2025 patient safety columns - Healthcare Hygiene magazine

The Role of Bedside Manner in Patient Safety and Quality

By Kristina Pirollo-Ketchum, BA, AA, CHL, CRCST

This article originally appeared in the July-August 2025 issue of Healthcare Hygiene magazine.

Focus on patient safety and quality of care is a pillar of the modern healthcare system. These principles deal with avoiding harm to the patients and the provision of evidence-based medical responses that lead to the best health results. Whereas the technical competence and the medical knowledge are crucial, as highlighted by Sharkiya (2023), the interpersonal activity, such as bedside manner and other interactions, shapes the patient experience, closing the loophole. Bedside manner is the term that can be associated with the communication of healthcare professionals to the patients and their attitude of presenting empathy, respect, and being at the side of a patient. When facilitated by doctors, surgeons, and nurses, compassion assists in developing trust, active listening, and bearing it out. Instead, a negative bedside manner can lead to a dissatisfied patient, anxious feelings, and lost recovery (Sharkiya, 2023). This paper argues that bedside manner is essential to patient safety and quality of care, as it has a direct influence on the outcome of recovery and patient satisfaction.

Effective communication is one of the key contributions of a bedside manner to the safety of patients. Patients can better comprehend their health conditions and adhere to medical prescriptions whenever their physicians communicate effectively on diagnoses, treatment processes, and procedures. For example, Dhaliwal and Dang (2024) found that common, but potentially modifiable, factors increase readmission risk based on a study. Some of these factors include clinician or system-level problems. On the contrary, poor communication has been attributed to bad outcomes such as medical mistakes and adverse events. Moreover, they discovered that one of the key causes of patient readmission was poor information transfer between providers, especially those providers based in hospitals, and primary care providers.

Emotional support and empathy are also important factors in the recovery of patients. According to Babaii et al. (2021), effective communication is an easy yet effective means nurses could employ to establish comfort, joy, and energy in order to diminish sorrow and agony experienced by the patient. Patients felt more listened to and understood and felt less stressed, which improved healing rates. This all was according to a study conducted by Babaii, et al. (2021), who concluded that empathetic interactions between medical workers and patients contributed to increased pain control and emotional self-regulation, which is essential to recovery.

In addition to that, patient trust and patient compliance are affected by bedside manner. The ability of patients to open up to their caregivers and comply with care plans is more likely to happen when they feel that their caregivers are approachable and compassionate. According to the article by Herath, et al. (2023), the implementation of patient-focused interventions into clinical practice is a realistic way of enhancing the quality of medical care. This implies that such a perception by the patients in the parts where they feel cared for will lead to better cooperation and reduced infection and re-hospitalization rates.

In conclusion, clinical interventions do not exist in a vacuum and affect patient safety and quality of care but rather are profoundly affected by humanistic components of care. The bedside approach, which includes communication, empathy, and engagement of a patient, is of considerable importance in fostering health outcomes. Research and practice indicate that practitioners with a focus on excellent interpersonal skills improve recovery rates, minimize the occurrence of complications, and gain patient trust. Therefore, bedside manner should be a crucial issue of healthcare quality improvement.

Kristina Pirollo-Ketchum, BA, AA, CHL, CRCST, is an independent consultant and principal of Ketchum Konsulting, LLC.

References:

Babaii A, Mohammadi E and Sadooghiasl A. (2021). The Meaning of the Empathetic Nurse–Patient Communication: A Qualitative Study. Journal of Patient Experience, 8. https://doi.org/10.1177/23743735211056432

Dhaliwal JS and Dang AK. (2024, June 7). Reducing Hospital Readmissions. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK606114/

Herath M, Reid JL, Ting YY, Bradshaw EL, Edwards S, Bruening M and Maddern GJ. (2023). Patient focused interventions and communication in the surgical clinic: a systematic review and meta-analysis. EClinicalMedicine, 57, 101893. https://doi.org/10.1016/j.eclinm.2023.101893

Healthcare Professionals and Substance Abuse: The Implications for Patient Safety

By Kristina Pirollo-Ketchum, BA, AA, CHL, CRCST

This article originally appeared in the May-June 2025 issue of Healthcare Hygiene magazine.

Healthcare professionals' substance abuse is a definite threat to patient safety and the quality of healthcare. This is a widespread problem, as The Grove Estate (2024) indicates that about 15 percent of physicians have a drug or alcohol problem in a given period of their career, and approximately 100,000 healthcare providers are practicing while being impaired. The rate of illicit use among nurses is 5.7 percent, and for prescription abuse, 9.9 percent, according to Fisher (2023). Consequences of healthcare practice failure include negative effects for individual practitioner and patient outcomes, organizational reputation, and public health. This paper discusses substance abuse dangers in healthcare settings, clinical staff sobriety, support mechanisms for their addicted professionals, and cases of impaired staff that have presented threats to patient care.

Risk factors related to substance use are most prominent in the workplace of healthcare workers. Major sources of this risk factor include work-related stress, exposure to trauma and death, workload, and shift work. According to research-centered on the substance use problems within the physicians and other people in general, the root cause is a family history of alcoholism. In general, the rates of nurse substance abuse vary from one specialty to another; however, nursing homes and hospice areas seem to have higher rates of substance use than other populations. Most used substances are alcohol, opioids prescribed by a doctor, and easily obtainable from the healthcare setting, such as benzodiazepines and prescription drugs. Stigma worsens the experience of patients with addictions since the participants presented delayed help-seeking behaviour that results in poorer outcomes for both the patient and the provider.

Below are some examples of how substance abuse can lead to compromised patient safety. A Kentucky plastic surgeon was charged in 2018 after reporting to work with alcohol in his system. He was challenged by the hospital staff over the impairment before he left, and he was then arrested by police (Merriman, 2023). From July to October of 2020, a nurse at a Connecticut clinic that specializes in fertility treatments stole, in steps, 75 percent of the fentanyl intended for patients and replaced it with saline solution; more than 20 women given injections fused (Nyhus, 2021). An emergency department nurse with substance use disorder caused an outbreak of Hepatitis C by practicing unsafe injecting while diverting medication in 2017 and 2018, affecting at least a dozen patients, as found by Nyhus (2021).

Comprehensive policies addressing substance use concerns need to be implemented in healthcare institutions along with supportive interventions for impaired staff. Results from the evidence indicate that there is evidence of successful in-program treatment for early intervention and full recovery for healthcare professionals and other persons with substance use disorders. Successful outcomes are geared toward continued care. If left unaddressed, the risks to patient safety and such expenses as legal penalties, loss of eligibility to serve patients under Medicare contracts, and loss of the public’s trust can occur without preventative measures and supportive policies.

Healthcare professionals’ substance abuse poses myriad dangers to patient safety and care quality. The examples of documented cases show the serious consequences not only of impaired providers continuing their actions but also of not detecting them in time. At the same time, healthcare organizations must find the right balance between supporting staff who struggle with addiction while being rigorous in guarding against impaired practice. For substance abuse, a hospital must commit itself, go about with clear policies, and be vigilant enough to ensure the highest standards of patient care.

Kristina Pirollo-Ketchum, BA, AA, CHL, CRCST, is an independent consultant and principal of Ketchum Konsulting, LLC.

References:

Fisher P. (2023). The Rise In Substance Addiction Among Nurses - Detox Rehabs. Detox Rehabs. https://www.detoxrehabs.net/blog/substance-abuse-in-nurses/

Merriman A. (2023). Kentucky Plastic Surgeon Arrested for Allegedly Arriving at Hospital Intoxicated. Outpatient Surgery; Association of periOperative Registered Nurses. https://www.aorn.org/outpatient-surgery/article/2018-January-kentucky-plastic-surgeon-arrested-for-allegedly-arriving-at-hospital-intoxicated

Nyhus J. (2021). Drug diversion in healthcare. American Nurse. https://www.myamericannurse.com/drug-diversion-in-healthcare/

The Grove Estate. (2024). Statistics for Substance Abuse in Medical Professionals. The Grove Estate. https://grovetreatment.com/addiction/statistics/substance-abuse-in-medical-professionals/

Healthcare Professionals and Substance Abuse: The Implications for Patient Safety

By Kristina Pirollo-Ketchum, BA, AA, CHL, CRCST

This article originally appeared in the May-June 2025 issue of Healthcare Hygiene magazine.

Risk factors related to substance use are most prominent in the workplace of healthcare workers. Major sources of this risk factor include work-related stress, exposure to trauma and death, workload, and shift work. According to research-centered on the substance use problems within the physicians and other people in general, the root cause is a family history of alcoholism. In general, the rates of nurse substance abuse vary from one specialty to another; however, nursing homes and hospice areas seem to have higher rates of substance use than other populations. Most used substances are alcohol, opioids prescribed by a doctor, and easily obtainable from the healthcare setting, such as benzodiazepines and prescription drugs. Stigma worsens the experience of patients with addictions since the participants presented delayed help-seeking behavior that results in poorer outcomes for both the patient and the provider.

Kristina Pirollo-Ketchum, BA, AA, CHL, CRCST, is an independent consultant and principal of Ketchum Konsulting, LLC.

References:

Fisher P. (2023). The Rise In Substance Addiction Among Nurses - Detox Rehabs. Detox Rehabs. https://www.detoxrehabs.net/blog/substance-abuse-in-nurses/

Nyhus J. (2021). Drug diversion in healthcare. American Nurse. https://www.myamericannurse.com/drug-diversion-in-healthcare/

The Grove Estate. (2024). Statistics for Substance Abuse in Medical Professionals. The Grove Estate. https://grovetreatment.com/addiction/statistics/substance-abuse-in-medical-professionals/

Audits and Surveys as Mechanisms to Enhance Patient Safety

By Kristina Pirollo-Ketchum, BA, AA, CHL, CRCST

This article originally appeared in the March-April 2025 issue of Healthcare Hygiene magazine.

Healthcare management, including hospitals, relies heavily on audits and surveys because these fundamental measurement tools ensure patient safety together with high-quality care standards and regulatory approval. This article discusses how audits and surveys fit into healthcare, what the consequences of non-compliance are for patient safety, and how readiness for these evaluations can help ensure the safety of patients and healthcare staff.

Healthcare audits, as referred to, are systematic reviews with a look at many of health practice’s activities, such as keeping up protocol, level of patient care, and operational efficiency. Chizimu, et al. (2024) state that they are important in determining the differences between where a problem is and the areas that they can improve. Medical audits help identify errors and their basis cause so targeted interventions to improve patient care and operational processes can occur. Surveys of staff and patients are very useful and very visual to the healthcare environment. The Centers for Medicare & Medicaid Services (CMS) performed an audit that found significant shortcomings within an infection control system (Campbell, 2023). Sterilization of hospital surgical instruments was insufficient to protect patients from unnecessary immediate medical consequences. When CMS threatened to yank away their Medicare funding if they didn’t do timely remediation, the hospital lost their privileges. Audits are a critical mechanism in that they prevent failures that should protect the welfare of the patient.

To keep standards of safety high, regulatory healthcare requirements need to be followed. If noncompliance occurs, it can result in very severe penalties, legal consequences, and poor patient care (Kiani, 2022). If healthcare organizations don't do as they're supposed to and leave patients open to unsafe practices, they risk letting them get injured by medical errors or an adverse event. Short-term evaluation and long-term consequences that degrade institutional reputation and patient trust relationships caused by noncompliance events. Investigators from HSS located a New Jersey nursing home during 2020 with rule violations that included staff levels falling below standard and insufficient infection prevention practices. This also resulted in a large COVID outbreak causing severe COVID and resident deaths (GAO, 202). It meant fines, lawsuits, and more intense scrutiny from state regulators. The audit failure measures how regulatory enforcement activities relate and how following guidelines actually protects patients in healthcare settings.

Preparation for a survey is known as survey readiness and entails the readiness of healthcare facilities to satisfy compliance standards uniformly during the whole year. It is composed of staff training, organizational strategy development, and building a culture of patient safety (Deryabina, et al., 2021). Hospitals that prepare themselves for a state of readiness for audits and surveys respond quickly to evaluators’ queries and prove that they are practicing best practices. Thus, regular audits can identify potential problems before they become serious issues.

Surveys and audits are indispensable tools within the healthcare sector, aimed at protecting patients, guaranteeing the quality of care at the same time, and meeting the requirements of regulatory standards. These evaluations are important because not only do they determine what to enhance and what needs improvement, but they also help ensure that those dire consequences of noncompliance do not happen. Enabling safety for patients and staff by creating a culture of readiness for audits and surveys strengthens the relationship with the community and improves health outcomes.

Kristina Pirollo-Ketchum, BA, AA, CHL, CRCST, is an independent consultant and principal of Ketchum Konsulting, LLC.

References:

Campbell JL. (2023). Systemic Failures in Health Care Oversight. Ga. L. Rev., 58, 737. https://digitalcommons.law.uga.edu/cgi/viewcontent.cgi?article=1513&context=glr

Chizimu JY, Mudenda S, et al. (2024). Antimicrobial stewardship situation analysis in selected hospitals in Zambia: findings and implications from a national survey. Frontiers in Public Health, 12. https://doi.org/10.3389/fpubh.2024.1367703

Deryabina A, Lyman M, et al. (2021). Core components of infection prevention and control programs at the facility level in Georgia: key challenges and opportunities. Antimicrobial Resistance & Infection Control, 10(1). https://doi.org/10.1186/s13756-020-00879-3

Government Accountability Office (GAO). (May 20, 2020). Infection Control Deficiencies Were Widespread and Persistent in Nursing Homes Prior to COVID-19 Pandemic. Gao.gov. https://www.gao.gov/products/gao-20-576r

Kiani C. (2022). Planning Patient Safety: Philosophical, Political, and Economic Changes Required for Preventable Death Abolition. CMC Senior Theses. https://scholarship.claremont.edu/cmc_theses/3069/

Examining the Saline Solution Shortage in Healthcare

By Kristina Pirollo, BA, AA, CHL, CRCST

This article originally appeared in the January/February 2025 issue of Healthcare Hygiene magazine.

The shortage of saline solution has become one of the most significant issues of global healthcare concerns for hospitals, worsened by the COVID-19 pandemic due to the increased demand for IV fluids within patients. Oral and intravenous use of saline is important in the management of patients with hypovolemia, septic patients, and patients who have metabolic alkalosis. This article discusses points to understand the factors that have led to the saline shortage, the impacts that it has, and the measures being put in place to ensure that patients continue to receive their saline products.

Causes of the Saline Solution Shortage
The COVID-19 pandemic has further raised the need for intravenous (IV) fluids, more so isotonic saline solutions, due to high hospitalization levels in health facilities. At the height of the pandemic, the utilization of IV fluids increased, and the research suggested that the hospitals needed more than 40 million bags of saline solution monthly (Finfer et al., 2022). This has particularly stretched the existing shortages even before the pandemic due to some other factors such as interruption of production and logistical delays. Natural disasters, such as hurricanes, for instance Hurricane Helene, have compounded these challenges through the closure and halting of production facilities, the North Carolina Baxter, for instance.

Manufacturing issues are further exacerbated by constant quality concerns in several suppliers, one of which is B. Braun, which was already having issues with maintaining steady production before the pandemic. New sources of supply chain constraints have been born from logistics and regulatory constraints that have slowed manufacturers’ ability to satisfy growing demand. Such bottlenecks have contributed to the delay and lack of timely availability of saline solutions in hospitals (Shukar et al., 2021). In monetary terms, saline solutions are low-margin products for manufacturers, who consequently showed modest interest in increasing production capacity.

Impact on Healthcare Delivery
The lack of saline solution has greatly affected the treatment process, forcing patients to wait and use other substandard methods that may not be of so much help. Hospitals have limited the immediate critical care requirements, generally not emphasizing other procedures to preserve the saline solution available. This has raised the challenge of providers using other fluids or oral hydration solutions that may not have similar therapeutic effects as saline. These difficulties have been addressed by the utilization of conservation measures like centralization of stock control of IV fluids and checking on stocks regularly (Lawrence et al., 2020). Applying the acute care model, which is also called the congestive care model, hospitals try to spare more resources for the clinical areas where patients need treatment most of all while postponing treatments that are not vital for the patient’s life.

Alternative Measures to Address the Shortage
To overcome the issue of saline solution deficiency, physicians have been persuasive in prescribing oral rehydration solutions to patients who are mildly or moderately dehydrated. This approach will minimize the use of IV fluids, as patients can self-monitor and administer their fluids with ease and safety at home or within other caring environments. Furthermore, in place of saline, hospitals are using other fluids, including lactated Ringer’s solution or dextrose in sodium chloride solution, and these alternatives are customized depending on the patient and the clinical circumstances (Hirschmann et al., 2020). This flexibility goes a long way in reducing some of the pressure on saline supply while at the same time supplying patients with necessary fluids.

The other strategy includes the use of saline locks, which introduce a saline-filled tube into a peripheral vein but do not continuously infuse the fluids. It uses less saline and permits on-and-off dosing for bacterial exposure to the antibiotic. Also, where possible, converting from IV medications to oral forms reduces the use of saline solutions and enhances the efficient use of available resources (Shukar et al., 2021). This is where the interdisciplinary work is essential; better coordination of the caregivers and the health care workers in general is useful for clinical appraisal of the needs of the clients that they are serving as well as concerning the allocation of available resources.

Future Considerations and Recommendations
Realistically, solutions to rectify the lack of saline solution, in the long run, mean emphasizing increasing production. This could somehow involve granting incentives to manufacturers so that they increase space and incorporate features that improve operations. Also, relationships between the public and private sectors may enhance the sharing of resources and ideas on how best to undertake projects. It is suggested that policy recommendations should also underscore the need for information sharing across the healthcare chain so that supply, demand, and contingency information is shared. Such steps will help prevent future shortages and ensure quality care is delivered to patients in the future.

In conclusion, the availability of saline solutions has remained threatened due to some of the factors, such as high demand, disruptions of production, delayed supply chain, and producers’ adverse financial incentives, thus affecting healthcare and patients. To solve these issues, the cooperation of manufacturers, healthcare, and politics should be encouraged to seek long-term solutions and minimize future shortages. Iodine solutions are used in therapy and are another example of why healthcare supply chain management should be very strong in crises. Keeping a constant stock of saline solution is therefore very important for the delivery of good quality health care and, more importantly, to protect the health of citizens.

Kristina Pirollo-Ketchum, BA, AA, CHL, CRCST, is an independent consultant and principal of Ketchum Konsulting, LLC.

References:
Finfer S, et al. (2022). Balanced multielectrolyte solution versus saline in critically ill adults. New England Journal of Medicine, 386(9), 815-826. https://www.nejm.org/doi/abs/10.1056/NEJMoa2114464
Hirschmann MT, et al. (2020). COVID-19 coronavirus: recommended personal protective equipment for the orthopaedic and trauma surgeon. Knee Surgery, Sports Traumatology, Arthroscopy, 28, 1690-1698. https://link.springer.com/article/10.1007/s00167-020-06022-4
Lawrence JM, et al. (2020). Leveraging a Bayesian network approach to model and analyze supplier vulnerability to severe weather risk: A case study of the US pharmaceutical supply chain following Hurricane Maria. International Journal of Disaster Risk Reduction, 49, 101607. https://www.sciencedirect.com/science/article/pii/S2212420919311847
Shukar S, et al. (2021). Drug shortage: causes, impact, and mitigation strategies. Frontiers in pharmacology, 12, 693426. https://www.frontiersin.org/articles/10.3389/fphar.2021.693426/full