Research continues to show that patients do not remember - or understand - everything they are told when they are discharged from medical facilities.  An earlier Ix Blog post on health literacy and patient recall discussed findings such as 14% of patients being unaware of the fact that their physician had prescribed a new medication for them.

A more recent article in the Annals of Emergency Medicine found a strong tendency for patients to overestimate their understanding of emergency department (ED) care and discharge instructions.  Patients had more difficulty understanding post-ED discharge care instructions than information about the diagnosis and cause of their illness, ED care, or return instructions.

This research finding suggests that asking patients whether or not they understand medical instructions is not an adequate way to measure comprehension.  Although handwritten or printed discharge instructions are considered a best practice, this should not be the only method of communicating discharge instructions to patients.  Asking patients to explain information or instructions in their own words may be a better strategy for assessing patient understanding and providing clues about where to focus further discussion and explanation.

A recent University of California study reports a striking increase in fatal medication errors (FMEs) over the last 22 years.  The study examined accidental deaths occurring at home, but also included deaths occurring away from home.  The deaths were further categorized into those involving alcohol and/or street drugs and those not involving alcohol and/or street drugs.

The most striking increase in FMEs was with those that occurred at home, especially those involving alcohol and/or street drugs (a 3,196% increase).  FMEs at home, not involving alcohol and/or street drugs increased by 564%.   FMEs that occurred away from home involving alcohol and/or street drugs increased by 555%.  Finally, FMEs away from home, but not involving alcohol and/or street drugs increased by 5%.

Shifts in health care have resulted in reduced professional oversight and increased patient responsibility for monitoring medication use.  Information therapy prescriptions can play a critical role in complementing medication prescriptions.  If consumers are expected to manage increasingly complex - and potentially dangerous - drug regimes, they need access to tailored information to help them do so safely.

Last week, I attended the launch of the World Health Organization (WHO) “Safe Surgery Saves Lives” campaign. It’s an impressive international project that has tremendous potential for reducing surgical errors by the simple inclusion of a checklist into the process of surgical care.

As the initiative’s lead, Harvard surgeon and noted mainstream author Atul Gawande said, the idea is to borrow from the processes adopted by the much safer airline industry. Checklists went a long way in reducing flight errors so long ago that they are now fully ingrained in the process.

The Surgical Safety Checklist is brilliant in its simplicity and in the way it directly addresses many problems that arise with surgery, but I also think there’s a big missed opportunity on WHO’s “first edition” of the checklist. The third column–the “Sign Out” process–doesn’t specify any patient engagement. The closest it comes is, “Surgeon, anaesthesia professional and nurse review the key concerns for recovery and management of this patient.”

My understanding from people involved in the process was that the first stage of the campaign specifically decided to focus on the “intra-operative” aspects of safe surgery to the exclusion of patient participation and education. No doubt there are plenty of errors that can be solved by getting the surgical team all on the same page, but failure to engage patients is a major lost opportunity.

As WHO prepares for its “second edition,” I hope that at the very least, they add an additional box to check on the “Sign Out” column of the checklist that would read, “Patient’family provided an information prescription regarding instructions for post-operative management and what signs should trigger contact with providers or other actions.”

With Consumers Advancing Patient Safety President Susan Sheridan advising WHO, I know that they are getting excellent and passionate guidance about consumers’ information needs. I just hope that they listen to it as they go forward to maximize the potential impact of the Safe Surgery Saves Lives campaign.