A recent study in Applied Nursing Research concluded nurses needed to "share a consistent and clear message that they are there for patient safety". Patient falls with injury are the most common reportable incident in hospitals. Research has shown the highest risks for falls included the need to toilet coupled with a loss of balance and unexpected weakness.
Health Reform Making a Difference
As reported at the Society for Academic Emergency Medicine annual meeting, Massachusetts health reform was associated with statistically significant decrease in the rate of low-severity emergency department visits.
Skills Assessments for Older Physicians?
A recent article published in the Annals of Emergency Medicine focused on implementing a process to evaluate performance of older physicians. Some patient safety advocates are pressing for mandatory retirement age, an practice used in the aviation industry. Medicine has adopted other aviation industry practices such as checklists and team training in order to reduce errors and infections. A 2005 meta-analysis concluded the "longer a physician had been in practice, the worse his or her outcomes were likely to be and participation in continuing medical education and re-certification made no difference to the result." In response to this finding, the American Board of Internal Medicine published an editorial, "The profession cannot ignore this striking finding and its implications: Practice does not make perfect but it must be accompanied by ongoing active effort to maintain competence and quality of care." At present, there are no mandatory skills assessments for ongoing competency in any medical specialty.
Public Access Defibrillation - Is it working?
We are seeing AEDs (Automated external defibrillators) more and more in public spaces. A local grocery chain, the airport and sporting venues. Is the public prepared to utilize the AED in an emergency? A recent study published in the Annals of Emergency Medicine concluded the public was not prepared. "Only a minority of individuals demonstrate sufficient knowledge and willingness to operate an AED, suggesting that the public is not yet sufficiently prepared for the role it is destined for." The authors recommended wide-scale public information campaigns exploiting the lifesaving potential of public access defibrillation.
Therapeutic Hypothermia after Cardiac Arrest
A recent article published in the Annals of Emergency Medicine concluded therapeutic cooling (AKA hypothermia) does indeed improve not only survival post cardiac arrest but neurological outcomes, as well.
High sodium can be deadly
A May 2011 article published in The American Journal of Medical Sciences studied physician compliance with recommended guidelines related to hypernatremia (elevated levels of sodium in the blood) and the rate of correction of the electrolyte derangement. The retrospective cohort study analyzed 117 patients and concluded the correction of hypernatremia was slow resulting in inadequate correction in most patients. Inadequate correction of hypernatremia was found to be a significant predictor of 30-day mortality.
Hospital-acquired infections cause 100,000 annual deaths
1.7 million hospital-acquired infections occur each year in the U.S. Of those, 100,000 result in the person's death. More than half of these infections could be prevented by proper hand washing by hospital personnel.
Doctors choose different treatments than they recommend
A study published in April 2011 Archives of Internal Medicine focused on influences on physician decision making related to providing treatment recommendations to their patients. Patients look to their physicians for thoughtful recommendations when they are faced with difficult health decisions. This study concluded the act of making a recommendation changed the way the doctor thought about medical choices. Some doctors made different decisions for themselves than what they recommended for their patients. The study surveyed 240 physicians providing two scenarios. One was colon cancer with two surgery choices, both of which had 80% cure rates. One surgery had 20% mortality within two years. The other had a lower death rate but a higher risk of surgically related complications. Physicians chose the the first options for themselves but recommended the second option to their patients.
"If gaps exist between what [a doctor] would do [if he were] in the patient's position and what [he] is recommending for a patient, it is important for the physician to reflect on this disparity and evaluate himself for cognitive bias," said Timothy E. Quill, MD, author of an accompanying editorial in Archives. He is director of the Center for Ethics, Humanities and Palliative Care at the University of Rochester Medical Center in New York.
Source: American Medical News
Wrong-site surgeries occur nearly 40 times a week in the U.S.
In 2004, the Joint Commission mandated a "universal protocol" to prevent wrong site surgeries. This three step process includes pre-surgery patient identification, marking the correct surgical site and surgical "time out" immediately before the surgery commenced. In 2011, there is a lack of consistency in how these three checks are being performed among organizations being studied. Lack of consistency allows for continued mistakes or near misses. The number of wrong procedures reported to one Colorado medical liability carrier rose between 2002-2008. The Wrong Site Surgery Project has helped to identify simple mistakes with large potential to cause harm including not using indelible ink to mark the surgical site, marking the site too far away or the mark not being visible once the surgical drapes were applied. Related links:
Wrong Site Surgery Project, Joint Commission Center for Transforming Healthcare (www.centerfortransforminghealthcare.org/projects/display.aspx?projectid=4)
"Reducing the Risk of Wrong Site Surgery," Joint Commission Center for Transforming Healthcare (www.centerfortransforminghealthcare.org/UserFiles/file/ CTH_WSS_Storyboard_final_2011.pdf)
"Wrong-Site and Wrong-Patient Procedures in the Universal Protocol Era," Archives of Surgery, October 2010 (archsurg.ama-assn.org/cgi/content/abstract/145/10/978)
Jolly Consulting SWaM Certified!
Jolly Consulting, LLC has been certified as a Small and Woman owned business (SWaM) by Virginia's Department of Minority Business Enterprise.
Pressure Ulcer Staging
Dana Jolly will be attending the National Pressure Ulcer Advisory Council's webinar on the challenges of staging pressure ulcers and root cause analysis of facility acquired pressure ulcers. Root cause analysis is a truthful analysis of how the pressure ulcer developed. These reports are considered part of quality improvement programs.