This is part of the April 2013 issue of Sharing Nursing's Knowledge.

Survey of Nurses: Hospitals’ Patient Safety Programs Lacking

A new survey of hospital nurses in the United States, the United Kingdom, and China finds that nurses lack confidence in their hospitals’ safety programs.

The online survey, conducted by a research firm for the American Nurses Association (ANA) and GE Healthcare, included 500 respondents from the United States and 200 each from the United Kingdom and China. Each country's responses were given equal weight in the final results. Among the findings:

• Ninety-four percent of nurses report that their hospitals have programs in place that promote patient safety, but only 57 percent believe those programs are effective.
• Just 41 percent describe their hospital as “safe.”
• Ninety percent of nurses believe it is important that nurses not be penalized for reporting errors or near misses, but 59 percent agree that nurses often hold back in reporting patient errors in fear of punishment (67 percent in the United States, 62 percent in the United Kingdom, and 49 percent in China). Sixty-two percent agree that nurses often hold back in reporting near misses for the same reason (69 percent in the United States, 65 percent in the United Kingdom, and 54 percent in China).
• Thirty-three percent of nurses said that "poor communication among nurses at handoff" has increased the risk of patient safety incidents in their hospitals in the past 12 months. Thirty-one percent said "poor communication with doctors" has also increased the risk of patient safety incidents.

Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows and grantees. Some recent examples:

The average emergency room visit costs 40 percent more than a month’s rent, according to a study led by RWJF Physician Faculty Scholar Renee Hsia, MD, MSc. The study also found the “sticker price” for emergency department care varies widely, the Washington Post Wonk Blog reports, with a sprained ankle ranging from $4 to $24,110. Among the other outlets to report on Hsia’s findings: Health Day, Bloomberg, and MSN.com. Read a post Hsia wrote for the RWJF Human Capital Blog about ambulance diversion and emergency room crowding.

RWJF Health & Society Scholar Jennifer Karas Montez, PhD, was a guest on CNN’s The Situation Room with Wolf Blitzer to comment on a recently released longevity study. Montez' research in this area has focused on longevity among women, and she found that low-educated women (especially those without a high school education) have seen declines in their life expectancy, while life expectancy for men has stayed steady or increased. The Associated Press also reported on Montez research.

Americans support government intervention in matters of public health, such as curbing obesity, U.S. News & World Report says in reporting on research conducted by Michelle M. Mello, JD, PhD, MPhil, an RWJF Investigator Award in Health Policy Research recipient. Three-fourths of respondents in a survey said they support laws that would discourage obesity in adults, with most favoring less-intrusive measures such as posting calorie counts.

Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows and grantees. Some recent examples:

An op-ed in the Star-Ledger reflects on the contributions of Tom Kean, former governor of New Jersey, during his more than two decades of service on the RWJF Board of Trustees, including eight years as chairman of the Board. Learn more about Kean’s commitment to leadership and service.

The Washington Post reports on an inhaler with a built-in Global-Positioning System (GPS), designed by RWJF Health & Society Scholars alumnus David Van Sickle, PhD, MA, that sends a signal with the time and location to a remote server every time a patient uses it. The data is then sent regularly to patients and physicians to help provide more comprehensive treatment. The data can also be used to find asthma “hot spots” in cities, where attacks are triggered, Health & Society Scholar Meredith Barrett, PhD, said. Read more about Van Sickle’s work here and here.

Judi Hilman, director of the Utah Health Policy Project and an RWJF Community Health Leader, gave comments to the Deseret News about decisions and deadlines Utah will have to meet in 2013 to comply with the health reform law.

David Van Sickle, PhD, MA, an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program and founder and CEO of Asthmapolis, has created a new device called a Spiroscout. It is an inhaler with a built-in Global-Positioning System (GPS) that sends a signal with the time and location to a remote server every time a patient uses it. Asthmapolis tracks and analyzes the data and sends regular reports to patients and physicians, along with observations and recommendations.

Last summer, RWJF’s Alumni Network talked with Van Sickle, an epidemiologist and medical anthropologist, and then this month, the RWJF Human Capital Blog followed up with a few more questions. The combined results of those conversations follow:

RWJF Alumni Network (AN): Have you always been working on asthma?

David Van Sickle: My whole career has been focused on asthma. I did my dissertation research on asthma in India and worked at the respiratory center in Arizona during grad school. When I was at the Centers for Disease Control and Prevention (CDC), I was working in outbreak investigations, trying to figure out where and when asthma was happening, so we could better target our public health activities.

AN: How did you get the idea for your company?

Van Sickle: At the national level, we suffer from a lack of data about the day-to-day burden of asthma. When I went to the University of Wisconsin with the RWJF fellowship, and began to look more closely at the clinical management of asthma, I realized that physicians also suffered from a lack of information on how their patients were doing. I thought we could solve these two problems with one new technology that tracked where and when people are using their inhalers, which provides an important signal of how well the disease is being managed.

David Van Sickle, Ph.D., is a former epidemic intelligence service officer with the Centers for Disease Control and Prevention, and a 2006 Robert Wood Johnson Foundation Health & Society Scholar at the University of Wisconsin School of Medicine and Public Health.

This past June, I had the honor of being named one of 17 “Champions of Change” by the White House, in recognition of my work marrying emerging technologies to health care.

According to WhiteHouse.gov, “The Obama administration established the Champions of Change award to recognize and encourage ‘everyday heroes’ working to better their communities through hard work and creative solutions.” Many of these folks – such as awardee Todd Park, chief technology officer at the U.S. Department of Health and Human Services (HHS) – now occupy key roles in government where they are sparking new companies and revolutionizing industrial ecosystems in part by using whole new approaches to data.

As readers of the Robert Wood Johnson Foundation Human Capital Web site may recall, my work to develop a GPS-enabled asthma inhaler caught the attention of the Administration early last year, and I was invited to make a presentation at a Community Health Data Forum sponsored by HHS. The forum was an outgrowth of President Obama’s Community Health Data Initiative, which is focused on making HHS health data available so that software developers and others can put it to innovative and constructive use.

The idea behind the inhaler is to capture valuable data about asthma from daily life, by putting GPS technology to work tracking precisely when and where patients use their inhalers. That’s useful information to patients, because it means they can provide their physicians with the kinds of specifics that generally don’t make it into pen-and-paper logs – often because patients forget to keep track and instead fill them out days or weeks later, in the parking lot of their doctors’ offices, for example! But the device also has public health implications, because when we can identify patterns in asthma incidents, we can sometimes identify and then do something about environmental factors that cause them.

Asthmapolis, the company I formed to bring this to market, is gearing up to manufacture the first commercial version of the sensor and is busy hiring. We're up to six employees now and looking to hire two or three more. Our staff will help educate users and public health officials on the use of the product, design marketing materials, write related apps and more. It’s an exciting time in the life of the company, and it’s been an education moving along the path from idea to prototype to device and eventually to a marketable product. This fall we will launch in major health systems in three states.

In May, the U.S. Department of Housing and Urban Development (HUD) awarded a multi-year grant to an asthma prevention and treatment program run by 2008 Robert Wood Johnson Foundation Community Health Leader Ray Lopez of New York City. Lopez is the director of environmental health services at the Little Sisters of the Assumption Family Health Service in New York’s East Harlem. The grant award is shared with the New York Academy of Medicine.

Human Capital Blog: First, congratulations on the grant. Would you tell us about the project, please?

Ray Lopez: Our mission is to serve children in East Harlem by helping their families treat and prevent asthma incidents. Asthma rates are unusually high in New York City in general, and the problem’s even more acute in Harlem, the South Bronx and Central Brooklyn where there are all kinds of environmental factors in children’s homes. We’re focused on children in public housing, where there are a number of problems. A lot of the apartments have mold that has grown as a result of leaks, and they’ve also got a lot of cockroaches, and mice, which all contribute as well. What we do, and what this grant will help us do a lot more broadly, is to get treatment for the kids, but also to go into their apartments and get to work on reducing the environmental factors. Sometimes that means identifying moisture sources and safely cleaning the mold. Sometimes it means pressing the city’s housing authority to do major work. Sometimes it involves teaching the adults in the family about the safe use of pesticides and cleaning products. For each family we visit, we work with them to create an individualized service plan, and then we focus on remediating the asthma triggers.

Teaching is a major part of this, too, and the plan is to teach by showing and doing. Families are enrolled with us for a year, and by end of year, we hope they will have accumulated skills to manage these problems on their own in the long-term. It’s a three-year project, in all: two-plus years working with the families, and then a final phase that consists of data analysis and policy initiatives led by the New York Academy of Medicine.

HCB: And then what’s the plan with the data and the analysis?

Lopez: The plan is to build the business case for this kind of intervention, and then to persuade insurance companies and providers that it’s worth the investment to them to spend a little money up front to prevent asthma incidents, rather than paying for them in the emergency room.

The Economist featured a story about Robert Wood Johnson Foundation (RWJF) Health & Society Scholar David Van Sickle, Ph.D., who created an asthma inhaler equipped with a global positioning system (GPS) device. Every time the inhaler is used, it records the location, date and time, which can help track trends that will help public health professionals help asthma sufferers. Read The Economist story. Learn more about Van Sickle’s work.

Zachary F. Meisel, M.D., an emergency physician and RWJF Clinical Scholar, co-authored a column on TIME.com about whether emergency departments should turn away non-urgent patients. “The fact is that nobody knows if they are having an emergency when they go in” to the emergency department, they write. “We all need to recognize the value of figuring it out, explaining what the problem is and providing reassurance, and the convenience of being open all the time.” Read the column.

Utah is one of the states chosen to host a Regional Action Coalition (RAC), to implement the findings of the Institute of Medicine Future of Nursing report. Read the Salt Lake Tribune editorial, co-authored by Susan Hassmiler, Ph.D., R.N., F.A.A.N., RWJF senior advisor for nursing, on nurses’ role in health reform. Learn more about RACs and the Future of Nursing report.