Must Reads, Patient Safety

8 Ways We Need to Reconsider How We Think About Patient Safety Articles PPAHS have been reading the week of April 16, 2018

Articles we have been reading this past week of April 16, 2018 ask us to reconsider how we think about patient safety.

#1 – COPD prevalence is nearly double in rural areas compared to metropolitan areas

The risk of COPD is nearly double in rural areas compared to that in urban areas, according to CDC’s Weekly Morbidity and Mortality Report.

RT Magazine reports in “More Evidence of COPD’s Grip on Rural America”:

“COPD prevalence is nearly double in rural areas compared to metropolitan areas. The report found age-adjusted prevalence of diagnosed COPD increased from 4.7% among populations living in large metropolitan centers to 8.2% among adults living in rural areas.”

#2 – Patient safety needs to be increased in surgery centers

In a previous post, PPAHS discussed a recent investigation by Kaiser News and USA Today, surgery centers may be putting profits ahead of patient safety.

The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) recently responded to this investigation. Dr. Gary Brownstein, AAAASF President-elect writes in “AAAASF responds to story on surgery center safety:”

“AAAASF places patient safety at the core of its mission. AAAASF’s overriding focus is to mitigate untoward events through preparedness. AAAASF accomplishes this goal by requiring 100 percent compliance with all standards.”

However, there are differences between what the standards specified by the American Society of Anesthesiologists and AAAASF. Please read this article comparing some of the key points – http://bit.ly/2FA5e3l

#3 – Two in five private hospitals need to improve safety

In the article, “Two in five private hospitals need to improve safety,” results of the Care Quality Commission inspection and rating of 206 private hospitals is discussed:

“While overall, 70% were rated as good or excellent, safety was where CQC had the greatest concerns, rating 41% as requires improvement and 1% as inadequate. In terms of leadership, 30% of hospitals were rated as requires improvement and 3% as inadequate.

“Professor Ted Baker, chief inspector of Hospitals at the CQC said: ‘Too often, safety was viewed as the responsibility of individual clinicians, rather than a corporate responsibility supported by formal governance processes.’”

#4 – Opioids Useful in Some Patients For Managing Chronic Pain

Although the nation is in the midst of an opioid epidemic and a sentiment that opioid prescribing should be reduced, pain experts remind us that there are some patients that require opioids:

“There are more than 10 million Americans on opioids for chronic pain,” said Kurt Kroenke, MD, professor of medicine at Indiana University School of Medicine, in Indianapolis. “We all agree there is a national problem with prescription opioid use, including thousands of overdose deaths each year. However, most of the patients on chronic opioids do not misuse their medications, yet many are being pressured to discontinue their opioids, despite having taken them appropriately for years.”

#5 – We Need to Improve the Care of Babies Born with Drug Withdrawal

In the article, “As more babies are born with drug withdrawals, doctors are frantically working to improve their care,” The Journal-News writes:

“After a woman gives birth to a baby, the average stay in the hospital following a traditional delivery is 36 hours, or 60 hours after a Cesarean section.

“But the average stay for a baby born with neonatal abstinence syndrome, known as NAS or drug withdrawal, has ranged from 14 to nearly 18 days from 2011 to 2015 in Ohio. And it is costly, as total charges for NAS-reported births have nearly doubled from 2011 ($70.1 million) to 2015 ($133.1 million), according to the Ohio Department of Health.”

#6 – Medicare Announces New Guidelines on High-Dose Opioids

The Centers for Medicare & Medicaid Services (CMS) recently announced new guidelines on prescribing opioids:

“Prescriptions will be held to a standard of 90 morphine equivalent milligrams (MME) per day, which follows the CDC prescribing guidelines for primary care physicians released last year.

“The Medicare announcement—part of the 2019 Medicare Advantage and Part D Rate Announcement and Call Letter—also sets limits for opioid-naive patients on seven-day prescriptions, and notes the expansion and combination of the Overutilization Monitoring System and other government facets to identify “high-risk” opioid users, defined as using high levels of opioids from multiple sources, and “potentiator” users, who are using other medications (e.g., benzodiazepines) that increase the risk for adverse effects from opioids. CMS also plans to increase education on overdose risk and prevention.”

#7 – Patients should be assessed for risk of blood clots before discharge

The preventable death of a 42-year-old man reminds us of the need to assess patients for the risk of blood clots before discharge. The BBC News reported recently in “Simon Willans’s Anglesey blood clot death ‘preventable’”:

“The death of a 42-year-old man the day after a hospital discharged him after failing to diagnose blood clots was preventable, according to a coroner.”

#8 – Dentists have a special responsibility when it comes to opioids

The American Dental Association is urging dentists to be more responsible when prescribing opioids, particularly to young patients:

“‘3.5 million kids have their wisdom teeth taken out each year, and 85 percent are receiving opioids,” said Dr. Paul Moore, ADA spokesman and professor of pharmacology, dental anesthesiology and dental public health with the School of Dental Medicine at the University of Pittsburgh. “Those kids are very likely being exposed to opioids for the very first time.’”

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