ROSEMONT, Ill. -- The American Academy of Orthopaedic Surgeons (AAOS) is confronting patient safety with the same force that makes people become orthopaedic patients -- aggressive tackling.
"It's time for medical associations to step up to the plate and make their doctors aware of the patient safety problem and help devise systems that reduce errors," said AAOS President, James H. Herndon, MD. "The programs we're developing at the AAOS will benefit not only orthopaedic surgeons, but also all their patients."
The Academy recently formed the first-ever Orthopaedic Coalition for Patient Safety, a group consisting of general orthopaedists, orthopaedic specialists, military orthopaedists, orthopaedic nurses and representatives of the orthopaedic industry. Their goal is to promote and implement patient safety initiatives and practices within each of their organizations. The Academy's Patient Safety Committee has been instrumental in developing, monitoring and evaluating several patient safety initiatives including:
1. Sign Your Site Advisory Statement
2. Patient Safety Curriculum, Resident/Medical Student Training
3. Academy Fellow Training/Education Programs
4. Patient Safety Member Communications Program
5. Critical Incident Research - Surveying Patient Safety Near Misses
6. The "Positive Practices" Initiative: Medication Errors
7. Ambulatory Surgery Center/Practitioner Office Errors (ASCPOE)
Patient Safety Program
8. Patient Safety Web Site
9. Public Awareness Campaign
10. Patient Safety Tips Bookmark
For more information on patient safety, visit www.patientsafety.aaos.org and to receive a free patient safety tips bookmark, please send a self-addressed stamped envelope to Patient Safety Bookmark, P.O. Box 1998, Des Plaines, Ill. 60017.
The 26,047 member American Academy of Orthopaedic Surgeons is a not-for-profit organization that provides education programs for orthopaedic surgeons, allied health professionals and the public. An advocate for improved patient care, the Academy is participating in the Bone and Joint Decade, the global initiative in the years 2002-2011 to raise awareness of musculoskeletal health to stimulate research and improve people's quality of life. President Bush has declared the years 2002- 2011 National Bone and Joint Decade in support of these objectives.
American Academy of Orthopaedic Surgeons Patient Safety Initiatives:
Sign Your Site
The AAOS was among the first to call for elimination of wrong site surgery in the United States, in an advisory statement issued in September 1997, and reaffirmed in 2002. The statement reads, in part: Wrong-site surgery is ... a system problem that affects other surgical specialties as well. ... The American Academy of Orthopaedic Surgeons (AAOS) believes that a unified effort among surgeons, hospitals and other health care providers to initiate preoperative and other institutional regulations can effectively eliminate wrong-site surgery in the United States.
Eliminating wrong-site surgery means the surgeon, in consultation with the patient when possible, place his or her initials on the operative site in a way that cannot be overlooked and in a manner that will be clearly incorrect if transferred onto another body area prior to surgery. The patient's records also should be available in the operating facility.
This year, JCAHO adopted the elimination of wrong-site, wrong- patient, wrong-procedure surgery as one of its National Patient Safety Goals. It recommended that there be a preoperative verification process, such as a checklist, to confirm that appropriate documents such as medical records and imaging studies are available. It also recommended the AAOS idea of marking the surgical site, and involving the patient in the marking process.
Patient Safety Curriculum, Resident/Medical Student Training
Long-term improvement in the safety of patients will be realized only after those in training develop a heightened awareness of the problem, and understand the types of medical errors as well as the most common causes of these errors. This is best accomplished through education beginning in residency programs and medical schools. Patient safety education and discussion is not a consistent component of medical education in the United States at any training level. If educated early, these up-and-coming physicians will utilize established "best practice" models and create their own systems to avoid injury to their patients. When medical errors do occur, they will possess the skills needed to quickly and effectively respond to these errors. A special task force is currently designing the patient safety curriculum for approval this December and implementation summer 2004.
Academy Fellow Training/Education Programs
AAOS is implementing Fellowship education and training via a two-pronged approach: patient safety education taking the form of annual meeting programming, publications, topical articles and Advisory Statements that promote safe practices, and secondly, a series of "Positive Practices" initiatives that are tools designed to be incorporated into the surgeon's daily practices and surgical procedures, or in his/her interactions with patients or the surgeon's surgical team.
Patient Safety Member Communications Program
The goal of this program is to provide AAOS members with timely and useful information that could reduce the potential of medical errors occurring in orthopaedic practice. Patient Safety Member Alert is an email alert sent to quickly notify members about safety problems with drugs, devices, or biological products. The AAOS works in concert with the U.S. Food and Drug to disseminate information about orthopaedic device, drug, or biological product recalls and safety alerts.
In addition, an electronic newsletter, Patient Safety Update, is distributed quarterly to the membership with information on topics such as patient/physician communication, practice guidelines and standards as well as the overall progress of Patient Safety Committee.
Critical Incident Research - Surveying Patient Safety Near Misses
AAOS is in the process of conducting research to obtain a basic understanding of the causes of orthopaedic error and systems failure. The process includes one-on-one confidential interviews with fourth and fifth year orthopaedic residents over multiple years in order to create a database that would help shape future patient safety educational initiatives.
The "Positive Practices" Initiative: Medication Errors
Medication errors account for a large portion of medical errors each year, in fact preventable adverse drug events cost the nation an average of $2 billion annually. The AAOS Positive Practice Initiative is designed to provide recommendations and tools for orthopaedists to use to decrease the incidence of medical errors. Activities include the development of doctor customized standing order sets for frequently performed procedures, an advisory statement on prescription drug errors and how to prevent them and a consumer version of herb-drug chart (available at www.orthoinfo.org ). The AAOS also filed a formal comment to the FDA to endorse the implementation of bar coding labeling for pharmaceuticals.
Ambulatory Surgery Center/Practitioner Office Errors (ASCPOE) Patient Safety Program
Advances in the science of orthopaedic surgery have resulted in less invasive, less traumatic procedures. These procedures are often performed in outpatient settings, specifically ambulatory surgery centers (ASCs) and the orthopaedic surgeon's office. With increasing numbers of procedures performed in ASCs and the practitioner's office, the potential for errors rise proportionately, most specifically relating to selecting the appropriate patient for treatment at the ASC and practitioner's office. The AAOS is encouraging all ASCs to conduct complete histories and physical exams during the patient screening phase in order to enable the physician to determine if the patient is appropriate for the treatment. This will reduce anesthesia errors and better prepare them for potential complications due to the patient's condition.
Patient Safety Web Site
Patients can help make their healthcare experience safer by becoming active, involved and informed members of their healthcare team. The more information patients have about health care, the better they can make decisions about what is best for them. The AAOS patient education web site, Your Orthopaedic Connection, is a key tool in improving the public's awareness of issues surrounding patient safety. Several articles and tips are featured as well as links to the AAOS Patient Safety Web site that has useful information and resources for both patients and healthcare practitioners.
Public Awareness Campaign
The AAOS produced a multi-media public service campaign projected to reach nearly 120 million people with the slogan "Take Care! Patient Safety is No Accident." The campaign was launched at Annual Meeting in February 2003 and will be running nationally for the next two years. The public service ads are also displayed in airport posters throughout the country.
Patient Safety Tips Bookmark
The AAOS is distributing a bookmark with tips patients can use to protect themselves from becoming victims of medical errors. The public can also find these tips as well as many other helpful articles on patient safety on the 'Your Orthopaedic Connection' section of the AAOS web site.
Source: American Academy of Orthopaedic Surgeons