Karen Curtiss: Campaign Zero

Over Half of Adverse Drug Reactions in Hospitals Are Preventable: Study

2011-09-10T08:06:24+00:00

Better safety measures needed, researcher says More than one-half of all adverse drug reactions treated in hospitals and emergency care are preventable, according to a new study. In addition, prior research has shown that many preventable drug reactions—which include drug overdoses and internal bleeding associated with the improper use of blood thinners and painkillers—are life-threatening, said the Swedish researchers. This widespread problem, which is even more common among the elderly, has important implications for health care systems, they said. There are many reasons for the high numbers of preventable adverse drug reactions, according to Katja Hakkarainen, a pharmacist from the Nordic School of Public Health, Gothenburg. These may include “poor coordination of care, lack of time and knowledge among health professionals, and lack of patient education,” she said in an International Pharmaceutical Federation news release. “Unfortunately there is no consensus today on what to do” to prevent adverse drug reactions, she said. “But our finding that they are so common means that it is imperative to create a climate in which they are not hidden, and that there is no ‘blame and shame’ involved,” Hakkarainen added. Human error is inevitable, she said, “thus, safety measures need to be incorporated into the health system.” The findings were slated for presentation Thursday at the annual conference of the International Pharmaceutical Federation in Hyderabad, India. In conducting the meta-analysis, in which evidence from a number of studies is combined with the aim of getting results with more statistical power, researchers examined the results of 22 previous studies. Among adult outpatients, the frequency of preventable adverse drug reactions that resulted in hospitalization or emergency treatment was 2 percent, they found. Of these, 51 percent were preventable. Researchers also found that among the elderly, a full 71 percent of drug reactions could have been avoided. Among hospitalized patients, the frequency of harmful drug reactions was 1.6 percent, and 45 percent of them were preventable. The researchers added that as more drugs become available for people of all ages, the number of adverse drug reactions is likely to increase. They said it’s important to know which could have been prevented since they are typically much more severe than those that were unavoidable. In a different study, they noted, researchers found that nearly a third of preventable adverse drug reactions were life-threatening, compared to those that were unavoidable as part of treatment. The Swedish researchers also cautioned that patients should not stop taking their medications for fear of an adverse reaction. “Although it is clearly important to carry out such studies, we would like to emphasize that for most of the time, medications do much more good than harm,” said Hakkarainen. “We would not like to think of people discontinuing therapy as a result of our conclusions.” Experts say that information presented at medical meetings should be considered preliminary because it has not been subjected to the rigorous scrutiny required for publication in a peer-reviewed medical journal. More information The U.S. National Institutes of Health provides more information on drug reactions.

Study Finds Kids Want More Info About Their Hospital Care

2011-07-31T08:41:19+00:00

Excluding children from discussions about their hospital care can make them feel scared and angry, a new study finds. Parents and medical professionals need to make an effort to consult young patients and include them in decisions, said the researchers from Dublin, Ireland. The study authors interviewed 55 children and teens, aged 7 to 18, at three hospitals and found that the kids wanted to be included in discussions about their care and to have their views and concerns taken seriously. While some felt included in discussions, most reported difficulties. Many of the young patients relied on their parents to act as advocates and to explain what was happening, the researchers said. The investigators also found that the way health professionals communicated and behaved was a major barrier to children being included in discussions about their care. Most of the children said health professionals tended to “do things” to them with very brief or no explanations. Because of rushed consultations, many young patients said they couldn’t ask questions or offer information. In addition, health professionals often directed information at the parents and used language that young patients found hard to understand. The study is published in the August issue of the Journal of Clinical Nursing. “Health care organizations need to develop cultures where participation is firmly embedded, not just a desirable add-on. Communicating with children, and including them in decisions about their care, conveys respect, enhances and develops their decision-making capabilities and contributes to psychosocial well-being,” study co-author Imelda Coyne, from the School of Nursing and Midwifery at Trinity College Dublin, said in a journal news release.

Los cirujanos que tienen resaca cometen más errores, según un estudio

2011-04-21T08:13:44+00:00

En cirugías simuladas, estudiantes y expertos que bebieron excesivamente la noche anterior tuvieron peor desempeño Los cirujanos que beben en exceso la noche anterior a la cirugía tienen más probabilidades de cometer errores al día siguiente, incluso hasta las cuatro de la tarde, según un experimento novedoso descrito en un estudio irlandés reciente. El índice de errores en la sala de operaciones debido a la resaca pareció aumentar al máximo hacia la hora del almuerzo, según la investigación, publicada en la edición de abril de Archives of Surgery. El mensaje parece obvio. “Los cirujanos y otro [personal médico] no deberían beber en exceso la noche anterior a la cirugía”, aseguró Tony Gallagher, primer autor del estudio y profesor de factores humanos de la Facultad de medicina del Colegio Universitario de Cork en esa ciudad. “La definición de excesivo es un asunto que la profesión de la cirugía debe definir”. De hecho, con todos los retos que imponen las técnicas quirúrgicas modernas guiadas por imágenes, “la abstinencia del alcohol la noche anterior a la cirugía podría ser una consideración sensata para las cirujanos activos”, concluyeron los autores del estudio. A diferencia de los pilotos de las aerolíneas, que necesitan seguir un mandato sobre el mínimo de horas entre el consumo de la última bebida y un vuelo desde 1971, no existe una regla similar para los cirujanos. Ningún piloto de avión puede volar si ha consumido alcohol ocho horas antes del despegue o si su nivel de alcohol en la sangre es de 0.04 o más, según las regulaciones federales. Además se insta a los pilotos a no beber el día anterior al vuelo. Sin embargo, entre los médicos, “se espera que estén libres de sustancias todo el tiempo mientras trabajan, aunque no existe una regla real sobre [el consumo de alcohol fuera de las horas de trabajo]”, señaló el Dr. Albert Wu, profesor de gestión y políticas de salud de la Facultad de salud pública Bloomberg de la Universidad de Johns Hopkins, en Baltimore. “Si sus hallazgos se repiten, resultaría razonable [restringir] el consumo de alcohol tantas horas antes de entrar de turno”. Los investigadores irlandeses se enfocaron en la cirugía laparoscópica mínimamente invasiva que, según anotaron, establece exigencias particularmente elevadas sobre las capacidades cognitivas y perceptuales del cirujano. Los investigadores realizaron dos estudios, en realidad. En el primero, se pidió a 16 estudiantes universitarios de ciencia con capacidades laparoscópicas iniciales que no bebieran alcohol durante la noche anterior a una cirugía simulada o a que bebieran hasta embriagarse. En el otro, ocho expertos recibieron permiso para beber todo lo que quisieran. Independientemente de que se les hubiera indicado que consumieran alcohol o no, los participantes se reunieron para una cena en grupo con la presencia de al menos uno de los investigadores para determinar los niveles de intoxicación. Los expertos realizaron una cirugía simulada con el sistema de realidad virtual para capacitación quirúrgica el día anterior a las cenas en grupo para establecer una línea de base. El día siguiente a la cena, ambos grupos realizaron cirugía simuladas de realidad virtual en el mismo sistema a las 9 a. m., a la 1 p. m. y a las 4 p. m. En el primer grupo, los puntajes con registro de horas no fueron significativamente distintos entre los grupos que bebían y los que se abstenían, aunque hubo más errores entre los bebedores. Los investigadores anotaron problemas similares relacionados con la bebida en el otro grupo, en donde las diferencias alcanzaron un punto máximo hacia la 1 p. m. y se nivelaron hacia las 4 p. m. Se cometieron errores durante el día, aunque sólo los errores de la 1 p. m. fueron estadísticamente significativos. De manera extraña, los médicos realizaron los procedimientos más rápidamente la mañana siguiente al consumo excesivo de alcohol, frente al desempeño de la línea de base. Sin embargo, esto fue algo que los autores señalaron que podría atribuirse a la pérdida de la inhibición, no a un mejor desempeño. No hubo diferencias en el índice de errores antes y después de la cena en el grupo de control de estudiantes que se abstuvieron de beber. “Los cirujanos y la medicina necesitan conversar acerca de las implicaciones de los resultados mencionados. Una cosa queda clara. No deberían estar bebiendo excesivamente la noche anterior a la operación”, aseguró Gallagher, también del Centro Nacional de Capacitación en Cirugía del Real Colegio de Cirujanos de Dublín. Sin embargo, las dificultades no surgen únicamente por salir una vez, explicó Wu, y agregó que “esto no es más que la punta de un iceberg sustancial”. “Casi todo el mundo tiene dificultades en algún momento”, dijo. “Es plausible pensar que un dolor de cabeza muy intenso o que la privación del sueño puedan afectar la atención y la conciencia, incluso saltarse las comidas, discutir con la pareja, las deudas o un miembro de la familia enfermo”. Si se replican en estudios futuros, “podría valer la pena pensar” en los hallazgos de este estudio, “aunque junto con muchas otras cosas”, concluyó Wu. Más información La National Patient Safety Foundation tiene más información sobre cómo navegar de manera segura el sistema de atención de la salud.

Majority of Americans Give Quality of Health Care a C, D or F

2011-04-15T23:41:32+00:00

Poll should be considered ‘a wake-up call,’ expert says. Most Americans believe the quality of health care in the United States is average at best, a new poll finds. The telephone survey of 1,034 adults aged 18 and older found that 55 percent gave U.S. health care quality a C or D, and 11 percent gave it an F. Nearly half (47 percent) of respondents rated the quality of hospital care in the United States as a C, D or F. Income had a major influence on people’s perceptions of the quality of health care. Grades of C, D or F were given by 43 percent of those with household incomes of less than $50,000, compared with 21 percent of those with household incomes of $50,000 or more. In recent years, Americans have received significantly more information to help them compare the quality of local health care providers. But many people still opt for care from familiar health care providers instead of choosing those with the best quality ratings. For example, 57 percent of the survey participants said they would choose a familiar hospital, while 38 percent said they would select one that scores better in quality. About half (48 percent) said they would opt for a surgeon who successfully treated a family member or friend, while 47 percent said they would pick an unknown surgeon with higher quality ratings. The poll was commissioned by the Robert Wood Johnson Foundation and presented Tuesday at a meeting of the American Hospital Association in Washington, D.C. “The poll is a wake-up call for payers and the health care industry, both of which have been working steadily to improve the quality of care, but need to kick their efforts into overdrive toward accountability,” Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, said in a foundation news release. “American health care faces a crisis in quality. There is a dangerous divide between the potential for the high level of quality care that our health system promises, and the uneven quality that it actually delivers. Clearly, consumers are aware of it. There are too many errors, too much misuse of medical treatments and, too often, poorly coordinated care among a patient’s different health care providers,” Lavizzo-Mourey said. More information The U.S. Agency for Healthcare Research and Quality offers a guide to quality health care.

Better Cleaning in ICUs Lowers MRSA Infection Rates

2011-03-30T09:11:41+00:00

Study found staph infections in rooms previously occupied by MRSA patient dropped. Enhanced cleaning of hospital intensive care units reduces the risk of methicillin-resistant staphylococcus aureus (MRSA) infection for patients placed in a room previously occupied by someone with MRSA, a new study finds. MRSA is a a type of staph infection resistant to all first-line antibiotics. Researchers compared MRSA rates among patients admitted to 10 ICUs at a 750-bed academic medical center before and after implementation of an enhanced cleaning program. The program included inspections of cleaning efforts and feedback to staff, changing how the disinfectant was applied (from pouring from bottles onto cleaning cloths to immersing cloths in buckets), and educating staff about the importance of repeatedly immersing the cloths in buckets during cleaning. The rate of MRSA infections among patients in rooms previously occupied by patients with MRSA decreased from 3 percent (305 of 10,151) to 1.5 percent (182 of 11,849) after introduction of the enhanced cleaning program. In addition, rates of vancomycin-resistant enterococci (VRE) infection decreased from 3 percent (314 of 10,349) to 2.2 percent (256 of 11,871). “Environmental contamination with multidrug-resistant organisms may facilitate the spread of health care-associated infections,” the report noted, adding that this is particularly important in ICUs, in which patients are at high risk of infection due to co-exisiting illnesses, wounds and the use of medical devices. “Whereas enhanced ICU cleaning appears to be effective in decreasing MRSA and VRE transmission, it may be more effective in reducing transmission of MRSA compared with VRE. Reasons for this difference may include the generally higher burden of VRE contamination and evidence that room contamination may be a major factor in VRE transmission,” wrote Rupak Datta, of the University of California Irvine School of Medicine, and colleagues, in a university news release. The study appears in the March 28 issue of the Archives of Internal Medicine. More information The U.S. Centers for Disease Control and Prevention has more about MRSA infections.

La seguridad hospitalaria varía en todo el país, según un informe

2011-03-12T10:04:15+00:00

Según los investigadores, el lugar al que acuden los pacientes a recibir tratamiento puede significar la diferencia entre la vida y la muerte. Según un estudio reciente, ciertos tipos de errores médicos son 46 por ciento menos probables en los hospitales estadounidenses de más alta clasificación, frente a los de la más baja. Los investigadores de HealthGrades analizaron cuarenta millones de registros de pacientes de Medicare de 2007 a 2009 y se concentraron en trece indicadores de seguridad de los pacientes, como úlceras de decúbito, infecciones en el torrente sanguíneo por catéteres, objetos extraños dejados dentro del cuerpo luego de procedimientos y sangrado excesivo o magulladuras luego de una cirugía. Se usaron los indicadores de seguridad de los pacientes publicados por la Agency for Healthcare Research and Quality para identificar errores médicos prevenibles y qué hospitales estaban en el cinco por ciento superior para evitar esos errores. En todo el país, los hospitales variaron sustancialmente en desempeño, según el informe anual Patient Safety in American Hospitals (Seguridad de pacientes en hospitales estadounidenses) de HealthGrades, aunque algunos hospitales han logrado mejoras significativas, según el Dr. Rick May, vicepresidente de calidad clínica del servicio de HealthGrades y coautor del estudio. Las diez ciudades con los hospitales de mejor desempeño fueron: Minneapolis-St. Paul; Wichita, Kansas; Cleveland y Toledo, Ohio; Wilkes-Barre, Pensilvania; Boston; Greenville, Carolina del Sur; Honolulú; Charlotte, Carolina del Norte; y Oklahoma City. “Aun así, existen consecuencias enormes y de vida o muerte relacionadas con el lugar en el que un paciente elige recibir atención hospitalaria”, señaló May en un comunicado de prensa de HealthGrades. “Hasta que cerremos esa brecha, HealthGrades insta a los pacientes que investiguen la clasificación de seguridad para pacientes de los hospitales de su comunidad y que conozcan qué pasos pueden tomar para protegerse de los errores antes de la admisión”. Entre otros hallazgos se encontró lo siguiente: * Los pacientes de los hospitales mejor clasificados tuvieron treinta por ciento menos probabilidades de adquirir infección del torrente sanguíneo en el hospital por sepsis posquirúrgica que los de los hospitales de menor clasificación. Esas infecciones pueden ser mortales. Cerca de uno de cada seis pacientes que adquirieron una infección del torrente sanguíneo durante la hospitalización murió. * Los pacientes tratados en los hospitales de las mejores clasificaciones tuvieron 52 por ciento menos probabilidades de experimentar una infección del torrente sanguíneo en la línea central. * Durante los tres años del estudio, cuatro indicadores de seguridad de los pacientes correspondieron a más de las dos terceras partes de los eventos de seguridad de los pacientes. Los indicadores fueron muerte entre pacientes quirúrgicos hospitalizados con complicaciones graves tratables, úlceras de presión, insuficiencia respiratoria posquirúrgicas y sepsis posquirúrgica. * Los trece indicadores de seguridad para el paciente del estudio se relacionaron con $7.3 mil millones en costos adicionales o $181 por hospitalización de pacientes de Medicare. Más información Los Centros para el Control y la Prevención de Enfermedades presentan diez cosas que se pueden hacer para ser un paciente seguro.

Toward Elimination of Healthcare-associated Infections: A call to Action

2011-02-26T10:02:17+00:00

Recently, partners hosting the 5th Decennial International Conference on healthcare-associated infections (HAIs) – APIC, CDC, IDSA and SHEA – along with public health and other professional organizations (CSTE, ASTHO, PIDS), called for the elimination of healthcare-associated infections (HAIs), by implementing proven public health strategies used to combat other diseases (see statement in ICHE or AJIC). This is a bold step. Is it possible? Scientifically, there exists a legitimate opportunity to eliminate specific HAIs, including central line-associated bloodstream infections (CLABSIs). Recent local and regional initiatives have shown 60%-70% overall decreases of CLABSIs in intensive care units (ICUs), with some locations reporting zero CLABSIs for up to four years following implementation. Is this enough? More needs to be done to accomplish the HHS Action Plan to Prevent HAIs and extend those successes into all healthcare settings such as outpatient surgery centers, long-term care facilities and dialysis clinics. How? Elimination of HAIs depends on sustainable actions, requiring investment. These actions should include: * Empowering healthcare professionals with a will to succeed in this area at all levels * Ensuring adherence to evidence-based practices * Conducting research to close knowledge gaps * Aligning infection prevention efforts with incentives to reward excellence * Monitoring infect ion rates to assess progress and respond to emerging threats Why now? Momentum and investment at the federal, state and local levels in the prevention of HAIs, such as the HHS Action Plan to Prevent HAIs, the American Recovery and Relief Act funding, individual state mandates for public reporting, the Deficit Reduction Act, the Patient Protection and Affordable Care Act, and consumer expectations for transparency and accountability provide momentum for this success in this unique moment in time. We count on you. Please join us in this important call for the elimination of healthcare-associated infections. Team work in all levels of healthcare will be necessary, as are partnerships among several groups, including public health, healthcare facilities, legislators, consumers.

Hospitals Often Fail to Follow Up on Tests, Study Says

2011-02-09T10:11:29+00:00

Findings point to a ‘substantial problem, which impacts on patients’ safety.’ As many as 75 percent of hospital tests are not followed up and this failure can have serious consequences for patients, including delayed or missed diagnoses and even death, according to a new study. Researchers analyzed 12 international studies and found that between 20 percent and 61 percent of inpatient test results, and between 1 percent and 75 percent of tests on emergency care patients, were not followed up after patients were discharged. Follow-up was least likely for critical test results and results for patients moving between health care settings, such as from inpatient to outpatient care or to general practice. Rates of missed results were equally high for paper-based records systems, fully electronic systems and those that used a combination of paper and electronic records. The study is published Feb. 8 in the journal BMJ Quality and Safety. “There is evidence to suggest that the proportion of missed test results is a substantial problem, which impacts on patients’ safety,” the researchers concluded in a journal news release. More information The U.S. Agency for Healthcare Research and Quality offers patients tips about medical tests.

Older Patients May Get Lower Quality Care at Trauma Centers

2011-01-31T10:16:30+00:00

Trauma centers may not give the same high-quality care to severely injured elderly patients as they provide to younger patients, according to a new study. Researchers analyzed data on 87,754 trauma patients of all ages treated at 131 trauma centers in the United States and one trauma center in Canada. About one-quarter of the patients were elderly. When patients in all age groups were grouped together, 14 centers were rated as high performers, with lower than expected rates of death. When young and elderly patients were looked at separately, seven centers were high performers for young patients and nine were high performers for elderly patients. Only two centers were high performers for both young and elderly patients. The study findings are published in the January issue of the journal Annals of Surgery. “In the study we showed that although some centers demonstrate high performance overall, these same centers might not be providing the same high-quality care to the elderly,” Dr. Barbara Haas, of St. Michael’s Hospital, University of Toronto, said in a news release from the American College of Surgeons. “We’ve shown that elderly patients have different needs from young patients. Centers need to focus on the needs of the elderly specifically in order to improve their quality of care,” she added. The study authors noted that an aging population means trauma centers are seeing many more elderly patients, who are more likely than younger patients to have conditions such as heart disease, lung disease and diabetes. These health problems need to be taken into account at the same time elderly patients are being treated for their injuries.

Preparing Small Doses of Medication From Syringes Called Risky

2011-01-25T13:07:28+00:00

Errors involving powerful drugs such as morphine dangerous for babies, small children, study finds. Preparing small doses of medications from syringes can be inaccurate and lead to dangerous dosing errors for infants and small children, warns a new study. The problem is that small doses of potent drugs for young patients are often prepared from stock of less than 0.1 millileter (mL) in size, but the equipment does not permit the accurate measurement of volumes that small, explained study author Dr. Christopher Parshuram, of the University of Toronto. And medications that most often require small doses include powerful narcotics and sedatives such as morphine, lorazepam and fentanyl, as well as immunosuppressants, noted Parshuram, who works in the Department of Pediatrics at The Hospital for Sick Children and directs Pediatric Patient Safety Research at the University of Toronto Center for Patient Safety. It’s a Catch-22, he and his colleagues acknowledge. “The safe administration of medications requires formulations that permit accurate preparation and administration, but current equipment does not permit the accurate measurement of volumes less than 0.1 mL,” said Parshuram in a Canadian Medical Association Journal news release. In both hypothetical and clinical studies, he and his colleagues looked at 71,218 intravenous doses given to 1,531 infants and children admitted to an intensive care unit in 2006. Of those doses, 7.4 percent of the children and babies needed preparations of less than 0.1 mL of stock solution, and 17.5 percent needed preparations of less than 0.2 mL. “Our findings indicate a substantial source of dosing error that involved potent medications and affected more than a quarter of the children studied,” the researchers wrote. “Small volumes of stock solution are required because of the relatively low doses needed for infants and young children and the relatively high concentrations of commercially available stock solutions,” they added. “The clinical [consequences] of errors occurring as a result of preparing doses from small volumes will be compounded by incomplete safety data, errors in medication orders, and errors in preparation or administration.” Since the preparation of small doses of medication is common in pediatric hospitals across North America, there is a need to review preparation methods, regulatory requirements and manufacturing processes, the researchers concluded. The study appears in the current issue of the Canadian Medical Association Journal. More information The U.S. Food and Drug Administration has more about giving medications to children.

Private Rooms Cut Infection Risk in the ICU: Study

2011-01-12T01:20:03+00:00

Hospital’s switch from multibed to single occupancy led to fewer infections, shorter stays. Intensive care unit (ICU) patients in single, private rooms have lower infection rates than patients in shared rooms, a new study finds. About 30 percent of patients in ICUs acquire health care-associated infections, which can lead to serious illness and death, the study authors noted in background information in their report. “In ICU patients, these infections are associated with an increased length of stay of eight to nine days, and the resulting additional cost from excess stay alone is estimated to be $3.5 billion per year in the United States,” Dana Y. Teltsch, and colleagues at McGill University in Montreal, wrote in the study published in the Jan. 10 issue of the Archives of Internal Medicine. For this study, the researchers looked at infection rates among patients at a hospital before and after it changed the ICU from multibed rooms to private rooms (intervention hospital), and at another hospital that maintained a multibed ICU (comparison hospital). In total, the investigators analyzed 19,343 ICU admissions at the two hospitals between 2000 and 2005. The McGill team found the following changes at the hospital that switched to private ICU rooms: a 47 percent decrease in methicillin-resistant Staphylococcus aureus (MRSA) infections; a 43 percent decrease in cases of Clostridium difficile; a 51 percent decrease in yeast infections; and a 54 percent decrease in cases of MRSA, C. difficile and vancomycin-resistant Enterococcus species (VRE) combined. The average length of stay for patients at the comparison hospital increased during the study, while the adjusted length of stay at the intervention hospital fell by an estimated 10 percent after the switch to private rooms. “An ICU environment with private rooms may facilitate better infection control practices, therefore reducing the transmission of infectious organisms,” the researchers concluded in a journal news release. “Conversion to single rooms can substantially reduce the rate at which patients acquire infectious organisms while in the ICU.” More information The U.S. Centers for Disease Control and Prevention has more about health care-acquired infections.

Anesthesiologists Spreading Germs During Surgery: Study

2010-12-29T21:05:19+00:00

Expert calls for more compliance with hand-washing guidelines before operations. A disturbing new study finds that bacteria often contaminate the hands of those who give anesthesia to surgical patients, and those germs contribute to disease transmission during operations. “As anesthesiologists, we like to think that the surgical drapes protect the patient from tens of trillions of microorganisms that are in and on our bodies. Nope! These studies provide evidence that our bacterial flora contribute to surgical site infections,” Dr. Steven L. Shafer, editor-in chief of the journal Anesthesia & Analgesia, said in a news release from the International Anesthesia Research Society, which publishes the journal. Researchers from Dartmouth-Hitchcock Medical Center in Lebanon, N.H., studied 164 operating room procedures that involved anesthesia. In 11.5 percent of the procedures, researchers discovered that bacteria had been transmitted to the valves of intravenous lines. About half of the time, those germs were detected on the hands of those who provided the anesthesia, such as anesthesiologists and nurse-anesthetists. The researchers also found that bacteria was transmitted to the operating room in almost 90 percent of procedures. “Contamination of provider hands before patient care . . . represents an important modifiable risk factor for bacterial cross-contamination,” the researchers wrote. Shafer, who is a professor of anesthesiology at Columbia University in New York City, said it’s clear that not enough anesthesia providers are disinfecting themselves carefully enough before surgical procedures. “Although we know that hand-washing is an important step, our compliance is poor, and there is little excuse for hospitals not implementing systems that facilitate compliance with hand-washing guidelines,” Shafer said. “However, as these reports suggest, it is time to look at additional measures to protect our patients from the biofilm that we take into the operating room every day.” More information For more about anesthesia, visit the U.S. National Library of Medicine.

Health Tip: What Causes Bed Sores (Pressure Ulcers)?

2010-11-19T22:35:14+00:00

Pressure ulcers, commonly called bed sores, are wounds that develop on the skin from staying in one position without shifting your weight. People who have just had surgery and aren’t able to get out of bed, for example, may acquire a pressure ulcer because the constant weight on the affected area decreases blood supply, killing affected tissue. The U.S. National Library of Medicine says the following conditions may foster pressure ulcers.: * Being unable to get out of bed, or being confined to a wheelchair. * Developing skin wounds easily, or having a chronic condition that affects blood circulation. * Being unable to move parts of the body without assistance due to injury or illness. * Being malnourished. * Being mentally impaired or having dementia. * Being older or incontinent.

Program May Help Prevent Falls in Hospitalized Patients

2010-11-08T18:49:48+00:00

Hospital patients are at increased risk for falls because of illnesses, treatments and being in an unfamiliar environment. Falls and fall-related injuries can be devastating and costly for patients, health care workers and the health care system, according to Patricia C. Dykes, of Partners HealthCare System, Brigham and Women’s Hospital and Harvard Medical School, and colleagues. The team’s fall prevention tool kit (FPTK) included a fall risk assessment, patient-specific fall prevention plan and an educational handout and poster over the patient’s hospital bed. From January to June 2009, the researchers compared patient fall rates in eight units of four urban U.S. hospitals. Usual care was given to 5,104 patients in four units and the FPTK was used for 5,160 patients in the other four units. The average age of the 51.3 percent of patients aged 65 or older was 79 years while the average age of patients younger than 65 was 48 years. During the study, there were 67 falls among patients in the hospital units that used FPTK and 87 falls among patients in the units with usual care. The researchers calculated that for all eight hospital units in the study, the FPTK could potentially prevent one fall every four days, 7.5 falls each month, and about 90 falls each year. The study findings are published in the Nov. 3 issue of the Journal of the American Medical Association, a theme issue on aging. “To our knowledge, this is the first fall prevention clinical trial that provides evidence for using a specific HIT [health information technology] intervention to reduce falls in short-stay hospitals,” the researchers wrote in a news release from the publisher. “The effectiveness of the FPTK in older patients provides evidence that a HIT program that tailors interventions to address patient-specific determinants of risk and is implemented within existing workflows is effective in acute care hospitals with older adults. Because patient falls in hospitals are a major risk factor for fractures and other injuries, reducing falls is an important first step toward injury prevention, and any reduction in patient falls has clinical significance,” Dykes and colleagues said. “Further study is needed to determine if a similar program evaluated over a longer period of time can significantly reduce repeat falls. Moreover, work is needed to develop a set of interventions that will prevent fall-related injuries. However, the FPTK was effective at reducing numbers of falls in intervention versus control units,” the researchers concluded. SOURCE: Journal of the American Medical Association, news release, Nov. 2, 2010

AHRQ Awards $34 Million To Expand Fight Against Healthcare-Associated Infections

2010-11-04T21:13:35+00:00

The U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality today announced the award of $34 million for projects focused on preventing one of the top 10 leading causes of death in the United States - healthcare-associated infections (HAIs). This new funding will help improve the quality of care delivered to patients and expand the fight against HAIs in hospitals, ambulatory care settings, end-stage renal disease facilities and long-term care facilities. Based on estimates from the Centers for Disease Control and Prevention (CDC), each year there are nearly 2 million HAIs in hospitals, which contribute to almost 100,000 deaths. While there is a growing body of knowledge regarding the number of infections and methods to reduce those infections within hospitals, there is not enough information currently available on infections originating in other health care settings. “We know that infections can occur in any health care setting,” said Carolyn M. Clancy, M.D., AHRQ director. “With these new projects, we can apply what has worked in reducing infections in hospitals to other settings and ultimately help patients feel confident they are in safe hands, regardless of where they receive care.” For example, with the dramatic growth in surgery being performed in ambulatory surgical centers and a rise in the number of these surgery centers in the U.S. over the last two decades – from 336 in 1985 to 5,047 in 2007 – ensuring safe practices within these settings has become more critical, particularly since federal inspections have identified breaches in standard practices to prevent infections in over 60 percent of ASCs. AHRQ’s new projects also focus on end-stage renal disease and long-term care facilities, because their more than 500,000 patients and more than 1.5 million residents, respectively, are particularly vulnerable to infections. These awards are a part of a Department-wide effort to address HAIs. Funded projects will contribute to implementing the strategies outlined in the HHS Action Plan to Prevent Healthcare-Associated Infections (http://www.hhs.gov/ash/initiatives/hai/index.html). A broad array of partners across HHS, including AHRQ, CDC, the Centers for Medicare & Medicaid Services (CMS), and National Institutes of Health (NIH), have been working together to achieve the prevention goals in the Action Plan. To maximize the impact of the HAI investment, AHRQ has collaborated with CDC, CMS and NIH to identify research gaps to improve HAI prevention. With this new funding, researchers will be able to address some of these gaps, learn why infections occur, find ways to prevent them from happening, improve antibiotic prescribing practices and delivery and enhance communication and teamwork among health care providers. Preventing these infections is a national priority, and over the last several years AHRQ has demonstrated a sustained commitment to supporting this priority. From 2007-2009, AHRQ awarded over $27 million for projects on the use of standardized procedures, including a checklist of proven safety practices based on CDC recommendations, staff training and tools for improving teamwork among health care providers. With the additional $34 million in funding announced today, AHRQ is significantly expanding this important work. A complete list of institutions and projects funded in fiscal year 2010 under the $34 million announced today is available at http://www.ahrq.gov/qual/haify10.htm. SOURCE Agency for Healthcare Research & Quality

Practices that Could Prevent Hospital Infections

2010-08-04T15:00:19+00:00

Hospitals are not safe places. Period. It’s time for all of us to get over the feeling that we can check our worries at the hospital door because Dr. Welby or Dr. McDreamy will focus all of their brainy smarts and kind hearts on taking good care of us… and our parents… and children… and everyone else we love. Yes, hospitals are filled with great docs, fabulous nurses and lots of other committed professional, but their effectiveness is often bound by hospital policies, hospital culture, and available free time to learn new techniques and procedures. Sometimes the limitations are self-imposed – arrogance seems to be an all-too-common symptom of our healthcare system that puts doctors on a pedestal. In this maelstrom of hospital dynamics, patients get lost. Patient safety is jeopardized. Patient outcomes are not what they should be—and that is why you cannot check your worries at the door. That is why you and your family and friends need to be clear-eyed about our healthcare system so you are prepared to fill in the cracks in care in every hospital you and your loved ones may enter. Clear evidence that hospitals, in general, are negligent in placing patient safety at the center of care comes from a recent survey conducted by The Association for Professionals in Infection Control and Epidemiology. Results published this month (7/13) reveal that most have not adopted a simple checklist procedure to prevent deadly bloodstream infections. This checklist, which has been rigorously tested over time, reduces hospital infection by nearly 70%—on a cost-effective basis, no less! There is no excuse in the world that justifies a hospital’s failure to do something so simple as to make sure this checklist is used. It’s just five basic steps to prevent a deadly infection for every patient who needs medications delivered through their veins. Yet the majority of nurses surveyed report hospital administrators who turn a blind eye to patient safety, and fail to support them in introducing this simple “checklist solution” to life-threatening infection—which harms 80,000 hospital patients and kills 30,000 every single year. Where’s the common sense? There isn’t any—and no amount of rationalizing or debate will ever result in some reasonable explanation for this dire set of circumstances for patients. Unfortunately, as evidenced by study results, hospital cultures are not likely to change any time soon. (For more on this, just Google Dr. Peter Pronovost to learn about his uphill battle for patient safety.) In the meantime, for practical solutions you can use to prevent deadly hospital infections and other hospital hazards, go www.campaignzero.org and download the simple checklists we developed for patients and their families. None of us can change hospital policies and procedures, but we can walk through hospital doors, armed with information to protect ourselves and the people we love. Our information at Campaign Zero is your power. That’s not arrogance… that’s just good common sense.

Falls and Fractures

2010-07-28T18:59:27+00:00

It’s hard to believe a patient can fall while in a calm, quiet place for rest, but certain medical conditions and most hospital environments are, unfortunately, conducive to falls. Acute confusion — which can lead to falls (including falling out of bed) can be caused by any number of fairly common medical conditions: certain medications, infections, fever, dehydration, head trauma, multiple room changes, inadequate pain management and altered sleep/wake cycles. Falls account for 70% of patient accidents and fall-related injuries cost the U.S. health care system about $1.9 billion every year. When you know what the risk factors are, they can also be prevented with some common-sense simple precautions. Other serious hospital acquired injuries, and some deaths, are caused by restraints. (In 40% of death cases, the patient chokes and is unable to get free.) Injuries from falls and restraints result in bone fractures and dislocations, burns, and brain injuries. It’s understandable why they typically extend a patient’s hospital stay by nearly 10 days. We have some simple solutions to prevent falls outlined below. Look for hazards in your family member’s room. Point out furniture and equipment on wheels or casters to the patient. Move these items out of reach when not in use. Bring a four-pronged, rubber-tipped cane for your family member to use. If you are able bodied, lend your steady arm when your family members needs to get out of bed for any reason. Never leave your family member alone in the room while he/she is using the bathroom or commode. Make sure the hospital gown is securely tied and does not drape about your family member’s legs or drag on the floor. When your family member is preparing to get out of bed, make sure the IV tubing is not tangled or likely to interfere with getting out of bed or walking. Carefully gather the lines and hold them away from your family member’s body if necessary.

C. diff

2010-07-21T18:37:12+00:00

Considered an epidemic, with significant increases in the last several years, C. diff is a hospital-acquired infection which affects 500,000 patients and causes 17,500 deaths every year. C. diff is an intestinal bacteria that lives in about 5% of the general population, but does not harm most people until their immune systems are compromised by an illness and/or antibiotics. It is usually transmitted through fecal-oral contact, and because C. diff has heat-resistant spores, the bacteria can survive a cold hospital environment for a long period of time. You can help prevent the spread of C. diff in hospitals by being an informed, alert advocate. Follow this simple checklist, which also helps you detect the infection in its early stages. Keep a record of your family member’s antibiotics and other medications (types and doses). Help keep your family member’s surroundings extremely clean with antibacterial wipes and sprays. Wash your hands with antibacterial soap or alcohol-based, waterless gel after touching any surfaces or your family member. Wash hands (as above) before you leave your family member’s room (Please remind healthcare staff and visitors to do the same as necessary. Launder any clothing you wear in the hospital with bleach (don’t use the type for colors). Do not line dry—dryer heat helps kill bacteria. Caution visitors do the same. Launder your family member’s clothing, too. Bring freshly laundered clothes to the hospital for your family member and store in a suitcase or plastic bag for the trip home. Launder these upon arriving home. Follow all other precautions and procedures listed under Prevent MRSA/VRE.

Blood Clots

2010-07-14T18:08:05+00:00

Blood clots, also known as deep vein thrombosis (DVT), afflict more than 40,000 Americans every year. Hospitalized patients are especially vulnerable to blood clots because they are exposed to prolonged bed rest and more likely to have experienced a recent heart attack, childbirth obloodclotsr trauma to the lower body. If a blood clot dislodges, it can travel to the lungs and cause a blockage known as a pulmonary embolism, or lung clot. One out of every three lung clots is fatal. Blood clots are generally preventable with proper precautions, such as the use of compression stockings, pneumatic compression devices and blood thinners. However, only half of non-surgical patients at risk for clots routinely receive preventative care. And among surgical patients (who are all at risk), nearly 30% of patients do not get blood clot prevention care. Again, there are simple prevention strategies to prevent life-threatening blood clots from happening to you or someone you love. Engage medical staff—doctors and nursing—in creating a DVT prevention plan. Run down the list of risk factors that pertain to your loved one to help emphasize and focus on a plan. If a written plan is not provided by the hospital, write it yourself. Make sure a copy is included with your family member’s chart. Distribute copies to any other family friends who are acting as advocates too. The plan should include the following: use of mechanical, pulsing compression stocking/boots (24/7), regular and frequent walks and a prescribed blood thinner—such as Coumadin or Plavix. Record the blood thinner, dosage and frequency prescribed in your medication record (see medication error prevention) and monitor administration. Help your family member monitor the signs and symptoms for DVT and PE for at least 2 months after hospital discharge. Help keep DVT prevention a top priority, even if the patient is feeling 100% or back to normal in other ways. Encourage walking as often as possible—even with a physical therapist, if necessary.

Bed Sores

2010-07-07T18:51:11+00:00

Bed sores, also known as pressure wounds or ulcers, are caused by constant pressure or friction on skin, especially in bony areas that normally have limited circulation. Wounds develop in four stages, with the worst causing deep damage into the muscle and bone as skin and tissue cells die from restricted blood supply. Areas of the body where moisture can be trapped are also ripe for pressure wounds to erupt. Particularly vulnerable are bed-ridden patients or patients with conditions that hinder proper blood flow, including diabetes, terminal cancer and vascular disease, and any patient aged 65 and older. Only bed sores that cause an open wound—or ulcer—are reported to the Centers for Medicare and Medicaid Services. In 2007 alone, 257,412 cases of these preventable pressure ulcers were reported. The average healthcare cost to treat each bed sore/ulcer is about $43,180, but a staggering 60,000 patients end up dying from complications from these wounds each and every year. The most heartbreaking statistic, though, is that 95% of pressure wounds can be prevented. Thousands of lives could be saved every year just by following these simple prevention steps. Thoroughly check bony areas: back of the head, behind the ears, elbows, hip bone area, tailbone, knees, and heels. Check where moisture can collect: between buttocks and under breasts. (Moisture can break skin cells down quickly.) If your loved one is alert and capable of moving, encourage a change in position as often as possible—at least every hour. Set a timer to help stay on schedule if necessary. If your loved one cannot move, ask a nurse to help her/him change position every 2 hourse. (Again, a timer is very helpful. Re-positioning is critical for preventing painful pressure wounds by keeping blood circulation flowing.) Cushion ankles, elbows, back of head with pillows. If side lying, cushion between knees.

Pneumonia

2010-06-30T17:47:10+00:00

Most cases of pneumonia developed in the hospital are among patients dependent on supplemental oxygen, delivered by ventilator tubing which becomes contaminated with bacteria — this type is commonly known as “ventilator-associated pneumonia”, or VAP for short. VAP is a life-threatening infection, and lengthens a typical hospital stay by 13 days. It also adds about $40,000 to each pneumonia patient’s hospital bill. VAP is something you can help prevent from happening to your loved one. For example, in one study only 8% of ventilator patients whose beds were angled between 30 and 45 degrees acquired VAP while 34% of ventilator patients in the supine (laying flat, or less than 30 degrees) position acquired the infection. We offer a simple checklist to help you prevent VAP in the hospital. If orders are given for your family member to be intubated, double check with his/her doctor to find out if it is necessary—and for how long. On a daily basis (or at the estimated time for removal), ask if intubation is still necessary. (Ask for an “assessment of readiness to wean.”) Keep reminding as necessary. When the tube is inserted, watch to make sure that sterile procedures are followed. (Hands thoroughly washed with an antibacterial cleanser and nothing touched between hand washing and grasp of tools. Be vigilant that your loved one’s upper body and head are elevated 30 to 45 degrees. If your loved one falls or slumps, gently help prop up to maintain a straight posture. Make sure that your loved one receives daily oral care—bacteria in the mouth is a common cause of VAP. This care routine should consist of thorough, gentle tooth brushing to dislodge plaque followed by an oral rinse with chlorohexidine-based solution.

Urinary Tract Infections

2010-06-23T17:26:18+00:00

Urinary Tract Infections (UTIs) are the most common hospital-acquired bacterial infection among patients in the United States, accounting for 40% of all such infections. According to the latest research, 75% of hospitals do not monitor catheter duration despite the fact that every day a patient is fitted with a urinary catheter, the likelihood of acquiring an infection significantly increases. Studies show that one in four patients receives an indwelling urinary catheter at some point during their hospital stay and up to 50% of these catheters are placed unnecessarily. Urinary catheter reminders, which have been proven to dramatically decrease the number of UTIs, are used in fewer than 10% of U.S. hospitals. To prevent an unnecessary UTI/CAUTI from happening to your family member in the hospital, follow our simple checklist below. If orders are given for your family member to be catheterized for urine collection, double check with his/her doctor to find out if it is really necessary—and for how long. On a daily basis (or at the estimated time for removal), ask if the catheter is still necessary. Keep reminding as necessary. Make sure that the catheter and tubing receive daily soap and water maintenance around the insertion site from nursing staff. Double check to make sure that initial catheter insertion is performed using sterile gloves, sponges, patient drape and single-use petroleum jelly. On a regular basis (every few hours, or every time your family member moves or shifts in bed) check the tubing for kinks or tangles to prevent urine from back flowing. Check the collection bag often to make sure it is always well below the level of your loved one’s bladder—this helps prevent urine from back flowing too.

Surgery Errors

2010-06-02T17:09:00+00:00

One study estimates between 1,300 and 2,700 wrong-side/wrong-site, wrong-procedure/wrong-patient events (WSPEs) occur in U.S. hospitals every year. Why do they happen? Two patients with the same name can be mistaken for one another. Or a patient’s surgical site can be marked on the wrong limb or wrong side of the body. Surgical tools and sponges are accidentally left behind sometimes (in 1 out of every 1,500 abdominal surgeries in fact). Surgical errors can be deadly:10% of patients who die within 90 days of surgery do so because of a preventable error. The average cost of these types of errors is $40,323 and results in about 9.4 more days in the hospital. Patients and their family member advocates have the power to eliminate these tragedies. Follow our simple, common-sense ideas to prevent surgical errors from happening to you or someone you love. If you know someone who is scheduled for surgery, be a friend and share our checklist below. In the days before surgery, make sure your loved one showers (not bathes) for at least 2 days with antibacterial hair and body soaps. A final shower just before leaving for the hospital is a good idea, too. Ask your loved one about any antibiotics that may have been prescribed for a few days before surgery. If not prescribed, or your loved one forgot to ask, call the doctor’s office just to double check. If antibiotics have not been prescribed, make sure your loved one receives an antibiotic at least one hour before surgery. Help your loved one mark the part of the body to be operated on: “Cut here” with the patient’s name, blood type and any drug allergies inscribed too. In the case of limbs and twin organs, write “DON’T cut here” on the opposite limb/organ. When you get to the hospital, review these critical notes and confirm all details with the doctor, the anesthesiologist and all attending nurses. Confirm that the surgical team will be: 1) Taking a “Time Out” just before the surgery and 2) Using a checklist to account for instruments and sponges. If not, insist on it. (These are common-sense procedures a conscientious surgical team follows to prevent error.) Wait in the hospital during surgery and sit beside your loved one in the recovery area. Follow all infection prevention steps covered in the Prevent MRSA/VRE checklist

Medication Errors

2010-06-02T15:42:32+00:00

Medication errors are some of the most common adverse events to occur in hospitals. The Institute of Medicine estimates preventable medication errors cause 7,000 deaths every year in hospitals, with tens of thousands more happening in outpatient facilities and pharmacies. Not all medication mix-ups are fatal: an additional 1.5 million Americans suffer injuries each year from medication errors. Why do they happen? Sound-alike names is one of the most common causes (e.g. Celexa, Celebrex and Cerebyx), along with illegibly written prescriptions, inappropriate drug labeling, unknown patient allergies or other medications, and mixed-up dosages. Imagine you are supposed to receive 1.0 milligrams of a drug, and a barely visible decimal point causes the pharmacist to deliver 10 milligrams instead. Many feel that medication errors are the most preventable error in a hospital, as computerized drug ordering systems (as opposed to handwritten prescriptions) can reduce errors by 66%. If the doctor writes prescriptions in his/her own handwriting, ask the doctor to print all information. For all prescriptions—whether handwritten or e-scribed—follow these procedures: Repeat: Ask the prescribing doctor to read each prescription aloud in front of a nurse and yourself to confirm medication, dosage, frequency and administration instructions. (If not confirmed, ask the doctor to re-print the prescription and repeat confirmation steps until clear.) Remind: the doctor of any allergies or sensitivities (e.g., nausea) your loved one has to any medications. Ask: What will this medication do? (What are the benefits?) What are the side effects? What should I watch for? (What are the signs of progress and problems?) How long will the patient be on this drug? Review: the medications your loved one may already be taking, including herbal supplements, over-the-counter medications and any other legal or illegal drugs taken. Ask about potential drug interactions. Remember to include vitamins, nicotine patches, hormone replacement therapies, dies aids-even aspirin. Don’t withhold alcohol or recreational drug use; no one will make judgements. Keep your own up-to-date record of all of this information for all medications. Learn about the medications your loved one is taking. Buy a drug handbook or look up drugs online. Use a variety of sources to double-check dosing guidelines, drug interactions and potential side effects. Record notes about each medication in the medication record you keep for your loved one. Record every time a medication is given to your loved one (name, dose, type of administration, name of nurse who administered and time) and double-check against your medication record. Stop any drug from being administered to your loved one if you do not have a record of it. Before every drug administration, ask the nurse to check your loved one;s wrist band, say the patient’s name out loud, ans state the medication and dose about to be given. Double-check against your records. Don’t distract a nurse while giving a drug. Speak up, however, if you see or sense an error occurring.

Staph Infections

2010-06-02T14:57:37+00:00

The most common hospital-acquired infection is methicillin-resistant Staphylococcus aureus (MRSA, pronounced “mur-SAH”). Commonly known as a “staph infection,” MRSA has ballooned from 2,000 reported cases in 1993 to 880,000 in 2007, about 2.5% of all hospitalized patients. MRSA lives on surfaces of all kinds — skin, clothing (like uniforms and hospital drapes), hospital furniture, medical instruments and equipment. It spreads when one contaminated surface contacts another. About 85% of MRSA infections are contracted from a hospital or other health care facility. Two-thirds of these cases are discovered after the patient returns home. Patients with open wounds, invasive devices like a ventilator or catheter, and weakened immune systems are at greatest risk, especially those age 65 and older. MRSA is dangerous because it is increasingly resistant to common antibiotics, and typically requires aggressive antibiotic treatment. You can help prevent a MRSA infection in someone you love by following the common-sense checklist below. Handwashing with antibacterial or alcohol -based soap is critical for preventing staph infections. Don’t hesitate to politely ask doctors, nurses, and others to wash their hands before touching your loved one—and please make sure that nothing is touched in between. Use alcohol-based antibacterial wipes, sprays, and soaps to eliminate bacteria from… Doorknobs, toilet flush levers, faucets, light switches, cabinets, countertops, IV poles, IV pumps TV remote control, telephone, cell phones, PDAs, iPods Bed rails, tray tables, bedside tables Bedside chair, wheelchairs Stethoscopes, blood pressure cuffs, pulse oximeters, thermometers, nasal canulas, inhalers If necessary, ask healthcare workers to swab these with an anti-bacterial cleaner before use on your loved one. Wipe surfaces clean after every touch. Use wipe only once. Use only one side of the wipe. Dispose in the waste basket immediately after use. Never re-use. Try to avoid touching surfaces outside your family member’s hospital room. Always wash your hands properly—no matter what—when leaving and re-entering his/her room. Launder any clothing you wear in the hospital with bleach (not the type for colors). Do not line dry, as the dryer helps kill bacteria. Visitors should do the same. Do not allow anyone to sit on your loved one’s bed. Launder your patient’s clothing, too. Bring freshly laundered clothes to the hospital for your patient and store in a suitcase or plastic bag.