Healthcare Consulting Services
PO Box 1230
Grantham, NH 03753
ph: 716-550-1106
btruax
Healthcare Consulting Services with a Focus on Patient Safety Solutions and Quality Improvement Across the Health Care Continuum. Your Patient Safety Resource Solution.
November 29, 2022
Preventing Newborn Falls
One special category of falls, with unique contributing factors, is newborn falls. We discussed factors contributing to newborn falls in detail in the 3 columns list below.
The Children’s Hospital at Dartmouth Hitchcock Medical Center implemented a series of interventions to reduce newborn falls (Whatley 2022). In 2017 the hospital had 3 newborn falls occurring in a two-month period and a resultant newborn fall rate of 71.8 falls per 10,000 births. Root cause analysis (RCA) and chart review found prenatal maternal opioid intake in 4 of 10 cases. Mothers’ fatigue due to medication, delivery-related complications, the postpartum state, hesitancy to accept help, and being accustomed to co-sleeping were all cited as factors that might increase newborn falls. Interestingly, the mechanism of fall differed by mode of delivery, with more drops by a sleeping caregiver following vaginal deliveries and falls due to maternal trips after cesarean deliveries.
An interprofessional team developed and implemented parent education materials, a nursing Newborn Fall Risk Assessment tool and job aid, attention to physical layout, and a standardized reporting system. After interventions, the fall rate decreased to 15.5 per 10,000 births. Days between falls increased from a low of 9 days to a high of 467 days. No newborn injuries have occurred since early 2017. This improvement was accomplished while preserving rooming-in on a mother-baby unit with many opioid-exposed newborns.
We are still waiting to see if anyone has tried an intervention we suggested in our January 14, 2020 Patient Safety Tip of the Week “More on Newborn Falls”. Since mom’s drowsiness and falling asleep while feeding the baby is a major cause of newborn falls, that should be an area of focus. There is an iPhone app called “Keep Alert”. You focus the iPhone camera on your face and, if your eyelids droop or close, it sets off an alarm. We tried it on ourselves, and it clearly delivered as advertised. This could be a simple, inexpensive intervention on a maternity ward to trigger an alarm when a mom is breastfeeding or otherwise holding her newborn.
The Pennsylvania Patient Safety Authority has identified multiple factors contributing to newborn falls. In our July 28, 2015 Patient Safety Tip of the Week “Not All Falls Are the Same” and our March 2019 What's New in the Patient Safety World column “Newborn Falls” and our January 14, 2020 Patient Safety Tip of the Week “More on Newborn Falls” we highlighted a Pennsylvania Patient Safety Authority review that found a surprising number of newborn injuries related to falls (Wallace 2014) and a followup study a few years later (Kukielka 2019).
Kukielka and Wallace estimated annual rates of newborn falls as ranging from 3.7 to 5.9 falls per 10,000 live births from 2014 to 2018, with an average annual rate of newborn falls of 4.8 falls per 10,000 live births over the five-year study period. Almost 70% occurred within the first 72 hours following birth and 90% within the first 7 days.
56.6% of newborn falls occurred between midnight and 7 a.m. 52.8% of events took place after the caregiver fell asleep. A couple happened when a caregiver lost consciousness following a seizure. Other circumstances included caregiver dropping the newborn while in motion (19.8%), caregiver dropping the newborn while stationary (12.6%), and the newborn falling from another surface, such as a bed or couch (5.7%).
There were 5 cases (1.6%) in which the newborn fall occurred following a precipitous delivery.
The following contributing factors were identified:
84.6% of events involved the mother, 10.3% the father, 2.9% another family member (most often a grandparent), and 1.9% a member of the hospital staff (most often a nurse).
Regarding harm to the newborn, 10.4% were classified as Serious Events though, fortunately, none of the events resulted in permanent harm or death. In 63% of those classified as Serious Events, the newborn experienced temporary harm that required treatment or intervention. In the remaining 36.4%, the newborn experienced temporary harm (eg. bumps, bruises, swelling, hematomas, hemorrhages, and fractures) that required initial or prolonged hospitalization.
The authors of both PPSA studies focused heavily on feeding and, in particular, breastfeeding as important contributing factors. Since many hospitals allow the infants to sleep in-room (in bassinettes) with the mothers, the importance of putting the infant back in the bassinette becomes apparent.
The reports focus heavily on the sleepiness of the parents, particularly the mothers, noting studies demonstrating maternal sleep deprivation in the peripartum and postpartum periods. One of the most important points made by the authors is “The cluster of events during hours when parents or caregivers would otherwise be sleeping suggests that maternal sleep in the immediate postpartum period should be a focal point in newborn fall prevention strategies.”
Focusing on education for new parents may be an important intervention to prevent newborn falls. The authors give examples from some hospital interventions, such as giving new parents a welcome letter that includes information on newborn safety and safe sleep and discourages co-sleeping.
Parents should be encouraged to give their baby to nursing staff to take to the nursery if they are feeling tired or just need a break. Some also encourage parents to have a break in visiting hours from 2 p.m. to 4 p.m. each day to give them the opportunity to rest.
The earlier PPSA study mentioned hourly rounding as a potential preventive intervention, with nurses intervening when finding a sleepy mother with a newborn in her arms. One of the hospitals in the more recent PPSA study noted nurses were already rounding every hour on the maternity ward, so they increased this to every 15 minutes as an added precaution when mothers are breastfeeding. Some even use handheld timers to support the nurses in this practice.
Staff training should include education on the American Academy of Pediatrics recommendations for safe sleep practices to prevent sleep-related deaths among infants, and learning how to lock hospital beds in the lowest position to reduce the likelihood of injury if a newborn were to fall from the bed.
The earlier PPSA review (Wallace 2014) did note their literature review of risk factors noted cesarean birth, pain medication in the last two to four hours, and history of narcotic substance use and/or methadone treatment program as potential risk factors.
The Joint Commission, in a Quick Safety alert “Preventing Newborn Falls and Drops” (TJC 2018), advocated doing a risk assessment to identify newborns most at risk for falls, then educating the parents based on that assessment. The Joint Commission Quick Safety alert also recommends:
Note that we have stressed in several prior columns on falls the importance of doing post-fall assessments promptly. We’re not just talking about examining the newborn for evidence of physical harm. We are talking about determining factors that likely contributed to the event so that recurrences can be prevented. In prior columns we gave links to some examples of post-fall evaluation tools, such as an excellent form for post-fall huddles after newborn falls on the PPSA website.
.
The National Health Service (UK) also in 2019 released a safety alert on assessment and management of babies who are accidentally dropped in hospitals (NHS 2019a). A search of their National Reporting and Learning System (NRLS) for a recent 12-month period identified 182 babies who had been accidentally dropped in obstetric/midwifery inpatient settings, 66 babies accidentally dropped on pediatric wards, and two in mother and baby units in mental health trusts. Almost all of these 250 incidents occurred when the baby was in the care of parents or visiting family members. Eight of those dropped in the obstetrical settings had significant reported injuries, including fractured skulls and/or intracranial bleeds,
The NHS found that responses to such incidents were quite variable, so the alert provided a resource to support providers to develop or update a tailored local guide on the initial actions to take when a baby has been accidentally dropped. Guidelines for the latter (NHS 2019b) include recommendations on:
The 2 PPSA reviews, and other studies in our March 2019 What's New in the Patient Safety World column “Newborn Falls” such as the one from Driscoll et al. (Driscoll 2019), have emphasized breastfeeding and rooming-in as significant risk factors. Of course, we encourage breastfeeding. So, we need to take extra precautions to ensure that breastfeeding is done safely. In addition to the “educational” interventions, we like the ideas for signage and for upping the hourly rounding to every 15-minute rounding when the mother is breastfeeding. But that can be difficult on labor and delivery units, especially when there are several ongoing labors that may require staff be elsewhere during those nocturnal hours when newborns are at greatest risk. Is this a scenario where technology might help? Companies are working on smart cameras to detect when a car driver’s eyelids are getting heavy, such as the “Keep Alert” iPhone app we noted above. We strongly suspect that sort of technology could be used to identify mothers (or fathers) at risk of falling asleep while holding their newborns.
We like the idea of a technology intervention since most of the other interventions mentioned above rely heavily on education (of parents and staff). In one of our other January 2020 What's New in the Patient Safety World columns “ISMP Canada: Change Management to Prevent Recurrences” we again remind everyone that education/training rank lowest on our list of strengths of interventions. However, we also caution against overreliance on technology, since we may become complacent and assume the technology will prevent untoward events at the expense of our other interventions (see our Patient Safety Tips of the Week for August 23, 2016 “ISMP Canada: Automation Bias and Automation Complacency” and June 11, 2019 “ISMP’s Grissinger on Overreliance on Technology”).
And, yes, don’t forget dads, too. Fathers are the caregiver with the newborn in about 10% of the newborn falls. While moms have done all the work and are entitled to be fatigued, dads may get fatigued trying to balance visits to the maternity wing with caring for the other kids at home.
And what about those falls/drops that occur during deliveries? The viral video and the other report of newborns falling or being dropped during deliveries are particularly distressing. In one incident, a newborn was dropped on her head while being handled by staff immediately following delivery (Westfall 2019). Video of the incident shows three staff members transferring the baby from one set of blankets to another. The newborn is lifted up by one of them, who is still gripping a medical instrument. Then the worker loses control of her. The baby flips, lands on her head on the table and almost falls over the edge. The workers snatch her up, turn her over and wrap her in a blanket. The baby apparently had some sort of cerebral hemorrhage, though the article did not clarify whether that was the result of the drop or due to prematurity.
In the other incident, a newborn died during delivery (Penza 2019). His mother had reportedly been told to push, but he came out too fast and fell onto the ground. According to the father “My wife was in labor and was just about to have the baby and they asked her to push and she pushed so he would come out. He came out really fast and no-one grabbed him and he fell to the floor. The midwife didn’t have time to catch him and the obstetrician didn’t react.”
Seems to be a rarity. However, the UK NHS alert (NHS 2019a) also notes that 4% of their incidents occurred during “precipitate” birth and the recent PPSA study (Kukielka 2019) found 5 events over the 5 year period (1.6% of the total newborn falls) in which the newborn fall occurred following a precipitous delivery. Few details were provided though they note high-risk situations have been identified including delivery, especially when the mother has lost a significant amount of blood. The infant in the case described above (Westfall 2019) was a twin, though the article does not mention whether she was the first or second delivered (though one of many articles with the viral video said the father was watching delivery of the other twin while he was filming the video). Either way, it suggests some sort of urgency during the delivery. So, we’d probably add distractions (such as maternal hemorrhage or multiple births) as risk factors for newborn falls during delivery.
The increase in occurrence of newborn falls as noted by the PPSA and the Joint Commission and UK NHS should raise our awareness of the risks and contributing factors. Dartmouth Hitchcock did a nice job with their program to reduce risk factors for newborn falls. Particularly if your organization takes care of newborns in any setting, you should review RCA’s on any newborn falls you’ve encountered but also consider doing a FMEA (Failure Mode and Effects Analysis) to identify your potential vulnerabilities. And learn from the many valuable lessons in this and our other columns on newborn falls.
Some of our prior columns related to newborn falls:
References:
Whatley C, Schlogl J, Whalen BL, Holmes AV. A Longitudinal Study of a Multifaceted Intervention to Reduce Newborn Falls While Preserving Rooming-In on a Mother-Baby Unit. The Joint Commission Journal on Quality and Patient Safety 2022; 48(10): 521-528
https://www.sciencedirect.com/science/article/abs/pii/S155372502200126X
Wallace SC. (Pennsylvania Patient Safety Authority). Balancing Family and Newborn Bonding with Patient Safety. Pa Patient Saf Advis 2014; 11(3): 102-108
http://patientsafety.pa.gov/ADVISORIES/Pages/201409_102.aspx
Kukielka E, Wallace SC. Newborn Falls in Pennsylvania: An Analysis of Recent Events and a Review of Prevention Strategies. Patient Safety 2019; 1(2): 45-53 December 2019
https://patientsafetyj.com/index.php/patientsaf/article/view/newborn-falls/55
The Joint Commission. Quick Safety 40: Preventing Newborn Falls and Drops. The Joint Commission 2018; March 27, 2018
PPSA (Pennsylvania Patient Safety Authority). Newborn Fall UOR Debrief Form. PPSA 2014
http://patientsafety.pa.gov/pst/Pages/Newborn.Injuries/form.aspx
NHS (National Health Service UK). Patient Safety Alert. Assessment and management of babies who are accidentally dropped in hospital. NHS 2019; 9 May 2019
NHS (National Health Service UK). Creating a local guide for the assessment and management of babies who are accidentally dropped in hospital. NHS 2019
Driscoll CAH, Pereira N, Lichenstein R. In-hospital Neonatal Falls: An Unintended Consequence of Efforts to Improve Breastfeeding. Pediatrics 2019; 143(1): e20182488
Westfall A, Sanders RL. Graphic video shows baby dropped on head by staff at Chandler hospital. Arizona Republic 2019; May 3, 2019
Penza N. Freak Accident. Newborn baby died seconds after birth when medics failed to catch him and he fell headfirst on to the floor. The Sun 2019; 19 Dec 2019
https://www.thesun.co.uk/news/10566959/newborn-baby-died-birth-medics-fell-headfirst-floor/
Print “Preventing Newborn Falls”
To get "Patient Safety Tip of the Week "emailed to you, click here and enter "subscribe" in the subject field.
If you don't see the search term you expected to see here, its probably because that tip already went to our Tip of the Week Archive. We do a new tip every week. Click here to search the entire site or you can Go to Tip of the Week Archive a patient safety resource solution loaded with tips, tools, and techniques you can use in your patient safety and quality improvement initiatives. Or it may have moved to our What's New Archive.
Click here to see the consulting services and patient safety solutions that we provide.
What's New in the Patient Safety World
A pretty scary statistic emerged from a one-year follow-up on community-living patients, aged 65 years or older, who underwent major surgery. Gill and colleagues (Gill 2022) analyzed data on 5590 Medicare beneficiaries from the National Health and Aging Trends Study (NHATS).
The overall one-year mortality rate was 13.4%. That means that nearly 1 of every 7 community-living older US adults died in the year after major surgery. Mortality rates were 7.4% for elective surgeries and 22.3% for nonelective surgeries.
As you’d expect, mortality rates were greater as age increased. Mortality was highest for persons aged 90 years or older, intermediate for those aged 80 to 84 and 85 to 89 years, and lowest for those in the youngest 3 age groups. Unadjusted hazard ratios were 2.44 for those aged 80 to 84 years, 2.89 for those aged 85 to 89 years, and 6.06 for those aged 90 years or older.
Frailty and dementia played a major roles in the mortality risk. 1-year mortality was 6.0% for persons who were nonfrail, but 27.8% for those who were frail. Similarly, 1-year mortality was 11.6% for persons without dementia, but 32.7% for those with probable dementia.
And, of course, as pointed out in the editorial accompanying the Gill study (Perone 2022), the cumulative mortality over the course of the year suggests that death is not associated with surgery alone but also with chronic conditions (and changes derived from surgery) and the overall life expectancy of the population.
It is not clear what the 1-year mortality rate for a comparable population who did not have surgery would have been. But Gill et al. do state that the expected 1-year mortality
rate for their analytic sample, based on actuarial life tables was only 4.9%, considerably lower than the 13.4% overall mortality rate reported in their study.
Gill and colleagues and the editorialists both point to programs such as the American
College of Surgeons Geriatric Surgery Verification Program for recommendations
to improve outcomes after geriatric surgery (see our September 17, 2019 Patient Safety Tip of the Week “ACS Geriatric Surgery Verification Program”).
Some of our columns on preparation of patients prior to surgery:
Some of our prior columns on preoperative assessment and frailty:
References:
Gill TM, Vander Wyk B, Leo-Summers L, Murphy TE, Becher RD. Population-Based Estimates of 1-Year Mortality After Major Surgery Among Community-Living Older US Adults. JAMA Surg 2022; Published online October 19, 2022
https://jamanetwork.com/journals/jamasurgery/article-abstract/2797666
Perone JA, Anaya DA. Patient Experience Following Surgery in the Geriatric Population—Increased Relevance and Importance of Longer-Term Surgical Outcomes. JAMA Surg 2022; Published online October 19, 2022
https://jamanetwork.com/journals/jamasurgery/article-abstract/2797673
Print “December 2022 Scary Stat on Surgery in the Elderly”
We’ve done many columns on the importance of drugs and other conditions that prolong the QT interval, predisposing to the potentially lethal arrhythmia Torsade de Pointes. But might there be unintended consequences? A recent study in the oncology literature (Richardson 2022) suggests that use of certain formulas for calculating the QTc interval may erroneously preclude some patients from receiving the most appropriate chemotherapy.
The 3 most commonly used formulas for determining the adjusted QTc by oncologists are the Bazett, Fridericia, and Framingham formulas. Because some chemotherapy agents may prolong the QTc, Richardson and colleagues looked at how inappropriate modifications to chemotherapy might occur with each of those 3 formulas.
The percentage of ECG’s with grade 3 QTc prolongation differed by formula: Framingham 1.8%, Fridericia 2.8%, and Bazett 9.0% for all patients. For those patients receiving QT-prolonging chemotherapy the percentage of ECG’s with grade 3 QTc prolongation were: Framingham 2.7%, Fridericia 4.5%, and Bazett 12.5%. The Bazett formula resulted in a median QTc value 26.4 milliseconds higher than Fridericia and 27.8 milliseconds higher than Framingham.
Of the ECG’s classified as grade 3 by Bazett, 81.0% were grade 2 or less by either Fridericia or Framingham. 17.9% of evaluated clinical changes associated with prolonged QTc were deemed inappropriate when using either Fridericia or Framingham formula.
The authors conclude that use of the Bazett formula likely was associated with inappropriate changes in clinical management. These data support the use of a standard QTc formula (such as Fridericia or Framingham) for QTc correction in oncology. They argue for standardization of QTc monitoring practices across oncology.
The Richardson study did not report on patient outcomes or unwanted arrhythmias, so it is not known whether preferential use of the Fridericia or Framingham formulas allows more patients to receive certain chemotherapy agents safely. But it does raise the possibility that many patients are being denied the most appropriate management simply because of the formula chosen.
Some of our prior columns on QT interval prolongation and Torsade de Pointes:
June 29, 2010 “Torsade de Pointes: Are Your Patients At Risk?”
February 5, 2013 “Antidepressants and QT Interval Prolongation”
April 9, 2013 “Mayo Clinic System Alerts for QT Interval Prolongation”
June 10, 2014 “Another Clinical Decision Support Tool to Avoid Torsade de Pointes”
April 2015 “Anesthesia and QTc Prolongation”
October 10, 2017 “More on Torsade de Pointes”
June 25, 2019 “Found Dead in a Bed – Part 2”
April 7, 2020 “Patient Safety Tidbits for the COVID-19 Pandemic”
February 16, 2021 “New Methods for QTc Monitoring”
November 22, 2022 “The Apple Watch and Patient Safety”
References:
Richardson DR, Parish PC, Tan X, et al. Association of QTc Formula With the Clinical Management of Patients With Cancer. JAMA Oncol 2022; 8(11): 1616-1623 Published online September 22, 2022
https://jamanetwork.com/journals/jamaoncology/article-abstract/2796766
Print “December 2022 Unintended Consequences of a QTc Formula?”
Surgical site infections (SSI’s) remain a significant problem, particularly in abdominal surgeries. What if we had a simple, inexpensive intervention that could reduce SSI’s? Investigators recently completed a study that suggests we have one!
ChEETAh was a multicenter, cluster randomized trial in seven low-income and middle-income countries (Benin, Ghana, India, Mexico, Nigeria, Rwanda, South Africa), across a wide range of operation types, hospital types, and countries. Investigators randomly assigned 81 surgery locations to either the current practice group (n = 42) or the intervention group (n = 39). The intervention was a change of sterile gloves and change to sterile instruments before closure of the surgical incision in a variety of abdominal surgical procedures.
Data was obtained on over 13,000 patients. Glove and instrument change took place in 58 (0.8%) of 7157 patients in the current practice group and 6044 (98.3%) of 6144 patients in the intervention group. The SSI rate was 18.9% in the current practice group versus 16.0% in the intervention group (adjusted risk ratio: 0.87, p=0·0032).
The authors conclude that ChEETah robustly shows that routine change of gloves and instruments before wound closure reduced surgical site infections in clean–contaminated, contaminated, and dirty surgery, which was consistent across several sensitivity analyses. Lack of heterogeneity of effect across any of the prespecified subgroups suggests that the effect is consistent across a wide range of patients.
The accompanying editorial (Abiad 2022) notes some limitations of the study (cluster design, intention-to-treat analysis, lack of blinding, and failure to differentiate double-gloving from single-gloving). But it concludes that, despite these limitations, the results of the trial are plausible, meaningful, and impactful. Change of gloves and instruments before skin closure in clean–contaminated and contaminated–dirty abdominal procedures prevents one of every eight SSI’s, and the results are possibly if not probably generalizable globally and to non-abdominal surgery.
Although the study had a pragmatic design and was done solely in low-income and middle-income countries and the SSI rates were quite high in both the usual care group and intervention group, we agree the results may well be generalizable. We’d like to see this study replicated in the US and other high-income countries, and perhaps in surgeries in addition to abdominal surgery. But this could well be a game changer!
References:
NIHR Global Research Health Unit on Global Surgery. Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh): a pragmatic, cluster-randomised trial in seven low-income and middle-income countries. Lancet 2022; 400(10365): 1767-1776 November 19, 2022
Abiad MF, Kaafarani HMA. Changing gloves and switching instruments to decrease surgical site infection in abdominal surgery. Lancet 2022; 400(10365): 1742-1743 November 19, 2022
Print “December 2022 Game Changer to Prevent SSI’s in Abdominal Surgery?”
Despite a considerable literature on rapid response teams, we’ve yet to see a comprehensive analysis of the underlying reasons for such activations. Of course, a variety of physiological parameters are what lead to such activations, but we are talking about the underlying causes of those physiological phenomena.
A new study from Australia (Levkovich 2022) found that medication-related events led to a substantial proportion of Medical Emergency Team (MET) activations. The study was conducted at two academic teaching hospitals in Melbourne, Australia that had mature Rapid Response Systems. Over a 3-week study period, they found 628 MET activations. Of these, 23.2% were medication related: an incidence of 15.5 medication-related MET activation per 1000 admissions. Medication-related MET activations occurred a median of 46.6 hours earlier in an admission than non-medication-related activations, and this group also had more repeat MET activations during their admission.
Most importantly, 63% of medication-related MET activations were felt to be potentially preventable. Some specific examples were:
Over half (55.5%) of the medication-related MET activations were related to medication errors and cardiovascular medications were most often involved. Omissions of cardiovascular medications were the most common error. But inappropriate use of cardiovascular medications was also common. Such adverse drug reactions were often dose-related (18.5%) or time-related (17.8%). Beta blockers and antihypertensives were the medications most often implicated.
The accompanying editorial (Härkänen 2022) expressed surprise that more typical high-alert medications, such as anticoagulants and opioids were not commonly involved in MET activations in this study. The authors suggest might be because those serious ADE’s
are managed differently (eg. with antidotes) before there is a need for a MET. Another potential reason is that cardiovascular medications can cause rapid hemodynamic changes resulting in a MET/RRT activation, whereas anticoagulant and opiate errors typically do not. A third reason might be that cardiac arrest cases were excluded from the sample.
The editorialists suggest that the high number of events related to omission of cardiovascular medications might be related to either ineffective medication reconciliation on admission or to long waits in the emergency department or boarding of patients admitted to the emergency department.
The Levkovich study is an important contribution to our understanding of unexpected clinical deterioration of patients in the hospital. Hospitals could probably benefit from common cause analysis (see our October 2020 What's New in the Patient Safety World column “Common Cause Analysis”) of their RCA’s (root cause analyses) on rapid response team activations.
Our other columns on rapid response teams:
References:
Levkovich BJ, Orosz J, Bingham G, et al. Medication-related Medical Emergency Team activations: a case review study of frequency and preventability. BMJ Quality & Safety 2022; Published Online First: 05 July 2022
https://qualitysafety.bmj.com/content/early/2022/07/05/bmjqs-2021-014185
Härkänen M, Syyrilä T, Schepel L. Adverse drug events leading to medical emergency team activation in hospitals: what can we learn? BMJ Quality & Safety 2022; Published Online First: 21 November 2022
https://qualitysafety.bmj.com/content/early/2022/11/20/bmjqs-2022-015275?rss=1
Print “December 2022 Rapid Response Team Activations and Medication-Related Events”
Print “December 2022 What's New in the Patient Safety World (full column)”
Print “December 2022 Scary Stat on Surgery in the Elderly”
Print “December 2022 Unintended Consequences of a QTc Formula?”
Print “December 2022 Game Changer to Prevent SSI’s in Abdominal Surgery?”
Print “December 2022 Rapid Response Team Activations and Medication-Related Events”
Go to the "Whats New Archive"
Click on the "Contact Us" button at the left to send us your comments on our "What's New in the Patient Safety World" columns.
To get "Patient Safety Tip of the Week "emailed to you, click here and enter "subscribe" in the subject field.
Copyright 2012 The Truax Group Healthcare Consulting Patient Safety Solutions Tools Tips & Resources. All rights reserved.
PO Box 1230
Grantham, NH 03753
ph: 716-550-1106
btruax