Treatment Errors

Latest Issue of OR Manager
August 2018
Home Safety/Quality > Patient Safety > Treatment Errors

FDA letter updates risks of Type III endoleaks with aortic endovascular graft systems

Editor's Note In a June 19 letter to healthcare providers, the Food & Drug Administration (FDA) says it continues to evaluate information from several sources, including manufacturers, on the risks associated with Type III endoleaks with various endovascular graft systems used for treatment of abdominal aortic aneurysms (AAAs) and aorto-iliac…

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By: Judy Mathias
June 20, 2018
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AHRQ: Decline in HACs saves 8,000 lives, $2.9 billion

Editor's Note National efforts by the Centers for Medicare & Medicaid Services to reduce hospital-acquired conditions (HACs) helped prevent some 8,000 deaths and save $2.9 billion in costs between 2014 and 2016, according to a new report released June 5 by the Agency for Healthcare Research and Quality (AHRQ). Data…

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By: Judy Mathias
June 7, 2018
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Constancy: The key ingredient for safe patient care

When errors occur, sometimes with devastating consequences, healthcare leaders often perform a root cause analysis (RCA) to prevent a recurrence. Understanding what happened is an important step in the recovery process. It’s also important to realize the effect of a sentinel event on healthcare providers—those “second victims” who find themselves…

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By: Elizabeth Wood
May 18, 2018
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Analysis predicts costs of adverse patient safety events

Editor's Note A Frost & Sullivan analysis shows adverse patient safety events will cost the US and western Europe $383.7 billion by 2022, the February 26 Becker’s Clinical Leadership & Infection Control reports. These adverse events will lead to an estimated 91.8 million patient hospital admissions and about 1.95 million…

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By: Judy Mathias
March 5, 2018
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Joint Commission updates sentinel event stats for 2017

Editor's Note The Joint Commission on February 28 announced the update of its sentinel event statistics for 2017. Of 805 reports reviewed, the Top 10 events most frequently reported included: unintended retention of a foreign body−116 events (first place) wrong-patient, wrong-site, wrong-procedure−95 events (third place) medication error−32 events (eighth place)…

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By: Judy Mathias
March 1, 2018
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NPDB launches hospital attestation initiative

Editor's Note The Joint Commission on February 14 announced that the National Practitioner Data Bank (NPDB) has launched a new initiative for US hospitals to complete their attestation when renewing their NPDB registrations. The NPDB is a repository of reports on medical malpractice payments and adverse actions related to healthcare…

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By: Judy Mathias
February 16, 2018
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Visual cues help PACU staff avoid medication errors

Concern about opioid abuse has reached epic proportions in recent months, and healthcare providers have come under increasing pressure to help mitigate the problem. Curbing the tendency to overprescribe pain medications is considered the first, most obvious step, but there are other actions that can also improve patient safety. Nurse…

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By: Judith M. Mathias, MA, RN
January 19, 2018
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Meta-analysis supports ‘weekend effect’ for surgical patients

Editor's Note Postoperative mortality rises as the day of the week of elective surgery approaches the weekend and is higher after admission for urgent/emergent surgery on the weekend, this meta-analysis from the University of Calgary finds. The analysis included 10 studies that involved about 6.7 million patients having elective procedures…

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By: Judy Mathias
January 17, 2018
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Interventions increase reporting of adverse events by pediatric anesthesiologists

Editor's Note Electronic mandatory incident reporting system data entry and an initiative to understand and address reporting barriers and motivators were associated with sustained increases in adverse event reporting by pediatric anesthesiologists, in this study. Of 72,384 pediatric anesthetics analyzed, there were 2,689 adverse events. A subgroup of 54,469 cases…

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By: Judy Mathias
November 7, 2017
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Nonoperative treatment of appendicitis linked to higher death rate

Editor's Note Twice as many patients with appendicitis are being treated without surgery compared to 20 years ago; however, nonoperative management is associated with a higher death rate, finds this study presented October 26 at the American College of Surgeons Clinical Congress 2017 in San Diego. A total of  477,680…

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By: Judy Mathias
October 27, 2017
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