Integrating the best practices from the new Center for Medicare & Medicaid Services (“CMS”) Safer Guide into your electronic health record (“EHR”) configuration can provide significant benefits beyond compliance. These recommendations provide a roadmap to reducing patient care errors, which leads to a reduction in patient harm, medical malpractice and other financial risks.
Of the nine SAFER guides, the four “Clinical Process Guides” (#6-9) contain many powerful countermeasures that can be applied across the continuum of care. They focus on patient assessment, diagnostic decision making, ordering and interpreting tests, and tracking provider-to-provider communications.
While the new CMS requirements require annual self-certification of whether you have met each specific recommendation, there is currently no penalty associated with a negative response. However, investing time and resources to meet the recommendations of the SAFER guide can fill critical gaps in your facility’s patient safety process and program.
This can provide a potential competitive advantage by reducing harm to patients, limiting medical liability, increasing clinician and staff confidence and satisfaction, and protecting your company’s brand in the marketplace.
Where claims of malpractice arise in the care process
Throughout patient care, there are many areas of risk that can be mitigated by optimizing your EHR system, as shown in Table 1. The left column shows a typical 12-step “patient journey”. The column to the right contains the frequency of each discrete step associated with medical malpractice claims from a white paper published by CRICO, the malpractice and risk prevention research arm of Harvard Hospital Systems. Data was extracted from a national cohort of high-performing hospitals contributing cases to CRICO’s comparative database:
|step of the nursing process||% of cases of malpractice|
|1. The patient notices the problem and seeks help||1%|
|3. Patient assessment/assessment of symptoms||31%|
|4. Diagnostic processing||35%|
|5. Sequence of diagnostics/laboratory tests||31%|
|6. Conducting Tests||3%|
|7. Interpretation of the tests||23%|
|8. Receiving/transmitting test results (to providers)||5%|
|9. Doctor’s follow-up care of the patient||18%|
|10. Referral Management||21%|
|11. Provider-to-Provider Communications||12%|
|12. Patient compliance with follow-up plan||17%|
Table 1: Care history map with associated frequency of medical claims.
Where the SAFER guides have an impact on patient safety:
Each SAFER Guide recommendation can impact more than one treatment step, thereby multiplying its impact in preventing patient harm and reducing financial risk. The following table shows two sample recommendations from each of the four SAFER clinical process guides and links these recommendations to the individual treatment steps that, if implemented, can improve safety and reduce risk.
Table 2 provides examples that demonstrate the link between SAFER Clinical Processes Guide recommendations and the reduction of common medical errors throughout the patient journey. The powerful risk and safety measures built into SAFER clinical process guidelines can help your organization reduce patient harm and lower financial risks associated with errors in care. These improvements can translate into a competitive advantage through reduced patient harm, reduced financial risk and increased employee satisfaction.
|Safer Clinical Process Guide||SAFER Recommended Practice||Effect of the treatment step|
|#6 Patient Identification||An enterprise-wide master patient index that includes patient demographic information and medical record numbers from different parts of the same organization to identify patients.||1, 5, 6, 8, 10|
|#6 Patient Identification||The information needed to accurately identify the patient is clearly displayed on all computer screens, wristbands and printouts.||5, 7, 8, 9, 11|
|#7 Computerized vendor order entry with decision support||Coded allergen and reaction information or No Known Allergies (“NKA”) is entered and updated in the EHR prior to each order entry.||2, 4, 5, 9|
|#7 Computerized vendor order entry with decision support||Evidence-based ordering sets are available in the EHR for common tasks/conditions and are regularly updated.||5|
|#8 Reporting test results and follow-up||Workflows most prone to mishandling of test results, especially critical ones, are identified. Backup procedures ensure that test results are received by someone responsible for the care of the affected patient.||5, 6, 8, 9|
|#8 Reporting test results and follow-up||Automated, non-disruptive result notifications (also called “in-basket alerts” or “flags”) are limited to those that are clinically relevant to minimize alert fatigue.||3, 4, 11|
|#9 Clinic communication||Workflows most prone to mishandling of test results, especially critical ones, are identified. Backup procedures ensure that test results are received by someone responsible for the care of the affected patient.||5, 6, 8, 9|
|#9 Clinic communication||Automated, non-disruptive result notifications (also called “in-basket alerts” or “flags”) are limited to those that are clinically relevant to minimize alert fatigue.||3, 4, 11|
Table 2: Expected impact on the nursing process of implementing example recommendations from the SAFER Clinical Process Guides, numbers 6-9.