J Canc Educ DOI 10.1007/s13187-015-0821-4
Advancing the Future of Patient Safety in Oncology: Implications of Patient Safety Education on Cancer Care Delivery Ted A James 1,2 & Michael Goedde 1 & Tania Bertsch 1,2 & Dennis Beatty 1,2
# American Association for Cancer Education 2015
Abstract Emerging challenges in health care delivery demand systems of clinical practice capable of ensuring safe and reliable patient care. Oncology in particular is recognized for its high degree of complexity and potential for adverse events. New models of student education hold promise for producing a health care workforce armed with skills in patient safety. This training may have a particular impact on risk reduction in cancer care and ultimately improve clinical performance in oncology. A 1-day student program focused on the principles of patient safety was developed for the thirdyear medical school class. The core curriculum consisted of an online patient safety module, root cause analyses of actual patient safety events, and simulation scenarios designed to invoke patient safety skills. The program was successfully implemented and received an average of 4.2/5 on evaluations pertaining to its importance and effectiveness. Student surveys demonstrated that 59 % of students were not previously aware of system-based approaches to improving safety, 51 % of students had witnessed or experienced a patient safety issue, while only 10 % reported these events. Students reported feeling more empowered to act on patient safety issues as a result of the program. Educational programs can provide medical students with a foundation for skill development in medical error reduction and help enhance an organization’s culture of Electronic supplementary material The online version of this article (doi:10.1007/s13187-015-0821-4) contains supplementary material, which is available to authorized users. * Ted A James [email protected] 1
University of Vermont College of Medicine, 89 Beaumont Ave, Given Building, Burlington, VT 05405, USA
2
University of Vermont Medical Center, Burlington, VT, USA
safety. This has the potential to reduce adverse events in complex patient care settings such as clinical oncology.
Keywords Patient safety . Quality . Medical education . Cancer care
Introduction The Institute of Medicine (IOM) first published its report on the quality of cancer care in 1999 [1], highlighting the fact that many cancer patients receive inappropriate or inadequate care. Over a decade later, overcoming the barriers to high-quality cancer care remain a daunting challenge as evidenced in the 2013 IOM report on cancer care delivery [2]. This report describes cancer care in the USA as a system in crisis due to stressors from the growing demand and complexity of caring for patients with cancer. Patient harm from preventable medical errors has been recognized as one of the main contributing factors of the problems experienced with cancer care, as well as with the health care delivery system in general [3, 4]. The conditions under which health professionals must deliver care have surpassed the ability of human memory and attention to provide adequate safeguards against patient harm. Studies demonstrate that cancer care is among the most complex of patient care systems, and specific challenges treating patients with cancer further increase the risk of adverse patient events from medical error [5–10]. For example, the rate of serious injury from radiation therapy is estimated at 1000 times the rate of adverse events observed in other complex but safe field such as commercial aviation and modern anesthesiology [11]. Likewise, the administration of chemotherapy alone is a complex and error-prone endeavor given the narrow therapeutic index of most agents, the need to calculate precise doses based on body size and laboratory results, and
J Canc Educ
the multiple individuals involved in prescribing, preparing, and administering chemotherapy [12–14]. Indeed, it was a high-publicized chemotherapy overdose case which served as one of the main stimuli for the patient safety movement [15]. Additionally, cancer care delivery often requires the coordination of multidisciplinary teams composed of individuals who may be geographically dispersed, involved only transiently in the patient’s care, and may be focused on different aspects of the cancer care plan. As in other areas of health care, communication and team work are critical in oncology and are a potential source of failure in patient care [5, 9]. The growing number of patients diagnosed with cancer in the USA coupled with an increasing number of cancer survivors raises the likelihood that a health care professional will be involved in the management of a cancer patient in some capacity during their clinical career, regardless of their specialty. Progress has been made in patient safety through the implementation of system-based strategies including safety protocols, checklists, and improved applications of technology. These strategies are designed to compensate for human error and create safety nets capable of absorbing error before it results in patient harm. Future health care professionals will require a fundamental understanding of these techniques and skills in order to ensure safe and reliable care for all patients, including those who are undergoing complex cancer care. There are relatively few reports in the literature describing even the potential impact of patient safety education on medical errors and adverse events in clinical oncology. The following describes the development and initial findings of a medical student patient safety education program. We specifically take the opportunity to discuss the potential specialtyspecific implications of patient safety education on error reduction and quality improvement in cancer patient care.
Program Description The educational framework for the patient safety program began with an evidenced-based needs assessment performed by reviewing the literature on patient safety and medical errors to uncover potential performance gaps and inform key learning objectives [16–26]. Several recommendations for curriculum content were also identified from the World Health Organization (WHO) [27], Agency for Healthcare Research and Quality (AHRQ) [28], IOM reports [14, 15], and insight provided by local faculty with expertise in patient safety science and quality improvement theory. The key topics covered in the patient safety workshop are listed in Table 1. The instructional method used for the program was determined by selecting a diverse set of teaching formats (e.g., blended-learning, case method, team-based learning, and simulation activities) in order to actively engage students, appeal
Table 1
Core instructional principles
Understanding medical error •Complexity in health care •Human fallibility •Types of error •Common adverse events System-based approaches to safety •Avoidance of blame •Standardized protocols •Checklists •Process redesign Effective teamwork and communication •Situational awareness •Mutual support •Structured communication •Closing the loop Fundamentals of quality improvement •Error reporting and disclosure •Root cause analysis •PDSA •Leadership
to multiple learning styles, enhance experiential learning, and promote problem solving and critical thinking. The program was a mandatory component of the medical school curriculum, and all students completed the educational experience. All students were also required to document completion of an online patient safety module from the Institute of Healthcare Improvement (IHI) [29] as a pre-course assignment. This allowed the students to enter the classroom with a shared terminology and common set of concepts upon which they could build. Executive summaries of the IOM reports BTo err is Human^ [3] and BCrossing the Quality Chasm^ [4] also constituted the required pre-course material. The classroom curriculum included case-based discussions and practice root cause analyses (RCA) of actual medical errors publically reported to national patient safety networks and those selected from internal institutional cases. The primary case used for discussion was a video produced by the Partnership for Patient Safety and the Harvard Risk Management Foundation, presenting a series of errors involving a healthy obstetric patient and her unborn infant. Based on actual facts, the 18-min film illustrates a systems approach to issues with teamwork, communication skills, and authority gradients leading to patient harm [30]. Discussions were facilitated using a team-based learning approach. Students then participated in simulation scenarios designed to further invoke the learning objectives of the program in an immersive learning environment. The program culminated with a large group-debriefing session
J Canc Educ
and faculty panel discussion to review practical applications of the program objectives. The combined duration of the classroom and simulation components for the patient safety program was 4.5 h. Pre-course content was made available to the students at least 1 week prior to the program. Program evaluation consisted of a standardized student feedback form with Likert and yes/no type of questions rating the importance, effectiveness, and value of the patient safety education program. Questions were also designed to solicit students’ prior experience with medical errors, behaviors of error reporting, and knowledge of system-based approaches to error prevention, and determine their level of comfort acting on medical errors (Appendix I). Descriptive and summary statistics were used to report the main findings of the student survey.
Results Implementation of the patient safety education program was successful, with the inaugural program introduced into the medical school curriculum in 2012. The program is held twice per academic year, each time to approximately half of the third-year medical school class (i.e., approximately 55–59 students). Between the study period of 2012 and 2013, an estimated 230 students completed the training program. Standard policy of the College of Medicine is to solicit feedback from a random convenience sample of students in each class. A total of 90 surveys were completed during the study period. Responses to questions pertaining to the perceived value and effectiveness of the course are listed in Table 2. Overall, the program was well received and students described the training as an important addition to the curriculum. Analysis of the student evaluation survey revealed that 59 % of students reported that they were not previously aware of system-based approaches to medical error such as root cause analysis. Furthermore, 51 % of students reported experiencing or witnessing a medical error or patient safety issue during their clinical exposure; however, only 9.8 % of students formally reported these witnessed events. Table 2 Student evaluation of patient safety program
Discussion The patient safety program was perceived as a valuable addition to the medical student curriculum. The program served as a formal introduction to the fundamental principles of patient safety and quality improvement and provided a foundation upon which to develop competencies in these essential skills. The combination of case discussions of actual medical errors and simulation scenarios effectively engaged students and enabled them to practice applying their knowledge and skills in a controlled, observed environment. Our student survey revealed that more that one half of all students experienced a medical error or patient safety issue by the third year of medical school. Whether the students were directly involved in these cases or passive observers was not known. However, only approximately 10 % of students formally reported a witnessed medical error. Lack of medical error reporting is a well-recognized problem in the patient safety literature [31, 32]. Although not discernable from the survey, the low rate of student reporting is likely multifactorial. Students may not be aware of the importance of reporting errors, may feel intimidated by the medical hierarchy, or may feel that the responsibility of reporting lies in the hands of residents, faculty, or nurses. Increasing students’ ability and willingness to report witnessed errors may provide valuable additional information for quality improvement efforts. Case reports demonstrate that medical students, an often overlooked participant in ensuring patient safety, can serve as a valuable resource for advancing safety in patient care [33]. Proponents advocate for training medical students how to recognize and actively communicate observed errors and near misses as a strategy for improving clinical performance. Our survey found that students felt more empowered to act on patient safety issues following the patient safety training program. This may be an effective means of encouraging students to act as patient safety advocates and contribute to the culture of safety within an academic organization.
Survey question item
Response
Yes/no questions Prior to the course I was familiar with root cause analysis and/or the system-based approach to medical errors I have experienced a medical error or patient safety issue during my clinical training Have you ever formally reported a medical error you experienced?
Percent affirmative 41
Likert type: Strongly agree (5) to strongly disagree (1) The session increased my awareness, appreciation and/or knowledge of medical errors and patient safety. Topic is important to my medical education. I feel more empowered to act on a safety issue as a result of this session.
Mean value (n=90) 4.3/5
51.1 9.8
4.4/5 4.0/5
J Canc Educ Table 3 Examples of patient safety concepts in oncology
Patient safety concept
Implications in oncology
Communication and teamwork
Coordination of multidisciplinary cancer team Transitions between cancer care providers Appropriate palliation/end-of-life care Critical result reporting Complications in chemotherapy administration
Medication safety
Oncology medication errors Clinical trials Catheter-associated bloodstream infection Neutropenia-related infections Delay in cancer diagnosis Wrong site surgery Specimen handling/processing Cancer screening Compliance with ambulatory oral chemotherapeutics Misalignment of treatment goals
Infection control Diagnosis Surgical safety Patient education/engagement
Next Steps
Conclusion
Since its initial implementation, the patient safety program has transformed into an interprofessional education activity by the inclusion of nursing and pharmacy students along with medical students, learning with, from, and about each other to improve collaboration and the quality of care. The program offers an enhanced focus on team training and interprofessional communication. Efforts are also underway to introduce elements of the program in the pre-clinical curriculum in order to establish a longitudinal education experience.
A targeted patient safety program can provide medical students with a foundation upon which to develop skills in patient safety. The program imparts fundamental principles of quality improvement which students will require in order to optimize patient outcomes upon entry into clinical settings. Students view this training as important to their medical education. Medical students represent a potential untapped resource in patient safety and, through training, may serve as advocates for advancing an organization’s culture of safety. These initiatives have the potential to reduce medical errors and adverse patient events in complex patient care settings such as oncology.
Implications for Patient Safety in Cancer Care The patient safety education program has been effective in increasing the awareness of medical errors and advancing the culture of patient safety in the course participants. Further results of this type of learning innovation may lead to significant changes in the focus of education for medical and other health profession students, as well as provide practical applications to improve patient safety. Issues of patient safety in cancer care may directly benefit from the ability of health care professionals to effectively employ principles of medical errors reduction and prevent adverse patient events (Table 3). For example, basic techniques for reducing medication error and standardizing safety protocols during drug administration have direct applications to preventing adverse events in chemotherapy administration [13, 14, 34]. Likewise, central patient safety issues including diagnostic error, delays in treatment, and coordination of care have implications for addressing current challenges in the quality of cancer care [35–38].
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Hewitt M, Simone JV (1999) National cancer policy board. Ensuring the Quality of Cancer Care, Institute of Medicine and National Research Council Levit L, Balogh E, Nass S, Ganz PA (2013) Delivering high-quality cancer care: charting a new course for a system in crisis. Institute of Medicine, National Academies Press (US) (1999) To Err Is Human: Building a Safer Health System. Kohn L, Corrigan J, Donaldson M, eds. Washington, DC: Committee on Quality of Health Care in America, Institute of Medicine. National Academies Press (2001) Crossing the quality chasm: a new health system for the 21st century. Institute of Medicine. Washington, D.C.: National Academy Press Norton PG, Baker GR (2007) Patient safety in cancer care: a time for action, JNCI J Natl Cancer Inst Rowe M, Gallagher TH (2007) Confronting medical errors in oncology and disclosing them to cancer patients, JCO
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Tishelman C, Bernhardson BM, Blomberg K et al (2004) Complexity in caring for patients with advanced cancer. J Adv Nurs 45(4):420–429 Bunnell CA, Gross AH, Weingart SN et al (2013) High performance teamwork training and systems redesign in outpatient oncology. BMJ Qual Saf 22(5):405–413 Ko C, Chaudhry S (2002) The need for a multidisciplinary approach to cancer care. J Surg Res 105:53–57 Walsh KE, Dodd KS, Seetharaman K, Roblin DW, Herrinton LJ, Von Worley A, Usmani GN, Baer D, Gurwitz JH (2009) Medication errors among adults and children with cancer in the outpatient setting. J Clin Oncol 27(6):891–896 Ford EC, Terezakis S, Pronovost P, et al. (2010) Patient safety in radiation oncology: tools for improvement. Int J Radiat Oncol Biol Phys Gandhi TK, Bartel SB, Shulman LN et al (2005) Medication safety in the ambulatory chemotherapy setting. Cancer 104(11):2477– 2483 Goldspiel BR, DeChristoforo R, Daniels CE (2000) A continuous improvement approach for reducing the number of chemotherapyrelated medication errors. Am J Health Syst Pharm 4(Suppl 57):S4– S9 Fischer DS, Alfano S, Knobf MT et al (1996) Improving the cancer chemotherapy use process. J Clin Oncol 14:3148–3155 Bohmer R, Winslow A (1999) The Dana-Farber Cancer Institute. HBS Case #699-025. Harvard Business School Publishing, Boston Sandars J, Bax N, Mayer D, Wass V, Vickers R (2007) Educating undergraduate medical students about patient safety: priority areas for curriculum development. Med Teach 29(1):60–61 Armitage G, Cracknell A, Forrest K, Sandars J D2011] Twelve tips for implementing a patient safety curriculum in an undergraduate programme in medicine. Med Teach 33D7]:535–540, Epub 2011 Feb 28 Mayer D, Klamen DL, Gunderson A, Barach P (2009) Telluride interdisciplinary roundtable. Designing a patient safety undergraduate medical curriculum: the telluride interdisciplinary roundtable experience. Teach Learn Med 21(1):52–58 Alper E, Rosenberg EI, O’Brien KE, Fischer M, Durning SJ (2009) Patient safety education at U.S. and Canadian medical schools: results from the 2006 Clerkship Directors in Internal Medicine survey. Acad Med 84(12):1672–1676 Leung GK, Patil NG, Ip MS (2010) Introducing patient safety to undergraduate medical students—a pilot program delivered by health care administrators. Med Teach 32(12):e547–e551 Holmes JH, Balas EA, Boren SA (2002) A guide for developing patient safety curricula for undergraduate medical education. J Am Med Inform Assoc 9(6 Suppl):S124–S127 Smith SD, Henn P, Gaffney R, Hynes H, McAdoo J, Bradley C (2012) A study of innovative patient safety education. Clin Teach 9(1):37–40
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Advancing the Future of Patient Safety in Oncology: Implications of Patient Safety Education on Cancer Care Delivery Ted A James 1,2 & Michael Goedde 1 & Tania Bertsch 1,2 & Dennis Beatty 1,2
# American Association for Cancer Education 2015
Abstract Emerging challenges in health care delivery demand systems of clinical practice capable of ensuring safe and reliable patient care. Oncology in particular is recognized for its high degree of complexity and potential for adverse events. New models of student education hold promise for producing a health care workforce armed with skills in patient safety. This training may have a particular impact on risk reduction in cancer care and ultimately improve clinical performance in oncology. A 1-day student program focused on the principles of patient safety was developed for the thirdyear medical school class. The core curriculum consisted of an online patient safety module, root cause analyses of actual patient safety events, and simulation scenarios designed to invoke patient safety skills. The program was successfully implemented and received an average of 4.2/5 on evaluations pertaining to its importance and effectiveness. Student surveys demonstrated that 59 % of students were not previously aware of system-based approaches to improving safety, 51 % of students had witnessed or experienced a patient safety issue, while only 10 % reported these events. Students reported feeling more empowered to act on patient safety issues as a result of the program. Educational programs can provide medical students with a foundation for skill development in medical error reduction and help enhance an organization’s culture of Electronic supplementary material The online version of this article (doi:10.1007/s13187-015-0821-4) contains supplementary material, which is available to authorized users. * Ted A James [email protected] 1
University of Vermont College of Medicine, 89 Beaumont Ave, Given Building, Burlington, VT 05405, USA
2
University of Vermont Medical Center, Burlington, VT, USA
safety. This has the potential to reduce adverse events in complex patient care settings such as clinical oncology.
Keywords Patient safety . Quality . Medical education . Cancer care
Introduction The Institute of Medicine (IOM) first published its report on the quality of cancer care in 1999 [1], highlighting the fact that many cancer patients receive inappropriate or inadequate care. Over a decade later, overcoming the barriers to high-quality cancer care remain a daunting challenge as evidenced in the 2013 IOM report on cancer care delivery [2]. This report describes cancer care in the USA as a system in crisis due to stressors from the growing demand and complexity of caring for patients with cancer. Patient harm from preventable medical errors has been recognized as one of the main contributing factors of the problems experienced with cancer care, as well as with the health care delivery system in general [3, 4]. The conditions under which health professionals must deliver care have surpassed the ability of human memory and attention to provide adequate safeguards against patient harm. Studies demonstrate that cancer care is among the most complex of patient care systems, and specific challenges treating patients with cancer further increase the risk of adverse patient events from medical error [5–10]. For example, the rate of serious injury from radiation therapy is estimated at 1000 times the rate of adverse events observed in other complex but safe field such as commercial aviation and modern anesthesiology [11]. Likewise, the administration of chemotherapy alone is a complex and error-prone endeavor given the narrow therapeutic index of most agents, the need to calculate precise doses based on body size and laboratory results, and
J Canc Educ
the multiple individuals involved in prescribing, preparing, and administering chemotherapy [12–14]. Indeed, it was a high-publicized chemotherapy overdose case which served as one of the main stimuli for the patient safety movement [15]. Additionally, cancer care delivery often requires the coordination of multidisciplinary teams composed of individuals who may be geographically dispersed, involved only transiently in the patient’s care, and may be focused on different aspects of the cancer care plan. As in other areas of health care, communication and team work are critical in oncology and are a potential source of failure in patient care [5, 9]. The growing number of patients diagnosed with cancer in the USA coupled with an increasing number of cancer survivors raises the likelihood that a health care professional will be involved in the management of a cancer patient in some capacity during their clinical career, regardless of their specialty. Progress has been made in patient safety through the implementation of system-based strategies including safety protocols, checklists, and improved applications of technology. These strategies are designed to compensate for human error and create safety nets capable of absorbing error before it results in patient harm. Future health care professionals will require a fundamental understanding of these techniques and skills in order to ensure safe and reliable care for all patients, including those who are undergoing complex cancer care. There are relatively few reports in the literature describing even the potential impact of patient safety education on medical errors and adverse events in clinical oncology. The following describes the development and initial findings of a medical student patient safety education program. We specifically take the opportunity to discuss the potential specialtyspecific implications of patient safety education on error reduction and quality improvement in cancer patient care.
Program Description The educational framework for the patient safety program began with an evidenced-based needs assessment performed by reviewing the literature on patient safety and medical errors to uncover potential performance gaps and inform key learning objectives [16–26]. Several recommendations for curriculum content were also identified from the World Health Organization (WHO) [27], Agency for Healthcare Research and Quality (AHRQ) [28], IOM reports [14, 15], and insight provided by local faculty with expertise in patient safety science and quality improvement theory. The key topics covered in the patient safety workshop are listed in Table 1. The instructional method used for the program was determined by selecting a diverse set of teaching formats (e.g., blended-learning, case method, team-based learning, and simulation activities) in order to actively engage students, appeal
Table 1
Core instructional principles
Understanding medical error •Complexity in health care •Human fallibility •Types of error •Common adverse events System-based approaches to safety •Avoidance of blame •Standardized protocols •Checklists •Process redesign Effective teamwork and communication •Situational awareness •Mutual support •Structured communication •Closing the loop Fundamentals of quality improvement •Error reporting and disclosure •Root cause analysis •PDSA •Leadership
to multiple learning styles, enhance experiential learning, and promote problem solving and critical thinking. The program was a mandatory component of the medical school curriculum, and all students completed the educational experience. All students were also required to document completion of an online patient safety module from the Institute of Healthcare Improvement (IHI) [29] as a pre-course assignment. This allowed the students to enter the classroom with a shared terminology and common set of concepts upon which they could build. Executive summaries of the IOM reports BTo err is Human^ [3] and BCrossing the Quality Chasm^ [4] also constituted the required pre-course material. The classroom curriculum included case-based discussions and practice root cause analyses (RCA) of actual medical errors publically reported to national patient safety networks and those selected from internal institutional cases. The primary case used for discussion was a video produced by the Partnership for Patient Safety and the Harvard Risk Management Foundation, presenting a series of errors involving a healthy obstetric patient and her unborn infant. Based on actual facts, the 18-min film illustrates a systems approach to issues with teamwork, communication skills, and authority gradients leading to patient harm [30]. Discussions were facilitated using a team-based learning approach. Students then participated in simulation scenarios designed to further invoke the learning objectives of the program in an immersive learning environment. The program culminated with a large group-debriefing session
J Canc Educ
and faculty panel discussion to review practical applications of the program objectives. The combined duration of the classroom and simulation components for the patient safety program was 4.5 h. Pre-course content was made available to the students at least 1 week prior to the program. Program evaluation consisted of a standardized student feedback form with Likert and yes/no type of questions rating the importance, effectiveness, and value of the patient safety education program. Questions were also designed to solicit students’ prior experience with medical errors, behaviors of error reporting, and knowledge of system-based approaches to error prevention, and determine their level of comfort acting on medical errors (Appendix I). Descriptive and summary statistics were used to report the main findings of the student survey.
Results Implementation of the patient safety education program was successful, with the inaugural program introduced into the medical school curriculum in 2012. The program is held twice per academic year, each time to approximately half of the third-year medical school class (i.e., approximately 55–59 students). Between the study period of 2012 and 2013, an estimated 230 students completed the training program. Standard policy of the College of Medicine is to solicit feedback from a random convenience sample of students in each class. A total of 90 surveys were completed during the study period. Responses to questions pertaining to the perceived value and effectiveness of the course are listed in Table 2. Overall, the program was well received and students described the training as an important addition to the curriculum. Analysis of the student evaluation survey revealed that 59 % of students reported that they were not previously aware of system-based approaches to medical error such as root cause analysis. Furthermore, 51 % of students reported experiencing or witnessing a medical error or patient safety issue during their clinical exposure; however, only 9.8 % of students formally reported these witnessed events. Table 2 Student evaluation of patient safety program
Discussion The patient safety program was perceived as a valuable addition to the medical student curriculum. The program served as a formal introduction to the fundamental principles of patient safety and quality improvement and provided a foundation upon which to develop competencies in these essential skills. The combination of case discussions of actual medical errors and simulation scenarios effectively engaged students and enabled them to practice applying their knowledge and skills in a controlled, observed environment. Our student survey revealed that more that one half of all students experienced a medical error or patient safety issue by the third year of medical school. Whether the students were directly involved in these cases or passive observers was not known. However, only approximately 10 % of students formally reported a witnessed medical error. Lack of medical error reporting is a well-recognized problem in the patient safety literature [31, 32]. Although not discernable from the survey, the low rate of student reporting is likely multifactorial. Students may not be aware of the importance of reporting errors, may feel intimidated by the medical hierarchy, or may feel that the responsibility of reporting lies in the hands of residents, faculty, or nurses. Increasing students’ ability and willingness to report witnessed errors may provide valuable additional information for quality improvement efforts. Case reports demonstrate that medical students, an often overlooked participant in ensuring patient safety, can serve as a valuable resource for advancing safety in patient care [33]. Proponents advocate for training medical students how to recognize and actively communicate observed errors and near misses as a strategy for improving clinical performance. Our survey found that students felt more empowered to act on patient safety issues following the patient safety training program. This may be an effective means of encouraging students to act as patient safety advocates and contribute to the culture of safety within an academic organization.
Survey question item
Response
Yes/no questions Prior to the course I was familiar with root cause analysis and/or the system-based approach to medical errors I have experienced a medical error or patient safety issue during my clinical training Have you ever formally reported a medical error you experienced?
Percent affirmative 41
Likert type: Strongly agree (5) to strongly disagree (1) The session increased my awareness, appreciation and/or knowledge of medical errors and patient safety. Topic is important to my medical education. I feel more empowered to act on a safety issue as a result of this session.
Mean value (n=90) 4.3/5
51.1 9.8
4.4/5 4.0/5
J Canc Educ Table 3 Examples of patient safety concepts in oncology
Patient safety concept
Implications in oncology
Communication and teamwork
Coordination of multidisciplinary cancer team Transitions between cancer care providers Appropriate palliation/end-of-life care Critical result reporting Complications in chemotherapy administration
Medication safety
Oncology medication errors Clinical trials Catheter-associated bloodstream infection Neutropenia-related infections Delay in cancer diagnosis Wrong site surgery Specimen handling/processing Cancer screening Compliance with ambulatory oral chemotherapeutics Misalignment of treatment goals
Infection control Diagnosis Surgical safety Patient education/engagement
Next Steps
Conclusion
Since its initial implementation, the patient safety program has transformed into an interprofessional education activity by the inclusion of nursing and pharmacy students along with medical students, learning with, from, and about each other to improve collaboration and the quality of care. The program offers an enhanced focus on team training and interprofessional communication. Efforts are also underway to introduce elements of the program in the pre-clinical curriculum in order to establish a longitudinal education experience.
A targeted patient safety program can provide medical students with a foundation upon which to develop skills in patient safety. The program imparts fundamental principles of quality improvement which students will require in order to optimize patient outcomes upon entry into clinical settings. Students view this training as important to their medical education. Medical students represent a potential untapped resource in patient safety and, through training, may serve as advocates for advancing an organization’s culture of safety. These initiatives have the potential to reduce medical errors and adverse patient events in complex patient care settings such as oncology.
Implications for Patient Safety in Cancer Care The patient safety education program has been effective in increasing the awareness of medical errors and advancing the culture of patient safety in the course participants. Further results of this type of learning innovation may lead to significant changes in the focus of education for medical and other health profession students, as well as provide practical applications to improve patient safety. Issues of patient safety in cancer care may directly benefit from the ability of health care professionals to effectively employ principles of medical errors reduction and prevent adverse patient events (Table 3). For example, basic techniques for reducing medication error and standardizing safety protocols during drug administration have direct applications to preventing adverse events in chemotherapy administration [13, 14, 34]. Likewise, central patient safety issues including diagnostic error, delays in treatment, and coordination of care have implications for addressing current challenges in the quality of cancer care [35–38].
References 1.
2.
3.
4.
5. 6.
Hewitt M, Simone JV (1999) National cancer policy board. Ensuring the Quality of Cancer Care, Institute of Medicine and National Research Council Levit L, Balogh E, Nass S, Ganz PA (2013) Delivering high-quality cancer care: charting a new course for a system in crisis. Institute of Medicine, National Academies Press (US) (1999) To Err Is Human: Building a Safer Health System. Kohn L, Corrigan J, Donaldson M, eds. Washington, DC: Committee on Quality of Health Care in America, Institute of Medicine. National Academies Press (2001) Crossing the quality chasm: a new health system for the 21st century. Institute of Medicine. Washington, D.C.: National Academy Press Norton PG, Baker GR (2007) Patient safety in cancer care: a time for action, JNCI J Natl Cancer Inst Rowe M, Gallagher TH (2007) Confronting medical errors in oncology and disclosing them to cancer patients, JCO
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