of intimidation or manipulation or without consent.
  • Healthcare fraud: The healthcare team charges too much, falsifies claims, or charges for care but does not provide the healthcare service.

Call the police or 911 if someone is in immediate, life-threatening danger or use the Eldercare Locator.

Source: Medicare.gov

The evidence is not robust on how to avoid home-based older adult injuries, except for those recommendations provided by the CDC on fall prevention. In my opinion, the best geriatric safety prevention plan is the Medicare Annual Wellness Visit (AWV). This is a paid visit covered by Medicare part B. Your provider will ask questions and conduct screening questionnaires, which in turn, provide you with a personalized health plan based on your health and risk factors.

Additional Resources: 

 

References:

Uptodate.com

CDC (Center for Disease Control, www.cdc.gov)

NIH (National Institutes of Health, www.nih.gov)

Poison Control (poison.org)

Medicare.gov

The Patient Safety and Quality Improvement Act of 2005: An Introduction

Author Spotlight:

Tracy Chamblee

Phd, APRN, PCNS-BC, CPPS, CPHQ, FCNS

Patient Safety & Quality Executive

In the U.S., healthcare is a highly regulated industry. From the Health Insurance Portability and Accountability Act (HIPAA) to the Patient Protection and Affordable Care Act (ACA), numerous laws, rules, regulations, etc., that are designed to protect public wellbeing.

Another key law to understand is the Patient Safety and Quality Improvement Act of 2005 ( ), which facilitates the confidential gathering of information about patient safety events. The PSQIA is an important pillar of the healthcare system and benefits providers, payers, and patients by reducing medical errors and improving patient care.

In response to the 1999 landmark Institute of Medicine report, To Err is Human: Building a Safer Health System, the PSQIA (Public Law 109-41) was signed on July 29, 2005. The overarching goal of the PSQIA is to improve patient safety by encouraging voluntary and confidential reporting of adverse events and unsafe conditions that may contribute to patient harm.

The PSQIA reflects the Federal Government’s commitment to fostering a patient safety culture. It outlines a framework to establish Patient Safety Organizations (PSOs) to collect, aggregate, and analyze confidential information reported by health care providers. PSOs can receive reports on quality and safety from any health care provider, including hospitals, doctor’s offices, nursing homes, or ambulatory surgery centers. According to the Agency for Healthcare Research and Quality (AHRQ), a part of the U.S. Department of Health and Human Services (HHS), the PSQIA “encourages a culture of safety in healthcare organizations.”

Prior to the PSQIA, fear of legal discovery restricted discussion of patient safety events and contributed to a lack of reporting and data to review and analyze. The PSQIA allows PSO’s to analyze event data to identify trends and other opportunities to improve the quality of patient care across all healthcare settings and provide recommendations to mitigate identified risks.

Today, providers fear that patient safety event reports could be used against them in medical malpractice cases or disciplinary proceedings. However, the PSQIA specifically addresses these fears by providing Federal legal privilege and confidentiality protections to 1)  all information that is assembled and reported by providers to a PSO or developed by a PSO  for the conduct of patient safety activities referred to as patient safety work product (PSWP) and 2) how the patient safety information is collected developed, analyzed, and maintained, referred as the patient safety evaluation system (PSES).

 I hope that anyone who reads this blog will take the time to understand the main message of the PSQIA. The healthcare workforce should be familiar with PSOs and the protections they provide, feel empowered to report safety concerns, and confident that those reports will remain strictly confidential.

Link to PSQIA