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Published 10/1/2014

Second Look—Advocacy

Joint Commission issues Sentinel Event Alert
The Joint Commission has issued a Sentinel Event Alert regarding risk management during transition to new International Organization for Standardization tubing connector standards. Because tubes with different functions can easily be connected using Luer connectors, tubing misconnections continue to cause severe patient injury and death. The first new connector standard has been adopted, with others expected to be introduced and adopted through 2014 and 2015. The commission states that healthcare organizations “should begin preparing for changes in connectors and do everything possible during the transitional period to avoid tubing misconnections.”

FDA recalls Customed surgical packs
The U.S. Food and Drug Administration (FDA) has announced a voluntary recall of Customed, Inc. sterile convenience surgical packs, which it states have been found to have a potential defect due to adhesion, which could result in loss of product sterility. Customed convenience sterile surgical packs are used primarily in hospitals or medical offices for a variety of surgical interventions, including orthopaedic procedures.

Postoperative doctor shopping
Data published in The Journal of Bone & Joint Surgery (Aug. 6) suggest that many orthopaedic trauma patients may engage in “postoperative doctor shopping,” to obtain narcotic prescriptions from multiple providers. The prospective cohort study of 130 eligible patients identified through a state-controlled substance monitoring database found that 8.5 percent of patients engaged in preoperative narcotic use and 20.8 percent of patients sought multiple narcotic providers postoperatively. Patients with a high school education or less were 3.2 times more likely to seek multiple providers, and patients with a history of preoperative narcotic use were 4.5 times more likely to seek multiple

Reducing unnecessary antibiotic use
HealthLeaders Media
reports that the U.S. Centers for Disease Control and Prevention (CDC) and the American Hospital Association (AHA) plan to work with hospitals to start antibiotic stewardship programs. The following tips were provided by one hospital that launched a stewardship program in 2009:

  • Daily reviews of all antibiotic orders by pharmacists and review with infectious disease specialists
  • Diligence in checks for emergence of resistance in strains of bacteria within the hospital
  • Medication reconciliation by pharmacy staff in the emergency department
  • Appropriate antibiotics given to patients undergoing surgical procedures

Maintaining quality improvements
Findings from a study conducted in the United Kingdom and published in The New England Journal of Medicine (Aug. 7) suggest that it may be difficult to maintain short-term quality improvements after implementation of a pay-for-performance (P4P) system. The analysis of 30-day in-hospital mortality among 1,825,518 hospital admissions across 161 hospitals for eight conditions—three of which were covered by a P4P program with financial incentives—found performance in P4P participating hospitals continued to improve throughout the study period for the three covered conditions. However, nonparticipating hospitals saw an even greater reduction in mortality for the three covered conditions. By the end of the study period, no significant difference in mortality reduction was found.

Physician turnover rates
According to survey data released by the American Medical Group Association (AMGA) and Cejka Search, physician jobs turned over in 2013 at a rate of 6.8 percent. Overall, “retirement” was cited as the reason for separation 18 percent of the time. The survey also noted a reduction in turnover rate among advanced practice clinicians.

Hand washing and HAIs
An article in the Cleveland Plain Dealer profiles hospital efforts to reduce the incidence of hospital-acquired infection (HAI) through the use of hand washing programs. One hospital achieved a self-reported compliance rate of 97.6 percent through the hiring of four monitors who tracked hand washing after providers walked in and out of patient rooms. The program was also associated with a reduction in surgical site infections, central line–associated bloodstream infections, and ventilator-associated pneumonia, and an overall drop in HAIs of 38 percent since 2010.

MoM hip device lawsuit
Bloomberg reports that jury selection has begun in the first lawsuit over the DePuy Orthopaedics Pinnacle® Ultamet metal-on-metal (MOM) hip. The plaintiff claims that the device was defectively designed, causing metal debris to leech into patients’ bloodstreams. DePuy previously settled a series of suits that claimed that the company’s ASR hip devices caused dislocations, pain, and required surgical removal.

These items originally appeared in AAOS Headline News Now, a thrice-weekly enewsletter that keeps AAOS members up to date on clinical, socioeconomic, and political issues, with links to more detailed information. Subscribe at www.aaos.org/news/news.asp (member login required)