- Email: [email protected]
The LVHHN Patient Safety Video: Patients as Partners in Safe Care Delivery
Joint Commission
Journal on Quality and Safety
John M. Eisenberg Patient Safety Awards
The LVHHN Patient Safety Video:
photo courtesy of Imijination Photography; www.imijphoto.com
Patients as Partners in Safe Care Delivery
Elliot Sussman, M.D. ehigh Valley Hospital and Health Network (LVHHN) is an 800-bed, three-site academic community hospital located in Pennsylvania’s Lehigh Valley. Designated as a National Magnet Hospital, it is a member of the Council of Teaching Hospitals and serves as a chief clinical campus for Pennsylvania State University’s College of Medicine. The LVHHN hospitals function as both a provider of primary care and a major tertiary care referral center. The active medical staff of more than 850 includes both full-time and private-practice physicians, representing more than 50 specialties. LVHHN’s vision is to become a premier academic community hospital. To bring this vision to fruition, LVHHN differentiates itself through clinical innovation
L
640
December 2003
Robin Anthony, M.H.A. Francine Miranda, R.N., B.S.N. Zubina Mawji, M.D., M.P.H. Rosemary Cerimele, R.N., M.H.A. Ruth Davis, R.N., M.B.A. Susan Lawrence, M.S.
Article-at-a-Glance Background: In fall 2002, Lehigh Valley Hospital and Health Network (LVHHN), an 800-bed, three-site academic community hospital, embarked on an initiative to produce an educational patient safety video. Implementing the Initiative: The video addresses six topics relevant to optimum patient safety: treatment plan, medication safety, falls, surgical site identification, hand washing, and discharge planning. Each segment outlines strategies that patients may employ or observations they should make to improve patient safety. Results: Analysis of the patient survey data, which were based on 217 surveys, indicated that patients felt more comfortable talking with their health care workers about questions or concerns after viewing the video and that they rated their knowledge of patient safety higher. Patients generally rated the six sections as helpful. Discussion: The video was intended to become an important step in the preadmission process. Releasing the video to patients and staff helped to normalize some practices that initially were not comfortable for staff (repeatedly asking an inpatient for his or her name and date of birth before administering all medications) or patients (inquiring whether a staff member has washed his or her hands). Additional methods were in development to share the video with current and prospective patients and assess its impact. The LVHHN patient safety council plans to share the video with the community at large.
Volume 29 Number 12
Copyright 2003 Joint Commission on Accreditation of Healthcare Organizations
Joint Commission
Journal on Quality and Safety
(program development and care advancement) and service excellence. To communicate this concept, a tricycle analogy is frequently used. The “front wheel” of the tricycle, which drives the organization, is patient care. However, firmly supporting, guiding, and balancing the “patient care wheel” are two back wheels: research and education. LVHHN leadership’s commitment to quality and patient safety is evidenced by its prompt response to the release of the Institute of Medicine report To Err Is Human in early 2000.1 In fall 2000, while national debate ensued about the true incidence of errors and attributed mortality, LVHHN embarked on a multidisciplinary systems approach to reduce medical errors and improve the delivery of care. The initiative, titled Primum Non Nocere (PNN), or First, Do No Harm, is composed of 15 focused, practical projects that stress delivery of costeffective medical care and reduction of preventable adverse events through improved communication, process redesign, evidence-based protocol use, and reduced variability.2 In March 2002 Pennsylvania’s Medical Care Availability and Reduction of Error (MCARE) Act, or Act 13, was enacted.3 Pennsylvania is currently the only state that legislates active engagement of licensed health care workers in the responsibility of patient safety. The act’s other mandates include the following: ■ Designation of a patient safety officer ■ Establishment of a patient safety committee ■ Establishment of a system for an organization’s health care workers to report serious events and incidents ■ Prohibition of any retaliatory action against a health care worker for reporting a serious event or incident in accordance with the act of December 12, 1986 (P.L. 1559, No. 169), known as the Whistleblower Law ■ Provision for written notification of serious events to patients In reflecting on both LVHHN’s internal quality improvement efforts and external regulatory requirements, it became evident to the leadership that to be truly successful in our efforts to reduce patient harm and improve patient safety, we needed to actively engage the patient and have him or her directly participate in making health care safer.4 Although the “human factor” will always be present in care delivery, the likelihood of error
December 2003
reduction increases as more checks and balances are created. LVHHN believes that educating consumers to participate in safety prevention during care delivery is essential. After a search of available educational training videos, it became evident that none were available that met our needs. Therefore, in fall 2002, the patient safety staff, led by the patient safety officer [F.M.], and with the endorsement of the patient safety council (which is composed of hospital staff, physicians, a board member, and at-large community members), embarked on an initiative to produce an educational patient safety video. We believe that the video is innovative because there was no other similar product available at the time, either regionally or nationally. Although some printed materials were available, such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Speak Up brochure,5 available videos had been developed for the purpose of staff education rather than for education of patients and solicitation of their collaboration in ensuring safe care delivery. Therefore, it has filled a void in the patient educational materials market. The video’s primary objective was to raise the awareness of patients and their families about patient safety. The video was designed to encourage the patient to work collaboratively with the health care team while emphasizing LVHHN’s compassionate approach to care delivery. As a corollary to the primary objective, the video was also to serve as a vehicle for providing consistent and high-quality education to LVHHN staff and physicians about patient safety. Patient safety education, as required by Pennsylvania MCARE/Act 13,3 had previously been provided to staff through an internally developed Web-based education module, department in-services, and a patient safety pocket guide. However, the video would serve as a valuable mechanism by which to develop staff awareness of the specific information being provided to patients and complement the educational strategies previously used. This article describes the development and impact assessment of LVHHN’s Patient Safety Video, for which LVHHN is the recipient of the 2003 John M. Eisenberg Patient Safety Award for Advocacy.
Volume 29 Number 12
Copyright 2003 Joint Commission on Accreditation of Healthcare Organizations
641
Joint Commission
Journal on Quality and Safety
Implementing the Initiative Content Development The LVHHN Patient Safety Video (running time 11 minutes, 40 seconds) addresses six topics relevant to optimum patient safety: 1. Treatment plan 2. Medication safety 3. Falls 4. Surgical site identification 5. Hand washing 6. Discharge planning Each topic segment outlines strategies that patients may employ or observations that they should make to improve patient safety as collaborative members of the health care team. The content of each section was developed after detailed consultation with LVHHN topic experts. The medication errors prevention and fall prevention teams, infection control staff, and the JCAHO executive committee each provided input into specific sections. Selected board members and a few community members-at-large were also approached during the video’s development to review the script and initial footage. These stakeholders contributed valuable insights and suggestions that were addressed in the final product. The video’s content is consistent with patient safety recommendations and guidance published by the Institute for Safe Medication Practices, JCAHO, and the Centers for Disease Control and Prevention, among other organizations. For example, in the medication safety portion, the video highlights that two patient identifiers, such as name and date of birth, will be used before administering any medication to a patient; this approach is consistent with the 2003 JCAHO National Patient Safety Goals.6
Video Production After content was developed, a local production company was approached for production assistance. Through the production company, a professional script was drafted. The script was reviewed and edited by internal stakeholders, including the patient safety council. Production costs were a significant concern because development of a professional video typically costs $500–$1,000 per minute. Several strategies were employed to control costs. A grant was obtained through the LVHNN Friends of Nursing program; and
642
December 2003
a PNN project, Patient-Controlled Analgesia Error Reduction Committee, donated funds it received as a result of cost saving achieved through LVHHN’s Working Wonders program. 2 In addition, use of employees and medical staff as actors and some cost sharing with the production company further reduced overhead. The video was filmed on location at Lehigh Valley Hospital, Cedar Crest and I-78 campus, in Allentown, Pennsylvania. To make the transitions between the six content topics, a professional narrator was filmed in the hospital’s main lobby. LVHHN’s chief executive officer provided a personal introduction to LVHHN and the video’s content, as well as the importance of provider and patient partnership in ensuring safety, at the beginning of the film.
Roll-Out When the video was formally released in May 2003, it was available for viewing in multiple venues, including physician offices, preadmission areas, and inpatient rooms. The video was first shown during a two-week period to a convenience sample of 109 patients in ambulatory surgical areas, at either the preadmission testing visit or on the day of surgery. In a community outreach effort, the video was presented to a group of local high school and college students in May–June 2003. The video currently runs eight times per day on the LVHHN patient education channel, which is accessible from any patient room’s television. A five-question survey (Figure 1, page 643) was administered to all students and patients who viewed the video. Questions were scored on a five-point Likert scale; the higher the score, the greater the benefit the video provided to the viewer.
Results Patient Surveys Analysis of the patient survey data, which were based on 217 surveys administered from May through August 2003 (Figure 1), indicated that patients felt more comfortable talking with their health care workers about questions or concerns after compared with before viewing the video (mean score = 4.47 [standard deviation, 0.617] versus 4.09 [0.760], p < .001). After viewing the video, patients
Volume 29 Number 12
Copyright 2003 Joint Commission on Accreditation of Healthcare Organizations
Joint Commission
Journal on Quality and Safety
Patient Safety at Lehigh Valley Hospital and Health Network Video Evaluation
Figure 1. This five-question survey was administered to all students and patients who viewed the video; 1 = very poor; 2 = poor; 3 = fair; 4 = good; and 5 = very good.
rated their knowledge of patient safety higher (mean score = 4.48 [0.640] versus 3.93 [0.764], p < .001). We also asked patients to evaluate the helpfulness of each of the video’s six major sections. The mean score was 4.25, with a range of 4.20 to 4.32 for each of the individual sections (Figure 1). These data suggest that the video was meeting our objectives.
Student Surveys More than 350 high school and college students viewed the video as part of their health studies curriculum from May 25 to June 6, 2003. Analysis of the student survey responses, which were drawn from 288 surveys, indicated that after viewing the video, students felt more comfortable talking with their health care workers about questions or concerns (mean score = 4.08 [standard deviation, 0.725] versus 3.34 [0.831], p < .001), and they rated their knowledge of patient safety higher (mean score = 4.16 [standard deviation, 0.780] versus 3.19 [0.913], p < 001). Student evaluations of the helpfulness of each of the six major sections of the video yielded a mean score
December 2003
for all the sections of 3.84 (range, 3.71–3.96 for each of the individual sections). The mean score for the student population was lower than that of the patient population (p < 0.001.)
Discussion We recognized that true success in efforts to reduce patient harm and improve patient safety required active engagement from the patient. Numerous studies have documented that educated, involved patients are more likely to comply with their treatment regimens than are other patients. Compliance then leads to better patient outcomes, safer health care, and decreased health care costs.7,8 In addition, patients empowered to advocate for themselves and for safer care delivery systems add significant momentum to the health care industry’s efforts to improve patient safety.4 A primary objective of the video project was to create a mechanism to communicate with and educate patients. Typically, adult learners retain more information when they are able to recive education in comfortable
Volume 29 Number 12
Copyright 2003 Joint Commission on Accreditation of Healthcare Organizations
643
Joint Commission
Journal on Quality and Safety
Stoplight Reminder Cards
Figure 2. The laminated “stoplight card” is placed on the communication boards in each patient room to encourage patients and families to view the video on the patient education channel.
surroundings and proceed through the information at their own pace. Hence, the video is intended to become an important step in our preadmission process; patients will view the video before a planned admission—either in their physicians’ offices, during the preadmission testing process, or on the day of surgery. Patients are less apprehensive about their hospitalization when they are informed and encouraged to participate.7,8 Ease of access facilitates provision of education. Despite the recency of the distribution of the patient safety video, its impact has already been demonstrated, both quantitatively and qualitatively. Through actual illustration, it reinforces important safety topics, regulatory and accreditation requirements, and, importantly, staff performance expectations. Releasing the video to patients and staff has helped to normalize some practices that initially were not particularly comfortable for staff (for example, repeatedly asking an inpatient for his or her name and date of birth before administering all medications) or patients (for example, inquiring whether a staff member has washed his or her hands). Furthermore, engagement of employees in the video’s production has enhanced employees’ commitment to and involvement in patient safety initiatives. Further evaluation of the video may include formally assessing its impact on staff knowledge as well as on medical/medication errors, patient falls, and nosocomial infection rates. Despite the success with the video’s initial development, production, roll-out, health education, and
644
December 2003
outcomes, challenges in this process should be acknowledged. Specific project barriers that have been encountered include efficiently distributing the video to physician practices, marketing the video to community groups and consumers, collecting survey cards from patients viewing at physician practices or the in-house patient education channel, and managing the unanticipated volume of interested organizations and companies seeking to purchase or replicate the video. In addition, informing inpatients, specifically those with unplanned admissions, has become challenging. To address this barrier, patient reminder cards will be displayed in patient care areas and patient rooms. These laminated “stoplight cards” (Figure 2, left) will be placed on the communication boards in each patient room to encourage patients and families to view the video on the patient education channel. We are continuing to develop methods for sharing the video with current and prospective patients and assessing its impact. Additional arrangements have been made to use commercially available inpatient, ambulatory surgery, and obstetrical surveys to assess the video’s impact through the inclusion of questions about whether (1) staff confirmed with the patient about to undergo surgery or a procedure “the area of the body where the surgery/procedure would be” and (2) the patient felt comfortable that his or her identity was verified “before receiving medications, having blood drawn, or being taken for a test.” Data collection will begin with distribution of these surveys in October 2003. The patient safety council has committed to sharing the video not only with LVHNN’s internal (staff) and external (patients) customers but also with its community at large. The impact of medical errors has received substantial press and is a significant concern for the general public. Recognizing community needs, LVHHN now has copies of the VHS/DVD video available for distribution, in both the English and Spanish languages. Future plans include VHS/DVD availability in two additional formats: English language with subtitles and Spanish language with subtitles. The patient safety council’s intent is to have the video available for hospital/physician office settings, community libraries, community functions, colleges, universities, senior citizen groups, nursing programs, health bureaus, and any other organization that
Volume 29 Number 12
Copyright 2003 Joint Commission on Accreditation of Healthcare Organizations
Joint Commission
Journal on Quality and Safety
may request information about patient safety. The Allentown Public Library, which serves a large urban population, has added the video to its collection. A complimentary copy of the video is available to LVHHN patients and its medical staff. Community groups that wish to offer the video as part of their programming may have an LVHHN representative facilitate a showing of the video. In addition, plans to market the video on national and regional levels, with options for customization, are being finalized.
Conclusion LVHHN is committed to the Patient Safety Video in the belief that prevention of even a single error is well worth the time and resource commitment. Patient education and engagement, as advocated in the video, are critical to the advancement of patient safety. We expect that the video will reduce medical and medication errors, patient falls, and nosocomial infection rates and will increase the patient’s/family’s understanding of
what to anticipate and how to collaboratively participate during their hospitalization. J The authors acknowledge the efforts and dedication of Kelly Beauchamps, Darlene Hamershock, Kathryn Stephanoff, Kathryn Taylor, and Broadcast Images. The authors also extend thanks to the LVHHN patient safety council for their guidance and review of the Patient Safety Video, and to Allentown Central Catholic High School and Muhlenberg College for utilizing the video in their health curricula.
Robin Anthony, M.H.A., C.P.H.Q., R.H.I.A., is JCAHO Coordinator, Lehigh Valley Hospital and Health Network, Allentown, Pennsylvania. Francine Miranda, R.N., B.S.N., H.R.M., is Director, Risk Management/Patient Safety Officer. Zubina Mawji, M.D., M.P.H., is Senior Vice President, Quality and Care Management, and a member of the Joint Commission Journal on Quality and Safety’s Editorial Advisory Board. Ruth Davis, R.N., M.B.A., is Director, Care Management. Susan Lawrence, M.S., C.P.H.Q., is Administrator, Quality and Case Management. Rosemary Cerimele, R.N., M.H.A., H.R.M., is Assistant Risk Manager. Please address correspondence to Robin Anthony, M.H.A., C.P.H.Q., R.H.I.A., [email protected].
References 1. Institute of Medicine: To Err Is Human: Building a Safer Health System. Washington, D.C.: National Academy Press, 2000. 2. Mawji Z, et al: First Do No Harm: Integrating patient safety and quality Improvement. Jt Comm J Qual Improv 28:373–386, Jul. 2002. 3. Commonwealth of Pennsylvania: Act 13 of 2002: Medical Care Availability and Reduction of Error (MCARE) Act. http://www.mcare.state.pa.us/mclf/lib/mclf/hb1802.pdf (accessed Sep. 30, 2003). 4. Institute of Medicine: Crossing the Quality Chasm. Washington, DC: National Academy Press, 2001.
December 2003
5. Joint Commission on Accreditation of Healthcare Organizations: About the Speak Up Program. http://www.jcaho.org/general+public/ patient+safety/speak+up/index.htm (accessed Sep. 26, 2003). 6. Joint Commission on Accreditation of Healthcare Organizations: National Patient Safety Goals. http://www.jcaho.org/accredited+ organizations/patient+safety/npsg.htm (accessed Sep. 26, 2003). 7. Kaplan S.H., Greenfield S., Ware J.E. Jr.: Assessing the effects of physician–patient interactions on the outcomes of chronic disease. Med Care 27(3 suppl.):S110–S127, Mar. 1989. Erratum in Med Care 27:679, Jul. 1989 8. Rodin J.: Health, control and aging. In Baltes M., Baltes P.B. (eds.): The Psychology of Control and Aging. Hillsdale, N.J.: Lawrence Erlbaum, 1986, pp 139–165.
Volume 29 Number 12
Copyright 2003 Joint Commission on Accreditation of Healthcare Organizations
645
Journal on Quality and Safety
John M. Eisenberg Patient Safety Awards
The LVHHN Patient Safety Video:
photo courtesy of Imijination Photography; www.imijphoto.com
Patients as Partners in Safe Care Delivery
Elliot Sussman, M.D. ehigh Valley Hospital and Health Network (LVHHN) is an 800-bed, three-site academic community hospital located in Pennsylvania’s Lehigh Valley. Designated as a National Magnet Hospital, it is a member of the Council of Teaching Hospitals and serves as a chief clinical campus for Pennsylvania State University’s College of Medicine. The LVHHN hospitals function as both a provider of primary care and a major tertiary care referral center. The active medical staff of more than 850 includes both full-time and private-practice physicians, representing more than 50 specialties. LVHHN’s vision is to become a premier academic community hospital. To bring this vision to fruition, LVHHN differentiates itself through clinical innovation
L
640
December 2003
Robin Anthony, M.H.A. Francine Miranda, R.N., B.S.N. Zubina Mawji, M.D., M.P.H. Rosemary Cerimele, R.N., M.H.A. Ruth Davis, R.N., M.B.A. Susan Lawrence, M.S.
Article-at-a-Glance Background: In fall 2002, Lehigh Valley Hospital and Health Network (LVHHN), an 800-bed, three-site academic community hospital, embarked on an initiative to produce an educational patient safety video. Implementing the Initiative: The video addresses six topics relevant to optimum patient safety: treatment plan, medication safety, falls, surgical site identification, hand washing, and discharge planning. Each segment outlines strategies that patients may employ or observations they should make to improve patient safety. Results: Analysis of the patient survey data, which were based on 217 surveys, indicated that patients felt more comfortable talking with their health care workers about questions or concerns after viewing the video and that they rated their knowledge of patient safety higher. Patients generally rated the six sections as helpful. Discussion: The video was intended to become an important step in the preadmission process. Releasing the video to patients and staff helped to normalize some practices that initially were not comfortable for staff (repeatedly asking an inpatient for his or her name and date of birth before administering all medications) or patients (inquiring whether a staff member has washed his or her hands). Additional methods were in development to share the video with current and prospective patients and assess its impact. The LVHHN patient safety council plans to share the video with the community at large.
Volume 29 Number 12
Copyright 2003 Joint Commission on Accreditation of Healthcare Organizations
Joint Commission
Journal on Quality and Safety
(program development and care advancement) and service excellence. To communicate this concept, a tricycle analogy is frequently used. The “front wheel” of the tricycle, which drives the organization, is patient care. However, firmly supporting, guiding, and balancing the “patient care wheel” are two back wheels: research and education. LVHHN leadership’s commitment to quality and patient safety is evidenced by its prompt response to the release of the Institute of Medicine report To Err Is Human in early 2000.1 In fall 2000, while national debate ensued about the true incidence of errors and attributed mortality, LVHHN embarked on a multidisciplinary systems approach to reduce medical errors and improve the delivery of care. The initiative, titled Primum Non Nocere (PNN), or First, Do No Harm, is composed of 15 focused, practical projects that stress delivery of costeffective medical care and reduction of preventable adverse events through improved communication, process redesign, evidence-based protocol use, and reduced variability.2 In March 2002 Pennsylvania’s Medical Care Availability and Reduction of Error (MCARE) Act, or Act 13, was enacted.3 Pennsylvania is currently the only state that legislates active engagement of licensed health care workers in the responsibility of patient safety. The act’s other mandates include the following: ■ Designation of a patient safety officer ■ Establishment of a patient safety committee ■ Establishment of a system for an organization’s health care workers to report serious events and incidents ■ Prohibition of any retaliatory action against a health care worker for reporting a serious event or incident in accordance with the act of December 12, 1986 (P.L. 1559, No. 169), known as the Whistleblower Law ■ Provision for written notification of serious events to patients In reflecting on both LVHHN’s internal quality improvement efforts and external regulatory requirements, it became evident to the leadership that to be truly successful in our efforts to reduce patient harm and improve patient safety, we needed to actively engage the patient and have him or her directly participate in making health care safer.4 Although the “human factor” will always be present in care delivery, the likelihood of error
December 2003
reduction increases as more checks and balances are created. LVHHN believes that educating consumers to participate in safety prevention during care delivery is essential. After a search of available educational training videos, it became evident that none were available that met our needs. Therefore, in fall 2002, the patient safety staff, led by the patient safety officer [F.M.], and with the endorsement of the patient safety council (which is composed of hospital staff, physicians, a board member, and at-large community members), embarked on an initiative to produce an educational patient safety video. We believe that the video is innovative because there was no other similar product available at the time, either regionally or nationally. Although some printed materials were available, such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Speak Up brochure,5 available videos had been developed for the purpose of staff education rather than for education of patients and solicitation of their collaboration in ensuring safe care delivery. Therefore, it has filled a void in the patient educational materials market. The video’s primary objective was to raise the awareness of patients and their families about patient safety. The video was designed to encourage the patient to work collaboratively with the health care team while emphasizing LVHHN’s compassionate approach to care delivery. As a corollary to the primary objective, the video was also to serve as a vehicle for providing consistent and high-quality education to LVHHN staff and physicians about patient safety. Patient safety education, as required by Pennsylvania MCARE/Act 13,3 had previously been provided to staff through an internally developed Web-based education module, department in-services, and a patient safety pocket guide. However, the video would serve as a valuable mechanism by which to develop staff awareness of the specific information being provided to patients and complement the educational strategies previously used. This article describes the development and impact assessment of LVHHN’s Patient Safety Video, for which LVHHN is the recipient of the 2003 John M. Eisenberg Patient Safety Award for Advocacy.
Volume 29 Number 12
Copyright 2003 Joint Commission on Accreditation of Healthcare Organizations
641
Joint Commission
Journal on Quality and Safety
Implementing the Initiative Content Development The LVHHN Patient Safety Video (running time 11 minutes, 40 seconds) addresses six topics relevant to optimum patient safety: 1. Treatment plan 2. Medication safety 3. Falls 4. Surgical site identification 5. Hand washing 6. Discharge planning Each topic segment outlines strategies that patients may employ or observations that they should make to improve patient safety as collaborative members of the health care team. The content of each section was developed after detailed consultation with LVHHN topic experts. The medication errors prevention and fall prevention teams, infection control staff, and the JCAHO executive committee each provided input into specific sections. Selected board members and a few community members-at-large were also approached during the video’s development to review the script and initial footage. These stakeholders contributed valuable insights and suggestions that were addressed in the final product. The video’s content is consistent with patient safety recommendations and guidance published by the Institute for Safe Medication Practices, JCAHO, and the Centers for Disease Control and Prevention, among other organizations. For example, in the medication safety portion, the video highlights that two patient identifiers, such as name and date of birth, will be used before administering any medication to a patient; this approach is consistent with the 2003 JCAHO National Patient Safety Goals.6
Video Production After content was developed, a local production company was approached for production assistance. Through the production company, a professional script was drafted. The script was reviewed and edited by internal stakeholders, including the patient safety council. Production costs were a significant concern because development of a professional video typically costs $500–$1,000 per minute. Several strategies were employed to control costs. A grant was obtained through the LVHNN Friends of Nursing program; and
642
December 2003
a PNN project, Patient-Controlled Analgesia Error Reduction Committee, donated funds it received as a result of cost saving achieved through LVHHN’s Working Wonders program. 2 In addition, use of employees and medical staff as actors and some cost sharing with the production company further reduced overhead. The video was filmed on location at Lehigh Valley Hospital, Cedar Crest and I-78 campus, in Allentown, Pennsylvania. To make the transitions between the six content topics, a professional narrator was filmed in the hospital’s main lobby. LVHHN’s chief executive officer provided a personal introduction to LVHHN and the video’s content, as well as the importance of provider and patient partnership in ensuring safety, at the beginning of the film.
Roll-Out When the video was formally released in May 2003, it was available for viewing in multiple venues, including physician offices, preadmission areas, and inpatient rooms. The video was first shown during a two-week period to a convenience sample of 109 patients in ambulatory surgical areas, at either the preadmission testing visit or on the day of surgery. In a community outreach effort, the video was presented to a group of local high school and college students in May–June 2003. The video currently runs eight times per day on the LVHHN patient education channel, which is accessible from any patient room’s television. A five-question survey (Figure 1, page 643) was administered to all students and patients who viewed the video. Questions were scored on a five-point Likert scale; the higher the score, the greater the benefit the video provided to the viewer.
Results Patient Surveys Analysis of the patient survey data, which were based on 217 surveys administered from May through August 2003 (Figure 1), indicated that patients felt more comfortable talking with their health care workers about questions or concerns after compared with before viewing the video (mean score = 4.47 [standard deviation, 0.617] versus 4.09 [0.760], p < .001). After viewing the video, patients
Volume 29 Number 12
Copyright 2003 Joint Commission on Accreditation of Healthcare Organizations
Joint Commission
Journal on Quality and Safety
Patient Safety at Lehigh Valley Hospital and Health Network Video Evaluation
Figure 1. This five-question survey was administered to all students and patients who viewed the video; 1 = very poor; 2 = poor; 3 = fair; 4 = good; and 5 = very good.
rated their knowledge of patient safety higher (mean score = 4.48 [0.640] versus 3.93 [0.764], p < .001). We also asked patients to evaluate the helpfulness of each of the video’s six major sections. The mean score was 4.25, with a range of 4.20 to 4.32 for each of the individual sections (Figure 1). These data suggest that the video was meeting our objectives.
Student Surveys More than 350 high school and college students viewed the video as part of their health studies curriculum from May 25 to June 6, 2003. Analysis of the student survey responses, which were drawn from 288 surveys, indicated that after viewing the video, students felt more comfortable talking with their health care workers about questions or concerns (mean score = 4.08 [standard deviation, 0.725] versus 3.34 [0.831], p < .001), and they rated their knowledge of patient safety higher (mean score = 4.16 [standard deviation, 0.780] versus 3.19 [0.913], p < 001). Student evaluations of the helpfulness of each of the six major sections of the video yielded a mean score
December 2003
for all the sections of 3.84 (range, 3.71–3.96 for each of the individual sections). The mean score for the student population was lower than that of the patient population (p < 0.001.)
Discussion We recognized that true success in efforts to reduce patient harm and improve patient safety required active engagement from the patient. Numerous studies have documented that educated, involved patients are more likely to comply with their treatment regimens than are other patients. Compliance then leads to better patient outcomes, safer health care, and decreased health care costs.7,8 In addition, patients empowered to advocate for themselves and for safer care delivery systems add significant momentum to the health care industry’s efforts to improve patient safety.4 A primary objective of the video project was to create a mechanism to communicate with and educate patients. Typically, adult learners retain more information when they are able to recive education in comfortable
Volume 29 Number 12
Copyright 2003 Joint Commission on Accreditation of Healthcare Organizations
643
Joint Commission
Journal on Quality and Safety
Stoplight Reminder Cards
Figure 2. The laminated “stoplight card” is placed on the communication boards in each patient room to encourage patients and families to view the video on the patient education channel.
surroundings and proceed through the information at their own pace. Hence, the video is intended to become an important step in our preadmission process; patients will view the video before a planned admission—either in their physicians’ offices, during the preadmission testing process, or on the day of surgery. Patients are less apprehensive about their hospitalization when they are informed and encouraged to participate.7,8 Ease of access facilitates provision of education. Despite the recency of the distribution of the patient safety video, its impact has already been demonstrated, both quantitatively and qualitatively. Through actual illustration, it reinforces important safety topics, regulatory and accreditation requirements, and, importantly, staff performance expectations. Releasing the video to patients and staff has helped to normalize some practices that initially were not particularly comfortable for staff (for example, repeatedly asking an inpatient for his or her name and date of birth before administering all medications) or patients (for example, inquiring whether a staff member has washed his or her hands). Furthermore, engagement of employees in the video’s production has enhanced employees’ commitment to and involvement in patient safety initiatives. Further evaluation of the video may include formally assessing its impact on staff knowledge as well as on medical/medication errors, patient falls, and nosocomial infection rates. Despite the success with the video’s initial development, production, roll-out, health education, and
644
December 2003
outcomes, challenges in this process should be acknowledged. Specific project barriers that have been encountered include efficiently distributing the video to physician practices, marketing the video to community groups and consumers, collecting survey cards from patients viewing at physician practices or the in-house patient education channel, and managing the unanticipated volume of interested organizations and companies seeking to purchase or replicate the video. In addition, informing inpatients, specifically those with unplanned admissions, has become challenging. To address this barrier, patient reminder cards will be displayed in patient care areas and patient rooms. These laminated “stoplight cards” (Figure 2, left) will be placed on the communication boards in each patient room to encourage patients and families to view the video on the patient education channel. We are continuing to develop methods for sharing the video with current and prospective patients and assessing its impact. Additional arrangements have been made to use commercially available inpatient, ambulatory surgery, and obstetrical surveys to assess the video’s impact through the inclusion of questions about whether (1) staff confirmed with the patient about to undergo surgery or a procedure “the area of the body where the surgery/procedure would be” and (2) the patient felt comfortable that his or her identity was verified “before receiving medications, having blood drawn, or being taken for a test.” Data collection will begin with distribution of these surveys in October 2003. The patient safety council has committed to sharing the video not only with LVHNN’s internal (staff) and external (patients) customers but also with its community at large. The impact of medical errors has received substantial press and is a significant concern for the general public. Recognizing community needs, LVHHN now has copies of the VHS/DVD video available for distribution, in both the English and Spanish languages. Future plans include VHS/DVD availability in two additional formats: English language with subtitles and Spanish language with subtitles. The patient safety council’s intent is to have the video available for hospital/physician office settings, community libraries, community functions, colleges, universities, senior citizen groups, nursing programs, health bureaus, and any other organization that
Volume 29 Number 12
Copyright 2003 Joint Commission on Accreditation of Healthcare Organizations
Joint Commission
Journal on Quality and Safety
may request information about patient safety. The Allentown Public Library, which serves a large urban population, has added the video to its collection. A complimentary copy of the video is available to LVHHN patients and its medical staff. Community groups that wish to offer the video as part of their programming may have an LVHHN representative facilitate a showing of the video. In addition, plans to market the video on national and regional levels, with options for customization, are being finalized.
Conclusion LVHHN is committed to the Patient Safety Video in the belief that prevention of even a single error is well worth the time and resource commitment. Patient education and engagement, as advocated in the video, are critical to the advancement of patient safety. We expect that the video will reduce medical and medication errors, patient falls, and nosocomial infection rates and will increase the patient’s/family’s understanding of
what to anticipate and how to collaboratively participate during their hospitalization. J The authors acknowledge the efforts and dedication of Kelly Beauchamps, Darlene Hamershock, Kathryn Stephanoff, Kathryn Taylor, and Broadcast Images. The authors also extend thanks to the LVHHN patient safety council for their guidance and review of the Patient Safety Video, and to Allentown Central Catholic High School and Muhlenberg College for utilizing the video in their health curricula.
Robin Anthony, M.H.A., C.P.H.Q., R.H.I.A., is JCAHO Coordinator, Lehigh Valley Hospital and Health Network, Allentown, Pennsylvania. Francine Miranda, R.N., B.S.N., H.R.M., is Director, Risk Management/Patient Safety Officer. Zubina Mawji, M.D., M.P.H., is Senior Vice President, Quality and Care Management, and a member of the Joint Commission Journal on Quality and Safety’s Editorial Advisory Board. Ruth Davis, R.N., M.B.A., is Director, Care Management. Susan Lawrence, M.S., C.P.H.Q., is Administrator, Quality and Case Management. Rosemary Cerimele, R.N., M.H.A., H.R.M., is Assistant Risk Manager. Please address correspondence to Robin Anthony, M.H.A., C.P.H.Q., R.H.I.A., [email protected].
References 1. Institute of Medicine: To Err Is Human: Building a Safer Health System. Washington, D.C.: National Academy Press, 2000. 2. Mawji Z, et al: First Do No Harm: Integrating patient safety and quality Improvement. Jt Comm J Qual Improv 28:373–386, Jul. 2002. 3. Commonwealth of Pennsylvania: Act 13 of 2002: Medical Care Availability and Reduction of Error (MCARE) Act. http://www.mcare.state.pa.us/mclf/lib/mclf/hb1802.pdf (accessed Sep. 30, 2003). 4. Institute of Medicine: Crossing the Quality Chasm. Washington, DC: National Academy Press, 2001.
December 2003
5. Joint Commission on Accreditation of Healthcare Organizations: About the Speak Up Program. http://www.jcaho.org/general+public/ patient+safety/speak+up/index.htm (accessed Sep. 26, 2003). 6. Joint Commission on Accreditation of Healthcare Organizations: National Patient Safety Goals. http://www.jcaho.org/accredited+ organizations/patient+safety/npsg.htm (accessed Sep. 26, 2003). 7. Kaplan S.H., Greenfield S., Ware J.E. Jr.: Assessing the effects of physician–patient interactions on the outcomes of chronic disease. Med Care 27(3 suppl.):S110–S127, Mar. 1989. Erratum in Med Care 27:679, Jul. 1989 8. Rodin J.: Health, control and aging. In Baltes M., Baltes P.B. (eds.): The Psychology of Control and Aging. Hillsdale, N.J.: Lawrence Erlbaum, 1986, pp 139–165.
Volume 29 Number 12
Copyright 2003 Joint Commission on Accreditation of Healthcare Organizations
645