Health Care Safety Index July through October 2016

Surgical Malpractice
Health Care Safety Index April/May 2016
June 18, 2016

Health Care Safety Index July through October 2016

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The Centers for Disease Control and Prevention recommended lowering the dosage of vaccination for human papillomavirus (HPV) to two vaccine doses administered at least six months apart for females 15 years or younger. Three doses are still recommended for females over 15 years old.

During the 2015-2016 influenza season, data from the United States Influenza Vaccine Effectiveness Network indicated that inactivated influenza vaccine (IIV) was more effective in preventing influenza in children than live attenuated influenza vaccine (LAIV). As a result, in August 2016, the United States Centers for Disease Control and Prevention recommended that LAIV not be used during the 2016-2017 influenza season.

A study appearing in the New England Journal of Medicine suggests that treating women with a ten-year course (instead of a five-year course) of an aromatase inhibitor may decrease the risk of recurrence in non-metastatic hormone receptor-positive breast cancer.

The American Thoracic Society has developed guidelines for evaluation of children younger than 2 years of age suffering from recurrent wheezing unresponsive to bronchodilators or inhaled or systemic glucocorticoids. Recommendations now include videofluoroscopic swallowing studies for possible swallowing dysfunction; 24-hour esophageal pH monitoring for assessment of gastroesophageal reflux; and/or flexible fiberoptic bronchoscopy bronchoalveolar lavage  to assess for lower airway bacterial infection.

The British Association of Dermatologists released new guidelines for the management of Stevens-Johnson syndrome.

The American Academy of Ophthalmology issued revised recommendations for screening and prevention of retinopathy for patients taking the antimalarial agents hydroxychloroquine (HCQ) and chloroquine for the treatment of systemic lupus erythematosus, rheumatoid arthritis, and other inflammatory and dermatologic conditions. All patients should undergo a baseline eye examination before or within a year of beginning treatment with these drugs and at least annually after five years of exposure for patients without major risk factors.

The Pennsylvania Department of Health and the CDC established an association between M. Chimaera infections and exposure to contaminated Stockert 3T heater-cooler devices used in open heart surgery. Providers of patients who have undergone cardiac surgery should be aware of the possibility of M. chimaera infection, even months to years following the procedure.

A study in the New England Journal of Medicine concluded that the use of CPAP for obstructive sleep apnea does not prevent cardiovascular events in patients in patients with moderate to severe obstructive sleep apnea.

An article in the New England Journal of Medicine concluded that there is a stronger association between pulmonary embolisms and syncope than was previously thought.

A study in Pediatrics concluded that a systematic collaborative care approach for adolescents suffering from persistent post-concussive symptoms involving embedded cognitive-behavioral therapy, care management, and psychopharmacological consultation was more successful in reducing post-concussive and psychological symptoms.

A paper published in Neurology demonstrated that there are no benefits associated with the use of estrogen in postmenopausal women for verbal memory, executive function or global cognition.

A paper in BMJ concluded that there was no clinically relevant difference between twelve weeks of supervised physical therapy and arthroscopic surgery in patients who suffer from degenerative meniscal tears.

In a study published in JAMA, the United States Preventive Services Task Force indicated that there was insufficient evidence to assess the balance of benefits and harms of a visual skin examination by a clinician to screen for skin cancer in adults.

The CDC reported that incidents of chlamydia, gonorrhea and syphilis are at an all-time high.  

A study published in JAMA Psychiatry called into question the assumed relationship between ADHD during childhood in adults suffering from the condition, noting that only 12.6% of young adults in the study with ADHD had the disorder in childhood.

A study published in the Lancet concluded that while endovascular repair had early survival benefits over open repair of abdominal aortic aneurysm, it had inferior benefit for late survival because of secondary aneurysm sac rupture. The authors concluded that patients receiving endovascular repair of abdominal aortic aneurysms should receive life-long surveillance.

An article appearing in Lancet Oncology supported the use of Ibrutinib in patients with chronic lymphocytic leukaemia or small lymphocytic lymphoma.

The Infectious Diseases Society of America and the American Thoracic Society published new guidelines regarding the management of hospital-acquired and ventilator-associated pneumonia.

A study in JAMA Pediatrics found no association between labor induction with Oxytocin and autism.

A study published in Pediatrics concluded that preschool-age children with early weekday bedtimes (8:00 pm or earlier) were one-half as likely to be obese as adolescents as children with late bedtimes (after 9:00 pm).

The CDC announced that the five leading causes of death include heart disease, cancer, stroke, chronic lower respiratory illnesses and accidents. Forty percent of the deaths from these five leading causes were deemed preventable.

A study undertaken by the Joint Commission Center for Transforming Healthcare Project concluded that patient injuries related to falls continue to be an issue at U.S. hospitals even though many organizations have implemented initiatives to address this problem. Unfortunately, common practices are not implemented consistently.

The Pew Charitable Trusts, in collaboration with the Johns Hopkins Armstrong Institute for Patient Safety and Quality convened 70 experts representing makers of Electronic Health Records (EHR) systems, hospitals, clinicians, patient safety advocates, and the federal government to discuss how to improve electronic health records. Three major problems were identified with current EHR records systems. First, not all vendors of EHR systems perform comprehensive usability assessments before the products are deployed in hospitals. This causes problems because the smallest changes during development and installation can cause patient harm. Second, industry-wide there is an absence of metrics for EHR patient safety performance. Third, there is no system in place that allows for sharing the development and implementation of resolutions to EHR problems among facilities.

An article published in BMJ Quality and Safety concluded that substituting nursing assistants for professional nurses in acute care hospitals in Europe led to poorer quality of care and increased mortality.

The Accreditation Council for Graduate Medical Education has recommended scrapping the 16-hour shift limit and recommended allowing first year residents to work a 28 consecutive hour shift instead. Both the American Medical Student Association and the Committee of Interns and Residents oppose the proposal.

The World Health Organization issued new guidelines about how to prevent surgical site infections.

A study presented at the The Mental Health Services 2016 Conference of the Institute of Psychiatric Services concluded that SSRI’s disrupt sleep in the elderly and may contribute to dementia.

The American Association of Blood Banks issued new guidelines for transfusions. The new recommendations include two tiers of hemoglobin level transfusion triggers: 7 g/dL for hemodynamically stable adults (even those in critical care) and 8 g/dL for patients with preexisting cardiovascular disease or those undergoing cardiac or orthopedic surgery.

The FDA warned against the use of homeopathic teething tablets and gels. The warning recommended that use of tablets and gels stop and that these devices be disposed of. The warning further indicated that medical care should be sought immediately if seizures, difficulty breathing, lethargy, excessive sleepiness, muscle weakness, skin flushing, constipation, difficulty urinating, or agitation were present.

A study published in Pediatrics concluded 1 in 5 parents committed dosing errors when administering liquid medication to children.  Oral syringes should be used for the measurement of liquid medications, particularly when small doses are recommended.

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