Managing Hospital Safety: Common Safety Concerns

1. Managing Hospital Safety: Common Safety Concerns Part 1 of 4

2. Objectives • Focus on the impact of medication errors, “never” events and hospital-acquired conditions on patient safety • Highlight the significance of needlestick injuries and practices to help prevent their occurrence • Review the role of the health care team in maintaining hospital safety • Discuss best hospital practices when handling high-alert medications • Identify strategies and solutions to improve safety with insulin therapy

3. Patient Health and Safety Is the Primary Goal of Hospitals “First, do no harm” — Galen

4. Common Safety Concerns Within the Hospital Setting • Medication errors • Needlestick injuries • “Never” events • Hospital-acquired conditions

5. Medication Errors • A medication error is defined as "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer"1 • May lead to adverse outcomes and potential fatalities2 • Health care staff often worried about inflicting harm on patients and associated consequences2 1. Phillips J et al. Am J Health-Syst Pharm. 2001;58(19):1835-1841. 2. Pelegrin GM. Medication errors in hospitals: an analysis. Pharmacy Times. October 2004. http://www.pharmacytimes.com/issues/articles/2004-10_1564.asp. Accessed January 29, 2009.

6. Medication Errors Within the HospitalSetting Are a Significant Burden • ~1.3 million Americans are injured yearly as a result of medication errors that occur in both the inpatient and outpatient setting1 • At least 1 death per day is due to a medication error1 • Typically, medication errors occur in nearly 1 out of every 5 doses given to patients within the hospital2 • Preventable inpatient adverse drug events, including medication errors, may cost ~$2 billion per year3 1. US Food and Drug Administration. Medication errors. http://www.fda.gov/cder/handbook/mederror.htm.Accessed January 29, 2009. 2. Barker KN et al. Arch Intern Med. 2002;162(16):1897-1903. 3. Kohn LT et al. To err is human: building a safer health system. 2000. http://www.nap.edu/openbook.php?isbn=0309068371. Accessed January 29, 2009.

7. Types of Medication Errors • Prescription and Transcription Errors • Illegible orders • Missing or misplaced zeroes and decimal points • Use of abbreviations • Unintended drug ordered based on variety of drug formulations • Dispensing Errors • Look-alike, sound-alike medications • Incorrect preparation • Administration Errors • Incorrect dosage, drug, or infusion rate • Medication given to wrong patient • Lack of drug monitoring or double-checking Jackson MA, Reines WG. US Pharmacist. 2003;28(6):69-79.

8. Serious Moderate Significant Errors Associated With Adverse Drug Events in the Inpatient Setting* 13 11 Patient casesreported (n) 4 Selection Dosage Surveillance Type of Error * Patients studied were in Swiss hospitals. No patients studied were located in the United States. Of 6383 Swiss patients, error-associated adverse drug events were identified in 28 patients. Hardmeier B et al. Swiss Med Wkly. 2004;134(45-46):664-670.

9. Needlestick Injuries • Injuries due to needlesticks can be caused by hypodermic needles, blood collection needles, intravenous (IV) stylets and needles used to connect parts of IV delivery systems1 • Health care workers are concerned about increased risk of exposure to bloodborne pathogens and infection1 • Incidence of these injuries is often underreported2 1. National Institute for Occupational Safety and Health. Preventing needlestick injuries in health care settings. November 1999. http://www.cdc.gov/NIOSH/pdfs/2000-108.pdf. Accessed January 29, 2009. 2. American Nurses Association. 2008 study of nurses’ views on workplace safety and needlestick injuries. http://www.nursingworld.org/MainMenuCategories/OccupationalandEnvironmental/occupationalhealth/SafeNeedles/2008InviroStudy.aspx. Accessed January 29, 2009.

10. Identify Source of Potential Injury National Institute for Occupational Safety and Health. Preventing needlestick injuries in health care settings. November 1999. http://www.cdc.gov/NIOSH/pdfs/2000-108.pdf. Accessed January 29, 2009.