Eliminating Harm and Reducing Error: Wendy M. Crean and Patient Safety
Patient safety lies at the centre of our commitment to the highest quality care at SickKids. While most hospital patients receive safe care, the potential for harm in the very institution meant to heal them still exists—harm like medication error, infections and even falls. So far, we have made great strides in key areas such as sepsis, the primary cause of death from infection, globally, as well as have successfully implemented a new clinical protocol to aid health-care providers in the recognition and management of sepsis on inpatient units, which has led to many lives saved. This work is part of a larger SickKids initiative called Caring Safely, a program focused on key strategies for error reduction grounded in science and principles of safety culture.
Donations Support Improvements
Central to the success of improved patient safety standards is funding for programs and education sessions. As a graduate from The Hospital for Sick Children School of Nursing and the former Head Nurse of General Surgery in the Operating Room, Wendy Margesson Crean wanted to give back to the hospital that holds a special place in her heart. Passionate about patient safety, she and her husband John recently made a significant financial contribution to the Caring Safely initiative at SickKids while also creating an endowment for the annual Wendy Margesson Crean Patient Safety Lecture – a pioneering lectureship series on patient safety that this year took place at the MaRS Discovery District in collaboration with University Health Network.
Wendy’s reasons were simple: “I am fond of saying, any given hospital may have the best doctors and nurses and facilities but without a solid foundation in patient safety it is all for naught. My gift is just a small step to assist in the process.”
Photo caption: The generosity of Wendy and John Crean (pictured right) will help patients like Elliott (pictured left with mom, Melissa) who spent the first three months of his life at SickKids. One night, he was mistakenly given the wrong drug—a dose of morphine instead of heparin, a blood thinner. The error was caught quickly, and the critical care team set to work to save Elliott’s life. They succeeded, and Elliott, now three-and-a-half years old, is a happy and healthy little boy.
Peeking Behind the Curtain: Clinical Judgment Beyond Cognition
Giving the keynote address at the Caring Safely symposium this year is Dr. Carol-anne Moulton, Staff Surgeon and Medical Director of the Operating Room at Toronto General and Princess Margaret Hospitals. Her research focuses on surgical culture and cognition broadly, and surgical judgment and error specifically.
Dr. Moulton’s research highlights the complex cognitive and social processes involved in treating patients and functioning as a care provider within the fast-paced clinical environment that is steeped in culture. These factors must all be considered as contributors to patient safety, “Constantly weighing the risks associated with treatment courses, taking into account a wealth of variables from both a psychological and cognitive perspective, makes it almost impossible to eliminate every single patient’s risk during each step of their hospital visit.”
What’s more, “the culture within the medical field often celebrates the cognitive aspects of medicine and decision making, while neglecting the psychological and emotional side.” Instead of breeding a culture of certainty and independence, whereby healthcare professionals act as single entities, Dr. Moulton states there needs to be renewed emphasis on evolving culture to a place where practitioners are encouraged to become more vulnerable by calling for help and increasing collaboration to decrease patient safety risks. She suggests that while we might learn from other high-risk sectors with low incidence rates—like aviation and nuclear energy for example—culture, staff support, and training must be at the forefront of our thinking in any patient safety initiative. Dr. Moulton cautions that paediatric patient care is intrinsically different from adult care and brings with it different patient safety challenges.
"My gift is just a small step to assist in the process.”
Dr. Moulton acknowledges the ways that donations like Wendy’s are crucial for the continued improvement of patient safety across patient populations, central among which is the challenge of translating research into best practices.
Continued Development for Greater Implementation
Dr. Maitreya Coffey, Medical Officer of Patient Safety at SickKids, agrees that while there is variation based on child-focused needs compared to the adult population, culture and leadership are still the biggest factors in building a better patient safety framework, factors that SickKids continually strives to improve.
Wendy’s gift to nursing leaders at SickKids supports priority areas including helping to create time for leaders and champions of patient safety within the organization to implement greater forums of observation, discussion and education through supportive programming. It will also help central line associated blood stream infections (CLABSI) auditors evaluate current processes and make changes through leadership coaching and constructive feedback.
Dr. Coffey notes that “a revamped auditing program in 2018 led to an eight percent decrease in CLABSI incident rates, which may seem minor but when you consider the overall incident rate is so low to begin with, these incremental changes are huge steps forward in ensuring patient safety.”
She adds that while “continued efforts and partnerships aimed at eradicating safety incidents are producing promising results, improvements don’t happen overnight. It takes multiyear planning to see marked changes taking effect, especially when retooling cultural and communication dynamics. SickKids is still in the early years of its revamped patient safety plan yet we are experiencing the rewards of its implementation.”
With the generous support of donors like John and Wendy, SickKids can continue to promote and implement safety protocols to reduce error, improve communication and create best-in-class safety strategies across the Hospital.
Visit the Caring Safely website to learn more.
