Patient Safety

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    Quality Improvement Project: Deprescribing Statins in Patients Over 85 Years Old
    (2022) Shirai, Ren; Cantu, Ramon; Hadley, Lesca; Gibson, John
    Purpose: Recent studies have suggested that elderly patients over 85 years old do not benefit from statin therapy and may be more susceptible to adverse effects, including a higher mortality rate. The purpose of this project is to deprescribe statins in patients over 85 years old at a family medicine practice in Eagle Lake, TX. Methods: A chart review of patients over 85 years old encountered between September 2021 and October 2021 was conducted. Those on statin therapy was identified. Enhancement was subsequently implemented between October 2021 and November 2021, which involved identifying those who are over 85 years old on statin therapy and recommending them to discontinue it. Results: The pre-enhancement chart review of patients seen between September 2021 and October 2021 found 5 out of 7 patients who are over 85 years old were prescribed statins. 1 out of 2 patients over 85 years old seen during the enhancement period between October 2021 and November 2021 were on statin, which was subsequently deprescribed followed by patient education and counseling. Conclusions: Though we were only able to deprescribe statin on one elderly patient, our pre-enhancement chart review suggests there are more who may benefit from this enhancement. We have learned the importance of being up to date with the latest therapy guidelines. The next steps are to continue implementing this enhancement and educating patients and other family medicine providers within the practice.
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    Heard But Not Understood: Language Style Matching As a Predictor of Sentinel Events Among Nursing Staff
    (2022) Burrows, Jack; Arrowood, Robert
    Purpose: Communication plays a significant role in maintaining the daily workflow and safety of patients in a healthcare setting. In recent years, there has been increased interest in understanding how communication can affect sentinel events, adverse events, and near misses in a hospital setting. Previous studies have shown that a significant percentage of adverse events were precipitated as a result of communication failures during hall handovers at shift changes and during patient transfers. Therefore, effective communication is necessary to avoid unintentional harm to patients in a healthcare setting. This study examines language style matching (LSM), the action of matching another person's speech pattern based on nine sets of function words, in writing or conversation, between active nurses and nurse residents to evaluate whether teams with a high level of LSM will be associated with fewer sentinel events, near misses, and adverse events compared with teams with lower language style matching. Past studies have examined LSM in romantic relationships as well as corporate environments (Gonzales et al., 2010; Ireland et al., 2011; Tausczik & Pennebaker, 2010), however, this is the first study relating to nursing teams. Methods: Trained researchers administered a survey consisting of basic demographic information, list of closest coworkers, and self-reporting of adverse events. The survey also included a writing prompt (adapted from Pennebacker (2012)) ""Since time immemorial, laymen have doggedly adhered to pearls of folk wisdom such as, "Birds of a feather flock together" or "opposites attract." These platitudes are unquestionably simplistic. Nevertheless, one of the two is bound to be a close approximation of the truth. Which phrase do you believe is more accurate and why? Please spend about 5 minutes on your response.". Then, after data collection, utilizing named coworkers, 58 pairs were formed and LSM and self-reported adverse event data were analyzed using LIWC software. Results: Two logistic regression analyses were conducted. Repeat data was controlled in the first step of the model. Results showed a negative trend between LSM and near misses such that higher LSM was associated with a reduced likelihood of a near miss , b = -30.37 (S.E. = 23.72, Wald χ2 = 1.64, p = .20, odds ratio < .01, 95% C.I. = .001, 10069714.4. Furthermore, a significant positive trend was observed between LSM and sentinel events such that lower LSM was associated with a reduced likelihood of a sentinel event b = 9.27 (S.E. = 7.06), Wald χ2 = 1.73, p = .19, odds ratio < .10577.39, 95% C.I. = .01, 10711997526.96. Conclusions: Due to the reduced likelihood of near misses associated with higher LSM between individuals, further study is warranted. It is likely that the observed positive relationship between LSM and sentinel events is an artifact of data due to the small sample size. However, this research is applicable as a potential screening tool for team curation in a healthcare setting in order to reduce the overall number of near misses in patient-care.
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    The association between prescribing patterns and type of primary care visit among older adults with polypharmacy: a cross-sectional study
    (2022) Villanueva, Elias Arellano; Xiao, Yan; Espinoza, Anna; Muzaffar, Omair; Hendrix, Noah
    Background: Primary health care has been vitally disrupted by the COVID-19 crisis. Changes in primary care delivery in COVID-19 present an opportunity to study how patients and primary care professionals have adapted to the crisis. With the wide adoption of telehealth modalities, understanding changes in prescribing practices among elderly patients could serve to reduce adverse drug events. With the ongoing adoption of telehealth services, there are concerns about the potential of inappropriate prescribing practices. Moreover, older adults who take more medications and require more monitoring than all other age groups could be disproportionately impacted by policies enacted to limit the spread of SARS-Cov-2. The complex care requirements of elderly patients with multimorbidity's heightened health care strains due to COVID-19, and medication errors can have significant negative health consequences on elderly patients. In this cross-sectional study, we looked for associations between prescribing practices and visit modality for adults with polypharmacy within primary care. Methods: Through post-visit surveys, we interviewed a total of 64 low-acuity patients ≥ 50 who were on more than 5 medications and were attended by a provider within the Family Medicine Clinic at HSC Health Clinic between June 2021 and August 2021. Of the 64 patients, that were interviewed, 32 had an in-person visit and 32 had telehealth visits with their providers. The providers were also asked to complete a survey about their visit with the patient and the types of changes that were made during the consult. We looked for an association between the visit modality type and prescription changes through the following question: "Did the total number of medicines or supplements change as a result of this visit" from the surveys provided by the providers. Logistic regression was used to look at the association between prescription changes & visit modality while controlling for age and gender. Results: Of the 64 patients that completed the survey, age (M = 66.66 years, SD = 9.57 years), gender included Female (n=50) and Male (n=14). Data for this study included adults who self-reported as White (n=43), Black or African American (n=19), Prefer not to Answer (n=1) and Unknown or not Listed (n=1). The association between prescription changes and visit modality was found to be non-significant (odds ratio [OR] .1.140; 95% confidence interval [CI] .417-3.115). This finding did not change even while adjusting for gender and age (adjusted odds ratio [OR] .820; 95% confidence interval [CI] .384-3.35). Conclusions: Prescription changes were similar between in-person visits and telehealth visits for adults ≥ 50 years who were on ≥ 5 medications while adjusting for gender and age. If differences between visit modality and prescribing changes were to be found other factors should be investigated. Given the need to reduce medication errors among older adults, providers can provide accessibility options through different visit modalities while ensuring consistency in medication changes.