Risk Watch e-column
December 2005
An update of risk management news, issues and items of interest
Flu Vaccine Distribution Continues to Leave High-Risk Patients at Risk
The California Medical Association (CMA) received 299 responses to its question, “Did You Receive Your Flu Vaccine on Time?” The results indicate high-risk patients are not getting first-priority vaccination. As of November 3, 2005, 75% physicians still did not have flu vaccines for all patients, and 54% had not received any. To view the entire survey results, click here.
Meanwhile, some retailers, including pharmacies and grocery stores, have been dispensing shots since early fall. “This vaccine shortage has been especially bad for elderly and other vulnerable patients in rural California, where there are no chain stores,” says California Academy of Family Physicians (CAFP) President Eric Ramos MD. “In more populated regions, these stores have no way of identifying who needs the vaccine most—they take all comers and that is bad for our most vulnerable patients.”
Dr. Ramos’ Modesto, California, practice includes 1,500 high-risk patients, and reported receiving only 10 doses of vaccine. The CMA and CAFP encourage physicians to vaccinate all patients into January and February, as the flu season often peaks in late winter.
(Source: CMA)
Advance Draft: WHO Guidelines on Hand Hygiene in Healthcare
The World Health Organization (WHO) has released advance draft guidelines for hand hygiene in healthcare settings. The guidelines are part of the WHO Global Patient Safety Challenge, 2005-2006, titled “Clean Care is Safer Care.” According to findings of 17 observational studies, “the frequency of hand hygiene opportunities per hour of care may be very high, and despite the hand hygiene compliance rate, the applied technique may fail.” (The average duration of hand cleansing by approximately two-thirds of observed healthcare workers was less than 15 seconds.)
“Perceived barriers to adherence with hand hygiene practice recommendations include skin irritation caused by hand hygiene agents, inaccessible hand hygiene supplies…and the lack of scientific information showing a definitive impact of improved hand hygiene on health care-associated infection rates.”
Even the use of gloves only goes so far to reduce patient contamination without an appropriate antiseptic agent; and laboratory and clinical studies cited provide strong evidence that hands should still be decontaminated or washed after glove removal. The study includes cultural and religious factors affecting hand hygiene practice, suggesting sufficient friction and drying may be more efficacious than the specific washing compounds. To read the advance draft guidelines, click here.
(Source: WHO)
ISMP and FDA Join Forces to Eliminate Error-Prone Medical Abbreviations
According to the Institute of Medicine, more than 7,000 deaths each year are due to medication errors, from prescription to administration of a drug. The Institute for Safe Medication Practices (ISMP) and the U.S. Food and Drug Administration (FDA) have joined forces to eliminate the use of ambiguous and potentially harmful medical abbreviations with an educational campaign aimed at healthcare professionals, medical writers, the pharmaceutical industry, and FDA staff. Beginning the first half of 2006, the campaign will recommend that the ISMP’s list of abbreviations, symbols, and dose designations most often associated with medication errors be referenced whenever and wherever medical information is communicated. The view the current list, click here.
ISMP’s full listing includes additional abbreviations that have been associated with medication errors reported to the USP-ISMP Medication Errors Reporting Program. For example: OD, intended to mean “once daily” may be mistaken as “right eye” (OD-oculus dexter).
(Source: ISMP)
Body Piercing Complications Can be Life-Threatening
American Family Physician magazine recently ran an article addressing complications of body piercing. While the traditional earlobe piercing complications can be irritating or disfiguring, other piercing sites (such as nose, mouth, navel, genitals and nipples) offer potential medical challenges, from local (allergic reaction) to systemic (bacterial endocarditis).
Author Donna I. Meltzer MD, State University of New York at Stony Brook School of Medicine, suggests, “persons with increased vulnerability to infection (e.g., patients with diabetes, patients taking corticosteroids) and those who have an increased likelihood of hemorrhage (e.g., persons taking anticoagulant medication) may be at greater risk of complications from body piercing.”
Family physicians may want to warn patients that non-sterile piercing techniques and poor hygiene contribute significantly to the increased risk of infection, and may be a possible vector for human immunodeficiency virus (HIV) transmission. For a patient handout on body piercing, click here.
(Source: American Family Physician magazine, November 15, 2005, Volume 72, Number 10)
