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Misuse of prescription opioids represents a serious patient safety issue. Using commercial claims from 2014 - 2018, researchers examined the association between the 2016 CDC guidelines to reduce unsafe opioid prescribing and opioid dispensing for patients with four common chronic pain diagnoses. Findings indicate that the release of the 2016 guidelines was associated with reductions in the percentage of patients receiving opioids, average dose prescribed, percentage receiving high-dose prescriptions, number of days supplied, and the percentage of patients receiving concurrent opioid/benzodiazepine prescriptions. The authors observe that questions remain about how clinicians are tailoring opioid reductions using a patient-centered approach.

Fall prevention remains a patient safety priority. This article describes how fall prevention strategies are being implemented and operationalized across 60 hospitals in the United States. While many hospitals employed recommended strategies identified, implementation was suboptimal at times – for example, interdisciplinary fall committees were common but rarely included physicians.

Patient suicide, attempted suicide, or self-harm are considered ‘never events.’ This article describes the development and implementation of a safety protocol for emergency department (ED) patients at risk for self-harm, including the creation of safe bathrooms and increasing the number of trained observers in the ED. Implementation of the protocol was correlated with lower rates of self-harm.  

Building upon earlier work, the authors engaged a technical expert panel to reach consensus on a definition for omissions of care in nursing homes. The article details the terms and concepts included in (and excluded from) the proposed definition, provides examples of omissions of care, intended uses (e.g., to guide quality improvement activities or training and education), and describes the implications of the definition for clinical practice, policy, and research.  

Over the last decade, children have experienced a dramatic rise in hospitalizations and intensive care unit stays related to opioid use. Based on Medicaid claims in North Carolina, prescribers of opioids for children were most commonly physicians and dentists. More than 3% of children ages 1 to 17 years had at least one opioid prescription filled annually; 76.6 children per 100,000 experienced an opioid-related adverse event or other harm. Adolescents ages 15 to 17 years disproportionately experienced these harms compared to younger age groups. Black and urban children were less likely to fill opioid prescriptions or experience adverse events, but they were more likely to experience other opioid-related harm, such as abuse or dependence.   

Antimicrobial stewardship is one strategy to improve antibiotic use to reduce hospital-acquired infections. In this editorial, the authors discuss negative effects of COVID-19 on antimicrobial resistance and antibiotic stewardship in the emergency department (ED) and approaches for optimizing ED stewardship during the pandemic.  

This systematic review examined effectiveness of hospital- or system-wide interventions in reducing healthcare-associated infections (HAIs). The review identified several strategies for reducing HAIs, including enhanced environmental cleaning using disinfection technologies; EHR implementation; multimodal infection control programs; multichannel hand hygiene promotion; and hospital-wide cultural transformations. The review identifies approaches meriting additional research and exploration.

Based on survey data, this study explored intrapersonal, interpersonal and organizational triggers resulting in disruptive and unprofessional behavior. All three types of triggers were significantly related to disruptive behavior among nurses; intrapersonal and interpersonal triggers were significantly related to disruptive behavior among clinicians. The most frequent triggers included pressures from high census; environmental overload; chronic, unresolved system issues; and personal characteristics or issues impeding job performance.

This study used hypothetical scenarios to explore factors influencing prescribers’ decision-making on whether to discontinue antibiotics at early review. Prescribers (from acute/general hospitals) were more likely to continue antibiotics when discontinuation would conflict with local guidelines, when systems clearly indicated antibiotics, and when patients had severe frailty or comorbidities.

The researchers in this study directly observed nurses administering medications to pediatric patients to measure the association between double-checking and medication administration errors. When double-checking was mandated, the researchers did not find any significant association with medication errors. When double-checking was not mandated but was performed, medication administration errors were less likely to occur and were less severe, but the association was not significant. These findings raise questions about the benefits compared to single-checking.

This article discusses the action hierarchy, which is a tool for generating corrective actions to improve safety and focuses on those recommendations relying less on human factors and more on systems change. The authors propose a multifaceted definition of ‘systems change’ and a rubric for determining the extent to which a corrective action addresses ‘systems change’ (‘systems change hierarchy’).

This position statement shares 11 recommendations drawn from a review of the evidence to improve the safety of pediatric dosing in pre-hospital emergent situations. Suggestions for improvement include use of kilograms as the standard unit of weight, pre-calculated weight-based dosing, and dose-derivation strategies to minimize use of calculations in real time.   

This systematic review investigated the use of anatomical side markers (ASM), which are used in radiology to identify the correct anatomical side and prevent confusion. The seven studies included demonstrated that use of ASMs is common, but the literature documented some barriers to use, such as risk of obscuring essential anatomical parts.

This scoping review characterized the evidence base on patients’ attitudes and behaviors concerning their engagement in ensuring the safety of their care. The review found increasing interest in patient and family engagement in safety and identified several research gaps, such as a need to better understand patients’ attitudes across the continuum of care, the role of family members, and engagement in primary care safety practices.

The authors of this article outline ten recommendations for safely reopening simulation facilities for clinical training in the post-lockdown phase of the COVID-19 crisis. The recommendations are based on national guidance and regulations, as well as international public health recommendations. Future reopening activities should focus on safety as well as flexibility principles, taking different contexts and facility characteristics into account.