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Association of inappropriate outpatient pediatric antibiotic prescriptions with adverse drug events and health care expenditures.

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Butler AM, Brown DS, Durkin MJ, et al. JAMA Netw Open. 2022;5:e2214153.

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.

Wellbeing, burnout, and safe practice among healthcare professionals: predictive influences of mindfulness, values, and self-compassion.

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Prudenzi A, D. Graham C, Flaxman PE, et al. Psychol Health Med. 2022;27:1130-1143.

Previous research has found that mindfulness interventions can reduce stress and burnout among physicians. This survey of 98 healthcare workers within the UK National Health Service (NHS) explored the relationship between poor wellbeing, burnout and perceived safe practice and identified a positive relationship between mindfulness processes and perceived safe practices.

What is the medication iatrogenic risk in elderly outpatients for chronic pain?

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Jambon J, Choukroun C, Roux-Marson C, et al. Clin Neuropharmacol. 2022;45:65-71.

Polypharmacy in older adults is an ongoing safety concern due to the risk of being prescribed a potentially inappropriate medication or co-prescription of medications with dangerous interactions. In this study of adults aged 65 and older with chronic pain, 54% were taking at least one potentially inappropriate medication and 43% were at moderate or high risk of adverse drug events. Measures such as involvement of a pharmacist in medication review could reduce risk of adverse drug events in older adult outpatients.

Management of Cardiac Arrest in Unconventional Locations.

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May 16, 2022

This WebM&M describes two cases involving patients who became unresponsive in unconventional locations – inside of a computed tomography (CT) scanner and at an outpatient transplant clinic – and strategies to ensure that all healthcare teams are prepared to deliver advanced cardiac life support (ACLS), such as the use of mock codes and standardized ACLS algorithms.

Clinician distress and inappropriate antibiotic prescribing for acute respiratory tract infections: a retrospective cohort study.

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Brady KJS, Barlam TF, Trockel MT, et al. Jt Comm J Qual Patient Saf. 2022;48:287-297.

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.

Identifying patients whose symptoms are underrecognized during treatment with breast radiotherapy.

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Jagsi R, Griffith KA, Vicini F, et al for the Michigan Radiation Oncology Quality Consortium. JAMA Oncol. Epub 2022 Apr 21.

Concordance of patient-reported symptoms and provider-documented symptoms is necessary for appropriate patient care and has clinical implications for research. This study compared patient-reported symptoms (pain, pruritus, edema, and fatigue) following radiotherapy for breast cancer with provider assessments. Underrecognition of at least one symptom occurred in more than 50% of patients. Underrecognition was more common in Black patients and those seen by male physicians. The authors suggest that interventions to improve communication between providers and patients may not only improve outcomes but also reduce racial disparities.

The patient's "story": an examination of patient-reported safety incidents in general practice.

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Madden C, Lydon S, Murphy AW, et al. Fam Pract. 2022;Epub Apr 20.

Patient complaints and patient-reported incidents can help identify safety issues. This study compared clinician perceptions and patients’ accounts regarding patient safety incidents and identified a significant difference in perceptions about incident severity. Patients’ accounts of incidents commonly described deficiencies related to communication, staff performance, compassion, and respect.

ISMP Guidelines for Sterile Compounding and the Safe Use of Sterile Compounding Technology.

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Plymouth Meeting, PA: Institute for Safe Medication Practices; 2022.

This updated report describes best practices to ensure safety when preparing sterile compounds, including pharmacist verification of orders entered into computerized provider order entry systems. The guidelines emphasize the role of technologies such as barcoding and robotic image recognition as approaches to enhance safety. In addition, it covers safe practices when technologies are not available.

Error and cognitive bias in diagnostic radiology.

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Tee QX, Nambiar M, Stuckey S. J Med Imaging Radiat Oncol. 2022;66:202-207.

Diagnostic errors in radiology can result in treatment delays and contribute to patient harm. This article provides an overview of the common cognitive biases encountered in diagnostic radiology that can contribute to diagnostic error, and strategies to avoid these biases, such as the use of a cognitive bias mitigation strategy checklist, peer feedback, promoting a just culture, and technology approaches including artificial intelligence (AI).

Inviting patients to identify diagnostic concerns through structured evaluation of their online visit notes.

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Giardina TD, Choi DT, Upadhyay DK, et al. J Am Med Inform Assoc. 2022;29:1091-1100.

Most patients can now access their provider visit notes via online portals and many have reported mistakes such as diagnostic errors or missed allergies. This study asked patients who may be “at-risk” for diagnostic error about perceived concerns in their visit notes. Patients were more likely to report having concerns if they did not trust their provider and did not have a good feeling about the visit. Soliciting patient concerns may be one way to improve transparency regarding diagnostic errors and trust in providers.

Disrespectful Behavior in your workplace.

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Institute for Safe Medication Practices.

Workplace bullying and disrespectful behavior have been shown to negatively affect fall rates, medication errors, and other adverse events. The Institute for Safe Medication Practices is seeking clinician input on and experiences with disrespectful behaviors in the ambulatory care setting (e.g., community, specialty, and long-term care pharmacies, physician practices, and outpatient visits) and how organizations have been working to improve the culture of respect. The survey will be open until May 27, 2022.

Pharmacist-led mobile health intervention and transplant medication safety: a randomized controlled clinical trial.

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April 7, 2022

Mobile health apps are becoming increasingly popular for patients and clinicians. This innovative study implemented a pharmacist-led mobile health based intervention to improve medication safety of patients following kidney transplant.

HEAR Her Concerns.

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National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health; Centers for Disease Control and Prevention.

Maternal harm during and after pregnancy is a sentinel event. This campaign encourages women, families, and health providers to identify and speak up with concerns about maternal care and act on them. The program seeks to inform the design of support systems and tool development that enhance maternal safety.

Annual Perspective: Topics in Medication Safety

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March 31, 2022

Errors in medication management and administration are major threats to patient safety. This piece explores issues with opioid and nursing-sensitive medication safety as well as medication safety in older adults. Future research directions in medication safety are also discussed.

Annual Perspective: Psychological Safety of Healthcare Staff

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March 31, 2022

A psychologically safe environment for healthcare teams is desirable for optimal team performance, team member well-being, and favorable patient safety outcomes. This piece explores facilitators of and barriers to psychological safety across healthcare settings. Future research directions examining psychological safety in healthcare are discussed.

A Case of Mistaken Capacity: Why A Thorough Psychosocial History Can Improve Care.

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March 31, 2022

This Spotlight Case describes an older man incidentally diagnosed with prostate cancer, with metastases to the bone. He was seen in clinic one month after that discharge, without family present, and scheduled for outpatient biopsy. He showed up to the biopsy without adequate preparation and so it was rescheduled. He did not show up to the following four oncology appointments.

Prescribing errors in post-COVID-19 patients: prevalence, severity, and risk factors in patients visiting a post-COVID-19 outpatient clinic.

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Mahomedradja RF, van den Beukel TO, van den Bos M, et al. BMC Emerg Med. 2022;22:35.

The potential for medication errors may increase due to redeployment and reorganization of hospital resources during COVID-19 surges. In this study of patients hospitalized during the first wave of the pandemic, over 90% had at least one prescribing error three months after hospitalization. Intensive care unit admission and a history of chronic obstructive pulmonary disease (COPD) or asthma were risk factors for prescribing errors. Acknowledging and understanding these risk factors allows hospital leadership to target interventions for this population.

Estimation of breast cancer overdiagnosis in a U.S. breast screening cohort.

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Ryser MD, Lange J, Inoue LYT, et al. Ann Intern Med. 2022;175:471-478.

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.

Comparison of a focused family cancer history questionnaire to family history documentation in the electronic medical record.

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Clift K, Macklin-Mantia S, Barnhorst M, et al. J Prim Care Community Health. 2022;13:215013192110697.

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.

The source of purchased medications and its impact on medication mistakes and hospitalizations.

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Coates MC, Granche J, Sefcik JS, et al. Res Gerontol Nurs. 2022;15:69-75.

Older adults, especially those taking multiple medications, are at increased risk for medication self-administration (MSE) errors. Data from the National Health and Aging Trends Study (NHATS) was analyzed to ascertain if the source of the medication – picking up from local pharmacy, receiving the medication via mail-order pharmacy, or both – impacted MSE or hospitalization. Respondents receiving medications via both mail-order and pick up were more likely to report hospitalizations and medication mistakes.

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