Premier Safety Share
In this issue
Premier Safety Web site
March 2004
Dear Colleague:
You can download the latest evidence-based guidelines for safety and infection control, from AHRQ, NQF, CDC and others from the Safety Web's Guidelines - Infection prevention and safety section.
Please share this newsletter with your colleagues and encourage them to subscribe to Safety Share so they don't miss any issues.
Sincerely,
Gina Pugliese, editor
Vice President, Premier Safety Institute
News
- MRI projectile object injury underscores need for all-staff training
- AHRQ releases interactive pneumonia decision-support tool
- More nurses lead to improved patient outcomes
- FDA imposes 2006 deadline for bar codes on drugs and blood products
- CDC publishes online workbook on sharps injury prevention
- Lifting teams and equipment key to preventing back injuries
- Patient safety principles drive new hospital design
- H2E offers tools to improve environmental purchasing and practices
- Pediatric vaccine update: Influenza efficacy and suspension of fourth dose of pneumococcal vaccine
Safety tools
- On-line revised forms: FDA MedWatch
- GAO tool: Tracking states’ progress in bioterrorism preparedness
- OSHA’s Web-based National Emergency Management Plan
- EPA options: Safe at-home needle disposal
- OSHA compliance resources: Web-based education, e-tools, QuickTakes
MRI projectile object injury underscores need for all staff training
Healthcare facilities should only allow magnetic resonance (MR)-safe or R-compatible equipment in the MR scan room and in areas beyond public access. Policies written to enforce this measure will limit the likelihood of potentially fatal projectile incidents. The list of objects that have crashed into MR scanners is extensive and includes oxygen cylinders, floor buffers, pulse oximeters, and even handguns. As reported in the January 2004 Journal of Magnetic Resonance Imaging, an incident involving an oxygen cylinder occurred when a patient undergoing a MR exam experienced an increased pulse rate and decreased oxygen saturation, prompting the MR staff to give the patient supplemental oxygen. After the full oxygen cylinder was wheeled into the MR scan room and drawn into the MR scanner; one staff member suffered minor injuries, and subsequent repairs and lost service time for the scanner cost the hospital more than $110,000.
Steps that healthcare facilities can take to prevent projectile incidents include providing formal MR safety training to all staff who might enter the MR environment, restricting the access of personnel who have not received such training, and emphasizing more clearly that the magnetic field of the MR scanner is always on, even if the scanner is not in active use. Also, facilities should allow only MR-safe or MR-compatible equipment in the immediate MR environment, particularly that which might be used in an emergency. As reported in December 2003 edition of Safety Share, a free checklist is available in a white paper issued by the American College of Radiology.
- Colletti PM. Size "H" oxygen cylinder: accidental MR projectile at
1.5 Tesla. J Magn Reson Imaging 2004 Jan;19(1):141-3. No
abstract, but article is available for a fee at:
http://www3.interscience.wiley.com/cgi-bin/jissue/106592162 - Kanal E. Clinical utility of the American College of Radiology. “MR Safe Practice Guidelines” {guest editorial}. J Magn Reson Imaging 2004 Jan;19(1):2-5. No abstract, but article is available for a fee at: http://www3.interscience.wiley.com/cgi-bin/jissue/106592162
- Download the American College of Radiology white paper on MR safety by Kanal E, Borgstede JP, Barkovich AJ, et al. or go to: http://www.acr.org/dyna/?doc=committees/mr_safety/safe_mri.html
AHRQ releases interactive pneumonia decision-support tool
The Agency for Healthcare Research and Quality (AHRQ) has released an interactive computer program that provides an electronic index of pneumonia symptoms. The program asks a series of questions based on a patient's medical history, physical examination findings and a limited set of laboratory results to determine whether or not the patient requires hospitalization or can be treated at home. The interactive computer program called the Pneumonia Severity Index Calculator can be downloaded for free onto a personal digital assistant from the AHRQ Web site. The Pneumonia Severity Index Calculator is based on a clinical algorithm produced in 1997 by the Pneumonia Patient Outcomes Research Team (PORT), an AHRQ-funded multidisciplinary research team . The Pneumonia PORT developed and tested the Pneumonia Severity Index clinical algorithm to aid clinicians in treatment decisions for patients with community-acquired pneumonia. The AHRQ Pneumonia Severity Index Calculator is available in Palm OS, Pocket PC and HTML formats.
- AHRQ Web site at http://pda.ahrq.gov
More nurses lead to improved patient outcomes
Patients suffering myocardial infarction (MI) and treated in hospitals staffed by more registered nurses (RNs) are less likely to die than patients treated in hospitals staffed by fewer RNs, according to a recent study published in the January 2004 issue of Medical Care. The study hypothesized that nurse-staffing ratios are associated with nursing-related quality of care. Researchers examined whether these ratios had an effect on in-hospital mortality, independent of patient characteristics, treatment, and hospital characteristics. Patient characteristics were obtained using medical record abstractions from the Cooperative Cardiovascular Project (CCP) dataset and nurse-staffing ratios from the contemporaneous American Hospital Association (AHA) survey of hospital characteristics. By combining these data sets, the authors were able to perform extensive adjustment for both patient-level and hospital characteristics. The study conclusion was that even after extensive adjustment of these variables, higher RN staffing levels were associated with lower mortality.
- Download abstract Medical Care Nurse Staffing (.doc) (29 KB)
- Full article can be obtained for a fee at: www.medicalcaresection.org/medical_care_journal.html
FDA imposes 2006 deadline for bar codes on drugs and blood products
The Food and Drug Administration (FDA) has issued a final rule (Editor Link below to rule) effective February 26, 2004, requiring bar codes on the labels of thousands of human drugs and biological products by 2006. The measure is intended to help protect patients from preventable medication errors and reduce the cost of healthcare. It also represents a major step forward in the department's efforts to harness information technology to promote higher quality care. A long-time advocate of bar coding, Premier believes that industry adoption represents a critical advance in the hospital community's efforts to improve patient safety and delivery of care. See Premier's press release.
As numerous studies have demonstrated, bar-coded medications in care settings go a long way toward guaranteeing the critical "five rights" – the right patient, the right drug, the right dosage, the right time and the right route of administration. In a study conducted at a Veterans Affairs Medical Center employing a bar-code scanning system, 5.7 million doses of medication were administered to patients with no medication errors.
The bar code rule calls for linear bar-coded labels on most prescription and certain over-the-counter drugs that are commonly prescribed and used in hospitals. Each bar code is required to contain, at a minimum, the drug's existing encoded National Drug Code (NDC) number. Companies also may include information about lot number and product expiration date, a move Premier strongly urged during the comment period.
The rule also requires the use of machine-readable information on bar-coded labels of blood and blood product containers. The FDA estimates that the bar code rule, when fully implemented, will help prevent nearly 500,000 adverse events and transfusion errors over 20 years. The economic benefit of reducing healthcare costs, patient pain and suffering, and lost work time is estimated at $93 billion over the same period. The final rule applies to most drug manufacturers, re-packagers, re-labelers, private-label distributors and blood establishments. New medications covered by the rule must include bar codes within 60 days of their approval. Most previously approved medicines and all blood and blood products will have to comply with the new requirements by 2006, a change from the originally proposed three-year implementation period.
-
Download the final bar code rule from Premier’s Web site.
(.pdf) (522 KB) - Download Premier’s comments on the final rule. (.pdf) (78 KB)
- Obtain the HHS press release and fact sheet from:
http://www.fda.gov/oc/initiatives/barcode-sadr
CDC publishes online workbook on sharps injury prevention
A free online sharps injury prevention workbook is available from the Centers for Disease Control and Prevention (CDC). The comprehensive workbook outlines organizational steps – such as the creation of a multidisciplinary sharps team, integration with ongoing quality improvement programs, and setting priorities for an action plan and operational processes – such as a culture of safety, injury reporting, data analysis, and device selection and analysis to help facilities develop or enhance sharps injury prevention programs. It includes a variety of sample forms for each of these steps. The workbook, launched during a February 11 audio-conference on sharps injury prevention hosted by Premier's Safety Institute, is available on the CDC Web site.
CDC's workbook can be used in conjunction with ECRI's “Sharps Safety and Needlestick Prevention, 2nd Edition,” which includes an evaluation of currently available needlestick-prevention device and sharps safety technology. Sharps safety committees can use these tools in the report to evaluate devices for implementation in their facilities. More information on ECRI's “Sharps Safety and Needlestick Prevention, 2nd Edition,” is available at http://www.ecri.org/Newsroom/Document_Detail.aspx?docid=20031210_91.
- CDC’s Web site. http://www.cdc.gov/sharpssafety/index.html
Lifting teams and equipment key to preventing back injuries
A California healthcare organization experienced a 22 percent drop in employee injuries from patient lifting after implementing a patient-lift team program, according to the January 2004 edition of Briefings on Hospital Safety.
The organization considered three essential components to improve patient handling and reduce injuries to patients and staff:
- Nurse training on back safety, equipment use and how to safely move patients;
- Equipment that is readily available to help with vertical lifts and horizontal transfers; and
- Lift teams comprised of members trained to perform high-risk transfers with equipment and other staff.
The two-person lift teams are available from 5:30 a.m. to 8 p.m. – the peak hours of demand for lifting assistance – to help clinicians with such high-risk patient handling tasks as lifting or turning patients who weigh more than 150 pounds; quadriplegics, paraplegics, and amputees; and patients who have fallen. Allowing lift team members 30 minutes of paid time at the beginning of their shift to stretch and warm up is key to the program's success. While lift team members do not necessarily need to have excessive physical strength, they should be physically fit and flexible, and have good customer service skills.
Formal lift teams can be part of an overall effort within a healthcare facility to reduce healthcare worker injuries that stem from patient care activities. For related information, see resources from Premier’s Safety Share and Back Injury Prevention Web site module.
- The Briefings on Hospital Safety article is available to
subscribers at
http://www.hcprolibrary.com/PublicationDetail.cfm?oc_id=45.
More information from Premier’s Safety Share:
- Nurses report frequent back pain -- Few using lifting equipment (1/04) and
- Endurance exercises for low back pain hasten return to work (2/04), as well as
- Premier Safety Institute’s Web site module on Back Injury Prevention.
Patient safety principles drive new hospital design
A Wisconsin regional healthcare system has designed its new hospital to promote a culture of patient safety. West Bend, WI-based St. Joseph’s Community Hospital assembled a multi-departmental team of architects, patients, families, hospital staff, physicians and local citizens to design a hospital that would be safety driven from the ground up. The design, described in a special article from the Joint Commission Journal on Quality and Safety, includes standardized patient rooms, new technology that will help minimize falls, and patient care alcoves in each patient room. Additional design principles for the new facility include visibility of patients to staff, automation such as bar-coding of medications, and noise reduction. The hospital was designed to be adaptable and flexible and allow for future growth.
- Download the free article from the Joint Commission Journal on
Quality and Safety's Web site at:
http://www.jcrinc.com/subscribers/journal.asp?durki=32
and select the “Free Sample Article” link
H2E workshop offers tools to improve environmental purchasing and practices
Hospitals for a Healthy Environment (H2E) will sponsor a day of hands-on workshops that will provide attendees with the tools and resources necessary to duplicate H2E members’ award-winning initiatives. H2E is a collaborative program of American Hospital Association (AHA) and the Environmental Protection Agency (EPA) designed to help healthcare facilities enhance work place safety, waste minimization, and overall reduction of exposures to toxins such as mercury, PVC, and DEHP through environmentally preferable purchasing choices and safer environmental practices.
Workshops will address the following areas:
- Recycling and waste minimization;
- Regulated medical waste reduction;
- Hazardous chemicals reduction;
- Environmentally preferable purchasing;
- Facilities/green buildings; and
- Policy and program commitment.
Registration for this one-day workshop series, which includes a luncheon presentation of 2004 H2E award winners, is $75. The 2004 CleanMed conference on April 14-15 follows the H2E event and is co-sponsored by a number of organizations, including Health Care Without Harm, H2E, and Premier, Inc. To register for the CleanMed conference, or for more information, go to the organization’s Web site at www.cleanmed.org.
- For more information, see Environmentally Preferred Purchasing on Premier’s Safety Web.
Pediatric vaccine update: Influenza efficacy and suspension of fourth dose of pneumococcal vaccine
Inactive flu vaccine safe for children: A study in the March 1, 2004 issue of Clinical Infectious Diseases found that "killed" influenza vaccine, an inactive form of the flu virus in vaccine form, is safe and effective for children as young as six months old. According to the Infectious Diseases Society of America (IDSA), which publishes the journal, the Centers for Disease Control and Prevention (CDC) will officially begin recommending the vaccine for children six to 23 months old this fall. IDSA reported that the vaccine is safe even for children with high-risk conditions such as asthma, immunodeficiency, or chronic heart or lung conditions, unlike the live virus flu vaccine which may have side effects in high-risk patients and is not recommended for anyone under five or over 49 years old. Evidence indicates that averting illness by vaccinating children can save $10 – 25 per child, compared to the cost of treating unvaccinated children who develop the flu. Vaccinating children against the flu may also protect adults from getting infected.
Suspension of fourth dose of the pneumococcal conjugate vaccine (PCV7): The CDC’s Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) have issued a joint recommendation that healthcare providers temporarily suspend routine use of fourth dose of the pneumococcal conjugate vaccine (PCV7). The recommendation was made to conserve vaccine and minimize the likelihood of shortages caused by production and supply problems at Wyeth Vaccines, the only U.S. supplier of the vaccine. The recommendation calls for the temporary suspension of the fourth dose of PCV7, a booster dose given at 12-to-15 months of age. Healthcare providers should move to a three-dose series (one dose at two months, one dose at four months, and one dose at six months). Providers should continue to administer the fourth dose to children who have increased risk of severe disease. Children whose booster dose is deferred should receive PCV7 on their first visit after supplies return to normal. This recommendation is not expected to have any adverse health consequences for children. CDC estimates this action will help conserve more than 1 million doses by July 2004, making widespread or prolonged disruptions less likely.
- Download an abstract of the influenza study (.doc) (31 KB)
- Subscribers may access the full article at: http://www.journals.uchicago.edu/CID/home.html
- Download a summary in question and answer format regarding the recommendations (.doc) (29 KB)
Safety tools
- On-line revised forms: FDA MedWatch
- GAO tool: Tracking states’ progress in bioterrorism preparedness
- OSHA’s Web-based National Emergency Management Plan
- EPA options: Safe at-home needle disposal
- OSHA compliance resources: Web-based education, e-tools, QuickTakes
On-line revised forms: FDA MedWatch
The Food and Drug Administration today announced revised forms for healthcare facilities and others to use in reporting adverse events involving single-use medical devices that have been reprocessed for reuse. The revised forms and instructions, for voluntary and mandatory reporting to MedWatch, are available at http://www.fda.gov/medwatch/getforms.htm. The new forms are effective immediately, although the prior version of the forms can be used until August 17, 2004.
- For more information, see the Federal Register notice at:
http://www.access.gpo.gov/su_docs/fedreg/a040217c.html
under "Food and Drug Administration."
GAO tool: Tracking states’ progress in bioterrorism preparedness
The General Accounting Office (GAO) has released findings of its review of the states’ bioterrorism preparedness programs (.pdf) (353 KB). The report, HHS bioterrorism preparedness programs: States reported progress but fell short of program goals for 2002, examines the extent to which states completed 2002 cooperative agreement requirements and whether they identified any factors that hindered implementation of the Centers for Control and Prevention (CDC) and Health Resources and Services Administration’s (HRSA) cooperative agreement programs.
Although all states reported progress, no state completed all of the program requirements. Factors that hindered their ability to complete the requirements included:
- Redirection of resources to the National Smallpox Vaccination Program;
- Difficulties in maintaining staffing as a result of state and local budget deficits; and
- Delays caused by state and local management practices, such as contracting and hiring procedures.
The GAO concludes that although the states’ progress fell short of 2002 program goals, CDC’s and HRSA’s cooperative agreement programs enabled states to make much needed improvements in public health and health capacities critical for preparedness.
OSHA’s Web-based National Emergency Management Plan
The Office of Safety and Health Administration (OSHA) has released its National Emergency Management Plan. The plan calls for specialized response teams, an emergency preparedness executive steering committee, and regional emergency response plans during a national emergency. The agency recently published its National Emergency Management Plan that details the agency's roles and responsibilities during responses to national emergencies and outlines procedures to ensure assistance is in place for responder and recovery workers' health and safety.
- More details on emergency preparedness and response efforts for
the workplace are available on OSHA's Emergency Preparedness and
Response page at:
http://www.osha.gov/SLTC/emergencypreparedness/index.html.
EPA options: Safe at-home needle management
The Environmental Protection Agency (EPA) has introduced new at-home sharps disposal options based on the recommendations of the Coalition for Safe Community Needle Disposal. It has added to its current recommendations additional new options for disposal of medical sharps outside the healthcare setting. The information can be found on the EPA Web site at http://www.epa.gov/epaoswer/other/medical/sharps.htm.
The information is included in several brochures that are available for download on the site. The brochures include:
- Disposal Tips for Home Health Care (patient flyer) (.pdf) (65 KB)
-
Disposal Tips for Home Health Care (professional brochure)
(.pdf) (153 KB), and - New Information About Disposing of Medical Sharps (.pdf) (13 KB)
An estimated 9 million people in the United States use more than 3 billion needles, syringes and lancets each year to manage medical conditions at home. The majority of these needles are being disposed of in household trash, posing a danger to waste and janitorial workers, according to the EPA.
OSHA compliance resources: Web-based education, e-tools, QuickTakes
During a recent audio conference conducted by Premier’s Safety Institute, OSHA faculty identified a number of resources that are linked from Premier’s Web site on Sharps injury prevention. One recent addition, Quick Takes is a free electronic bi-monthly newsletter produced by OSHA to inform the public about recent OSHA activities. OSHA’s Hospital e-tool is a Web-based training tool for safety and health hazard assessments in hospitals that provides a virtual hospital using graphics and visual assists for learning. Also, OSHA has multiple training and education resources available at the Office of Training and Education Web site. The site provides links to self-training on multiple topics using slide presentations. Premier’s Safety Institute Web site also provides additional resources at OSHA sharps safety compliance tools.
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Editorial team
Gina Pugliese, RN, MS editor
Judene Bartley, MS, MPH, associate editor
Donna Bernstein, MPH, marketing consultant
John Hall, BSJ, contributor
Derek Kleckner, BA, Web master
Judith Luca, RN, BSN, contributor
About Premier
Premier, Inc. is a healthcare alliance entirely owned by 200 of the nation's leading not-for-profit hospital and healthcare systems. These systems operate or are affiliated with 1,500 hospital facilities and hundreds of other healthcare sites. Premier provides an array of resources supporting health services delivery, including clinical and operational comparative data applications for quality/safety performance improvement, group purchasing and supply chain services, and insurance programs. The Centers for Medicare and Medicaid Services (CMS) has recently partnered with Premier for a three-year quality incentive demonstration project. Participating hospitals using Premier’s Perspective Online database can receive recognition and additional Medicare payment when they meet or exceed specific quality measures.