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Q & A: Promoting Patient Safety: Interview with Robert Bayly, MD

 ROBERT-BAYLY-2x2.5As Vice President of Quality and Patient Safety at JFK Medical Center in Edison, NJ, Robert Bayly, MD, draws on everything from the latest scientific research and national guidelines to his experience as a critical care physician to implement programs that protect patients' well-being during their hospital stay. In a recent interview with nj.com, Dr. Bayly discussed both the scope of patient-safety issues on a national level and the initiatives that have caused JFK Medical Center to be recognized for its leadership in this area.

Q. It seems that every few weeks there is a news report about a patient-safety issue at a hospital somewhere in the United States, whether it be an infection being spread within the institution or some sort of error that led to a patient receiving the wrong drug or being injured. Can you give us a sense of the extent of this problem?
A. In 1999, the Institute of Medicine released a report estimating that 98,000 Americans die each year due to preventable medical mistakes, whether in the hospital setting or elsewhere. That statistic is somewhat dated, but I share it because the Institute's report really focused public attention on this issue. Since then, great strides have been made, but much more remains to be done. More recent reports, using somewhat different criteria, put the number of avoidable deaths even higher. Meanwhile, to look at just one aspect of the overall issue, the Centers for Disease Control and Prevention (CDC) reported that in 2011, 1 patient in 25 acquired an infection while in the hospital. That amounts to roughly 722,000 health-care associated infections, or HAIs, and the CDC estimates that 75,000 people with HAIs died during their hospitalizations that year, whether due to the HAI itself or another cause.

Q. Those numbers are startling, but you said that improvements are being made?
A. The numbers are startling, both in their own right and because we think of hospitals as places where you heal and recover, not acquire a new illness or injury. And, of course, the great majority of patients who are hospitalized do not encounter any of these problems, but we need to work continuously to further reduce the number of infections, injuries, and other issues.

Improvements are being made on several fronts, and many of them are being driven by the adoption of evidence-based protocols that every member of the team follows to prevent a mistake, an injury, or the transmission of infection. The use of electronic medical records, or EMRs, is a huge help in this regard, because each member of the care team has access to information about the patient and the care he or she is receiving. These EMRs also have a number of built-in safety features, such as alerts that warn a nurse about a patient's allergies or that flag a possible drug-drug interaction when a physician wants to add a new drug to the patient's regimen.

Q. We've talked a bit about infections acquired in the hospital and medication errors, but what are some of the other safety issues involved?
A. There are many, but some of the other major ones include preventing falls, avoiding the development of pressure ulcers – commonly referred to as bed sores – and preventing blood clots, particularly in patients who have had major surgery.

Q. JFK Medical Center has been recognized for its leadership in this area, with the independent organization The Leapfrog Group recently awarding JFK Medical Center an "A" for patient safety for the seventh reporting period in a row. What are you doing to achieve this kind of success?
A. We've developed a number of programs to address specific issues, but I think the main thing we've done is develop a multi-disciplinary approach in which every member of the care team has a voice, has a role, and has a responsibility. We have an office of Quality and Patient Safety staffed with some very talented people, but our office doesn't just issue directions to front-line clinical personnel. Instead, we identify everyone who has a role to play in patient care, and then we bring those people together to review the latest evidence and guidelines and to discuss how to best integrate the science and the guidance into everything we do. When people know not only what they're supposed to do, but why and why it matters to patients, they are fully invested and committed. Similarly, when you draw upon each team member's knowledge and experience, you come up with approaches that reflect the reality of day-to-day care and, as a result, are very effective.

Q. What are some of the programs you have implemented to promote patient safety?
A. One example is our closed-loop process for guarding against medication errors. When a physician prescribes a drug for one of our patients, he or she does so via a computerized physician order entry system. The hospital pharmacy reviews the prescription to ensure that there are no issues with drug-drug interactions, allergies, or other potential problems. We then use robots for the actual dispensing and delivery to the correct location, and when the medication reaches the floor, a nurse uses a barcode scan to confirm that it is the right medication, in the right dosage, for the right patient.

We also follow nationally validated protocols specifying why, when, and how to insert and remove central lines and catheters, which can be sources of infection. We've made substantial strides in preventing deep vein thrombosis, or the development of blood clots in the legs, through use of a protocol that begins with a nurse performing a risk assessment on each patient and that then involves implementation of preventative measures individualized to that patient's situation. Similarly, we've made substantial progress in preventing the development of pressure ulcers through a system of risk assessment, simple preventive steps, and peer rounding and review.

Q: What can patients and their families do to help avoid some of these problems?
A. Ask questions. That is perhaps the first and most vital step. If you're being given a medicine, ask what it is and what it is for. Ask about potential side effects and interactions with other drugs. If you have a concern, raise it. In addition to getting information, it's also important that you give information. Make sure that your physicians, nurses, and others taking care of you know how you are feeling and any symptoms you are experiencing. Tell them about your medical history, your medications, and anything else you think may be relevant. Obviously, if a patient is gravely ill or has dementia or some other cognitive difficulty, the family or other caregivers have to be the ones who provide this background. Even when patients are fully capable of providing information, however, it's helpful for the family to be fully informed and involved. In short, when it comes to patient safety, knowledge truly is power, and the more the patients knows, and the more the hospital's care team knows, the better able we are to take good care of you and avoid any problems.