Health Literacy Of The Patients

Zoya and her family were aware of her allergy towards sulfa-containing antibiotics. While an event like this is unpredictable, in future it would be more beneficial if patients like Zoya who have multiple drug allergies become more aware of consequences of taking a wrong medication. Resilience in the health care system is non-linear and complex in nature. An anomaly from one level propagates through the entire other levels until a barrier is put in at one of them.

Through increased patient health literacy, there is an opportunity to stop the flow of the error thus focusing on making sure everything goes right rather than fixing what went wrong. Again, referring to two of 7 principles of resilience, encourage learning and broaden participation. There is a constant need for stimulating learning in a complex adaptive system because it is extremely dynamic and many processes are occurring at once at different levels. By having participation of well-informed individuals in the system, collective and collaborative actions can be taken with a sense of trust. What are the solutions? Some solutions to solve cases like Zoya’s in the future include:

1. The first and foremost solution is to maintain all health records electronically, for the sake of ease of connectivity. But that does not need to be done specifically by the doctors, because verbal communication with the patient is crucial than staring at a computer screen. When a document cannot be stored electronically, a note of it should be made on the system with clear description. With health records, discharge summaries and progress notes on the same system, there is very less chance of skipping information.
2. The drug allergy record was registered as the brand name and not the class of drug it belonged to. Zoya was allergic to drugs of penicillin and sulphonamide class. It is better to note the class of drugs to avoid misunderstanding.
3. Using the decision support software with training. Dr. Stanley was not that proficient with computers but he received basic training for entering progress notes into the system. In Zoya’s case, the use of a decision support software would have warned the doctor for his choice of drug. Modern day practice should utilize the available information technology to provide better care to the patients.
4. Reviewing information during the consultation. As mentioned earlier, if the patient information is simply reviewed in brief while talking to them, taking history of their illness, any discrepancies in the information can be noted and anything that the practitioner might have gone over can be caught.
5. Lack of hard stop in the health record information system. As mentioned in Zoya’s case study, there was not a hard stop in the patient form on the system if one of the fields such as allergies and medication was left blank unintentionally. It is not difficult to design such a form as evident from a lot of websites on which no matter how many time we click ‘next page’, it does not process until mandatory fields are filled.
6. Patient awareness is as important as other solutions listed above. Well informed patients can effectively provide useful information to the doctor thus improving their own safety.
7. Much like the health record system, the packaging software at the pharmacy also needs to be designed in a way that whenever a patient buys their medication, the software picks up their previous history and alert the pharmacist. A simple conversation from the pharmacist asking “Do you have any allergies to any medications? ” can also prevent tragedies.

Conclusion

Zoya’s story makes us think about the different holes throughout the health system. Due to its multifaceted, dynamic and constantly changing nature, it is called as a complex adaptive system. The new concept of patient safety, Safety-II, encourages us to focus on factors in the systems that are indeed working and not over focusing on things that went wrong. (10) Applying that to Zoya’s case, in future incidents like these can be prevented through above listed solutions.

There are a few recommendations which can be useful in the immediate future. Firstly, providing ample training to staff who work with the health records will ensure that little or no mistakes are made which would endanger patient safety. This includes uploading complete discharge summaries, maintaining clinical visit records and keeping all that information uniform and in one place. Secondly, the advent of modern information technology tools and their application in health practice has proven extremely beneficial but much like the applications on our mobile phones, these softwares need periodic updates and development to be more and more precise and efficient. The reason for this recommendation is that as seen in Zoya’s case study, both the software at the Get Well clinic and the pharmacy did not alert the users.

A pop up notification, a banner or simply a mandatory patient detail form can make a difference worth a life. My final recommendation would be informational sessions for patients with such allergies, to increase the health literacy thereby improving patient safety. Errors in the healthcare systems are not predictable. Each day is a different scenario, some successful and some not. What we can do is focus more on the successful side, making it happen more and aiming that there are less people like Zoya in the future.