Becker's Clinical Quality & Infection Control

16 QUALITY IMPROVEMENT & MEASUREMENT HHS revives childhood vaccine task force: 7 notes By Mariah Taylor HHS has reinstated the Safer Childhood Vaccines task force, the agency said in an Aug. 14 news release. Here are six things to know: 1. e task force, created by Congress, was originally disbanded in 1998. 2. In its new iteration, the panel will include senior leadership from the National Institutes of Health, FDA and CDC. NIH Director Jay Bhattacharya, MD, PhD, will serve as chairman. 3. e panel will aim to improve the safety, quality and oversight of vaccines administered to children. It will work with the Advisory Commission on Childhood Vaccines to create regular recommendations focused on the development, promotion and refinement of childhood vaccines that result in fewer and less serious adverse reactions; and to improve vaccine development, production, distribution and adverse reaction reporting. 4. HHS will submit its first formal report to Congress within two years, with updates occurring every two years from then on. 5. e announcement comes on the heels of changes to other federal panels. In June, HHS terminated all 17 members of the Advisory Committee on Immunization Practices and appointed eight new members to the CDC panel. In early August, the agency barred physician groups and other experts from the vaccine panel's working groups. 6. Vaccine panels are not the only change with respect to vaccines in the past few weeks: • Vinay Prasad, MD, former head of the FDA's vaccine and gene therapy division who resigned under political pressure in late July, will return to the agency. • HHS Secretary Robert F. Kennedy Jr. canceled nearly $500 million in federal contracts associated with mRNA vaccine development. • Vaccine exemptions reached a record high this year. e percentage of children entering kindergarten with an exemption in 2024-25 was 3.6%, up from 3.3% the previous year. • HHS and CMS eliminated a federal policy that tied hospital reimbursement to staff COVID-19 vaccination reporting. 7. e 1986 Task Force on Safer Childhood Vaccines was formed as part of the National Childhood Vaccine Injury Act, which aimed to compensate children who had adverse reactions to vaccines, NBC News reported. In May, a lawsuit funded by Children's Health Defense, an anti-vaccine group Mr. Kennedy founded, claimed that Mr. Kennedy violated the 1986 act by failing to establish a taskforce dedicated to making childhood vaccines safer. n Hospitals miss 49% of patient harm events: HHS report By Paige Twenter A ccording to a July report from HHS' Office of Inspector General, hospitals failed to capture 49% of patient harm events because staff either did not consider them harmful or were not required to disclose them. The OIG established the first national rate of harm among hospitalized Medicare patients in a 2010 report, which found that more than 1 in 4 experienced harm, the report said. In 2012, the HHS branch said hospitals failed to identify 86% of harm events. In 2022, the OIG reported 25% of hospitalized Medicare patients experienced harm during their stays in October 2018, and 43% of these harms were preventable. For this study, the OIG traced 299 harm events among 770 Medicare patients discharged in October 2018. The harm occurred at 154 hospitals, which provided information for 266 of the 299 events. The OIG used this data to estimate a national rate of harm events among hospitalized Medicare patients. Four things to know: 1. Among the 49% of missed harm events in October 2018, hospital staff did not consider 46% to be patient harm — rather, they explained the events as known complications or side effects, the report found. For 16% of these events, it was not standard practice to report because they did not meet hospitals' criteria. Several hospitals only required disclosure for harm events leading to serious injury or death. 2. Hospitals said 20% of these missed harm events were difficult to distinguish from underlying disease, and 4% were attributed to post-discharge harm. Eight percent should have been captured, hospital staff said. 3. Surgery- and procedure-related harm events accounted for 73% of missed harm events. Additionally, teaching hospitals missed 62% of harm, whereas non-teaching hospitals missed 46% — possibly due to a higher complexity of care, the report said. 4. "[D]efinitions of harm events vary widely across hospitals," the OIG said. "This means that a harm event reportable at one hospital may not be considered reportable in another hospital, which undermines reliable measurement of the extent of patient harm across hospitals." n

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