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| JCAHO Alerts Facilities to Medication Error Risks
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The Joint Commission on Accreditation of Healthcare Organizations is warning healthcare providers to exercise extreme caution when medicating patients in transition between locations or personnel. In a Sentinel Event Alert issued Jan. 25, JCAHO cited transitions as a high risk for patient injury or death due to drug duplication; drug incompatibility; incorrect, insufficient or unnecessary doses; or other medication errors.
In a statement issued with the alert, JCAHO reports that the United States Pharmacopeia received more than 2,000 voluntary reports of such errors in 2005 and that the Institute of Medicine estimated in 1999 that medication errors cause more than 7,000 hospital deaths a year.
"It's clear that, overall, the majority of adverse outcomes have as at least one of their root causes ineffective communication," especially ineffective "hand-off" communication, says Rick Croteau, MD, JCAHO's executive director for patient safety. As a result, the commission recommends taking the following steps to ensure medication accuracy:
In accordance with JCAHO's National Patient Safety Goals, compile and confirm a complete list of every patient's current medications upon admission.
In accordance with the patient safety goals, provide this list to any other provider to whom a patient is referred or transferred.
Keep the list visible in the patient's chart, along with dosage, schedule, immunization and allergy information.
Reconcile the patient's medications at admission, transfer, discharge or any other transition of care.
Give each patient a full listing of the medications and medicating instructions he'll be subject to following his discharge, in order to notify subsequent providers.
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| Study Defines Risk Factors in Patients with Pulmonary Embolisms
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Ten risk factors are the key to determining which patients suffering from pulmonary embolisms can be candidates for outpatient surgery, according to a study in the Jan. 23 issue of the Archives of Internal Medicine.
Researchers found they could determine whether patients were at low risk of death and other adverse complications in the short term by looking at the following factors: age ≥70 years; history of cancer, heart failure, chronic lung disease, chronic renal disease, and cerebrovascular disease; and clinical variables of pulse rate ≥110 beats/minute, systolic blood pressure >100 mm Hg, altered mental status and arterial oxygen saturation >90 percent.
Patients with none of these factors were defined as low risk. The 30-day mortality rates for low-risk patients ranged from 0 percent to 1.5 percent, in the derivation, internal validation and external validation samples. The rates of nonfatal adverse medical outcomes were less than 1 percent among low-risk patients across all study samples.
The study examined the records of 15,531 inpatients at 186 Pennsylvania hospitals who had a discharge diagnosis of pulmonary embolism and examined mortality and nonfatal adverse outcomes of these patients. "The main study outcome used to derive our prediction rule was death from all causes within 30 days of each hospitalization," write the researchers, as most pulmonary embolism-related complications occur within 30 days post-op.
"Treating patients with pulmonary embolism identified as low risk using our prediction rule in an ambulatory setting could result in important cost savings," write researchers. "However ... it is important for physicians also to consider psychosocial contraindications to outpatient care (such as lack of treatment adherence). Other potential barriers to outpatient treatment are the lack of outpatient systems of healthcare and the absence of insurance coverage for more costly low-molecular-weight heparin (which is used as treatment for pulmonary embolism)."
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| Prompt Repair of Inguinal Hernia May Be Unnecessary
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"Watchful waiting" may be an acceptable option for men with minimally symptomatic inguinal hernias, new research suggests. A study in the Jan. 18 Journal of the American Medical Association reports that the rare occurrence of acute hernia incarceration means that surgical repair can be delayed until symptoms increase.
In a randomized trial involving 720 men with inguinal hernias causing minimal symptoms, researchers found that the complication rate for patients having initial surgery and the rate for patients who delayed surgery were the same during six-month and annual examinations.
At the two-year follow-up, the rate of activities limited by pain was about 3.5 percent in each group. Nearly one-fourth (23 percent) of patients assigned to the watchful waiting group ultimately moved to the surgery group, typically due to an increase in hernia-related pain, say researchers.
"If the results of this study are reproduced in other populations and for other types of hernia, then the era of preventive hernia repair should go the way of prophylactic tonsillectomy, (gallbladder removal), and appendectomy," comments David R. Flum, MD, of the University of Washington in Seattle in a related editorial.
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| News and Notes
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CMS HAS DESIGNATED ADVANCED MEDICAL OPTICS' TECNIS IOL as a new technology intraocular lens, creating a new class of NTIOLs, "reduced spherical aberration," and making the Tecnis IOL eligible for an additional $50 payment when provided to a Medicare beneficiary in an ASC. The designation follows labeling claims approved by FDA in April 2004 that the Tecnis reduced post-operative spherical aberrations compared to lenses with spherical optics and improved night driving simulator performance. "For these lenses, there is clear evidence of improved functional vision and contrast acuity," says CMS administrator Mark McClellan, MD, PhD, in a statement. This designation goes into effect February 27 and includes both the acrylic and silicone platform Tecnis lenses.
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