“We [the EMS industry] need a unified message on safety,” was a key message tying together several presentations at the Center for Patient Safety’s 2013 EMS conference held on May 7th in Columbia, Missouri.
This year’s fourth annual event brought over 80 attendees a variety of updates and ideas about safety culture in EMS at national and local levels, from the broad-based need for an industry safety culture being developed through the National Culture of Safety Project; learning to recognize expertise and its influence on perceptions of safety; understanding that “you can’t be curious and angry at the same time,” to perform unbiased event investigations; and learning about one agency’s success at identifying medication errors, and how they have changed their system for administering medications.Comments from attendees included: “This conference featured some of the best speakers that I have heard in a long time”; “The topics presented were useful, relevant, and interesting”; and “I will be taking a hard look at medication errors.”
Visit our conference web page for downloads and recordings!!
The Second Victim Experience: Train-the-Trainer Workshop
Presented by Sue Scott, RN, MSN and Laura Hirschinger, RN, MSN
The Center for Patient Safety is pleased to offer this unique workshop on June 11, 2013 to learn and teach the skills to support staff members and physicians who are impacted by adverse and/or unexpected clinical outcomes. Participants will gain insights into the “second victim” experience as well as supportive interventions from faculty who developed and implemented the University of Missouri Health System’s successful “second victim” program. Participants will also acquire the knowledge, skills and techniques necessary to implement a “second victim” program for peers at their organizations.
Space is limited to 40 participants and will be made available on first come first serve basis.
- To discuss the ‘second victim’ phenomenon
- To describe the various stages of second victim recovery
- To identify and reflect on several second victim events
- To recognize high risk clinical events which could expose clinicians to the ‘second victim’ phenomenon
- To identify various interventional strategies to support clinicians experiencing the ‘second victim’ phenomenon
- To identify and practice ways to initiate a crucial conversation with a second victim
- To describe the various steps necessary to deploy a support team
DATE: June 11, 2013
TIME: 8:00 AM to 4:00 PM (registration and continental breakfast 7:30-8:00 AM)
FEE: $375 per person (continental breakfast, lunch, and snacks included)
Top 10 essentials for effective instrument cleaning from the ECRI Institute PSO:
- Provide adequate trained staff, facilities, and resources for the sterile processing department.
- Standardize and simplify procedures in all areas where instruments are reprocessed.
- Monitor the quality of instrument reprocessing through post-cleaning inspections.
- Seek input from reprocessing department staff on instrument and equipment purchases.
- Limit the operating room’s dependence on immediate-use sterilization.
- Establish delivery criteria for loaned instruments and prohibit immediate-use sterilization of them.
- Require regular competency assessments of staff who reprocess instruments.
- Foster collaboration and teamwork among reprocessing department and operating room staff.
- Recognize and respect the contribution by reprocessing staff to patient safety and quality care.
- Encourage prompt reporting of events or near misses involving contaminated instruments.
Read the full article at “Infection Control Today“.
Posted in AHRQ, CMS Posted April 18, 2013
On March 15, 2013, the Centers for Medicare and Medicaid Services (CMS) released a memo about the Agency for Healthcare Research and Quality’s (AHRQ’s) Common Formats. The memo provides information on the Common Formats and how their use may help hospitals meet the CMS Quality Assessment and Performance Improvement (QAPI) requirements.
Hospitals are required to track adverse patient events as a Condition of Participation (CoP) for QAPI requirements. Although Common Formats use is voluntary, CMS is encouraging surveyors to become familiar with them. CMS states that, “Use of the AHRQ Common Formats by hospitals is not required under the QAPI CoP. We suggest, however, that a hospital that uses the Common Formats and is adept at the analysis that this structured system permits, will be in a better position to meet the CMS QAPI requirements.”
To view the memo, please go to CMS’ Web site at: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-13-19.html
Posted in Patient Safety Posted March 27, 2013
Root Cause Analysis is a key part of patient safety work. Think Reliability offers periodic FREE webinars that examine aspects of this critical discipline, usually through discussion of a great example. A recent program discussed the interrelationship between process maps (that flow from start to finish) and RCA’s (which flow from the finish to the start). The company offers its excel-based RCA tool free on its website if you register at www.thinkreliability.com, where you can also get information on upcoming webinars.