Author Archive
ASPPS at One Year
On Jan 09, 2012 | Comments
Who is responsible for patient safety in your organization? The obvious answer may be the chief patient safety officer or the director of quality and safety. But that’s only partly right.
Patient safety has grown to become a distinct discipline involving practitioners from diverse areas of the health care spectrum who work under engaged and involved leaders. It involves representatives of nursing, medicine, environmental services, pharmacy, and other areas, none more important than the leadership team. Last January, the National Patient Safety Foundation established the American Society of Professionals in Patient Safety (ASPPS) as a multidisciplinary community of individuals committed to advancing patient safety best practices. Read More→
Report Finds Most Errors at Hospitals Go Unreported
On Jan 06, 2012 | CommentsThe New York Times, January 6, 2012.
WASHINGTON — Hospital employees recognize and report only one out of seven errors, accidents and other events that harm Medicare patients while they are hospitalized, federal investigators say in a new report.
Yet even after hospitals investigate preventable injuries and infections that have been reported, they rarely change their practices to prevent repetition of the “adverse events,” according to the study, from Daniel R. Levinson, inspector general of the Department of Health and Human Services.
Focus on Patient Safety: Volume 14, Issue 3
On Dec 23, 2011 | Comments...
Current Awareness Literature Alert: December #1, 2011
On Dec 09, 2011 | CommentsDecember (1) 2011 | Volume 15, Issue 12:1
Safer Transitions
On Dec 01, 2011 | CommentsResearch Study to Focus on Handoffs of Care in the ICU
“Handoff” is not the friendliest word, yet in healthcare, it has come to define the delicate transfer of information when a patient is discharged from one care setting to another, or when staff members change shifts. Much has been written about the safety gaps that can occur during these transitions, but this topic is still ripe for research—as Emily Patterson, PhD, well knows.
Current Awareness Literature Alert: November #2, 2011
On Nov 28, 2011 | CommentsNovember (2) 2011 | Volume 15, Issue 11:2
Medical tests are pointless when results don’t reach the doctor or patient
On Nov 28, 2011 | CommentsThe Washington Post, November 28, 2011
“Health reform and payment reform are moving us toward integrating care to a degree that we don’t do right now,” says Diane Pinakiewicz, president of the National Patient Safety Foundation , a Boston-based consumer group. More…
Promoting Patient Safety: What Family Caregivers Can Do
On Nov 15, 2011 | CommentsBy Diane C. Pinakiewicz, MBA, President, National Patient Safety Foundation
November was National Family Caregiver Month. This article is an excerpt from a recent issue of Take Care!, the newsletter of the National Family Caregivers Association. Read the full article online.
If you are caring for a family member or loved one, it’s important for to think of yourself as his or her advocate. Being engaged and asking questions are probably the most important things you can do to keep your loved one and yourself safe from medical errors.
In the Hospital
Earlier this year, the U.S. Department of Health and Human Services, in conjunction with the federal Centers for Medicare and Medicaid Services, launched the Partnership for Patients: Better Care, Lower Costs, with the goal of making hospital care “safer, more reliable and less costly.” Although this initiative seeks to reduce all causes of harm, the primary areas of focus include medication errors, hospital-acquired infections, surgical-site infections, pressure ulcers, falls, and obstetrical adverse events.
When the person you are caring for is hospitalized, here are some things you can do:
- Talk to your loved one about his or her wishes regarding communication with the clinical team. If he or she wants you to know everything that’s going on, be sure the doctors and nurses know that, so that you can be fully involved in the treatment plan.
- Make sure that hospital staff check your loved one’s identification before any treatment, tests, or procedures.
- Learn about hospital-acquired conditions and whether your loved one is at risk. Ask what protocols are followed to avoid these conditions.
- If your loved one is at risk of a fall, ask how that risk is communicated to different members of the team and what methods the hospital employs to minimize the risk.
- Find out if the hospital has a medical emergency team (MET) or a rapid response team, and when it is appropriate to seek their help. These teams respond when a patient’s condition appears to be deteriorating. Many hospitals empower families and patients to activate such teams if a medical condition is worsening.
- Never turn off an alarm on medical equipment in the assumption that “someone will be coming.” Let the medical team respond, and alert them if they do not respond quickly.
- Don’t be shy. Now is not the time to keep silent if you think something is not right — or even if you are simply confused. Speak up about safety practices, such as hand washing, if you don’t see them happening.
- Recognize that common safety practices apply to you, too. Wash your hands (or use alcohol-based hand sanitizer) before entering your loved one’s room. If you have a cough or cold, stay home so as not to spread it to others.
- Before your loved one is discharged from the hospital, be sure you understand what the next steps are for follow-up care.
At the Doctor’s Office or Pharmacy
Although the vast majority of healthcare is provided in outpatient settings, most of the research about patient safety has been done in hospitals. Some in the patient safety field consider outpatient care the “next frontier” in this work.
Here are some things to watch out for when visiting the doctor’s office or the pharmacy with your loved one:
- Help your loved one prepare in advance for a doctor’s appointment by updating his or her list of medications and writing down any questions.
- Make sure each medical or pharmacy staff member taking care of your loved one verifies his or her identification.
- Know what medications the doctor has prescribed, what they are for, and how they should be taken. Understand the treatment plan and what the patient needs to do.
- If lab tests or radiologic studies are ordered, be sure they are completed. Follow up to get the results. Don’t assume “no news is good news.”
- Make sure the members of your loved one’s clinical team know you and how to reach you.
- As with hospital care, don’t be shy about speaking up if you think something is not right. All the basic safety practices, such as hand washing, apply just as much in the outpatient setting as in the inpatient setting.
Excerpted from “Patient Safety: How to Protect Your Loved One From Medical Errors.” Reprinted from Take Care! (Summer 2011, Vol. 20. No. 2) by permission of the National Family Caregivers Association, Kensington, MD, the nation’s leading organization for all family caregivers, 1-800-896-3650, or http://www.thefamilycaregiver.org/.
Current Awareness Literature Alert: November #1, 2011
On Nov 11, 2011 | Comments...





