“Meaningful improvement only occurs when you normalize honesty.” 

                                                                                          —Rick Boothman  

As the executive director of clinical safety and chief risk officer at the University of Michigan Health System, Rick Boothman, JD, works with patients, families, clinicians, and staff members following cases of medical injury. Boothman started a program at Michigan in July 2001 that established honesty and respect as ground rules for communication, apology, and resolution of cases that traditionally have been ignored, shunned, or—when the subject of malpractice complaints—denied and defended.

Boothman was the closing speaker at the fourth annual forum of the Massachusetts Alliance for Communication and Resolution following Medical Injury (MACRMI), held at the offices of the Massachusetts Medical Society (MMS) in April. The founders of MACRMI were inspired by Boothman’s “Michigan model” and a handful of other programs across the country dedicated to offering open communication, apology, and fair compensation to patients and families harmed by medical care (Beaulieu, 2012). These programs also treat clinicians and staff members with compassion and often offer them emotional support, recognizing that healthcare workers may be traumatized by adverse events involving patients.

“Meaningful improvement only occurs when you normalize honesty.” 

Clinicians using a trigger tool can track overall harms and specific harms over time, and learn from past incidents and assess patient safety efforts, researchers say.

This article first appeared on HealthLeaders Media, June 8, 2016.

By: Alexandra Wilson Pesci

A new tool to retrospectively identify adverse events has the potential to make pediatric hospital care safer, research suggests.

Researchers at the AHRQ-funded Center of Excellence for Pediatric Quality Measurement at Boston Children’s Hospital have developed and tested the Global Assessment of Pediatric Patient Safety (GAPPS) trigger tool, which flags triggers, or clues, in the medical record that tip off medical professionals that an adverse event might have occurred.

Institute for Safe Medication Practices revises two of its six existing best practices, adds five more The Institute for Safe Medication Practices’ (ISMP) recently released “2016-2017 Targeted Medication Safety Best Practices for Hospitals,” which includes revisions to two existing best practices and five additional recommendations to reduce common medication errors. All told, the ISMP recommendations … Continued

In April, a Pennsylvania patient was being treated for a urinary tract infection when her physicians discovered she had a strain of colistin-resistant E. coli. Colistin is the industry’s “fallback” antibiotic, only used when bacteria are resistant to all other forms of antibiotics. The discovery means an antibacterial-resistance exists for every type of antibiotic, creating the risk of an infection invulnerable to all antibiotic treatments.

Antimicrobial Agents and Chemotherapy reported that the E. coli’s colistin resistance came from a gene called mcr-1. The mcr-1 gene and its corresponding drug resistance can be shared between bacteria, potentially creating entire strains of colistin-resistant infections. Researchers say that when combined with other forms of sharable antibiotic-resistance, mcr-1 could result in the first infection that’s completely invulnerable to all forms of antibiotics.

Source: HealthLeaders Media News In addition to aligning with coming standards from The Joint Commission, the document also promises to help hospitals follow existing guidelines from CMS and the CDC. A new “playbook” on the appropriate use of antibiotics aims to help hospitals reduce rates of drug-resistant infections and prepare for new standards to be … Continued

In a bold move, the Joint Commission deleted 131 requirements for the hospital program in late April. The deleted requirements include a number of documentation, privacy, and information continuity requirements. Some of the deleted requirements were removed because they were duplicative of other requirements or implicit in other standards, the Joint Commission said. Others, however, … Continued

CMS held a webinar on May 12 explaining the methodology and upcoming changes to its controversial five-star hospital ranking system. Under the ranking system, hospitals would receive more stars for better compliance with a set of measures that focus on mortality, safety, hospital readmissions, and the timeliness and effectiveness of care. Prior to the webinar, … Continued

EC.02.06.01 and IC.02.02.01 were the two most challenging standards for hospitals in 2015, both of which have significant patient safety implications.

The top two most frequently cited Joint Commission standards in 2015 are not necessarily surprising. Both are widely recognized as catchall standards that encapsulate a wide variety of survey violations.

However, both standards have clear patient safety implications that reveal ongoing concerns about scope reprocessing, infection prevention best practices, and managing behavioral health patients in the ED.

According to The Joint Commission, the top two most frequently cited standards for hospitals in 2015 were:

• EC.02.06.01 – Maintaining an environment that is safe and functional (62% noncompliance)
• IC.02.02.01 – Reducing infection risks from medical devices, equipment, and supplies (59% noncompliance)
  

By Richard Best Organizations across all industries are required to follow the Occupational Safety and Health Administration (OSHA) regulations in order to support a safe and healthful workplace. For healthcare facilities, compliance efforts span everything from safeguarding environmental conditions to preventing hazardous materials exposure to ensuring ergonomically correct procedures. Although OSHA focuses on preserving worker … Continued

By Tinker Ready, HealthLeaders Media

There’s hope. And there’s reality. On close inspection, the link between cost and quality is actually pretty fuzzy: We just don’t know.

One of the incentives for improving the quality of healthcare is the notion that it will also lower costs.

Ideally, patients will have a medical home to go to instead of an emergency room.