Preventing Retained Surgical Items

The Joint Commission, which accredits and certifies more than 20,000 health care organizations and programs in the United States, recently  issued a Sentinel Event Alert urging hospitals to look at ways to avoid mistankenly leaving items in a patient’s body after surgery.

Known as retained surgical items (RSIs) or unintended retention of foreign objects (URFOs), they can cause death or harm to patients both physically and emotionally. Examples of items left in a patient’s body can be towels, sponges or instruments.

In the past seven years, the Joint Commission has received more than 770 voluntary reports of surgical items left behind. Of these, 16 cases resulted in death and 95 percent of incidents resulted in additional care. According to the Joint Commission, studies have shown that objects left behind after surgery can cost as much as $200,000 per case in medical and liability payments.

Some actions recommended in The Joint Commission Alert include:

·         Creating a highly reliable and standardized counting system to prevent URFOs – making sure all surgical items are identified and accounted for.

·         Developing and implementing effective evidence-based organization-wide standardized policy and procedures for the prevention of URFOs through a collaborative process promoting consistency in practice to achieve zero defects.

·         Specific recommendations for counting procedures, wound opening and closing procedures and hen intra-operative radiographs should be performed.

·         Organizations should research the potential of using assistive technologies to supplement manual counting procedures and methodical wound exploration.

·         Effective communication should be a standard part of the surgical procedure, including team briefings and debriefings, to allow the opportunity for any team member to express concerns they have regarding the safety of the patient, including the potential for an URFO.

·         Appropriate documentation should include the results of counts of surgical items, instruments, or items intentionally left inside a patient (such as needle or device fragments deemed safer to remain than remove), and actions taken if count discrepancies occur. Tracking discrepant counts is important to understanding practical problems.

The most common root causes of RSIs are the absence of policies and procedures, incomplete staff education, failure to comply with existing policies and procedures, failure in communication with physicians and failure of staff to communicate relevant patient information.

Playsets recalled

Infinitoy Inc. is recalling the Super Safari Set model #30025 and the Deluxe Circus Train Set model #30040. The model number can be found on the back of the box in the lower right corner. The sets come in a white box with "Softimals. Build, Play, Repeat" and "Ages 1 ½ to 5" printed in a colorful font on the front and back of the package. They were sold at specialty toy stores nationwide and online at Amazon.com and Mindware.com from September 2012 to September 2013.

WHY: The plastic hats found on playset figures pose a choking and aspiration hazard for children.

INCIDENTS: One incident in which an 18-month-old child placed a hat in their mouth and started to gag/choke but the toy was removed. No injuries have been reported.

HOW MANY: About 7,134 units.

FOR MORE: Call Infinitoy at (888) 558-0933 or visit www.infinitoy.com, then click on Safety/Recall at the bottom of the page for more information.

Culture of Patient Safety

Many hospitals have put in place patent safety programs in order to help reduce hospital-acquired infections, but further steps are necessary to prevent avoidable patient deaths.

Taken from FierceHealthcare, below are five steps to create a culture of patient safety that can prevent avoidable patient deaths:

1. Develop a system of transparency. The government needs to lead in the creation of a standardized process for hospitals to define, measure and report healthcare-acquired infections (HAI) and healthcare-acquired conditions (HAC). Kiani called for Congress to require hospitals to publicly report HAI and HAC rates to facilitate quality comparisons.

2. Create incentives and disincentives. He suggests Congress suspend payments to hospitals that don't have evidence-based strategies for prevention and shield hospitals that do implement evidence-based practices from malpractice lawsuits through an affirmative defense and limits on damages.

3. Establish a "patient data super highway" so hospitals can openly share data with each other, patients and all parties that can use the information to improve patient safety.

4. Extend legal safe harbor to medical technology companies to encourage reporting of adverse events.

5. Assign a patient advocate to every hospital so patients and their families have someone to turn to if they experience a lack of empathy or problems with communication related to their care.

Hospital-acquired infections

According to research published in JAMA Internal Medicine, hospital-acquired infections (HAI) cost approximately $9.8 billion per year, with surgical site infections alone accounting for one-third of those costs.

The most expensive type of HAI are central line-associated bloodstream infections, and they cost an average of $45,814 per patient. Other costly HAIs are catheter-associated urinary tract infections, Clostridium difficile infections, surgical site infections, and ventilator-associated pneumonia.  

Researchers reviewed 37 years’ worth of published medical literature to determine how expensive there HAIs are.

Safe Patient

As a patient, you're at a hospital to get better. However, medical mistakes can happen anytime and you are always at risk for getting an infection. Taken from the Centers for Disease Control and Prevention (CDC), below are 10 things you can do to be a safe patient.  
 

1. Talk to your doctor about any worries you have about your safety and ask them what they are doing to protect you.

2. Keep hands clean. If you do not see your healthcare providers clean their hands, please ask them to do so. Also remind your loved ones and visitors. Washing hands can prevent the spread of germs.

3. Ask if you still need a central line catheter or urinary catheter. Leaving a catheter in place too long increases the chances of getting an infection. Let your doctor or nurse know if the area around the central line becomes sore or red, or if the bandage falls off or looks wet or dirty.

4. Ask your healthcare provider, "Will there be a new needle, new syringe, and a new vial for this procedure or injection?" Healthcare providers should never reuse a needle or syringe on more than one patient.

5. Be careful with medications. Avoid taking too much medicine by following package directions. Also, to avoid harmful drug interactions, tell your doctor about all the medicines you are taking.

6. Get Smart about antibiotics. Help prevent antibiotic resistance by taking all your antibiotics as prescribed, and not sharing your antibiotics with other people. Remember that antibiotics don't work against viruses like the ones that cause the common cold.

7. Prepare for surgery. There are things you can do to reduce your risk of getting a surgical site infection. Talk to your doctor to learn what you should do to prepare for surgery. Let your doctor know about other medical problems you have.

8. Watch out for C. diff. Tell your doctor if you have severe diarrhea, especially if you are also taking an antibiotic.

9. Know the signs and symptoms of infection. Some skin infections, such as MRSA, appear as redness, pain, or drainage at an IV catheter site or surgical incision site. Often these symptoms come with a fever. Tell your doctor if you have these symptoms.

10. Get your flu shot. Protect yourself against the flu and other complications by getting vaccinated.

A life-saving app

HealthTap, a health information start-up, recently heard from its 10,000^th user, who said the site saved her life.  

The user explained that her local doctor brushed her off and told her that what she was experiencing was nothing but anxiety. After the appointment, she turned to HealthTap, where she was able to explain to a medical expert what she was going through. The doctor who took the question told the user that her condition sounded like a blocked artery. Sure enough, she soon saw a cardiology specialist who later inserted a coronary stent.  

Since 2012, the site has logged nearly a billion questions and answers that range from headaches and the common cold to things more serious such as concerns about cancer treatment and medications. After questions are asked, they are routed to a physician who is an expert in that particular field of medicine and who is determined to be most likely to respond quickly.  

Nearly 50,000 doctors contribute their advice for free to this site. HealthTap is both a Web site and a mobile application.

Flu season starts as CDC remains idle

Because of the government shutdown, the Centers for Disease Control and Prevention (CDC) labs and surveillance programs are idle, causing outside experts to worry that important data is being lost in regards to the fall flu season. 

According to an article published in MedPage Today, approximately 80 to 85 percent of the usual staff is on enforced leave, and that almost all of the regular apparatus that monitors flu and flu-like illness has been shut down. Information about things such as anti-viral resistance, pediatric influenza, admissions to hospital for flu or flu-like illness and mortality is not being gathered.  

As of right now, there is no “national snapshot” for this flu season.  

State health departments are currently collecting flu data, but the information is not being sent over to the CDC. With the agency not knowing what the geographic spread of the disease is, we will not understand if this season is mild or severe, if the flu has developed resistance to anti-viral medications, or is the vaccine strains match those circulating in the community.

Quality hospital care

The following was taken from the Joint Commission on choosing quality care in a hospital.

When you need care in a hospital, and it is not an emergency, you should take time to find out some information to help you choose the best hospital for you or your loved one. Your doctor can recommend some hospitals. Talk with representatives at each hospital. The following questions can help you get the information you need.

Questions about care:
• Ask about the operation or treatment that you need. How often is it performed? What are the risks?
• Will you receive written information about your operation or treatment?
• Will a care plan be created? The plan should cover the services that the patient will receive and how long
treatment will last.
• Who will be responsible for the care plan?
• How are nurses and other health care professionals updated about your care?
• How is your family updated about your care?
• Ask how your pain will be treated. Will you meet your anesthesiologist?
• What are the hospital’s rules for visitors?
• Are family members allowed in the recovery area?
• How do they provide security? How do they protect all patients?
• What is the cost of your operation or treatment?
• Is your operation or treatment covered by your medical insurance?
• Where can you get help finding financial assistance if you need it?
• Is the hospital “accredited?” Accredited means that the hospital follows rules for patient safety and quality. Go to Quality Check® at www.qualitycheck.org to find Joint Commission accredited hospitals.
• What are your rights and responsibilities? Ask for a paper copy and an explanation of your rights and
responsibilities.
• Is patient information kept confidential? Is there any reason patient information is released?

Questions about staff:
• What is the training and background of the doctor?
• Is the doctor certified by a medical board?
• Are social workers available? What services do they provide?

Questions about emergency care:
• Is there a 24-hour telephone number you can call if you have questions or problems? Will a doctor or
nurse answer the phone? How are emergencies handled after hours?
• Is there an emergency plan? Can care still be provided if there is a power failure or natural disaster? Is
there a plan for moving patients to another hospital if there is an emergency?

Questions about care when leaving the hospital:
• Will a discharge plan be created?
• Will you or your family be given clear instructions about your care after you leave the hospital? For
example, how to change dressings and continue medicines.
• What services are available after you leave the hospital?
• Will your regular doctor be given information about your condition?

Recalled Children's Book

DETAILS: Children’s books titled ‘‘Count my Kisses, 1, 2, 3’’ and ‘‘Red, Green, Blue, I Love You.’’ The board-shaped children’s books have cut out covers that serve as a handle and include an embedded bar in the handle with beads for children to play with. ‘‘Ages 3+’’ is printed on the back covers and the ISBN numbers are also on the back covers near the bar code. Two titles are included. Count my Kisses, 1, 2, 3, ISBN: 978-0-316-13354-8, has five colored cylindrical wooden beads with printed hearts on the rod. I Love You, ISBN: 978-0-316-13353-1, has five colored circular wooden beads on the metal rod. They were sold from June 2013 to August 2013.

WHY: A metal rod holding small beads on the cover of books can detach and release small parts on which children could choke. A detached metal bar can expose a sharp edge posing a laceration hazard.

HOW MANY: About 70,000.

FOR MORE: Call Hachette Book Group at 888-965-5802 or visit www.hachettebookrecall.com or www.hachettebookgroup.com and click on the link in the Recall/Important Safety Notice box on the home page.

Unreliable Hospitals

The Joint Commission, which accredits and certifies more than 20,000 health care organizations and programs in the United States, say that too many hospitals and health care leaders experience serious safety failures every day.

Because of these failures, millions of Americans are affected each year. According to the article, major changes need to take place in both leadership and safety culture. If changes can successfully be made, hospitals can make progress towards becoming highly reliable.

There are three major things that hospitals can do. According to the Joint Commission:

·         Hospital leadership must commit to the ultimate goal of high reliability or zero patient harm rather than viewing it as unrealistic.

·         Hospitals must create a culture of safety that emphasizes trust, reporting and improvement. This means hospitals must put a stop to the intimidation and blame that drive safety concerns underground and instead emphasize accountability and the early identification of unsafe practices and conditions.

·         Hospitals need new process improvement tools and methods—a combination of Six Sigma, Lean, and change management in order to make far greater progress toward eliminating patient harm. Government regulation is unlikely to drive high reliability, but identifying and eliminating mandates that either do not directly contribute to or distract from quality challenges is necessary. Well-crafted programs that require public reporting of reliable and valid quality measures are also recommended.

Currently, no hospital has been able to achieve high reliability, but changes can be made to improve safety.

Opioid Label Change

According to an article published in MedPage Today, the FDA has ordered a class-wide label change for long-acting opioids. The opioids, such as OxyContin, would be limited to patients with only severe pain.

With this move, the agency hopes it will help the prescription painkiller epidemic. The drugs, which are important pain relieving medications that provide significant benefits when used appropriately, will also include a label clarification about the risks of abuse and death while taking it as well as a boxed warning about the risks of neonatal opioid withdrawals syndrome.

The indication of the drugs will be changed to people who have pain severe enough to require daily and long-term treatment where alternative treatment options are inadequate. Physicians and patients will have to discuss the eligibility of the opioids. Therefore, patients in pain will be assessed by a thoughtful determination of pain instead of by a rating on a pain scale. 

Nutrition in Schools

According to a study by the Centers for Disease Control and Prevention (CDC), school districts across the country are making improvements in terms of nutrition and exercise.  

For years, schools have been phasing out junk food like candy and chips. The percentage of school districts that prohibited these types of food in vending machines increased to 43 percent in 2012 from 30 percent in 2006. Also, more than half of school districts have made information available to families on the nutrition and caloric content of foods available to students.

Also, the number of school districts that require elementary schools to teach physical education has increased. 

Dangerous Doctors

According to an article published in USA Today, the nation’s state medical boards continue to allow thousands of physicians to keep practicing medicine after findings of serious misconduct that can put patients at risk. 

Many doctors have been banded by hospitals and other medical facilities, but their medical licenses remain intact.

Research shows that even the worst misconduct goes unpunished; nearly 250 doctors were cited as an “immediate threat to health and safety,” but their licenses were never taken away.

By law, hospitals and other health care institutions are required to report to the National Practitioner Data Bank when doctors lose clinical privileges in connection with investigations of substandard care or misconduct. At the beginning of 2011, however, 47 percent of hospitals had never reported restricting or revoking a doctor’s clinical privileges.

Even though many doctors have had their medicine practicing privileges taken away, their state medical boards have unfortunately taken no action against their licenses to practice, allowing more patients to be put in danger.

Improving Patient Safety in the OR

According to a statement by the American Heart Association (AHA), hospitals can prevent medical errors during cardiac surgeries by training operating room staff on how to communicate with one another and work together as a team.

Communication failures are the most common cause of problems in hospitals and are oftentimes the root cause of medical errors, according to research that was published in AHA’s journal, Circulation.

These five strategies can ultimately strengthen communication and teamwork:

• Use checklists and conduct postoperative debriefings during cardiac surgeries;
• Train all members of the cardiac operative team on communication, leadership and situational awareness;
• Set up formal handoff protocols during transfer of the care of cardiac surgical patients to new medical personnel;
• Hold scenario training for significant and rare nonroutine events (i.e., emergency oxygenator change out); and
• Conduct studies of teamwork and communication that consider optimal communication models, team-training models, impediments to implementation of formal training in teamwork and communication skills, long-term studies of the sustained impact of such training on provider outcomes, efficacy of formal training in teamwork and communication skills in improving patient outcomes, and set up an anonymous national multidisciplinary event-reporting system to obtain data about events.

Toy Recall

Details: Light-up toy frogs and ducks sold exclusively at Cost Plus World Market between July 2012 and December 2012. The frog comes in green and the ducks come in yellow, pink, and clear. There is a round tag attached to the product with the UPC number 2424 5159.

Why: The metal conductor pin on the bottom of the toys can come out, posing a choking hazard.

How many: About 30,000.

For more: Call Toysmith at (800) 356-0474 or visit www.toysmith.com and click on Safety on the left side of the page for more information.

Minimizing errors at the pharmacy

Prescription errors happen more than you might think. Medical providers are constantly multi-tasking, which can easily cause a medical mistake in terms of your prescription.  

When you are prescribed any kind of medication, be sure to ask what it is; know the name of it and write it down. After that: 

·         Ask the reasons why you are being prescribed the medication, unless it is obvious what it is for.

·         Ask about any potential side effects.

·         Ask what dosage you are to take and how often.

·         Ask how long you are supposed to be on the medication for.

Also, be sure to let your medical provider know what other medications you are currently taking, including over-the-counter medicines. Many drugs can have adverse interactions if taken together.

If you get a written prescription, look it over and make sure it matches what your medical provider just told you.

When picking up your prescription from the pharmacy, read the label carefully and make sure the medication prescribed by your medical provider matches the medications in the prescription.

• The pharmacist should give you a print out of patient information about the drug that was prescribed to you. If not, ask for it.
• If you think there is any type of medication error, bring it up to the pharmacist immediately.
• Make sure your allergy information is correct in the pharmacy computer and make updates as needed.

Medical errors occur every day, but you can help prevent them.

Snyder and Wenner, P.C.

2200 E Camelback Road
Suite 213
Phoenix, AZ 85016

602-224-0005

Tired Surgeons

While there are no regulations on how many operations an orthopedic surgeon can perform per day, multiple studies have shown that a tired surgeon may put patients at risk.

According to an article published in the Poughkeepsie Journal, surgeons were interviewed in a 2011 Georgia Regents University study and said that fatigue has an effect on their emotions, cognitive capability, and fine-motor skills. Few of them reported that it has a large effect on patient safety. However, scientific studies have since stated that medical errors are much more likely to occur with a fatigued surgeon.

An article published in the New England Journal of Medicine in 2008 stated that a study showed the dangers of muscle fatigue, noting it increases how long the surgery takes, while a 2010 article declared there was an 83 percent increase in the risk of surgical complications for patients whose surgeons were not fully rested.

The Joint Commission has stated that fatigue increases the risk of medical errors, compromises patient safety, and increases risk to personal well-being. However, the commission or any other association does not provide guidance on the number of surgeries that can be performed by a physician in a given day.

Hot Summer Temperatures

With hot summer temperatures around the country, being outside can place the body under excessive stress.

According to an article published in The New York Times, one common response to the heat is fainting, also called heat syncope. Fainting usually happens when a person has been standing for a long period of time or when they suddenly stand up.

In hot weather, blood vessels expand because the body is trying to cool itself down. Gravity will take into effect and cause blood to drain downward into the legs and feet, depriving the brain of oxygen. This ultimately leads to dizziness, lightheadedness and fainting.

If you ever witness a person suffering from this, you can raise their legs to direct the blood flow to the brain. When the person regains consciousness, give them water or a sports drink, since dehydration can increase the risk for other heat-related maladies.

Skin Safety Tips

According to the American Cancer Society, skin cancer has become the most common form of cancer in the United States.

If you’re going to be in the sun, be sure to generously apply a broad-spectrum, water resistant sunscreen with an SPF of 15 or higher. Sunscreen should be applied to all exposed skin, even during winter or cloudy days. For prolonged outdoor activity, use a sunscreen with an SPF of 30 or higher. It should be reapplied roughly every two hours and right after swimming or sweating. 

Other sun-safe habits:

Wear protective clothing such as a long-sleeved shirt, pants, a wide-brimmed hat, and UV-protection sunglasses, where possible.

Seek shade when available, especially between 10 a.m. and 4 p.m., when the sun’s rays are strongest.

Use extra caution near water, sand, and snow, because they reflect and intensify the rays of the sun, which can increase your chances of sunburn and skin damage.

Avoid tanning booths and beds. Ultraviolet light from the sun and indoor tanning can cause skin cancer and wrinkling.

Perform regular self-skin examinations. If you notice anything changing, growing, or bleeding on your skin, see a dermatologist.

Alarm Management

The Joint Commission, which accredits and certifies more than 20,000 health care organizations and programs in the United States, has issued a National Patient Safety Goal on Alarm Management in hopes of improving the safety of clinical alarm systems. 

According to an article published on Market Watch, the goal will require hospital leaders to establish alarm safety and take specific actions to help avoid patient injuries and deaths related to the alarms. 

While clinical alarms are intended to alert patient caregivers if something is amiss, many alarms in hospitals and other health care facilities are not properly managed, which can compromise patient safety. According to the Joint Commission, the most common issue is alarm fatigue, which occurs when monitoring technologies produce false alarms. These false alarms can lead to delayed response in care and poor patient outcomes, such as injury or death. 

Phase I from the Joint Commission, which will begin in January 2014, will make hospitals identify the most important alarms to manage as well as establish alarms as an organization priority. 

Phase II will begin in 2016, where hospitals will be expected to develop and implement specific components of policies and procedures. Education about alarm system management will also be required.

Snyder and Wenner, P.C.
2200 E Camelback Road
Suite 213
Phoenix, AZ 85016
602-224-0005