At the heart of our UNC Department of Medicine, patient safety is more than a priority, it\u2019s a daily practice woven into every aspect of care. In recognition of Patient Safety Day on September 17, we highlight how our providers put patient safety into action to safeguard patients and strengthen a culture of trust, collaboration, and resilience.<\/p>\n
It\u2019s the mindset that\u00a0small mistakes, near misses, or weak signals\u00a0are important warning signs. Instead of dismissing them, high-reliability teams pay close attention because they may reveal larger vulnerabilities in the system.<\/p>\n
In the ICU, even small oversights can have significant consequences. That\u2019s why our teams approach patient care with a proactive focus on identifying risks before they lead to harm. Two initiatives, focused on infection prevention and procedure standardization, demonstrate how a proactive approach protects patients and strengthens a culture of safety. Kenton Dover, MD and Honey Jones, DNP, have championed these efforts.<\/p>\n
Central Line-Associated Bloodstream Infections (CLABSI) and Hospital-Acquired Pressure Injuries (HAPIs)<\/strong><\/p>\n The interdisciplinary nature of these quality rounds has been essential, not only reducing complications but also shifting the culture within the ICU. By creating consistent spaces for collaboration, nurses, physicians, and specialists are able to spot risks early, share expertise, and reinforce safe practices together.<\/p>\n Standardizing Endotracheal Intubation<\/strong><\/p>\n Coaching and collaborative design were critical in building this checklist and documentation process. By empowering staff to speak up and reinforcing a standardized approach, the team enhanced both provider confidence and patient safety during one of the ICU\u2019s most high-risk procedures.<\/p>\n The Outpatient Parenteral Antibiotic Therapy (OPAT ) Team, including Angela Perhac, PharmD, Terre Oosterwyk, RN, and Claire Farel, MD, recognized that the complex transition from the medical center to a patient’s home could create significant safety risks. To address these potential issues, we developed a multi-faceted strategy focused on standardizing processes and providing tools to ensure patients receive safe and accurate care outside the hospital.<\/p>\n Our efforts centered on three key areas: ensuring safe transitions, standardizing documentation and monitoring, and enhancing communication and management post-discharge.<\/p>\n Ensuring Safe Transitions to Home<\/strong><\/p>\n We created resources to standardize the handoff process and proactively identify potential safety concerns.<\/p>\n Standardizing Documentation and Monitoring<\/strong><\/p>\n We developed a suite of tools to help providers accurately and consistently manage patient care, reducing the risk of error.<\/p>\n Post-Discharge Management<\/strong><\/p>\n After a patient is discharged, we follow up to ensure continued safety. We reach out to review key information on medication administration, reportable side effects, and OPAT contact information. Our team also places a weekly OPAT clinic note with updated labs and medication adjustments to ensure consistent, safe care.<\/p>\n By focusing on these strategies and tools, the OPAT team is constantly working to mitigate significant barriers to a safe transition of care, ensuring a higher standard of safety for patients continuing their treatment at home.<\/p>\n Chest pain accounts for nearly 7 million emergency department visits every year, but most patients are not experiencing a heart attack. Traditionally, many of these patients were admitted \u201cjust in case,\u201d leading to unnecessary hospitalizations and costs.<\/p>\n\n
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\nImproving Patient Safety in OPAT Transitions of Care<\/h3>\n
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\nA Safer Pathway for Chest Pain Patients<\/h3>\n