Patient safety recommendations

Patient safety is a major concern in heaith care systems woridwide. Patients with serious conditions, muitimorbidity, and with intense and fragmented health care utilization, like end-stage renal disease (ESRD) patients, are at increased risk for suffering adverse events. In this chapter, the fundamental terms and concepts of patient safety are introduced. Essential epidemiological data relating to the frequency of adverse events and medical errors are provided. The chapter reports important safety threats for ESRD patients and describes examples of key innovations which contribute to patient safety. Recommendations and risk reduction strategies to improve care of ESRD patients are presented. 

Respirator parts Moist heat (autoclave) Moist heat (low- temperature steam, or hot water at 80°C) Sterilization Disinfection Sterilization by steam where possible Chemicals not recommended may be microbiplogically ineffective, may present hazard to patient safety by compromising the safety devices on the machine... 

The decision to use these agents should be made with considerable caution, and only after possible underlying causes of the patient s symptoms have been explored and treated appropriately. Although surveys indicate that BZDs are frequently prescribed for elderly patients, the NIH Consensus Development Conference stated that the efficacy and safety of sedatives and hypnotics have not been established for older people, nor has the extent to which they contribute to or alleviate sleep problems (302, 305, 306). Saizman (307) has pointed out that relatively few research studies, most of which are seriously flawed, have examined the therapeutic effect of these agents in elderly patients. Thus, recommendations for the use of BZDs in elderly patients are derived almost exclusively from studies of young adult patients, studies of pharmacokinetics and toxicity in elderly patients, and clinical and anecdotal experience. 

The JCAHO has a major focus on patient safety, including medication safety. As facilities report internal sentinel events to JCAHO, they are reviewed and analyzed. JCAHO has issued a number of sentinel event alerts, notifying healfh care organizafions and consumers to specific safety issues and practice recommendations to improve them. Several have addressed medication issues such as potassium chloride and other concentrated electrolytes, insulin, heparin, injectable opiates and narcotics, infusion pumps, and look- and sound-alike medications and abbreviations. Table 16.10 summarizes the recommendations for these sentinel event alerts. ... 

To Err Is Human contains a four-part plan for decreasing the number of medical errors, and each part has implications for the pharmacy profession. To provide leadership and a research focus for patient safety. Part one recommends the creation of a center for patient safety within the Agency for Healthcare Research and Quality (AHRQ). Pharmacy organizations and pharmacists have the opportunity to contribute by including the study of medical errors in their applied research agendas. Using their expertise, pharmacists can provide input to the national goals, their content, and professional responsibilities for medicahon safety. ... 

Significant deficiencies in the security and control of samples have been well documented. " " In fact, it has been estimated that just over half of samples actually reach patients. Samples may be used by prescribers and staff, or they may be diverted. Personal use of drug samples by physicians and other healthcare providers raises ethical concerns and is not without risk." Limaye and Paauw described three medical residents who self-prescribed antimicrobials and were subsequently diagnosed with Clostridium difficile infection." Tong and Lien reported self-medication with samples and distribution of samples to nonphysicians by almost 60% of pharmaceutical representatives surveyed at a Canadian family practice office. A contributing factor to some of these issues is that institutional or facility sample policy and procedures are often absent, or compliance is poor. One institution found only 10% compliance when the inventory of samples was compared with the required written documentation. Even after an educational program in which the policy was explained to the house staff, a second audit found only 26% compliance. " Poor compliance with policy and procedure may jeopardize patient safety, as well as put the institution at risk for JCAHO recommendations or Board of Pharmacy penalties. 

USPCenterfortheAdvancementof Patient Safety. USP issues recommendations for preventing medication errors in children. January 21, 2003. 

The varicella vaccine has an excellent safety record. Pain, local swelling, and erythema at the injection site occur in up to 32% of patients and fever in 10% to 15%. A varicella-like rash occurs in approximately 4% of vaccinees, accompanied by few, if any, systemic symptoms. The rash may be localized at the injection site or generalized. Lesions are usually few in number (2 to 10) and often papular rather than vesicular. Transmission of vaccine virus to susceptible close contacts has occurred, but it is very rare and is believed to occur only when the vaccinee develops a rash. Because the risk of vaccine virus transmission is very low and primary infection can be very severe, vaccination of household contacts of immunocompromised patients is recommended to prevent introduction of varicella into the household. " ... 

In order to reduce the risk of myopathy the CSM in the UK have advised that statins should be used with care in patients who are at increased risk of this adverse effect. Among other risk factors, they mention concomitant use with fibrates, such as gemfibrozil , (p.llOO), and with inhibitors of CYP3A4 such as ciclosporin , (p.l097), macrolides ,(p.ll04), azoles , (p.l093), and protease inhibitors , (p.1108). They also recommend that patients should be made aware of the risks of myopathy and rhabdomyolysis, and asked to promptly report muscle pain, tenderness, or weakness, especially if accompanied by malaise, fever, or dark urine. A 2002 advisory on the use of statins gives some important safety recommendations, which are useful in the context of interactions ... 

However, while the objective of the report, and the thrust of its recommendations, was to stimulate a national effort to improve patient safety, what initially grabbed public attention was the declaration that between 44 000 and 98 000 people die in US hospitals annually as a result of medical errors. 

Recommendations from incident investigations were often not implemented. Senior managers had a top down approach to patient safety and did not engage staff in the development of safety solutions. Sustainability of solutions would be achieved if frontline staff were engaged in developing solutions, rather than having them imposed from above. 

European Society for Quality in Healthcare 2010. Use of Patient Safety Culture Instruments and Recommendations. EUNetPas Project Report, Aarhus, Demnark. 

Other international efforts have included the EUNetPaS (European Union Network for Patient Safety) which was officially launched in 2008 in Utrecht, the Netherlands to establish an umbrella netwoik of all European Union (EU) Member States to encourage collaboration in patient safety. EUNetPaS sought to establish common principles at the EU level, integrating knowledge, experiences and expertise from member states and offering support to countries that were less advanced in patient safety. EUNetPaS published a two-volume report in 2010 reviewing patient safety culture instraments (Kristensen and Bartels 2010). The AHRQ Hospital SOPS was one of only three patient safety culture instruments that was officially recommended after an extensive review of available tools. 

Velji et al. (2008) Situation- Background- Assessment- Recommendation Six to twelve months Clinical unit in a rehabilitation hospital Hospital Survey on Patient Safety Culture Eight of the survey dimensions improved by at least 5%... 

European Society for Quality in Healthcare 2010. Use of patient safety culture instruments and recommendations. EUNetPas Project Report, Aarhus, Denmark. Available at http //ns208606.ovh.net/ xtranet/images/EUNetPaS Publications/eunetpas-report-use-of-psci-and-reconunandatioiis-april-8-2010. pdf (last accessed on 22 April 2014). 

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