Problem: Over the years, numerous cases of confusion between methylpred-nisolone acetate (Depo-Medrol) and methylprednisolone sodium succinate (Solu-Medrol) have been reported. Although both forms of the product are used to treat inflammation, dosing may differ. The acetate form should never be given by intravenous (IV) administration.
I am confident that readers of P&T struggle with the critical issue of medication adherence on a regular basis. I am also sure that most of us are frustrated by our feeble attempts to improve low rates of patient compliance, especially with medications needed for chronic conditions. I am always on the lookout for help in this area. An article in the Archives of
Internal Medicine might just shed some light on our collective conundru m. Researchers at Emory University School of Medicine in Atlanta and at McMaster University in Hamilton, Ontario, Canada, completed an incredible piece of scholarship: they reviewed every randomized controlled trial published from January 1967 to September 2004. The articles covered interventions that were intended to enhance adherence to therapy with self-administered medications to treat chronic medical conditions. Allow me to set the stage for this study, outline the key components, and comment on their findings.
All physicians agree that change is inevitable in the practice of medicine. Practicing Medicine in the 21st Century is targeted toward medical students, residents, and physicians in a variety of settings. As a practicing physician for over 25 years, I predict that this book will be extremely useful for physicians of all ages and at all stages of their professional careers.
Pharmacists around the country now have one more administrative chore to worry about. Fortunately, this task concerns only their Medicaid patients—but that may be small comfort.
October 1, 2007, was the start date for a new federal requirement that pharmacists fill only those Medicaid prescriptions, including those for over-the-counter medications, that are written on “tamper-proof pads.
Problem: A hospitalized patient whose arm was connected to a portable blood pressure (BP) monitoring device was transported to the radiology department for magnetic resonance imaging (MRI). A length of tubing that led from the monitor’s BP cuff inflator had a male Luer connector. This connector fit into a female connector on a shorter length of white tubing that was integrated with a Critikon disposable BP cuff (Figure 1). The tubing and cuff were disconnected before the MRI procedure, because the Luer connector on the monitor’s tubing was metal.
PROMOTING A CULTURE OF SAFETY
A culture of fear stifles creativity and innovation, and it impedes continuous improvement by enabling defects to remain undetected—or unreported. Fear fosters gaps between “what we know” and “what we do.” To close this gap, it is imperative to promote and to support a culture in which staff members can search for defects and can continually seek and eliminate the flaws in the system. When employees are afraid or hesitant, productivity suffers. Fear drives people to remove the source of fear, not the source of the problem. Improved performance cannot occur unless staff members feel comfortable in reporting defects and speaking truthfully and are confident thattheir suggestions will be taken seriously.
In the 2005 Patient Safety Culture Survey (total respondents = 601), the staff gave VA-NYHHS a mean patient safety grade of 3.97 (acceptable, borderline very good), which was higher than the means of the Veterans Integrated Service Network (VISN 3) (3.89) and the VA nationally (3.87). Despite that high overall grade, the NYHHS grade was below the VA national mean for the following patient safety dimensions: Nonpunitive Response to Error (-0.86) and Perceptions of Patient Safety at Your Facility (-0.12). These results indicated that the VA-NYHHS staff was still associating incident reporting with punitive consequences.
In October 2006, several nurses, pharmacists and providers commented that the medication error-reporting process at the Veterans Affairs-New York Harbor Healthcare System (VA-NYHHS) was lengthy and cumbersome and did not promote the reporting of all medication close calls and adverse events. The staff’s concerns were validated by the medication error-reporting data.
