Archive for September, 2010
Posted by James
During the pilot project, it became clear that not only were the medication safety huddles helping us to identify important safety issues not captured in medication incident documentation processes, but they were also readily facilitating resolution of these problems.
Over 90% of hospital pharmacies have medication incident reporting systems. One survey has shown that most nurses know that incident reporting is the primary means for identifying medication errors. Unfortunately, however, incident reporting is a reactive approach to medication error. Medication safety huddles emphasize a proactive approach to identifying and preventing error and to effecting change in medication safety systems. In this context, near misses or “good catches” are considered as important as actual errors. Input from nurses has played a critical role in elucidating factors that contribute to medication errors and near misses that may not have been considered previously.
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Posted by James
The pilot trial of medication safety huddles on our AMU has yielded promising results. Examples of medication issues identified and interventions implemented during this short period are summarized. Several unit and hospital-wide initiatives have been generated from discussions arising during medication safety huddles. For example, nurses’ concerns about inconsistent insulin orders (e.g., sliding-scale insulin prescribed without specification of frequency or without consideration of continuous or enteral feeding) have prompted development of a preprinted order form for sliding-scale insulin on our unit. Read the rest of this entry »
Posted by James
Medication safety huddles are now a fixture on the AMU. Because of supportive staff response and the significant medication safety information that has been generated, these medication safety huddles merit continuation, especially given the minimal investment of time and resources. In fact, medication safety huddles will soon be introduced on 8 other patient care units at our hospital. A multidisciplinary steering committee will be charged with storing the data collected to allow sharing of information, to improve consistency, and to reduce duplication of effort in developing new interventions. These safety briefings form one element of a broader safety initiative launched by our health authority in response to expressed interest in identifying and targeting global inefficiencies related to medication safety. Medication safety huddles are currently being introduced to other hospitals within the Vancouver Coastal Health authority.
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Posted by James
The Acute Medical Unit (AMU) at Vancouver General Hospital is a 43-bed unit admitting adult patients who require medical management of diverse diagnoses. Although many of the patients are critically ill, there are no ventilators, and no drug therapy requiring electronic cardiac monitoring is administered in this setting. The ratio of nursing staff to patients ranges from 1:2 to 1:6, depending on patient acuity and time of day (e.g., day versus night shift). Three clinical pharmacists are assigned to adult medicine and family practice patients, and the AMU is one site where pharmacists execute their daily pharmaceutical care responsibilities. Automated dispensing cabinets supply narcotics and controlled drugs as well as ward stock. The pharmacy department offers a centralized IV admixture service and traditional 7-day distribution for personal medications.
Patients are admitted to the AMU through the internal medicine and subspecialty services. The Vancouver General Hospital is the major patient care, teaching, and research hospital in British Columbia, and the AMU is consequently a site for core adult medicine rotations in medical school, nursing, and allied health training programs.
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Posted by James
INTRODUCTION
The focus on patient safety in health care has intensified over the past 5 years. The 1999 Institute of Medicine report To Err is Human, which outlined the alarmingly high rate of medical errors in the United States, mirrored recognition of iatrogenic injury in Australia and the United Kingdom and generated an unprecedented response in health care policy. Many health care organizations launched initiatives to promote patient safety and, in December 2003, the Canadian government funded establishment of the Canadian Patient Safety Institute. Recently, much anticipated data for a national estimate of hospital-based adverse events has been published. In this review of hospital records for 3745 randomly selected patients from across the country, it was estimated that 7.5% of patients admitted to acute care hospitals experienced one or more adverse events.
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Posted by James
Capsule Endoscopy and Double-Balloon Enteroscopy Complementary for Detecting Small-Bowel Pathology
In a retrospective chart review of diagnostic procedures, researchers compared the diagnostic yield of capsule endoscopy versus double-balloon enteroscopy in the detection of small-bowel pathology. Outcomes were evaluated in consecutive patients who underwent both procedures, performed by the same endoscopist, between January 2005 and August 2006. The most common indication for double-balloon enteroscopy was obscure overt gastrointestinal bleeding (48%), followed by obscure occult gastrointestinal bleeding (32%), mucosal changes (10%), suspected mass (9%), and a retained capsule (1%). Of the 237 patients evaluated, 50.6% were male and the mean age was 65 years (range, 17—100 years). Abnormalities were detected in 72% of patients with double-balloon enteroscopy, compared to 68% with capsule endoscopy, yielding a nonsignificant trend toward agreement between the 2 tests (kappa value, 0.28; P=.06). Double-balloon enteroscopy revealed small-bowel pathology in 24 of 45 patients (53.3%) with negative results by capsule endos-copy. Read the rest of this entry »