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June 15, 2022
Publish Date: June 14, 2022   |  Tags:   Patient Safety

THIS WEEK'S ARTICLES

Sharp Reductions in Sharps Injuries Are Achievable

Help Patients Return Unused Opioids

Fortune's "Change the World" List Recognizes Companies That Make a Difference - Sponsored Content

Can AI Reduce Pressure Injuries?

High-Risk Hip Fracture Patients Can Safely Take Anti-Bleeding Drug

 

Sharp Reductions in Sharps Injuries Are Achievable

Diligent tracking, analysis and policies can combine to make a huge impact.

Sharps Pamela Bevelhymer
OPEN BOOK The keys to preventing sharps injuries can often be found in the logs of previous incidents.

OSHA estimates 5.6 million healthcare workers and related occupations are at risk of exposure to bloodborne pathogens — including HIV, hepatitis B and hepatitis C — due to sharps injuries. While proper handling and passing practices remain important, the best way to protect your surgeons and staff from sticks and cuts is to eliminate the devices that cause them.

Janice Kilby, RN, MAN, MN, CNOR, a practice consultant at Kaiser Permanente Mid-Atlantic States (KPMAS), maintains a log to track sharps injury rates and analyze the nature of each injury. She includes the type and brand of devices involved in each exposure, the department or work area where the exposure occurred and an explanation of how the incident happened. The confidentiality of staff members involved is maintained.

By watching the trends, she identifies who is most at risk for injuries and why they occurred. The log forms the basis of quarterly reviews to determine if the injuries are related to product design, device failure, clinical factors such as sudden patient movement or the activity being performed. Ms. Kilby then designs and implements sharps safety education campaigns based on problem areas or injury types. Recently, for example, she found that about 30% of KPMAS' injuries involved surgeons, and that syringes were involved in 40% of injuries for a variety of reasons: the intricacies involved in giving an injection, difficulty in activating the syringe's safety mechanism and improper disposal of used needles.

The Needlestick Safety and Prevention Act, the law of the land for two decades, requires facilities to trial safety-engineered devices such as sharps disposal containers, self-sheathing needles and safety scalpels annually to identify and implement safe options. This requirement generates conversation and collaboration among physicians, clinical staff and managers to identify procedures during which unsafe devices are used, find safer alternatives, identify and address device usage challenges and, if necessary, file sharps exception requests.

KPMAS's sharps safety council, with support from leadership, mandated that all clinical managers submit sharps exception requests before being allowed to use non-safety-engineered devices within their respective departments. When clinical circumstances require use of non-safety-engineered devices, a surgeon or staff member partners with the department manager to apply for the use of the item.

"Look at the procedure being performed as well as the appropriateness of how the device is intended to be used," says Ms. Kilby. Once an exception is established and approved, she says you should require the user to renew the application for the device every two years, which enables you to determine if newer, safer alternatives have become available. Ms. Kilby says the requirement for those providers to constantly assess safer alternatives leads many to realize that safety-engineered devices not only limit exposure risks for themselves and their colleagues, but are also clinically effective.

As a result of this hard work, the sharps injury rate at KPMAS has trended downward over the past two years and the injury rate among the health system's ambulatory surgery centers dropped by 82% between 2016 to 2020. By implementing a continuous, comprehensive and collaborative safety program, your surgeons and staff can likewise be better protected from sharps injuries and the serious harm they can cause.

Help Patients Return Unused Opioids

Penn study shows surgical patients are more likely to get rid of extra painkillers when mailed disposal kits.

Pill BREAKING HABITS Giving or sending patients disposal kits for unused opioids is more likely to reduce abuse while wasting the leftover meds safely and properly.

Encouraging patients to throw away their unused opioids following surgery by sending them disposal kits can double the rate of people who get rid of the extra painkillers, according to a 2021 study by researchers at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.

During the study, 235 patients who underwent orthopedic and urologic procedures and were prescribed opioids for post-op pain were sent text messages with a suggestion to throw out any pills they didn't use along with a list of disposal locations. Half of them were also mailed a disposal container, which was used by 60% of those patients. Just 43% of those who received only the text instructions disposed of the medications.

National studies show that 20% to 30% of patients properly dispose of unused opioids, which means the patients who were sent the $2 disposal kits doubled or tripled the usual amount. "I was pleased to see that such a simple 'snail mail' approach could change behavior and promote self-reported disposal," says study lead author Anish Agarwal, MD, an assistant professor of emergency medicine and chief wellness officer of the Department of Emergency Medicine at Penn Medicine.

Dr. Agarwal believes the relatively small study's results are very promising for a nation grappling with a longstanding opioid abuse crisis. "One could imagine that if scaled up to the thousands of surgeries that are done per year in our health system and millions done in the U.S., how this could be extremely impactful at scale," he says.

Fortune's "Change the World" List Recognizes Companies That Make a Difference
Sponsored Content

Stryker's safety products and collaboration with healthcare partners help to prevent never events. 

Keeping patients and caregivers safe is a shared endeavor. Stryker enters safety-focused agreements with customers, where the net purchase price for Stryker products is based on achieving decreases in the "never events" that the company's safety products are designed to reduce. As a result of this work, Stryker was named to Fortune magazine's 2021 Change the World list.

The list, now in its seventh edition, was created by Fortune to showcase those companies that are making a real difference. According to Fortune, companies that have made an important social or environmental impact through their operations and business model in the past year are being recognized.

Organizations included in the list are recognized for their innovative business strategies that positively impact the world. This list has included companies from the United States, Canada, Asia, Europe, Africa, Latin America and the Middle East. According to Fortune, "The list is built on the premise that the profit motive can inspire companies to tackle society's unmet needs."

It highlights companies that have had a positive social impact through activities that are part of their core business strategy. Fortune writers and editors, with help from the Shared Value Initiative, a global platform for organizations seeking business solutions to social challenges, evaluated and ranked the companies by four factors: measurable social impact, business results, degree of innovation and corporate integration.

It's a great honor to be part of this group as Fortune named Stryker one of the 53 companies that are changing the world. This recognition is based on the impact of Stryker's strong company commitment to safer care and better outcomes across its specialized businesses, which have joined forces to elevate safety initiatives across the portfolio – spanning the continuum of care. Through education, ongoing support, processes and partnership with customers, Stryker continues to drive toward greater impact through new, innovative technologies to help deliver better patient outcomes and, ultimately, make healthcare better.

Note: For more information please go to https://www.stryker.com/us/en/about/annual-review/2021.html

Can AI Reduce Pressure Injuries?

New research aims to show how big data can help providers better identify patients who are at increased risk.

Longer, more complex surgeries are moving to ASCs every year, and with those more intricate procedures comes the inherent risk of pressure injuries (PIs). PIs can not only compromise a patient's quality of life, but could also lead to life-threatening infections, increased complications and higher costs of care.

Obviously, a comprehensive and standardized PI prevention protocol should be at the forefront of any ASC's efforts, but artificial intelligence (AI) technology could also play a major role going forward. That's what Dana Tschannen, PhD, RN, and Christine Anderson, PhD, RN, clinical professor and clinical associate professor, respectively, at the University of Michigan School of Nursing in Ann Arbor, hope their latest research will confirm.

The doctors coordinated with data scientists to use AI to predict the probability of patients developing pressure injuries. "We were able to utilize two years of electronic health record data and pull from hundreds of variables that we identified as potential risk factors," says Dr. Tschannen.

They say findings from their study identified risk profiles for various surgical services that must be considered when determining prevention and intervention strategies to employ. Not only does AI show promise in predicting the probability of pressure injuries in surgical patients, but it also opens the door to collaboration between frontline nurses and data scientists, a coordination of care they say has been lacking.

"It was a great example of how we can work with data scientists and statistical experts to provide clinical expertise and to say, 'OK, maybe from a statistical standpoint this issue is coming up, but let's talk it through in terms of what that would mean for nurses in practice,'" says Dr. Tschannen.

The doctors' current project is to create an app that determines the percentage risk of a patient developing a PI based on data culled from AI. "We've developed a prototype of this app," says Dr. Tschannen. "We'll be doing some field testing to see how frontline nurses could utilize it as a decision-support tool."

High-Risk Hip Fracture Patients Can Safely Take Anti-Bleeding Drug

Study finds no evidence of increased mortality risk or other serious adverse outcomes.

Recent research shows tranexamic acid (TXA), a medication given to reduce the risk of bleeding during some orthopedic procedures, can be safely used in patients with intertrochanteric (IT) hip fractures and high risk of blood clot-related complications. "We found no evidence of increased mortality risk or other serious adverse outcomes," according to Steven B. Porter, MD, and colleagues at Mayo Clinic.

The study, published in The Journal of Bone & Joint Surgery, analyzed data for 1,147 patients who underwent IT surgery between 2015 and 2019. The average age of the patients was 81.5 years. IT fractures are a common type of hip fracture that are often caused by falls in older adults.

About half of the patients already had conditions such as atrial fibrillation, clotting abnormalities or previous stroke, deep vein thrombosis (DVT) or pulmonary embolism (PE), all of which could increase risk of blood clot-related complications. These existing health problems place them at a higher risk of blood clot-related thromboembolic complications, including (DVT), (PE), stroke or myocardial infarction. The TXA medication reduces the risk of bleeding by encouraging blood clotting. Current guidelines for elective total joint replacement surgery recommend the use of TXA to reduce bleeding and the need for transfusions.

The researchers compared the risks of significant complications and death after IT surgery for patients who did and did not receive TXA. The results showed no correlation between TXA administration and the risk of death, DVT, PE, myocardial infarction or stroke in either cohort.

Dr. Porter and his colleagues conclude that the study provides support for the safety profile of TXA administration for all patients presenting for surgical repair of IT fractures.

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