Browsing by Subject "patient safety"

Now showing 1 - 10 of 13
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    Against Medical Advice Discharge: A Narrative Review and Recommendations for a Systematic Approach
    (Elsevier, 2021-06) Holmes, Emily G.; Cooley, Benjamin S.; Fleisch, Sheryl B.; Rosenstein, Donald L.; Psychiatry, School of Medicine
    Approximately 1%-2% of hospitalizations in the United States result in an against medical advice discharge. Still, the practice of discharging patients against medical advice is highly subjective and variable. Discharges against medical advice are associated with physician distress, patient stigma, and adverse outcomes, including increased morbidity and mortality. This review summarizes discharge against medical advice research, proposes a definition for against medical advice discharge, and recommends a standard approach to a patient's request for discharge against medical advice.
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    Assessing the Medical Emergency Preparedness of Dental Faculty, Residents, and Practicing Periodontists: An Exploratory Study
    (ADEA, 2018-05) de Bedout, Tatiana; Kramer, Kyle; Blanchard, Steven; Hamada, Yusuke; Eckert, George J.; Maupome, Gerardo; John, Vanchit; Oral and Maxillofacial Surgery and Hospital Dentistry, School of Dentistry
    With the increased number of elderly and medically compromised individuals receiving dental care and the presence of systemic comorbidities and associated treatment modalities in this patient population, it is imperative that dentists be prepared to manage a variety of medical emergencies. The aim of this study was to assess the knowledge of and preparedness to manage common medical emergencies of cohorts of practicing periodontists, specialty residents, and faculty members, both for comparative purposes and as an aid to refining a dental school’s standardized case scenarios. The study, conducted in 2017, was designed for four groups of randomly selected participants with at least 20 in each group; the actual number of voluntary participants was 28 private practice periodontists, 22 residents in specialty programs, 21 specialist faculty members, and 24 general practice faculty members. Participants were asked to evaluate ten clinical emergency cases and identify the diagnosis and indicated intervention for each. Groups were also evaluated for differences among correct responses for each case. Overall, there were no statistically significant differences for number of correct diagnoses or interventions among the four groups. However, several cases had varying degrees of incorrect diagnoses and management across all groups. Participants who had recently graduated or were still in school were able to treat cases appropriately more often than the other participants. Further refinement of cases to assess provider preparedness to correctly diagnose and manage medical emergencies is needed, specifically establishing case-specific features and addressing areas of potential confusion before the cases are used for educational purposes.
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    Intravascular Iodinated Contrast Media Administration in Adults: A Patient Safety Approach
    (Indianapolis Coalition for Patient Safety, 2017-03-01) Indianapolis Coalition for Patient Safety
    In 2013, The ICPS Contrast Media Usage and Exposure Workgroup was formed to review, define, assess and implement best practices regarding the use of intravascular iodinated contrast media (CM) in diagnostic and interventional procedures with respect to the associated risk of contrast media - induced nephropathy (CIN) and other adverse events. The interdisciplinary workgroup consisted of radiologists, cardiologists, nephrologists, nurses, technologists, pharmacists and patient safety experts. The workgroup met regularly to review published best practices and current practices within each member health-system. The workgroup focused on opportunities to improve patient safety within rep resent health-systems and emphasized consensus-based recommendations aimed at reducing intra-institutional variability. Based on current literature, best practices, and professional experience, the workgroup created these recommendations for safe use of intravenous iodinated contrast media. These recommendations do not replace sound clinical judgment or other published guidelines.
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    Linking Health Information Technology to Patient Safety and Quality Outcomes: A Bibliometric Analysis and Review
    (http://informahealthcare.com/doi/abs/10.3109/17538157.2012.678451, 2013-01) Whipple, Elizabeth C.; Dixon, Brian E.; McGowan, Julie J.
    OBJECTIVE: To assess the scholarly output of grants funded by the Agency for Healthcare Research and Quality (AHRQ) that published knowledge relevant to the impact of health information technologies on patient safety and quality of care outcomes. STUDY DESIGN: We performed a bibliometric analysis of the identified scholarly articles, their journals, and citations. In addition, we performed a qualitative review of the full-text articles and grant documents. DATA COLLECTION/EXTRACTION METHODS: Papers published by AHRQ-funded investigators were retrieved from MEDLINE, journal impact factors were extracted from the 2010 Thompson Reuters Journal Citation Report, citations were retrieved from ISI's Web of Knowledge and Google Scholar. PRINCIPAL FINDINGS: Seventy-two articles met the criteria for review. Most articles addressed one or more of AHRQ's outcome goals and focus priorities. The average impact factor for the journals was 4.005 (range: 0.654-28.899). The articles, and their respective grants, represented a broad range of health information technologies. CONCLUSIONS: This set of AHRQ-funded research projects addressed the goals and priorities of AHRQ, indicating notable contributions to the scientific knowledge base on the impact of information system use in healthcare.
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    Methods for Detecting Pediatric Adverse Drug Reactions from the Electronic Medical Record
    (Wiley, 2021-11) Joyner, Lydia M.; Alicea, Leah A.; Goldman, Jennifer L.; Suppes, Sarah L.; Tillman, Emma M.; Medicine, School of Medicine
    Adverse drug reactions (ADRs) are common, yet are often underreported making them difficult to track and study. Prospective pharmacovigilance programs significantly increase detection and reporting of ADRs. The aim of this pilot study was to apply triggers used by a prospective pharmacovigilance program at a free-standing children's hospital to retrospectively detect ADRs at our institution, therefore determining if these methods could be replicated and provide the basis for implementation of a prospective pharmacovigilance program. In 2019, our institution had 22,000 inpatient admissions and 51,000 emergency room visits and had 21 ADRs voluntarily reported in an electronic medication safety tracking system. Additional ADRs were identified by methods including new or modifications to the patient's allergy profile in the electronic medical record (EMR) and International Classification of Disease (ICD) codes. We identified 754 unique patients with changes to allergy profile and 5,719 ICD codes in 3,966 unique patients to evaluate. These triggers prompted screening of the EMR to validate the ADR, and we identified 280 ADRs occurring in 2019. Eight (2.8%) were identified solely by the electronic medication safety tracking system, 64 (23%) were identified by the allergy list, 110 (39%) were identified only by ICD coding, and the remaining 98 (35%) were identified by multiple methods. The use of triggers followed by review of the EMR identified thirteen-fold more ADRs than were voluntarily reported, illustrating the need for an active pharmacovigilance service and the successful use of multi-modal methods to detect and track ADRs. This article is protected by copyright. All rights reserved
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    The Patient in Patient Safety: Clinicians’ Experiences Engaging Patients as Partners in Safety
    (Sage, 2019-09) Lerner Papautsky, Elizabeth; Holden, Richard J.; Valdez, Rupa S.; Gruss, Valerie; Panzer, Jeffrey; Perry, Shawna J.; Medicine, School of Medicine
    Patients and families play a role in the safety of care provided across clinical settings, highlighting the need to understand clinician perspectives and experiences related to their engagement. Through a panel discussion entitled, The Patient in Patient Safety: Clinicians’ Experiences Engaging Patients as Partners in Safety, we elicited clinician perspectives that have implications for human factors relevance in both, research and solution development/evaluation. We provide an overview of the panel including participants, format and content, and the resulting discussion.
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    Patient Safety and Patients' Rights
    (2004-06) Silverman, Ross D.
    Patient safety can be improved through the implementation of a physician reporting system, in which medical errors can be reported confidentially. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.
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    Pharmacogenomically actionable medications in a safety net health care system
    (2016) Carpenter, Janet S.; Rosenman, Marc B.; Knisely, Mitchell R.; Decker, Brian S.; Levy, Kenneth D.; Flockhart, David A.; IU School of Nursing
    OBJECTIVE: Prior to implementing a trial to evaluate the economic costs and clinical outcomes of pharmacogenetic testing in a large safety net health care system, we determined the number of patients taking targeted medications and their clinical care encounter sites. METHODS: Using 1-year electronic medical record data, we evaluated the number of patients who had started one or more of 30 known pharmacogenomically actionable medications and the number of care encounter sites the patients had visited. RESULTS: Results showed 7039 unique patients who started one or more of the target medications within a 12-month period with visits to 73 care sites within the system. CONCLUSION: Findings suggest that the type of large-scale, multi-drug, multi-gene approach to pharmacogenetic testing we are planning is widely relevant, and successful implementation will require wide-scale education of prescribers and other personnel involved in medication dispensing and handling.
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    Preliminary Evaluation of a Measure for Reliable Assessment of Need for Constant Visual Observation in Adults with Traumatic Brain Injury
    (Taylor & Francis, 2016) Moessner, Anne; Malec, James F.; Beveridge, Scott; Reddy, Cara Camiolo; Huffman, Tracy; Marton, Julia; Department of Physical Medicine and Rehabilitation, IU School of Medicine
    Primary objective: To develop and provide initial validation of a measure for accurately determining the need for Constant Visual Observation (CVO) in patients with traumatic brain injury (TBI) admitted to inpatient rehabilitation. Research design: Rating scale development and evaluation through Rasch analysis and assessment of concurrent validity. Methods and procedures: One hundred and thirty-four individuals with moderate–severe TBI were studied in seven inpatient brain rehabilitation units associated with the National Institute for Disability, Independent Living and Rehabilitation Research (NIDILRR) TBI Model System. Participants were rated on the preliminary version of the CVO Needs Assessment scale (CVONA) and, by independent raters, on the Levels of Risk (LoR) and Supervision Rating Scale (SRS) at four time points during inpatient rehabilitation: admission, Days 2–3, Days 5–6 and Days 8–9. Outcomes and results: After pruning misfitting items, the CVONA showed satisfactory internal consistency (Person Reliability = 0.85–0.88) across time points. With reference to the LoR and SRS, low false negative rates (sensitivity > 90%) were associated with moderate-to-high false positive rates (29–56%). Conclusions: The CVONA may be a useful objective metric to complement clinical judgement regarding the need for CVO; however, further prospective study is desirable to further assess its utility in identifying at-risk patients, reducing adverse events and decreasing CVO costs.