Blood transfusions errors can have serious consequences. In this retrospective study including 15 community hospitals, researchers identified high rates of unnecessary blood transfusions, primarily attributed to overreliance on laboratory transfusion criteria and failure to follow guidelines regarding blood management.

In 2016, the Centers for Disease Control and Prevention (CDC) released guidelines for safe opioid prescribing for chronic pain. Based on an updated evidence review, the CDC has revised the guidelines and released the Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022, include recommendations for outpatient acute, subacute, and chronic opioid use. The twelve recommendations fall into four broad categories: determining whether or not to initiate opioids for pain; selecting opioids and determining opioid dosages; deciding duration of initial opioid prescription and conducting follow-up; and assessing risk and addressing potential harms of opioid use. The CDC will update and develop tools and resources to support dissemination of these guidelines. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care, or for patients in the emergency department or admitted to the hospital.

Patients with diabetes, particularly those taking multiple medications, are at increased for medication adverse events. In this review of nearly 200 studies of potentially inappropriate prescribing (PIP) for patients with diabetes, several types of PIPs occurred: contraindication, omission, incorrect dosing, drug-drug interaction, inappropriate drug selection, and unnecessary drug therapy.

Prophylactic antimicrobials are frequently prescribed for surgical patients despite the risks of antimicrobial overuse (e.g., resistance). This review summarizes how and why antimicrobials continue to be prescribed in surgical settings despite evidence of overuse. Eight overarching concepts were identified: hierarchy; fear drives action; deprioritized; convention trumps evidence; complex judgments; discontinuity of care; team dynamics; and practice environment.

Appropriate antibiotic prescribing is a core component of antibiotic stewardship programs to reduce the risk of antibiotic-resistant microbes. This study assessed the rate of misdiagnosed pediatric urinary tract infections (UTI) and associated antibiotic use following implementation of a quality improvement intervention. Using three interventions (diagnostic algorithm, callback system, standardized discharge antibiotic prescription), misdiagnosis of UTI decreased by half, and 2,128 antibiotic days were saved.

Frail older adults are at increased risk of adverse events including rehospitalization and overtreatment. In this study, researchers assessed the association of care coordination and preventable adverse events in frail older adults. Compared with non-frail older adults, frail older adults reported experiencing more adverse events they believed could have been prevented with better care coordination.

Inappropriately prescribing antibiotics for non-bacterial infections remains common in outpatient settings despite the associated risks. This analysis of antibiotics prescribed to more than 2.8 million children showed more than 30% of children with bacterial infection, and 4%-70% of children with viral infection were inappropriately prescribed antibiotics. Inappropriate prescribing led to increased risk of adverse drug events (e.g., allergic reaction) and increased health expenditures in the following 30 days.

Stewardship interventions seek to optimize use of healthcare services, such as diagnostic tests or antibiotics. This article reports findings from a 14-site multidisciplinary collaborative evaluating pediatric intensive care unit (PICU) blood culture practices before and after implementation of a diagnostic stewardship intervention. Researchers found that rates of blood cultures, broad-spectrum antibiotic use, and central line-associated blood stream infections (CLABSI) were reduced postintervention.

Inappropriate prescribing of antibiotics to treat viral illnesses is an ongoing patient safety threat. This study examined the association between clinician depression, anxiety, and burnout and inappropriate prescribing of antibiotics for acute respiratory tract infections (RTIs) in outpatient care. Depression and anxiety, but not burnout, were associated with increased adjusted odds of inappropriate prescribing for RTIs.

Older adults living in nursing homes are at increased risk of polypharmacy and its associated adverse outcomes, such as drug-drug interactions. The medication records of 222 older adult residents of one Spanish nursing home were screened for potential drug-drug adverse events. Nearly all included residents were taking at least one potentially inappropriate medication, and drug-drug interactions were common.

Overtreatment and overuse can have unanticipated consequences, ranging from patient anxiety while awaiting test results to medical complications. The authors identify several factors that can contribute to patient overtreatment (fear of uncertainty, cognitive bias, applying low-quality evidence, and overfocusing on diagnosis). Interventions to overcome these issues include educating clinicians that uncertainty is a part of medicine and shifting to a focus on patient-centered management rather than focusing on identifying a diagnosis.

Medication errors can occur in all clinical settings, but can have especially devastating results in emergency departments (EDs). Between January 1, 2011, and December 31, 2020, 250 serious medication errors occurring in the ED were reported to the Pennsylvania Patient Safety Reporting System. Errors were more likely to occur on weekends and between 12:00 pm and midnight; patients were more likely to be women. Potential strategies to reduce serious medication errors (e.g., inclusion of emergency medicine pharmacists in patient care) are discussed.

Several factors contribute to pediatric antibiotic medication errors in the emergency department, such as the frequent use of verbal orders and the need for  weight-based dosing. Results of this study align with previous research and reinforce the need for further investigation and interventions to reduce antibiotic medication errors such as computerized provider order entry.

Overdiagnosis of breast cancer can result in overtreatment and cause physical and emotional harm. Based on data from 35,986 women in a US-based breast cancer screening registry, this study estimates that15.4% of screen-detected cancers are overdiagnosed (i.e., detecting indolent preclinical cancer or detecting progressive preclinical cancer among women who would have died of unrelated causes before clinical diagnosis), which is higher than previous estimates. The authors suggest that data can improve shared decision-making between patients and physicians.

Knowing a patient’s individual risk factors for developing cancer can assist patients and providers in deciding when to screen for cancers and can prevent both overtreatment and delays in care. This study compared patient-reported family history of cancer in the electronic health record (EHR) and family history collected using a focused questionnaire. Results showed inconsistencies between the two, especially for patients with more complicated family histories.

Defensive medicine refers to clinician behaviors with the intent to avoid malpractice risk due to care omissions. This article provides an overview of defensive medicine and its relationship to the taxonomies of medical errors and the risks that defensive medicine places on patients, hospital administrators, and systems, as well as clinicians.

Overuse of medical care represents a significant patient safety challenge. This review discusses the impacts of healthcare overuse and unnecessary care on patient safety, including contributions to avoidable adverse events, increasing risks for healthcare-acquired infections, and adverse psychological outcomes.

Polypharmacy and potentially inappropriate medications continue to pose health risks in older adults. Using a Delphi approach, experts identified 85 minimal requirements for safe medication prescribing in nursing homes. The five key topics recommend structured, regular review and monitoring, interprofessional collaboration, and involving the resident.