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Showing results for tags 'USA'.
Found 654 results
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Content ArticleThe United States is one of only three countries in the world that does not use the metric system. Yet, every single medication prescribed today is based on it. In addition to dosages based on the metric system, some doses are also very dependent on patient weight. These include blood thinners, certain antibiotics, chemotherapy agents, and many pediatric doses. The very young, very old, and people with certain medical conditions are at the highest risk of experiencing harm because their bodies are more sensitive to the effects of an error. Calculations made with incorrect weights can have devastating, if not fatal, consequences. Further reading Patient Safety Authority Department of Health: Final recommendation to ensure accurate patient weights
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Content ArticleConvened shortly after President Trump’s inauguration in 2017, the Lancet Commission on public policy and health in the Trump era, offers the first comprehensive assessment of the detrimental legislation and executive actions during Trump’s presidency with devastating effects on every aspect of health in the USA. The Lancet Commission traces the decades of policy failures that preceded and fueled Trump’s ascent and left the USA lagging behind other high-income nations on life expectancy. The report warns that a return to pre-Trump era policies is not enough to protect health. Instead, sweeping reforms are needed to redress long-standing racism, weakened social and health safety nets that have deepened inequality, and calls on the important role of health professionals in advocating for health care reform in the USA.
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Content ArticleInside the US Trump administration, sensible ideas for how to manage a massive, unprecedented distribution of vaccinations were no match for bureaucratic knife fighting, gung ho hubris, and a knee-jerk aversion to strong federal action.
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Content ArticleThis report to Congress details a strategy to achieve the principal purpose and objective of Operation Warp Speed (OWS): ensuring that every American who wants to receive a COVID-19 vaccine can receive one, by delivering safe and effective vaccine doses to the American people beginning January 2021.
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Content ArticleThe purpose of this study from Kleven et al. was to provide a national estimate of the number of healthcare-associated infections (HAI) and deaths in United States hospitals.
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Content ArticleDespite it being 20 years since the Institute of Medicine reported poor quality and high variability in healthcare delivery, there are still significant opportunities for clinical quality improvement (QI). As frontline clinicians and future healthcare leaders tasked with driving these changes, resident physicians are an important cohort to equip with knowledge, skills, and experience in QI and patient safety. In this article, Mitchel and Li review the barriers to resident engagement, leadership and success with QI initiatives and propose potential solutions. Several barriers are unique to psychiatric training. The barriers described are broadly categorised as either structural or process-related, a distinction derived from Donabedian who described a framework for understanding the causal relationship between structures, processes, and outcomes in QI. In addition, the authors provide an example of a resident-led QI initiative to illustrate the proposed solutions.
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Content ArticleThe Patient Safety Authority is an independent state agency that collects reports of patient safety events from Pennsylvania healthcare facilities. Pennsylvania is the only state that requires healthcare facilities to report all incidents of harm (serious events) or potential harm (incidents).
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Content ArticleThe latest newsletter from the Patient Safety Authority highlights the importance of stronger warnings on medications, tracking the way misinformation spreads online, treating brain conditions through art and music, and more.
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Content Article
The Beryl Institute
Patient Safety Learning posted an article in The Beryl Institute
The US Beryl Institute is the global community of practice committed to elevating the human experience in healthcare. The Beryl Institute believes human experience is grounded in experiences of patients and families, those who work in healthcare and the communities they serve. Take a look at their website for resources, learning and connections, including access to tools to build organisational experience strategy and develop skills of team members. -
Content ArticleThis report from the American Enterprise Institute provides a road map for navigating through the current COVID-19 pandemic in the United States.
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Content Article
This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Dan talks to us about how his experiences as a paediatrician and military doctor have influenced his view of patient safety. He also describes the increasing complexity in healthcare systems and highlights the need for the Government to commit policy and resources to building and sustaining the NHS workforce. -
Content ArticleIn this article, Rachel Star Withers shares her account of receiving electroconvulsive therapy to treat her severe depression and schizophrenia while in her final year at college. She describes how the treatment robbed her of her memory, reading and writing abilities, but saved her life. Without ECT, Rachel believe she would have committed suicide. She talks about the need to educate people about the realities of ECT and undo unhelpful 'horror-story' stereotypes.
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Content ArticleThis article in the Anesthesia Patient Safety Foundation newsletter looks at the issues surrounding the contribution of anaesthetic gasses to healthcare pollution and emissions. The authors argue that the next patient safety movement should be sustainable healthcare. They highlight that anaesthetists have the opportunity to lead in the effort to reduce healthcare’s impact on population health, and demonstrate to the wider sector that sustainable healthcare is possible and important to the wellbeing of patients.
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Content ArticleWhat a subway killing reveals about New York City’s revolving-door approach to mental illness and homelessness.
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Content ArticleAs the number of Pennsylvanians diagnosed with autism spectrum disorder (ASD) continues to grow, healthcare facilities are seeing an increase in the number of these individuals seeking care. Negative interactions with the healthcare system and concerns about the quality of care provided to this population have been reported by individuals with ASD, their families, and healthcare providers. The Pennsylvania Patient Safety Authority received 138 reports of events involving patients with ASD from July 2004 through August 2014. Qualitative analysis of event report narratives revealed 12 patient safety concern themes involving patients with ASD. Injury to self or potential injury to self was identified as the most frequently reported concern (n = 75), followed by interference or lack of cooperation with care (n = 30). Other events included aggressive behavior and/or injury to others, use of chemical or physical restraints, patient communication difficulties, and caregiver communication difficulties and/or consent issues. The patient safety concerns commonly encountered by ASD patients and their families as reported to the Authority are consistent with the concerns cited in the published literature. Resources such as those developed by the Western Pennsylvania Autism Services, Education, Resources, and Training Collaborative are available to help healthcare facilities improve care for this population.
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Content ArticleAn examination of how humans interact with their environments and each other led this team to question one of its long-standing medication safety practices and change how they work.
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Content ArticleMedication safety events with the potential for patient harm do occur in healthcare settings. Pharmacists are regularly tasked with utilizing their medication knowledge to optimize the medication-use process and reduce the likelihood of error. To prepare for these responsibilities in professional practice, it is important to introduce patient safety principles during educational experiences. The Accreditation Council for Pharmacy Education (ACPE) and the American Society of Health-System Pharmacists (ASHP) have set forth accreditation standards focused on the management of medication-use processes to ensure these competencies during pharmacy didactic learning and postgraduate training. The experience described here provides perspective on educational and experiential opportunities across the continuum of pharmacy education, with a focus on a relationship between a college of pharmacy and healthcare system. Various activities, including discussions, medication event reviews, audits, and continuous quality improvement efforts, have provided the experiences to achieve standards for these pharmacy learners. These activities support a culture of safety from early training.
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Content ArticleThe overall goal for the Quality and Safety Education for Nurses (QSEN) project is to meet the challenge of preparing future nurses who will have the knowledge, skills and attitudes necessary to continuously improve the quality and safety of the healthcare systems they work in. This webpage outlines the competencies in the QSEN competency framework: Patient-Centered Care Teamwork and Collaboration Evidence-based Practice (EBP) Quality Improvement (QI) Safety Informatics
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Content ArticleThe Communication, Apology and Resolution model (CARe) offers healthcare organisations a detailed process for responding to unanticipated adverse outcomes, which includes proactively communicating with patients and families, examining and explaining what happened, avoiding recurrences by improving systems of care and, where appropriate, apologising and offering financial compensation. The model recognises that clinicians and staff will need peer support and training to effectively communicate with patients and families. In June 2022, advocates of the CARe model held an annual forum to highlight the successes of CARe programs in Massachusetts and to look at challenges health care providers face in doing this work consistently across their organisations. This article by the Betsy Lehman Center highlights video recordings shared at the forum including: A family member testimonial by Jane Bugbee, whose healthy daughter, Lindsay, died of Strep A and sepsis shortly after giving birth to her third child in July 2018 A simulation of a resolution conversation with a family A simulation of a conversation with provider after an adverse event.
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Content ArticleThis article by the US Centers for Disease Control and Prevention (CDC) provides advice for patients about steps they can take to help avoid catching healthcare-associated infections, which can ultimately lead to sepsis and even death. It outlines ten things patients and their families can do to protect themselves or their loved ones while receiving medical care. Speak up Keep hands clean Ask each day if your central line catheter or urinary catheter is necessary Prepare for surgery Ask your healthcare provider, “Will there be a new needle, new syringe, and a new vial for this procedure or injection?” Be antibiotics aware Watch out for deadly diarrhoea (aka Clostridium difficile) Know the signs and symptoms of infection Get vaccinated Cover your mouth and nose
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Content ArticleThis toolkit from the Department of Veterans Affairs (VA) National Center for Health Promotion and Disease Prevention contains tools that help promote patient engagement in healthcare settings. It was developed in consultation with VA staff and veterans and is based on the Patient Aligned Care Team (PACT) model.
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Content ArticleHealth literacy is a person’s ability to find, understand, and use information and services to inform health-related decisions and actions. Not surprisingly, many Americans do not have levels of health literacy that allow them to truly understand their care or take appropriate actions to improve their health. According to the Centers for Disease Control and Prevention (CDC), 9 out of 10 adults have difficulty understanding health information when it is complex or unfamiliar. In this blog, Regina Hoffman, Executive Director of Pennsylvania’s Patient Safety Authority, outlines the steps your organisation can take to fulfill its role in closing the gap on health literacy.
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Content ArticleThis cross-sectional study in BMJ Quality & Safety aimed to assess patient comfort in speaking up about problems during hospitalisation, and to identify patients at increased risk of having a problem and not feeling comfortable speaking up. The authors assessed the responses of 10,212 patients at eight hospitals in Maryland and Washington to the question, "How often did you feel comfortable speaking up if you had any problems in your care?" The study found that 48.6% of respondents indicated that they had experienced a problem during hospitalisation. Of these, 1,514 (30.5%) did not always feel comfortable speaking up. The authors concluded that creating conditions for patients to be comfortable speaking up may result in service recovery opportunities and improved patient experience.
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Content ArticleHealth care providers that encourage patients and parents to be "the eyes and ears" of patient safety gain many insights into opportunities for improvement and risk prevention. However, in the world of quality improvement the voices of patients and their families often go unheard. Dale Micalizzi and Marie Bismark published this article in the journal Pediatric Clinics of North America to share their perspectives as mothers of children who have benefited from and been harmed by paediatric care.
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Content ArticleThis blog describes the experience of Colonel Steven Coffee, Cofounder of Patients for Patient Safety US, who experienced a series of medical errors following the birth of his son. After a missed diagnosis of galactosemia, his son suffered liver failure and underwent a liver transplant at eight weeks old. Following his operation, the hospital where he was being treated did not have access to the powdered soy milk which was essential for his son's recovery. This experience spurred Colonel Coffee on to become an advocate for patient quality and safety in health care. For the last nine years, he has worked toward improved patient safety as the first community chair of MedStar Health’s Patient and Family Advisory Council for Quality and Safety (PFACQ).
