Safety advocates: Certain patient safety practices should be mandatory
Hand hygiene compliance and influenza vaccination are two patient safety practices that should be considered mandatory, according to experts at the National Patient Safety Foundation's (NPSF) Lucian Leape Institute.
Robert M. Wachter, MD, professor and interim chairman of the department of medicine, chief of the division of hospital medicine at the University of California, San Francisco (UCSF), and a member of the Lucian Leape Institute, outlines the "must do" list in a Health Affairs blog post. He argues that both hand hygiene and influenza vaccinations have been associated with "major reductions in harm," therefore hospitals should expect 100% compliance from clinicians. NPSF considered including surgical checklists as well, but opted against their inclusion based on studies that showed universal adherence can be challenging and it does not translate to uniformly improved outcomes.
"While 'no blame' remains the correct reaction to most mistakes, it is not the appropriate response when clinicians are disruptive, incompetent, or willfully choose to ignore evidence-based safety rules," Wachter writes.
Wachter also outlines a set of five criteria that would place additional practices on the "must do" list, including identifying practices that have been proven to be both effective and feasible. Healthcare organizations should identify certain practices that meet these criteria and then hold clinicians accountable for full compliance.
To read the full Health Affairs article, visit: http://healthaffairs.org/blog/2015/08/20/the-must-do-list-certain-patient-safety-rules-should-not-be-elective.
CDC releases recommendations for antibiotic stewardship in nursing homes
A new guideline released by the CDC targets improved antibiotic prescribing within nursing homes, expanding on updated recommendations released last year for acute care hospitals.
The "Core Elements of Antibiotic Stewardship for Nursing Homes" underscores seven elements of stewardship in postacute care facilities, including leadership commitment, drug expertise, tracking reporting, and education. According to the CDC, as much as 70% of residents receive one or more courses of antibiotics over the course of a year, and 75% of those antibiotics are prescribed incorrectly.
The guidelines were released on the heels of a CMS proposed rule requiring long-term care facilities to implement stewardship programs and prescribing protocols.
To view the full guidelines, visit: www.cdc.gov/longtermcare/prevention/antibiotic-stewardship.html.
Pennsylvania shows delirium can lead to harm
More than 400 patients in Pennsylvania hospitals experienced delirium over the last 10 years, leading to 64 instances of patient harm, according to a new report released by the Pennsylvania Patient Safety Authority (PPSA).
Furthermore, instances of delirium saw a dramatic increase from two-and-a-half events per quarter in 2005 to 16 events per quarter in 2014. Researchers added that the actual number of events could be much higher since diagnostic challenges still exist in many hospitals. Delirium can contribute to increased morbidity, mortality, and length of stay, although delirium goes undetected in approximately 33% to 50% of cases.
Elderly male patients with a preexisting cognitive impairment, depression, and severe illness were at a higher risk for delirium. PPSA also released evidence-based guidelines to identify and prevent delirium in the hospital environment, as well as a graphic identifying the top risk factors associated with delirium.
To see the PPSA report, visit: http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2015/Sep;12(3)/Pages/85.aspx.