I just downloaded the PPN app for my iPad and got around to reading a summary of the ISMP webinar on Medication Safety that documented what the Joint Commission (TJC) identified as a 2-year "slump" in compliance with medication safety standards. It was somewhat alarming (Pharmacy Practice News Volume 41, September 2014).
It reinforced my perception that we have a hard time keeping safety at top-of-mind. The work pressures we face on a daily basis focus on productivity, not on safety. And, with an inspection that only occurs every few years, it's not like we get constant reinforcement for the right things to do. This results in a known human bias called
the normalization of deviance.
Any of us who has ever had a speeding ticket knows about the normalization of deviance. We go by signs every day telling us what the speed limit is, often at speeds well above the posted limits. Mea maxima culpa.
What happens is that we do it, and nothing bad happens, so we do it again, and again, until it becomes normal. If we get stopped for speeding, our driving changes for a little while, but pretty soon we are back where we were. And if it appears that everyone around us is speeding, the trip back there is even faster.
Back to our practice, the same thing happens when we fail to follow established standards. Nothing bad happens... or so we perceive... and eventually it just becomes normal to do that.
As is quoted in that article, communication is required to keep compliance front of mind. I would like to append to that the notion that the communication must contain the "why" as much as it contains the "what".
In a previous blog, I commented on what I call the "
checklist mentality" where compliance with the steps in a process becomes a surrogate for actually thinking about the goal of that compliance. The result is that, as long as I can "check the box", I move on without giving it further thought.
In the article from PPN, Pat Adamski (Division of Healthcare Improvement, TJC) described finding medication reconciliation programs where medication history information was acquired, but was never reconciled with current treatment requirements. The acquisition of the data had become a surrogate for actually doing the reconciliation. The box got checked, but the work wasn't really done.
When our messaging on patient safety focuses on the outcomes we are looking for, and the paths to that outcome (the "why"), compliance becomes less about checking the box than it does about achieving the goal.
What do you think?
Dennis A. Tribble, Pharm. D., FASHP
Daytona Beach, FL
DATdoc@aol.com
The ideas and opinions expressed herein are my own, and do not necessarily represent those of my employer or ASHP