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What’s New in the
Patient Safety World
August 2022
Visitors – Good or
Bad?
Restrictions on visiting patients may be due to legitimate
reasons (eg. a COVID-19 outbreak or other contagious
disease outbreak). But often we end up restricting visitors for reasons that
are inappropriate or even selfish. We often just don’t want to be interrupted
by questions from visitors. We’ve even seen physicians who round early in the
morning to avoid having to speak with relatives or other patient visitors!
But visitors can also be helpful. They can assist the
hospital staff with things like feeding patients. We often recommend that
relatives or close friends sit in the room with patients who have delirium. And
they can often serve to ensure that a patient understands instructions when the
patient might be otherwise distracted or cognitively impaired.
So, are visitors good or bad? Researchers at the
Pennsylvania Patient Safety Authority actually looked
at this. Sanchez et al. culled information from patient safety reports from 92
hospitals in Pennsylvania (Sanchez
2022). Not surprisingly, they found visitor behavior might have good or bad
influence on patient risks.
They found evidence of helpful visitor behavior. For
example, visitors often helped reposition patients, helped them ambulate,
helped them gain balance, and even escorted patients within the hospital in
some cases. They identified instances where visitor behaviors prevented events such
as falls, administration of incorrect medication, or allergic reactions from
occurring.
But some other behaviors might be good or bad. For example,
they might give a patient something potentially harmful or they might take such
an item away from a patient. Or they might alert staff to a potential safety situation or they might distract staff from other
responsibilities.
And some behaviors may always be detrimental, such as powering
on or off devices or equipment, disconnecting equipment, or changing placement
of equipment. The equipment or devices most frequently manipulated by visitors
were bed or chair alarms and intravenous (IV) catheters.
Some specific detrimental actions they found included:
- Patient was given a home or over-the-counter medication
- Food given to or removed from a patient was not consistent
with their prescribed diet, was a known allergen, or was otherwise
potentially harmful to the patient
Of course, the classic detrimental action by a visitor is
manipulating a PCA (patient-controlled analgesia) pump (see our many columns on
PCA safety listed below).
Sanchez et al. suggest some potential safety strategies
targeting visitor behaviors:
- Display warning and instructional
signage
- Implement a policy that
infusion pumps must be locked when appropriate, which could prevent
visitors from manipulating the device.
- Use infusion pumps with
auto-locking keypads, when appropriate, which could prevent visitors from
manipulating the device.
- Develop and implement
educational programs for visitors.
- Bed or chair alarm
manufacturers should consider designing and incorporating a feature that
locks the alarm setting, which could prevent visitors from manipulating
the device.
They note that development and display of warning and
instructional signs require minimal effort and could be designed to impact
numerous behaviors and event types. The article has a nice table with design
recommendations for effective signage.
Overall, this is an excellent contribution to a topic we
don’t pay enough attention to.
Other Patient Safety
Tips of the Week pertaining PCA safety:
- January 4, 2011 “Safer Use of PCA”
- May 12, 2009 “Errors With PCA Pumps”
- September 6, 2011 “More Tips on PCA Safety”
- February
21, 2012 “Improving PCA Safety
with Capnography”
- Tools: PCA Pump Audit Tool
and the PCA Pump Criteria
References:
Sanchez CE, Taylor MA, Jones R. Visitor Behaviors Can
Influence the Risk of Patient Harm: An Analysis of Patient Safety Reports From
92 Hospitals. Patient Safety 2022; 4(2): 70-79
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