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Health information technology presents numerous opportunities for improving and transforming healthcare, including:

-Reducing human errors.
-Facilitating care coordination.
-Improving practice and workflow.
-Knowledge enhancement.

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Background

The concept of safety culture originated outside health care, in studies of high reliability organizations, organizations that consistently minimize adverse events despite carrying out intrinsically complex and hazardous work. High reliability organizations maintain a commitment to safety at all levels, from frontline providers to managers and executives. This commitment establishes a "culture of safety" that encompasses these key features:

acknowledgment of the high-risk nature of an organization's activities and the determination to achieve consistently safe operations

a blame-free environment where individuals are able to report errors or near misses without fear of reprimand or punishment

encouragement of collaboration across ranks and disciplines to seek solutions to patient safety problems

organizational commitment of resources to address safety concerns

Improving the culture of safety within health care is an essential component of preventing or reducing errors and improving overall health care quality. Studies have documented considerable variation in perceptions of safety culture across organizations and job descriptions. In prior surveys, nurses have consistently complained of the lack of a blame-free environment, and providers at all levels have noted problems with organizational commitment to establishing a culture of safety. The underlying reasons for the underdeveloped health care safety culture are complex, with poor teamwork and communication, a "culture of low expectations," and authority gradients all playing a role.

Measuring and Achieving a Culture of Safety

Safety culture is generally measured by surveys of providers at all levels. Available validated surveys include AHRQ's Surveys on Patient Safety Culture™ (SOPS®) and the Safety Attitudes Questionnaire. These surveys ask providers to rate the safety culture in their unit and in the organization as a whole, specifically with regard to the key features listed above. Versions of the AHRQ Patient Safety Culture survey are available for hospitals and nursing homes, and AHRQ provides yearly updated benchmarking data from the hospital survey.

Safety culture has been defined and can be measured, and poor perceived safety culture has been linked to increased error rates. However, achieving sustained improvements in safety culture can be difficult. Specific measures, such as teamwork training, executive walk rounds, and establishing unit-based safety teams, have been associated with improvements in safety culture measurements and have been linked to lower error rates in some studies. Other methods, such as rapid response teams and structured communication methods such as SBAR, are being widely implemented to help address cultural issues such as rigid hierarchies and communication problems, but their effect on overall safety culture and error rates remains unproven.

The culture of individual blame still dominant and traditional in health care undoubtedly impairs the advancement of a safety culture. One issue is that, while "no blame" is the appropriate stance for many errors, certain errors do seem blameworthy and demand accountability. In an effort to reconcile the twin needs for no-blame and appropriate accountability, the concept of just culture is now widely used. A just culture focuses on identifying and addressing systems issues that lead individuals to engage in unsafe behaviors, while maintaining individual accountability by establishing zero tolerance for reckless behavior. It distinguishes between human error (eg, slips), at-risk behavior (eg, taking shortcuts), and reckless behavior (eg, ignoring required safety steps), in contrast to an overarching "no-blame" approach still favored by some. In a just culture, the response to an error or near miss is predicated on the type of behavior associated with the error, and not the severity of the event. For example, reckless behavior such as refusing to perform a "time-out" prior to surgery would merit punitive action, even if patients were not harmed.

Safety culture is fundamentally a local problem, in that wide variations in the perception of safety culture can exist within a single organization. The perception of safety culture might be high in one unit within a hospital and low in another unit, or high among management and low among frontline workers. Research also shows that individual provider burnout negatively affects safety culture perception. These variations likely contribute to the mixed record of interventions intended to improve safety climate and reduce errors. Therefore, organizational leadership must be deeply involved with and attentive to the issues frontline workers face, and they must understand the established norms and "hidden culture" that often guide behavior. Many determinants of safety culture are dependent on interprofessional relationships and other local circumstances, and thus changing safety culture occurs at a microsystem level. As a result, safety culture improvement often needs to emphasize incremental changes to providers' everyday behaviors.

Current Context

The National Quality Forum's Safe Practices for Healthcare and the Leapfrog Group both mandate safety culture assessment. The Agency for Healthcare Research and Quality also recommends yearly measurement of safety culture as one of its "10 patient safety tips for hospitals." Baseline data on safety culture in a variety of hospital settings, derived from the Hospital Survey on Patient Safety Culture, are available from AHRQ.

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Background The concept of safety culture originated outside health care, in studies of high reliability organizations, organizations that consistently minimize adverse events despite carrying out intrinsically complex and hazardous work. High reliability organizations maintain a commitment to safety…

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Continuing Education Activity

A medical error is a preventable adverse effect of medical care, whether or not it is evident or harmful to the patient. Among the problems that commonly occur during providing health care are adverse drug events and improper transfusions, misdiagnosis, under and overtreatment, surgical injuries and wrong-site surgery, suicides, restraint-related injuries or death, falls, burns, pressure ulcers, and mistaken patient identities. High error rates with serious consequences are most likely to occur in intensive care units, operating rooms, and emergency departments. Medical errors are also associated with extremes of age, new procedures, urgency, and the severity of the medical condition being treated. This activity outlines common sources of medical errors and highlights the role of the interprofessional team in improving the care of the patient and enhancing safety by using techniques to avoid errors.

Objectives:

Describe common sources of medical errors.

Review the locations where medical errors are most likely to occur.

Explain the meaning of a medical error.

Outline interprofessional team strategies for enhancing care coordination and communication to avoid medical errors and improve outcomes.

Access free multiple choice questions on this topic.
Introduction

A medical error is a preventable adverse effect of medical care, whether or not it is evident or harmful to the patient.[1] Among the problems that commonly occur during providing health care are adverse drug events and improper transfusions, misdiagnosis, under and over treatment, surgical injuries and wrong-site surgery, suicides, restraint-related injuries or death, falls, burns, pressure ulcers, and mistaken patient identities. High error rates with serious consequences are most likely to occur in intensive care units, operating rooms, and emergency departments. Medical errors are also associated with extremes of age, new procedures, urgency, and the severity of the medical condition being treated.

Clinical Significance

The Institute of Medicine's (IOM) legendary report in 1999, "To Err is Human," estimated 98,000 iatrogenic deaths making it the sixth leading cause of death in the U.S. A later study in 2010 yielded almost twice that many deaths, at 180,000. The most recent study in 2013 suggested the numbers range from 210,000 to 440,000 deaths per year. The latter number would make it the third leading cause of death after heart disease and cancer.[2] However, these numbers can only be estimated because medical records are often inaccurate and providers might be reluctant to disclose mistakes.

One of the 1999 IOM report's main conclusions is that the majority of medical errors do not result from individual recklessness or the actions of a particular group. More commonly, errors are caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them. For example, stocking patient-care units in hospitals with certain full-strength drugs, even though they are toxic unless diluted, has resulted in deadly mistakes. Thus, mistakes can best be prevented by designing the health system at all levels to make it safer--to make it harder for people to do something wrong and easier for them to do it right. Of course, individuals should be still held accountable when an error can be attributed to them. As an example, anchoring bias (persistence with an initial diagnostic impression despite evidence of another diagnosis) is a major source of diagnostic error. When an error occurs, however, blaming an individual does little to make the system safer and prevent someone else from committing the same error.[1]

The most common medical errors in the United States by occurrence are: adverse drug events, catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), injury from falls and immobility, obstetrical adverse events, pressure ulcers, surgical site infections (SSI), venous thrombosis (blood clots), ventilator-associated pneumonia (VAP), wrong site/wrong procedure surgery (most common basis for quality of care violations), and the following five most mis-diagnosed conditions: cancer related issues; neurological related issues; cardiac-related issues; timely responding to complications during surgery and post-operatively; and urological related issues. [3]

The November 2016 issue of Risk Management Monthly (Volume 10, Number 11) extracted highlights from The Emergency Medicine Closed Claims Study from The Doctors Company that analyzed 332 closed claims in emergency medicine in 2007-2013. The major findings were:

1. Issues related to diagnosis constituted the majority of cases. These included failure to diagnose, delayed diagnosis or an incorrect diagnosis. This could involve one or more of the following: failure to establish a differential diagnosis, failure to order diagnostic tests, failure to address abnormal findings, failure to consider available clinical information. Other issues adversely influencing the diagnostic process were a failure to obtain a consult and a premature discharge from the ED. The most frequently misdiagnosed conditions included acute cerebral vascular accident, myocardial infarction, spinal epidural abscess, pulmonary embolism, necrotizing fasciitis, meningitis, testicular torsion, subarachnoid hemorrhage, septicemia, lung cancer, fractures, and appendicitis. The study identified specific factors that contributed to the patient injury.[4]

2. Contributing factors in medical errors included failure to order appropriate tests and address abnormal results, and failure to use clinical information and establish the differential diagnosis were cited. Patient characteristics such as obesity (led to skipping specific exam elements), non-adherence to treatment plans and follow-up appointments, and poor patient hygiene also contributed.

3. Communication issues among providers led to medical errors, and these included: failure to communicate, failure to review the medical record, poor professional rapport, and communication between providers and the patient/family including not using qualified interpreters when applicable.

4. A summary of the study's tips for avoiding diagnostic error: Avoid first impression or intuition-based diagnoses. Complete and document a thorough differential diagnosis for each patient. Ensure that all specialists who are called to evaluate patients in the ED receive a comprehensive summary of the clinical picture. Practice effective handoffs. The handoff discussion should include clear delegation of the individual who has responsibility for review and follow-up of all test results.[5]

A study by Sklar, D.P., et al., addressing unanticipated deaths occurring within seven days after emergency department discharge made several observations. There were 30 deaths per 100,000 discharges, half of which were unexpected but related to the ED visit and 60% of which involved a possible error. There were four recurring themes:

1. Atypical presentations of unusual problems

2. Chronic diseases with decompensation.

3. For nearly all of the unexpected deaths, vital signs were abnormal at discharge (most often tachycardia).

4. Mental disability or psychiatric problems were frequent. The study reported that such patients received fewer diagnostic tests and less pain relief and that follow-up was unclear in patients with chronic psychiatric diagnoses. Another way to look at this is to remember that a psychiatric illness does not somehow "protect" a patient against developing a new medical condition. It often is the case that those with underlying psychiatric conditions are more at risk to develop new, significant illnesses. These may be even difficult to appreciate because of the bias often present when evaluating patients with psychiatric illnesses.[6]

The article Medical Malpractice Liability in the Age of Electronic Health Records cites three phases of malpractice risk associated with EHR systems:

1. Implementation phase. During this, physicians are learning to use a new system. Inadequate training, the biggest problem occurring during this phase, can create new error pathways. Various intricacies of the different systems might defy standard logic, causing erroneous diversions by the user.

2. Transition phase. During the transition from paper to a computerized system, records are frequently divided, and procedures to avoid errors are often not implemented. User errors can create incorrect or missing data entries, and gaps in documentation and communication.

3. Mature phase. Systemwide bugs and failures can occur during the mature phase (e.g., is tech support immediately available when the system goes down at 2 am), creating departmental chaos and significantly interfering with documentation.[7]

Enhancing Healthcare Team Outcomes

Medical errors continue to occur, albeit at a much lower rate than in the past. It is imperative that all healthcare workers on the interprofessional team, including the pharmacist, nurse, and physician be aware that medical errors not only subject patients to harm but also lead to medical malpractice litigation. Clinicians need to verify their orders before submission. The pharmacist will perform an interaction check, and verify dose and agent selection. Finally, the nurse serves as the final backstop before administering a drug, checking the right dose, right drug, and right patient. There are many causes of medical errors and most hospitals have introduced rules and regulations to minimize these errors with a system of checks. In the end, constant awareness by every member of the interprofessional team is the only way to reduce medical errors.

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A medical error is a preventable adverse effect of medical care, whether or not it is evident or harmful to the patient.[1] Among the problems that commonly occur during providing health care are adverse drug events and improper transfusions, misdiagnosis, under and over treatment, surgical injuries and wrong-site surgery, suicides, restraint-related injuries or death, falls, burns, pressure ulcers, and mistaken patient identities.

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This refers to errors in delivering a drug to a patient. They are among the most common errors that affect patients in hospitals.

Research has found that approximately 1/3 of ADEs take place in writing the prescription, while  another 1/3 takes place during administration of the medication.

Studies estimate that up to 18% of patients may be affected by a serious ADE. Moreover, ADEs cost up to $3.5 billion every year.

Here, we will talk about some of the technologies that have improved patient safety during medication administration.

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Computerized Provider Order Entry (CPOE)

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Computerized Provider Order Entry (CPOE)

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This is a system in which clinicians directly place orders electronically.

A study conducted in 2013 by Radley et. al showed that processing a prescription through a CPOE system reduced the likelihood of medication errors by 48% by reducing the probability of transcription error. This implies that CPOE can substantially reduce the frequency of medication errors in acute-care settings.

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Typically paired with CPOE, CDSS suggest default values for drug doses, routes of administration, and frequency. It may also offer safety features such as checking drug allergies, drug-drug or drug-laboratory interactions.

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Upon admission to a hospital, all patients are provided with a barcode wristband. Prior to administrating a medication, the nurse scans both the armband and the barcode on the medication; this confirms that the patient is administering the correct medication to the correct patient. This ensures that the rights of medication administration are being followed.

Research has shown that BCMA technology has reduced administration errors by over 50% and serious ADEs by 25%.

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In 2016 the total cost burden for patient harm in the U.S. was $146 billion. Of these adverse events, 30 to 70 percent were potentially avoidable, leaving a significant opportunity for healthcare to improve patient safety. Successful and sustainable patient safety improvement rests heavily on an organizational culture of patient safety, in which leadership supports systemwide attitudes, actions, teamwork, and technology to reduce the risk of patient harm. In an era in which healthcare IT is guiding critical decisions affecting patient safety, health leaders need a sociotechnical improvement framework that addresses culture, process, and technology.

According to a 2016 study, an improved safety culture and teamwork can help health systems reduce patient harm across entire hospital systems and multiple harm types. Based on results from the Safety Attitudes Questionnaire (SAQ), as workforce attitudes towards safety improved, all-hospital harm decreased significantly, as did serious safety events.

Organizations that don't prioritize a safety culture risk the following adverse consequences:

Underreported safety events.

Lack of improvement.

A higher rate of harm.

Workforce burnout and turnover.

Rising costs.

This article describes the sociotechnical framework of a safety culture in which staff can openly share safety information and leverage healthcare IT to support safety goals. This structure gives health systems a roadmap to improved patient safety, better healthcare and employee outcomes, and lower costs.

Safety Culture: A Blame-Free Environment that Prioritizes Patient Safety

The Patient Safety Network (PSNET) bases its concepts of a patient safety culture on research in industries outside of healthcare that carry out complex, hazardous work. High reliability organizations minimize adverse events despite inherent risks in the workplace. In healthcare, high reliability organizations commit to a culture of safety that observes four key features:

1. Acknowledges the high-risk nature of the organization's activities and commits to consistently safe operations.

2. Supports a blame-free environment, in which individuals can report errors or risks for harm without fear of repercussions.

3. Encourages systemwide collaboration to resolve patient safety problems.

4. Dedicates organizational resources to address safety concerns.

Cultural Challenges to Improving Patient Safety

To establish an effective and sustainable safety culture, healthcare leaders must have strategies and tools to navigate several known cultural challenges:

Underreporting of safety events-frontline clinicians (particularly those who are not managers or supervisors) do not consistently report safety events because they fear blame and negative repercussions.

Lack of commitment from senior leadership-senior leaders may have inadequate commitment to patient safety compared with supervisors and frontline clinicians.

Inadequate teamwork and communication-caregivers in the operating room have different perceptions of teamwork by role (e.g., surgeons versus nurses), potentially impacting safety coordination efforts.

Seven Ways a Sociotechnical Framework Improves a Safety Culture

As explained above, organizational culture often blocks meaningful improvement or gains in patient safety. To address the cultural challenges of improving safety culture, as well as the process and technology elements that support and sustain a culture of safety, health systems can use a sociotechnical framework. Culture includes patient- and family-centered care, leadership, teamwork, frontline staff burnout, and economic impact of culture; process includes organizational fairness, reliability, and process improvement; and technology includes healthcare IT.

Figure 1 shows how a sociotechnical approach combines culture, process, and technology. The laddered score measures the three elements and shows whether a health system is doing poorly (very low) or well (very high) with its safety culture.

Figure 1: A sociotechnical approach to improving patient safety

A patient safety culture based on sociotechnical framework has seven key strengths:

1. Leverages Qualitative and Quantitative Data (Versus Quantitative Safety Scores Alone)

High quantitative cultural scores at the unit level don't reflect whether an organization is using healthcare IT safely, or that its healthcare IT systems are safe. To determine if a culture of safety exists among team members or if they have a fundamental understanding of the principles of patient safety and are practicing them, health systems need qualitative data (e.g., focus groups).

2. Doesn't Rely on HIMSS Stage Levels to Tell the Complete Safety Picture

The HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) scores health systems on their EMR capabilities, but these scores may not align with clinical safety. Clinical units can score a HIMSS stage five or higher, but, according to qualitative feedback from frontline staff, can still experience safety issues. HIMSS levels, however, don't measure patient safety and culture of safety issues.

3. Gives Frontline Clinicians a Voice in Decision Making

When decision making is relegated to and centralized at healthcare IT higher management levels, frontline caregivers are less able to quickly act on safety issues they identify. With local (versus top-down) oversight, frontline clinicians can address potential harm immediately. Empowering frontline clinicians with patient-specific safety analytics allows for immediate clinical decision making to mitigate or prevent harm.

4. Makes IT Solutions Accessible to Non-Technical Users

Frontline clinicians must be able to easily access and use safety analytics solutions to make timely safety-related decisions. Inefficiencies with technology not only delay addressing safety issues and increases risk, but also create stress for users, which increases the risk for workforce burnout. Organizations can make efficient patient safety solutions accessible to frontline clinicians with a secure, cloud-based software module (e.g., thePatient Safety Monitor™ Suite: Surveillance Module). The Surveillance Module helps detect, monitor, and prevent patient safety events and automates reporting to provide predictive data and all-harm identification and analysis.

5. Encourages Frontline Clinicians to Report Safety and Quality Issues

With an organizational culture in which frontline staff are comfortable reporting any safety or quality concerns, health systems can more accurately measure safety issues (an essential step in reducing risk). To ensure that staff are comfortable speaking up, leadership must uphold an environment of non-negotiable mutual respect for all team members.

6. Treats a Safety Issue in One Area as a Potential Systemwide Risk

An IT-related safety issue in one unit of a health system may indicate risk throughout the system. For example, if a medication reconciliation form for all patients in the emergency department (ED) has an error in the underlying structure and is a potential safety risk, it would affect every patient admitted to the health system from its ED. By identifying issues in one unit that can repeat across the system (e.g., incorrect/inaccurate protocols, problems with auto-population, and inaccurate medication mapping), organizations can mitigate systemwide risk.

7. Performs Thorough Due Diligence Before Taking Safety IT Solutions Live

For health systems to fully leverage IT solutions to improve patient safety, they must perform thorough due diligence before going live with the tools. Organizations risk derailing technology and improvement goals when they launch tools before testing for even basic functionality (e.g., logging on to care modules).

The Sociotechnical Framework: Combining Culture, Process, and Technology to Improve Patient Safety

By incorporating qualitative and quantitative data, a simplified sociotechnical framework of culture, process, and technology gives health systems a comprehensive guideline to measure and improve their safety culture, including how they use healthcare IT solutions. Organizations can keep safety improvement on track by using the sociotechnical framework to guide periodic reassessments of their safety work and culture.

Additional Reading

Would you like to learn more about this topic? Here are some articles we suggest:

1. How to Use Data to Improve Patient Safety

2. Improving Patient Safety: Machine Learning Targets an Urgent Concern

3. Survey Shows the Role of Technology in the Progress of Patient Safety

4. Collaborative, Data-Driven Approach Reduces Sepsis Mortality by 54 Percent

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Safety Culture in Healthcare: A 7-Step Framework

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In 2016 the total cost burden for patient harm in the U.S. was $146 billion. Of these adverse events, 30 to 70 percent were potentially avoidable, leaving a significant opportunity for healthcare to improve patient safety.

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7 Keys for Creating a Safety Culture

In my consulting work and in presenting to large groups, the topic of creating or supporting a safety culture comes up without fail.  What I find most often is a varied understanding of what is needed by leaders and employees to ingrain a safety culture into the fabric of their organization. It’s important to begin with a common definition of a safety culture: a set of core values and behaviors that emphasize safety as an overriding priority.

While values are the foundation, safety culture is ultimately expressed through what is said and done—through behavior.  Each organization has or should have its own description of an ideal safety culture (based in values) however there are some elements that should be common to all.  Following are seven keys to an effective safety culture:

1. The entire workforce relentlessly pursues the identification and remediation of hazards. Correcting hazards as quickly as possible and maintaining good communications around hazards will not only create a safer workplace, it will improve your employees’ engagement. Frontline employees who believe management takes care of hazards are more willing to participate fully in safety initiatives.

2. Employees at all levels are equally comfortable stopping each other when at-risk behavior is observed and recognizing each other when safe behavior is observed. While good constructive feedback is important for improvement, positive reinforcement for safe behavior is essential for building safe habits.  The more actively involved all levels of the organization are in delivering positive reinforcement for behaviors consistent with the desired culture, the stronger the culture will be.

3. No one is blamed for near misses or incidents. Instead, systemic causes are pursued. Often when people engage in at-risk behaviors that lead to incidents, there are organizational systems and practices that inadvertently encourage those at-risk practices. It is important to uncover those and establish accountability for making the changes to the systems and practices to encourage safe behavior.

4. The fear of discipline which drives under-reporting and stifles involvement has been driven out of the culture. Discipline has a place, but most safety issues can be effectively dealt with without discipline, which has side effects that work against building a culture of safety.  When discipline is used disproportionately in relation to positive consequences it leads to lower morale, reduced trust, lower productivity, less teamwork and lack of engagement.  Equally disturbing is that it suppresses reporting incidents which cripples the organizations ability to learn from mistakes and become more proactive.

5. The workforce is characterized by good relationships at all levels. Trust is an essential component for an effective safety culture.  As noted above, mistakes and errors, while unfortunate, provide invaluable learning.  Employees who have good working relationships with management are more likely to speak openly and honestly about what is working, what is not and what still needs to change.  They are also more engaged in other aspects of safety.

6. Safety is integrated into day-to-day work. It is not treated as something separate to be discussed during a weekly safety meeting or only at shift change.  Safety should be part of every conversation and considered in every decision.

7.  Successes are celebrated along the way. Pride shouldn’t be focused solely on a company’s safety record, but also in what is being done every day, all day to achieve that record.

Once you have defined the ideal safety culture for your organization, the science of behavior analysis can be used to develop behaviors consistent with that culture.  Targeted positive reinforcement of desired behaviors leads to rapid change and the effects multiply quickly as all employees begin to not only display desired cultural behaviors, but to reinforce those behaviors in others.

Read about Judy Agnew's newest book "A Supervisor's Guide to Safety Leadership: Preventing Injury in the Workplace."

Featured Video

Posted by Judy Agnew, Ph.D.

As senior vice president of safety solutions, Judy spends her time helping clients create sustainable safety cultures. She also helps clients with strategy execution beyond safety, and general management and leadership improvement across cultural and generational differences.

© Aubrey Daniels International, Inc. All rights reserved. 2022

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In my consulting work and in presenting to large groups, the topic of creating or supporting a safety culture comes up without fail. What I find most often is a varied understanding of what is needed by leaders and employees to ingrain a safety culture into the fabric of their organization.

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Flipgrid is where social and emotional learning happens! The leading video discussion platform for millions of PreK to PhD educators, students, and families.

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List 2 ways your organization promotes a culture of safety.

What technology do you think is the most beneficial to patient safety?

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The American Co llege of Healthcare Executives (ACHE) and the Lucian Leape Institute (LLI) have partnered to develop a guide intended to assist leaders in creating, shaping, and sustaining the type of culture needed to advance patient and workforce safety efforts. Leading a Culture of Safety: A Blueprint for Success is designed to inspire, motivate, and inform you as you lead your organization on its journey to zero harm. The following is an excerpt from the Blueprint.

The journey toward patient and workforce safety requires vigilance and the highest level of dedication. Safety cannot be merely a strategic priority, but must be a core value that is woven into the fabric of our organizations. A culture of safety demands the involvement and commitment of the full health care team, from patients to clinicians to the entirety of the workforce.

However, an organization cannot be what its leader is not. It is both the obligation and the privilege of every health care CEO to create and represent a compelling vision for a culture of safety: a culture in which mistakes are acknowledged and lead to sustainable, positive change. These changes promote respectful and inclusive behaviors that become instinctive and serve as the behavioral norms for the organization. In this culture of health care the physical and psychological safety of patients and the workforce is both highly valued and ardently protected. This goal is one that needs constant energy and investment to achieve; these six domains are a place we can start:

Establish a compelling vision for safety - An organization's vision reflects priorities that, when aligned with its mission, establish a strong foundation for the work of the organization. By embedding a vision for total patient and workforce safety within the organization, health care leaders demonstrate that safety is a core value.
Learn more in the full report, Leading a Culture of Safety: A Blueprint for Success.
Build trust, respect, and inclusion - Establishing trust, showing respect, and promoting inclusion - and demonstrating these principles throughout the organization and with patients and families - is essential to a leader's ability to create and sustain a culture of safety. In order to achieve zero harm, leaders must ensure that their actions are consistent at all times and across all levels of the organization. Trust, respect, and inclusion are non-negotiable standards that must encompass the Board room, the C-suite, clinical departments, and the entire workforce.

Select, develop, and engage your Board - Governing Boards play a vital role in creating and maintaining safety cultures. CEOs are responsible for ensuring the education of their Board members on foundational safety science, including the importance of and processes for keeping patients and the workforce safe. Boards must ensure metrics that meaningfully assess organizational safety and a culture of safety are in place and systematically reviewed, analyzed, and the results acted upon.

Prioritize safety in the selection and development of leaders - It is the responsibility of the CEO, in collaboration with the Board, to include accountability for safety as part of the leadership development strategy for the organization. In addition, identifying physicians, nurses, and other clinical leaders as safety champions is key to closing the gap between administrative and clinical leadership development. Expectations for the design and delivery of relevant safety training for all executive and clinical leaders must be set by the CEO and subsequently spread throughout the organization.

Lead and reward a just culture - Leaders must possess a thorough understanding of the principles and behaviors of a just culture, and be committed to teaching and modeling them. Human error is and always will be a reality. In a just culture framework, the focus is on addressing systems issues that contribute to errors and harm. While clinicians and the workforce are held accountable for actively disregarding protocols and procedures, the reporting of errors, lapses, near-misses, and adverse events is encouraged. The workforce is supported when systems break down and errors occur. In a true just culture, all workforce members-both clinical and non-clinical-are empowered and unafraid to voice concerns about threats to patient and workforce safety.

Establish organizational behavior expectations - Senior leaders are responsible for establishing safety-mindfulness for all clinicians and the workforce and, perhaps even more importantly, modeling these behaviors and actions. These behaviors include, but are not limited to, transparency, effective teamwork, active communication, civility, and direct and timely feedback. These cultural commitments must be universally understood and apply equally to the entire workforce, regardless of rank, role, or department.

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The American College of Healthcare Executives (ACHE) and the Lucian Leape Institute (LLI) have partnered to develop a guide intended to assist leaders in creating, shaping, and sustaining the type of culture needed to advance patient and workforce safety efforts.

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RaDonda Vaught listens to the opening statements during her trial. (Stephanie Amador/AP)

Last month, RaDonda Vaught, a nurse in Tennessee, was found guilty of negligent homicide and gross neglect of an impaired adult after giving the wrong medication to a patient. Charlene Murphey, a 75-year-old woman, who was hospitalized at Vanderbilt University Medical Center for bleeding in her brain, died after receiving the erroneous injection.

Vaught could face as many as eight years in prison. But she has already been devastated by her role in Murphey's death. After the verdict was announced, she told reporters, "Nothing that the district attorney said yesterday is worse than anything that I've said to myself." While her sense of guilt is understandable, her legal punishment only serves to obscure the conditions that make such medical errors possible. Indeed, sentences like the one she faces may make medicine less safe for the very patients they're supposed to defend and protect.

On that day of the accident in December 2017, Vaught was working as the "Help All" nurse in the neuro unit, assisting her colleagues with various tasks without any patients directly assigned to her. She was also orienting a new nurse. Murphey needed a radiology scan. While in the scanner, she became anxious, and the doctor ordered a medication called Versed for her.

Vaught offered to run down to the scanner to administer the medication to the patient. She went into the medication-dispensing machine and attempted to type in the brand name of the medicine. When it didn't pop up, she pressed a button to override the machine.

While these machines are intended to keep patients safe, they also can be maddeningly restrictive at times. As an emergency room doctor, I may need a medicine urgently to stop a life-threatening seizure or to force a sluggish heart to beat faster but am unable to leave the patient's bedside to place an order at my computer. During those times, I give verbal instructions to inject the drug. The nurse then overrides the system to pull the medicine without a formal computer order. What's more, according to Vaught, Vanderbilt had recently upgraded its system, and overriding was a routine action taken by nurses.

But when Vaught typed in "V-E," the machine offered up vecuronium, a powerful medicine that temporarily paralyzes patients in anticipation of using a ventilator to mechanically take over their breathing. The drug comes in powder form, while Versed is dispensed as a liquid. A red top on the medicine bottle warned that it was a paralytic. During this process, Vaught was also teaching her orientee about another test they were planning to perform on a different patient.

It may seem ridiculous that a trained medical professional could miss such cautionary signals. And one should certainly be held responsible for overlooking them. Yet anyone who has worked in health care knows that many of Vaught's actions were not altogether unusual. When we are bombarded with many warnings during a busy shift, from pop-ups on our computer screens to the bells and beeps emitted by the monitors, we become desensitized to them, an experience known as alert fatigue.

While Vaught's case has grabbed headlines - and worried health-care workers - it isn't an anomalous incident. In 2010, a pediatric intensive care unit nurse named Kimberly Hiatt gave a fatal dose of medication to a baby at Seattle Children's Hospital. Due to a miscalculation, she gave 10 times the needed dose, which stopped the child's heart. By all accounts, she was an exemplary nurse for 24 years. She loved her patients fiercely. But she was fired and then struggled to keep her license. As the investigation continued, she worked construction jobs. Finally, seven months after the child's death, Hiatt died by suicide. This has been called the second victim effect of medical errors.

A few years ago, a nurse I was working with made the same mistake as Hiatt, with a different drug. Thankfully, the patient didn't suffer any adverse consequences. It is unbearable to think that if there had been a different outcome for the same action, this nurse could be banned from health care and imprisoned. She's one of the most competent and compassionate nurses in the hospital, and, despite her error, there is no one I trust more to care for patients.

Any medical mistake that leads to a patient's death or suffering is a harrowing tragedy, but there are important steps that can be taken after. Vaught realized that she had given the wrong medication and immediately reported what she had done. This is a key component of what's often known as "Just Culture," a concept which recognizes that most medical errors are due to systemic problems. The aim is to be open about errors so that they can be reviewed, allowing institutions to implement organizational changes that will protect future patients instead of simply blaming individuals. Just Culture encourages asking "What went wrong?" rather than "Who wronged?"

This movement of transparency rose from a landmark report put out by the Institute of Medicine in 1999, called "To Err is Human." The document, according to its creators, "breaks the silence that has surrounded medical errors and their consequence - but not by pointing fingers at caring health care professionals who make honest mistakes." The authors argued that "blaming an individual does little to make the system safer and prevent someone else from committing the same error."

It's precisely this risk of perpetuating systemic problems that's in play here. Nurses and other health-care workers across the country let out a collective gasp when we learned of the verdict, in part because we all know that we could've been RaDonda Vaught. But we also know that it's harder to prevent those errors when we leap to blame individuals. My hospital sent out an institution-wide email criticizing the decision to criminalize a medical mistake. The American Nurses Association responded with a similar statement: "Transparent, just and timely reporting mechanisms of medical errors without the fear of criminalization preserve safe patient care environments." The verdict was especially heartbreaking during a time when nurses are already quitting in record numbers, making it increasingly difficult to provide quality care.

When we equate a medical error with a criminal action, we push patient safety back. In this case, we've simply punished a single worker when we could have instead encouraged institutions to improve their systems and processes so that future patients don't suffer from similar errors. Mistakes are a tragic but inevitable aspect of medicine, because people are an essential part of medicine. If we want to eliminate all errors, we would have to eradicate all humans from health care. We should instead recognize the fallibility of those humans and strive to ensure that they have the support they need to best care for patients.

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Perspective | The trouble with punishing health-care workers who make mistakes

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Placeholder while article actions load Last month, RaDonda Vaught, a nurse in Tennessee, was found guilty of negligent homicide and gross neglect of an impaired adult after giving the wrong medication to a patient. Charlene Murphey, a 75-year-old woman, who was hospitalized at Vanderbilt University Medical Center for bleeding in her brain, died after receiving the erroneous injection.

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Transparency, Compassion, and Truth in Medical Errors: Leilani Schweitzer at TEDxUniversityofNevada

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Episode Description

We are joined by Ken Segel from Value Capture, to reflect on the impact of RaDonda Vaught’s conviction on healthcare. Ken co-authored an article with John Toussaint, “4 Actions to Reduce Medical Errors in US Hospitals,” that was recently published in Harvard Business Review.

See all episodes

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53. What the RaDonda Vaught Case Teaches Us About Culture's Influence on Patient Safety

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Listen to this episode from The Lens on Spotify. We are joined by Ken Segel from Value Capture, to reflect on the impact of RaDonda Vaught's conviction on healthcare. Ken co-authored an article with John Toussaint, "4 Actions to Reduce Medical Errors in US Hospitals," that was recently published in Harvard Business Review.

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Patient safety always comes first for healthcare providers. However, while providers take an oath to protect their patients, in reality, it’s difficult to keep all patients safe. In fact, medical error is the third-leading cause of death in the United States, leading to over 250,000 deaths each year. We believe that sentinel events associated with medical errors are preventable. So, how can healthcare providers reverse this disturbing patient safety trend?

The challenge isn’t in creating best practices for patient safety, but, rather, in implementing them with consistency. Training and manual processes have some positive effects on improving patient care, but health information technology has emerged as one of the most efficient, cost-effective, and safe alternatives to traditional methods in improving patient safety and quality care.

Enhancing Patient Care Through Technology

Although technology comes with its deficiencies and limitations, tech-enabled innovations often prove to be exceptionally more accurate and measurable than what even the best behavioral health administrators and staff can provide in terms of improving patient safety outcomes. Tech consistently certifies a reduction in errors, a decrease in miscommunications, and an assurance in provider compliance. Despite some growing pains during acquisition and onboarding, providers are using emerging patient care technology to improve patient outcomes that also serve staff in making their jobs easier.

Read on to learn more about how providers are using technology to improve patient care and maximize safety standards.

1. Improving Provider Communication

Mental health patients and those in other behavioral health settings see a handful of doctors, nurses, specialists, and other medical staff during their stay. With so many health professionals working with one patient, miscommunications are bound to happen. That’s when patients may get injured or engage in behaviors that lead to other sentinel events.

Medical staff needs access to accurate patient records that are updated in real-time. With cloud-based patient profiles, this access and transparency is possible. This gives providers an instant snapshot of the patient’s experience and cuts down on the miscommunications that often lead to patient harm. As evidenced by ObservSmart, our proximity-based rounding tool, utilizing technology to improve staff communication while ensuring patient safety checks is one of the simplest, yet effective, solutions for improving patient safety in a hospital setting.

2. Enhancing Drug Safety

Providers need to make sure that patients take the right medication, at the correct dose, at the right time, and in a way that won’t interfere with other drugs. But prescribing errors are common, leading to adverse events that can severely injure or lead to the death of vulnerable patients. Patient care technology like electronic prescribing practices minimizes miscommunications between the doctor, pharmacy, and patient.

This technology can also flag a patient’s medical records if they have a drug allergy. Other solutions for patient safety and medication are also on the horizon. Healthcare tech brands are creating highly-connected devices to ensure patient medication compliance, which is critical for at-risk populations like the elderly and those in psychiatric facilities.

3. Boosting Diagnostic Accuracy

It’s not unheard-of for errors to occur with diagnostic testing, such as lab work or imaging. With manual processes, it’s easy to mislabel an X-ray, for example. Medical professionals rely on a patient’s diagnosis to recommend swift, effective treatment. But if there’s a problem with the diagnosis, the patient is at risk of unnecessary treatments or even death from untreated issues.

Digitized diagnostic tools and communication systems are some of the many technologies that improve patient care. These assessments work to ensure that the right patient is matched to the correct diagnostic tests and that their providers have instant access to those test results. Automation also speeds up communication between the patient, doctor, and imaging facility to start the right treatment without delays, thus endorsing the value in leveraging technology to streamline complex medical processes.

Patient Care Technologies

Patients — and the friends and family who care about them — deserve to know that they can trust their healthcare providers. From improving provider communication to enhancing drug safety and boosting diagnostic accuracy, these three examples of patient care technologies demonstrate how providers can improve patient safety and quality care.

Contact us today to learn more about how we are developing technology that is revolutionizing how patient safety checks are being done in a variety of medical settings.

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3 Ways Technology is Improving Patient Safety and Quality Care - ObservSMART

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Healthcare technology is essential in improving patient safety and quality care. Read the blog for 3 ways technological innovation is enhancing patient care.

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Shift hand-off is the process of transferring important patient data from one caregiver to another. Hand-off is largely dependent on interpersonal communication as well as the knowledge and experience level of the caregiver. According to the Joint Commission and the Agency for Healthcare Research, ineffective hand-off communication has contributed to prolonged lengths of stay, avoidable re-admissions, delayed or inappropriate treatment, increased costs, inefficiencies related to rework, and care omissions. Approximately 70% of serious medical errors are the result of ineffective handoff.

Nebraska Medicine conducted a study to analyze the effectiveness of a standardized handoff tool. Utilizing a patient-centered bedside report tool called ISHAPED, the study found that this tool reduced nursing overtime, the number of adverse events related to handoff, and patient/family engagement. Therefore, implementing a standardized hand-off tool can improve continuity of care, reduce adverse events, and improve satisfaction among staff and patients.

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Nursing Handoff: Ensuring Easy Transitions for Patients

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Please click here if you are not redirected within a few seconds. Images Nursing Handoff: Ensuring Easy Transitions for Patients www.travelnursesource.com Images may be subject to copyright.

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Nurses will always play an essential role in maintaining and improving patient safety!

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Nurses will always play an essential role in maintaining and improving patient safety!

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Radio Frequency Identification (RFID) refers to a wireless system comprised of two components: tags and readers.

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Smart rooms/hospitals keep the patients at the center of care. The television doubles as an access point to their own chart and patient education, among other things. This allows the patient to be in control and involved in their healthcare. (Heath, 2020)

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Robotics and Smart Room Technology - Revolutionizing Healthcare

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Heart rate monitors are part and parcel of smartwatches and fitness trackers now, but electrocardiogram (ECG/EKG) is the new sensor in town.

The technology is designed to help people keep closer tabs on their heart health, and can even be used to help identify atrial fibrillation (Afib) a serious medical condition that is a leading cause of stroke.

ECG was thrust into the wearable spotlight via the Apple Watch Series 5. But it can nw be found on a wider range of smartwatches, including the Samsung Galaxy Watch 4 and new Fitbit Sense health watch.

What is ECG and why is it a useful feature to have on a smartwatch? We get into all of the key details below.

What is ECG?

Most of the wearables on the market at the moment have optical heart rate monitors inside them. This is a monitor that uses flashing LEDs to penetrate the skin and detect blood flow. When light is reflected off the flow of blood, it's captured by the sensors. The algorithm then gets to work to turn that into an estimation of your heart rate.

But it's not as accurate as it could be - especially where medical issues are involved.

Enter the electrocardiogram (ECG or EKG). Rather than measuring blood flow, it's designed to measure how well your heart is working.

It's a term you'd more commonly hear in the medical industry, referring to an electrocardiograph that's used to detect cardiac abnormalities.

Why would I buy an ECG smartwatch?

An ECG smartwatch can detect if you have atrial fibrillation, a condition that causes an irregular heart rate, and is a leading cause of strokes.

Taking an ECG reading on your watch can tell you if you have a healthy heart rhythm - but for many people the feature is something you'll likely use once and then forget about.

But for a large subset of people, having ECG capabilities can be hugely beneficial.

Smartwatches from the likes of Apple and Fitbit can export an ECG graph of your heart rate, which can be a huge help when talking to your doctor.

"ECG on wearables is super high value for a small segment. It is probably going to be more advantageous to our users over 50 than 20 year olds, but we're trying to build something for everybody," Dr Conor Heneghan, Director of Research Algorithms at Fitbit told Wareable.

"Afib can come and go, as can conditions that affect the rhythm of your heart. That means having a device that can take spot readings at any time, makes it a hugely powerful health tool to have at your disposal," he said.

How do ECG smartwatches work?

Most watches have a build in sensor, that can take a spot reading of your heart rate. You start the app and then place your finger on a specific part of the watch (usually the case or crown) for the duration of the test.

Fitbit has recently launched a new feature in the US that continuously monitors heart rate rhythms, and can look for atrial fibrillation using the PPG sensor. While this has an advantage over ECG watches for spotting Afib, ECG smartwatches offer the benefit of being able to export a graph of your heart rate rhythm.

Which smartwatches have ECG?

The list of smartwatches that currently include an ECG are the following:

ECG wearables available right now

Apple Watch Series 4/5/6/7

Price when reviewed: $399 (40mm GPS)

The latest Apple Watch Series 7 (and the Series 4/5/6) has ECG functionality, with sensors built into the ceramic heart rate monitor under the watch, and also the new Digital Crown.

Fire up the ECG app, pop your finger on the crown and you'll be guided through the reading.

You'll get a notification of whether the reading was normal or Afib, and an EKG graph of your heart rate will be logged in the Apple Health smartwatch app, which can be downloaded and shared with your doctor.

Apple has FDA approval for its ECG, as well as clearance in the European Economic Area with more than 20 countries now able to make use of the health feature.

Fitbit Sense

The Fitbit Sense is the company's first health watch, and it brings a host of new sensors including ECG.

You can perform ECG spot checks using the app on the watch. When you open the app, touch your fingers to the aluminium case and hold as instructed on the watch for an ECG to be taken. Again, this can be exported via a PDF.

The PPG sensor also scans for abnormal rhythms including high and low heart rate.

The Fitbit ECG sensor has gained full FDA and CE approval for use in the US and Europe.

Fitbit Charge 5

Price when reviewed: $279.99

Staying with Fitbit, the company has launched the ECG feature on its new Charge 5 fitness tracker.

It's the only fitness tracker form factor which can take an ECG reading - so a good option for those who don't want to wear a smartwatch.

You pinch the sides of the case to take the reading, which is delivered to the Fitbit app.

You can share your results with your doctor, as well as getting immediate feedback on whether your heart rhythm is normal or Afib.
Price when reviewed: $279.99

Read our full Fitbit Charge 5 review.

Samsung Galaxy Watch 4

The Galaxy Watch 4 is the latest Samsung smartwatch in town - and the move to Wear OS hasn't affected its ability to take an ECG measurement.

The ECG app can be found on the Galaxy Watch 4 - just as it was on the Galaxy Watch 3 and Galaxy Watch Active 2 below.

It takes a 30 second reading when you place your finger on the sensor built into the top physical button. You'll also need to remain still with your forearm resting on a flat surface.

Samsung's Health Monitor app is live in the US and South Korea and it's received clearance in Europe.

It's available in Iceland, Germany, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Hungary, Ireland, Italy, Latvia, Belgium, Lithuania, Netherlands, Greece, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, Austria, and the United Kingdom.
Price when reviewed: $279

What's more, Japan, Indonesia, UAE, Chile, India and China are all confirmed for 2021.

Have a read of our full Samsung Galaxy Watch 4 review and our guide how to take an ECG reading on Samsung smartwatches.

Samsung Galaxy Watch Active 2

The Watch Active 2 was the first Samsung smartwatch to pack an ECG, and takes that reading just as described for the Galaxy Watch 4.
Price when reviewed: $249
It's been updated to support the feature, and like its flagship sibling, it's cleared by regulators for use in Europe, the US, South Korea as well as Chile, Indonesia, and the UAE.

Now that the Galaxy Watch 4 has been released, support for the Active 2 has been set to three years. So it's technically obsolete, but still available at some decent prices.

Check out our Samsung Galaxy Watch Active 2 review.

Withings ScanWatch

The Withings ScanWatch offers even more sensors, with SpO2 detection of sleep apnea also on board.

You can take off-the-cuff ECG readings to check for afib, and the results can be presented in a PDF to show to your doctor.
Price when reviewed: $129.95
The optical heart rate sensor that checks your heart rate throughout the day will also keep an eye out for irregular heartbeats, and if it thinks you may have them, suggest you take an ECG test.

ScanWatch has been out in the EU since 2020, and is now available in the US. That's great news, as it's an excellent health wearable - and it's heading for a much bigger audience.

Check out our Withings ScanWatch review.

Withings Move ECG

Price when reviewed: $699.99
The first hybrid watch to feature the ability to take an electrocardiogram reading - helping detect the signs of atrial fibrillation - the Move ECG is also water resistant up to 50 meters and will automatically track your activity.

Unfortunately, this one is currently still undergoing clinical validation from the FDA in the US, though it is available in the EU already.

Read our full Withings Move ECG review.

Coros Vertix 2

You may not have heard of Coros, but it's a US-based fitness wearables brand that has Garmin in its sights
From around $145
The Vertix 2 is the company's new outdoors GPS watch, which offers an enormous 140 hours of GPS battery life, mapping and training insights.

But up its sleeve is an ECG sensor - but it's not used to take the same type of Afib readings as the other devices in our list. It's designed to take heart rate variability readings as a stress sensor.

Read our Coros Vertix 2 review.

Amazfit Verge 2

Amazfit's latest and greatest, the Verge 2 packs ECG technology to place it as a direct competitor for other watches on this list. This works by using Huami's Huanghan No.1 always-on AI chip.

This nifty chip features a cardiac biometrics engine to monitor your heart rate more accurately, including screening for heart arrhythmia and atrial fibrillation.

At the moment, however, the Verge 2 is only available in China, with US and European launches planned.

How does ECG smartwatch tech work?

An ECG records the tiny electrical signals that are generated by the beating of your heart under your skin, which it presents as a trace. This then allows trained professionals, machines or wearables to understand more about how your heart is functioning - and determine if there are any abnormalities.

"In the simplest sense, it can tell you the heart rate (how fast), the rhythm (how regular), the state of the conduction system and muscle tissue (heart attacks), and even the level of certain chemicals like potassium in the blood, and the effect of medication," says Dr Keith Grimes, GP and Clinical Innovation Director at Babylon Health.

An electrocardiograph in a medical setting usually requires placing electrodes on the skin situated close to the heart, which measure electrical activity produced by the heart as it contracts. The electrical activity is sent to a receiver that records the information, and this is where the heart's rhythm can be analysed and irregularities can be detected.

But the tech inside the Apple Watch (and other ECG-reading devices you can use at home) works differently.

For example, rather than place electrodes on your skin, the Apple Watch example requires you to hold your finger on the device's digital crown. Wait for 30 seconds and the electrical activity of your heart draws a red trace across the watch's screen. Once you're done, the app will let you know whether the trace captured a normal heartbeat, called a sinus rhythm, or an abnormal heart beat.

On the Fitbit Sense, when you've opened its ECG app you'll be prompted to place your fingers on the corners of the watch's frame for the same 30 seconds to take a reading. It will then indicate whether you have a normal sinus rhythm, or whether there are signs that you might have atrial fibrillation or just an inconclusive reading.

Samsung's ECG-packing smartwatches uses their touch-sensitive button as a sensor that you'll place your finger on for 30 seconds as well. After that, it will measure your heart rate and rhythm, and classify it as sinus rhythm (normal) or AFib.

The biggest difference between an electrocardiograph at a hospital and the ECG tech in your Apple, Fitbit or Samsung smartwatch is the first is a 12 lead and the latter is a single lead. In the simplest terms, the 12 lead is taking lots of readings about your heart - the single lead is taking one.

That means a single lead ECG has limited capabilities and offers a single view of your heart. It can't be relied upon to detect all heart rhythm abnormalities - or worsening heart problems. It also can't be relied upon to detect the electrical changes that take place during a heart attack or abnormal heart structure.

Apple makes this clear, but it's important to differentiate between what an ECG at the hospital can offer and what tech you use at home can offer.

How can ECG tech save your life?

An ECG carried out by a medical professional can identify many issues with your heart. But ECG devices designed to be used at home aren't quite there yet.

Here are a few of the ways the ECG tech found in your Apple Watch or Samsung smartwatch can currently save your life though, including the problems that they can identify and the others they might be able to.

Atrial fibrillation

Atrial fibrillation is a heart condition that can cause an irregular and abnormally fast heartbeat. It's common and potentially deadly. It's also intermittent, which makes it difficult to detect. This is the one condition that both Apple and Samsung are FDA-cleared to detect. FDA approval is still pending for Fitbit's new Sense watch to do the same.

ZDNet writer Jason Perlow was part of the early testing of Apple's Atrial fibrillation detection, and identified a problem with his heart in 2018 thanks to the data that was collected.

The reason personal devices are effective at recognising this particular kind of arrhythmia (irregular heartbeat), and the reason Perlow cites for its effectiveness in his case, is because you can take them at any time.

Unlike getting an ECG at the hospital, you can monitor your heart throughout the day. "Irregularities in heart rate can be episodic, and difficult to capture," explains Dr Grimes, "So a personal ECG that you carry with you can help clinicians record when palpitations happen and help with diagnosis."

This means you can take a 30-second ECG whenever you feel symptoms and also better understand the context of what may have brought them on. For example, if you just got back from a run and you're feeling a bit off.

Dr. Tony Faranesh, senior research scientist at Fitbit says the optimal way to identify atrial fibrillation through heart rate tracking is to screen while at rest, making sleep ideal for detection.

On Fitbit's devices, that's done by using its optical-based PPG heart rate sensor. The ECG sensor, like Apple and Samsung, is used for spot checks.

Like Apple, it seems that Fitbit won't be continually scanning for signs of Afib. Though Apple and Fitbit both use the PPG sensor to check for irregular rhythms such as high or low heart rate.

Dr. Julia Reynolds, Associate Director at Innovation Agency, tells us that the Kardia Mobile built by startup AliveCor is sometimes even prescribed to patients for this exact reason.

"Individuals may be given a mobile ECG device by their health professional if they are concerned they may have paroxysmal Atrial fibrillation - that's when it comes and goes. That way, if they are feeling signs and symptoms, they can take their own ECG when they are experiencing symptoms."

Abnormal heart rhythms (arrythmia)

Neither the Apple Watch 4 or the KardiaBand are cleared to detect other kinds of abnormal heart rhythm, but that doesn't mean they aren't able to if you or a professional can interpret the data.

The team at AliveCor has been able to use data from the KardiaBand to detect Long QT Syndrome (LQTS), which is a condition that can cause an irregular heartbeat and could lead to fainting and sudden death.

"In July 2018, AliveCor announced a collaboration with Mayo Clinic to develop tools to facilitate screening for LQTS," an AliveCor spokesperson says. "Although this feature hasn't yet been commercialised, it's a promising step toward detecting this deadly disorder before it's too late."

Like Atrial fibrillation, one of the reasons personal ECG devices lend themselves to detecting a condition like LQTS is that it's often brought on through exercise and stress. That means even if you've had an ECG with a professional it might not have been detected. But being able to take a reading when you're out and about, at the gym or exercising could be a life-saver.

Heart attack

An ST-elevation myocardial infarction (STEMI) is a serious heart attack that occurs when one of the heart's major arteries is blocked.

Like LQTS, there's no official word that personal ECG devices can detect a heart attack. But that doesn't mean AliveCor isn't using its technology to try.

"In November 2018, findings from the STLEUIS International Multicenter Study suggest that a research version of AliveCor's ECG technology is capable of identifying STEMI," a spokesperson from AliveCor told us.

The study tested a standard 12-lead ECG (like the one a medical professional would use) against a mobile ECG and the AliveCor app to find the mobile version was effective in identifying STEMI with high sensitivity in comparison to the professional test.

Healthier insights

Detecting a heart attack or atrial fibrillation could be life-saving, but ECG tech could also be useful in helping us to paint a more accurate picture of our health and fitness.

QardioCore is a chest-based ECG monitor that, unlike the Apple Watch, can be worn throughout the day collecting more than 20 million data points. Although it can also detect heart rhythm irregularities, its design makes it ideal for those who are in fitness training and need more reliable feedback when heart rate activity fluctuates.

Combined with readings about body temperature, breathing rate and stress levels, an ECG measurement can be used to find out more about your body and how it responds to exercise than ever before at home.

For those serious about athletic training, this is done through Heart Rate Variability (HRV) and a Root Mean Square of the Successive Differences (RMSDD) measurement, which identifies the time between peaks and troughs in your heartbeat and helps you to train smarter.

How often should I take an ECG reading?

Provided your heart gets a normal sinus rhythm, you're likely to only need to periodically take an ECG test, just to check everything is in order.

But if you suffer from the feeling of your heart racing, palpitations or periods of feeling unwell, then you can use the ECG app as and when you need it. And it becomes an incredibly important health tool, right on your wrist.

Fitbit's Director of Research Algorithms, Conor Heneghan, says that means users can have a better informed conversation with your doctor.

"The problem with cardiac issues with rhythm is they're so intermittent," said Heneghan.

"For people who have palpitations or other symptoms, ECG can be a reassurance. And if they feel like something's a bit odd going on physiologically they can capture that moment to speak with their doctor about it," he continued.

Fitbit also recommends that the ECG feature should only be used by those aged 22 or above.

The problems with false positives - and negatives

ECG devices available to consumers can detect a range of heart problems, whether they've been cleared to or not, but that doesn't mean they should replace a trip to your doctor.

"Reading an ECG is tricky," Dr Grimes explains. "Current technology uses machine learning to detect common abnormalities, but personal ECG, like the kind you find on the Apple Watch, is not as accurate as medical devices."

Personal ECG devices are proven to save lives, but on the flip-side they can still miss major problems or cause people to worry they have issues with their heart when they don't. Dr Grimes calls these "false negatives" and "false positives".

Although many in the medical profession are warning people to be wary of the results they get from their Apple Watch or other ECG device, having more control over our health at home is going to become more widespread over time.

That means instead of advising against ECG devices, people need to be informed that readings might not always be accurate - but it's best to head to a medical professional if you see a reading you're concerned about, to get it checked out.

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ECG smartwatches explained: How they work and the best on the market

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Heart rate monitors are part and parcel of smartwatches and fitness trackers now, but electrocardiogram (ECG/EKG) is the new sensor in town. The technology is designed to help people keep closer tabs on their heart health, and can even be used to help identify atrial fibrillation (Afib) a serious medical condition that is a leading...

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Although these technologies provide safety checks, the nurse is the last defense to preventing errors.

At the bedside, nurses:
-Collect information about patient needs to individualize care.
-Utilize information to coordinate care and improve patient outcomes.
-Assess safety and implement risk reduction interventions.
-Utilize CDSS to look up medications they are unfamiliar with.
-Assess whether it is safe to administer a medication based on vital signs, labs, and assessment data.
-Question orders.
-Follow EMR alerts, facility policies, and rights of medication administration.

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With the growing concern for patient safety, Congress granted the Agency for Healthcare Research and Quality (AHRQ) $50 million (McGonigle & Mastrian, 2018, p. 294). Shortly after this grant, multiple different agencies came up with patient safety solutions such as The Joint Commission’s National Patient Safety Goals. The National patient safety goals takes the most common safety errors seen in healtchare and then produces evidence-based practices on how to prevent them.