Risk Watch e-column
September 2006
An update of risk management news, issues and items of interest
Staph Is on the Loose
While authorities continue to warn of and prepare for a potential bird flu pandemic, another super bug is already making itself felt in physicians’ offices and emergency departments throughout the United States.
Once occurring almost exclusively in the confines of hospitals, methicillin-resistant Staphylococcus aureus (MRSA) has become common in the general population.
A recent study funded by the Centers for Disease Control and Prevention (CDC) found that MRSA infections are often misdiagnosed as spider bites that will not heal, and are treated with medications that will not kill the bacteria. The results of the study were published in the August 17 issue of the New England Journal of Medicine (NEJM).
Skin infections can potentially become life-threatening if the bacteria enter the bloodstream. The drug-resistant strains—such as MRSA—can also cause a serious type of pneumonia and necrotizing wounds.
In the CDC study, researchers analyzed all the skin infections reported by hospital emergency departments in 11 cities during August 2004. Of the 422 cases, 249 or 59% were caused by MRSA, which is resistant to the penicillin family of drugs.
Data was collected from emergency departments in Albuquerque; Atlanta; Kansas City, MO; Los Angeles; Minneapolis; New Orleans; New York; Philadelphia and Portland, OR.
In recent years, outbreaks of MRSA have occurred among children, athletes and prisoners with the bacteria spreading through skin-to-skin contact or shared items such as towels.
Though potent and dangerous, the MRSA in the general population tends to be easier to treat than the strain found in hospitals. Typically, older sulfa drugs will cure it. A separate study in the August 17 issue of the NEJM suggests that the antibiotic Cubicin could be another effective drug for treating MRSA. The CDC study also recommended a non-pharmaceutical treatment for MRSA: lancing the wound and draining the pus.
(Source: Centers for Disease Control and Prevention )
Is Robotic Care in the Future?
A robot as the constant companion of grandpa or grandma now may be closer to reality than ever. A recent conference titled “Growing with the Times: Future Trends in Aging and Technology” hosted by Lassell College in Massachusetts outlined how robots will care for the aging American population.
With iconic fictional models such as the ever-efficient Robby the Robot and C-3PO as the standard, real-life robots of the past could not measure up to their big-screen counterparts. These early robots were bulky and not very helpful.
Today’s household robots are closer to the ones familiar in fiction. They are about a quarter of the size of their ancestors and perform a variety of functions, from mowing lawns to vacuuming floors to reminding seniors to take their medications. All these life-enhancing services could allow the aging boomer population to continue their active, independent lifestyles, according to presenters at the Lassell conference.
Though the technology to make robots useful tools for seniors is ready, the conference presenters noted that the business model is not. But this may simply be a case of business playing catch up with the technology. Currently there are at least nine companies in Japan and four in the United States developing eldercare robots.
(Source: www.townonline.com)
Fear of Lawsuits Not Cause for Silence on Errors
A code of silence rather than fear of being sued keeps physicians from disclosing medical errors, according to two studies published in the August 21 issue of the Archives of Internal Medicine.
The studies surveyed 1,404 physicians in Canada and 1,233 physicians in Missouri and the state of Washington. This is the first time physicians in Canada and the United States have been compared on this subject. And the differences between the two survey groups are significant.
The Canadian doctors pay less for malpractice insurance and are much less likely to be sued than their American counterparts. When they are sued, cases are heard by judges, not juries. Damages for pain and suffering are capped, and punitive damages are rare. If a patient loses his or her suit, the patient is responsible for the doctor’s legal fees.
Missouri and Washington are on the other side of the liability coin. Both have been identified by tort reform advocates as “crisis” states because of the lack of affordable malpractice insurance.
Even with the differences, both survey groups indicated that they were less likely to disclose a serious error to patients if it was unlikely the patient would discover the error on his or her own. The study found that the likelihood of a lawsuit did not affect the physician’s decision to disclose the error.
The survey also found that more than half of the physicians would mention an “adverse event” to patients, but would not say that it resulted from their error. About a third said they would apologize.
The culture of medicine with its aim toward perfectionism—which is instilled in medical school—may be the culprit in keeping physicians quiet, according to the studies’ lead author Thomas Gallagher MD of the University of Washington’s School of Medicine.
However, Dr. Gallagher predicted that the medical culture will likely shift and, consequently, there will be greater transparency in medicine.
(Source: Archives of Internal Medicine )
Camouflaged Needles May Reduce Nerves
Patients—young and old—who are squeamish when faced with the prospect of getting an injection are less so when the syringe is decorated to look like a butterfly, according to researchers at the University of New Mexico Health Sciences Center.
The researchers recruited 60 patients from the university’s outpatient clinics. They were then randomly exposed to eight designs of winged needles and six designs of conventional syringes.
When exposed to conventional syringes, 80% experienced moderate-to-severe aversion, 63% suffered moderate-to-severe fear, and 62% showed moderate-to-severe anxiety. This was reduced to 68%, 53%, and 53% respectively when the patients were shown the decorated syringes.
According to the study, decorated needles and other decorated medical devices may interfere with an established link between visual recognition of a perceived threat and emotional response to that threat.
Fear of needles can severely impact the quality of care. Young children who are fearful can become hysterical, while adults will often avoid pursuing medical treatment altogether.
(Source: University of New Mexico Health Sciences Center )
