Ms. Deborah Duncombe This is Me

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1. 1. Oncology Nursing Today Speakers

   www.stratosinstitute.com/ONTod - [Cached]

   Published on: 9/30/2007   Last Visited: 9/30/2007

   Deborah Duncombe, MHP Risk Manager

2. 2. Preventing Medication Errors

   www.stratosinstitute.com/news/ - [Cached]

   Published on: 1/1/2000   Last Visited: 9/30/2007

   Joining Ms. Lane as guest experts are five of her colleagues from Dana-Farber: Sylvia Bartel, RPh, MPH, Director of Pharmacy; Maureen Connor, RN, MPH, Director, Risk Management; Deborah Duncombe, MHP, Risk Manager; Judith Prisby, RN, BSN, OCN®, Clinical Research Nurse; and Robert Soiffer, MD, Chair, Pharmacy and Therapeutics Committee.
   ...
   "Error occurs because something in the process allows it to occur," Ms. Duncombe explains.

3. 3. Today's Hospitalist :: One Boston hospital gives executive walk rounds a grassroots twist

   www.todayshospitalist.com/inde - [Cached]

   Published on: 2/1/2007   Last Visited: 11/15/2007

   Deborah Duncombe, MHP Dana-Farber Cancer Institute
   ...
   The risk manager who helped spearhead the project was Deborah Duncombe, MHP, who has worked at the center for years. In keeping with the informal nature of the program, Ms. Duncombe says she avoided the scripted questions that are typical during executive walk rounds.
   
   She admits, however, that she has a short list of questions that are particularly effective in engaging nurses and physicians to talk about obstacles to providing safe care. One question that often elicits a response: "Do you have any work-arounds?" That question, says Ms. Duncombe, "really encourages people to think outside of the box."
   
   One of the challenges of getting peers to talk about problems, she says, is that many people at first don't understand how broad patient safety issues really are. When she first began conducting patient safety rounds, for example, most staff wanted to talk about problems with medications and physical safety.
   
   To start a dialogue about what exactly constitutes patient safety, she often uses a question that many providers find provocative: "What was your last mistake?"
   
   That question, she notes, causes staff to really stop and think. Some people assume she's asking for information about an incident that was either "their fault" or resulted in harm to a patient, she says. The real objective, however, is to help staff understand that not only does everyone make mistakes, but that mistakes should be shared so others can learn from them.
   
   "When I explain that a mistake doesn't mean that there was a patient event, it opens up a dialogue," Ms. Duncombe says. "I've had people say, 'Do you mean the times I return a drug because it wasn't labeled correctly?' There's a lot of education involved."
   
   Spurring new initiatives When it comes to results, the rounds have led to a variety of new initiatives. Many changes have been incremental, Ms. Duncombe says, such as tweaks and modifications to the cancer center's medication order entry system.
   
   Another change was first suggested by a relatively new staff member, who asked why she had to walk to the utility room to dispose of chemo bags. While she found the walk to be a nuisance, she also thought that carrying chemo bags around the cancer center's halls was an accident waiting to happen.
   ...
   "If orders have to change because of changes in a patient's labs," Ms. Duncombe says, "communicating that change can be difficult." Since that issue was raised, the cancer center has piloted and implemented a number of unit-based initiatives to improve communications between the ordering physicians and treating nurses, including morning "huddles" on one unit, and team work projects among physicians, nurses and pharmacists.
   
   Lessons learned When rounds first started, Ms. Duncombe tried visiting units every other week, but she quickly learned that was too often. One big problem was that she ended up talking to the same people over and over.
   
   Now, she visits each of the infusion units about 10 times a year and exam units five to six times a year, approaching staff at workstations, hallways and workrooms. She spends 45 minutes to an hour in each unit. She also tries to mix up the time and day she visits, so she has a chance to talk to people who work different shifts.
   
   Ms. Duncombe attributes the program's success in part to the fact that she's worked at Dana-Farber for a long time; most people know and are comfortable with her. And she says the institute's risk management program is clinically oriented and viewed more as a staff resource for patient safety issues than as a more traditional program that stresses compliance or insurance and regulatory issues.
   
   "That helps set the stage," she says, "for people to not be threatened."
   ...
   While Ms. Duncombe can't discuss the results, which have been submitted for publication, she notes that one common theme was service quality. While she acknowledges that the findings may not address typical patient safety issues, she says the research team would like to see more research explore how patient attitudes toward service quality issues affect their overall perception of safety.