Introduction of enterprise risk management in neonatal intensive care unit to reduce breast milk errors.

Preterm infants born before 34 weeks gestation are unable to feed by mouth. Mothers of these preterm infants are thus asked to pump breast milk to be fed to infants through a nasogastric tube. Each mother's pumped breast milk must be carefully labelled and stored so that it is not fed to the wrong baby during the infants stay in the neonatal intensive care unit, which can range from days to months. All hospitals have strict policies and procedures in place to ensure infants are fed their mother's milk but still occasional errors are reported. We looked at the effect of introducing the enterprise risk management method in preventing breast milk errors in our neonatal intensive care unit.

Vitamin D levels in subjects with or without chronic kidney disease among Veterans with diabetes in North East United States.

AIM: To evaluate the prevalence of vitamin D deficiency and its relation to diabetes and kidney disease in Veterans residing in the North East United States (VISN 2). METHODS: In this retrospective study, we used data from the computerized patient record system at Stratton Veterans Administration Medical Center at Albany, NY (VHA) for those patients who had 25-hydroxyvitamin D levels and 1,25 (OH) vitamin D levels measured between 2007 and 2010. We collected demographic information including age, sex, body mass index and race; clinical data including diabetes, hypertension and CAD; and laboratory data including calcium, creatinine and parathyroid hormone (PTH) (intact). Vitamin D deficiency is defined as a serum 25-hydroxyvitamin D level of less than 20 ng/mL (50 nmol/L), and insufficiency is defined as a serum 25-hydroxyvitamin D level of 20 to 30 ng/mL (50 to 75 nmol/L). RESULTS: Data was available for approximately 68000 subjects. We identified 64144 subjects for analysis after exclusion of duplicates. Among them, 27098 had diabetes. The mean age of subjects with diabetes was 68 ± 11 with a mean body mass index (BMI) of 32 ± 7 and duration of diabetes of 5.6 ± 3.2 years. The mean 25 (OH) vitamin D level among subjects with diabetes was 27 ± 11.6. There was no significant difference in 25 (OH) vitamin D levels between subjects with diabetes and glomerular filtration rate (e-GFR) < 60 compared to those with e-GFR ≥ 60. As expected, subjects with e-GFR < 60 had significantly lower 1,25 (OH) vitamin D levels and significantly elevated PTH-intact. Of the 64144 subjects, 580 had end-stage renal disease. Of those, 407 had diabetes and 173 did not. Vitamin D levels in both groups were in the insufficiency range and there was no significant difference irrespective of presence or absence of diabetes. Subjects with vitamin D levels less than 20 ng/mL had a higher BMI and elevated PTH, and higher HbA1C levels compared to those with vitamin D levels more than 20 ng/mL. CONCLUSION: We conclude that we need to keep a close eye on vitamin D levels in subjects with mild chronic kidney disease as well as those with moderate control of diabetes.

Vitamin d levels in subjects with prostate cancer compared to age-matched controls.

Prostate cancer (PCa) is the second most common cancer in men worldwide and the second leading cause of cancer deaths in men in the United States. Vitamin D is considered to have anticancer properties, currently thought to work mainly through its nuclear receptor or vitamin D receptor. In this retrospective study, we compared vitamin D levels in subjects with PCa with those of age-matched men without PCa. Study subjects included 479 in each group with a mean age of 73 and a mean creatinine of 1.05 and 1.15. Levels of 25 (OH) vitamin D were 28.4 ± 0.54 and 28.05 ± 0.62 in subjects with and without PCa. Levels of 1,25 (OH) vitamin D were 47.2 ± 6.8 and 47.1 ± 7.11 in subjects with and without PCa. In contrast to other studies, we did not find a significant difference in vitamin D levels. Among prostate cancer patients, vitamin D levels correlated positively with age (r = 0.12, P < 0.02), and were negatively associated with BMI (r = -0.13, P = 0.003), glucose (r = -0.12, P < 0.007), HbA1C (r = -0.16, P = 0.001), and PTH (r = -0.21; P < 0.0001). The data do not show the causal effect of vitamin D levels on PCa.

Consensus-based recommendations for research priorities related to interventions to safeguard patient safety in the crowded emergency department.

This article describes the results of the Interventions to Safeguard Safety breakout session of the 2011 Academic Emergency Medicine (AEM) consensus conference entitled "Interventions to Assure Quality in the Crowded Emergency Department." Using a multistep nominal group technique, experts in emergency department (ED) crowding, patient safety, and systems engineering defined knowledge gaps and priority research questions related to the maintenance of safety in the crowded ED. Consensus was reached for seven research priorities related to interventions to maintain safety in the setting of a crowded ED. Included among these are: 1) How do routine corrective processes and compensating mechanism change during crowding? 2) What metrics should be used to determine ED safety? 3) How can checklists ensure safer care and what factors contribute to their success or failure? 4) What constitutes safe staffing levels/ratios? 5) How can we align emergency medicine (EM)-specific patient safety issues with national patient safety issues? 6) How can we develop metrics and skills to recognize when an ED is getting close to catastrophic overload conditions? and 7) What can EM learn from experts and modeling from fields outside of medicine to develop innovative solutions? These priorities have the potential to inform future clinical and human factors research and extramural funding decisions related to this important topic.

2010 Annual National Patient Safety Foundation Congress: conference proceedings.

On May 17Y19, 2010, the National Patient Safety Foundation(NPSF) held its Annual Patient Safety Congress in Orlando, Florida. Entitled 'Getting Results: Solutions That Work', the meeting reinforced the need to focus on critical work in patient safety as health care reform begins to unfold. Without this focus, the industry will not be able to realize the Institute of Medicine's aims for safer, more efficient, equitable, timely, and truly patient-centered health care. The NPSF Congress provided meaningful content through plenary and breakout sessions that discussed a variety of real-world tools, resources, and evidence-based solutions to safety issues. The Congress was co-chaired by 2 distinguished leaders in patient safety: Doug Bonacum, MBA, BS, vice president for Safety Management at Kaiser Permanente and a member of the board of directors of NPSF; and Barbara J. Youngberg, JD, MSW, BSN, visiting professor in the School of Law at Loyola University Chicago and a member of the board of directors of NPSF. The main conference was preceded by 2 concurrent day-long workshops and 2 half-day workshops: Leadership Day: Creating An Accountable Culture to Drive Needed Change; Community Engagement from the Patient and Family Perspective; Simulation Fundamentals to Advance Your Patient Safety Agenda; and Measurement Boot Camp: Strategies and Tactics for the Real World. The Congress featured 4 plenary sessions, 35 breakout sessions, and the debut of the Learning and Simulation Center, which created an environment for attendees to engage in hands-on, interactive settings and provided real-world solutions to improve patient safety and quality of care. This article provides summaries of the plenary sessions.

Event reporting: the value of a nonpunitive approach.

This article will discuss why patient safety has been so hard to achieve due to long standing beliefs that when errors occur individuals must be blamed or punished. It will offer suggestions as to how a culture of learning can be advanced by fostering a different approach to medical errors and how reporting systems and an analytic process that always identifies root causes of problems can help physicians reduce harm to patients and ultimately malpractice risk.

Organizational factors associated with high performance in quality and safety in academic medical centers.

PURPOSE: Leaders of academic medical centers (AMCs) are challenged to ensure consistent high performance in quality and safety across all clinical services. The authors sought to identify organizational factors associated with AMCs that stood out from their peers in a composite scoring system for quality and safety derived from patient-level data. METHOD: A scoring method using measures of safety, mortality, clinical effectiveness, and equity of care was applied to discharge abstract data from 79 AMCs for 2003-2004. Six institutions (three top and three average performers) were selected for site visits; the performance status of the six institutions was withheld from the site visit team. Through interviews and document review, the team sought to identify factors that were associated with the performance status of the institution. RESULTS: The scoring system discriminated performance among the 79 AMCs in a clinically meaningful way. For example, the transition of a typical 500-bed hospital from average to top levels of performance could result in 150 fewer deaths per year. Abstraction of key findings from the interview notes revealed distinctive themes in the top versus average performers. Common qualities shared by top performers included a shared sense of purpose, a hands-on leadership style, accountability systems for quality and safety, a focus on results, and a culture of collaboration. CONCLUSIONS: Distinctive leadership behaviors and organizational practices are associated with measurable differences in patient-level measures of quality and safety.

Using information to empower nurse managers to become champions for patient safety.

There is no longer any question about the risks to patients safety that exist in the hospital. Hospitals are macrosystems that are built upon many interrelated microsystems. Most patient care and hence most errors that directly affect the care outcomes and negatively impact patient safety occur at the microsystem unit level, which is the same level that many improvements to patient safety occur. Patient Safety Net (PSN) is an on-line occurrence reporting tool being used by University HealthSystem Consortium (UHC) member hospitals to report medical events and improve care. As PSN became progressively integrated into the daily operations of these UHC members isolated anecdotes began to surface about how unit nurse managers were able to implement rapid and effective patient safety improvements at the microsystem level on the basis of data received through PSN, without involving performance and safety committees mechanisms. This article highlights the survey performed to validate these improvement anecdotes.

Panniculectomy--an option for people who are morbidly obese.

Obesity is becoming a major health issue across the nation. Surgical procedures to alleviate problems of severely limited ambulation, development of open wounds, and overeating may be an option for people who are morbidly obese. A gastric bypass procedure and panniculectomy are among the surgical options available. In this article, the preoperative, intraoperative, and postoperative care of a patient undergoing a panniculectomy are presented. A safe, complication-free procedure can be performed with preplanning; a precise, detailed team effort; and an informed, motivated patient.