Rates of prescription opioid misuse and abuse led to recommendations for dose tapering for patients with chronic pain. However, concerns have been raised about the potential harms associated with rapidly decreasing doses or discontinuing opioids. Building on previous research, these researchers used a large claims database to explore the unintended negative consequences of tapering patients on stable, long-term opioid therapy. Findings indicate that opioid tapering was associated with fewer primary care visits, greater numbers of emergency department visits, and reduced adherence to antihypertensive and antidiabetic medications.

Adverse events associated with long-term opioid therapy have led to recommendations for dose tapering for patients with chronic pain. This study assessed the long-term risks of overdose and mental health crisis as a result of dose tapering. Consistent with earlier research on short-term risks, results indicate that opioid tapering is associated with increased risk of adverse events up to 24 months after initiation of tapering.

The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) are widely used for measuring and reporting hospital quality and patient safety. This paper describes the process of reweighing the composite patient safety indicator (PSI 90) to incorporate excess harm reflecting patients’ preferences for various possible related outcomes (e.g., readmissions, reoperation, long-term care stay, death). Compared to the original frequency-based weighting, some component indicators in the reweighted composite – including postoperative respiratory failure, postoperative sepsis, and perioperative pulmonary embolism or deep vein thrombosis – contributed to the greatest harm.

Sudden discontinuation of opioids has been linked to increased patient harm. This observational study evaluated the link between tapering and overdose, and mental health crisis among patients who were receiving long-term opioid therapy. Patients who underwent dose tapering had an increased risk of overdose and mental health crisis compared to those who did not undergo dose tapering. 

Clinical decision support (CDS) alerts can improve patient safety, and prior research suggests that monitoring alert overrides can identify errors. The researchers describe a novel approach to using existing CDS systems to detect medication prescribing errors based on drug-drug interaction and allergy alert overrides. Dose alert overrides had high sensitivity to detect medication prescribing errors occurring in an inpatient setting.

For the first time, the World Health Organization ICD-11 will include a taxonomy for quality and safety events. Researchers applied the new system to 45 patient safety vignettes gleaned from sources such as AHRQ WebM&M, then they described its strengths and limitations. Explicit identification of adverse events in administrative datasets could improve detection of errors, adverse events, and near misses on a population level.

AHRQ Patient Safety Indicators (PSIs) have been utilized to identify safety problems and suboptimal care quality in acute care settings using ICD-9 codes in administrative discharge data. Despite limitations in the accuracy of PSIs, they have been widely employed as a quality metric. The implementation of ICD-10 and diagnosis timing codes necessitate development of a new set of PSIs. This consensus and validation study used a Delphi panel process to determine ICD-10 codes associated with safety and quality concerns. Experts grouped the 640 identified diagnostic codes into 18 PSI categories. Application of these novel PSIs in over 10 years of hospital discharge data uncovered safety problems in 5% of hospitalizations. The authors recommend that these proposed PSIs should be further validated using record review or prospective case review.

Suboptimal communication between patients and physicians can result in patients misunderstanding important aspects of their care. This study found that the majority of patients with cancer reported a more optimistic survival prognosis than their oncologists. These findings suggest the need to improve physician–patient communication about prognosis in order to ensure appropriate discussion of treatment decisions and goals.

… the International Society for Quality in Health Care … Int J Qual Health Care … Although the 10th revision of the …

The variable success of patient safety interventions has been attributed to the context in which these strategies have been implemented. In this systematic review, researchers found that contextual aspects that influence success of interventions are not systematically examined or reported, hindering understanding of how context affects implementation of patient safety efforts.

… the extent of agreement among hospital ratings issued by U.S. News & World Report , HealthGrades , The Leapfrog Group , …

… the International Society for Quality in Health Care … Int J Qual Health Care … This commentary introduces the …

Children are at high risk for medication errors in emergency departments (EDs). Physician prescribing has been implicated as the most common source of these errors. This retrospective study found that telemedicine consultations for pediatric critical care were associated with fewer physician-related medication errors among seriously ill children in rural EDs. Telemedicine consultations seemed to reduce medication errors more than traditional telephone consultations. Telemedicine may prove to be an important tool for improving the care of rural patients across many different scenarios.

… Journal of patient safety … J Patient Saf … Despite availability of multiple publicly … into a score comprised equally of process measures (e.g., barcode medication ordering), which recognize safety efforts, and outcome measures (e.g., catheter-associated infections ). The panel also …

… Journal of general internal medicine … J Gen Intern Med … Although the 2003 duty hour regulations …

… 2011 Accreditation Council for Graduate Medical Education's (ACGME) resident duty hour restrictions have placed …

This study describes how AHRQ Patient Safety Indicators may help identify improvement opportunities for nursing care, their documentation practices, and their role in driving system-level changes.

The 2003 residency duty hour regulations were not associated with a change in the 30-day hospital readmission rate for Medicare patients hospitalized with common medical or surgical conditions.