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improving patient safety care

Improving patient safety wherever care occurs

By: Lillee Gelinas, MSN, RN, CPPS, FAAN

Nurses, providers, and pharmacists collaborate to improve patient safety.

By Lillee Gelinas, MSN, RN, CPPS, FAAN

Patient safety is critical to quality care. Since the publication of the Institute of Medicine’s landmark report, To Err is Human, 15 years ago, most patient safety efforts have concentrated on acute-care settings. However, most healthcare is delivered outside of hospitals in settings where safety issues are quite different than those in hospitals. Ambulatory settings are environments susceptible to safety hazards. For example, although little research exists on medical errors in primary care, studies indicate that medication errors are common and that adverse drug events occur in up to 25% of patients within 30 days of being prescribed a drug.

Problem of polypharmacy

improving patient safety care postMy areas of responsibility at the University of North Texas Health Science Center include several ambulatory care clinics. My attention to safety, which always has been an area of professional interest, has been heightened by understanding just how different ambulatory care is from acute care. Did you know that a key medication safety issue in ambulatory settings is polypharmacy in older adults? American Nurse Today has published many articles on polypharmacy, and based on what I experience every day, we can’t stop bringing this important nursing issue to the forefront.

Adverse drug events continue to increase in the geriatric population, who account for more than one third of all prescription medications in the United States. Seniors are at especially high risk for medication errors because of their high incidence of polypharmacy. The unacceptable level of harm experienced by this vulnerable group in both acute and ambulatory settings must change through evidence-based practices and new interventions that hold promise for sustainability.

Collaborative care

Medication-related patient safety is difficult to manage in the time-constrained, primary care environment. Current research provides no reliable guidance on how to improve prescribing, medication management, or patient self-management. Most studies conclude that more and better research is needed to improve patient safety. This conclusion also is true when it comes to pharmacist-led interventions.

Based on the current state of the literature and the reality of current practice, the team where I work is piloting an intervention that capitalizes on the interprofessional team concept and expands the role of the pharmacist in the clinic setting.

Focusing on patient education and medication adherence, the pharmacist becomes a central part of the care team. The intervention starts by identifying high-risk patients and creating a safety net around them by combining the talents of the provider, nurse, and pharmacist. This strategy also promotes “top of license” practice for each profession.

New challenges, new practices

New challenges drive us to try new practices, especially when past practices don’t work anymore in a fast-paced, consumer-centric world. Nursing always steps up to the plate when the going gets hard, and bringing our interprofessional colleagues to the table to create solutions is rewarding for them, for nursing, and most of all for patients. As more care moves from inpatient settings to settings all across the healthcare continuum, the practice rigor and discipline that characterizes our acute-care experience can help transform post-acute care. I see that reality through the role of nurse practitioners all the time.

If you have a successful acute-care to ambulatory care innovation or story to share, email me at lgelinas@myamericannurse.com. No matter where it occurs, patient safety is critical to quality patient care.


lillee gelinas msn rn cpps faan editor in chief





Lillee Gelinas, MSN, RN, CPPS, FAAN

1 Comment.

  • Meghan Johnson, RN
    July 23, 2018 9:58 am

    In the July 2018 issue, Vol. 13 No. 7, readers are brought to the attention of polypharmacy and the risks it ensues, particularly to the elderly population, in your article “Improving patient safety wherever care occurs”. When you state that, “The unacceptable level of harm experienced by this vulnerable group in both acute and ambulatory settings must change through evidence-based practices and new interventions that hold promise for sustainability”, I simply cannot agree more. Safeguarding that the elderly population receives the appropriate recipe of pharmaceuticals is certainly a difficult task in today’s healthcare environment.

    My purpose for writing to you today is to express my support of the topic and ensure my own experience with polypharmacy is recognized. In order to properly care for these vulnerable individuals, we must increase the awareness of inappropriately implemented polypharmacy and the risks thereof. I myself have been a victim of the “prescribing cascade” in which the symptoms I was experiencing from already prescribed medications were viewed as a new disease and further treated with freshly prescribed medications, leading to additional symptoms and ultimately poor adherence. The Journal of International Oral Health, 2014, provides a wonderful article on polypharmacy and how it is a global risk factor for elderly people. With the evidence-based information the article provides, nurses are supported in their opinion that the complications of polypharmacy cannot continue to go unnoticed.

    I cannot express how thankful I am that nurses like you exist to help with this contemporary nursing issue. Often, patients are left unaware of the reasons for taking the medications and the side effects they may experience as a result of taking these drugs. As an association, nurses must continue to share their case reports and what self-employed solutions were implemented in order to reduce the problems associated with polypharmacy. Let’s initiate a healthcare environment where fear of polypharmacy is non-existent.

    Meghan Johnson, RN

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