JAMA Internal Medicine: Device/Product Safety Topic Collection

Hip Implant Failure for Men and Women What and When We Need to Know Comment on “Sex and Risk of Hip Implant Failure” Hip Implant Failure for Men and Women

Zuckerman D. — Mon, 25 Mar 2013 00:00:00 GMT

Total hip arthroplasty (THA) is a popular procedure that is increasing as the baby boom generation ages. In this issue of the journal, Inacio et al report that most US patients undergoing THA are women, who have a 29% higher risk of short-term THA failure than men after statistically controlling for key risk factors.

Barriers to Reducing Urinary Catheter Use A Qualitative Assessment of a Statewide Initiative Barriers to Reducing Urinary Catheter Use

Krein SL, Kowalski CP, Harrod M, et al. — Mon, 25 Mar 2013 00:00:00 GMT

Importance

Preventing catheter-associated urinary tract infection (CAUTI), a common health care–associated infection, is important for improving the care of hospitalized patients and in meeting the goals for reduction of health care–associated infections set by the US Department of Health and Human Services.

Objective

To identify ways to enhance CAUTI prevention efforts based on the experiences of hospitals participating in the Michigan Health and Hospital Association Keystone Center for Patient Safety statewide program to reduce unnecessary use of urinary catheters (the Bladder Bundle).

Design

Qualitative assessment of data collected through semistructured telephone interviews with key informants at 12 hospitals and in-person interviews and site visits at 3 of the 12 hospitals. The analysis focused on perceptions and key issues identified by hospitals as influencing implementation of CAUTI prevention practices as recommended by the Bladder Bundle initiative.

Setting

Twelve purposefully sampled hospitals in Michigan.

Participants

Key informants including infection preventionists, clinical personnel, and senior executives.

Results

Common barriers to Bladder Bundle implementation and appropriate urinary catheter use included (1) difficulty with nurse and physician engagement, (2) patient and family request for indwelling catheters, and (3) catheter insertion practices and customs in the emergency department. Strategies to address these barriers were also identified by several of the participating hospitals, including (1) incorporating urinary management (eg, planned toileting) as part of other patient safety programs, such as a fall reduction program, (2) explicitly discussing the risks of indwelling urinary catheters with patients and families, and (3) engaging with emergency department nurses and physicians to implement a process that ensures that appropriate indications for catheter use are followed.

Conclusions and Relevance

The Bladder Bundle program provides a model for implementing strategies to reduce CAUTI. These findings provide actionable information to inform CAUTI prevention-related activities in hospitals throughout the country.

Our Lights Are on for Safety Comment on “Preventing Catheter-Associated Uniary Tract Infection in the United States” Lights for Safety

Pottinger PS. — Mon, 25 Mar 2013 00:00:00 GMT

Imagine—just for a moment—that you are driving a bus full of passengers. In the distance, your destination twinkles brightly. You must choose between 2 routes: One takes you through a lawless land, without speed limits or tolls—it will be a quick trip, but one with substantial risk of wrecking the vehicle. The other route takes you on a neat, orderly journey though a community where traffic laws are rigorously enforced—what it lacks in excitement and speed, it makes up for in safety and predictability. When faced with this choice, sensible drivers should opt for the second route, recognizing the value of a modest investment of their time and effort.