CT Center for Patient Safety
CT Center for Patient Safety Newsletter

October 2015
In This Issue
Community Paramedicine

Community Paramedicine: a newer practice of having paramedics provide house-call services to frail, elderly, underserved and rural patients who are challenged with chronic medical conditions.  These providers are able to build on existing programs that traditionally provided home services.  They are able to treat patients who don't meet the criteria for home nursing care, but still need some extra services in order to be in their home and take care of themselves.  

The benefit of such services is to intervene early, thus keeping patients from the emergency rooms and hospital stays when this additional support at home will do the trick. It can be a win-win situation for everyone.  However, because it is a newer model of health care delivery, the payment models are not well developed and it is not available to everyone.  It is important to recognize  that with the innovative strategies that are being developed, including this and the use of telemedicine, we just might see patients happier to stay in their homes with more alternatives for safe, effective care delivered at lower costs.  Sounds like it might be a winning formula!
Healthcare's Brave New World: 
Patient-Centered Care
Derby, CT, August 20, 2015 - The 9th annual Patient-Centered Care Awareness Month campaign will emphasize that when healthcare professionals, patients and family members courageously engage with each other as partners, healthcare interactions are more constructive, experiences are more positive and outcomes improve. The theme of this year's campaign is Healthcare's Brave New World: Patient-Centered Care. 

Patient-Centered Care Awareness Month is an awareness-building campaign commemorated globally every October to engage all healthcare stakeholders in adopting and advancing patient-centered approaches to care.  The term patient-centered was coined by Planetree nearly 40 years ago to describe an approach to care that is 1.) organized around the needs of the patient; and 2.) promotes relationships between patients, their families and their healthcare teams that nurture trust, transparency and collaboration.  This year, campaign activities will challenge patients, family members, healthcare professionals and communities to venture bravely into a dialogue about how engaging differently with each other can transform the healthcare experience - and outcomes.

"In developing this theme for the 2015 campaign, we're acknowledging that patient-centered care is not easy," said Susan Frampton, President of Planetree, Inc.  "And yet it is vital in this brave new world of healthcare.  We know that the healthcare system's ability to drive quality and value hinges on healthcare interactions that achieve mutual participation and partnership among the patient and the professional caregivers."   "That's where bravery comes in," Frampton adds.  "For patients, it may take courage to vocalize their own expertise about their health amidst a team of highly trained professionals.  For professionals, it takes courage to open themselves up to getting to know their patients more personally in order to deliver more compassionate and individualized care.  It also takes courage to acknowledge that clinical expertise alone is not enough to deliver quality care and yield optimal outcomes."
Legislative follow-up - The CARE Act

The CARE (Caregiver, Advise, Record and Enable) Act that we wrote about in our July issue,
Care Partner Programs: Advancing Advocacy at the Bedside took effect on October 1st.  It requires hospitals to identify, educate, train, and support family caregivers before a patient is discharged. For anyone who wants to see more about this legislation, a summary can be found at the following link: 
Safety First: Community Healthcare Provider Home Visit Safety Tips

by Antoinette Towle EdD., APRN
I have worked the vast majority of my thirty five year nursing career, both as a registered nurse (RN) and an advanced practice registered nurse (APRN) in the community. Having worked in a wide variety of community settings such as schools, nursing homes, elderly apartments, adult and children day care centers, group homes and privately owned homes, as well as in a vast variety of locations, inner city to the out most parts of rural Connecticut, I have repeatedly experienced a major safety concern over and over again! People do not lock their doors! In approximately 50-75% of the homes and facilities I go to, the door is unlocked or someone gladly lets me in without even knowing who I am or why I am there. I have freely walked in a door and throughout the entire house or building before I located the person I have come to see. The lack of locking the door cannot be attribute solely to the idea that the person knew I was coming because most of the time I only give a range of time for my arrival such as between 8 am and 12 noon. Unfortunately, in today's world, with the increase in violent assaults occurring within our homes, schools and other community centers, people need to be extra cautious in protecting both themselves and others. Here are a few safety questions that everyone should ask a community healthcare provider (HCP) prior to them coming to their home or facility for a visit:
  • the person's name, title, and affiliation
  • the purpose of their visit
  • what the visit entails
  • how long it will take
  • who will pay for the visit, and if there is any cost to you
  • when are they planning on coming (approximate time frame)
  • if anyone is coming with them  
  • what the information will be used for
  • who will see the information (confidentiality)
Once you have gotten all of the answers to your questions, you may want to consider calling the agency or company they identify as being with to confirm that they are really from that company. Ask the HCP to call you just prior to visiting. At that time you can give them any specific instructions including the best way to let you know they have arrived and how best to enter your home / facility for i.e. rear door, knock, use the door bell, intercom system etc. Also, ask them what they will be wearing i.e. scrubs, lab coat.  If for any reason you are uncomfortable letting a strange into your home, postpone the visit until a time when you can have another family member or friend present during the visit. Most HCP are very accommodating and have no problem visiting in the evening on weekends. Before letting the HCP into your home always ask them their name and to show you identification. Remember to conduct the visit in the room that you feel the most comfortable and safest in. This is your home and your visit! If at any point during the visit you are uncomfortable or feel unsafe, you can stop the visit and ask the HCP to leave. Prior to the HCP leaving, ask them for their card or contact information. AND always escort them to the door and lock the door once they leave!!!

Dr. Towle  is an Assistant Professor of Nursing at Southern Connecticut State University 
Under Pressure, Physicians are Improving Their Bedside Manner
Traditionally, doctors have received their medical education with a focus on being good diagnosticians, or good surgeons, but not so much on being compassionate or being good listeners. That is beginning to change as a consequence of several factors.  The Affordable Care Act includes payment initiatives that are tied to patient satisfaction surveys also known as HCAHPS (pronounced "H-caps").  These initiatives focusing on the relationship with patients is increasing.  We are also seeing additional pressure on doctors coming from websites such as YELP, HealthGrades, or RateMyMD amongst others, as social media is also providing widespread ratings.  Another big factor is that patients are bearing
more of the cost of their health care and want to get good value for their money.

A study from 2011 found that just over of hospitalized patients who were surveyed said that they experienced compassion when getting their health care.  Today, everyone is able to go on the Medicare Hospital Compare website (https://www.medicare.gov/hospitalcompare/search.html) and look at hospitals that you are interested in to see what their recent HCAHPS scores are. While there are many other useful ratings available, this article is focusing on the patient satisfaction scores. Hospital systems across the country are undertaking many initiatives to improve their patient satisfaction scores.  Efforts range from providing more comfortable patient rooms with large flat screen TV's to offering training and courses to clinicians focusing on how to be more empathetic.

A significant underlying benefit of these various surveys is the same as we find from transparency in health care in general.  According to the Chief Experience Officer at the Cleveland Clinic, "If you really don't get any feedback on your ability to communicate or be empathic, you won't think you have a problem."  In other words, taking that one step further, you can't fix what you aren't aware of.

Furthermore, the benefit of improved patient satisfaction as a consequence of clinician compassion is also reflected in generally better results from care.  Many studies point to the higher rate of patient adherence to their care plans when they feel that their clinician truly cares about them as individuals.  They are more likely to take their prescribed medications and stick with their follow-up visits. In addition, it seems obvious as well that when a clinician listens more attentively, they will likely notice cues and details that they otherwise might have missed. This results not only in better health outcomes, but also in cost savings for everyone involved.
Dear Members, 
Happy autumn to everyone!  
As the weather in Connecticut starts cooling off, at CTCPS we are busier than ever and staying warm!  Our team is working on a number of projects including ones focused on patient and clinician patient safety education, person-centered initiatives focused on supporting the establishment and growth of patient and family advisory councils in all of our state's hospitals and policy work with leaders in the state and at the national level.
This issue of our newsletter continues our tradition of bringing in guest authors to represent the diverse perspectives of our members on a number of issues.  I want to extend an invitation to all of our readers to contribute articles.  If you have an idea of something you wish to share: a patient perspective on a health care situation or a policy, a new way to deal with some of the challenges faced in healthcare, or a particular concern, we invite you to contact us so that we can consider including an article written by you in a future newsletter.
We hope that everyone has a happy, cheerful and colorful Halloween season!

Lisa Freeman
PULSE of NY Launches Universal Patient Safety Flag

Wantagh, NY, September 25, 2015 (Newswire)
Training and advocacy organization saw need for a unifying symbol.
Every country has one; so do international organizations like the Red Cross, causes such as same-sex marriage, and ethnic groups such as Aboriginal people in Australia. We're talking about flags. A good flag is immediately identifiable and unites people who understand its meaning.
Now, the cause of patient safety has a flag too.

Ilene Corina, who heads Long Island-based patient safety advocacy group PULSE of NY, designed the new flag. She says, "With more than 400,000 lives lost in this country due to preventable medical error every year, there has to be a connection between all those people who have lost loved ones. We hope the new flag will symbolize their unity."
"A bright sun on a somber field is a simple symbol, but it sends a powerful message: hope can rise from sorrow."

Purple, she says, is not only a royal color, but in many places a color of mourning and grief. But within the purple field is a sunrise-yellow disc symbolizing hope and new beginnings.

Other patient safety leaders are in support. "This symbol represents the solidarity of patients in support of safe, patient-centered care and active patient engagement," comments Lisa Freeman, Executive Director of the Connecticut Center for Patient Safety. "By sharing this symbol and spreading it far and wide, we are all raising awareness of the patient's perspective in all aspects and at all levels of the healthcare system, and at the same time, we are empowering patients.  Nothing about us without us."

Helen Haskell , Founder, Mothers Against Medical Error and President, Consumers Advancing Patient Safety, adds: "A bright sun on a somber field is a simple symbol, but it sends a powerful message: hope can rise from sorrow. The aspiration to create good from tragedy, to bring hope to those who are most vulnerable, is at the core of the patient safety movement. This is a badge that those who advocate for a brighter future for all patients can wear with pride."

The Connecticut Center for Patient Safety will soon have flag pins available for distribution.  Watch for our announcement of how to order yours.
The Need for Better Health Literacy

According to the US Department of Health and Human Services, "Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." More concerning is that only 12% of adults have proficient health literacy according to the National Assessment of Adult Literacy. Nearly nine out of ten adults may lack the skills needed to manage their health and prevent disease.

Having health insurance is one thing, understanding it another
Having health insurance is one thing, understanding it another.

The complexity of health insurance and lagging levels of insurance literacy have long been a concern. But many experts say the problem is particularly urgent now...

For more information, view the Quick Guide to Health Literacy Fact Sheet at http://health.gov/communication/literacy/quickguide/factsbasic.htm
October Is Health Literacy Month

For the reasons mentioned above, it is important for individuals to develop literacy skills. Additionally, low literacy has been linked to poorer health outcomes such as higher rates of hospitalization and less frequent use of preventive services. 

Improving Health Literacy in Connecticut
An event to raise awareness and share tools and strategies that is a collaboration of the Business Committee to Improve Health Literacy
Featured speakers will include:

Kevin Lembo,  CT State Comptroller
Dominic Lorusso, Consumer Reports
Ed Musante, Connecticut Chambers of Commerce and
Lisa Freeman, Connecticut Center for Patient Safety.

When:     Friday, Oct. 9, 2015           
           9AM - 11AM
Where:    Gateway Community College
            20 Church St.
            New Haven, CT 06510 

Free parking available
Everyone is welcome to this free event,
but for security reasons, pre-registration is a must!!
To reserve your seat call: (800) 953-4467 
Or email: Wanda Picagli wpicagli@cfr-cit.com

We have received a matching challenge donation to support our educational programs.  Please consider making a donating today!  It will be matched dollar for dollar!  

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