For patients with severe, disabling rheumatoid arthritis (RA), oral methotrexate is often the preferred disease-modifying antirheumatic drug, unless it is specifically contraindicated (Bykerk et al., 2012; Saag et al., 2008; Singh et al., 2012). compared to dosing for antineoplastic indications, methotrexate for RA is administered once weekly as low-dose therapy (Sing et al., 2012). According to official prescribing information, the recommended starting dose is a single oral dose of 7.5 mg once weekly or divided oral doses of 2.5 mg every 12 hours for three doses per week. The dosing schedule may be adjusted to achieve optimal response, with doses up to about 25 mg weekly.

Ask 10 healthcare leaders if they’ve heard of high reliability, and it’s almost certain all 10 will say they have. Ask those same 10 to define high reliability, and things get interesting.

Many healthcare leaders have a genuine interest in high reliability but often do not know exactly what it means or how to incorporate it among their organization’s other priorities. They just know it sounds right to say their organization is working to “get to high reliability,” and they hope it will be the silver bullet that solves all problems. Unfortunately, the term “high reliability” can become a buzzword when used without understanding what it is. Employed this way, it may sound great but lack substance—all sizzle and no steak.

As I approached the end of my first postgraduate year (PGY­1), one of the chief residents asked me to participate on the “LMP PCC project.” He explained that LMP PCC referred to a multidisciplinary labor-management, patient-centered care project where representatives from different disciplines would work together to enhance patient experience. At the beginning, I wasn’t sure what that actually meant, but I was excited for the opportunity to work on something that promised to make a difference, especially in my patients’ lives. As a PGY-1 resident, my days were usually occupied with floor work, didactic activities, and clinic schedules, so I looked forward to working on my first quality improvement project.

During the transition from hospital to home–or a skilled nursing or long-term care facility–patients with complex medical needs are at risk for sub-optimal outcomes due to issues with medication adherence and errors. Of particular concern are patients who, once discharged, do not obtain the medications prescribed for them during their hospital stay.

Recently I sat patiently in an examination room while my physician typed notes into a computer terminal. After a few moments, he paused and asked, “You know what electronic medical records are good at?” I smiled politely. “Federal compliance and billing,” he said. I didn’t have to wait long for the follow-up I knew was coming. “You know what they’re bad at? Caring for patients.”

Earlier this year, the National Patient Safety Foundation’s Lucian Leape Institute released a report calling for greater transparency in healthcare as a means of improving patient safety. Defining transparency as “the free, uninhibited flow of information available to the scrutiny of others,” the report argues for transparency across all areas of healthcare: between clinicians and patients; among clinicians; between organizations; and with the public (NPSF Lucian Leape Institute, 2015).

In our cover feature, Deborah Wachenheim tells the story of a grassroots effort in Massachusetts that resulted in a mandate for every hospital in the state to have a patient and family advisory council (PFAC). Now, five years after the mandate went into effect, PFACs are in use in many hospitals across the country. Deborah, who was involved in the Massachusetts movement, also describes experiences and lessons learned in two hospitals—an academic medical center and a community hospital.

In 1996, the Institute for Safe Medication Practices (ISMP) began describing cases of inadvertent intravenous (IV) administration of liquid substances meant for administration via feeding tubes (Using oral syringes, 1996). Of course, incidents had been happening long before that time, putting patients who simultaneously have IV lines and small-bore nasogastric (NG) feeding tubes or percutaneously inserted gastric tubes at risk.

Announcing our 39th Annual Health Care Quality & Patient Safety Conference

Although recent publications have enhanced our understanding of the second victim phenomenon, many questions remain unanswered. In an effort to explain this possible career-ending circumstance, the vast majority of the literature focuses on describing the second victim experience.