Pennsylvania Patient Safety Authority releases annual report
May 6, 2009
In its 2008 report about patient safety practices in the state of Pennsylvania, The Pennsylvania Patient Safety Authority (PPSA) has seen some improvement among the five domains it measured, but says there is still room for bettering patient safety leadership and reporting practices.
Two hundred healthcare facilities participated in the 2008 survey, 118 of which represented hospitals. Facilities reported on the following domains: leadership and patient safety, medication safety, safe surgery, infection prevention, and device safety. The survey results show that about one-third of hospitals had instituted leadership walkarounds at least once in the past year, but two-thirds had not adopted the practice. Also, although about half of all patient safety officers had attended four board meetings throughout the year, one-third of patient safety officers had not attended any. A bright spot in the report indicated that 70% of hospitals had implemented some level of "just culture."
In June 2004, Pennsylvania became the only state to require mandatory event and near miss reporting. Because of this, the PPSA has a lot of data to use in comparing rates of errors. The Authority saw an increase in event and incident reporting by 3.7% in 2008, compared to 2007. An increased number of reported events is actually a good thing and illustrates a better understanding on the whole of just culture and the need for error reporting.