Patient Safety
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Patient Safety
General Information
NEWS:
1 of 7 Prescriptions Are "Off-Label" "About 15% of prescriptions were for off-label uses that lacked scientific support . Patients should ask their doctors whether a prescription is off-label and, if so, whether there are good data to support it ."
5 out of 6 adults stumped by health instructions
14 Hospitals Ranked Best in U.S.
65% of Promised Drug Studies Pending
Antibiotic-Resistant Staph Now a Major Threat: It's the No. 1 source of skin infections seen in U.S. emergency rooms, study finds "People can prevent infections by not sharing towels, razors or other common items, and by washing hands with soap and water, experts say."
Clearer prescription drug data needed: IOM panel "When it comes to drug safety, U.S. patients and doctors need less advertising hype and more data to help decide whether to use prescription medicines ."
Crisis Seen in Nation's ER Care "Emergency medical care in the United States is on the verge of collapse, with the nation's declining number of emergency rooms dangerously overcrowded and often unable to provide the expertise needed to treat seriously ill people in a safe and efficient manner. . Long waits for treatment are epidemic, the reports said, with ambulances sometimes idling for hours to unload patients. Once in the ER, patients sometimes wait up to two days to be admitted to a hospital bed"
Dangerous Deception — Hiding the Evidence of Adverse Drug Effects
Diagnostic Dyes May Put Patients at Risk "Injected radiocontrast dyes used in diagnostic testing can trigger declines in kidney function, and a new study suggests that even a fairly minor decline in kidney function can increase death risk for patients."
Doctors discourage use of cough medicine
Drug errors injure more than 1.5 million a year "Perhaps the most stunning finding of the report was that, on average, a hospitalized patient is subject to at least one medication error per day, despite intense efforts to improve hospital care in the six years since the institute began focusing attention on medical mistakes of all kinds."
Drug-Resistant Staph a Growing Problem "A drug-resistant form of the bacteria that causes staph, Staphylococcus aureus, has been rapidly spreading worldwide and might become an even bigger problem in the future, researchers report online in The Lancet. The drug-resistant bug can cause infections in various parts of the body. While most aren't serious, some can be life-threatening. Millions around the world are already infected with the drug-resistant strain, which is spread by contact with infected people or contaminated objects. Those with weak immune systems and living in hospitals, nursing homes, and other health care centers are most vulnerable."
Early, Unproven Findings Changing Doctors' Practice "Too many American doctors are jumping the gun when it comes to how they treat patients -- switching to new, largely unproven therapies on which there is only early, incomplete data. That's the conclusion of a study in the March 15 issue of the Journal of the National Cancer Institute that discovered early findings presented at a national cancer conference rapidly changed the way doctors treated breast cancer -- even though the trial needed much more data and time to offer up conclusive results."
FDA at odds over safety of mercury fillings
FDA Safety Changes: Effexor, Effexor XR, Depakene "The US Food and Drug Administration (FDA) has approved safety labeling revisions to advise of the risk for sustained hypertension in patients receiving venlafaxine therapy; the potential risk for teratogenic effects associated with use of valproic acid during pregnancy; and the risk for hyperammonemia with or without encephalopathy in patients receiving concomitant therapy with valproic acid and topiramate."
FDA seen needing to fix post-market drug safety
Fixing America's Hospitals "The most urgent hurdle of all: improving patient safety. In 1999, the Institute of Medicine declared that close to 100,000 Americans die annually from medical errors. This year, more dire news: medication errors harm at least 1.5 million people and cost some $3.5 billion per year. What goes wrong? Missed diagnoses, incorrect drug dosing, failure to treat promptly. Experts agree that doctors, nurses, pharmacists and technicians will always make mistakes—it's the safety net around them that needs to be fixed."
Grapefruit and Prescription Drugs: Mix Carefully ". more than 30 commonly prescribed drugs carry a warning against mixing their use and grapefruits or grapefruit juice. This is not innocuous, because so many Americans have grapefruit for breakfast at a time when they also take their medications."
High Blood Sugar Linked to More ICU Deaths "For the critically ill, blood sugar that's even slightly higher than normal increases the chance of death, says a study that tracked 216,000 intensive-care patients in veterans hospitals. The risk was highest in patients suffering heart attacks, strokes or other cardiovascular conditions -- and in patients with undiagnosed diabetes, concluded research presented at a meeting Monday of the American Diabetes Association."
Hospital Rating May Not Show Death Rate "New research offers this warning to consumers shopping for top-notch hospitals: Many that are highly rated by government regulators only have marginally lower patient death rates."
Hospital-acquired infections related to contaminated substances. (J Hosp Infect. 2006)
How Can Physicians Stay Current on Prescription Drugs? "Many patients take multiple drugs, and as that number increases, so does the number of potential errors, interactions, and side effects. Drug errors have become an increasingly significant problem because of this phenomenon of multiple prescriptions. As an academic physician, I try to stay abreast of new drugs, especially new drug classes. I go to conferences, I read The Medical Letter, and I read medical articles on most days. Nonetheless, the amount of information that I could know still exceeds what I do know. For us to improve our drug use (and decrease errors), we need a dramatic change in continuing medical education (CME) and we need intelligent electronic medical records."
How long do nosocomial pathogens persist on inanimate surfaces? A systematic review (BMC Infectious Diseases 2006) "Most gram-positive bacteria, such as Enterococcus spp. (including VRE), Staphylococcus aureus (including MRSA), or Streptococcus pyogenes, survive for months on dry surfaces. Many gram-negative species, such as Acinetobacter spp., Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, Serratia marcescens, or Shigella spp., can also survive for months. … The most common nosocomial pathogens may well survive or persist on surfaces for months and can thereby be a continuous source of transmission if no regular preventive surface disinfection is performed."
How not to be killed in hospital "In ten per cent of cases when a person goes into hospital, something bad happens - there's an accident that harms them. In one in five cases, it's serious, and in one case in 30, it leads to death."
Many Americans Say They Get Poor Health Care "Problems cited included medical errors; duplicated tests; uncoordinated, inefficient or unsafe care involving unnecessary treatment; and a failure to communicate important information or test results, according to the report from the Commonwealth Fund Commission on a High Performance Health System."
Medical Errors Common Among Doctors-in-Training "About one-third of American doctors-in-training report making at least one major error during the recent past, a new survey finds. Often, the errors were associated with a great deal of personal distress. That distress, in turn, increased the odds of future errors, setting off a vicious cycle. "
Medication Errors Injure 1.5 Million People and Cost Billions of Dollars Annually; Report Offers Comprehensive Strategies for Reducing Drug-Related Mistakes "Studies indicate that 400,000 preventable drug-related injuries occur each year in hospitals. Another 800,000 occur in long-term care settings, and roughly 530,000 occur just among Medicare recipients in outpatient clinics. The committee noted that these are likely underestimates. . Establishing and maintaining strong partnerships between health care providers and patients is crucial to reducing medication errors, the report says. . The report recommends specific steps that physicians, nurses, pharmacists, and other health professionals should take to ensure that their patients are fully informed about their drug regimens and to minimize opportunities for mistakes to occur. . Currently, health care providers typically do not inform the patient or the patient's guardians about errors unless injury or death results. .. The report also provides consumers with a list of specific questions to ask health care providers, such as how to take their medications properly and what to do if side effects occur. Also included are actions consumers should take, such as requesting that their providers give them a printed record of the drugs they have been prescribed. Patients should maintain an up-to-date list of all medications they use -- including over-the-counter products and dietary supplements -- and share it with all their health care providers. This list should also note the reasons they are taking each product and any drug and food allergies they have. "
Most Americans Getting Substandard Health Care "Overall, those surveyed got 54.9 percent of the care experts recommend for their condition."
Paracetamol causes most liver failure in UK and US "Unintentional overdose with the painkiller paracetamol (acetaminophen) is the most common cause of acute liver failure in United Kingdom . Paracetamol's toxicity is also the single biggest cause of acute liver failure in the United States."
Performance of Top-Ranked Heart Care Hospitals on Evidence-Based Process Measures. (Circulation. 2006) "CONCLUSIONS: A number of the US News & World Report top hospitals fell short in regularly applying evidenced-based care for their heart patients. At the same time, many lesser known hospitals routinely provided cardiovascular care that was consistent with nationally established guidelines."
Physician group warns of plastic surgery risks "Undergoing cosmetic surgery performed by someone who's improperly trained can result in scarring, burning and, in some cases, even death, a group of dermatologic surgeons warns. The American Society of Dermatologic Surgery (ASDS) has launched a public safety campaign in response to what it calls the "alarming national trend" of non-physicians performing procedures such as Botox injections, laser hair removal, microdermabrasion and chemical peels."
Physicians Often Don't Tell Patients Important Medication Info "The authors conclude patients who do not get all the instructions about their medication may be less likely to take it properly, partly because they don't understand how. That can lead to several problems including the patient's illness getting worse, the treatment not working, dangerous side effects, and drug overdose."
Physicians' Extended Work Shifts Associated with Increased Risk of Medical Errors That Harm Patients
Poor Handwashing Practices Among Health Care Workers
Prescribing errors resulting in adverse drug events: how can they be prevented? (Expert Opin Drug Saf. 2006) "As approximately 19% of medical errors occurring in hospitals are related to medication errors, reduction of these is one of the major goals to be achieved by healthcare providers. Medication errors may occur at different levels: i) prescribing; ii) transcription; iii) dispensing; and iv) administration."
Primary Evaluation and Management of Statin Therapy Complications (South Med J. 2006) "HMG-CoA reductase inhibitors (statins) have become one of the most commonly prescribed classes of medications in the United States. While serious adverse events are rare, less serious events are frequently seen. Published guidelines recommend initial screening labs as well as ongoing monitoring of liver enzymes during therapy. Up to 5% of patients will have some muscle complaints while taking statins."
Recovery after hip fracture. (Injury. 2006) "CONCLUSIONS: Patients with proximal femoral fracture derive no benefit from acute hospital admission of more than 8 days and the majority acquire nosocomial infection after this."
Reemergence of Gram-negative Health Care-Associated Bloodstream Infections (Arch Intern Med. 2006)
Repeat After Me: Simple Change Cuts Medical Errors
Second opinion counts for a lot Doctors should encourage patients to be part of the information-gathering process, he says, because it's ultimately patients who must make the tough decisions. 'Our job here is to inform them and give them the best opinion about what the outcome will be if we choose one route or another.' One more important note: A second opinion isn't always better than the first. Patients could well end up following their first doctor's advice. 'It's all about getting some options,' ..."
Seniors at greater risk of medicine mix-ups "Mistakes with prescription drugs are a leading cause of death or injury in the United States, and a new study finds that older patients are most at risk because they typically have more medicines and more doctors."
Shock Wave Therapy For Kidney Stones Linked To Increased Risk Of Diabetes, Hypertension
Soaring CT use may prompt need for long-term dose monitoring "We can't be absolutely sure that those scans will significantly boost this patient's chances of cancer later in life, but available evidence suggests we have a reason to be concerned. Most experts believe that dose is cumulative and exposure to ionizing radiation in medical settings can cause cancer. Further, the National Toxicology Program last year added x-ray and gamma radiation to its list of human carcinogens."
Study Links Doctor Errors, Bad Diagnoses
TV News Offers Fuzzy Picture on Health
U.S. gets bad grade on health care scorecard "The United States spends far more on health care than any other country but gets only mediocre care in return for its investment, according to a report released Wednesday. The U.S. national average score on 37 separate measures of health care falls far short when compared either to a few centers of excellence within the country, or to other countries, the report from the Commonwealth Fund found."
U.S. health care mediocre across the board "Startling research from the biggest study ever of U.S. health care quality suggests that Americans - rich, poor, black, white - get roughly equal treatment, but it's woefully mediocre for all. . Overall, patients received only 55 percent of recommended steps for top-quality care - and no group did much better or worse than that. . Health experts blame the overall poor care on an overburdened, fragmented system that fails to keep close track of patients with an increasing number of multiple conditions. Quality specialists said improvements can come with more public reporting of performance, more uniform training, more computerized checks and more coordination by patients themselves."
U.S. Hospital Medical Errors Keep Rising: Report "The most common safety incidents were decubitus ulcers (bedsores), post-operative sepsis (a bacterial bloodstream infection), and failure to rescue."
Vioxx raises risk for year after use, doctors say
ARTICLES:
Anti-inflammatory drugs: What is safe?
Carcinogenic Diagnosis "CT scans use multiple x-rays to create three-dimensional images that are diagnostically useful but expose people to far more radiation than conventional x-rays. In fact, one CT scan exposes a patient to the lower range of radiation received by some Nagasaki bombing survivors. Up to one in a thousand patients will develop cancer from this exposure.[2] Sixty million CT scans a year will thus cause cancer in thousands of people. Yet most consent forms are silent about this."
Check Your Medicines: Tips for Taking Medicines Safely
Drug safety in Canada: 2 steps forward, 1 step back
Imaging X-rays Cause Cancer: A Call to Action for Caregivers and Patients
Information and shared decision-making are top patients' priorities
Medical Errors That Lead to Missed Diagnoses in Primary Care
Minimum surgery volumes in hospitals: Are the outcomes better in hospitals that do more operations?
Radiation Risk From CT Scans: A Call for Patient-Focused Imaging
Report from RSNA: Irish radiologists take urgent action to eradicate superbug " Colonized and infected patients are the main reservoirs of MRSA, but it has also been found on floors, sinks, work areas, tourniquets used for blood drawing, and blood pressure cuffs. Once it becomes endemic, it is rarely eliminated and may eventually account for up to half of all nosocomial Staphylococcal infections. … Scanlon advises radiologists to make sure the correct cleaning substance (i.e., a hyperchlorite anti-MRSA microbial agent) is used. He recommends introducing a regular biannual screening program to ensure detection and monitoring of MRSA, as well as having strict handwashing and glove-wearing policies."
Scientists Suggest Alternative to COX-2 Drugs "Cox-2s work by suppressing a key enzyme called cyclooxegenase-2 (cox-2), which in turn dampens the production of two cox-2-derived compounds, prostacyclin (PGI2) and prostaglandin 2 (PGE2). Trouble is, both PGI2 and PGE2 are thought to help maintain cardiovascular health by preventing platelets in blood vessels from clumping together. So researchers speculated that cox-2 suppression might keep PGI2 and/or PGE2 from doing their job, boosting risks for stroke or heart attack. ."
Staphylococcus aureus bacteremia in patients with prosthetic devices: costs and outcomes. (Am J Med. 2005)
Ten Things Your Hospital Won't Tell You
There Have Been Inadequate Warnings That Erectile Dysfunction Drugs Can Cause Blindness
Visual loss with erectile dysfunction medications.
What Is An Appropriate Response to the Dangers of CT Radiation?
JOURNAL ARTICLES:
Are Physicians Ready for Patients With Internet-Based Health Information? (Journal of Medical Internet Research (JMIR) 2006) "Conclusion: Effective initiatives at the level of the health care system are needed. The potential of Internet-based health information to lead to better physician-patient communication and patient outcomes could be facilitated by promoting physician acknowledgment of increasing use of the Internet among patients and by developing patient management guidelines and incentives for physicians."
Case reports of suspected adverse drug reactions-systematic literature survey of follow-up (BMJ 2006)
[Frequency and utility of internet use by orthopaedic patients.] ( Orthop Ihre Grenzgeb. 2006 )
Handwashing: a simple, economical and effective method for preventing nosocomial infections in intensive care units. (J Hosp Infect. 2006)
Healthcare equipment as a source of nosocomial infection: a systematic review. (J Hosp Infect. 2006)
[Medication errors in pediatric inpatients: a multicentric prospective study.] (Arch Pediatr. 2006)
Nonsteroidal Antiinflammatory Drugs, Acetaminophen, and the Risk of Cardiovascular Events (Circulation 2006)
[NSAIDs and COX-2-inhibitors: current status.] (Internist (Berl). 2006)
Postsurgical Infections are Reduced with Specialized Nutrition Support. (World J Surg. 2006)
When Do Older Adults Turn to the Internet for Health Information? Findings from the Wisconsin Longitudinal Study. ( Gen Intern Med. 2006)
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