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Content ArticleSome medical mistakes have been stubbornly hard to eliminate. Now, hospitals hope technology can make a difference. This Washington Post article highlights are some of the biggest problems that caregivers are trying to address with technology.
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Content ArticleEvery day, healthcare professionals face the risk of traumatic events — such as an unexpected death, a medical error, or an unplanned transfer to the ICU. Yet few hospitals have programmes to support “second victims.” Too often, these employees experience self-doubt, burnout and other problems that cause personal anguish and hinder their ability to deliver safe, compassionate care. The Caring for the Caregiver programme from John Hopkins Medicine in the USA guides hospitals to set up peer-responder programmes that deliver “psychological first aid and emotional support” to health care professionals following difficult events. Modelled on the Resilience in Stressful Events (RISE) team at The Johns Hopkins Hospital, the programme prepares employees to provide skilled, nonjudgmental and confidential support to individuals and groups.
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Content ArticleMonthly publications from the Joint Commission that outlines an incident, topic or trend in healthcare that could compromise patient safety.
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Content ArticleIn the US, patients receiving cancer treatment via Medicare or Medicaid—two federal health insurance programmes—can face barriers to accessing treatment when insurers use the Prior Authorization Process to deny access. In this letter to the Centers for Medicare & Medicaid Services, the Community Oncology Alliance (COA) outlines its concerns that prior authorizations are acting as "roadblocks to Americans with cancer getting the optimal treatment on a timely basis." Referring to proposed rule changes that aim to reduce the burden that prior authorization processes place on providers, the COA calls for the inclusion of medications to ensure that American's with cancer are not denied the treatment they need.
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Content ArticleSleep deprivation and fatigue lead to a wide range of performance issues that may pose risks to workers and others in the work environment. This review in Frontiers in Neuroscience discusses relevant literature on the topic of fatigue-related performance effects, with a special emphasis physiological and behavioural response variables that have shown to be sensitive to changes in fatigue. It also looks at methods for mitigating these performance effects and discusses their usefulness in regulating them.
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Content Article
Guiding principles for determining work shift duration and addressing the effects of work shift duration on performance, safety, and health: guidance from the American Academy of Sleep Medicine and the Sleep Research Society (1 November 2021)
Patient-Safety-Learning posted an article in Workforce and resources
Regulators, organisations, communities and workers often struggle with how to manage shift duration and address associated risks from fatigue and sleepiness, while continuing to meet the societal demands for work. This article in the Journal of Clinical Sleep Medicine proposes a series of guiding principles help design a shift duration decision-making process that effectively balances the need to meet operational demands with the need to manage fatigue-related risks. -
Content ArticleThis article in the American Journal of Nursing provides basic information about the assessment of dark skin tone and calls for action in academia and professional practice to ensure the performance of effective skin assessments in all patients.
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Content ArticleHealthcare is a $4 trillion component of the US economy, and the well-being of the clinician workforce is a major factor determining its effectiveness. Extensive evidence indicates that inefficiency, poorly designed workflows and processes, suboptimal teamwork, work overload, isolation, problems with work-life integration, and a professional culture that expects perfection and discourages help-seeking are currently contributing to high levels of occupational distress among clinicians. Although the problem and its impact on the health care delivery system are well defined, there is minimal evidence regarding effective interventions to drive progress. This knowledge gap is, in large part, due to the near-complete absence of federal funding for research to address one of the critical challenges facing the US health care delivery system.
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Content ArticleIn this video, William Pileggi, a registered nurse anaesthetist, discusses the implementation of the Golden Eagle Project at the VA Pittsburgh Healthcare System to improve outcomes for veterans who may be prone to experiencing post-operative emergent delirium. Through assessments to prescreen for PTSD, staff training and using alternative drug therapies, his hospital has had zero injury events related to emergent delirium since 2018. With minor modifications, the program is replicable at civilian hospitals.
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Content ArticleThis article in Nurse Leader examines mounting evidence for nurse and patient safety associated with registered nurse (RN) fatigue. What changes driven by strong evidence are nursing leaders enacting to reduce the impact of RN fatigue on patient and nurse safety?
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Content ArticleThis systematic review in the Western Journal of Nursing Research examined the relationship between hospital nurse fatigue and outcomes. The authors found that fatigue was consistently associated with mental health problems, decreased nursing performance and sickness absence. Many studies confirmed that nurse fatigue is negatively associated with nurse, patient-safety and organisational outcomes. The review also highlighted gaps in current knowledge and the need for future research using a longitudinal design and measuring additional outcomes to better understand the consequences of nurse fatigue.
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Content ArticleThis Patient Safety Advisory from the Pennsylvania Patient Safety Authority provides an overview of the issues associated with healthcare worker fatigue. It outlines fatigue risk mitigation practices that are being used in healthcare and other industries, including comprehensive fatigue risk management programs.
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Content ArticleWhen healthcare workers are fatigued, the safety of both patients and staff is compromised. This short article in the American Journal of Nursing reports on a recent webinar in which the Joint Commission distilled current research on fatigue, discussing its causes and symptoms and the various means of addressing the issue. Ann Scott Blouin, a nurse and Executive Vice President of Customer Relations at the Joint Commission, led the discussion and highlighted that factors contributing to staff fatigue fall into three categories: organisation and management issues, the nature of the work and personal challenges. Fatigue has emotional, physical, and behavioural consequences, including lapses in attention, diminished reaction time, and reduced motivation.
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Content ArticleHospitals and other medical organisations are being hit by a rising number of cyberattacks; ransomware strikes on healthcare doubled annually between 2016 and 2021, according to a study published in December in the Journal of the American Medical Association. After a cyberattack, hospitals are forced to cancel procedures, reroute patients to other facilities and resort to pen-and-paper record-keeping. In this article, Wall Street Journal reporter James Rundle looks at how cyberattacks and a regulatory push are increasing the pressure on medical device manufacturers to improve the security of their products.
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Content ArticleNurses work long hours and play a critical role in keeping patients healthy. Many nurses feel that fatigue “comes with the territory” of such a high-stress, high-impact job. But what’s really at risk when a nurse is fatigued? This blog by US insurance company Nurses Service Organization (NSO) looks at the impact of nurse fatigue on patient and staff safety. It suggests several strategies to address the issue: Designing schedules and organising work to reduce nurse fatigue Developing a fatigue management plan Educating staff on sleep hygiene and the effects of fatigue on nurse health and patient safety Providing opportunities for staff to express concerns about fatigue and taking action to address those concerns Making sure extended shifts have adequate staff support and rest periods
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Content ArticleSentinel Event Alerts from the Joint Commission identify specific types of sentinel event (a patient safety event that results in death, permanent harm or severe temporary harm), describe their common underlying causes and suggest steps to prevent them occurring in the future. This Sentinel Event Alert looks at the well-documented link between health care worker fatigue and adverse events. It looks at: The impact of fatigue Contributing factors to fatigue and risks to patients Actions suggested by The Joint Commission for healthcare organisations
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Content ArticleFatigue in anaesthesia practice is often ignored or accepted as the norm due to persistent, high-intensity work demands and expectations. This document produced by the American Association of Nurse Anesthesiology (AANA) aims to provide guidance to healthcare professionals, healthcare facilities and nurse anaesthesia programs regarding sleep deprivation and fatigue. It provides evidence-based information that promotes fatigue management and work-life balance.
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Content ArticleFatigue is a workplace hazard that affects the health and safety of patients, health care providers and the community. This blog from health tech company Cerner looks at the importance of managing fatigue in healthcare staff. The author suggests a three-step approach to lessen fatigue: Shift the culture of safety to include recognising and dealing with fatigue. Operationalise fatigue reduction measures within the organisation. Promote fatigue self-management through preventative strategies.
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Content ArticleThis brief paper reviews the available published literature on shiftwork and safety that allows the estimation of the relative risk of “accidents” or injuries associated with specific features of shift systems. It discusses three main trends in risk: Risk is higher on the night shift, and to a lesser extent the afternoon shift, than on the morning shift Risk increases over a span of shifts, especially so if they are night shifts Risk increases with increasing shift length over eight hours The authors discuss the fact that some of these trends are not entirely consistent with predictions made based on considerations of the circadian variations in sleep propensity or rated sleepiness, and consider factors relating to sleep that may underlie the observed trends in risk. They also discuss the practical implications of the trends in risk for the design of safer shift systems.
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Content ArticleThis practice recommendation offers practical recommendations to assist acute-care hospitals in prioritising and implementing strategies to prevent healthcare-associated infections (HAIs) through hand hygiene. It updates Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals through Hand Hygiene, published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association and The Joint Commission.
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Content Article
The haunting brain science of Long Covid (Stat,16 February 2023)
Patient-Safety-Learning posted an article in Blogs
In this article for Stat, E. Wesley Ely, Professor of Medicine and Critical Care at Vanderbilt University Medical Center, looks at the impact Covid-19 and Long Covid can have on people's brains. He speaks to people with Long Covid who have experienced a sharp decline in brain function, leading to them losing their jobs, struggling to hold a conversation and in some cases developing early-onset dementia. He also highlights biomedical research that has shown changes to the brain in people with confirmed Covid-19 infections, including a reduction in grey matter, problems in the cells lining the blood vessels and impaired cellular metabolism in the frontal lobe six months following acute Covid. -
Content ArticleIn this opinion piece for US website Stat, Michael Millenson explores how financial factors have contributed to the lack of progress in reducing avoidable harm in the US over the past decade. He argues that the private, insurance-based system means that hospitals make more money from patients with complications, therefore patient safety improvements reduce healthcare organisations' profits. He highlights that research demonstrating this link is only now uncovering what hospital executives have known for years—that current payment structures may “reduce the willingness of hospitals to invest in patient safety.”
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News Article
USA: House Bill establishes Federal Agency dedicated to patient safety
Patient Safety Learning posted a news article in News
Nanette Barragán, US representative for California’s 44th Congressional District, has announced the introduction of new legislation intended to establish a National Patient Safety Board (NPSB) as a non-punitive, collaborative, independent agency to address safety in healthcare. This landmark legislation is a critical step to improve safety for patients and healthcare providers by coordinating existing efforts within a single independent agency solely focused on addressing safety in health care through data-driven solutions. Prior to the COVID-19 pandemic, medical error was the third leading cause of death in the United States, with conservative estimates of more than 250,000 patients dying annually from preventable medical harm and costs of more than $17 billion to the U.S. healthcare system. Recent data from the Centers for Medicare and Medicaid Services and Centers for Disease Control and Prevention indicate that patient safety worsened during the pandemic. The NPSB’s solutions would focus on problems like medication errors, wrong-site surgeries, hospital-acquired infections, errors in pathology labs, and issues in transition from acute to long-term care. By leveraging interdisciplinary teams of researchers and new technology, including automated systems with AI algorithms, the NPSB’s solutions would help relieve the burden of data collection at the frontline, while also detecting precursors to harm. A coalition of leaders in health care, technology, business, academia, and other industries has united to call for the establishment of an NPSB. “We have seen many valiant efforts to reduce the problem of preventable medical error, but most of these have relied on the frontline workforce to do the work or take extraordinary precautions,” said Karen Wolk Feinstein, PhD, president and CEO of the Pittsburgh Regional Health Initiative and spokesperson for the NPSB Advocacy Coalition. “The pandemic has now made things worse as weary, frustrated, and stressed nurses, doctors, and technicians leave clinical care, resulting in a cycle where harm becomes more prevalent. Many organizations have united to advance a national home for patient safety to promote substantive solutions, including those that deploy modern technologies to make safety as autonomous as possible.” Read full story Source: Business Wire, 8 December 2022 -
News Article
US putting on a full-court press to secure support for hospitals and patients
Patient Safety Learning posted a news article in News
As the US Congress convenes, the American Hospital Association are turning up the pressure to secure additional support for hospitals and the patients and communities they serve. Specifically, they are asking Congress to: Prevent any further damaging cuts to health programmes, including stopping the forthcoming 4% Statutory Pay-As-You-Go (PAYGO) sequester. Establish a temporary per diem payment targeted to hospitals to address the issue of hospitals not being able to discharge patients to post-acute care or behavioural facilities because of staffing shortages. Increase the number of Medicare-funded graduate medical education positions to address the workforce need for additional physicians in the USA. Extend or make permanent the Low-volume Adjustment and the Medicare-dependent Hospital programmes — critical rural programmes that are due to expire on 16 December. Make permanent the expansion of telehealth services and extend the hospital-at-home programme. Finalize Senate passage of the Improving Seniors’ Timely Access to Care Act, which streamlines prior authorisation requirements under Medicare Advantage plans. Create a special statutory designation for certain hospitals that serve marginalised urban communities. Read full story Source: American Hospital Association, 2 December 2022 -
News Article
The FDA is still letting doctors implant untested devices into our bodies
Patient Safety Learning posted a news article in News
When Kathleen Yaremchuk, Chair of the department of otorhinolaryngology (ear, nose and throat) at Henry Ford Hospital in Detroit, began getting calls about mysterious cases of respiratory distress, she launched a study to figure out what was going on. All these patients, it turned out, had a small device implanted in the top of their spines to relieve pain. The object, used to hold a protein that stimulates bone growth, was cleared for sale by the Food and Drug Administration in 2003 without clinical testing in humans. When Yaremchuk and her colleagues reviewed the records of all 260 patients implanted with the device at Henry Ford Hospital between 2004 and 2009, they found that a significant number developed airway obstruction, trouble swallowing and respiratory failure, in some cases leading to death. The neck implant is just one of the products associated over the past decade with 1.7 million injuries and more than 80,000 deaths. A searing global investigation last year by the International Consortium of Investigative Journalists places much of the blame on significant failings in the FDA’s oversight. The agency’s laissez faire attitude has resulted in artificial hips that cause cobalt poisoning (which can damage the heart and brain); surgical mesh that cuts through flesh and organs, causing infections and haemorrhage; and defibrillators that repeatedly shock patients beyond human endurance. Safety problems have led to recalls of devices implanted in hundreds of thousands of people. And the devices can be difficult or impossible to remove if they go bad No wonder many patient advocates cheered when the FDA announced in November that it planned to make “transformative” changes in the way more than 80% of medical devices are cleared for sale in the United States. But the promised transformation is mere window dressing. Two key loopholes still exist, allowing most products to be approved for sale without clinical trials in humans. Read full story (paywalled) Source: The Washington Post, 4 January 2019
