“A lot of falls occur in locations where there isn’t as much one-on-one supervision, such as hallways and restrooms, so patients need more assistance there,” Beebe says.
Designing for safety
Design, of course, plays a critical role in patient safety. There is a movement toward designing to increase efficiency in rooms, corridors and workflow areas, and to make the most of existing space — factors that impact patient safety on every level, says Joseph Sprague, principal and senior vice president, HKS, Dallas.
“For example, bringing equipment directly into the patient room would reduce not only the patient transport, but the distance the patient would have to move to get to the equipment,” he says. “We’re working to produce a better functional design based on the operational plan.”
Designers also are paying more attention to the placement, layout and lighting of medication rooms, Suchomel says. “Errors can occur from the wrong drug or wrong dose, and that could be because the person is interrupted or can’t see very well.”
More hospitals are decentralizing nurse stations to improve patient proximity to staff, reduce nurse foot traffic and fatigue and, hopefully, minimize errors, says Leo Gehring, director of facilities at Sutter Medical Center, Sacramento, Calif.
“Nurses’ stations are a vestige of the old days,” Gehring says. “Creating satellite nurse stations located closer to clusters of patient rooms allows them to respond more quickly to patients and reduce distractions, which can cause errors.”
And before designers take the first step, more of them will rely on full-scale mock-ups to guide the course of the project, Suchomel says. “More designers are creating a prototype before they build 30 or 50 or 100 patient rooms, so they can move things around and see how the elements work together.”
As new laws and regulations are created and health care becomes more and more complicated, facilities and environmental services managers will need to rely more than ever on guidance from industry leaders to chart their course. Hospital executives and boards need to make sure their staff are up to speed on best practices as they emerge.
AHE recently introduced a certification program called Certified Healthcare Environmental Services Technician. CHEST uses a “train-the-trainer” model to teach managers to train front-line environmental services personnel in seven core domain areas, including infection prevention, cleaning and surface disinfection, customer service and waste handling, to name a few. Recently introduced as a pilot program at Renown Health System in Nevada, the subsequent program attendance has “exceeded our early expectations,” AHE’s Costello says. “We’re not just teaching trainers how to train to the technical content, we’re also training to the ‘why’ the job needs to be performed a certain way every time — in this case, patient safety, customer service and positive outcomes.”
ASHE also is working on a new patient safety resource. ASHE recently received a grant to join with the CDC to develop new guidance on reducing hospital-acquired infections through the design of the hospital’s built environment. As ASHE continues to play a leading role in patient safety, Scott encourages members to stay on top of these and all available resources.
Creating a safe environment for patients is vastly more complicated than just implementing effective hand-hygiene programs and installing seamless epoxy flooring to prevent slips and falls. In today’s health care climate, hospital executives and boards are working with facilities managers to create an entire culture of safety vs. focusing on a series of targets. That encompasses everything from developing a shared mindset among leaders and staff to staying on top of changing laws and regulations to designing the facility — inside and out — for patient and staff safety.
While many improvements are dictated by codes and regulations, hospitals also are putting in the extra work required to take patient safety to a higher level. “Many changes are driven by compliance with codes and regulations, which, for the most part, do foster a safe environment, but many health care personnel also realize the importance of going above and beyond that threshold,” Beebe says.
Often that involves a concerted level of teamwork. For example, before launching a new project, some designers and architects are shadowing hospital staff on their daily routines, making notes about potential safety enhancements to improve the design, says Joseph Sprague, principal and senior vice president, HKS, Dallas.
“Factors like room proximity and workflow layout may contribute to stress, fatigue, disruptions and interruptions of the health care staff’s duties that can increase errors and lead to safety incidents,” Sprague says. “What we will do is incorporate changes into the design that address these issues.”
— Beth Burhmahl is a freelance writer in Lake Villa, Ill. •