New ISMP Long-Term Care AdvisERR newsletter

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The Institute for Safe Medication Practices (ISMP) has issued the July edition of its newsletter, Long-Term Care AdvisERR.  The newsletter includes tips on safe administration of U-500 Insulin, safe use of new oral dispensers for morphine sulfate, as well as addressing how to set up your MAR to avoid confusion.  Here is a link to subscribe to this free resource that offers advice on frequently reported medication safety events and access past issues.

AHRQ and The Joint Commission e-learning module for LTC

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The Agency for Healthcare Research and Quality (AHRQ) and The Joint Commission released an e-learning module last week aimed at reducing healthcare-associated infections (HAIs) in assisted living and nursing homes.  The tool is available to all long-term care facilities and includes resources and quizzes in an online format.   The objective of the tool is to provide principles to “prevent infections and achieve high safety performance over extended periods of time”.

Opportunity for Long Term Care Facilities!

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National Collaborative to Reduce Infections, Focus on CAUTI!  SIGN UP BY AUGUST 29th!

The Center for Patient Safety and Missouri Hospital Association are partnering to bring national faculty and resources to Missouri nursing homes to work collaboratively on reducing infections with a focus on eliminating CAUTI!  Sign-up for this opportunity is only available until August 29th!  There is no cost for participating in this collaborative!

To learn more about the project:

Register to participate on the national informational call on August 5th at 2 PM CST. Register for the call here!

For additional information, including an overview of the project, team leaders responsibilities and a downloadable Project Interest Form, go here.

If you have any questions, please contact Kathy Wire at the Center for Patient Safety at or Jessica Rowden at the Missouri Hospital Association at

Did you miss the NHTSA EMS Focus Webinar?

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Last month, NHTSA’s Office of Emergency Medical Services (OEMS) hosted the first installment of its EMS Focus: A Collaborative Federal Webinar Series.

The first webinar, moderated by Dr. Brinsfield, Federal Involvement in EMS — provided the EMS community with an opportunity to discuss EMS activity at the federal level – in real time. The priorities include:

  • Evidence Based Guidelines
  • Preparedness
  • Military to Civilian Credentialing

For this recording or future webinars visit their website.

PSOs connect to share legal overview with participants

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On July 17, 2014, PSO Participants were invited to attend “PSO Participation and Protections – a Practical and Legal Perspective”, a webinar cohosted by the North Carolina Quality Center PSO and the Center for Patient Safety PSO.  Topic coverage included legal perspectives and PSOs presented by Michael R. Callahan. Mr. Callahan also reviewed case law and the North Carolina, Illinois and Missouri Statutes.  CPS PSO Participants can download materials and watch the recorded session.

Strategy for a National EMS Culture of Safety

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Almost a year later…have you read it yet?

It’s been almost a year since once of the most important safety and culture documents has been released.  The Center for Patient Safety encourages you to read the Strategy for a National EMS Culture of Safety and support discussion with your peers.

Exciting Membership News

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The Center for Patient Safety is exited to announce our newly acquired membership with the American Ambulance Association (AAA). Our membership with AAA will support the opportunity to engage work with EMS leaders from diverse organizations around the country. The Center will be exhibiting at the AAA Annual Conference and Trade Show November 17-19 in Las Vegas.
For more information visit their website:

Senate Holds Hearing on Need to Improve Patient Safety, Reduce Harm, Solutions Proposed

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On July 17, a Subcommittee of the US Senate Committee on Health, Education, Labor and Pensions, held a hearing “More than 1,000 Preventable Deaths a Day is Too Many: The Need to Improve Patient Safety”; a topic near and dear to the heart of the Center for Patient Safety.

National patient safety experts testified before the subcommittee highlighting the need for increased attention on patient safety and the need to reduce patient harm. Highlights of testimony provided by these experts included updated statistics on preventable deaths being as high as 400,000 annually and a call for a focus on the science of safety, improving the safety culture, improving measurement, utilizing health information technology to link systems and providing more information to the public about quality and safety to make health care decisions.  Possible solutions offered by these experts include a greater role for the government such as expanding the role of the CDC to receive and report data, developing a National Patient Safety Board or expanding roles of The Joint Commission and CMS to increase health care oversight, enhancing information technology, increasing transparency and aligning leadership incentives focused on quality and safety.

Many of the topics are being addressed through the Center’s work:  The importance of assessing and improving the safety culture; collecting adverse event, near miss and unsafe conditions to identify what medical errors occur, evaluate why they occur and identify solutions to prevent harm; encouraging discussions across providers on medical error, harm and prevention to share learning and training and supporting evidence based practices to improve safety culture and reduce healthcare-acquired infections through our work in collaboration with the Missouri Hospital Association.

A Webcast of the hearing is available at

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