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Patient Safety Monitor is the premier online destination for news, analysis, and training in the patient safety community.

This time-saving resource includes:

  • Patient Safety Crosswalk: an interactive grid that organizes state, CMS, and Joint Commission requirements by topic
  • Patient Safety Monitor Journal newsletter and weekly email newsletter
  • Patient Safety Monitor Blog and Talk Group
  • Tools Library with sample forms and policies
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Patient Safety Monitor Journal

Patient Safety Monitor Journal answers your most important patient safety questions and offers field-tested compliance strategies to ensure your patient safety efforts measure up to The Joint Commission.

  • Many patients using anticoagulants are taking aspirin the same day

    Physicians who’ve prescribed anticoagulants to their patients should double-check to make sure those patients aren’t using aspirin too, a new study out of Michigan Medicine suggests.

    The study, published this month in JAMA Internal Medicine, found that 37.5% of the 6,539 patients reviewed were receiving the anticoagulant warfarin and aspirin without a clear indication, and that these patients were at a significant increase in adverse outcomes. 

    “Nearly 2,500 patients who were prescribed warfarin were taking aspirin without any clear reason over a seven-year period,” says senior author Geoffrey Barnes, MD, a vascular cardiologist and an assistant professor of internal medicine at U-M Medical School. “No doctors really own the prescribing of aspirin, so it’s possible it got overlooked.”

    The study cohort included 6,539 patients who were enrolled at six anticoagulation clinics in Michigan between 2010 and 2017.

  • High hospital C-section rates will be published online in 2020

    Next year, patients and potential parents will have one more metric by which to judge your hospital. Starting July 2020, The Joint Commission (TJC) will publicly report hospitals that have consistently high C-section rates on its Quality Check website.
    Hospital rankings will be based on TJC’s perinatal care (PC) Cesarean Birth measure PC-02. Hospitals accredited by TJC are already required to report that data to the accreditor, but this will be the first time it’ll be visible to the public.
    TJC will only track the number of C-sections done on nulliparous, term, singleton, vertex (NTSV) births—procedures performed on first-time mothers carrying a single baby that has its head facing down at the onset of labor.

  • Q&A: Legal marijuana use in hospitals

    While still illegal federally, there are currently 33 states that have legalized marijuana for medical use. At the moment, the laws on this topic are very dependent on where your facility is located, and you should take the time to look up your state laws.

    This Q&A is meant to clear up some of the broader questions around medical cannabis in healthcare—for patients as well as healthcare employees.

    This Q&A has been lightly edited for clarity.

    Benjamin Caplan, MD,
    is the founder of the CED Clinic and a spokesman for Doctors for Cannabis Regulation, the only national physicians’ association dedicated to the effective regulation of cannabis in the United States. 

    Q: If a patient has a valid medical marijuana recommendation, is he or she allowed to bring it to the hospital? Say if they’re going to be there for an extended period of time or overnight?
    That’s a policy question for hospitals. There are places in the United States where it’s legal to bring [medical cannabis] to a hospital, although they would not be administering it. But it’s different region to region.
    I think there’s a legal question and an ethical question. State laws are telling medical patients that they are allowed to have a choice to use this particular medicine. Hospital policies are quite different, and for good reason. In order for doctors to best manage illnesses carefully, and to the best of our abilities, we must know as much as we can [about] what a patient is taking. But it’s very common for patients to sneak cannabis in back rooms or under the radar, which is really unfortunate for everyone. I think the hospital perspective should be embracing what patients find helpful.
    To have cases where patients are having seizures in a hospital and they can’t get the medicine that they want (and find helpful) as an outpatient is a real cultural disconnect for the medical establishment. I think the solution is for people to not sneak around; the solution is for hospitals to open their arms to patients who find a medication helpful. 

  • ER doctor: Protect your staff from workplace violence

    Amy Costigan, MD, wants to be able to practice emergency medicine without being punched in the face.

  • PSMF takes aim at postoperative delirium in elders

    The PSMF has named postoperative delirium as its 18th patient safety challenge, collecting solutions for organizations to implement to reduce the number of preventable deaths from the condition.
    Delirium is a condition of acute cerebral dysfunction that may be seen in patients in the early postoperative period or in ICU patients.

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