Medication errors are a common cause of preventable harm in long-term care facilities. This systematic review explored how residents and families engage in medication management in aged care facilities. Factors hindering effective engagement included insufficient communication between residents, families, and providers; families’ hesitation about decision making; and lack of provider training.

Interprofessional communication is critical to safe medication management during transitions of care. Researchers conducted this ethnographic study to explore inter- and intra-professional communications during older adults’ transitions of care. Communication was influenced by the transferring setting, receiving setting, and ‘real-time’ communication. Lack of, or poor, communication impacted medication safety; researchers recommend more proactive communication and involvement of the pharmacist.

Medical emergency teams (MET), also known as rapid response teams, are used to improve the identification and management of patients demonstrating signs of rapid deterioration. This study found that modifying activation criteria to trigger METs at more extreme levels of clinical deterioration were not associated with negative patient safety outcomes.

Researchers in this multicenter cohort study found that 19% of patients experienced an adverse event during the transition from the intensive care unit (ICU)  to the hospital ward, with most (62%) occurring within three days of transfer. Compared to patients who did not experience an adverse events, those with adverse events were at increased risk for negative outcomes including ICU readmission, increased length of stay and inpatient morality. Approximately one-third (36%) of these events were deemed preventable by the research team.

… confers a meaningful safety benefit. A previous WebM&M commentary discussed an incident involving a nurse who …

Transitions of care represent a vulnerable time for patients. Older adults in particular may experience a variety of challenges related to such transitions, including managing changes to their medications. This systematic review suggests that there is significant opportunity for health care providers to improve family engagement in managing medications of elderly patients during care transitions.

This retrospective observation cohort study conducted at nine hospitals sought to determine whether discharge from the intensive care unit (ICU) directly to home affected odds of readmission within 30 days or mortality within 1 year. Overall, patients discharged from the ICU to home are younger and less ill than patients who are transferred from the ICU to the hospital ward before returning home. The proportion of patients discharged from ICU to home varied widely by site. When researchers compared patients discharged from ICU to home to patients of similar age and severity of illness upon ICU admission who were discharged home from the hospital ward, they found no differences in odds of readmission or mortality. A related commentary explores why discharges from ICU to home occur and calls for implementing care transitions best practices upon ICU discharge in order to support optimal patient outcomes and prevent readmissions.

Patients evaluated by a rapid response team at night were less likely to be transferred to the intensive care unit and more likely to die in the hospital compared to patients evaluated during the daytime. A previous WebM&M commentary discussed a preventable adverse event occurring in part due to less intensive nighttime staffing.

… Journal of clinical nursing … J Clin Nurs … Rapid response teams are well established in …

This qualitative study of hospitalized patients in Sweden found that patients expressed interest in engaging in their care. Themes included shared decision-making and increasing patient understanding of health conditions. Patients also expressed concern about the power dynamic between patients and providers and uncertainty about how to best participate in their own hospital care.

… the International Society for Quality in Health Care … Int J Qual Health Care … Efforts to improve the safety of …

Rapid response systems have been widely accepted as a method to improve outcomes of hospitalized patients demonstrating signs of rapid deterioration. This commentary provides an overview of rapid response systems, including factors that influence their effectiveness in enhancing safety, resources and educational programs required to support implementation, and associated improvements in mortality rates following deployment.

Although rapid response teams have been widely advocated, the evidence for their benefit remains mixed. This observational study sought to analyze the incidence of inpatient cardiopulmonary arrest and related mortality while rapid response teams were being implemented in Australia. Between 2002 and 2009, the mortality associated with inpatient cardiopulmonary arrests decreased over time. The authors found that most of the decline was due to decreased incidence of arrest, not increased survival following arrest. This finding suggests that rapid response did not play a significant role in reducing mortality from in-hospital arrest in this population, consistent with prior studies.

This study group created a standardized running sheet for documenting medical emergency team (MET) events at their medical center. About half of ward nurses felt that this tool improved patient handoffs to the arriving METs.

In this study, conducted at seven hospitals in three countries, nearly one-third of patients seen by a rapid response team ultimately had limitations placed on their care (such as do-not-resuscitate orders). This finding indicates a need for improved advanced care planning.

Delays in clinical deterioration recognition and failures to rescue lead to serious adverse events. Rapid response systems (RRS) have been implemented with the aim of improving the identification and management of clinically worsening hospital ward patients. Although early studies reviewing RRS showed improvements in clinical outcomes, subsequent results have not shown consistent benefit. This review describes RRS, including controversies surrounding them, potential benefits and limitations, as well as strategies to implement them successfully. An AHRQ WebM&M perspective discusses lessons from early experiences with RRS.

Atrial fibrillation, a common cardiac arrhythmia, triggered a significant proportion of rapid response system activations at an Australian hospital, and was associated with worsened clinical outcomes.

… Journal of nursing management … J Nurs Manag … This review found that nurses play a major …

The most common reason for rapid response system activation was concern on the part of a staff member (usually the bedside nurse). Objective criteria, such as vital sign abnormalities, were not used as frequently.

Nearly all of the calls to a rapid response team in this large Australian study required critical care interventions such as airway management or use of inotropic drugs. Calls were also significantly more common during morning hours.