December 2010 Pennsylvania Patient Safety Advisory

Advisories & Events

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Pennsylvania Patient Safety Advisory

December 2010, Vol. 7, No. 4

201012

Reviews & Analyses

Management of Unanticipated Difficult Intubation

Even the most thorough assessment of the airway may not detect the possibility of a difficult intubation. Anesthesia providers need to always be prepared to manage an unanticipated difficult intubation.

Managing Patient Access and Flow in the Emergency Department to Improve Patient Safety

Timeliness of care in the emergency department starts with the period between the patient arrival and the diagnostic evaluation. This period influences timeliness of care for the remainder of the visit and has been associated with clinical outcomes and patient safety issues.

The Dirt on Flexible Endoscope Reprocessing

To reduce the likelihood of endoscopy-related cross contamination between patients, healthcare facilities can develop and adhere to comprehensive, model-specific reprocessing protocols.

Focus on Infection Prevention

Controlling the Annual Threat of Norovirus Gastroenteritis Outbreaks

Evidence-based strategies to modify risk factors for outbreaks include preparing for norovirus season, ensuring basic outbreak control measures, using enhanced precautions, and conducting leadership and postoutbreak activities.

From the Database

Data Snapshot: Falls Reported by Behavioral Health Facilities

An assessment of fall events reported in 2009 at behavioral health hospitals suggests that hospitals should consider which medications are being administered and how they may increase patients’ risk of falls.

Update

Quarterly Update: The Evidence Base for Best Practices for Preventing Wrong-Site Surgery

Facilities may wish to use this information to inform surgeons and anesthesiologists on the rationale behind implementing best practices for following the Universal Protocol.

Other Features

Letter to the Editor: Marking the Nonoperative Site

A reader from a Pennsylvania community teaching hospital contacts the Pennsylvania Patient Safety Authority for guidance in ongoing efforts to eliminate wrong-site surgery.

Letter to the Editor: Silver-Coated Catheters in an MR Environment

A reader from a Pennsylvania rehabilitation hospital asks whether the Pennsylvania Patient Safety Authority is aware of any events that have occurred with silver-coated urinary catheters in a magnetic resonance (MR) environment.

Meeting the Challenges Associated with Morbidly Obese Patients

Northwest Patient Safety Liaison, Richard M. Kundravi, BS, discusses efforts to ensure morbidly obese patients receive the same care as any other patient and promotes on Pennsylvania hospital’s efforts to anticipate the needs of such patients and the staff caring for them.

Other Patient Safety Information

EVAC Sticker Program for Emergency Response

A Pennsylvania rehabilitation hospital has developed a program that helps identify special needs individuals who may require additional assistance during an emergency response.