Articles related to PATIENT SAFETY

Investigating how an insulin bolus affects the management of diabetic ketoacidosis reveals startling new information. In the diabetes field, experts widely use insulin as a core treatment for diabetic ketoacidosis (DKA). However, the debate over the best dosage and method of administration, specifically concerning the use of an initial insulin bolus, continues. This study evaluates the safety and effectiveness of this insulin bolus in DKA treatment. Employing a retrospective chart review, researchers examined patient outcomes for DKA treatment with and without an insulin bolus. They included 59 patients in the bolus group, and 108 in the non-bolus group. The study primarily tracked whether the administration of insulin had to be interrupted, or if patients experienced hypoglycemia or hypokalemia within eight hours of starting insulin. Comparing baseline characteristics, the groups showed no significant differences. Most patients exhibited mild DKA. Results revealed that adverse effects—particularly hypokalemia—occurred significantly more often in the bolus group (45.8% versus 25%, P = .003). Additionally, while time to anion gap closure was shorter in the bolus group, this did not reach statistical significance (6:39 versus 9:00, P = .063). Similarly, non-significant differences emerged in time to discontinuation of insulin infusion and time to ICU and hospital discharge. […]

Dive into the essence of AANA’s updated guidelines for obstetric anesthesia and analgesia as we spotlight its focus on health equity and safety in maternal care. Commencing with the unveiling of the revised practice guidelines for obstetric anesthesia and analgesia, the American Association of Nurse Anesthesiology (AANA) has emphasized enhancing patient care and safety. Interestingly, these updates also strive to tackle the critical issue of enduring health disparities in the United States. The AANA firmly believes in the power of certified registered nurse anesthetists (CRNAs) to help curb maternal mortality rates. The primary strategy focuses on mitigating racial and ethnic imbalances in pregnancy-related deaths. Beth Ann Clayton, DNP, CRNA, FAANA, FAAN, the key subject matter expert behind the revisions, underscores these inequalities as significant barriers to optimal maternal care. Using an evidence-based process, the AANA revised the guidelines, paying careful attention to current research. They’ve prioritized enhancing the readability of the content, updating the quality of references, and broadening their scope to encompass the most recent recommendations on obstetric analgesia and anesthesia care. The notable alterations include the broadening of analgesia and anesthesia considerations for labor and delivery. This expansion encompasses inhalation analgesia, neuraxial analgesia, general anesthesia, and an updated […]

Delve into the changes in the updated Beers criteria and their implications for medication use in older patients. The American Geriatrics Society (AGS) has recently revised the Beers criteria. Significantly, these guidelines advise physicians to be cautious when prescribing medications like warfarin and sodium-glucose cotransporter-2 (SGLT2) inhibitors for patients over 65. Importantly, warfarin is now a drug to avoid in initial therapy for venous thromboembolism or nonvalvular atrial fibrillation unless alternatives are contraindicated or face significant usage barriers. The Beers criteria are organized into five distinct categories. These include potentially inappropriate medications, ones that might be inappropriate for patients with certain conditions, medications requiring careful usage, potential drug-drug interactions, and medications needing renal function-based dosage adjustments. An expert panel sifted through evidence from June 1, 2017, to May 31, 2022, to create these updates. These guidelines apply to patients aged 65 years and older in most care settings in the US, excluding hospice and end-of-life care situations. Among the notable changes since 2019 is the inclusion of warfarin. For older patients using warfarin long-term, continuation might be reasonable if they show well-controlled international normalized ratios and no adverse effects. Additional drugs introduced since 2019 include ticagrelor and SGLT2 inhibitors (use […]

The case involves a 73-year-old patient, Ms. B, who had a history of rheumatoid arthritis and was taking prednisone for adrenal insufficiency caused by a pituitary tumor. She was treated by an internist, Dr. R, for various ailments over a period of four years. In November 2016, Ms. B was diagnosed with severe community-acquired pneumonia and admitted to the hospital, where she was treated with levofloxacin. After being discharged, she continued taking levofloxacin and suffered an acute rupture of the gluteus medius tendon, resulting in significant disabilities. Ms. B filed a lawsuit against Dr. R, alleging negligence and failure to inform her about the risks and contraindications of the medication. Dr. R sought a summary judgment to have the case dismissed but was denied by the court. The court ruled that a Boxed Warning on a medication, such as the one associated with levofloxacin, can create a triable issue of fact regarding a physician’s departure from accepted medical practice. Dr. R claimed he was unaware of the risks and relied on the hospitalists’ choice of medication, but the court found that he should have been knowledgeable about the specific risks and suitability of the medication for his patient. The case […]

Do you understand how to protect your patients and team from biofilm that can build in dental unit waterlines (DUWLs)? Take this quiz to see how well you understand this critical safety issue.

A federal science panel has recommended revisions to a National Toxicology Program (NTP) report on the potential associations between fluoride and IQ. The NTP Board of Scientific Counselors unanimously voted to adopt the findings and recommendations of a working group that assessed the report. The systematic literature review, which has been ongoing for several years, aims to summarize the existing research on the relationship between fluoride exposure and neurodevelopmental and cognitive health. The panel identified potential biases in the study and suggested revisions to the meta-analysis based on reviewer comments. The American Dental Association (ADA) expressed concerns about the report’s methodology and transparency, urging the NTP not to publish it until the concerns are addressed. The draft report claims that higher fluoride exposure is associated with lower IQ in children, but several studies published after the study period ended in 2020 have questioned the methodology used and the strength of the conclusions. The BSC Working Group recommended that the NTP acknowledge potential publication bias and make improvements to the clarity and language used in the report. The recommendations will be forwarded to the NTP director for further consideration.