There was a statistically significant decrease in the occurrence of VAP with strict enforcement of a VAPP protocol, regardless of head AIS score. Although the difference in patients with a head AIS score <3 was not statistically significant, it was clinically meaningful, decreasing the already-low rate of VAP by half. Strict enforcement of VAPP protocols may be cost efficient for hospitals and prevent decreased reimbursement under the Medicare pay-for-performance strategies.

SummaryIn many orthopaedic operating rooms, anaesthesia providers routinely wear lead aprons for protection from radiation, but some studies have questioned whether this is needed. We conducted a systematic review to identify studies that measured the amount of radiation that anaesthetists were exposed to in the orthopaedic operating room. Multiple studies have shown that at 1.5 m from the source of radiation, anaesthetists received no radiation, or amounts so small that a person would have to be present in an unreasonable number of operations to receive cumulative doses of any significance. Radiation doses at this distance were often at the limits of the sensitivity of the measuring dosimeter. We question the need to wear lead protection for anaesthesia providers who are routinely at 1.5 m or a greater distance from standard fluoroscopy units.

ObjectivesTo quantify medication-related errors, in particular prescribing errors, identified by pharmacists and assess their potential impact on inpatients in community hospitals.MethodsPharmacists recorded all interventions to optimise medication for community hospital inpatients over 14 days in November 2013. Interventions were subsequently classified by type (prescribing error; omitted or delayed drug administration; or attributable to other issues) and rated for potential clinical impact.Results15 organisations participated in the study reporting on 4077 medication charts. In total, 52 033 medication orders were screened by pharmacists. A medication-related intervention was made on 1 in 3 charts for one or more medications. A total of 2782 interventions were recorded. The majority were categorised as a prescriber error (67%, 1872/2782). The remainder (33%, 910/2782) were not directly attributable to prescriber error; of these omitted and delayed medicine administration accounted for 11% (298/2782). Of the 1872 interventions classed as prescriber error, a third, if left undetected, might have caused moderate or severe patient harm. The prescribing error rate was 3.6 errors per 100 medication orders.ConclusionsPharmacists reported intervening to improve the care provided to over a third of patients in this study. Two-thirds of interventions were in response to prescribing errors, a third of which, if left undetected, could have led to harm. The results suggest that inpatients in community hospitals are subject to prescribing errors at a rate comparable to those seen in acute and mental health hospitals. A clinical pharmacy service is vital to ensure patient safety in community hospitals.

A one-day 'snapshot' study was conducted to determine the nature and extent of specific safety issues faced by community nurses who care for patients unable to self-administer insulin. Community teams from 19 NHS trusts reported 607 patients requiring support with insulin administration. In total, 15.1% of insulin administration documents had an abbreviation for the word 'units', which is a serious safety hazard where any resulting serious harm would be classed as a 'never event'. Pens or disposable devices were used for 52.9% of all administrations, with 16.7% using an insulin device without any previous device-specific training. Major differences were discovered between trusts in many aspects of practice and insulin use, and comparative data can be used to benchmark activity and drive safety and cost improvement For example, 50.9% of patients had insulin administered more than once a day, but individual trusts reported figures ranging from 25.9% to 66.7%. If it were possible for all 19 trusts to manage 60% of patients on once-daily regimens, total annual service costs could be reduced by about pounds 200,000, or by pounds 3.5 million across the U.K.s.