Essentials of Patient Safety in Physical Therapy Practice

Original Editor - Sivapriya Ramakrishnan.

Top Contributors - Sivapriya Ramakrishnan, Shaimaa Eldib and Kim Jackson  

Introduction[edit | edit source]

Patient safety is defined as a commitment from the healthcare team member in providing the patient with safe techniques and procedures that reduces the risks and errors and maximize the recovery of the patient[1]. The WHO Global Safety Action Plan 2021-2030[2] emphasizes various action from the stakeholders to promote zero harm for the patients. The patient safety curriculum guide given by WHO- multidisciplinary edition does not provide information specifically from the perspectives of Physiotherapy practice[3]. Physiotherapists as a healthcare team member must be aware about patient safety protocols[4][5] and they must be trained in this area to improve their competencies[6] and hence the patient safety.[7]

Domains of patient safety practices[edit | edit source]

  • Knowledge about the adverse events and the system involved in patient safety[8]: The physical therapist must have knowledge on factors such as Infection control procedures [3], near misses, errors and risk mitigation strategies[9] and the patient safety assessment manual used at their place of work like hospitals[10] and primary care[11].
  • Communication[12][13][14]: Communicating with the patient is one of the essential competencies across the globe. Communication with the patient, family members and team members will begin from informed consent[15], history taking[16], providing knowledge to the patient[17] about the condition and action taken plan, giving instructions while treatment, explaining the home exercise program to the patient and caregivers and it may extend up to negotiation of in terms of long-term care requirement for the patient. Collaboration with the team members[18][19].[20]
  • Managing and acting at the moment[21]: According to Endsley's theory of situational awareness, the therapist must be aware of how to tackle the situation. It involves three phases perception, understanding and prediction.
    • Perception[21]: The therapist is being aware of the situation around, which includes people, environment, modalities, team members action, patient details, medical records, family members etc.
    • Understanding[21]: Once the stage of perception has completed, the therapist must now act in a way to integrate these details to practice and understand how one factor can affect all other factors[22].
    • Prediction[21]: As the phase of perception and understanding shall pass, now the therapist must be in a scenario to anticipate that may happen and act ahead of time to create check list and incident management plan. Checklist[23] is considered as one of the important resources to be used in critical situations, to reduce human errors. Physical therapist in collaboration with the healthcare team members shall create a checklist to be used to address the patient safety concerns across different situations eg- safety considerations while transferring the patient, pulling up the bed rails after treatment to prevent patient falls, crutch height considerations to prevent axillary nerve injury etc. This can be utilized either in the form of physical checklist or using technology an automated one to be chosen according to the case. This requires meticulous practice and training with the organization considering the legislative and socio-cultural norms involved within.
  • Information technology to reduce risks: Using information technology can enhance patient safety in physical therapy practice like, Electronic Medical Records (EMR), Electronic Physician's orders, Clinical Decision Support (CDS) tools, Asynchronous and Synchronous Telerehabilitation[24], Patient Handover[25].
  • Being a life-long learner: Physical therapist must seek to enhance knowledge by participating in formal and informal opportunities of learning. Formal opportunities includes presenting their cases in the departmental meetings, participating in competency based continuous professional development[26] activities i.e pertaining to attend seminars, workshops and conferences that improve the knowledge, skills, approaches and attitude in their practice[27] and so does the patient centered care. Organizations/Institutions must take up some responsibilities in organizing professional development activities based on the needs analysis of the employees that will benefit both the parties[28].
  • Collaborator[29]: Patient safety is shared amongst all healthcare professionals[30]. Decision making process involves clinical reasoning across the healthcare team to ensure patient safety is a priority[31][32].

Linking Physiotherapy practice to Physiotherapy Education[edit | edit source]

Patient safety can no longer be a part of the hidden curriculum, but it has to emphasized to embedded across the curriculum[33]. There is limited evidence to showcase the same and research are less in this area, which questions the actual implementation of the patient safety curriculum in physiotherapy education and the limited knowledge about patient safety for physiotherapists.[34] The patient safety framework provided by the Australian Patient Safety Education Framework (APSEF) and Canadian safety competency framework emphasizes various domains and in a programmatic method to be introduced in the curriculum [3]. Integrating the physiotherapy education[35] with practice with experiential learning strategies [36]on patient safety can promote the domains addressed[37][38].

Physiotherapy and Patient safety
Physiotherapy and Patient safety

Methods to inculcate Patient Safety in the physiotherapy education[edit | edit source]

Simulation- Simulated environment and standardized patient is one of the methods to expose the students in an unfamiliar environment, which let the students to gain confidence before approaching a real working situations[39].

Project Based Learning- Assigning the final year students to prepare the project considering the real-world working systems quality in mind to promote patient safety[40].

Interprofessional Problem Based Learning & Team Based Learning- Providing the students with the problem pertaining to the errors and risk mitigation and facilitate the process of learning through inquiry has an impact on the retention of the concept applied [41]and it is enhanced more if the students are working in groups of various health care professionals[42].

References[edit | edit source]

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  2. World Health Organization. Global patient safety action plan 2021–2030: towards eliminating avoidable harm in health care.
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