Integration of safety technologies into rheumatology and orthopedics practices: A randomized, controlled trial

Abstract

Objective. To identify and integrate new safety technologies into outpatient musculoskeletal procedures and measure the effect on outcome, including pain.Methods. Using national resources for patient safety and literature review, the following safety technologies were identified: a safety needle to reduce inadvertent needlesticks to heath care workers, and the reciprocating procedure device (RPD) to improve patient safety and reduce pain. Five hundred sixty-six musculoskeletal procedures involving syringes and needles were randomized to either an RPD group or a conventional syringe group, and pain, quality, safety, and physician acceptance were measured.Results. During 566 procedures, no accidental needlesticks occurred with safety needles. Use of the RPD resulted in a 35.4% reduction (95% confidence interval [95% CI] 24-46%) in patient-assessed pain (mean ؎ SD scores on a visual analog pain scale [VAPS] 3.12 ؎ 2.23 for the RPD and 4.83 ؎ 3.22 for the conventional syringe; P < 0.001) and a 49.5% reduction (95% CI 34-64%) in patient-assessed significant pain (VAPS score >5) (P < 0.001). Physician acceptance of the RPD combined with a safety needle was excellent.Conclusion. As mandated by the Joint Commission and the Occupational Safety and Health Administration, safety technologies and the use of pain scales can be successfully integrated into rheumatologic and orthopedic procedures. The combination of a safety needle to reduce needlestick injuries to health care workers and the RPD to improve safety and outcome of patients is effective and well accepted by physicians.Injuries to patients and health care workers during and after physician-performed procedures are considerable and are among the greatest risks to the safety of patients and health care workers yet are challenging to prevent, requiring changes in both behavior and medical technology (1-22). The Joint Commission, the Needlestick Safety and Prevention Act, and the Occupational Safety and Health Administration all direct health care entities, including rheumatology and orthopedics services, to develop formal mechanisms to improve patient and health care worker safety and outcomes, including but not limited to integration of new safety technologies and routine pain assessment (1-5). Improvement in the safety design of medical instruments through safety engineering is one of the most robust methods to improve patient safety and reduce iatrogenic injuries to patients and needlesticks to health care workers (1-4,9-12). To date, however, few rheumatology or orthopedics departments have formally

The outcomes and cost-effectiveness of intraarticular injection of the rheumatoid knee

“…Second, removing synovial Xuid from the joint prior to injecting a medication reduces intraarticular volume and increases eVective intraarticular concentrations of the medication, resulting in improved outcomes [2,6]. Finally, a Xare of rheumatoid arthritis in a joint is indistinguishable from an infected joint; thus, as a matter of patient safety, all rheumatoid joints should be aspirated prior to injecting [21,22].…”

“…Certain of these methods, including pre-injection of air, saline or lidocaine to dilate the intraarticular space, aspiration of droplets of synovial Xuid or moisture into the barrel of the syringe, minimal retraction of the needle tip after palpation of an articular cartilage or bone surface, use of highly controlled mechanical syringes, the one-needle two-syringe technique, and the use of the longer-acting triamcinolone esters, do not substantially increase the overall cost of intraarticular injections and are either cost-eVective or cost-neutral [2,[5][6][7][8][9][10][11][12][22][23][24][25].…”

“…Thus, performing arthrocentesis prior to injecting the rheumatoid joint is a no-cost intervention that improves outcomes, contributing to substantial cost-eVectiveness [2,5,6,[20][21][22].…”

Chinese EPINet and Recall Rates for Percutaneous Injuries: An Epidemic Proportion of Underreporting in the Taiwan Healthcare System

“…This suggests that the Taiwanese healthcare system has improved its work safety culture among HCWs, but still has some way to go. Healthcare workers' behaviour has been the focus of many safety issues such as hand hygiene, however significant and impressive reductions in PIs have been associated with engineering rather than behavioural changes 8,11,17) . Nevertheless, HCWs must take some responsibility for their personal safety and report their injuries, while hospital administrations must take the responsibility for a decade during which an unsafe working culture has developed and where complacency about nor reporting is accepted.…”

“…Underestimated EPINet rates or over-estimated recall rates beg the questionwhen will rates be high enough for administration to introduce safety equipment devices (SEDs)? No ethical administration could surely choose to remain unaware of the need to supply safety equipment given the high epidemic level of PIs 8,11,17,18) .…”