Improving the use of intravenous antihypertensive medications in the hospital setting: a quality improvement initiative for patient safety
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Intravenous (IV) hydralazine, enalapril and labetalol are oftentimes used without indication for the treatment of asymptomatic hypertension in the hospital setting and have been shown to have substantial adverse effects that are associated with increased morbidity and mortality, as well as longer length of stay. Their use is also associated with greater monetary costs. In this project, we studied the frequency of use and consequences of these medications before and after a series of education cycles which clarified when and when not to use intravenous antihypertensives (IVAHs). Our initial aim was to decrease the unindicated use of IVAH by at least 25% in the setting of asymptomatic hypertension in our community hospital within a 1-year period after introducing education on the topic. Multidisciplinary involvement throughout three Plan-Do-Study-Act (PDSA) cycles yielded favourable results. We focused on education towards a hospital-wide knowledge gap stemming from a lack of guidelines regarding the treatment of asymptomatic hypertension, as well as the guideline indications for IVAH. After three cycles of education targeting different groups, the unindicated use of IVAH fell by a total of 66%, decreasing patient exposure by approximately 248 cases over the total course of the study and ultimately, yielding a 52% increase in patient safety. Secondary outcome included a reduction in cost. It was noted that IV drugs cost more than their oral counterparts. The culture change in switching away from IVAH unless otherwise indicated was driven by repetitive education and group discussion to close the gap created by a lack of guidelines.Keywords:
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Abstract Background Adverse drug events encompass a wide range of potential unintended and harmful events, from adverse drug reactions to medication errors, many of which in retrospect, are considered preventable. However, the primary challenge towards reducing their burden lies in consistently identifying and monitoring these occurrences, a challenge faced across the spectrum of healthcare, including the emergency medical services. The aim of this study was to identify and describe medication related adverse events (AEs) in the out-of-hospital setting. Methods The medication components of a dedicated patient safety register were analysed and described for the period Jan 2017 – Sept 2020. Univariate descriptive analysis was used to summarize and report on basic case and patient demographics, intervention related AEs, medication related AEs, and AE severity. Multivariable logistic regression was used to assess the odds of AE severity, by AE type. Findings A total of 3475 patient records were assessed where 161 individual medication AEs were found in 150 (4.32%), 12 of which were categorised as harmful. Failure to provide a required medication was found to be the most common error (1.67%), followed by the administration of medications outside of prescribed practice guidelines (1.18%). There was evidence to suggest a 63% increase in crude odds of any AE severity [OR 1.63 (95% CI: 1.03 – 2.6), p = 0.035] with the medication only AEs when compared to the intervention only AEs. Conclusion Prehospital medication related adverse events remain a significant threat to patient safety in this setting and warrant greater widespread attention and future identification of strategies aimed at their reduction.
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Objective Nationwide initiatives have focused on improving patient safety through greater use of health information technology. We examined the association of hospitals’ electronic health record (EHR) adoption and occurrence rates of adverse events among exposed patients. Methods We conducted a retrospective analysis of patient discharges using data from the 2012 and 2013 Medicare Patient Safety Monitoring System. The sample included patients age 18 and older that were hospitalized for one of 3 conditions: acute cardiovascular disease, pneumonia, or conditions requiring surgery. The main outcome measures were in-hospital adverse events, including hospital-acquired infections, adverse drug events (based on selected medications), general events, and postprocedural events. Adverse event rates and patient exposure to a fully electronic EHR were determined through chart abstraction. Results Among the 45,235 patients who were at risk for 347,281 adverse events in the study sample, the occurrence rate of adverse events was 2.3%, and 13.0% of patients were exposed to a fully electronic EHR. In multivariate modeling adjusted for patient and hospital characteristics, patient exposure to a fully electronic EHR was associated with 17% to 30% lower odds of any adverse event for cardiovascular (odds ratio [OR], 0.80; 95% confidence interval [CI], 0.72–0.90), pneumonia (OR, 0.70; CI, 0.62–0.80), and surgery (OR, 0.83; CI, 0.72–0.96) patients. The associations of EHR adoption and adverse events varied by event type and by medical condition. Conclusions Cardiovascular, pneumonia, and surgery patients exposed to a fully electronic EHR were less likely to experience in-hospital adverse events.
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Patient safety addresses the risks involved in health care, simplifying or eliminating adverse events, these are defined as incidents that occur during the provision of health care and that result in harm to the patient. Health care is increasingly complex and can increase the potential for incidents, errors or failures to occur. Hemodialysis is a technically complex procedure, with many potential sources of error and which can cause harm to patients. Dialysis is a therapy that in recent years has benefited many patients, but it is a care process that involves important dangers and risks. Hemodialysis is a hospital sector with a great risk potential for the occurrence of adverse events, this occurs for several reasons such as complex procedures, the use of high technology, the characteristic of chronic kidney disease, the high use of medications. Strategies need to be taken to reduce the occurrence of adverse events, thus ensuring the quality of dialysis, consequently the quality of life of patients with chronic kidney disease undergoing dialysis treatment.
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Although there is extensive evidence of racial disparities in processes and outcomes of medical care, there has been limited investigation of disparities in patient safety.
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Background. Patient safety 'best practices' that call for patient participation to prevent adverse drug events have not been rigorously evaluated.
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Abstract Introduction Medical Emergency Teams (METs), also known as Rapid Response Teams, are recommended as a patient safety measure. A potential benefit of implementing an MET is the capacity to systematically assess preventable adverse events, which are defined as poor outcomes caused by errors or system design flaws. We describe how we used MET calls to systematically identify preventable adverse events in an academic tertiary care hospital, and describe our surveillance results. Methods For four weeks we collected standard information on consecutive MET calls. Within a week of the MET call, a multi-disciplinary team reviewed the information and rated the cause of the outcome using a previously developed rating scale. We classified the type and severity of the preventable adverse event. Results We captured information on all 65 MET calls occurring during the study period. Of these, 16 (24%, 95% confidence interval [CI] 16%–36%) were felt to be preventable adverse events. The most common cause of the preventable adverse events was error in providing appropriate therapy despite an accurate diagnosis. One service accounted for a disproportionate number of preventable adverse events (n = 5, [31%, 95% CI 14%–56%]). Conclusions Our method of reviewing MET calls was easy to implement and yielded important results. Hospitals maintaining an MET can use our method as a preventable adverse event detection system at little additional cost.
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Adverse events are common occurrences in hospitals that detract from quality of care. There are few data on errors in otolaryngology (ENT) and even fewer data comparing ENT to other services.We retrospectively reviewed adverse event data collected across a regional hospital network from July 2014 to August 2017. We examined categories of adverse events that occurred most commonly in ENT and compared the number of adverse events reported in ENT to those reported across all other departments. Descriptive analysis and the paired t test were used to analyze the data.Two hundred ninety-one adverse events were reported in ENT departments during the period studied compared to 58,219 events reported across all other specialties. In ENT, the most commonly reported adverse events occurred in the perioperative setting, followed by issues regarding equipment and medical devices and, lastly, airway management. Across all other departments, the most common categories included medication and fluid errors, falls, and safety and security events. ENT departments had significantly higher proportions of perioperative and airway management errors and significantly lower proportions of events related to diagnosis and treatment (P = .004), falls (P < .001), lab results and specimens (P = .001), medication and fluids (P < .001), and safety and security (P < .001).Perioperative and airway management errors occur with a statistically higher frequency in ENT compared to other in-patient and out-patient departments across hospitals. It is important to analyze adverse event reporting in surgical specialties to ensure the development of appropriate quality initiatives.4 Laryngoscope, 131:509-512, 2021.
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Abstract Background If multiple medical specialties are involved in treatment there is a danger of increasing risks to patient safety. This is due to the need for greater co-ordination and communication with other specialties, less emergency cover for individual sub-specialties, and a drop in general care and the overview of care. This study aims to determine if the number of medical specialties treating a patient is associated with the risk of experiencing harm during hospital admission. Methods We performed a retrospective patient record review study using a stratified sample of 20 hospitals in the Netherlands. In each hospital 200 patient admissions were included. We related the occurrence of preventable adverse events and non-preventable adverse events to the number of specialties treating a patient through a stepwise multilevel logistic regression analysis. Results Compared to patients treated by only one specialty, patients treated by three or more specialties had an odds ratio of experiencing an adverse event of 3.01 (95% CI 2.09 to 4.34), and an odds ratio of experiencing a preventable adverse event of 2.78 (95% CI 1.77 to 4.37). After adding characteristics related to the patient and the type of health care, the odds ratio for non-preventable adverse events decreased to 1.46 (95% CI 0.95 to 2.26), and for preventable adverse events to 2.31 (95% CI 1.40 to 3.81). There were no large differences found between the groups relating to the causes of preventable adverse events. However, in patients treated by three or more specialties, the greater number of preventable adverse events was related to the diagnostic process. Conclusions The more specialties treating a patient the greater the risk of an adverse event. This finding became more pronounced for preventable adverse events than for non-preventable adverse events after corrections for the characteristics of the patient and their health care. This study highlights the importance of taking the number of specialties treating a patient into account. More research is needed to gain insight into the underlying causes of inadequate care when multiple specialties are required to treat a patient. This could result in appropriate solutions resulting in improvements to care.
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Background: Hospital incidence reporting system has limitation on sensitivity and underreport in detecting the adverse events thus under report them. Trigger tool may provide a more simplified review process for detecting adverse events in a developing country setting. Objectives: To evaluate the effectiveness of the trigger tool on identifying adverse events in Thai hospitalized patients, and to classify the events by the patient safety goals. Materials and methods: A cross-sectional medical record review was conducted to identify adverse events in hospitalized patients at King Chulalongkorn Memorial Hospital during January 2 2008, using the Global Trigger Tool (GTT) by Institute for Healthcare Improvement. Adverse events, severity rating, and preventability were determined by reviewer teams. Types of adverse events were described according to the Patient Safety Goals of Thailand. Results: Five hundred seventy six medical records were reviewed. The total patient-days were 4,460 days. Two hundred thirty six adverse events were detected with a mean rate of 41.0 events per 100 patients or 50.4 events per 1,000 patient-days. One hundred twenty five events (53%) were temporary harm, while 122 (51.7%) were preventable. Regarding the category of adverse event, 75 (31.8%) were related to patient care process, 48 (20.3%) were in safe surgery and 42 (17.8%) were in medication and blood safety. Conclusion: Adverse events using the GTT detected more events than previous reports. Most events had low severity and were preventable. Most events were related to prevention of complications, safe surgery, and medication safety. Assessment of validity is needed before using GTT in medical service.
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