Blog & Articles

[6 MIN READ]

Is there really such a thing as a normal day on the OB unit? Highly doubtful. Unpredictability and uncertainty loom from the beginning of your shift to the end. But what if you could achieve some control over your day and try to decrease both your personal stress level and the stress of those in your immediate environment? While keeping your day 100% stress-free may not be possible, at least lowering the stress level for yourself and others is achievable and can help you to maintain stellar composure through the most grueling of patient scenarios.

[7 MIN READ]

As heightened U.S. maternal morbidity and mortality rates gain national attention, AWHONN and ACOG, as well as state perinatal quality collaboratives, notably California, have emphasized that hospitals need to focus on improving outcomes with specific attention to the leading causes of maternal mortality.

The RSQ® Assessment – Obstetrics provides the framework for the creation of a comprehensive obstetrics safety program within your organization, as well as the foundation for an obstetric culture of safety surrounding the key drivers of maternal mortality and morbidity.

[3 MIN READ]

The incidence of spinal epidural abscess (SEA) has doubled in the past 2 decades due to the epidemic of MRSA infections, the spread of IV drug use, and the increased number of spinal and vascular access procedures. Delayed or missed diagnosis of SEA leads to profound disability or death; lawsuits in this arena are exceptionally costly.

[6 MIN READ]

Physicians, nurses and other “healers” have had special relationships with patients for centuries. This unique bond between those who provide medical treatment and those who receive their care is currently being endangered by a massive and impersonal healthcare delivery system that is becoming more dependent on automation and technology with each passing year. The good news is that patient attitudes, impressions, and subsequent compliance with treatment plans can be positively influenced when healthcare professionals improve their communication skills with their patients.

Studies show that there is a clear relationship between high patient satisfaction and healthcare organizations that provide safe, quality care. A report by Health Grades (May 2012) noted that hospitals that were ranked (by patients) in the top percentages for nursing and physician communication had lower rates of adverse patient safety events. For example, bed sores occurred approximately 46% more frequently in hospitals that patients had ranked in the lowest 10% for provider communication.

[7 MIN READ]

The care of the surgical patient is dependent upon doctors, nurses, technicians and both office and hospital staff. Like all humans, despite their best efforts, they make mistakes. Encouraging them to “try harder” simply will not work.

To reduce surgical errors we need to identify root causes and institute system-based processes to prevent them.

Studies have suggested specific areas that offer opportunities for improvement. Kim et al.^[1] noted that adverse events from surgical intervention are more commonly due to preoperative and/or postoperative errors. These include delay in diagnosis and/or treatment and communication errors between the healthcare team and the patient/family or other members of the healthcare team. Process measures that can address these issues include:

[3 MIN READ]

Headache is a common reason for a visit to practitioners in primary care, urgent care, and emergency medicine. Patients with the chief complaint of non-traumatic headache comprise 3% of all emergency department visits.

The vast majority of these headaches will have a benign etiology such as tension or migraine. Unpredictably interspersed among these benign presentations are patients with a serious cause of headache such as hemorrhage or CNS infection.

Malpractice cases involving headaches frequently involve the missed diagnosis of subarachnoid hemorrhage (SAH). The reasons the diagnosis of SAH is missed include the following:

[5 MIN READ]

Despite the wake-up call given almost 20 years ago by the Institute of Medicine’s report “To Err is Human,” medical errors still occur at alarming rates.

The landmark publication estimated that up to 98,000 Americans die each year from medical errors, and one out of every twenty-five hospitalized patients is harmed by a medical mistake.

There is, however, cause for guarded optimism. Many organizations, agencies and legislatures have stepped forward and created solutions and educational programs targeted at reducing medical errors.

[3 MIN READ]

Malpractice claims related to the chief complaint of chest pain continue to plague clinicians. Foremost among these claims is the allegation of “missed MI,” which has now been expanded to include missed unstable angina as well as missed actual myocardial infarction.

Although the evaluation of the adult with chest pain is fraught with many pitfalls, one of the most glaring yet avoidable errors is the reliance upon “bedside maneuvers” to exclude the diagnosis of coronary etiology.

[9 MIN READ]

Standardization is known for reducing variation and increasing consistency; it continues to be a recognized safeguard to decreasing liability and improving outcomes.

High-quality postpartum care includes implementation of both standardized discharge processes and teaching that can improve maternal outcomes.

AWHONN promotes postpartum discharge standardization and encourages that specific components of postpartum discharge teaching align with leading causes of maternal morbidity and mortality.

While we previously outlined best practices in postpartum discharge teaching strategies, here we will discuss specific standardized teaching content that needs to be communicated to postpartum patients and their families at the time of discharge or sooner.

Educating patients and their families to recognize important warning signs and symptoms and clearly understand normal healing versus abnormal symptomatology is strategic in reducing maternal morbidity and mortality.

[6 MIN READ]

An adverse drug event (ADE) is defined as harm experienced by a patient resulting from exposure to a medication. An ADE can be caused by an error or poor care, but it is estimated that about half of ADEs are caused by a medication error; these are known as preventable adverse drug events.

Statistics are staggering; they reveal that ADEs lead to 700,000 ED visits, 100,000 hospitalizations, and between 7,000 and 9,000 deaths every year in the U.S. Even within the “safe” confines of hospital care, about 5% of hospitalized patients experience an ADE. 

Opioid analgesic use in the hospital setting is usually safe, but it is also associated with serious ADEs. In this issue, we present a case of an adverse drug event that illustrates many of the features known to contribute to opioid-related ADEs in the hospital. Whether this ADE was preventable, treatable or unavoidable – you be the judge!