Creative strategies to improve patient safety: allergies and adverse drug reactions.

Approximately 770,000 Americans are hospitalized and suffer adverse drug events (ADEs) costing billions of dollars each year. An ADE occurs when a patient is injured by an adverse drug reaction. Improved medication administration could prevent about 2.5 million ADEs (Institute of Medicine, 2004). This project provided an education for patients and nurses and a medication fact sheet. Outcomes included updating allergy records, improving medication safety knowledge, and improving nurses' adverse drug reactions and allergy reports.

Treatment of chronic subdural haematomas - a retrospective comparison of minicraniectomy versus burrhole drainage.

Primary chronic subdural haematomas remains one of the commonest conditions managed by neurosurgeons. Despite this there is a relative lack of evidence regarding best management and certain treatments such as minicraniectomy, have rarely been assessed in the literature. A retrospective case note review comparing minicraniectomy and burrhole drainage of primary chronic subdural haematoma was therefore performed. We sought to determine the proportion of patients requiring repeat drainage or dandy cannula aspiration following initial surgery and to assess outcome at outpatient follow-up. The mean age of patients undergoing minicraniectomy was 73, compared to 63 in the burrhole group (p < 0.001). 130 patients underwent burrhole drainage, 23 of whom (18%) developed a symptomatic recurrence. 21 (16%) of these patients required repeat drainage. Of the 116 patients who underwent a craniectomy 23 (20%) patients suffered a symptomatic recurrence. 15 (13%) patients required the minicraniectomy to be reopened for further washout (p = 0.48). (8%) patients who underwent burrhole drainage died compared to 20 (17%) patients following craniectomy (95%CI 2 to 18%; p = 0.03). However, controlling for age using logistic logression, showed no significant difference between the two treatment groups in recurrence (p = 0.28) or death (p = 0.06). Craniectomy may be considered as a treatment option particularly in the elderly population and in patients with multiple loculated collections.

Simple morphometry of axonal swellings cannot be used in isolation for dating lesions after traumatic brain injury.

Disruption of fast axonal transport as a result of traumatic brain injury is characterized by the accumulation of beta-amyloid precursor protein (APP) in axonal swellings. A recent report has suggested a correlation between the size of axonal swellings and survival time up to about 85 h after blunt head injury. The authors of the report concluded that this correlation, in conjunction with other evidence, might be useful in forensic science for timing injuries. To test this hypothesis we have used image analysis software to measure a number of different morphological parameters of axonal swellings. Paraffin sections from 63 cases of fatal head injury were stained with an antibody raised against the N-terminus of APP and counterstained with haematoxylin. Three different measurements were made of the APP-immunoreactive axonal swellings from the corpus callosum: (i) minimum and (ii) maximum Feret diameters, and (iii) area. Linear regression revealed a significant correlation between survival time and the minimum Feret diameter (p < 0.0001) and the area (p < 0.001) of axonal swellings. Our findings are in agreement with the previous study in that there is a significant correlation between axonal swelling size and survival time. However, we would suggest that the large variability in swelling size within individual cases and the heterogeneity of the original trauma seriously compromise the utility of such information in the timing of lesions.

Nurses improve medication safety with medication allergy and adverse drug reports.

Medicine-related illnesses cost more than 75 billion dollars annually. Adverse drug reactions (ADRs) are the fourth to sixth leading causes of death in the United States. An educational campaign to reduce ADRs and improve documentation included (1) an allergy awareness campaign, (2) staff nurses' training on documentation of allergies/ADRs, (3) patient-oriented brochures to encourage allergy reporting and ADRs, and (4) a fact sheet about ADRs. As a result, the documentation of medication allergies and ADRs improved significantly in our organization.