Premier Safety Share
In this edition
Premier Safety Web site
June 2002
Welcome to Safety Share, the online newsletter from the Premier Safety Institute. We invite you to comment.
In addition to the news, this newsletter includes other important features. Also, visit our Safety Web site for more safety resources.
News
- OSHA prohibits needle removal and phlebotomy tube holder reuse
- Congress allocates $520 million for hospital disaster preparedness
- Recommendations for management of anthrax updated
- HHS issues guidelines on disaster readiness for ventilation systems
- AHRQ study links hospital nurse staffing and patient outcomes
- Needlesticks linked to staffing levels of nurses
- ISMP provides tips on reducing overdose from patient-controlled analgesia
- Insulin, heparin, and morphine top drugs associated with errors
- New book documents serious quality gaps
OSHA prohibits needle removal and phlebotomy tube holder reuse
The Occupational Health and Safety Administration (OSHA) issued a news release on June 12, 2002 highlighting a long-awaited letter of interpretation that clarifies its position against removal of contaminated needles from blood tube holders and reuse of those holders. OSHA notes that needle removal and reusing blood tube holders pose unnecessary risks to workers, and issued the letter to clarify its revised compliance directive 2-2.69 from late 2001. The letter states that blood tube holders with needles attached should be immediately discarded into a sharps container after use. OSHA’s intent is to prevent injuries to workers from the "back end" contaminated needle.
Although this is a new interpretation for Federal OSHA, some state OSHA plans, such as California’s, have already prohibited needle removal and phlebotomy holder reuse for some time.
For further information, see Premier’s OSHA compliance tools and FAQs on this issue.
- Download OSHA news release (36.5 KB).
- Download OSHA letter of interpretation (24.5 KB).
- Download CPL2-2.69 (649 KB).
- For more information, go to Sharps Injury Prevention | OSHA compliance tools and FAQ.
Congress allocates $520 million for hospital disaster preparedness
President Bush signed the Public Health Security and Bioterrorism Preparedness Response Act (H.R. 3448) on June 11, 2002 after passage by Congress weeks earlier. This act contains $520 million for enhancing hospital preparedness for nuclear, biological, and chemical attacks. A provision in the agreement allows for additional funding if a significant change in circumstances warrants it. From fiscal year 2004-06, the legislation will provide funding for hospital-based preparedness activities, in addition to grants to the states. Hospital funding will be provided in an environment of collaboration with local and/or state entities responsible for disaster preparedness.
In addition, the Department of Health and Human Services (HHS) has approved plans to strengthen public health and bioterrorism preparedness, paving the way for states to receive the remaining 80 percent of the $1.1 billion appropriated in fiscal year 2002. Money, which will be channeled through the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA), is intended to improve public health infrastructure, enhance disease surveillance, and better equip hospitals. Under the program, all state governors and the mayors of Chicago, Los Angeles, and New York were required to develop strategic workplans on how they would use the funds to strengthen preparedness. As of June 7, 2002, 24 states and two cities had been approved. Approval is expected soon for the remainder.
More information on disaster readiness is available on Premier’s Safety Web site.
- A
summary of specific authorizations for fiscal year 2002 and fiscal
year 2003 for the Public Health Security and Bioterrorism
Preparedness Response Act (H.R. 3448) can be downloaded
(297 KB). - The Public Health Security and Bioterrorism Preparedness and Response Act may also be viewed at http://energycommerce.house.gov.
Recommendations for management of anthrax updated
A working group has reviewed and updated the recommendations for medical and public health professionals following the anthrax attacks against civilians in 2001. The group included experts from academic medical centers, research organizations, and governmental, military, public health, and emergency management institutions and agencies. Their recommendations update the 2001 consensus document.
Specific recommendations cover diagnosis of anthrax infection, indications for vaccination, therapy, post-exposure prophylaxis, decontamination of the environment, and suggested research. The revised consensus statement presents new information based on the analysis of last year’s anthrax attacks, including developments in the investigation; important symptoms, signs, and laboratory studies; new diagnostic clues that may help in future recognition of the disease; current vaccine information; updated antibiotic therapeutic considerations; and judgments about environmental surveillance and decontamination.
A videotape titled "Anthrax — What Every Clinician Should Know," is available from the Premier Safety Institute’s Safety Store. The tape offers physicians and other healthcare workers a clinical primer on bacillus anthracis (anthrax) from the Centers for Disease Control and Prevention (CDC).
- The complete article from the May 1, 2002 "Journal of the American Medical Association" (JAMA) may be downloaded (328 KB).
- The article may be viewed at http://jama.ama-assn.org.
- "Anthrax — What Every Clinician Should Know" may be ordered from the Safety Store.
HHS issues guidelines on disaster readiness for ventilation systems
The Department of Health and Human Services (HHS) has issued new guidelines for protecting ventilation systems in commercial and government buildings from chemical, biological, and radiological attacks. The guidelines address the physical security of ventilation systems, airflow and filtration, systems maintenance, program administration, and maintenance staff training. The recommendations are helpful for organizations performing hazard vulnerability assessments required by the Environment of Care — Emergency management standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). A copy of the HHS guidance is available.
More information on disaster readiness is available on Premier’s Safety Web site.
- "Guidance for Protecting Building Environments from Airborne Chemical, Biological, or Radiological Attacks" may be downloaded (672 KB).
- View disaster readiness information on Premier’s Safety Web site. Select "Safety resources," and "Disaster readiness."
AHRQ study links hospital nurse staffing and patient outcomes
A study funded by the Agency for Healthcare Research and Quality (AHRQ) confirms important relationships between staffing and patient outcomes. The study found that the number of registered nurses and the hours they spend with patients are directly related to serious outcomes, including clinical complications or death.
Investigators re-examined and refined their previous analysis released by the Health Resources and Services Administration (HRSA) in April 2001 as part of an ongoing collaboration within the Department of Health and Human Services (HHS) to improve nursing care in American hospitals. A higher proportion of hours of care per day provided by R.N.s and a greater absolute number of care hours provided by them resulted in improved outcomes for both medical and surgical patients. For medical patients, results included shorter lengths of stay and reduced rates of urinary tract infections, upper gastrointestinal bleeding, pneumonia, shock, cardiac arrest, and failure to rescue. For surgical patients, the analysis showed lower rates of urinary tract infections and failure to rescue.
Previous studies that found associations between nurse staffing and adverse outcomes were limited in sample size. This study, which used a sample of 799 hospitals in 11 states, represented more than six million discharges -- making it is one of the largest studies conducted to date on this topic. The study by J. Needleman, "Nurse-Staffing Levels and the Quality Of Care in Hospitals," was published in the May 30, 2002 issue of the "New England Journal of Medicine."
- The complete article may be downloaded (110 KB).
Needlesticks linked to staffing levels of nurses
Needlestick injuries in hospital nurses increase dramatically when nurse staffing levels are low, University of Pennsylvania researchers conclude in the June 2002 issue of the "American Journal of Infection Control." While current research indicates that patient outcomes suffer when nurse staffing levels fall, this is one of the first studies linking on-the-job injuries in hospital nurses with heavier workloads. Injuries from used needles and other sharps put healthcare workers at risk for serious bloodborne infections such as HIV and Hepatitis C.
The study, conducted in 22 U.S. hospitals with 2,287 medical-surgical unit nurses, all with reputations for excellence, found that poor organizational climate and high workloads were associated with 50 to 200 percent increases in the likelihood of needlestick injuries and near-misses. This study gives additional urgency to the findings of the AHRQ study noted above.
In addition, the report states that hospital cost cutting might have a double-edged effect on injuries. "Nurses potentially unfamiliar with safe use of sharps were often forced to become proficient while their workloads were increasing in other ways. Nurses in our study who took on routine blood draws or intravenous insertions as a new task in the previous year were almost twice as likely to sustain injuries," said Sean Clarke, Ph.D., R.N., associate director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing.
ISMP provides tips on reducing overdose from patient-controlled analgesia
The May 29, 2002 "Medication Safety Alert" from the Institute for Safe Medication Practices (ISMP) offers six tips to reduce the risk of overdoses from patient- controlled analgesia (PCA) by proxy. Tips include selection criteria, protocols, monitoring, and education.
Earlier alerts warned about the risk of overdosing patients when family members or clinicians activate PCA pumps (PCA by proxy). Patient-controlled analgesia provides a built-in safety feature to avoid toxicity because a sedated patient will not push the PCA button.
The ISMP is a nonprofit agency that works closely with healthcare practitioners and institutions to provide education on adverse drug events and their prevention. If your organization handles medications in any way, you should regularly check the IMSP publication, the "ISMP Medication Safety Alert."
- The May 29, 2002 "ISMP Medication Safety Alert" may be downloaded (23 KB).
- View the ISMP Web site at http://www.ismp.org.
Insulin, heparin, and morphine top drugs associated with errors
United States Pharmacopeia (USP) has released the second MedMARx annual report on medication error data submitted by hospitals and health systems nationwide. The drugs linked most frequently with potential or actual errors include insulin, heparin, and morphine. Data indicate that although the number of medication errors was substantial last year, 97 percent did not harm patients, and 31 percent were caught before reaching the patient. Less than one percent resulted in patient deaths. The most commonly reported errors included those of omission, improper dose or quantity, and unauthorized drugs. Errors most frequently occurred during the administration, documentation, and dispensing steps in the medication process.
Reporting of errors to MedMARx for the 2001 calendar year has increased from the previous two years, USP said. Approximately 400 healthcare facilities participated, and more than 100,000 reports were filed. Trends are similar to previous years. While there is progress in reporting, the same types of errors are being made, indicating deeper and more systemic causes.
USP's MedMARx report for 2001 is slated for release late this year. MedMARx is a product developed by USP for use by hospitals to anonymously report and track medication errors.
"Reducing Medication Errors," one of a four-part videotape series titled "Safety Issues in Healthcare,"s is available from the Safety Institute's Safety Store. Winner of the 2001 Time, Inc. Healthcare Safety Freddie Award, these videotapes feature more than 40 nationally recognized safety experts sharing their strategies for successful programs on patient safety, prevention of medication errors, and occupational and environmental safety.
- USP press lease may be downloaded (31 KB).
- More information on MedMARx at www.usp.org/medmarx2000
- Videotape ordering information
New book documents serious quality gaps
The Commonwealth Fund has released the "Quality of Health Care in the United States: A Chartbook" by Sheila Leatherman and Douglas McCarthy. The book describes the state of healthcare in the United States by examining medical mistakes, substandard care for chronic conditions, disparities in care, and the lack of preventive care. Based on more than 150 published studies and reports on quality of care, the book contains a series of charts and analyses that document serious gaps in many crucial dimensions of care. It also includes examples of collaborative projects leading to quality improvement and addresses effectiveness, patient safety, access and timeliness, focus on the patient, disparities in healthcare, and capacity to improve.
- Download Quality of Care book (754 KB).
Other features - short takes
- Safety job description and safety program resources/samples now online
- User’s manual available on IOM2 report
- FDA focuses special Web sites on medical devices and medication errors
- Web site lists nursing home complaint investigations
- New patient safety award program honors Eisenberg
Safety job description and safety program resources/samples now online
The Premier Safety Institute maintains a free public Web site with resources on patient, worker, and environmental safety issues in healthcare. The site includes a "Patient Safety Program Resource Guide" with a job description for a safety officer, an organization-wide safety plan, Power Point slides of program elements and key committees, sample grids for documenting interdisciplinary components, and other tools.
- Download at Safety Store.
User’s manual available on IOM2 report
Dr. Donald Berwick from the Institute of Medicine has condensed the message of the second IOM report, "Crossing the Quality Chasm," into a user’s manual. The manual summarizes the report’s themes for improvements in the U.S. healthcare system using a four-level framework: patients’ experiences; functioning of small units of care delivery; functioning of the organizations that support microsystems; and the supporting environment that shapes the organization.
- Download the manual (147 KB).
FDA focuses special Web sites on medical devices and medication errors
The Center for Devices and Radiological Health (CDRH) keeps a list of people and organizations interested in discussing medical device issues and policies at FDA-sponsored forums. Sign up for the database voluntarily, and choose areas of interest at www.accessdata.fda.gov/scripts/cdrh/cfdocs/contacts/Index.cfm.
The Center for Drug Evaluation and Research (CDER) maintains a Web site devoted to medication errors. The site includes links to articles, FDA announcements, and other useful documentation. Go to www.fda.gov/cder/drug/MedErrors/reports.htm.
Web site lists nursing home complaint investigations
The Centers for Medicare and Medicaid Services (CMS) has a pilot Web site that lists health deficiencies for nursing homes that have been filed, examined, and confirmed following complaints. Go to the "Nursing Home Compare" section under Search Tools of the CMS site.
- Locate the site at www.medicare.gov.
New patient safety award program honors Eisenberg
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the National Quality Forum (NQF) have established an awards program in honor of John M. Eisenberg. Dr. Eisenberg, who died earlier this year, headed the Agency for Healthcare Research and Quality (AHRQ). Up to four awards will be awarded each year for lifetime achievement in patient safety, advocacy, system innovation, and research. The nomination deadline is July 15, 2002.
- Download information (28 KB).
Editorial team
Gina Pugliese, RN, MS editor
Judene Bartley, MS, MPH, associate editor
Donna Bernstein, MPH, marketing consultant
Derek Kleckner, BA, Web master
About Premier
Premier, Inc. is a national strategic alliance of leading hospitals and healthcare systems representing more than 200 not-for-profit owners that own, operate, or are affiliated with approximately 1,600 facilities. Premier members have access to a wealth of resources that support them as they evolve into integrated delivery systems and improve community health across the continuum of care. Premier maintains corporate offices in San Diego, CA; Charlotte, NC; Chicago, IL; and Washington, DC. For information, visit www.premierinc.com.