DoD Places New Emphasis on Patient Safety

A February White House release unveiled several initiatives to increase patient safety in the United States. The White House specifically called for several actions within the Defense Department.

“One of our top priorities is providing not only quality healthcare, but safe healthcare,” said Dr. Sue Bailey, assistant secretary of defense for health affairs. She said DoD medical experts are focusing on three main areas: adverse-event reporting, an improved pharmacy database, and computerized patient records.

DoD already has stricter reporting requirements than most states, Bailey said, but now the department is attempting to take that even further. “We report healthcare providers to the National Practitioners Databank when appropriate. And we report sentinel events that may result in loss of life or limb, events where someone may die or when a surgical event goes terribly awry, to the Joint Commission on Accreditation of Healthcare Organizations,” she said.

Now DoD is attempting to implement a reporting system for less serious mistakes so healthcare providers can learn from them and prevent them in the future. “We need to provide an environment of learning that is nonpunitive, where there are no reprisals, so we can not only prevent an error from occurring today, but prevent lots of errors from occurring tomorrow,” Bailey said.

The department is even taking the extra step of reporting “near misses,” modeled after the Air Force’s practice of studying close calls in aviation.

“Did we almost give the wrong medication? Did we almost make a mistake?” Bailey said. “What are we doing that we nearly had a serious accident? Everyone has to be willing to identify, on a voluntary basis, an error that occurred or almost occurred.”

Another area of further improvement is pharmacy services, Bailey said. DoD is now planning its new Pharmacy Data Transaction System, which will send up a computerized red flag to tell the pharmacist there could be a problem with a patient’s prescription. The real advantage of this system is that it will combine the information from military pharmacies, the National Mail Order system, and network retail pharmacies. The current system can only identify potential prescription problems in military facilities and it does not link the military facilities.

“This is particularly important for our people in the military, who move from place to place,” Bailey said. In the future, she said, the system will alert pharmacists to possible adverse drug interactions, duplicate prescriptions and past allergic reactions.

A third area being examined is medical record keeping. “We realize in the military that medicine has come a long way, but our ability to record what’s going on medically has not come along as quickly as we would like,” Bailey said. She explained that this is true in the private sector as well, where there are “storerooms filled with x-ray films from years ago.”

Bailey suggested advancements such as teleradiology, digital information, and computerized patient records would help offset this problem. To that end, DoD is in the final stages of developing and testing the Composite Health Care System II, a computerized patient record. It will be tested this year at Tripler Army Medical Center, Hawaii; Portsmouth Naval Hospital and Langley Air Force Base Hospital, both in Virginia; and Seymour Johnson Air Force Base Hospital, N.C. The system will be phased in throughout DoD over the next three years.

“All of us who ever wore the uniform remember trekking around with our own records from place to place," Bailey said. That's not the best or the safest system, and it's one that’s going to change, she remarked.

“We really need to know what’s happening when individuals come in, whether for an episodic visit or so we can understand how to promote good health for them and prevent problems in the future,” she said.

She said part of safety in medicine is continuity of care. “We need to know what happened to you last time you came in. We need to know your health history,” she said. “We need to know your family’s health history in order to make good decisions about a diagnosis today and treatment in the future.”

One area the military medical system leads the civilian sector is in the number of hours physicians in training are allowed to work. In addition to limitations on work hours, military interns, residents and other trainees are not allowed to moonlight.

“We control the hours they work so they’re more alert and we keep errors to a minimum,” Bailey said.

She said human error is always a factor in patient safety, but DoD is taking steps to minimize it. “We’re restricting the hours they work so they can be fresher, smarter and safer for our patients,” Bailey said.