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PATIENT CONNECTION OPERATING ROOM


Critical drugs for hospital ERs remain in short supply At some hospitals, posters on the wall in the emergency department list the drugs that are in short supply or unavailable, along with recom- mended alternatives. The low-tech visual aid can save time with


critically ill patients, allowing doctors to focus on caring for them rather than doing research on the fly, said Dr. Jesse Pines, a professor of emergency medicine and director of the Office for Clinical Practice Innovation at the George Washington University School of Medicine and Health Sciences. He has studied the problems created by shortages. The need for such workarounds probably


won’t end anytime soon. According to a new study, shortages of many drugs that are essen- tial in emergency care have increased in both number and duration in recent years even as shortages for drugs for non-acute or chronic care have eased somewhat. The shortages have persisted despite a federal law enacted in 2012 that gave the Food and Drug Administration regulatory powers to respond to drug short- ages, the study found. For this report, researchers analyzed drug


shortage data between 2001 and 2014 from the University of Utah’s Drug Information Ser- vice, which contains all confirmed national drug shortages, according to the study. They divided the drugs into acute and non-


acute categories. Acute-care drugs were those used in the emergency department for many of the urgent and severe conditions handled there and include remedies such as pain medications, heart drugs, saline solution and electrolyte products. Overall, the study found that 52 percent of


the 1,929 shortages during the time period studied were for acute-care drugs. Follow- ing passage of the federal law in 2012, the number of active shortages of non-acute care drugs began to decline for the first time since 2004, but there was no corresponding dropoff in shortages of drugs that emergency depart- ments and intensive care units rely on, the researchers reported. Shortages of the drugs for emergency care


lasted longer as well, the study found. Half of the shortages of drugs for acute care lasted longer than 242 days, compared with 173 days for non-acute care drugs. Seventy percent of the drugs that were difficult to get were injectable drugs, which emergency departments rely on to a much greater degree than other types of providers. The most common acute-care drugs affected were those to fight infections, such as anti- biotics; those that affect the central nervous system, including painkillers and sedatives; and the drugs that suppress or stimulate the autonomic nervous system, which controls heart and breathing rates.


Tooling up to prevent Never Events


by Susan Cantrell, ELS H


ealthcare changed dramatically in October 2008, when the Centers for Medicare & Medicaid Services


(CMS) stopped reimbursing providers for many expenses related to certain preventable medical events, also referred to as Never Events. Private insurers have followed suit. Never Events are exactly what the name implies: serious, preventable medical mis- takes that should NEVER happen. According to the Agency for Healthcare Research and Quality,1


limited to: • unintended retention of a foreign object in a patient after surgery or other procedure


• patient death or serious injury associated with a medication error


• surgery or other invasive procedure per- formed on the wrong body part or on the wrong patient


• patient or staff death or serious injury associated with a burn incurred from any source in the course of a patient-care process in a healthcare setting


• catheter-associated urinary tract infection • vascular catheter-associated infection • certain surgical-site infections Furthermore, new research published last month, led by Martin Makery, Professor of Surgery and Health Policy and Management at Johns Hopkins University, shows 9.5 percent of all deaths each year in the U.S. are caused by medical error — the third leading cause of death behind heart disease and cancer, not


Martin Makery


respiratory disease as current health statistics indicate.


In an open letter to Dr. Thomas Frieden, Director of the Centers for Disease Control and Prevention (CDC), Makery and his team urged for a change in the way the CDC collects annual vital health statistics, which currently tallies causes of death based only on disease, morbid conditions, and injuries. “Drawing on reliable data, deaths from care, rather than from the disease that brought the person into care, should be ad- dressed with the same resources and vigor as other scientific endeavors,” the letter said. “We need more honest conversations about the problem. It would also help the many clinicians who cope with the mental trauma,


14 June 2016 • HEALTHCARE PURCHASING NEWS • hpnonline.com


and even post traumatic stress disorder, after being involved in a patient death due to error.”


Never Events have a rippling effect


Never Events include, but are not


Nicole Wilson, RN, MSN, CPHIMS, Clinical Marketing Manager, Medication Manage- ment Solutions, BD, pointed out the domino effect that nonreimbursement by CMS has when Never Events happen. “The intent is to improve quality and reduce healthcare costs by forcing hospitals to improve practices,” said Wilson. “This has had a positive impact, as hospitals are paying closer attention to quality by making improvements through education, implementation of technology, and changes to policies and procedures.” Latisha Richardson, MSN, BSN, RN, Clinical Consultant, Ansell, discussed other impacts that Never Events are having on medical facilities and patients. “In essence, hospitals are going to have to absorb these additional costs, affecting the overall operat- ing budget of the facility and the available resources to maintain quality patient care,” said Richardson. “While Never Events are rare, when they do occur, they are often devastating in both clinical and financial terms. From 2004 to 2015, The Joint Commis- sion reported a total of 1,196 wrong-patient, wrong-site, wrong-procedure incidents and 462 medication-error sentinel events.1


Over


the past 12 years, 71 percent of Never Events reported to The Joint Commission were fatal.2 “Patients and their families must cope


with physical and/or psychological injury, in addition to potential changes to personal financial standing,” Richardson added. “Pub- lic reporting of these events has increased hospital accountability and intensified the pressure to eliminate these occurrences entirely.”


Joe Guido, Vice President, Commercial Marketing and Business Development, Invu- ity Inc., suggested that public reporting of Never Events places additional pressure on medical facilities to raise the bar on quality care for their patients. Guido referred to a let- ter written by CMS and the National Quality Forum (NQF) and addressed to state Medic- aid directors in 2008. According to the letter, which places the responsibility for Never Events squarely on the shoulders of medical


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