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The Evolution of Patient Safety

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The editors at Accelerated Nursing Degrees decided to research the topic of

The Evolution of Patient Safety

Primum non-nocere is the motto by which all physicians practice. ('First, do no harm').

The focus on patient safety has evolved over the past 2,000 years from focusing on cleanliness through sterilization, to single-use surgical instruments, to the present day focus on safety through more effective and thorough management of information relating to the patient - information that will lead medical providers to make smarter treatment decisions, ultimately resulting in greater patient safety and reduced mortality rates.

The Importance of Patient Safety:

- With 98,000 annual deaths, medical errors are 5th leading cause of death in the U.S.
- Simply adopting health information technology (HIT) could widely reduce risks and save $81 billion annually.

The Patient Safety Timeline

Pre-20th Century

- 130 - 200 AD: Boiled Instruments
- Galen the Greek was 2nd to Hippocrates in fame. As a leader in medicine of the time, he was one of the first to boil medical instruments prior to caring for his patients; wounded Roman gladiators.
- 1847: Hand washing and Fingernail Scrubbing
- It's hard to believe that handwashing was not a common practice until the 1800's, but it took a Hungarian obstetrician named Ignaz Semmelweis to advocate the clinical value of handwashing and fingernail scrubbing.
- 1890's: Development of the Germ Theory of Disease
- The germ theory of disease (pathogenic theory of medicine) postulates that microorganisms are the source of numerous diseases. The theory itself was tentative at first, but is now a pillar of modern medicine and microbiology. Antibiotics and hygiene practices are all rooted in the study of germs.

Turn of the 19th Century: Autoclave

- Autoclaves are found in hospitals and laboratories among other places that need to sterilize tools. Single-use items have become popular so as to avoid the need to autoclave. Some notable examples are:
- Hypodermic needles
- Forceps
- Needle holders
- Scalpel handles

20-21st Centuries and Beyond

- 1920's The Development of Health Records
- Physicians realized that documenting the history of patients would be very beneficial to both the physician and the patient. Keeping this information readily available made it far easier to treat patients based on their health history.
- At first, these records were kept on paper. This explains why their managers were referred to as 'record librarians.'
- 1949: Disposable Syringes
- While syringes had been around in one form or another since the 1600's, the disposable syringe was invented centuries later by Arthur E. Smith to prevent the spread of disease between patients.
- 1978: Personal Health Records
- The first mention of a 'personal health record' was used in an article by PubMed. Personal health records were meant to provide a wide range of historical data about a patient including:
- Allergies
- Chronic diseases
- Family history
- Past illness
- X-Rays
- Lab Results
- Prescriptions
- Surgeries
- Late 1990's: Electronic Health Record (EHR) The Electronic Health Record (EHR) reduces error by providing comprehensive info on clients. It includes all of the information above as well as:
- Where patients pick up prescriptions
- Reminders of important dates concerning patients
- Access to patient information from any location
- Early 2000's: Active RFID platform
- These platforms are based on audio recorded electronic tags verifying the reliability of patient information. There are different options available:
- Identification by request of health care personnel using scanners.
- Automatic identification upon entry of patient.
- Identification through proximity to the patient
- Hospitals using this system include:
- Hospital La Fe in Valencia (Spain)
- Wayne Memorial Hospital (USA)
- Royal Alexandria Hospital (UK)
- 2006: Computerized Provider Order Entry (CPOE)
- It's estimated that every hospitalized patient is at risk of 1 medication error per day. The CPOE reduces this risk by 80% and decrease patient harm by 55% by taking away the opportunity for human error in administering prescriptions to patients.

Today: Complete Safety Medication System

- This latest system relies on a simple bar code system to dispense drugs and could prevent 25% of errors. Unfortunately, as technology evolves, doctors fear adopting new systems for fear that they will be outdated just a few years later.

While medical safety has evolved over time, adopting new technologies can truly take it to the next level.