Abstract
System failures may occur in healthcare facilities and have deleterious effects on patient safety and ultimate healthcare outcomes. While these failures occur, healthcare organizations can minimize them to improve quality of care for patients. Language barrier has become a common problem because of many Americans who are not proficient in English. While such patients require medical care, they cannot gain access to interpreters. Physicians and other healthcare providers can take precautions by providing trained medical interpreters and facilitating collaboration and advocacy among healthcare workers to minimize impacts of language barrier.
Insufficient drug information and inadequate drug references have led to poor drug prescription for patients. There are nonformulary drugs that could lead to system failures due to inadequate information and references. Pharmacists must consult thoroughly and interpret information accurately to ensure that the right information is provided to patients on medications. Recent studies show that healthcare workers require information on drugs at their point of care to facilitate decision-making on prescription. In addition, they should only use reliable sources when confirming information on indications and dosing.
Introduction
System failures are common in healthcare facilities and usually have detrimental effects on patient safety and healthcare outcomes (Smetzer, 1998). There are several system failures based on a given healthcare situation. Healthcare providers should identify these failures and develop effective methods of reducing their harmful impacts on patients and potential legal issues for care providers. This research paper focuses on two of the system failures identified by Smetzer (1998).
The Language barrier
The language barrier is a critical part of the system failure that prevented the staff from discussing and providing appropriate treatment options (Smetzer, 1998). While it was clear that the patient did not require urgent medical interventions, “the neonatologist was not convinced that the patient’s parents comprehended the relevance of follow-up” (Smetzer, 1998). Consequently, the neonatologist decided to treat the patient while still in the facility even without laboratory test results.
Given the impact of language barrier on health outcomes, it is imperative to take precaution to reduce its adverse outcomes. Singleton and Krause (2009) noted that limited language proficiency, low health literacy and cultural barriers are referred to as ‘triple threat’ to any meaningful health communication. Healthcare providers should continually develop their communication abilities and understand health literacy among their patients. In some instances, healthcare providers rely on uninformed strategies to determine the needs of their patients. For instance, past studies have shown that healthcare workers rely on ‘gut feelings’ to assess health literacy of patients (Singleton & Krause, 2009).
This approach is highly imprecise. Healthcare facilities should provide trained medical interpreters to overcome language barriers. Finally, there should be health literacy advocates to tackle communication barriers in healthcare facilities.
Precautions for mitigating language barrier should emerge from nursing discipline. Singleton and Krause (2009) noted, “Nurses are in an ideal position to facilitate the interconnections between patient culture, language and health literacy in order to improve health outcomes for culturally diverse patients” (Manuscript 4). They can act as health literacy advocates to overcome language barriers, pursue self-directed learning for cultural competence and awareness and understand effects of impaired communication on quality of care.
Insufficient drug information and inadequate drug references
Failure to understand information presented on the nonformulary drug led to system failure in the case of the patient. There was no pediatric pharmacist to recommend the required penicillin G benzathine dosage for the infant. In addition, the pharmacist misread health department’s recommendation and Drug Facts and Comparisons, as well as the drug order (Smetzer, 1998). Still, the pharmacist could have misinterpreted further information on the drug order units.
Pharmacists should take precaution when prescribing dosage for children. Mukattash et al. (2013) noted that there was little available information for indications and dosing regimens of medications for infants because of a lack of properly tested medicine for children. As a result, many healthcare providers rely on different sources of information when prescribing medications for infants. Sources used to obtain information varied on reliability. Pharmacists, therefore, should determine the correct dosage from highly reliable sources and properly read and understand information provided on drug orders.
Pharmacists and pediatricians should collaborate to provide information on improving dosing regimens and indications on infant nonformulary drugs. A pharmacist should be available to ensure that all nonformulary drugs for infants have the right and adequate information on indications and dosing. Overall, pharmacists have the ultimate role of intervening to ensure that all prescriptions have the right information before dispensing drugs to patients. At the same time, there is a need to provide the right and easily accessible drug information to pharmacists at the point of care to facilitate decision-making when prescribing nonformulary infant drugs.
Recent piece of evidence for the system failures
The language barrier
Many Americans speak a language other than English while others have limited English proficiency. Yet several patients who require medical interpreters cannot gain access to them. Recent studies have shown that language barrier could have deleterious impacts on healthcare outcomes (Singleton & Krause, 2009). Patients who have communication challenges are likely to experience medical errors and increased non-adherence to medication because such challenges reduce access to healthcare, compromise healthcare quality and result into adverse healthcare outcomes.
Studies have shown that it is imperative to provide interpretation and translation services for patients with language barriers to reduce healthcare barriers and ensure effective care (Coren, Filipetto, & Weiss, 2009). This implies that patients with language barriers should receive appropriate care and healthcare providers must attempt to ensure that they understand information offered.
Healthcare providers are also encouraged to collaborate with their colleagues to communicate health messages to patients with language barriers. This could require an interdisciplinary learning to overcome cultural, literacy and language challenges to improve quality of care (Singleton & Krause, 2009). Health literacy advocates are necessary to assist healthcare facilities to tackle challenges of communication barriers. Hence, nurses can offer the best solutions because they understand how poor communication affects healthcare outcomes and patient safety. In addition, recent studies have recommended that nurses should develop appropriate educational materials to meet the needs of patients with language barriers (Singleton & Krause, 2009).
In summary, Singleton and Krause see greater role for nurses to overcome language barriers through healthcare literacy, culture and language awareness in addition to collaboration and advocacy. Coren et al. (2009) noted that healthcare providers must attempt to offer interpretation services and provide comprehensive information to patients.
Insufficient drug information and inadequate drug references
According to Mukattash et al. (2013), pediatricians must use various sources of information when prescribing medications for infants because of a lack of readily available information on infant medication indications and dosing. This situation occurs due to a lack of properly tested medicines for children (Mukattash et al., 2013). Vromans et al. (2013) noted that information contained in Product Characteristics (SmPCs) and patient information leaflets (PILs) were the “only officially approved information on prescription-only medicinal products addressing healthcare professionals (HCPs) and patients” (p. e003033).
Given the inadequacy of information on drugs, a study by Rahmner et al. (2012) showed that the current information on drugs does not meet the needs of physicians while its structure, contents and format on SmPCs cannot be easily transferred to Clinical Decision Support Systems (CDSSs) and support patient data in the Electronic Health Records. Relevant and easily accessible drug information at “a point of care is essential for physicians’ decision-making when prescribing drugs to patients” (Rahmner et al., 2012, p. 115).
Rahmner et al. (2012) showed that there was a need to provide reliable, accessible information on medicinal products to support the needs of patients and physicians, as well as needs of current information society. In addition, healthcare providers require relevant information on medications at the point of care to support their decision-making processes on dosing for quality of care and patient safety (Rahmner et al., 2012). Knowledge databases should offer reliable and consistent medicinal information for both current and new drugs.
In summary, Mukattash et al. (2013) noted that healthcare workers use various sources of information for prescription due a lack of readily available information on infant medication indications and dosing. Vromans et al. (2013) observed that HCPs should rely on reliable sources of information such as SmPCs and PILs while Rahmner et al. (2012) noted that HCPs should have accurate, reliable information on drugs at the point of care to facilitate decision-making on prescription.
Conclusion
System failures such as language barriers, insufficient drug information and inadequate drug references could have deleterious impacts on healthcare outcomes and legal challenges for healthcare providers. Current studies (Coren et al., 2009; Singleton & Krause, 2009; Rahmner et al., 2012) show that healthcare facilities could mitigate these challenges and reduce their impacts on patient safety and outcomes. Language barriers require healthcare trained interpreters to assist patients and healthcare workers. In addition, healthcare providers should collaborate with their colleagues and act as language advocates to overcome such barriers in their organizations.
References
Coren, J., Filipetto, F., & Weiss, L. (2009). Eliminating Barriers for Patients With Limited English Proficiency. The Journal of the American Osteopathic Association, 109(12), 634-640.
Mukattash, L., Nuseir, Q., Jarab, S., Alzoubi, H., Al-Azzam, S., & Shara, M. (2013). Sources of Information Used when Prescribing for Children, A Survey of Hospital Based Pediatricians. Current Clinical Pharmacology. Web.
Rahmner, P., Eiermann, B., Korkmaz, S., Gustafsson, L., Gruvén, M., Maxwell, S…Vég, A. (2012). Physicians’ reported needs of drug information at point of care in Sweden. British Journal of Clinical Pharmacology, 73(1), 115-25. Web.
Singleton, K., & Krause, E. (2009). Understanding Cultural and Linguistic Barriers to Health Literacy. OJIN: The Online Journal of Issues in Nursing, 14(3), Manuscript 4. Web.
Smetzer, J. (1998). Lesson from Colorado: Beyond Blaming Individuals. Nursing Management, 29(6), 49-51.
Vromans, L., Doyle, G., Petak-Opel, S., Rödiger, A., Röttgermann, M., Schlüssel, E., & Stetter, E. (2013). Shaping medicinal product information: a before and after study exploring physicians’ perspectives on the summary of product characteristics. BMJ Open, 3(8), e003033. Web.