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Journal Article > Study
Collard HR, Saint S, Matthay MA. Ann Intern Med. 2003;138:494-501.
Health care–associated infections (HAIs) are a common adverse event in hospitalized patients and an increasing source of study for preventive strategies. Ventilator-associated pneumonia (VAP) is one of the four most common HAIs along with catheter-related bloodstream infection, catheter-associated urinary tract infection, and surgical site infection. This systematic review provides a series of recommendations to reduce the incidence of VAP, including use of semi-recumbent positioning, sucralfate rather than H2-antagonists, and aspiration of subglottic secretions in select patient populations. The authors point out that while many studies highlight the success of preventive strategies, no randomized trial has evaluated the effects of combining the preventive practices as an additive bundle or checklist.
Journal Article > Study
Rothschild JM, Keohane CA, Rogers S, et al. JAMA. 2009;302:1565-1572.
Limitations on housestaff duty hours were implemented with the intent of protecting patients by reducing errors made by fatigued residents. Indeed, prior studies have shown that sleep-deprived residents are more prone to committing errors and inadvertently sustaining needlestick injuries. However, comparatively little attention has been paid to the effect of fatigue on attending physicians. Conducted at a single academic medical center, this study evaluated the relationship between sleep deprivation (defined as having operated the night before the scheduled procedure) and complication rates for a range of surgical, obstetric, and gynecologic procedures. There was no overall link between fatigue and complications, but the complication rate was increased for surgeons who had the opportunity to sleep less than 6 hours. Other studies have found that fatigue is influenced by many factors other than hours worked, and therefore further reductions in shift length (as called for in a recent Institute of Medicine report) may not significantly improve patient safety.
National Quality Forum. Washington, DC: National Quality Forum; 2010.
The National Quality Forum originally published the Safe Practices for Better Healthcare in 2003. These practices are intended to be universally applicable, "gold standard" interventions for reducing preventable harm, and have been widely endorsed and implemented. As in the 2009 update, the 34 specific practices are organized into seven content areas: creating a culture of safety, providing patient-centered care and disclosing errors, matching health care needs with delivery capacity, facilitating information transfer and clear communication between providers, managing medications safely, preventing health care–associated infections, and implementing safe practices for specific clinical conditions and sites of care. There are no major changes in the recommended practices since 2009, but the report contains specific recommendations on engaging patients and families in safety efforts.
Journal Article > Review
Systematic review of physiologic monitor alarm characteristics and pragmatic interventions to reduce alarm frequency.
Paine CW, Goel VV, Ely E, et al. J Hosp Med. 2016;11:136-144.
Alarm safety is now a Joint Commission National Patient Safety Goal. This systematic review analyzed 24 studies on alarm characteristics and 8 studies that evaluated interventions to improve alert fatigue. Consistent with other studies, the vast majority of the time, alarms do not signal problems that require clinician action. The most promising intervention strategies for reducing alarms that have emerged thus far are widening alarm parameters, implementing alarm delays, and frequently changing telemetry electrodes and wires. A PSNet perspective discussed approaches to reduce alert fatigue while maintaining safety.