Patient safety hospitalization period

It s a promising way to automate aspects of medication administration, says Robert Krawisz, former executive director of the National Patient Safety Foundation. The technology s impact at VA hospitals so far has been amazing. The Department of Veterans Affairs (VA) already uses bar codes nationwide in its hospitals, and the result has been a drastic reduction in medication errors. For example, the VA medical center in Topeka, Kan., has reported that bar coding reduced its medication error rate by 86 percent over a nine-year period. 

In 2004 the occurrence of a sentinel event - an incompatible blood group heart transplant - at University Hospital Zurich abruptly made patient safety a central concern of the hospital. This sentinel event created a major public stir, not least because the patient, who died in the postoperative period, was followed live by a television reporting team. The way in which this sentinel event was dealt with thus became a matter of public interest. Attention was no longer focused... 

The strrveys of patient safely climate served Urriversity Hospital Zurich as a kind of roadmap to the futirre. Over the period between the comprehensive initial strrvey, conducted in 2006, and the most recerrt assessmerrt of patient safety chmate in an individual organisational rrrrit, these srrrveys have become a more or less standardised component of the hospital s qrralily management system. It has also been found that assessments of patient safety climate can be undertaken both at the level of individual teams in cormection with an intervention... 

If all hospitals performed at the level of Distinguished Hospitals for Patient Safety, approximately 206,286 patient safety incidents and 34,393 deaths of Medicare patients could have been avoided while saving the United States approximately 1.74 billion during the period 2003 to 2005. 

The first consideration, as always, will be safety information that can be obtained more safely in healthy subjects, which may subsequently reduce risk to patients, should prompt a debate on whether it is wise to progress according to plan or whether an additional study should be performed in healthy subjects. Another option that may be considered is to proceed with the planned study in patients but to admit them to hospital or a clinical investigation unit for all or part of the dosing period. However, this might not be feasible because suitable facilities and staff are not available or because the anticipated rate of patient recruitment might be considered unacceptably slow. 

Cocaine use may account for up to 25% of acute myocardial infarctions among patients aged 18-45 years. The safety of a 12-hour observation period in a chest pain unit followed by discharge in individuals with cocaine-associated chest discomfort who are at low risk of cardiovascular events has been evaluated in 302 consecutive patients aged 18 years or older (66% men, 70% black, 84% tobacco users) who developed chest pain within 1 week of cocaine use or who tested positive for cocaine (59). Cocaine use was self-reported by 247 of the 302 subjects and rest had urine positive for cocaine 203 had used crack cocaine, 51 reported snorting, and 10 had used it intravenously. Of the 247 who reported cocaine use, 237 (96%) said they had used it in the week before presentation and 169 (68%) within 24 hours before presentation. Follow-up information was obtained for 300 subjects. There were no deaths from cardiovascular causes. Four patients had a non-fatal myocardial infarction during the 30-day period all four had continued to use cocaine. Of the 42 who were directly admitted to hospital, 20 had acute coronary syndrome. The authors suggested that in... 

If in doubt from the history of the patient, the only way to determine hypersensitivity is through provocation tests. A challenge test battery with several controls is used (Table 3). We prefer to have patients in the hospital for their own safety and so that they can be followed closely during the 2-week test period. The time in the hospital may prove less than the loss of working days from the urticaria itself. 

One of the challenges of understanding and improving safety and quality is to capture the full range of events that occurs during a patient s journey through healthcare. Clearly a complete description is not feasible, but we would at least like to capture the most important experiences and incidents. Medical records contain some of this information bnt are only a summary of key events and decisions. Interviews with staff can prodnce more detail but, as they have lives to lead and need to sleep periodically, they too have only a partial picture. The hospitalized patient on the other hand is there all the time, with little to do except watch and wait. Potentially therefore, they are an ideal observer. 

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