Must Reads, Patient Safety

Ideas to Improve Patient Safety Articles PPAHS have been reading the week of July 9, 2018

Articles the Physician-Patient Alliance for Health & Safety (PPAHS) have been reading the week of July 16, 2018 suggest ideas to improve patient safety.

Ideas to Improve Patient Safety – Requiring Patients to Comply to Conduct Rules to Fight the Opioid Epidemic

The University of Tennessee Medical Center (UTMC) is now requiring patients admitted for medical treatments of drug-use-related infections to comply with new conduct rules. Dr. Jerry Epps, UTMC’s senior vice president and chief medical officer, explains:

“This is done first and foremost for patient safety. When patients are bringing in needles and drugs, and their friends are coming in with drugs, and they can shoot up in the bathroom and maybe kill themselves, I argue we’re doing our best to protect patients and team members from this dreadful problem.”

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Ideas to Improve Patient Safety – Encourage COPD Patients to Regularly Exercise

Researchers at the University of Lincoln and the University of Oxford have found:

“Pulmonary rehabilitation — a patient-tailored approach combining exercise, education, and behavioral changes — can improve physical capacity, reduce shortness of breath, and enhance the quality of life of COPD patients.”

Arwel Jones, PhD, research fellow at the Lincoln Institute for Health in the U.K., who is the senior author of the study, discusses the difficulty that such a recommendation may be for COPD patients:

“Being physically active is extremely important for people with COPD, however, people with the disease find it difficult to remain physically active once they have finished pulmonary rehabilitation.”

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Ideas to Improve Patient Safety – Utilize Capnography to Monitoring Patients Under Conscious Sedation

Referring to the clinical education podcast, “Capnography Monitoring During Conscious Sedation: A Must for Maintaining “Eyes and Ears,” Melicent Lavers-Sailly writes about the value of monitoring with capnography:

“Capnography, the measurement of carbon dioxide (CO2) in respiratory gases, has long been used to monitor the breathing of patients under anesthesia in the operating room. Now there is a growing recognition of its value as a reliable tool for monitoring patients under conscious sedation in ambulatory settings outside the OR.”

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Ideas to Improve Patient Safety – Use Data to Help Make Better Healthcare Decisions & Treatment Choices

In the article, “The benefits of leveraging data and analytics in EMS,” Dr. Brent Myers makes the case for using date to help make better healthcare decisions and treatment choices. Rather than make decisions “either guessing or using their gut,” Dr. Myers encourages “leveraging data to make smarter decisions.”

He provides two examples where data has helped make smarter decisions:

“For example, stroke assessment and care have changed since the beginning of 2018, dramatically. This can’t be emphasized enough as the entire industry is still processing this information. Two recent studies – the DAWN Trial and the DEFUSE-3 Study – highlight findings that provide new guidelines for stroke patient assessment and transport. Specifically, these studies indicate the benefit of extending the treatment window to 16 or even 24 hours after the onset of symptoms for a subset of patients with large vessel occlusion acute ischemic stroke (LVO-AIS).

“While the nearest hospital may have been an appropriate destination in the past, the new research indicates transport to the nearest thrombectomy-capable or comprehensive stroke center may be preferred for those with evidence of LVO-AIS, even when it is not the nearest facility.”

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Ideas to Improve Patient Safety – Reducing Psychological Distress May Decrease the Risk of COPD and Other Diseases

A research team led by Catharine Gale, PhD, a professor at the University of Edinburgh and at MRC Lifecourse Epidemiology Unit, University of Southampton, reviewed the clinical records of 16,485 individuals over a three-year period and found that psychological distress may increase the risk of COPD and other diseases:

“The study showed that, compared with people who had no symptoms of psychological distress, those with low levels of distress had a 57% increased chance of having arthritis and those with moderate distress levels had a 72% increased chance. A similar pattern was reported regarding cardiovascular diseases, with low distress levels increasing the risk by 46% and moderate levels by 77%.”

Reducing Psychological Distress May Decrease the Risk of COPD and Other Diseases Click To Tweet
Must Reads

3 Ways We May Need to Change Our Perception of Opioids and Other Sedatives Articles PPAHS have been reading the week of July 9, 2018

Articles the Physician-Patient Alliance for Health & Safety (PPAHS) have been reading the week of July 9, 2018 ask us to consider 3 ways we need to change our perception of opioids, pain medications, and other sedatives

There is No Absolute Safety When Using an Opioid

In an interview with Christopher G. Gharibo, MD, a pain specialist and the director of pain medicine at NYU Langone Health, Dr. Gharibo discusses the use of opioids and pain medications. He cautions, “what we need to keep in mind is that there is no absolute safety in many of the medicines that we prescribe, whether it is an opioid or a nonopioid.”

To improve the safety when using opioids, he suggests a number of measures, including these two:

  • Individualize Treatment – “This is a category—that is clearly effective—that needs to be individualized to the patient, and that needs to be kept in check in terms of the dosing that’s provided to the patient, the pill counts, and the combination therapy that’s provided.”
  • Be Prepared for An Adverse Event – “What can also be available when opioids are prescribed—especially in the chronic setting—is a take-home naloxone. Now this comes in a variety of different forms. Whatever the form is, it needs to be easy to administer, and it needs to be reliably administered to reverse the effects of the opioid. Now that’s not so simple. I think it also concomitantly requires education of the patient as well as the caretaker for the patient. … This is something that is relatively low-cost and can make a huge difference in the ultimate outcome.”

To read the complete interview with  Dr. Gharibo, please go to Pain Medicine News.

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Opioids Aren’t necessarily the Culprit

Much has been discussed about the role of opioids in deaths. However, a recent study found that 82.5% of opioid-related overdose deaths in 2016 involved either fentanyl or heroin.

This is not to suggest that caution should not be used when prescribing or using opioids, but merely to point out that it is often opioid use in combination with other substances that is deadly.

#Opioids Aren’t necessarily the Culprit Click To Tweet

Under General Anesthesia May Not Mean “Out Cold”

Being under general anesthesia is often thought to be when the patient is “out cold.” However, recent research suggests that brain activity and responses to stimuli may persist. Harry Scheinin, MD, PhD, one of the project leaders, commented on the results:

“I don’t think it’s bad that brains are working more than we had previously thought and that anesthesia would resemble sleep more than we had previously thought. But there still is this problem of unintended awareness, so we need better ways to measure really objectively the level of sleep, especially when we are using these muscle relaxants because we are then putting the patients into a situation where they can’t show ‘hey, I’m awake.’”

Under General Anesthesia May Not Mean “Out Cold” Click To Tweet
Must Reads

3 Patient Safety Ideas to Implement Articles PPAHS have been reading the week of July 2, 2018

Articles the Physician-Patient Alliance for Health & Safety (PPAHS) have been reading the week of July 2, 2018 ask us to consider 3 patient safety ideas to implement.

#1 Patient Safety to Implement – Remember that Some Patients Need Opioids

In the nation’s battle to curtail the use of opioids, there are patients who need them.

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Must Reads, Patient Safety

What do Environmental Concerns, C-Sections, the Value of a Human Life and Opioids have in common? Articles PPAHS have been reading the weeks of May 14 and 21, 2018

What do environmental concerns, pressure ulcers, C-sections, the value of a human life, and opioids have in common?

They are the themes in the articles we have been reading the past two weeks of May 14 and 21, 2018.

Your Environment May Increase Your Risk of COPD  

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Although cigarette smoking is often the cause of COPD, a recent study led by researchers from the Barcelona Institute for Global Health (ISGlobal) reminds us that COPD may be caused by other factors.

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Must Reads, Patient Safety

8 Ways to Improve Patient Safety and Health Outcomes Articles PPAHS have been reading the week of April 23, 2018

Articles we have been reading this past week of April 23, 2018 discuss eight ways to improve patient safety and health outcomes.

#1 Way to Improve Patient Safety and Health Outcomes- Use Opioid-Sparing Strategies and More Precise Monitoring

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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.

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Must Reads

5 Suggestions for Improving the Health of Babies Articles PPAHS has been reading the week of February 12, 2018

Articles we have been reading this past week of February 12, 2018 provide 5 suggestions for improving the health of babies.

#1 – Exercise the Appropriate Standards of Care

PPAHS has been following the case of Amber Athwal, who suffered brain damage after undergoing dental surgery to extract some of her teeth.

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Must Reads, Opioid Safety

What is and Isn’t being done to stop the opioid epidemic Articles the PPAHS team has been reading the week of January 22, 2018

3 actions that aren’t being taken to stop the opioid epidemic

#1 Action Not Being Taken to Stop the Opioid Epidemic – Government action

Government is not doing enough to end the opioid epidemic, according to a CNN article interviewing Patrick Kennedy, who is on the US president’s opioid commission.

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