Areas for greatest impact
The Institute’s will work broadly to improve all aspects of patient safety and health care quality. But after analyzing the highest priority needs of the region, and understanding our core strengths, the Institute has identified three priority areas with the highest potential for short term impact on health. These areas are:
Hospital in-patient facilities have been the traditional focus for patient safety activities. While in-patient safety remains a critical area for improvement, modern medical care is becoming increasingly delivered in an ambulatory setting – whether that be ambulatory day surgery, outpatient chemotherapy, home-based cardiac rehabilitation, or numerous other programs. In addition, patients who are admitted to the hospital are discharged earlier than ever, with increasing amounts and complexity of care being provided outside of the hospital walls. As such, the Institute will have as a primary area of focus “patient safety in the outpatient ambulatory environment,” reflecting the ongoing trend in how American health care will be delivered in the future.
In 2013, there were 44.7 million Americans older than 65 years, representing one in seven Americans. By 2060, that number will grow to nearly 100 million. Our longer lives are accompanied, unfortunately, by greater challenges related to patient safety. Frequently, older adults have multiple chronic diseases, are on multiple medications, undergo invasive procedures, and are cared for in multiple settings (hospital, nursing facility, home care). Each of these factors, along with patient factors such as poor eyesight and balance, increases the risk of medical error and preventable harm. UNTHSC, known nationally for its excellence in geriatric care, has chosen to accept the complex challenge of patient safety for older adults, and therefore geriatrics is a major focus area of the Institute.
Precision Medication Safety
An adverse drug event (ADE) is defined as harm experienced by a patient as a result of exposure to a medication, and ADEs account for nearly 700,000 emergency department visits and 100,000 hospitalizations each year. ADEs affect nearly 5 percent of hospitalized patients, making them one of the most common types of inpatient errors. Ambulatory patients may experience ADEs at even higher rates. Transitions in care are also a well-documented source of preventable harm related to ADEs.
Confronting opioid abuse
Moreover, we face new critical challenges related to medication safety, such as the increasing use and abuse of opioid pain medications. In 2010, over 16,600 U.S. deaths were attributed to opioid medications. Now, over 240 million prescriptions for opioids are dispensed every year in the United States. Too frequently, patients become dependent on prescription narcotics for long periods beyond their medical need. This leads to non-prescription abuse of opioids in as many as 10 million Americans each year. Even worse, non-medical use frequently leads to abuse of illicit, often lethal street drugs like heroin. Current estimates are that over 900,000 Americans use heroin, an almost 150 percent increase in 8 years. But this progression from medical use, to non-medical abuse, to addiction can be interrupted before it starts, by appropriate, personalized approaches to pain control that use opioids for the precisely correct time, at the correct dose, and then are weaned when other pain alleviation strategies can be substituted.
Achieving the right dose
Finally, research has shown that the correct dosages of powerful medications, like anticoagulants (“blood thinners”) vary widely among individual patients. As a result, many patients receive a dose that is too high for them, risking complication. Others receive a dose that is too low, and therefore the drug does not provide full benefit. Much of this variability in dosing can be predicted by understanding the patient’s genetics, diet, lifestyle and other factors. Therefore, a major focus of the Institute is to perform research, education and practice changes that will assure that the dose provided to patients is right for that specific patient, not just an average patient in a textbook. Not only will adverse reactions be decreased, but the precise dosages will allow the full benefit of the drug being prescribed.
This page was last modified on March 1, 2018