“First do no harm; then try to prevent it”

Throughout my career—be it as a practicing physician or helping to develop innovative pharmaceuticals and medical devices—my guiding philosophy has been “patients first.” The basic foundation of this idea can be found in the ancient medical maxim, “First do no harm; then try to prevent it.”

Preventable harm in healthcare is exactly that – preventable. And yet, it remains a major public health issue. The human cost is heartbreaking, with medical errors cited as a leading cause of death in the U.S.[i] The financial impact is also significant, costing health care systems billions of dollars each year.[ii]

So, why are preventable harm incidents such a prevalent issue? There are many potential causes.

Medical treatment often requires many moving pieces and careful management to be effective. Healthcare teams—physicians, nurses, pharmacists, technicians and many more—are complex, and these individuals are frequently working with hundreds of systems at once to save and sustain the lives of their patients. We must also recognize that clinicians are human, which means, like the rest of us, they are potentially prone to making “slips” in attention or judgement.  If one link in this lengthy chain fails for any reason, patients can be harmed.

All parties invested in providing patient care recognize and emphasize patient safety, and are taking great strides to address the issue of preventable harm. I have a front-row seat to see how technology is enhancing human skills to help clinicians be the “best they can be.” Here are a few reasons to be optimistic for the future:

Checklists: An Age-Old Tool Meets Advanced Technology

Not so different than checking off your grocery list, checklists are a simple but powerful tool with potential to make a real impact in healthcare – a seemingly obvious suggestion, but data shows effective checklist use in real-world healthcare settings can be less than ideal.[iii

One way to increase this behavior is to incorporate checklist-like functionality directly into healthcare technology design, so that following specific steps is integral to operating the device. This may take the form of step-by-step instructions for loading a dialyzer on a continuous renal replacement therapy (CRRT) machine; safety software with intuitive workflows in an infusion pump to help guide clinicians to safely deliver therapies; or audible voice instructions for patients on how to operate a peritoneal dialysis (PD) machine in their home.

To be truly helpful (and avoid frustrating users), this functionality must be seamlessly integrated, simple and as easy to use as possible. If implemented in this way, these features serve as an important and most welcome confirmation for clinicians to avoid potential errors. Check.

Optimizing EMR Interoperability

The adoption and use of electronic medical record (EMR) systems was supposed to provide significant advancements over traditional paper patient records, including being more understandable and accessible by clinicians. Hospitals have struggled with systems that are challenging to use, with devices and technology not always communicating with the EMR, requiring clinicians to manually document this information -- taking them away from the patient and interrupting their workflow.

Today, the tide is turning. New hospital technology and devices are designed to interface directly with the EMR, helping simplify workflow and reduce errors. The industry is increasingly following common industry standards that allow devices to “talk” to one another and to the EMR. For instance, infusion pump integration with EMR systems allows the automated population of patient infusion parameters through use of pump onscreen barcode technology to decrease the risk of manual programming errors and improve clinician efficiency.

Device connectivity with the EMR not only helps identify potential errors, but also helps improve clinician workflow. Every minute a clinician spends charting patient information at a nurses’ station is a minute they spend away from the patient’s bedside.

Despite this progress, we’re not yet where we need to be when it comes to interoperability. Companies like Baxter can certainly play a role through the products we provide and by working with standards-setting bodies to influence common standards in a way that benefits healthcare companies, providers and patients. And hospitals can make their voices heard to demand better interoperability from the products and services they purchase.

Achieving Total Mission Alignment

While technology can help make the mission possible—or at least easier to achieve—it isn’t a means to an end. If we want to avoid preventable harm, teams need total alignment on addressing the issue at all levels.

To illustrate this point, I’m reminded of an apocryphal story about John F. Kennedy and the race to put the first man on the moon. In 1961, JFK publicly set a goal of a moon landing before the end of the decade - an incredibly ambitious undertaking, and one that would require significant resources and the nation’s full attention.

As the story goes, while JFK was visiting NASA to check in on progress, he decided to speak with workers at the facility, one of whom was a janitor cleaning an area in the building. He walked over to the man, introduced himself, and asked, “What are you doing?”

The janitor replied, “I’m helping put a man on the moon.”

I often keep this story in mind when I think about teamwork needed to accomplish a mission. At Baxter, everyone has a role to play in accomplishing our mission to save and sustain lives. As an industry, all of us in healthcare—manufacturers, providers, pharmacists, technicians, administrators—can come together behind the common cause of preventing patient harm.

After all, each of us are in the business of patient care. And when you align around that mission, you will always do the right thing.

[i] Institute for Healthcare Improvement / NPSF. Preventable Health Care Harm Is a Public Health Crisis. Available at: https://www.npsf.org/page/public_health_crisis. Accessed February 28, 2019.

[ii] Van Den Bos, J, Rustagi K, Gray T, et al. The $17.1 Billion Problem: The Annual Cost of Measurable Medical Errors. Health Affairs. 2011; 30(4):596-603.

[iii] Cullati S, Le Du S, Rae AC, et al. Is the Surgical Safety Checklist successfully conducted? An observational study of social interactions in the operating rooms of a tertiary hospital. BMJ Qual Saf. 2013;22:639-646.