Are Advanced Directives a Patient Safety Issue?
A great man died this week.
Most people won’t know him. He was a member of the congregation I have
belonged to for over 25 years. He was diagnosed with cancer that quickly
took his life in a matter of months after the diagnosis.
According to the Society to Reduce
Diagnosis in Medicine there are an estimated 40,000 – 80,000 deaths annually in
the Unites States from diagnosis errors. Diagnostic error is responsible
for billions of healthcare dollars for inappropriate care, and is the leading
cause of medical malpractice claims.
As the
patient, a prominent and well loved member of a
close community, quickly became sicker and weaker, his wife was
forced to start making decisions. What doctors are the “best”, what
hospital should they use that would support their wishes of care and as things
progressed quickly, what to do now that he had to leave the hospital;
nursing home, rehab or hospice? Does he need at home care or should
he be in a facility that he could get care? What could they afford and
now that he is weaker, what would he want? What could his wife live
with? Could she really take him home to overwhelm her life and
home? What does it all mean and why, oh why couldn’t his lovely wife just
sit at his side and hold his hand as the end of his life comes to a
close?
How do we make these decisions
before we need it?
How do we want our end of life care
to be?
Is this a patient safety
issue?
I put the question out there because
I struggle myself to explain how advanced directives or living wills fall under
the heading of “patient safety”. Patient safety, as described by the
corporate world is very different than that of the advocate / activists side.
According to an 18 page paper by
some of our patient safety leaders; What Exactly is Patient Safety; quality
is described as three parts, underuse, overuse and misuse. The term misuse became the term for conceptualizing patient
safety as a component of quality.
Patient safety is a
discipline in the health care sector that applies safety science methods toward
the goal of achieving a trustworthy system of health care delivery. Patient
safety is also an attribute of health care systems; it minimizes the incidence
and impact of, and maximizes recovery from, adverse events.
The National Patient Safety Foundation describes
patient safety as the avoidance and prevention, of adverse outcomes or
injuries stemming from the processes of healthcare.
I asked members of a patient safety
advocate Facebook page what they thought of advanced directives and end of life
care being part of patient safety.
The response is an obvious
“yes”. Advanced directives is a patient safety issue. Here are just
some of the comments:
- When unwanted or unnecessary medicines and procedures
are done at the end of life (or any other time for that matter) they bring
risks.
- Root-causing the failure to die in peace underscored
for me, even beyond our personal experiences, that safety is more than
physical. It's existential.
Although one can argue that advanced
directives and making your wishes known is a human rights issue or encourages
patient empowerment and makes healthcare more patient centeredness and does not
fall into a patient safety category. But, if we think of advanced
directives as “informed consent” of which it really is, it surely becomes a
patient safety issue.
I would love to know your thoughts.
Here are some things on the topic
you don’t want to miss:
Bart Windrum Dying in Peace
Institute of Medicine Committee on Approaching Death:
Addressing Key End of Life Issues: Second Meeting
Decide now who will be your agent
and speak for you if you can't speak for yourself and ask yourself, do they
know what I want?http://www.pulseofny.org/resources/HealthCareProxy.pdf
CBS News on Medical Misdiagnosis
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