Combating the white coat effect


By Gerard Stevens*
Friday, 27 September, 2019

Combating the white coat effect

Communication and system consistency keep patients safe from crashing.

Did you know that Australians are more likely to be admitted to hospital due to medication misuse or misadventure than to lose their bags on a plane?

In a Medicine Safety report released earlier this year, the Pharmaceutical Society of Australia identified that somewhere between 2 and 15% of hospital admissions are due to medication issues and this rises to between 15 and 38% for geriatric patients.1

While Sydney Airport won’t say how many bags are handled each year, it does say “more than 99.4% of bags processed at Sydney Airport make their flight”.

So airlines lose three to six bags per 1000 passengers, affecting between 0.3 and 0.6% of all passengers.

I like to refer to the aviation industry because it is another sector where safety is crucial to outcomes. There are many layers of systems and fail-safes to keep planes from crashing; if one system fails, another kicks in to recover the situation. So there are multiple redundancies throughout systems being operated to keep planes in the air.

Interestingly, the same layering of systems is to pick up the first sign of risk which is not employed when it comes to baggage handling. The outcomes are therefore quite different — the risk of error in baggage handling is much higher and more open to human error.

Despite this, the likelihood of medication errors is still higher than errors caused by baggage handling processes — especially when the proper systems are not in place. When the consequences of medication misadventures are so high, putting patients at risk of harm or even death, what can healthcare professionals do to create a safer environment?

Information technology and design-driven systems

At Webstercare, we apply information technology and design-driven systems with built-in redundancies to ensure that incidents of human error can be picked up before they cause harm.

Medication management, packing and administration systems are therefore all crucial to how we provide medication services. They underpin safety throughout all medication dispensing, packing, supply and administration processes.

This is especially so for frail and vulnerable elderly patients who typically take multiple medications, who can sometimes be afflicted with confusion and whose biochemistries are different from the healthy individuals that pharmaceutical safety trials are based on.

But just like medication, which loses effectiveness when taken incorrectly, systems won’t fulfil their capability if they’re not operated optimally.

Quality of communication

The quality of communication is key to the quality of understanding. Simply passing on information doesn’t cut it because it assumes comprehension.

Yet there are many barriers to understanding. We all know about the white coat effect which talks to comprehension difficulties following a diagnosis.

Other barriers include:

  • use of technical or medical jargon which can be misinterpreted;
  • reliance on print communication, disregarding different preferences and learning styles;
  • a focus on what we want the patient to know rather than what they should do;
  • limited awareness of cultural differences such as language and word meanings, which can lead to poor understanding.

But we also need to reflect on our communication with each other. Poor communication between health professionals contributes significantly to negative outcomes.

Interprofessional coordination

Evidence recently given to the Royal Commission into Aged Care Quality and Safety by Professor Johanna Westbrook, Director of the Centre for Health Systems and Safety Research at Macquarie University, emphasised the need for better systems and greater coordination between GPs, nurses and pharmacists to improve medication safety for residents of aged-care facilities.2,3

Prof Westbrook’s research found that residents had on average nearly 10 discrepancies between the GP’s medication records and those kept by the facility.

Given that a lack of consistency, continuity or completeness in patient information can create an environment ripe for errors, it’s no surprise that the majority of medication incidents occur during transitions of care and changes to medication therapy.

We’re all guilty of focusing on our own backyard, sometimes to the exclusion of others in the healthcare team. Maintaining the status quo will ensure medication management remains a risky business.

But by improving interprofessional communication and coordination, and consistently taking advantage of the technology-driven systems at our disposal, we can significantly reduce unnecessary human error from our processes. We all want that, because less risk in the medication management cycle converts to less morbidity and mortality for our patients.

  1. Medicine Safety: Take Care. Pharmaceutical Society of Australia, 2019.

*Gerard Stevens AM is founder of Webstercare and inventor of the Webster-pak. He was the first Australian pharmacist accredited to perform residential medication management reviews.

Top image credit: © Khrutmuang

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