• Tyler’s Story: A Deadly PCA Medical Error

    Tyler was 18-years old when he died following a successful routine procedure in hospital. His mother, Victoria Ireland, tells the heartbreaking story of how he succumbed to opioid-induced respiratory depression while on a patient-controlled analgesia (PCA) pump. To view the video, please click here.
  • Case Studies Illustrating the Value of Capnography

    Dr. Melissa Langhan (Assistant Professor of Pediatrics, Emergency Medicine, at Yale School of Medicine) – discusses the value of monitoring with capnography in these patient case studies.
  • Ensuring child safety during common medical procedures

    Dr. Melissa Langhan (Assistant Professor of Pediatrics, Emergency Medicine, at Yale School of Medicine) – “Unfortunately, continuous capnography is not routinely used outside of the operating room. Capnography can really enhance patient safety, and healthcare professionals need to think about using it more often. As our study found, using capnography enhanced patient safety, by being able … Read More


  • 3 Must View Podcasts on Reducing Opioid-Related Adverse Events

    Editor’s note: In this personal message from the Founder and Executive Director, Physician-Patient Alliance for Health & Safety, Michael Wong invites you to listen to 3 must view podcasts on reducing opioid-related adverse events. By Michael Wong, JD (Founder and Executive Director, Physician-Patient Alliance for Health & Safety) Watch and share these 3 Clinical Education Podcasts on … Read More
  • Capnography use associated with reduction of adverse outcomes during procedural sedation

    Millions of gastrointestinal endoscopy are performed each year in the US, with colonoscopies making up the majority of such procedures. Research conducted by Michael W. Jopling, MD and Qiu Jiejing published in BMC Anesthesiology concluded that capnography use associated with reduction of adverse outcomes during procedural sedation. Their research sought to “estimate the incidence of pharmacological … Read More
  • 5 Questions on Battling the Opioid Epidemic

    Reading about the ongoing coverage of the opioid epidemic this past week has prompted the following questions – do you agree or disagree? Should newborns with opioid withdrawal be kept together with their mothers? Newborns suffering from opioid withdrawal have traditionally been separated from their mothers. The Canadian Paediatric Society is recommending changing this practice … Read More
  • Effective Hip Injury Management

    With the right medical care, exercise and nutrition, patients can confidently mitigate the impact of a hip injury. By Jennifer Dawson Hip injuries are a cause for serious concern in all age ranges, but especially adolescents and the elderly. An unattended injury can cause growth impediments or restrict mobility. Scientific studies by JCCA even found … Read More

In the News

  • Home & Long Term Care News – (joint CPSI/PPAHS article) Preventing medical errors during a transfer of care

    In this joint article, Michael Wong, JD (Founder & Executive Director of the Physician-Patient Alliance for Health & Safety) and Stephen Routledge, MPH (Patient Safety Improvement Lead, Canadian Patient Safety Institute) discuss how medical errors during transfers of care can be prevented.

    To read the article, which was published in the December 2017 issue of Home & Long Term Care News, please click Preventing medical errors during a transfer of care.

  • Press Release – Capnography Monitoring During Conscious Sedation: Essential for Maintaining “Eyes and Ears” on Patients

    The Physician-Physician Alliance for Health Safety released a clinical education podcast on capnography monitoring with Barbara McArthur, RN, BScN, CPN(C). Barbara is an advanced practice nurse at Sunnybrook Health Sciences Centre in Toronto, Canada.

    After reviewing the current literature, Sunnybrook decided that monitoring with capnography resulted in safer patient care. Capnography monitoring provides an early indicator of patient deterioration, which can be crucial in averting adverse events and patient deaths. Capnography monitoring, says Ms. McArthur, is monitoring in "real time. With pulse oximetry, there is a delay, which could be up to a minute in healthy patients. So, that's a significant sort of time that is delayed that reaction could happen."

    To read the press release, please click here.

    To view the podcast, please click here.

  • BCMJ (Joint CPSI-PPAHS Article) – Three resources to prevent medical errors during transfer of care

    Medical errors can be costly for both patient and hospital. As defined by the Joint Commission: In order to keep patients safe, clinicians should focus on the three key points along the patient’s continuum of care. To help, we offer these free resources:

    To read the article, please go to the British Columbia Medical Journal blog, but clicking here.

  • Press Release – Today’s Must-Have: Capnography Monitoring During Conscious Sedation

    The Physician-Patient Alliance for Health & Safety released a clinical education podcast with Matt Kurrek, MD, FRCPC (Professor, Department of Anesthesia, University of Toronto) and Richard Merchant, MD, FRCPC (Clinical Professor, University of British Columbia, Department of Anesthesia, Pharmacology & Therapeutics).

    To read a transcript of the interview, please click here.

    The podcast may be viewed on the PPAHS YouTube channel by clicking here.


Patient Stories

Clinical Tools

  • Continuous Electronic Monitoring & Opioid Use – Position Statement

    Much of the public attention has been focused on the harm caused by prescription use and abuse of opioids. However, there is another facet that must be focused on: opioid-induced respiratory depression in clinical settings. This includes patients undergoing moderate and conscious sedation, or recovering from procedures and managing pain using a patient-controlled analgesia (PCA) … Read More
  • Position Paper: Patient Ambulation

    Movement is a critical factor to improving patient health. Patient ambulation, the ability to walk from place to place independently with or without an assistive device, is necessary to improve joint and muscle strength, as well as prevent pressure ulcers during extended bed rest. It is a critical factor in improving patient well-being while in … Read More
  • STOPBang Questionnaire

    STOPBang Questionnaire The STOPBang Questionnaire helps screen patients for obstructive sleep apnea (OSA). Twenty-four percent of men and nine percent of women are affected by OSA. According to researchers, “an estimated 82% of men and 92% of women with moderate-to severe OSA have not been diagnosed.”
  • San Diego Patient Safety Council Patient-Controlled Analgesia (PCA) Guidelines of Care

    San Diego Patient Safety Council Patient-Controlled Analgesia (PCA) Guidelines of Care This toolkit was prepared by The San Diego Patient Safety Council, which consists of clinicians and healthcare professionals from acute care facilities across Southern California. Although it was prepared “to provide San Diego County Acute Care settings with recommendations for the standardization of intravenous Patient Controlled Analgesia (PCA) … Read More
  • New York Partnership for Patients Adverse Drug Event Reduction Initiative Team Planning Worksheet for Opioids

    New York Partnership for Patients Adverse Drug Event Reduction Initiative Team Planning Worksheet for Opioids The New York State Partnership for Patients (NYSPFP) is a joint initiative of the Healthcare Association of New York State (HANYS) and the Greater New York Hospital Association (GNYHA)-hospital trade associations representing not-for profit and public health care institutions, including … Read More
  • Stroke VTE Safety Recommendations (PDF)

    Click Here
  • OB VTE Safety Recommendations (PDF)

    Click Here
  • PCA Safety Checklist (Word)

    Click Here
  • PCA Safety Checklist (PDF)

    Click Here
  • Alarm Safety

    Alarm Safety is actively managing the number of alarms (by for example configuring default settings for the specific patient and regularly changing electrodes) and ensuring monitors sound at the appropriate volume and are not muted. Learn more.

Show Me:

PPAHS Patient Safety resources explore safety issues and ways to improve health outcomes. Focusing on opiod safety (pain management), venous thromboembolism (blood clots), and alarm management (noise fatigue).

PPAHS Patient Safety Podcasts and Videos offer in-depth interviews with thought leaders, researchers, patients, and health care professionals from the field to bring a diverse set of perspectives on patient safety issues.

PPAHS Surveys

Conference Poster and Webinar Presentations