Patient Safety and the Audiologist

Audiologists and all health care workers must be concerned with patient safety procedures. It is necessary to recognize theoretical and actual safety concerns, take proactive steps to prevent safety risks, and follow appropriate procedures if any safety issues arise in the workplace.

ASHA Information on Patient Safety

The following document addresses patient safety in relation to the procedure or setting described:

Health Literacy: The Cornerstone of Patient Safety (The ASHA Leader article)

Joint Commission Safety Goals

Consistent with the national focus on patient safety among federal and private healthcare analysts, The Joint Commission has implemented 12 patient safety goals. The 2007 goals include:

To improve the accuracy of patient identification
To improve the effectiveness of caregiver communication
To improve the safety of using medications
To reduce the risk of health care-associated infections
To accurately and completely reconcile medications across the continuum of care
To reduce the risk of patient harm resulting from falls
To reduce the risk of influenza and pneumococcal disease in institutionalized older adults
To reduce the risk of surgical fires
To implement applicable National Patient Safety Goals and associated requirements by components and practitioner sites
To encourage patients' active involvement in their own care as a patient safety strategy
To prevent health care-associated pressure ulcers
To organize and identify safety risks inherent in its patient population

The safety goal that affects audiologists the most is "to improve the effectiveness of caregiver communication." This goal requires implementing a process of verifying verbal or telephone orders by having the individual receiving the order read it back. Another requirement of this goal is that facilities standardize abbreviations, acronyms and symbols, including a list of "do not use" abbreviations and symbols that could be easily misread.

In 2005, The Joint Commission instituted its "Do Not Use" list of abbreviations in medical settings.

Every Joint Commission accredited facility goes through a yearly survey process. Your facility has most likely already designated an administrator to coordinate preparation for your survey, and that individual will let you know what you will need to do. Personnel files for all audiologists (including outside contractors who provide services in your facility) should contain evidence of their licensure and certification, as well as demonstration of competencies that involve high volume/high risk within the facility. This can be accomplished by various means, including checklists of skill areas and documentation of attendance at continuing education programs or successful completion of self-study programs. An additional area targeted by The Joint Commission is age-related competencies, which require demonstrated knowledge of developmental, physical and psychosocial aspects of all age groups that may be treated in your facility. See the article " Assessing Staff Competencies" from the ASHA Special Interest Group 11 newsletter for additional information.

Audiologists and Multiskilling

Another patient safety issue that affects audiologists is the issue of "multiskilling." This issue presents new challenges for individuals who must perform activities that were not previously expected of them. Some of these activities are not considered "skilled" and are also taught to family members and technicians, such as taking blood pressures, suctioning, or assisting with transfers. Other activities, such as completing functional assessments, require audiologists to score items about a patient's status that they may not feel trained to evaluate. ASHA's Code of Ethics states that clinicians must be competent by virtue of training, education and experience to perform any activities they undertake. Thus, appropriate training and support are necessary for an audiologist to undertake any activity in which they are not already competent. It may be advisable for your facility to develop a written policy that addresses the level of involvement and training that audiologists will have, as well as a mechanism for verifying their competency. See ASHA's position statement on multiskilling.

Additional ASHA Resources

Preferred Practice Patterns for the Profession of Audiology
Joint Audiology Committee Clinical Practice Statements and Algorithms (Guidelines)
ASHA Practice Policy
Certificates and Competence (The ASHA Leader article)
The Ethics of Competence (The ASHA Leader article)
Standards-Based Competency (The ASHA Leader article)

Articles of Interest

Bates, D. W., & Gawande A. A. (2003). Improving safety with information technology. New England Journal of Medicine, 348, 2526-2534.
Gerberding, J. L. (2002). Hospital-Onset Infections: A Patient Safety Issue. Annals of Internal Medicine, 137, 665-670.
Leape, L. L. (2004). Making health care safe: Are we up to it? (Gross Lecture). Journal of Pediatric Surgery, 39, 258-266.
Leape, L. L., Berwick, D. M., & Bates, D. W. (2002). What practices will most improve safety? Evidence-based medicine meets patient safety. Journal of the American Medical Association, 288, 501-507.
Leape, L. L., Woods, D. D, Hatlie, M. J., Kizer, K. W., Schroeder, S. A., & Lundberg, G. D. (1998). Promoting patient safety by preventing medical error. Journal of the American Medical Association, 280, 1444-1447.