patient safety quality healthcare

ISMP Releases New Safe Practice Guidelines for Adult IV Push Medications

While much emphasis has been placed on the improvement of IV infusion safety, standardized safe practices associated with IV push injection safety remain limited. The Institute for Safe Medication Practices (ISMP) recently released new guidelines to help healthcare practitioners identify risks associated with adult IV push medications.  

The guidelines were developed as part of a national summit held by ISMP in 2014 to address safety concerns reported through ISMP’s National Medication Errors Reporting Program and uncovered by several ISMP surveys, as well as unsafe practices and at-risk behaviors observed during onsite consultations at acute care and outpatient locations across the U.S.

Funded by a grant from BD, the summit brought together expert stakeholders, including frontline practitioners, professional organizations, regulatory agencies, and product vendors, to gain consensus on strategies for safe IV push administration of parenteral medications to adults. Participants also identified a number of unresolved issues that deserve additional study. A draft of the document was shared on ISMP’s website for public comment before being finalized.

The guidelines discuss the risks associated with IV push therapy, and present recommendations that address the following areas:

  • Acquisition and distribution
  • Aseptic technique
  • Clinician preparation
  • Labeling
  • Clinician administration
  • Drug information resources
  • Competency assessment
  • Error reporting
  • Future inquiry

The guidelines also call on manufacturers to provide IV products in the most ready-to-administer form possible and to design devices and technology that promote safe IV push drug administration. Researchers are asked to take on the unanswered questions expressed by participants, leading the healthcare community to a better understanding of what places patients at risk and the corresponding evidence-based risk-reduction strategies that have proven to be the most successful.

"A number of latent system issues have contributed to the variable state of IV push injection practices—they can differ significantly not only between healthcare organizations, but even within a single organization’s individual clinical units," says Michael Cohen, RPh, MS, ScD (hon.), DPS (hon.), FASHP, president of ISMP. "Through dedicated commitment to standardization, we can significantly improve patient outcomes and prevent errors."

“BD shares ISMP’s goal of reducing the risks associated with IV push medication errors,” said William A. Tozzi, worldwide president, BD Medical – Medication and Procedural Solutions. “One of BD’s top priorities is to provide solutions that help improve medication safety, and our grant to ISMP will help support development of standardized safe practices associated with IV push medication use.”

For a copy of ISMP's Safe Practice Guidelines for Adult IV Push Medications, visit the Institute’s website at: http://www.ismp.org/Tools/guidelines/ivsummitpush/ivpushmedguidelines.pdf

AHA Advisory Group Issues Report on Interoperability

In a report released in July, the American Hospital Association’s (AHA) Interoperability Advisory Group (IAG) calls on health systems and hospitals, developers and vendors of electronic devices and information systems, and government and regulatory agencies to work together to improve the interoperability of healthcare data.

In Achieving Interoperability that Supports Care Transformation, the group observes that the United States will gain full advantage of its recent investment in electronic health records (EHR) only when information can be shared easily and securely among all who need to use it. Acknowledging that initiatives such as meaningful use and EHR certification provide starting points, the report faults the Office of the National Coordinator (ONC) for not doing enough to support interoperability. EHR certification includes standards that support data sharing, but the IAG reports that organizations need more practical help for implementation and better oversight of vendor offerings before they will be able to achieve the goal of interoperability:

…ONC generally did not provide implementation guidance for the use of the standards, allowed flexibility in how the standards are used by vendors and adopted relatively lax testing of EHRs for certification. As
a result, AHA members report very limited actual interoperability today.

Members of the IAG include administrative and clinical leaders, as well as experts in information technology, and represent the range of AHA member organizations from large academic medical centers to standalone hospitals.

In addition to wanting ONC and the federal government in general to focus more effectively on standards, certification, and testing, the IAG’s report describes things the private sector must do to advance interoperability. The private sector includes providers, vendors, health information exchanges, and organizations that represent the interests of other stakeholders. Among the ways they can support interoperability, the IAG highlights demanding that vendors adhere to accepted standards, contributing use cases that accurately represent the need for sharing information, and sharing lessons learned and best practices.

In addition to a long to-do list for the private and public sectors, the IAG suggests that a new multi-stakeholder organization may be necessary to “drive progress on interoperability.” Citing the success of CAQH—a non-profit alliance that promotes standardized sharing of financial and business data for healthcare organizations— the IAG proposes that a similar group might help navigate the competing stakeholder interests and accelerate what so far has been slow progress on interoperability.

ABMRS Administers First Exam for MR Safety Certification

On Wednesday, June 24, 2015, the American Board of Magnetic Resonance Safety (ABMRS) administered the first examination to certify individuals with the credentials MR Medical Director/Physician (MRMD) and MR Safety Officer (MRSO). More than 100 radiologists, technologists, and medical physicists took the exam for either the MRMD or MRSO. Only licensed physicians may sit for the MRMD exam. The ABMRS will also offer an MR Safety Expert (MRSE) credential, for which the inaugural exam will be administered on October 21, 2015, in Orlando, Florida. Exams for the MRMD and MRSO credentials will also be offered at that time.

The MRMD and MRSO examinations cover distinct aspects of the same MR safety knowledge domains (e.g., static magnetic fields, gradient magnetic fields, radio frequency energies, contrast agents, bioeffects, etc.). The exams focus directly on the candidates’ knowledge of the underlying MR safety concepts as well as their ability to apply that knowledge to real-world clinical and research situations.

The ABMRS was formed in 2014 to certify healthcare professionals who oversee safety in all magnetic resonance environments. For more information visit the ABMRS website.

See also “New MR Safety Certification Focuses on Radiologists, Technologists, and Physicists.”

Brain and Spine Surgery No More Risky When Physicians-In-Training Participate, Study Finds

Having residents—physicians in training—participate in surgery does not in itself increase a patient’s risk of postoperative complications or of dying within 30 days of the surgery, according to a recent study of more than 16,000 brain and spine surgeries. A report on the study appears in the April issue of the Journal of Neurosurgery.

“Patients often ask whether a resident is going to be involved in their case, and they’re usually not looking to have more residents involved,” says Mohamad Bydon, MD, himself a resident in neurosurgery at The Johns Hopkins Hospital. “Some people have a fear of being treated in a hospital that trains doctors.”

To see whether that fear is borne out by real-world outcomes, Bydon worked with Judy Huang, MD, a professor of neurosurgery and director of the neurosurgery residency program at the Johns Hopkins University School of Medicine, and other collaborators to analyze data from the American College of Surgeons National Surgical Quality Improvement Program database. Specifically, they examined outcomes for all patients who had brain and spine surgeries between 2006 and 2012—16,098 in total.

The initial analysis appeared to affirm the fear, showing that patients operated on by a fully trained physician—known as an attending—plus a resident had a complication rate of 20.12 percent, while patients with only an attending had a complication rate of 11.7 percent. The patients operated on by attendings plus residents also had a slightly higher risk of death within 30 days after the surgery.

But, the research team suspected, that might not be a difference caused by the participation of the residents. Residents are most often found in teaching hospitals associated with academic medical centers, and such hospitals are also the most likely to treat higher risk, more complicated cases. So the team did a deeper analysis of the data, one that took into account patients’ conditions and severity of illness prior to surgery. That analysis showed that having a resident present in the surgery was not an independent risk factor for postsurgical complications or death.

The authors say the study’s results may help physicians reassure nervous patients about the prospect of having a trainee assist with a surgery.

Shulkin Confirmed as Under Secretary of Health for US Department of Veterans Affairs

The U.S. Senate has confirmed David J. Shulkin, MD, as the Under Secretary of Health for Veterans Affairs. As the chief executive of the Veterans Health Administration (VHA), Shulkin will lead the nation’s largest integrated healthcare system with more than 1,700 sites of care, serving 8.76 million veterans each year. VHA is also the nation’s largest provider of graduate medical education and a major contributor of medical research. Shulkin will oversee the 300,000 people who work at the VHA.

Shulkin was nominated by President Obama on March 19, 2015, to serve as under secretary and confirmed by the U.S. Senate on June 23, 2015. The vote to confirm Shulkin comes as Congress has shown concern over issues at the VA over the past year related to access and quality of care.

Shulkin, 55, of Pennsylvania, will replace interim Under Secretary Carolyn Clancy, MD, who took over shortly after Dr. Robert Petzel resigned in 2014.

At his Senate confirmation hearing, Shulkin pledged to improve the largest healthcare organization in the U.S. by using his private sector experience to help guide the VA beyond patient access problems that led to waiting lists and falsified records in Phoenix and elsewhere around the country. Dr. Shulkin told senators at his hearing on May 5, 2015, that “VA needs change” and that the time had come to create a “new VA” with “superior access and the highest standards for quality of care.”

Shulkin said that taking care of veterans is a personal mission. His father served as a captain in the Army and his grandfather was chief pharmacist at the Madison Wisconsin Veterans Medical Center. Both Shulkin and his wife, Dr. Merle Bari, worked in a number of VA facilities during their medical training.

Prior to becoming under secretary, Shulkin led a number of healthcare organizations. He most recently served as president of Morristown Medical Center and vice president of Atlantic Health System in Morristown, New Jersey, where he led the hospital during a period of significant growth and transformation. Prior to that, Shulkin was president and CEO of Beth Israel Medical Center in New York City. Shulkin has also served as the chief medical officer of the University of Pennsylvania Health System, Temple University Hospital, and the Medical College of Pennsylvania Hospital.

Shulkin’s expertise includes management in healthcare organizations and integrated delivery systems, medical education, health services research, and health technology. He has been an entrepreneur, author, researcher, and academic leader in the areas of health administration, quality, and patient safety. Dr. Shulkin founded DoctorQuality, Inc., one of the first companies in the country to help consumers choose better quality healthcare.

Shulkin, a general internist, is a graduate of Drexel University School of Medicine and did his medical training at Yale University and the University of Pittsburgh. Shulkin was a Robert Wood Johnson Foundation Clinical Scholar at the University of Pennsylvania. Most recently he has been Professor of Medicine at Mt. Sinai School of Medicine.

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ABQAURP American Society for Quality American Society for Quality Healthcare Division Consumers Advancing Patient Safety
EMPSF Institute for Safe Medical Practices
           
Medically Induced Trauma Support Services (MITSS) Medication Safety Officers Society NPSF Partnership for Patient Safety Society to Improve Diagnosis in Medicine