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Newspaper/Magazine Article

How your hospital can make you sick.

Consumer Reports. July 29, 2015.

This news article reports on health care–associated infections, particularly Clostridium difficile and methicillin-resistant Staphylococcus aureus, discusses ways hospitals and patients can help prevent them, and emphasizes the need to advocate for reduced antibiotic use and improved cleanliness.

Press Release/Announcement

ISMP Resurvey on the 2014–2015 Targeted Medication Safety Best Practices for Hospitals.

Horsham, PA: Institute for Safe Medication Practices. 

This survey seeks to assess the implementation of six consensus-based best practices to improve medication safety in health care facilities.

Journal Article > Commentary

Temporal trends in patient safety in the Netherlands: reductions in preventable adverse events or the end of adverse events as a useful metric?

Shojania KG, Marang-van de Mheen PJ. BMJ Qual Saf. 2015;24:541-544.

Patient safety advocates recognize the lack of appropriate measures to track improvements, and the debate continues regarding what metrics can fulfill this role. Building on results of a recent study of hospitals in the Netherlands, this commentary discusses the degree to which the nonsignificant reduction in preventable adverse events may actually signify real improvements. The authors also suggest that the study findings highlight some of the limitations of adverse events as a measure of progress in patient safety.

Book/Report

Guidelines for Adult IV Push Medications.

Horsham, PA: The Institute for Safe Medication Practices; July 2015.

To address the lack of standards on intravenous (IV) push medication administration, this guidance reflects applied expert opinion and current evidence regarding IV push medication administration to support application of best practices to facilitate safe care. To ensure the applicability and use of the recommendations in hospitals, the authors sought broader consensus and review from the field.

Journal Article > Review

Defining attributes of patient safety through a concept analysis.

Kim L, Lyder CH, McNeese-Smith D, Leach LS, Needleman J. J Adv Nurs. 2015;71:2490–2503.

Researchers searched the term "patient safety" in the nursing literature and found that few articles gave clear explanations of the concept. Using case discussions to illustrate patient safety in practice situations, the authors seek to help nurses understand the concept, empower them to engage in multidisciplinary efforts to improve safety in care environments, and promote measurement of patient safety data.

Journal Article > Commentary

The future of graduate medical education: a systems-based approach to ensure patient safety.

Bagian JP. Acad Med. 2015;90:1199-1202.

Patient safety concepts in medical education are lacking. Discussing the value of teaching medical students to identify and address safety hazards, this commentary calls for faculty to not only provide training for these competencies but personally exhibit safe behaviors and practice.

Journal Article > Study

Accidents and incidents related to intravenous drug administration: a pre-post study following implementation of smart pumps in a teaching hospital.

Guérin A, Tourel J, Delage E, et al. Drug Saf. 2015;38:729-736.

This pre-post study evaluated the impact of smart pump infusion devices on reported adverse drug events (ADEs) in an inpatient setting. Researchers observed an increase in ADEs immediately following implementation of the new devices, as has been previously seen after electronic health record implementation. Subsequently, ADEs returned to rates similar to before smart pump use. This lack of benefit from smart pumps indicates the need for human factors approaches to characterize the actual use of devices.

Journal Article > Commentary

The problem with checklists.

Catchpole K, Russ S. BMJ Qual Saf. 2015;24:545-549.

Checklists, while popularly considered to address safety issues, can be difficult to use reliably. Spotlighting the complexities around designing and implementing checklists to augment health care safety, this commentary relates the differences between medical and aviation checklists to underscore the need to consider sociocultural elements to ensure the success of this safety intervention.

Journal Article > Study

Apologies following an adverse medical event: the importance of focusing on the consumer's needs.

Allan A, McKillop D, Dooley J, Allan MM, Preece DA. Patient Educ Couns. 2015;98:1058-1062.

In this study, participants observed two video-recorded scenarios of a surgeon apologizing for an adverse event. Although apologies that focused on admissions of responsibility, expressions of regret, and offers of restitution were viewed positively, those that also explicitly accounted for the patient's perspective by understanding the impact on the patient and offering to address the harm in a meaningful manner were better received.

Journal Article > Study

Hospital board oversight of quality and safety: a stakeholder analysis exploring the role of trust and intelligence.

Millar R, Freeman T, Mannion R. BMC Health Serv Res. 2015;15:196.

This qualitative study examined mechanisms by which hospital boards could provide more effective oversight of quality and safety activities. Trust among organizational leadership and prioritization of data analysis emerged as important methods by which boards could help improve safety.

Journal Article > Commentary

Standardized competencies for parenteral nutrition prescribing: The American Society for Parenteral and Enteral Nutrition Model.

Guenter P, Boullata JI, Ayers P, et al; Parenteral Nutrition Safety Task Force, American Society for Parenteral and Enteral Nutrition. Nutr Clin Pract. 2015;30:570-576.

Parenteral nutrition has the potential to result in patient harm if administered or prepared incorrectly. This commentary builds on a set of overarching recommendations to define competencies that enable the safe prescribing and delivery of parenteral nutrition. The model is designed to help organizations apply the suggestions in their particular care environments.

Journal Article > Commentary

Concepts for the development of a customizable checklist for use by patients.

Fernando RJ, Shapiro FE, Rosenberg NM, Bader AM, Urman RD. J Patient Saf. 2015 Jun 10; [Epub ahead of print].

Checklists have been highlighted as useful tools for nurses and physicians to improve communication and reduce care omissions. This commentary describes the development of a customizable checklist template designed to enable patients to engage in their care and safety.

Journal Article > Commentary

When medical care leads to harm—difficulty finding words: a teachable moment.

Chamberlain E, DiVeronica M, Segura R. JAMA Intern Med. 2015;175:1271-1272.

To illustrate the potential for harm associated with overuse of medical care, this commentary describes an incident involving a patient who received unnecessary diagnostic imaging which resulted in iatrogenic harm. A previous AHRQ WebM&M perspective explored medical care overuse as a patient safety problem.

Journal Article > Commentary

A scholarly pathway in quality improvement and patient safety.

Ferguson CC, Lamb G. Acad Med. 2015;90:1358–1362.

There is a recognized need for patient safety content in medical school curricula. This commentary describes the development, implementation, and evaluation of a program that integrated quality and safety improvement concepts into an existing 3-year curriculum. A patient safety expert worked with faculty to recommend the content and goals of the pathway. Students reported positive reactions to the program.

Journal Article > Study

Improving the reliability of verbal communication between primary care physicians and pediatric hospitalists at hospital discharge.

Mussman GM, Vossmeyer MT, Brady PW, Warrick DM, Simmons JM, White CM. J Hosp Med. 2015;10:574-580.

Every day the care of hospital patients is handed off from clinician to clinician, creating serious risks for patient safety. A comprehensive quality improvement program that standardized communication processes and introduced basic electronic health record messaging enhanced the rate of postdischarge verbal handoffs to primary care providers.

Journal Article > Study

Raising the alarm: a cross-sectional study exploring the factors affecting patients' willingness to escalate care on surgical wards.

Johnston MJ, Davis RE, Arora S, King D, Reissis Y, Darzi A. World J Surg. 2015;39:2207-2213.

This cross-sectional study at three London hospitals evaluated factors related to surgical ward patients' willingness to call for help. Although patients were more likely to call a nurse for help, they were more willing to ask for help if encouraged to do so by a doctor rather than a nurse.

Journal Article > Study

Variation in printed handoff documents: results and recommendations from a multicenter needs assessment.

Rosenbluth G, Bale JF, Starmer AJ, et al; I-PASS Study Education Executive Committee. J Hosp Med. 2015;10:517-524.

Significant progress has been made in preventing errors at the time of handoffs between clinicians. As demonstrated in the landmark I-PASS study, patient safety can be improved by implementation of a standard format for verbal handoffs. This study—performed by the I-PASS study investigators—examined the quality of written signout documents, which are used by overnight covering physicians to complement the verbal signout. Written signouts were not standardized in either structure or content, and they frequently lacked information elements (such as illness severity) that are considered essential for a high-quality signout. Based on these findings, the authors make recommendations for the core data elements for written signouts. A case of a delayed diagnosis due to inadequate signout is discussed in a previous AHRQ WebM&M commentary.

Journal Article > Review

A safe practice standard for barcode technology.

Leung AA, Denham CR, Gandhi TK, et al. J Patient Saf. 2015;11:89-99.

Barcode technology has been advocated as a strategy to reduce medication errors. This narrative review explored barcoding solutions applied in various care settings and found that they resulted in notable reductions of transcription, dispensing, and administration errors. The authors recommend standards for successful implementation of barcode technology systems.

Journal Article > Study

Acceptability and feasibility of the Leapfrog computerized physician order entry evaluation tool for hospitals outside the United States.

Cho I, Lee JH, Choi SK, Choi JW, Hwang H, Bates DW. Int J Med Inform. 2015;84:694-701.

Applying the Leapfrog computerized provider order entry evaluation tool to four hospitals in South Korea exposed many opportunities for improvement. Although initially there was concern that national differences in drug prescription patterns might make the tool, which was developed for practices in the United States, unreliable, researchers found sufficient overlap to successfully complete the evaluation.

Book/Report

The Patient Survival Handbook.

Powell SM, Stone RD. Peachtree City, GA: Synensis; 2015.

Engaging patients in their care is increasingly advocated as a way to improve safety. This book recommends actions for patients and families to reduce risk of error during their primary care visit, hospitalization, communications with providers, and discharge. A past AHRQ WebM&M perspective highlighted the importance of involving patients in safety.

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