Becker's Hospital Review

78 CMO / CARE DELIVERY Survey: 1 in 5 Americans Say They've Experienced a Medical Error By Mackenzie Bean M ore than 20 percent of Americans say they have experienced a med- ical error, according to survey re- sults released Sep. 28. e independent research organization NORC at the University of Chicago conduct- ed the survey in partnership with the IHI/ NPSF Lucian Leape Institute and with fund- ing from Medtronic. For the survey, NORC polled a nationally representative sample of 2,536 adults between May 12 and June 26 about their experience with medical errors. Here are five survey findings. 1. Twenty-one percent of respondents report- ed personally experiencing a medical error and 31 percent reported involvement in the care of someone who experienced a medical error. 2. e most common types of medical errors involved diagnoses. Fiy-nine percent of re- spondents who either experienced medical errors personally or as caregivers said the error involved a medical issue that went un- diagnosed, was diagnosed incorrectly or re- ceived a delayed diagnosis. 3. When given a list of 23 factors that could have contributed to a medical error, respon- dents most commonly cited "healthcare pro- viders who do not pay attention to detail" as the main reason for the error. 4. Forty-five percent of respondents who ex- perienced a medical error notified medical personnel, and 32 percent of respondents re- ported learning of the error from a provider or facility staff. 5. irty-nine percent of respondents said pa- tient safety has stayed the same over the last five years, 29 percent said it's improved, and 12 percent said it has gotten worse. n Study: Medicare Places Few Prescribing Restrictions on Opioids By Brian Zimmerman M edicare plans enact few limitations on pre- scription opioids, despite federal guide- lines recommending restrictions on these drugs, according to a study published in Annals of Internal Medicine. The CDC issued prescribing guidelines for opioids in 2016. The guidelines urge physicians to prescribe opioids at the lowest effective dose possible and preferably just for acute, short-term pain with some exceptions. For the study, researchers examined CMS prescrip- tion drug plan formulary files on Medicare Advan- tage and Part D plans for the years 2006, 2011 and 2015. Researchers identified no restrictions — such as prior authorization — in one-third of opioid pre- scriptions in 2015. While this is a significant decrease in unrestricted opioid prescriptions compared to 2006 when two-thirds of Medicare opioid prescrip- tion were unrestricted, the 2015 rate of unrestricted opioid prescriptions is still significant, according to researchers. Additionally, researchers found the number of opi- oids on the formulary list increased from 2006 to 2015. The study's authors also noted that only 13 percent of opioid prescriptions issued in 2015 were aligned with the CDC guidelines. n Sepsis Initiatives May Hinder Antibiotic Stewardship, Boost C. Diff Rates By Mackenzie Bean S epsis screening and treatment protocols in healthcare set- tings may inadvertently cause increased antibiotic use and Clostridium difficile infection rates, according to a study pub- lished in the American Journal of Infection Control. For the study, researchers assessed data on adult inpatients at four medicine wards at a large, tertiary academic medical center from June 2011 to July 2014. Researchers examined patient outcomes and treatment before, during and after the hospital implemented a sepsis initiative, which included elec- tronic screening, laboratory tests and possible antibiotic treat- ment. The sepsis initiative allowed for the administration of broad-spectrum antibiotics without preauthorization from an antibiotic stewardship team. Both antibiotic use and hospital-acquired C. diff infection rates increased during and after the sepsis initiative implementation. The main drivers of overall antibiotic use were not included in the sepsis order set. "Integrated sepsis care streamlines how treatment is delivered. Yet as our research indicates, providers face the tough task of addressing how to deliver timely sepsis care, while mitigat- ing potential unintended consequences such as an increase in healthcare facility-onset Clostridium difficile infection that may be linked to increased use of broad-spectrum antibiotics," said lead author Jashvant Poeran, MD, PhD, an assistant professor at the Icahn School of Medicine at Mount Sinai in New York City. "Hos- pitals' antibiotic stewardship teams can use these observations to align protocol with processes that ensure appropriate antibiotic administration." n

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