Economic impact of redundant antimicrobial therapy in US hospitals.

BACKGROUND: Overutilization of antimicrobial therapy places patients at risk for harm and contributes to antimicrobial resistance and escalating healthcare costs. Focusing on redundant or duplicate antimicrobial therapy is 1 recommended strategy to reduce overutilization and its attendant effects on patient safety and hospital costs. OBJECTIVE: This study explored the incidence and economic impact of potentially redundant antimicrobial therapy. METHODS: We conducted a retrospective analysis of inpatient administrative data drawn from 505 nonfederal US hospitals. All hospitalized patients discharged between January 1, 2008, and December 31, 2011, were eligible for study inclusion. Potentially redundant antimicrobial therapy was identified from pharmacy records and was defined as patients receiving treatment with overlapping antibiotic spectra for 2 or more consecutive days. RESULTS: We found evidence of potentially inappropriate, redundant antimicrobial coverage for 23 different antimicrobial combinations in 394 of the 505 (78%) hospitals, representing a total of 32,507 cases. High-frequency redundancies were observed in 3 antianaerobic regimens, accounting for 22,701 (70%) of the cases. Of these, metronidazole and piperacillin-tazobactam accounted for 53% (n = 17,326) of all potentially redundant cases. Days of redundant therapy totaled 148,589, representing greater than $12 million in potentially avoidable healthcare costs. CONCLUSIONS: Our study suggests that there may be pervasive use of redundant antimicrobial therapy within US hospitals. Appropriate use of antimicrobials may reduce the risk of harm to patients and lower healthcare costs.

Injection practices among clinicians in United States health care settings.

BACKGROUND: Improper use of syringes, needles, and medication vials has resulted in patient-to-patient transmission of bloodborne pathogens, including hepatitis C virus. This study examined the injection practices of health care providers to identify trends and target opportunities for education on safe practices. METHODS: An on-line survey was conducted in May and June 2010 of clinicians in US health care settings that prepare and/or administer parenteral medications. RESULTS: The majority of the 5446 eligible respondents reported injection practices consistent with current recommendations. However, the following unsafe practices were identified: 6.0% "sometimes or always" use single-dose/single-use vials for more than 1 patient; 0.9% "sometimes or always" reuse a syringe but change the needle for use on a second patient; 15.1% reuse a syringe to enter a multidose vial and then 6.5% save that vial for use on another patient (1.1% overall). CONCLUSION: Unsafe injection practices represent an ongoing threat to patient safety. Ensuring safe injection practices in all health care settings will require a multifaceted approach that focuses on surveillance, oversight, enforcement, and continuing education.

Home study program. Can we build a safer OR?

PEOPLE WHO WORK in health care are among the brightest and most dedicated workers in the United States, but they are human, and humans make mistakes. HEALTH CARE FACILITIES are moving away from a culture of perfection and exploring how human factors predispose people to make certain types of errors. THIS ARTICLE discusses the types of errors being made and the organizations that are working to redesign the health care system to make it easier to do the job more safely and more difficult to make a mistake.

What is working in patient safety?

The authors discuss the purpose and themes of Partnership Symposium 2002: Smart Designs for Patient Safety, which was held in Washington, DC, October 14-16, 2002.

Organizational and environmental factors that affect worker health and safety and patient outcomes.

This article reviews organizational factors that influence the satisfaction, health, safety, and well-being of health care workers and ultimately, the satisfaction, safety, and quality of care for patients. The impact of the work environment on working conditions and the effects on health care workers and patients are also addressed. Studies focusing on worker health and safety concerns affected by the organization and the physical work environment provide evidence of direct positive and/or adverse effects on performance and suggest indirect effects on the quality of patient care. The strongest links between worker and patient outcomes are demonstrated in literature on nosocomial transmission of infections. Transmission of infections from worker to patient and from patient to patient via health care worker has been well documented in clinical studies. Literature on outbreaks of infectious diseases in health care settings has linked the physical environment with adverse patient and worker outcomes. An increasing number of studies are looking at the relationship between improvement in organizational factors and measurable and positive change in patient outcomes. Characteristics of selected magnet hospitals are reviewed as one model for improving patient and worker outcomes.

In search of safety: an interview with Gina Pugliese. Interview by Alison P. Smith.

Gina Pugliese, MS, RN, is currently a vice-president for Premier, Inc. In addition to faculty and editorial positions, she directs international training courses in hospital epidemiology. She has made innumerable contributions to the field of safety over the past 25 years through her work with regulatory and federal agencies. Changing organizational culture from a "blame culture" to a "safety culture" is one notable challenge facing organizations. The airline industry has achieved significant changes in its safety culture by virtually eliminating a power hierarchy in the cockpit, a worthy example for operating rooms. Redesigning care delivery processes will minimize the opportunity for error if efforts are made to avoid reliance on memory, automate repetitive functions, reduce the number of steps involved, or use protocols when appropriate. The sophistication of consumers and the emergence of organizations like the Leap Frog Group will continue to challenge health care providers and potentially accelerate safety improvements.