What does your patient safety brochure really say?

What does your patient safety brochure really say about safety?
Most patient safety advocates agree that educated patients are the safest patients. The concept is clear: patients who know what to expect will be more aware of potential risks and errors. What is less clear is exactly how organizations educate patients and their caregivers about their role in safety and encourage their contributions. At a minimum, most healthcare providers attempt to involve patients in safety by distributing a handout or brochure that covers general safety tips and encourages patients to speak up about the hazards they may encounter. The emphasis is usually on actions patients can take to help ensure their safety. Unfortunately, the impact of patient safety brochures has not been well studied. While these have the potential to reduce errors, a recent analysis1 of five leading national patient safety brochures suggest that they may also result in unintended consequences that can compromise patient safety efforts. The study was conducted with participants from academic, clinical, administrative, and consumer settings who had been promoting or researching patients' perspectives on, and contributions to, safety. Based on this analysis, we have put together questions and recommendations to help you design or improve the patient safety brochures that you distribute to patients. Although many nurses do not directly participate in the development of patient safety brochures, all nurses can still benefit from reviewing the assessment questions and recommendations
in Table 1. Nurses are typically the most visible healthcare practitioners to hospitalized patients, so they are in the best position to discuss safety with patients, reinforce the safety messages in a safety brochure, and respond to patients' concerns about safety. Reference: 1) Entwistle VA, Mello MM, Brennan TA.
Advising patients about patient safety: current initiatives risk shifting responsibility. Jt Comm J Qual Patient Saf. September 2005; 31(9):483-94.

What the Study1 Shows Recommendations Is the safety information well defined?
Most safety tips are broad-based and generalized. Patients who are ill are less likely to act on vague safety tips, such as “Ask questions.”
Patients are more likely to heed advice if the instructions are clear and concise, such as “Make sure your name is spelled correctly and your birth date is correct on the bracelet applied to your wrist when you are admitted.”
Is the basis for the safety tips provided? Many times, the basis for the safety tips are not provided. Recommendations without a rationale represent missed opportunities to broadly educate patients about safety issues in healthcare.
Safety tips should clearly explain why specific actions are recommended and the desired outcome or goal of the recommendations. Knowing the reason for a safety tip also helps patients remember it and use it.
Are the safety tips prioritized? Participants in the study noted that the sheer number of tips in a handout may overwhelm patients because they cannot act on all of them. Tell patients which safety tips are most important based on likely impact on their safety during hospitalization.
Does the safety brochure specify what the organization is doing to enhance safety?
A long list of safety tips for patients alone may imply that patients are the only ones looking out for their safety. Describe how patient participation contributes to what the organization is already doing to ensure safety, to reassure patients that their safety is not in their hands, alone.
Are patients advised how to report hazards and errors? Patients and families may observe or perceive risks during the course of care that healthcare providers may not notice. But some patients are not comfortable telling their direct caregivers about these risks, yet they would like to make the organization aware of them.
Tell patients several ways they can report safety problems, including avenues that bypass their direct caregivers, such as telephone hotlines, safety suggestion boxes, surveys, and patient advocate rounds. Also include information about rapid response teams, if available.
Is the patient safety brochure written from the patient’s perspective?
According to the study’s authors, safety handouts are often written from the provider’s perspective.
Learn about the predominant concerns and self-perceived information needs of the patient community served before creating/reviewing the brochure. Test the contents of the brochure with patients before finalizing the design.
Do the safety tips require patients to check or challenge healthcare providers? Advice that requires checking and challenging providers may be particularly problematic for patients, who may fear being labeled as difficult if they speak up. Staff also may be less inclined to interact with patients who challenge them, potentially worsening safety risks. Include some safety tips that do not require patients to check and challenge providers.
Create an environment that demonstrates respect for the patient’s assertiveness regarding safety and encourages patients to speak up about safety.
Does the brochure shift responsibility for safe care from the provider to the patient?
Patients may perceive the safety tips in the brochure as inappropriately shifting responsibility for safe care from the healthcare provider to the patient, particularly if there’s little evidence that the healthcare provider is also taking steps to improve safety.
Be clear about the key initiatives that the organization has implemented or is planning to implement to protect the patient’s safety while providing healthcare services.
Do staff reinforce the safety tips and offer patients support in carrying them out?
Healthcare providers are not likely to discuss the safety tips in the brochure with patients and encourage them to participate unless organizational leaders value and reinforce this behavior. As noted by one study participant: “Systems aren’t set up to have you involved…you have to bully your way in to be a partner… and you’re really not a partner, you’re an imposition at that point. And patients feel that.”

All staff should know the safety tips offered in their organization’s patient safety brochure and
be fully conversant with patients about their meaning and implementation. Beyond distributing
advice in safety brochures, organizations need to build the infrastructure required to ensure that patients’ contributions to error prevention are encouraged and met with appropriate responses.

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