Patient Safety Blog

Critical thinking, communication and honest working relationships between doctors and nurses leads to better patient care. This sounds like common sense, but it is also the result of an analysis done by Dr. Barbara Loeb and RNs Mary Sue Dailey and Cheryl Peterman.

In brief, the three main areas that need improvement and hold potential for better patient care are:

1) Critical thinking--focusing on solving problems rather than blaming, analyzing root causes, looking at issues in different lights

2) Communication--doctors and nurses being open with each other about their concerns and sharing vital information, rather than assuming that important information is already known to everybody

3) Collaboration and collegiality--mutual respect and positive interactions between doctors, nurses and other healthcare providers.

As we have discussed before, communication and teamwork are an essential aspect of good medical care.

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Posted In: Communication

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A thirty-year analysis shows that anemia drugs produced by Amgen Inc. and Johnson & Johnson raise the risk of leukemia incidence.

The following drugs are implicated in this study: Aranesp and Epogen (by Amgen Inc.), and Procrit (by Johnson & Johnson).

In addition, the steroid danazol was linked to higher risk of leukemia.

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Posted In: Medications

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What happens when a hospital makes a mistake in medical care, and the harm to the patient results in the need for another medical treatment? It used to be that the patient was charged for this subsequent treatment, which would have been unnecessary but for the hospital's error. An article in the Journal of the American Medical Association (JAMA), cited in the New York Times discusses the economics of this system. Indeed, the system is set up so hospitals are financially rewarded for their mistakes.

But as the NY Times article points out, Medicare has changed its rules so that it will no longer compensate hospitals for the following mistakes: objects left in patients during surgery, incompatible blood transfusions, infections from vascular catheters and other hospital-acquired problems. This does bring up the potential problem of hospitals not having financial incentive to provide good care for these medical problems, but there are laws in place mandating that hospitals provide such care, so that may not be as much of a problem as some would fear.

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Posted In: Standard of Care--Hospitals

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Shockingly, nursing homes having been giving elderly residents anti-psychotic drugs--not to combat actual psychosis, but rather to quiet symptoms of Alzheimer's or other forms of dementia and make the patients more docile and controllable.

This overuse of anti-psychotics is so rampant that it accounts for why Medicaid has recently spent more money on anti-psychotics than on any other type of pharmaceuticals.

This is not wholly due to malicious intent on the part of the nursing homes, but also on the fact that federal insurance programs are more willing to give money for drugs rather than for the extra staff that are needed to care for elderly patients with dementia.

This report highlights how medical institutions can harm the most vulnerable patients by giving them medications they do not require in order to meet economic or administrative goals.

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Posted In: Medications , Standard of Care--Hospitals

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Acute sinusitis is often treated with antibiotics, and possibly also a topical steroid.

However, a recent study found this common treatment to be no more effective than a placebo.

Commenters on the study have noted that there may be some patients for whom antibiotics might help, but there is no reliable way for a clinician to tell those patients from the others.

It is possible that this result is due to the greater level of resistance to antibiotics that has resulted from increased use of antibiotics over the last few years.

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Posted In: Medications

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An article in the New Yorker by Atul Gawande highlights the simple ways in which hospitals can be made less dangerous places for their patients. A checklist to make sure intensive care doctors and nurses handle catheters correctly has been proven to dramatically reduce the risk of deadly infections. Gawande focuses on the work of Peter Pronovost, MD, an intensive care specialist at Johns Hopkins Hospital who consults with hospitals around the country to spread his gospel of routinizing simple procedures. For example, on catheter infections, Pronovost's work was first published in December 2006 in the New England Journal of Medicine. In 108 ICU's across Michigan, they were able to virtually wipe out catheter-based infection by enforcing a required checklist of five interventions: hand-washing before handling a catheter, full-body draping when inserting a central venous catheter, scrubbing the skin with chlorhexidine, avoiding catheters in the groin, and removing unneeded catheters as soon as possible. All hospitals should implement these simple ideas which can prevent deadly infections and save lives. Dr. Pronovost is a pioneer in patient safety research.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Communication , Infections , Standard of Care--Hospitals

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A new study shows that although an overwhelming majority of doctors believe they should report colleagues who make serious medical errors or otherwise violate professional standards, most do not actually do so.

This hesitance to report colleagues is understandable. But it makes detecting, tracking and studying medical error very difficult.

The senior author of the study, Dr. David Blumenthal, says that he is optimistic because most doctors support existing standards and the lack of report is not due to disagreement over ethical obligations. He also notes that doctors who practice in groups of three or more are more likely to report than other doctors.

Another interesting result of the study is that one-third of doctors admit that they would order an unnecessary MRI. Given the costs and the possible side-effects of unnecessary testing, this fact may have consequences.

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Posted In: Medical Error

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Hospitals have been getting some negative attention recently as a result of their high rates of infection. That is why it is good to hear that they are stepping up efforts to fight MRSA, one of the worst "superbugs" that infect patients in hospitals.

Their efforts can be boiled down to two categories: testing and hygiene. They are trying to make it a common practice to test surfaces and equipment and patients for the presence of these bugs. They are also encouraging hygiene by placing alcohol sanitizer dispensers in hallways and outside patient rooms, and by placing secret observers to watch if their doctors and nurses are washing their hands as often as they are supposed to.

Patients cannot do very much to ascertain whether or not their hospital is testing for MRSA, but hygiene is often much more obvious. A careful patient or family member should watch and see if there are sanitizer dispensers in their hospital's hallways, and if the healthcare providers are taking advantage of these dispensers. You should not hesitate to ask if the doctor or nurse has washed their hands, or to complain if you know that they have not. Such basic measures can prevent deadly infections.

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Posted In: Standard of Care--Hospitals

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