Patient safety is a perennial hot-button issue in healthcare, for nurses as well as physicians and other providers. Yet despite the fact that most care is delivered in the outpatient (ambulatory care) setting, initiatives to improve safety have focused mainly on inpatient environments. Does everything we know about keeping patients safe in the hospital carry over to ambulatory care? There’s currently not much research in this area, although the Agency for Healthcare Research and Quality (AHRQ) is coordinating an effort to identify factors that influence patient safety in ambulatory care, the types of errors most likely to occur there, and potential strategies for improving patient safety in outpatient care settings.
It’s easy to fall into the trap of thinking that patients are inherently safer as outpatients, because they are receiving care in settings where the pace is slower, and are less sick than hospitalized patients. But is this true?
There are several factors that influence patient safety differently in ambulatory care than they do in critical care. These include:
- The role of patient engagement. Primary and secondary care is largely episodic in nature. When patients go weeks or months without seeing a provider, they are taking responsibility for their own health in between office visits—possibly even self-managing a chronic illness. Only very engaged patients can monitor their own blood pressure, adjust their own insulin dose, or know when to report new symptoms or complications. The same holds true for post-op patients when they leave an ambulatory surgical center: they must be engaged and health-literate enough to care for an incision, take meds as instructed, and monitor for signs of infection. Ambulatory care nurses must be aware of the ways in which they can enhance patient engagement and support their patients’ self-management efforts through culturally appropriate education.
- The role of provider-patient interaction. We’ve all heard about the 10-minute office visit, where limited face-to-face interaction can leave patients confused and bewildered about their health or treatment status. In primary care and specialty care, nurses are often called upon to communicate with patients through telephone triage or giving instruction in matters like self-care and managing symptoms or side effects. Being skilled at these tasks can help prevent an adverse event that jeopardizes patient safety.
- The role of the overall health system. Unfortunately, our healthcare system is still fragmented in ways that can put ambulatory patients at risk. Communication problems can be compounded when the patient has several doctors who don’t share information like lab results or work collaboratively—and this can lead to adverse events, particularly during transitions of care. Small practices may be less likely than a large hospital to use an EMR that can catch errors. And they are far less regulated or scrutinized than a hospital that is visited regularly by the Joint Commission.
As the system increasingly shifts to ambulatory care for all but the sickest patients, safety initiatives for outpatient settings will increase as well. If you’re a nurse working in ambulatory care, consider taking a leadership role in patient safety. One of the most effective ways to do that is to stay current and continuously expand your knowledge, perhaps through advancing formal education or seeking certification in ambulatory care. Do you want to make a difference in the lives of your patients? Empower yourself with knowledge through an online RN to BSN or RN to MSN degree. American Sentinel University is an innovative, accredited provider of online nursing degrees, including programs that prepare nurses for a specialty in case management, infection control, and executive leadership.