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Anemia is not a diagnosis; it is a manifestation of an underlying disorder. Anemia can occur as the result of one or more of three basic mechanisms; blood loss, deficient erythropoiesis, and excessive hemolysis (Lichtin, 2017). 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Nosocomial GI bleeding is source of preventable hospital morbidity and mortality (Herzig et al. 2013). Causes of upper GI bleeding include peptic ulcers, gastritis and inflammation of the GI lining from ingested materials. Ulcers are localized erosions of the mucosal lining of the digestive tract and they usually occur in the stomach or duodenum. Breakdown of the mucosal lining results in damage to blood vessels, which causes bleeding. Gastritis and inflammation of the GI lining may be caused by non-steroidal anti-inflammatory drugs (NSAIDs) and steroids (Lanza et al. 2009; Narum et al. 2014). In the ICU, stress-induced mucosal lesions are a risk factor for bleeding (McEvoy & Shander, 2013).",{"type":15,"attrs":431,"content":432},{"textAlign":53},[433],{"text":434,"type":295},"Acute GI bleeding will appear as vomiting of blood, bloody bowel movements or black, tarry stools. Vomited blood may look like coffee grounds. 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As a drug category, anticoagulants are one of the top five drug types associated with patient safety incidents (Cousins, 2006).",{"type":15,"attrs":573,"content":574},{"textAlign":53},[575],{"text":576,"type":295},"Antithrombotic agents* are included on the Institute for Safe Medication Practice's (ISMP, 2018) high alert medication list due to the significant risk of causing life-threatening bleeding or thrombosis if the appropriate safe practices are not in place. This high risk is due to the complexity of administering this therapy:",{"type":442,"content":578},[579,586,593,600,607,614,621,628],{"type":445,"content":580},[581],{"type":15,"attrs":582,"content":583},{"textAlign":53},[584],{"text":585,"type":295},"Selecting the appropriate agent and determining the appropriate dose",{"type":445,"content":587},[588],{"type":15,"attrs":589,"content":590},{"textAlign":53},[591],{"text":592,"type":295},"Individual patient variability in response to therapy",{"type":445,"content":594},[595],{"type":15,"attrs":596,"content":597},{"textAlign":53},[598],{"text":599,"type":295},"Timing of and use of the appropriate laboratory measures to monitor response",{"type":445,"content":601},[602],{"type":15,"attrs":603,"content":604},{"textAlign":53},[605],{"text":606,"type":295},"Proper adjustment of dose based upon the laboratory parameters and/or clinical response",{"type":445,"content":608},[609],{"type":15,"attrs":610,"content":611},{"textAlign":53},[612],{"text":613,"type":295},"The transition of patients from Heparin therapy to Warfarin",{"type":445,"content":615},[616],{"type":15,"attrs":617,"content":618},{"textAlign":53},[619],{"text":620,"type":295},"Ensuring patient education and compliance",{"type":445,"content":622},[623],{"type":15,"attrs":624,"content":625},{"textAlign":53},[626],{"text":627,"type":295},"Use of these agents in a variety of settings, by various practitioners, and within differing patient populations",{"type":445,"content":629},[630],{"type":15,"attrs":631,"content":632},{"textAlign":53},[633],{"text":634,"type":295},"Interdisciplinary coordination needed between lab, pharmacy, nursing, medical staff, and dietary (Purdue University PharmaTAP, 2008)",{"type":15,"attrs":636,"content":637},{"textAlign":53},[638],{"text":639,"type":295},"*Antithrombotic agents, include:",{"type":442,"content":641},[642,649,656,663],{"type":445,"content":643},[644],{"type":15,"attrs":645,"content":646},{"textAlign":53},[647],{"text":648,"type":295},"anticoagulants (e.g., warfarin, low molecular weight heparin, IV unfractionated heparin)",{"type":445,"content":650},[651],{"type":15,"attrs":652,"content":653},{"textAlign":53},[654],{"text":655,"type":295},"Factor Xa inhibitors (e.g., fondaparinux, apixaban, rivaroxaban) direct thrombin inhibitors (e.g., argatroban, bivalirudin, dabigatran etexilate)",{"type":445,"content":657},[658],{"type":15,"attrs":659,"content":660},{"textAlign":53},[661],{"text":662,"type":295},"thrombolytics (e.g., alteplase, reteplase, tenecteplase)",{"type":445,"content":664},[665],{"type":15,"attrs":666,"content":667},{"textAlign":53},[668],{"text":669,"type":295},"glycoprotein IIb/IIIa inhibitors (e.g., eptifibatide)",{"type":15,"attrs":671,"content":672},{"textAlign":53},[673],{"text":674,"type":295},"Adverse drug events associated with anticoagulants can be reduced by implementing recognized safe practices in high risk areas such as: Use Programmable Pumps and Independent Double-Checks for IV Anticoagulants, Prepare All Heparin Doses and Solutions in the Hospital Pharmacy, and Provide Coagulation Test Results Within Two Hours or at Bedside (IHI, 2020b).",{"type":15,"attrs":676,"content":677},{"textAlign":53},[678],{"text":679,"type":295},"Patients who are receiving anticoagulant therapy have increased risk of hemorrhage when undergoing medical and surgical procedures (Guidelines and Protocols Advisory Committee 2015). Bleeding that occurs in hospital is associated with increased morbidity, mortality, increased length of stay, increased health care costs and increased hospital readmission (Purdue University PharmaTAP, 2008; Herzig et al. 2013; McEvoy & Shander, 2013).",{"type":15,"attrs":681,"content":682},{"textAlign":53},[683,685,698],{"text":684,"type":295},"For additional information regarding anemia – hemorrhage associated with a medical or surgical procedure, please refer to the Hospital Harm Improvement Resource ",{"text":686,"type":295,"marks":687},"Procedure Associated Conditions: Anemia – Hemorrhage",[688],{"type":407,"attrs":689},{"href":690,"uuid":691,"anchor":53,"custom":692,"target":412,"linktype":413,"story":693},"/resources/anemia-hemorrhage-procedure-associated-conditions-","ff1f3d03-2ddc-48c7-9a9e-0e9a3049552e",{},{"name":694,"id":695,"uuid":691,"slug":696,"url":697,"full_slug":697,"_stopResolving":301},"Anemia – Hemorrhage (Procedure-Associated Conditions)",122365821297521,"anemia-hemorrhage-procedure-associated-conditions","resources/anemia-hemorrhage-procedure-associated-conditions",{"text":699,"type":295},".","simple-richtext","wysiwyg-program",{"_uid":703,"items":704,"title":759,"component":760,"description":761},"4cd50058-6039-4f5c-937b-e7f3c4004796",[705,740],{"_uid":706,"title":707,"ctaLeft":708,"ctaRight":709,"component":718,"columnLeft":719,"columnRight":723},"ee763740-c4c5-4ef7-bd5d-9c2a6bbe174b","Dennis Quaid Recounts Twins' Drug Ordeal",[],[710],{"_uid":711,"link":712,"label":707,"component":717},"9f44c7c4-6b26-40e8-b025-ba0a69913051",{"id":16,"url":713,"target":714,"linktype":715,"fieldtype":716,"cached_url":713},"https://www.cbsnews.com/news/dennis-quaid-recounts-twins-drug-ordeal/","_blank","url","multilink","simple-link-only","accordion-item-columns",{"type":12,"content":720},[721],{"type":15,"attrs":722},{"textAlign":53},{"type":12,"content":724},[725,730,735],{"type":15,"attrs":726,"content":727},{"textAlign":53},[728],{"text":729,"type":295},"[The twins] were supposed to have been given a pediatric blood thinner called Hep-lock to flush out their IV lines and prevent blood clots. But instead, they had been given two doses of Heparin, the adult version of the drug, which is 1,000 times stronger…. \"It was ten units that our kids are supposed to get. They got 10,000. And what it did is, it basically turned their blood to the consistency of water, where they had a complete inability to clot. And they were basically bleeding out at that point.\"",{"type":15,"attrs":731,"content":732},{"textAlign":53},[733],{"text":734,"type":295},"\"There was blood oozing out of little blood draws on their feet, and things like that, you know, through band-aids,\" he adds….",{"type":15,"attrs":736,"content":737},{"textAlign":53},[738],{"text":739,"type":295},"And to make matters worse the same avoidable mistake had occurred a year earlier at Methodist Hospital in Indianapolis. Six infants were given multiple adult doses of Heparin instead of the pediatric version; three of the infants survived, three did not….",{"_uid":741,"title":742,"ctaLeft":743,"ctaRight":744,"component":718,"columnLeft":749,"columnRight":752},"a422d018-0b74-48dc-ae62-512e27781ccf","Popular Blood Thinner Causing Deaths, Injuries at Nursing Homes",[],[745],{"_uid":746,"link":747,"label":742,"component":717},"b3b2b545-f50c-40b9-b410-0de5fa838fe0",{"id":16,"url":748,"target":714,"linktype":715,"fieldtype":716,"cached_url":748},"https://www.propublica.org/article/popular-blood-thinner-causing-deaths-injuries-at-nursing-homes",{"type":12,"content":750},[751],{"type":15},{"type":12,"content":753},[754],{"type":15,"attrs":755,"content":756},{"textAlign":53},[757],{"text":758,"type":295},"Some facilities fail to properly oversee Coumadin. Too much can cause bleeding; too little, clots. Nursing homes are \"a perfect setup for bad things happening,\" one expert says….","Importance to Patients and Families","accordion-2-columns",{"type":12,"content":762},[763],{"type":15,"attrs":764,"content":765},{"textAlign":53},[766],{"text":767,"type":295},"Hemorrhage is understandably alarming to patients and families. Not only may it be life-threatening, it complicates care and prolongs hospitalization. Anticoagulants such as warfarin and heparin are powerful medications that save lives and prevent further harm. This group of medications also has the potential to cause serious harm if not taken carefully. Patients who are knowledgeable about their medication therapy can help to reduce the risk of adverse drug events (IHI, 2020a).",{"_uid":769,"items":770,"title":918,"component":760,"description":919},"56ab3959-1b16-41e9-818d-10a351c10b24",[771],{"_uid":772,"title":773,"ctaLeft":774,"ctaRight":775,"component":718,"columnLeft":776,"columnRight":797},"610b88a1-8386-4bd1-868e-1ec5ba02ae49","Expand to see a full list of resources",[],[],{"type":12,"content":777},[778],{"type":15,"attrs":779,"content":780},{"textAlign":53},[781,786,793],{"text":782,"type":295,"marks":783},"To develop a more in-depth understanding of the care delivered to patients, chart audits, incident analyses and prospective analyses can be helpful in identifying quality improvement opportunities. Links to key resources for conducting chart audits and analysis methods are included in the ",[784],{"type":298,"attrs":785},{"color":300},{"text":787,"type":295,"marks":788},"Hospital Harm Improvement Resource Introduction",[789],{"type":407,"attrs":790},{"href":409,"uuid":410,"anchor":53,"custom":791,"target":412,"linktype":413,"story":792},{},{"name":404,"id":415,"uuid":410,"slug":416,"url":417,"full_slug":417,"_stopResolving":301},{"text":699,"type":295,"marks":794},[795],{"type":298,"attrs":796},{"color":300},{"type":12,"content":798},[799,804],{"type":15,"attrs":800,"content":801},{"textAlign":53},[802],{"text":803,"type":295},"If your review reveals that your cases of anemia - hemorrhage are linked to specific processes or procedures, you may find these resources helpful:",{"type":442,"content":805},[806,820,834,841,854,869,883,890,897,904,911],{"type":445,"content":807},[808],{"type":15,"attrs":809,"content":810},{"textAlign":53},[811,813],{"text":812,"type":295},"Institute for Safe Medication Practices (ISMP). ",{"text":814,"type":295,"marks":815},"www.ismp.org",[816],{"type":407,"attrs":817},{"href":818,"uuid":53,"anchor":53,"custom":819,"target":714,"linktype":715},"https://home.ecri.org/pages/ismp",{},{"type":445,"content":821},[822],{"type":15,"attrs":823,"content":824},{"textAlign":53},[825,827],{"text":826,"type":295},"British Columbia. ",{"text":828,"type":295,"marks":829},"BCGuidelines.ca",[830],{"type":407,"attrs":831},{"href":832,"uuid":53,"anchor":53,"custom":833,"target":714,"linktype":715},"https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines",{},{"type":445,"content":835},[836],{"type":15,"attrs":837,"content":838},{"textAlign":53},[839],{"text":840,"type":295},"National Blood Authority Australia. Patient Blood Management.",{"type":445,"content":842},[843],{"type":15,"attrs":844,"content":845},{"textAlign":53},[846,853],{"text":847,"type":295,"marks":848},"NATA, Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis",[849],{"type":407,"attrs":850},{"href":851,"uuid":53,"anchor":53,"custom":852,"target":714,"linktype":715},"https://nataonline.com/",{},{"text":699,"type":295},{"type":445,"content":855},[856],{"type":15,"attrs":857,"content":858},{"textAlign":53},[859,861,868],{"text":860,"type":295},"Thrombosis Canada. ",{"text":862,"type":295,"marks":863},"Clinical Guides",[864],{"type":407,"attrs":865},{"href":866,"uuid":53,"anchor":53,"custom":867,"target":714,"linktype":715},"https://thrombosiscanada.ca/hcp/practice/clinical_guides",{},{"text":699,"type":295},{"type":445,"content":870},[871],{"type":15,"attrs":872,"content":873},{"textAlign":53},[874,876],{"text":875,"type":295},"American Society of Health-System Pharmacists (ASHP): Gastrointestinal Stress Ulcer Prophylaxis (pending) ",{"text":877,"type":295,"marks":878},"https://www.ashp.org/pharmacy-practice/policy-positions-and-guidelines/browse-by-document-type/therapeutic-guidelines",[879],{"type":407,"attrs":880},{"href":881,"uuid":53,"anchor":53,"custom":882,"target":714,"linktype":715},"https://www.ashp.org/pharmacy-practice/policy-positions-and-guidelines/browse-by-document-type/therapeutic-guidelines?loginreturnUrl=SSOCheckOnly",{},{"type":445,"content":884},[885],{"type":15,"attrs":886,"content":887},{"textAlign":53},[888],{"text":889,"type":295},"Stress Ulcers in the Intensive Care Unit: Diagnosis management and Prevention (Weinhouse, 2020) www.uptodate.com",{"type":445,"content":891},[892],{"type":15,"attrs":893,"content":894},{"textAlign":53},[895],{"text":896,"type":295},"Institute for Healthcare Improvement (IHI): How-to guide: prevent harm from high-alert medications. 2012. http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventHarmfromHighAlertMedications.aspx",{"type":445,"content":898},[899],{"type":15,"attrs":900,"content":901},{"textAlign":53},[902],{"text":903,"type":295},"Changes: Reduce adverse drug events involving anticoagulants. 2020. http://www.ihi.org/resources/Pages/Changes/ReduceAdverseDrugEventsInvolvingAnticoagulants.aspx",{"type":445,"content":905},[906],{"type":15,"attrs":907,"content":908},{"textAlign":53},[909],{"text":910,"type":295},"Anticoagulant tool kit: Reducing adverse drug events & potential adverse drug events with unfractionated heparin, low molecular weight heparins and warfarin. 2008 http://www.ihi.org/resources/pages/tools/anticoagulanttoolkitreducingades.aspx",{"type":445,"content":912},[913],{"type":15,"attrs":914,"content":915},{"textAlign":53},[916],{"text":917,"type":295},"Joint Commission - National Patient Safety Goal to reduce the likelihood of patient harm associated with the use of anticoagulation therapy (Joint Commission, 2018).","Clinical and System Reviews, Incident Analyses",{"type":12,"content":920},[921,932,938],{"type":15,"attrs":922,"content":923},{"textAlign":53},[924,926,930],{"text":925,"type":295},"Given the broad range of potential causes of ",{"text":330,"type":295,"marks":927},[928],{"type":929},"italic",{"text":931,"type":295},", in addition to recommendations listed above, we recommend conducting clinical and system reviews to identify latent causes and determine appropriate recommendations.",{"type":15,"attrs":933,"content":935},{"textAlign":934},"left",[936],{"text":937,"type":295},"Occurrences of harm are often complex with many contributing factors. Organizations need to:",{"type":939,"attrs":940,"content":942},"ordered_list",{"order":941},1,[943,950,957,964],{"type":445,"content":944},[945],{"type":15,"attrs":946,"content":947},{"textAlign":53},[948],{"text":949,"type":295},"Measure and monitor the types and frequency of these occurrences.",{"type":445,"content":951},[952],{"type":15,"attrs":953,"content":954},{"textAlign":53},[955],{"text":956,"type":295},"Use appropriate analytical methods to understand the contributing factors.",{"type":445,"content":958},[959],{"type":15,"attrs":960,"content":961},{"textAlign":53},[962],{"text":963,"type":295},"Identify and implement solutions or interventions that are designed to prevent recurrence and reduce risk of harm.",{"type":445,"content":965},[966],{"type":15,"attrs":967,"content":968},{"textAlign":53},[969],{"text":970,"type":295},"Have mechanisms in place to mitigate consequences of harm when it occurs.",{"_uid":972,"items":973,"title":1009,"component":1010,"description":1011},"be3b7a82-b7ec-4b53-a512-e4112073c052",[974,985,993,1001],{"_uid":975,"image":976,"title":980,"component":981,"description":982},"458f36cf-6776-4902-a081-12df8c65ad9f",{"id":977,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":978,"copyright":16,"fieldtype":284,"meta_data":979,"is_external_url":286},119537678778928,"https://a-ca.storyblok.com/f/850807391887861/600x600/c301964117/checkmark-icon.png",{},"You may use different measures or modify the measures described below to make them more appropriate and/or useful to your particular setting. However, be aware that modifying measures may limit the comparability of your results to others.","small-text-image-item",{"type":12,"content":983},[984],{"type":15},{"_uid":986,"image":987,"title":989,"component":981,"description":990},"498e534c-913a-4ac0-90da-3396951645da",{"id":977,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":978,"copyright":16,"fieldtype":284,"meta_data":988,"is_external_url":286},{},"Evaluate your choice of measures in terms of the usefulness of the final results and the resources required to obtain them; try to maximize the former while minimizing the latter.",{"type":12,"content":991},[992],{"type":15},{"_uid":994,"image":995,"title":997,"component":981,"description":998},"5c88ef3c-3fd2-442e-b9cf-478a0643de91",{"id":977,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":978,"copyright":16,"fieldtype":284,"meta_data":996,"is_external_url":286},{},"Whenever possible, use measures you are already collecting for other programs.",{"type":12,"content":999},[1000],{"type":15},{"_uid":1002,"image":1003,"title":1005,"component":981,"description":1006},"6c6d04c8-d218-424c-945d-1f645847d838",{"id":977,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":978,"copyright":16,"fieldtype":284,"meta_data":1004,"is_external_url":286},{},"Try to include both process and outcome measures in your measurement scheme.",{"type":12,"content":1007},[1008],{"type":15},"Measures","small-text-image",{"type":12,"content":1012},[1013],{"type":15,"attrs":1014,"content":1015},{"textAlign":53},[1016],{"text":1017,"type":295},"Vital to quality improvement is measurement, and this applies specifically to implementation of interventions. The chosen measures will help to determine whether an impact is being made (primary outcome), whether the intervention is actually being carried out (process measures), and whether any unintended consequences ensue (balancing measures). In selecting your measures, consider the following:",{"_uid":1019,"items":1020,"title":1158,"component":760,"description":1159},"ed575e2d-c13a-4a32-9df1-afe3f84c8465",[1021,1061,1096,1125],{"_uid":1022,"title":1023,"ctaLeft":1024,"ctaRight":1025,"component":718,"columnLeft":1026,"columnRight":1038},"31df90e3-3c2a-448e-8c03-8cbb7c9f6e6f","Selection Criteria",[],[],{"type":12,"content":1027},[1028],{"type":15,"attrs":1029,"content":1030},{"textAlign":53},[1031,1036],{"text":1032,"type":295,"marks":1033},"Exclusions",[1034],{"type":1035},"bold",{"text":1037,"type":295},": Y60–Y84  in the same diagnosis cluster",{"type":12,"content":1039},[1040,1052],{"type":15,"attrs":1041,"content":1042},{"textAlign":53},[1043,1048],{"text":1044,"type":295,"marks":1045},"Code",[1046,1047],{"type":1035},{"type":929},{"text":1049,"type":295,"marks":1050},": Code Description",[1051],{"type":929},{"type":15,"attrs":1053,"content":1054},{"textAlign":53},[1055,1059],{"text":1056,"type":295,"marks":1057},"D62",[1058],{"type":1035},{"text":1060,"type":295},": Identified as diagnosis type (2) AND Y44.2 in the same diagnosis cluster",{"_uid":1062,"title":1063,"ctaLeft":1064,"ctaRight":1065,"component":718,"columnLeft":1066,"columnRight":1070},"b9b8c1e0-53ae-4f62-8dc7-54e61e464643","Codes & Code Descriptions",[],[],{"type":12,"content":1067},[1068],{"type":15,"attrs":1069},{"textAlign":53},{"type":12,"content":1071},[1072,1079,1087],{"type":15,"attrs":1073,"content":1074},{"textAlign":53},[1075,1078],{"text":1044,"type":295,"marks":1076},[1077],{"type":1035},{"text":1049,"type":295},{"type":15,"attrs":1080,"content":1081},{"textAlign":53},[1082,1085],{"text":1056,"type":295,"marks":1083},[1084],{"type":1035},{"text":1086,"type":295},": Acute posthemorrhagic anemia",{"type":15,"attrs":1088,"content":1089},{"textAlign":53},[1090,1094],{"text":1091,"type":295,"marks":1092},"D68.3",[1093],{"type":1035},{"text":1095,"type":295},": Hemorrhagic disorder due to circulating anticoagulants",{"_uid":1097,"title":1098,"ctaLeft":1099,"ctaRight":1100,"component":718,"columnLeft":1101,"columnRight":1105},"298700c3-a866-4c7b-9c20-e87c98c04dea","Additional codes & Inclusions",[],[],{"type":12,"content":1102},[1103],{"type":15,"attrs":1104},{"textAlign":53},{"type":12,"content":1106},[1107,1116],{"type":15,"attrs":1108,"content":1109},{"textAlign":53},[1110,1114],{"text":1111,"type":295,"marks":1112},"Additional Codes",[1113],{"type":1035},{"text":1115,"type":295},": Inclusions",{"type":15,"attrs":1117,"content":1118},{"textAlign":53},[1119,1123],{"text":1120,"type":295,"marks":1121},"Y44.2",[1122],{"type":1035},{"text":1124,"type":295},": Drugs, medicaments and biological substances causing adverse effects in therapeutic use, anticoagulants",{"_uid":1126,"title":1127,"ctaLeft":1128,"ctaRight":1129,"component":718,"columnLeft":1130,"columnRight":1134},"c821949f-5ba5-41b7-a677-56ff361a10be","Additional codes & Exclusions",[],[],{"type":12,"content":1131},[1132],{"type":15,"attrs":1133},{"textAlign":53},{"type":12,"content":1135},[1136,1144],{"type":15,"attrs":1137,"content":1138},{"textAlign":53},[1139,1142],{"text":1111,"type":295,"marks":1140},[1141],{"type":1035},{"text":1143,"type":295},": Exclusions",{"type":15,"attrs":1145,"content":1146},{"textAlign":53},[1147,1149,1156],{"text":1148,"type":295},"Y60-Y84: Complications of medical surgical care (refer to Appendix A of the ",{"text":1150,"type":295,"marks":1151},"Hospital Harm Indicator General Methodology Notes",[1152],{"type":407,"attrs":1153},{"href":1154,"uuid":53,"anchor":53,"custom":1155,"target":714,"linktype":715},"https://www.cihi.ca/sites/default/files/document/hospital-harm-indicator-general-methodology-notes.pdf",{},{"text":1157,"type":295},")","Discharge Abstract Database",{"type":12,"content":1160},[1161,1170,1179,1188],{"type":15,"attrs":1162,"content":1163},{"textAlign":53},[1164,1166],{"text":1165,"type":295},"Discharge Abstract Database (DAD) Codes included in this clinical category: ",{"text":1167,"type":295,"marks":1168},"A01: Anemia – Hemorrhage (Health Care/Medication Associated Condition)",[1169],{"type":1035},{"type":15,"attrs":1171,"content":1172},{"textAlign":53},[1173,1177],{"text":1174,"type":295,"marks":1175},"Concept",[1176],{"type":1035},{"text":1178,"type":295},": Hemorrhagic anemia or hemorrhagic disorders that require(s) blood transfusion, identified during a hospital stay, related to the health care delivered or therapeutic use of anticoagulants",{"type":15,"attrs":1180,"content":1181},{"textAlign":53},[1182,1186],{"text":1183,"type":295,"marks":1184},"Notes",[1185],{"type":1035},{"text":1187,"type":295},": ",{"type":939,"attrs":1189,"content":1190},{"order":941},[1191,1198],{"type":445,"content":1192},[1193],{"type":15,"attrs":1194,"content":1195},{"textAlign":53},[1196],{"text":1197,"type":295},"This clinical group excludes obstetric hemorrhage (refer to A02: Obstetric Hemorrhage and D02: Obstetric Hemorrhage) and hemorrhage or hemorrhagic anemia associated with a medical or surgical procedure (refer to D01: Anemia — Hemorrhage).",{"type":445,"content":1199},[1200],{"type":15,"attrs":1201,"content":1202},{"textAlign":53},[1203],{"text":1204,"type":295},"The blood transfusion indicator is optional to code in British Columbia.",{"_uid":1206,"content":1207,"component":701},"2550fee5-6a0c-4162-988a-4c480464db28",[1208],{"_uid":1209,"content":1210,"component":700},"d36fbdd0-6f96-4d82-aa8e-4931c3d6c7bb",{"type":12,"content":1211},[1212,1217],{"type":392,"attrs":1213,"content":1214},{"level":394,"textAlign":53},[1215],{"text":1216,"type":295},"Success Stories",{"type":15,"attrs":1218,"content":1219},{"textAlign":53},[1220],{"text":1221,"type":295},"​We are looking for an improvement success story related to Anemia - Hemorrhage. If you have one you would like to share, please contact Healthcare Excellence Canada at info@hec-esc.ca. ",{"_uid":1223,"items":1224,"title":1243,"component":760,"description":1244},"d27e0ee6-d543-4ffe-ba19-0beac7b5077d",[1225],{"_uid":1226,"title":1227,"ctaLeft":1228,"ctaRight":1229,"component":718,"columnLeft":1230,"columnRight":1234},"d1d27db9-bb85-49f3-bb9e-7342f7791eb1","Expand to see a full list of references",[],[],{"type":12,"content":1231},[1232],{"type":15,"attrs":1233},{"textAlign":53},{"type":12,"content":1235},[1236],{"type":15,"attrs":1237,"content":1238},{"textAlign":53},[1239],{"text":1240,"type":295,"marks":1241},"Add the listing of resources here. ",[1242],{"type":929},"References",{"type":12,"content":1245},[1246,1256,1261,1273,1278,1290,1302,1307,1312,1317,1322,1327,1338,1343,1355,1367,1379,1384],{"type":15,"attrs":1247,"content":1248},{"textAlign":53},[1249,1251],{"text":1250,"type":295},"Cairns JA, Connolly S, McMurtry S, Stephenson M, Talajic M, CCS Atrial Fibrillation Guidelines Committee. Canadian Cardiovascular Society atrial fibrillation guidelines 2010: prevention of stroke and systemic thromboembolism in atrial fibrillation and flutter. Cn J Cardiol. 2011; 27 (1), 74-90. doi: 10.1016/j.cjca.2010.11.007. ",{"text":1252,"type":295,"marks":1253},"https://www.onlinecjc.ca/article/S0828-282X%2810%2900008-5/fulltext",[1254],{"type":407,"attrs":1255},{"href":1252,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":715},{"type":15,"attrs":1257,"content":1258},{"textAlign":53},[1259],{"text":1260,"type":295},"Carnovale C, Brusadelli T, Casini ML. Drug-induced anaemia: a decade review of reporting to the Italian Pharmacovigilance data-base. Int Clin J Pharm. 2015, 37 (1), 23-26. doi: 10.1007/s11096-014-0054-3",{"type":15,"attrs":1262,"content":1263},{"textAlign":53},[1264,1266],{"text":1265,"type":295},"Christos S, Naples R. Anticoagulation reversal and treatment strategies in major bleeding: Update 2016. West J Emerg Med. 2016; 17 (3): 264-70. doi: 10.5811/westjem.2016.3.29294. ",{"text":1267,"type":295,"marks":1268},"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899056/",[1269],{"type":407,"attrs":1270},{"href":1271,"uuid":53,"anchor":53,"custom":1272,"target":714,"linktype":715},"https://pmc.ncbi.nlm.nih.gov/articles/PMC4899056/",{},{"type":15,"attrs":1274,"content":1275},{"textAlign":53},[1276],{"text":1277,"type":295},"Cousins D, Harris, Safe Medication Practice Team. Risk assessment of anticoagulation therapy. National Patient Safety Agency; 2006. https://www.sps.nhs.uk/wp-content/uploads/2018/02/NRLS-0233-Anticoagulant-tssessment-2006-01-v1.pdf",{"type":15,"attrs":1279,"content":1280},{"textAlign":53},[1281,1283],{"text":1282,"type":295},"Fernández CS, Formiga F, Camafort M, et al. Antithrombotic treatment in elderly patients with atrial fibrillation: a practical approach. BMC Cardiovasc Disord. 2015; 15: 143. doi: 10.1186/s12872-015-0137-7. ",{"text":1284,"type":295,"marks":1285},"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632329/",[1286],{"type":407,"attrs":1287},{"href":1288,"uuid":53,"anchor":53,"custom":1289,"target":714,"linktype":715},"https://pmc.ncbi.nlm.nih.gov/articles/PMC4632329/",{},{"type":15,"attrs":1291,"content":1292},{"textAlign":53},[1293,1295],{"text":1294,"type":295},"Erratum: Fernández CS, Formiga F, Camafort M, et al. Erratum: Antithrombotic treatment in elderly patients with atrial fibrillation: a practical approach. BMC Cardiovasc Disord. 2015; 15: 157. doi: 10.1186/s12872-015-0150-x. ",{"text":1296,"type":295,"marks":1297},"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653852/",[1298],{"type":407,"attrs":1299},{"href":1300,"uuid":53,"anchor":53,"custom":1301,"target":714,"linktype":715},"https://pmc.ncbi.nlm.nih.gov/articles/PMC4653852/",{},{"type":15,"attrs":1303,"content":1304},{"textAlign":53},[1305],{"text":1306,"type":295},"Guillamondegui OD, Gunter OL Jr, EAST Practice Management Guidelines Committee. Practice management guidelines for stress ulcer prophylaxis. Chicago, IL: Eastern Association for the Surgery of Trauma; 2008. https://www.east.org/education/practice-management-guidelines/stress-ulcer-prophylaxis",{"type":15,"attrs":1308,"content":1309},{"textAlign":53},[1310],{"text":1311,"type":295},"Herzig SJ, Rothberg MB, Feinbloom DB, et al. Risk factors for nosocomial gastrointestinal bleeding and use of acid-suppressive medication in non-critically ill patients. J Gen Intern Med. 2013; 28 (5): 683-690. doi: 10.1007/s11606-012-2296-x. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3631055/",{"type":15,"attrs":1313,"content":1314},{"textAlign":53},[1315],{"text":1316,"type":295},"Institute for Healthcare Improvement (IHI). How-to Guide: Prevent Harm from High-Alert Medications. Cambridge, MA: IHI; 2012. http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventHarmfromHighAlertMedications.aspx",{"type":15,"attrs":1318,"content":1319},{"textAlign":53},[1320],{"text":1321,"type":295},"Institute for Healthcare Improvement (IHI). Educate Patients to Manage Warfarin Therapy at Home. Cambridge, MA: IHI; 2020a. http://www.ihi.org/resources/Pages/Changes/EducatePatientstoManageWarfarinTherapyatHome.aspx",{"type":15,"attrs":1323,"content":1324},{"textAlign":53},[1325],{"text":1326,"type":295},"Institute for Healthcare Improvement (IHI). Changes: Reduce adverse drug events involving anticoagulants. Cambridge, MA: IHI; 2020b. http://www.ihi.org/resources/Pages/Changes/ReduceAdverseDrugEventsInvolvingAnticoagulants.aspx",{"type":15,"attrs":1328,"content":1329},{"textAlign":53},[1330,1332],{"text":1331,"type":295},"Institute for Safe Medication Practices (ISMP). ISMP list of high-alert medications in acute care settings. Horsham, PA; ISMP: 2018. ",{"text":1333,"type":295,"marks":1334},"https://www.ismp.org/sites/default/files/attachments/2018-08/highAlert2018-Acute-Final.pdf",[1335],{"type":407,"attrs":1336},{"href":1333,"uuid":53,"anchor":53,"custom":1337,"target":714,"linktype":715},{},{"type":15,"attrs":1339,"content":1340},{"textAlign":53},[1341],{"text":1342,"type":295},"Lanza FL, Chan FK, Quigley EM. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009; 104 (3), 728-738. doi: 10.1038/ajg.2009.115.",{"type":15,"attrs":1344,"content":1345},{"textAlign":53},[1346,1348],{"text":1347,"type":295},"Lichtin AE. Etiology of anemia. Merck Manual. 2017.",{"text":1349,"type":295,"marks":1350}," www.msdmanuals.com/professional/hematology-and-oncology/approach-to-the-patient-with-anemia/etiology-of-anemia",[1351],{"type":407,"attrs":1352},{"href":1353,"uuid":53,"anchor":53,"custom":1354,"target":714,"linktype":715},"https://www.msdmanuals.com/professional/hematology-and-oncology/approach-to-the-patient-with-anemia/etiology-of-anemia",{},{"type":15,"attrs":1356,"content":1357},{"textAlign":53},[1358,1360],{"text":1359,"type":295},"McEvoy MT, Shander A. Anemia, bleeding, and blood transfusion in the intensive care unit: causes, risks, costs, and new strategies. Am J Crit Care. 2013; 22 (6 Suppl): eS1-13. doi: 10.4037/ajcc2013729. ",{"text":1361,"type":295,"marks":1362},"http://ajcc.aacnjournals.org/content/22/6/eS1.long",[1363],{"type":407,"attrs":1364},{"href":1365,"uuid":53,"anchor":53,"custom":1366,"target":714,"linktype":715},"https://aacnjournals.org/ajcconline/article/22/6/eS1/3950/Anemia-Bleeding-and-Blood-Transfusion-in-the",{},{"type":15,"attrs":1368,"content":1369},{"textAlign":53},[1370,1372],{"text":1371,"type":295},"Narum S, Westergren T, Klemp M. Corticosteroids and risk of gastrointestinal bleeding: a systematic review and meta-analysis. BMJ Open. 2014, 4 (5): e004587. doi: 10.1136/bmjopen-2013-004587. ",{"text":1373,"type":295,"marks":1374},"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025450/",[1375],{"type":407,"attrs":1376},{"href":1377,"uuid":53,"anchor":53,"custom":1378,"target":714,"linktype":715},"https://pmc.ncbi.nlm.nih.gov/articles/PMC4025450/",{},{"type":15,"attrs":1380,"content":1381},{"textAlign":53},[1382],{"text":1383,"type":295},"Purdue University PharmaTAP. Anticoagulant tool kit: Reducing adverse drug events & potential adverse drug events with unfractionated heparin, low molecular weight heparins and warfarin. Indianapolis, IN: Purdue University PharmaTAP: 2008. http://www.ihi.org/resources/pages/tools/anticoagulanttoolkitreducingades.aspx",{"type":15,"attrs":1385,"content":1386},{"textAlign":53},[1387],{"text":1388,"type":295},"Weinhouse GL. Stress ulcer prophylaxis in the intensive care unit. UpToDate. 2018. https://www.uptodate.com/contents/stress-ulcer-prophylaxis-in-the-intensive-care-unit",{"id":16,"_uid":1390,"items":1391,"component":1413},"9b1a166e-b7ff-467c-b700-3fa455451106",[1392],{"_uid":1393,"link":1394,"image":1401,"title":1405,"component":1406,"description":1407},"22ad02f9-4026-44ee-a378-737a3c0ddd43",[1395],{"_uid":1396,"link":1397,"label":1399,"component":1400},"2480becb-0372-431e-a4e6-fbcee21ade88",{"id":275,"url":16,"linktype":413,"fieldtype":716,"cached_url":303,"story":1398},{"name":270,"id":274,"uuid":275,"slug":9,"url":303,"full_slug":303,"_stopResolving":301},"See all resources","simple-link",{"id":1402,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1403,"copyright":16,"fieldtype":284,"meta_data":1404,"is_external_url":286},121293076058734,"https://a-ca.storyblok.com/f/850807391887861/2068x1484/1aea4e8fb2/senior-woman-holding-doctors-hand.webp",{},"Hospital Harm Resources","image-text-colored-item",{"type":12,"content":1408},[1409],{"type":15,"attrs":1410,"content":1411},{"textAlign":53},[1412],{"text":294,"type":295},"image-text-colored",[129,150,136,122,143,115,157],[185,192,200],"hec-page-resource-single","anemia-hemorrhage-health-care-medication-associated-condition","resources/anemia-hemorrhage-health-care-medication-associated-condition",-18770,[],103604225865405,"f4827a69-9e18-4bb9-942f-5454abf6aefe","2025-12-12T21:01:18.391Z",[],[1426],{"path":1427,"name":1428,"lang":315,"published":301},"ressources/anemie-hemorragie-affections-liees-aux-soins-de-sante-ou-aux-medicaments","Anémie – hémorragie (Affections liées aux soins de santé ou aux médicaments)",{"name":1430,"created_at":1431,"published_at":1432,"updated_at":1433,"id":1434,"uuid":1435,"content":1436,"slug":2830,"full_slug":2831,"sort_by_date":53,"position":2832,"tag_list":2833,"is_startpage":286,"parent_id":1421,"meta_data":53,"group_id":2834,"first_published_at":2835,"release_id":53,"lang":309,"path":53,"alternates":2836,"default_full_slug":2831,"translated_slugs":2837},"Procedure-Associated Shock","2025-12-15T17:20:46.093Z","2026-03-10T16:21:42.030Z","2026-03-10T16:21:42.100Z",123411030455315,"d5088121-c600-443b-93d4-2e89c55a7e0b",{"new":286,"seo":1437,"_uid":341,"hero":1438,"type":174,"topics":1459,"Noindex":286,"content":1460,"audience":2828,"duration":16,"regional":2829,"component":1416},{"_uid":338,"title":1430,"plugin":339,"og_image":16,"og_title":16,"description":340,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},[1439],{"_uid":344,"image":1440,"title":1442,"format":1443,"component":353,"description":1446,"key_learning":1453,"prerequisite":1456},{"id":346,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":347,"copyright":16,"fieldtype":284,"meta_data":1441,"is_external_url":286},{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: Procedure-Associated Shock",{"type":12,"content":1444},[1445],{"type":15},{"type":12,"content":1447},[1448],{"type":15,"attrs":1449,"content":1450},{"textAlign":53},[1451],{"text":1452,"type":295},"Shock is a state of organ hypoperfusion with resultant cellular dysfunction and death. Mechanisms may involve decreased circulating volume, decreased cardiac output, and vasodilation, sometimes with shunting of blood to bypass capillary exchange beds (Procter, 2020). It is a clinical state that occurs when a mismatch arises between oxygen supply and metabolic demand, resulting in cellular hypoxia. If not recognized and treated appropriately, shock will ultimately progress to organ failure (Broussard & Ural, 2018; Gaieski & Mikkelsen, 2018; Vincent & De Backer, 2013). It is one of the leading causes of death in hospitalized patients (Nichol & Ahmed, 2014).",{"type":12,"content":1454},[1455],{"type":15},{"type":12,"content":1457},[1458],{"type":15},[76,8],[1461,1472,1787,1824,2564,2596,2699,2734,2810],{"_uid":370,"link":1462,"image":1463,"title":374,"component":375,"media_type":376,"description":1465},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":284,"meta_data":1464},{},{"type":12,"content":1466},[1467],{"type":15,"attrs":1468,"content":1469},{"textAlign":53},[1470],{"text":1471,"type":295},"Reduce the incidence of procedure-associated shock.",{"_uid":385,"content":1473,"component":701},[1474],{"_uid":388,"content":1475,"component":700},{"type":12,"content":1476},[1477,1481,1492,1497,1502,1507,1519,1779],{"type":392,"attrs":1478,"content":1479},{"level":394,"textAlign":53},[1480],{"text":397,"type":295},{"type":15,"attrs":1482,"content":1483},{"textAlign":53},[1484,1485,1491],{"text":402,"type":295},{"text":404,"type":295,"marks":1486},[1487],{"type":407,"attrs":1488},{"href":409,"uuid":410,"anchor":53,"custom":1489,"target":412,"linktype":413,"story":1490},{},{"name":404,"id":415,"uuid":410,"slug":416,"url":417,"full_slug":417,"_stopResolving":301},{"text":419,"type":295},{"type":15,"attrs":1493,"content":1494},{"textAlign":53},[1495],{"text":1496,"type":295},"There are several types of shock that a patient may experience during or after a procedure.  Mechanisms of organ hypoperfusion and shock may be due to a low circulating volume (hypovolemic shock), vasodilation (distributive shock), a primary decrease in cardiac output (both cardiogenic and obstructive shock), or a combination of all of them. Untreated shock is usually fatal. Even with treatment, mortality from cardiogenic shock after myocardial infarction [MI] (60 to 65 per cent) and septic shock (30 to 40 per cent) is high. Prognosis depends on the cause, preexisting or complicating illness, time between onset and diagnosis, and promptness and adequacy of therapy (Procter, 2020).",{"type":15,"attrs":1498,"content":1499},{"textAlign":53},[1500],{"text":1501,"type":295},"Organ dysfunction in patients can be represented by an increase in the Sequential Organ Failure Assessment (SOFA) score (Vincent et al., 1996) of two points or more, which is associated with an in-hospital mortality greater than 10 per cent. Patients with septic shock can be identified by a vasopressor requirement to maintain a mean arterial pressure of 65 mm Hg or greater AND serum lactate level greater than 2 mmol/L in the absence of hypovolemia (i.e. after adequate fluid resuscitation). This combination is associated with hospital mortality rates greater than 40 per cent (Singer et al., 2016).",{"type":15,"attrs":1503,"content":1504},{"textAlign":53},[1505],{"text":1506,"type":295},"Table 1 was created by Dr. Denny Laporta at the Jewish General Hospital, McGill University, Montreal, QC (Laporta, 2018). The table summarizes the various types of shock that may be encountered in the peri-procedure period. In hypovolemic shock the reduced cardiac output is due to a reduction in circulating volume and consequent venous return. It may be due to hemorrhage or when large volumes of fluid are lost perioperatively – expectedly or unexpectedly.",{"type":392,"attrs":1508,"content":1509},{"level":437,"textAlign":53},[1510,1512,1517],{"text":1511,"type":295},"Table 1: Examples of shock",{"text":1513,"type":295,"marks":1514},"1",[1515],{"type":1516},"superscript",{"text":1518,"type":295}," occurring during or after a procedure",{"type":1520,"content":1521},"table",[1522,1557,1599,1641,1678],{"type":1523,"content":1524},"tableRow",[1525,1537,1547],{"type":1526,"attrs":1527,"content":1528},"tableCell",{"colspan":941,"rowspan":941,"colwidth":53,"backgroundColor":53},[1529],{"type":392,"attrs":1530,"content":1532},{"level":1531,"textAlign":53},4,[1533],{"text":1534,"type":295,"marks":1535},"Peri-Procedure 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Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: First update 2016. 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Management of Coagulopathy in Postpartum Hemorrhage. Semin Thromb Hemost. 2016;42(7):724-731. doi:",{"text":2344,"type":295,"marks":2345},"10.1055/s-0036-1593417",[2346],{"type":407,"attrs":2347},{"href":2348,"uuid":53,"anchor":53,"custom":2349,"target":714,"linktype":715},"https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0036-1593417",{},{"type":445,"content":2351},[2352],{"type":15,"attrs":2353,"content":2354},{"textAlign":53},[2355,2357],{"text":2356,"type":295},"Society of Critical Care Medicine ",{"text":2358,"type":295,"marks":2359},"https://www.sccm.org/Research/Journals/Critical-Care-Medicine",[2360],{"type":407,"attrs":2361},{"href":2362,"uuid":53,"anchor":53,"custom":2363,"target":714,"linktype":715},"https://www.sccm.org/research/journals/critical-care-medicine",{},{"type":445,"content":2365},[2366],{"type":15,"attrs":2367,"content":2368},{"textAlign":53},[2369,2371],{"text":2370,"type":295},"Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45(3). doi:",{"text":2372,"type":295,"marks":2373},"10.1097/CCM.0000000000002255",[2374],{"type":407,"attrs":2375},{"href":2376,"uuid":53,"anchor":53,"custom":2377,"target":714,"linktype":715},"https://journals.lww.com/ccmjournal/fulltext/2017/03000/surviving_sepsis_campaign__international.15.aspx",{},{"type":445,"content":2379},[2380],{"type":15,"attrs":2381,"content":2382},{"textAlign":53},[2383],{"text":2384,"type":295},"UPTODATE www.uptodate.com",{"type":445,"content":2386},[2387],{"type":15,"attrs":2388,"content":2389},{"textAlign":53},[2390,2392],{"text":2391,"type":295},"Gaieski DF, Mikkelsen ME. Evaluation of and initial approach to the adult patient with undifferentiated hypotension and shock. UpToDate. 2018 October, last updated. ",{"text":2393,"type":295,"marks":2394},"https://www.uptodate.com/contents/evaluation-of-and-initial-approach-to-the-adult-patient-with-undifferentiated-hypotension-and-shock",[2395],{"type":407,"attrs":2396},{"href":2393,"uuid":53,"anchor":53,"custom":2397,"target":714,"linktype":715},{},{"type":445,"content":2399},[2400],{"type":15,"attrs":2401,"content":2402},{"textAlign":53},[2403,2405],{"text":2404,"type":295},"Hrymak C, Funk DJ, O'Connor MF, Jacobsohn E. Intraoperative management of shock in adults. UpToDate. 2018 July, last updated. ",{"text":2406,"type":295,"marks":2407},"https://www.uptodate.com/contents/intraoperative-management-of-shock-in-adults?search=Intraoperative%20management%20of%20shock%20in%20adults&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1",[2408],{"type":407,"attrs":2409},{"href":2406,"uuid":53,"anchor":53,"custom":2410,"target":714,"linktype":715},{},{"type":445,"content":2412},[2413],{"type":15,"attrs":2414,"content":2415},{"textAlign":53},[2416,2418],{"text":2417,"type":295},"Parker WH, Wagener WH. Management of hemorrhage in gynecologic surgery. UpToDate. 2018 May, last updated. ",{"text":2419,"type":295,"marks":2420},"https://www.uptodate.com/contents/management-of-hemorrhage-in-gynecologic-surgery",[2421],{"type":407,"attrs":2422},{"href":2419,"uuid":53,"anchor":53,"custom":2423,"target":714,"linktype":715},{},{"type":445,"content":2425},[2426],{"type":15,"attrs":2427,"content":2428},{"textAlign":53},[2429,2431],{"text":2430,"type":295},"Siparsky N. Overview of postoperative fluid therapy in adults. UpToDate. 2018 May, last updated. ",{"text":2432,"type":295,"marks":2433},"https://www.uptodate.com/contents/overview-of-postoperative-fluid-therapy-in-adults",[2434],{"type":407,"attrs":2435},{"href":2432,"uuid":53,"anchor":53,"custom":2436,"target":714,"linktype":715},{},{"type":445,"content":2438},[2439],{"type":15,"attrs":2440,"content":2441},{"textAlign":53},[2442],{"text":2443,"type":295},"For additional references you may also find the following Hospital Harm Improvement Resources helpful:",{"type":445,"content":2445},[2446],{"type":15,"attrs":2447,"content":2448},{"textAlign":53},[2449],{"text":2450,"type":295,"marks":2451},"Obstetric 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Identified as diagnosis type (2) AND Y60-84 in the same diagnostic cluster",{"_uid":1062,"title":1063,"ctaLeft":2627,"ctaRight":2628,"component":718,"columnLeft":2629,"columnRight":2633},[],[],{"type":12,"content":2630},[2631],{"type":15,"attrs":2632},{"textAlign":53},{"type":12,"content":2634},[2635,2642],{"type":15,"attrs":2636,"content":2637},{"textAlign":53},[2638,2641],{"text":1044,"type":295,"marks":2639},[2640],{"type":1035},{"text":1049,"type":295},{"type":15,"attrs":2643,"content":2644},{"textAlign":53},[2645,2648],{"text":2621,"type":295,"marks":2646},[2647],{"type":1035},{"text":2649,"type":295},": Shock during or resulting from a procedure, not elsewhere 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Notes.",[2678],{"type":407,"attrs":2679},{"href":1154,"uuid":53,"anchor":53,"custom":2680,"target":714,"linktype":715},{},{"type":12,"content":2682},[2683,2691],{"type":15,"attrs":2684,"content":2685},{"textAlign":53},[2686,2687],{"text":1165,"type":295},{"text":2688,"type":295,"marks":2689},"D25: Procedure-Associated Shock",[2690],{"type":1035},{"type":15,"attrs":2692,"content":2693},{"textAlign":53},[2694,2697],{"text":1174,"type":295,"marks":2695},[2696],{"type":1035},{"text":2698,"type":295},": Shock during or resulting from a procedure.",{"_uid":2700,"content":2701,"component":701},"e9f6966a-522e-4969-8c8e-8fac07d89f26",[2702],{"_uid":2703,"content":2704,"component":700},"4aea05a6-3f65-4776-92ce-11c63a02ff1f",{"type":12,"content":2705},[2706,2710,2715,2720,2725],{"type":392,"attrs":2707,"content":2708},{"level":394,"textAlign":53},[2709],{"text":1216,"type":295},{"type":392,"attrs":2711,"content":2712},{"level":437,"textAlign":53},[2713],{"text":2714,"type":295},"Surviving Sepsis",{"type":15,"attrs":2716,"content":2717},{"textAlign":53},[2718],{"text":2719,"type":295},"In April 2008, a 70-year-old independent lady with no previous comorbidities became a grandmother for the first time and was looking forward to watching her family grow-up. She developed a cough' became breathless and presented to her local hospital. She was admitted and developed severe sepsis and septic shock secondary to her community-acquired pneumonia; she died within seven hours. Her sepsis was not recognized, and antibiotics and fluids were not given in a timely manner. The patient's family and the well-meaning and competent medical and nursing team were devastated.",{"type":15,"attrs":2721,"content":2722},{"textAlign":53},[2723],{"text":2724,"type":295},"So begins the account of a real patient story that compelled Dr. Matt Inada-Kim and colleagues to tackle the problem of managing sepsis within their practice (Patient Stories, 2020).",{"type":15,"attrs":2726,"content":2727},{"textAlign":53},[2728],{"text":2729,"type":295,"marks":2730},"https://www.patientstories.org.uk/recent-posts/surviving-sepsis-a-human-factors-approach/",[2731],{"type":407,"attrs":2732},{"href":2729,"uuid":53,"anchor":53,"custom":2733,"target":714,"linktype":715},{},{"_uid":1223,"items":2735,"title":1243,"component":760,"description":2807},[2736],{"_uid":1226,"title":1227,"ctaLeft":2737,"ctaRight":2738,"component":718,"columnLeft":2739,"columnRight":2743},[],[],{"type":12,"content":2740},[2741],{"type":15,"attrs":2742},{"textAlign":53},{"type":12,"content":2744},[2745,2750,2755,2760,2764,2769,2781,2790,2795],{"type":15,"attrs":2746,"content":2747},{"textAlign":53},[2748],{"text":2749,"type":295},"Broussard D, Ural K.  Cardiovascular problems in the post-anesthesia care unit (PACU). UpToDate. 2018 June 5, last update.",{"type":15,"attrs":2751,"content":2752},{"textAlign":53},[2753],{"text":2754,"type":295},"Gaieski DF, Mikkelsen ME. Evaluation of and initial approach to the adult patient with undifferentiated hypotension and shock. UpToDate. 2018 October, last updated.",{"type":15,"attrs":2756,"content":2757},{"textAlign":53},[2758],{"text":2759,"type":295},"HIROC. Risk reference sheet: Failure to appreciate status changes/deteriorating patients. Acute care. Toronto, ON: HIROC; 2016. https://www.hiroc.com/getmedia/ab1d0552-af52-4b71-b4c1-4ba8b643b27e/2_Failure-to-Appreciate-Status-Change.pdf.aspx?ext=.pdf",{"type":15,"attrs":2761,"content":2762},{"textAlign":53},[2763],{"text":2213,"type":295},{"type":15,"attrs":2765,"content":2766},{"textAlign":53},[2767],{"text":2768,"type":295},"Laporta D. Types of shock encountered in the peri-procedure period. Personal communication; 2018 Marc.",{"type":15,"attrs":2770,"content":2771},{"textAlign":53},[2772,2774],{"text":2773,"type":295},"Nichol A, Ahmed B. Shock: causes, initial assessment, and investigations. Anesth Intens Care Med. 2014: 15 (2): 64-67. ",{"text":2775,"type":295,"marks":2776},"https://doi.org/10.1016/j.mpaic.2013.12.008",[2777],{"type":407,"attrs":2778},{"href":2779,"uuid":53,"anchor":53,"custom":2780,"target":714,"linktype":715},"https://www.anaesthesiajournal.co.uk/article/S1472-0299(13)00320-2/abstract",{},{"type":15,"attrs":2782,"content":2783},{"textAlign":53},[2784,2785],{"text":2262,"type":295},{"text":2264,"type":295,"marks":2786},[2787],{"type":407,"attrs":2788},{"href":2264,"uuid":53,"anchor":53,"custom":2789,"target":714,"linktype":715},{},{"type":15,"attrs":2791,"content":2792},{"textAlign":53},[2793],{"text":2794,"type":295},"Singer M, et. al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Journal of the American Medical Association. 2016; 315 (8): 801-810.",{"type":15,"attrs":2796,"content":2797},{"textAlign":53},[2798,2800],{"text":2799,"type":295},"Vincent JL, De Backer D. Circulatory shock. N Engl J Med. 2013; 369 (18): 1726-1734. doi: 10.1056/NEJMra1208943. Available at: ",{"text":2801,"type":295,"marks":2802},"https://www.nejm.org/doi/10.1056/NEJMra1208943?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dwww.ncbi.nlm.nih.gov&",[2803],{"type":407,"attrs":2804},{"href":2805,"uuid":53,"anchor":53,"custom":2806,"target":714,"linktype":715},"https://www.nejm.org/doi/10.1056/NEJMra1208943?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3Dwww.ncbi.nlm.nih.gov&",{},{"type":12,"content":2808},[2809],{"type":15},{"id":16,"_uid":2811,"items":2812,"component":1413},"74a08931-7302-4df6-b7fd-97a1c17001f4",[2813],{"_uid":2814,"link":2815,"image":2820,"title":1405,"component":1406,"description":2822},"d074a47f-97db-4147-8fae-54b5a95ba719",[2816],{"_uid":2817,"link":2818,"label":1399,"component":1400},"23bf6d2f-df36-4dbe-b20a-6959a74eadf9",{"id":275,"url":16,"linktype":413,"fieldtype":716,"cached_url":303,"story":2819},{"name":270,"id":274,"uuid":275,"slug":9,"url":303,"full_slug":303,"_stopResolving":301},{"id":1402,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1403,"copyright":16,"fieldtype":284,"meta_data":2821,"is_external_url":286},{},{"type":12,"content":2823},[2824],{"type":15,"attrs":2825,"content":2826},{"textAlign":53},[2827],{"text":294,"type":295},[129,150,136,122,143,115,157],[185,192,200],"procedure-associated-shock","resources/procedure-associated-shock",-18780,[],"2fe6c781-6164-45cb-b763-450bf970bc7f","2025-12-15T18:42:00.801Z",[],[2838],{"path":2839,"name":2840,"lang":315,"published":301},"ressources/choc-lie-a-une-intervention","Choc lié à une intervention",{"name":2842,"created_at":2843,"published_at":2844,"updated_at":2845,"id":2846,"uuid":2847,"content":2848,"slug":3663,"full_slug":3664,"sort_by_date":53,"position":3665,"tag_list":3666,"is_startpage":286,"parent_id":1421,"meta_data":53,"group_id":3667,"first_published_at":3668,"release_id":53,"lang":309,"path":53,"alternates":3669,"default_full_slug":3664,"translated_slugs":3670},"Electrolytes and Fluid Imbalance","2025-12-15T19:26:48.098Z","2026-03-10T16:21:10.063Z","2026-03-10T16:21:10.125Z",123442004534444,"d01e1483-dc02-4353-b9c8-d00e417768b7",{"new":286,"seo":2849,"_uid":341,"hero":2850,"type":174,"topics":2871,"Noindex":286,"content":2872,"audience":3661,"duration":16,"regional":3662,"component":1416},{"_uid":338,"title":2484,"plugin":339,"og_image":16,"og_title":16,"description":340,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},[2851],{"_uid":344,"image":2852,"title":2854,"format":2855,"component":353,"description":2858,"key_learning":2865,"prerequisite":2868},{"id":346,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":347,"copyright":16,"fieldtype":284,"meta_data":2853,"is_external_url":286},{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: Electrolyte and Fluid Imbalance",{"type":12,"content":2856},[2857],{"type":15},{"type":12,"content":2859},[2860],{"type":15,"attrs":2861,"content":2862},{"textAlign":53},[2863],{"text":2864,"type":295},"Many adult hospital inpatients require intravenous (IV) fluid therapy to prevent or correct problems with their fluid and/or electrolyte status. This may be because they cannot meet their normal needs through oral or enteral routes (related for example to swallowing problems or gastrointestinal dysfunction) or because they have unusual fluid and/or electrolyte deficits or demands caused by illness or injury (e.g., high gastrointestinal or renal losses). Deciding on the optimal amount and composition of IV fluids and the best rate at which to administer them can be a difficult task. Decisions must be based on careful assessment of the patient's individual needs (National Institute for Health and Care Excellence (NICE) 2013).",{"type":12,"content":2866},[2867],{"type":15},{"type":12,"content":2869},[2870],{"type":15},[76,8],[2873,2884,3080,3132,3307,3339,3503,3534,3643],{"_uid":370,"link":2874,"image":2875,"title":374,"component":375,"media_type":376,"description":2877},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":284,"meta_data":2876},{},{"type":12,"content":2878},[2879],{"type":15,"attrs":2880,"content":2881},{"textAlign":53},[2882],{"text":2883,"type":295},"Reduce the incidence of harm associated with electrolyte and fluid imbalance. ",{"_uid":385,"content":2885,"component":701},[2886],{"_uid":388,"content":2887,"component":700},{"type":12,"content":2888},[2889,2894,2905,2910,2968,2973,3003,3008,3013,3050,3055,3060,3065,3070,3075],{"type":392,"attrs":2890,"content":2891},{"level":394,"textAlign":53},[2892],{"text":2893,"type":295},"​Overview and Implications",{"type":15,"attrs":2895,"content":2896},{"textAlign":53},[2897,2898,2904],{"text":402,"type":295},{"text":404,"type":295,"marks":2899},[2900],{"type":407,"attrs":2901},{"href":409,"uuid":410,"anchor":53,"custom":2902,"target":412,"linktype":413,"story":2903},{},{"name":404,"id":415,"uuid":410,"slug":416,"url":417,"full_slug":417,"_stopResolving":301},{"text":419,"type":295},{"type":15,"attrs":2906,"content":2907},{"textAlign":53},[2908],{"text":2909,"type":295},"Although mismanagement of fluid therapy is rarely reported as being responsible for patient harm, it is likely that as many as one in five patients who receive intravenous (IV) fluids and electrolytes suffer complications or morbidity due to their inappropriate administration. (National Institute for Health and Care Excellence (NICE) 2013/2017),",{"type":442,"content":2911},[2912,2919,2926,2933,2940,2947,2954,2961],{"type":445,"content":2913},[2914],{"type":15,"attrs":2915,"content":2916},{"textAlign":53},[2917],{"text":2918,"type":295},"Potential complications of fluid and electrolyte therapy include:",{"type":445,"content":2920},[2921],{"type":15,"attrs":2922,"content":2923},{"textAlign":53},[2924],{"text":2925,"type":295},"hyponatremia,",{"type":445,"content":2927},[2928],{"type":15,"attrs":2929,"content":2930},{"textAlign":53},[2931],{"text":2932,"type":295},"hypernatremia ",{"type":445,"content":2934},[2935],{"type":15,"attrs":2936,"content":2937},{"textAlign":53},[2938],{"text":2939,"type":295},"hypokalemia",{"type":445,"content":2941},[2942],{"type":15,"attrs":2943,"content":2944},{"textAlign":53},[2945],{"text":2946,"type":295},"hyperkalemia",{"type":445,"content":2948},[2949],{"type":15,"attrs":2950,"content":2951},{"textAlign":53},[2952],{"text":2953,"type":295},"hyperchloraemic acidosis",{"type":445,"content":2955},[2956],{"type":15,"attrs":2957,"content":2958},{"textAlign":53},[2959],{"text":2960,"type":295},"volume overload",{"type":445,"content":2962},[2963],{"type":15,"attrs":2964,"content":2965},{"textAlign":53},[2966],{"text":2967,"type":295},"volume depletion (NICE 2013)",{"type":15,"attrs":2969,"content":2970},{"textAlign":53},[2971],{"text":2972,"type":295},"Hospitalized patients require intravenous (IV) fluid and electrolytes for one or more of the following reasons (the 4Rs):",{"type":442,"content":2974},[2975,2982,2989,2996],{"type":445,"content":2976},[2977],{"type":15,"attrs":2978,"content":2979},{"textAlign":53},[2980],{"text":2981,"type":295},"Fluid resuscitation ",{"type":445,"content":2983},[2984],{"type":15,"attrs":2985,"content":2986},{"textAlign":53},[2987],{"text":2988,"type":295},"Routine maintenance ",{"type":445,"content":2990},[2991],{"type":15,"attrs":2992,"content":2993},{"textAlign":53},[2994],{"text":2995,"type":295},"Replacement ",{"type":445,"content":2997},[2998],{"type":15,"attrs":2999,"content":3000},{"textAlign":53},[3001],{"text":3002,"type":295},"Redistribution (NICE 2013/2017)",{"type":15,"attrs":3004,"content":3005},{"textAlign":53},[3006],{"text":3007,"type":295},"Despite the almost ubiquitous need for, and use of intravenous fluids in acutely ill patients, there has been little consensus on the most appropriate rate of administration and composition of intravenous fluids, and practice patterns with respect to maintenance fluids vary widely (Moritz & Ayus 2015).",{"type":15,"attrs":3009,"content":3010},{"textAlign":53},[3011],{"text":3012,"type":295},"According to NICE (2013/2017) the principles underpinning safe and effective IV fluid and electrolyte therapy are: ",{"type":442,"content":3014},[3015,3022,3029,3036,3043],{"type":445,"content":3016},[3017],{"type":15,"attrs":3018,"content":3019},{"textAlign":53},[3020],{"text":3021,"type":295},"physiological principles that underpin fluid prescribing",{"type":445,"content":3023},[3024],{"type":15,"attrs":3025,"content":3026},{"textAlign":53},[3027],{"text":3028,"type":295},"pathophysiological changes that affect fluid balance in disease states",{"type":445,"content":3030},[3031],{"type":15,"attrs":3032,"content":3033},{"textAlign":53},[3034],{"text":3035,"type":295},"indications for IV fluid therapy",{"type":445,"content":3037},[3038],{"type":15,"attrs":3039,"content":3040},{"textAlign":53},[3041],{"text":3042,"type":295},"reasons for the choice of the various fluids available and",{"type":445,"content":3044},[3045],{"type":15,"attrs":3046,"content":3047},{"textAlign":53},[3048],{"text":3049,"type":295},"principles of assessing fluid balance",{"type":392,"attrs":3051,"content":3052},{"level":437,"textAlign":53},[3053],{"text":3054,"type":295},"Fluid overload",{"type":15,"attrs":3056,"content":3057},{"textAlign":53},[3058],{"text":3059,"type":295},"Fluid overload is a relatively frequent occurrence in critically ill patients and is often a consequence of critical care intervention. It may lead to pulmonary edema and in critically ill patients, fluid overload is independently associated with increased morbidity and mortality as well as increased hospital costs (NICE 2013; Ogbu et al. 2015).",{"type":392,"attrs":3061,"content":3062},{"level":437,"textAlign":53},[3063],{"text":3064,"type":295},"Transfusion-associated circulatory overload (TACO)",{"type":15,"attrs":3066,"content":3067},{"textAlign":53},[3068],{"text":3069,"type":295},"TACO is a complication of blood transfusion that is due to impaired cardiac function and/or an excessively rapid rate of transfusion. It occurs in one in 700 transfusion recipients and patients over 70 years of age, infants, and patients with severe euvolemic anemia (hemoglobin \u003C50 g/L), renal impairment, fluid overload, and cardiac dysfunction are particularly susceptible (Callum et al. 2016). The risk factors for TACO include, age over 70 years, history of heart failure, left ventricular dysfunction, history of myocardial infarction, renal dysfunction, and positive fluid balance.  The clinical presentation includes: dyspnea, orthopnea, cyanosis, tachycardia, increased venous pressure and hypertension (Callum et al. 2016).",{"type":392,"attrs":3071,"content":3072},{"level":437,"textAlign":53},[3073],{"text":3074,"type":295},"Hypovolemic shock",{"type":15,"attrs":3076,"content":3077},{"textAlign":53},[3078],{"text":3079,"type":295},"In hypovolemia, a patient's fluid needs are not met by oral, enteral or IV intake and the patient will demonstrate features of dehydration on clinical exam, low urine output or concentrated urine and biochemical indicators, such as more than 50 per cent increase in urea or creatinine with no other identifiable cause (NICE, 2013). Patients may exhibit thirst, vomiting, diarrhea, weight loss, dizziness, confusion, somnolence, reduced skin turgor, dry mucous membranes, sunken eyes, reduced capillary refill, tachycardia and postural hypotension (Frost 2015). Hypovolemic shock is an emergency condition in which severe blood and fluid loss make the heart unable to pump enough blood to the body.",{"_uid":1788,"content":3081,"component":701},[3082],{"_uid":1791,"content":3083,"component":700},{"type":12,"content":3084},[3085,3089,3094,3099,3103,3115,3127],{"type":392,"attrs":3086,"content":3087},{"level":394,"textAlign":53},[3088],{"text":759,"type":295},{"type":15,"attrs":3090,"content":3091},{"textAlign":53},[3092],{"text":3093,"type":295},"Fluid and electrolyte imbalances are associated with numerous complications, including increased morbidity and mortality, as well as increased hospital length of stay. Hospital patients needing IV fluids are very variable in terms of their fluid and electrolyte status and their likely responses to IV fluid therapy. Therefore, a full assessment is required by a competent clinician regarding the best content, volume and rate of IV fluids to be administered in order to minimize risks associated with fluid and electrolyte therapy (NICE 2013).",{"type":15,"attrs":3095,"content":3096},{"textAlign":53},[3097],{"text":3098,"type":295},"Patients have a valuable contribution to make to their fluid balance. If a patient needs IV fluids, the decision should be explained to them along with the signs and symptoms they need to look for if their fluid balance needs adjusting. If possible or when asked, provide written information (for example, NICE's Information for the public), and involve the patient's family members or careers (as appropriate) (NICE 2013).",{"type":392,"attrs":3100,"content":3101},{"level":437,"textAlign":53},[3102],{"text":1812,"type":295},{"type":15,"attrs":3104,"content":3105},{"textAlign":53},[3106,3113],{"text":3107,"type":295,"marks":3108},"Near Fatal: A Patient Safety Story",[3109],{"type":407,"attrs":3110},{"href":3111,"uuid":53,"anchor":53,"custom":3112,"target":714,"linktype":715},"https://www.youtube.com/watch?v=pcQUnGiuhzM",{},{"text":3114,"type":295}," (Saskatchewan Health Authority - Saskatoon area, 2015)",{"type":15,"attrs":3116,"content":3117},{"textAlign":53},[3118,3120],{"text":3119,"type":295},"Medication Error in the Hospital Kills Two-Year Old Emily Jerry. ",{"text":3121,"type":295,"marks":3122},"As told by Christopher S. Jerry (Patient Safety Movement, 2014)",[3123],{"type":407,"attrs":3124},{"href":3125,"uuid":53,"anchor":53,"custom":3126,"target":714,"linktype":715},"https://psmf.org/story/emily-jerry/",{},{"type":15,"attrs":3128,"content":3129},{"textAlign":53},[3130],{"text":3131,"type":295},"Emily Jerry was diagnosed with a yolk sac tumor about the size of a grapefruit when she was about 18 months old. Her doctors and nurses assured me that Emily's cancer was not only treatable, but curable…Sunday, Feb. 26, after the third day of her last chemotherapy treatment, Emily awoke from her nap groggy. She kept trying to sit up and asked her mom to hold her in her lap. She kept grabbing her head and moaning that it hurt…. She cried some more before she started screaming, \"Mommy, my head, my head hurts! MY HEAD HURTS!\"…Emily went completely limp and the nurses began to resuscitate her. Within the hour, my precious daughter was on life support.  Emily wound up brain dead and on life support – essentially dead due to the massive brain damage she had incurred. Our Emily was killed by an overdose of sodium chloride in her chemotherapy IV bag…..",{"_uid":769,"items":3133,"title":918,"component":760,"description":3265},[3134],{"_uid":772,"title":773,"ctaLeft":3135,"ctaRight":3136,"component":718,"columnLeft":3137,"columnRight":3150},[],[],{"type":12,"content":3138},[3139],{"type":15,"attrs":3140,"content":3141},{"textAlign":53},[3142,3143,3149],{"text":782,"type":295},{"text":787,"type":295,"marks":3144},[3145],{"type":407,"attrs":3146},{"href":409,"uuid":410,"anchor":53,"custom":3147,"target":412,"linktype":413,"story":3148},{},{"name":404,"id":415,"uuid":410,"slug":416,"url":417,"full_slug":417,"_stopResolving":301},{"text":699,"type":295},{"type":12,"content":3151},[3152,3157],{"type":15,"attrs":3153,"content":3154},{"textAlign":53},[3155],{"text":3156,"type":295},"If your review reveals that your cases of fluid and electrolyte imbalance are linked to specific processes or procedures, you may find these resources helpful:",{"type":442,"content":3158},[3159,3170,3177,3184,3195,3207,3219,3229,3241,3253],{"type":445,"content":3160},[3161],{"type":15,"attrs":3162,"content":3163},{"textAlign":53},[3164],{"text":3165,"type":295,"marks":3166},"Institute for Healthcare Improvement (IHI)",[3167],{"type":407,"attrs":3168},{"href":2205,"uuid":53,"anchor":53,"custom":3169,"target":714,"linktype":715},{},{"type":445,"content":3171},[3172],{"type":15,"attrs":3173,"content":3174},{"textAlign":53},[3175],{"text":3176,"type":295},"Reduce Adverse Drug Events Involving Electrolytes",{"type":445,"content":3178},[3179],{"type":15,"attrs":3180,"content":3181},{"textAlign":53},[3182],{"text":3183,"type":295},"How- to guide: prevent harm from high-alert medications. 2012",{"type":445,"content":3185},[3186],{"type":15,"attrs":3187,"content":3188},{"textAlign":53},[3189],{"text":3190,"type":295,"marks":3191},"Institute for Safe Medication Practice",[3192],{"type":407,"attrs":3193},{"href":818,"uuid":53,"anchor":53,"custom":3194,"target":714,"linktype":715},{},{"type":445,"content":3196},[3197],{"type":15,"attrs":3198,"content":3199},{"textAlign":53},[3200],{"text":3201,"type":295,"marks":3202},"Targeted Medication Safety Best Practices for Hospitals",[3203],{"type":407,"attrs":3204},{"href":3205,"uuid":53,"anchor":53,"custom":3206,"target":714,"linktype":715},"https://home.ecri.org/blogs/ismp-resources/targeted-medication-safety-best-practices-for-hospitals",{},{"type":445,"content":3208},[3209],{"type":15,"attrs":3210,"content":3211},{"textAlign":53},[3212],{"text":3213,"type":295,"marks":3214},"High-Alert Medications in Acute Care Settings",[3215],{"type":407,"attrs":3216},{"href":3217,"uuid":53,"anchor":53,"custom":3218,"target":714,"linktype":715},"https://home.ecri.org/blogs/ismp-resources/high-alert-medications-in-acute-care-settings",{},{"type":445,"content":3220},[3221],{"type":15,"attrs":3222,"content":3223},{"textAlign":53},[3224],{"text":2275,"type":295,"marks":3225},[3226],{"type":407,"attrs":3227},{"href":2281,"uuid":53,"anchor":53,"custom":3228,"target":714,"linktype":715},{},{"type":445,"content":3230},[3231],{"type":15,"attrs":3232,"content":3233},{"textAlign":53},[3234],{"text":3235,"type":295,"marks":3236},"Intravenous fluid therapy in adults in hospital: Clinical guideline [CG174] ",[3237],{"type":407,"attrs":3238},{"href":3239,"uuid":53,"anchor":53,"custom":3240,"target":714,"linktype":715},"https://www.nice.org.uk/guidance/cg174",{},{"type":445,"content":3242},[3243],{"type":15,"attrs":3244,"content":3245},{"textAlign":53},[3246],{"text":3247,"type":295,"marks":3248},"Intravenous fluid therapy in adults in hospital: Quality standard [QS66]",[3249],{"type":407,"attrs":3250},{"href":3251,"uuid":53,"anchor":53,"custom":3252,"target":714,"linktype":715},"https://www.nice.org.uk/guidance/qs66",{},{"type":445,"content":3254},[3255],{"type":15,"attrs":3256,"content":3257},{"textAlign":53},[3258],{"text":3259,"type":295,"marks":3260},"Ontario Regional Blood Coordinating Network: Bloody Easy for Healthcare Professionals",[3261],{"type":407,"attrs":3262},{"href":3263,"uuid":53,"anchor":53,"custom":3264,"target":714,"linktype":715},"https://transfusionontario.org/en/category/bloody-easy-e-tools-publications/",{},{"type":12,"content":3266},[3267,3276,3280],{"type":15,"attrs":3268,"content":3269},{"textAlign":53},[3270,3271,3275],{"text":925,"type":295},{"text":3272,"type":295,"marks":3273},"[TOPIC]",[3274],{"type":929},{"text":931,"type":295},{"type":15,"attrs":3277,"content":3278},{"textAlign":934},[3279],{"text":937,"type":295},{"type":939,"attrs":3281,"content":3282},{"order":941},[3283,3289,3295,3301],{"type":445,"content":3284},[3285],{"type":15,"attrs":3286,"content":3287},{"textAlign":53},[3288],{"text":949,"type":295},{"type":445,"content":3290},[3291],{"type":15,"attrs":3292,"content":3293},{"textAlign":53},[3294],{"text":956,"type":295},{"type":445,"content":3296},[3297],{"type":15,"attrs":3298,"content":3299},{"textAlign":53},[3300],{"text":963,"type":295},{"type":445,"content":3302},[3303],{"type":15,"attrs":3304,"content":3305},{"textAlign":53},[3306],{"text":970,"type":295},{"_uid":972,"items":3308,"title":1009,"component":1010,"description":3333},[3309,3315,3321,3327],{"_uid":975,"image":3310,"title":980,"component":981,"description":3312},{"id":977,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":978,"copyright":16,"fieldtype":284,"meta_data":3311,"is_external_url":286},{},{"type":12,"content":3313},[3314],{"type":15},{"_uid":986,"image":3316,"title":989,"component":981,"description":3318},{"id":977,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":978,"copyright":16,"fieldtype":284,"meta_data":3317,"is_external_url":286},{},{"type":12,"content":3319},[3320],{"type":15},{"_uid":994,"image":3322,"title":997,"component":981,"description":3324},{"id":977,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":978,"copyright":16,"fieldtype":284,"meta_data":3323,"is_external_url":286},{},{"type":12,"content":3325},[3326],{"type":15},{"_uid":1002,"image":3328,"title":1005,"component":981,"description":3330},{"id":977,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":978,"copyright":16,"fieldtype":284,"meta_data":3329,"is_external_url":286},{},{"type":12,"content":3331},[3332],{"type":15},{"type":12,"content":3334},[3335],{"type":15,"attrs":3336,"content":3337},{"textAlign":53},[3338],{"text":1017,"type":295},{"_uid":1019,"items":3340,"title":1158,"component":760,"description":3477},[3341,3387,3437],{"_uid":1022,"title":1023,"ctaLeft":3342,"ctaRight":3343,"component":718,"columnLeft":3344,"columnRight":3348},[],[],{"type":12,"content":3345},[3346],{"type":15,"attrs":3347},{"textAlign":53},{"type":12,"content":3349},[3350,3360,3369,3378],{"type":15,"attrs":3351,"content":3352},{"textAlign":53},[3353,3357],{"text":1044,"type":295,"marks":3354},[3355,3356],{"type":1035},{"type":929},{"text":1049,"type":295,"marks":3358},[3359],{"type":929},{"type":15,"attrs":3361,"content":3362},{"textAlign":53},[3363,3367],{"text":3364,"type":295,"marks":3365},"E86.–, E87.–",[3366],{"type":1035},{"text":3368,"type":295},": Identified as diagnosis type (2)",{"type":15,"attrs":3370,"content":3371},{"textAlign":53},[3372,3376],{"text":3373,"type":295,"marks":3374},"E87.7",[3375],{"type":1035},{"text":3377,"type":295},": Identified as diagnosis type (3) AND T80.8 as diagnosis type (2) AND Y60–Y84  in the same diagnosis cluster",{"type":15,"attrs":3379,"content":3380},{"textAlign":53},[3381,3385],{"text":3382,"type":295,"marks":3383},"R57.1",[3384],{"type":1035},{"text":3386,"type":295},": Identified as diagnosis type (2) not in a diagnosis cluster",{"_uid":1062,"title":1063,"ctaLeft":3388,"ctaRight":3389,"component":718,"columnLeft":3390,"columnRight":3394},[],[],{"type":12,"content":3391},[3392],{"type":15,"attrs":3393},{"textAlign":53},{"type":12,"content":3395},[3396,3403,3412,3421,3429],{"type":15,"attrs":3397,"content":3398},{"textAlign":53},[3399,3402],{"text":1044,"type":295,"marks":3400},[3401],{"type":1035},{"text":1049,"type":295},{"type":15,"attrs":3404,"content":3405},{"textAlign":53},[3406,3410],{"text":3407,"type":295,"marks":3408},"E86.–",[3409],{"type":1035},{"text":3411,"type":295},": Volume depletion",{"type":15,"attrs":3413,"content":3414},{"textAlign":53},[3415,3419],{"text":3416,"type":295,"marks":3417},"E87.–",[3418],{"type":1035},{"text":3420,"type":295},": Other disorders of fluid, electrolyte and acid-base balance",{"type":15,"attrs":3422,"content":3423},{"textAlign":53},[3424,3427],{"text":3373,"type":295,"marks":3425},[3426],{"type":1035},{"text":3428,"type":295},": Fluid overload",{"type":15,"attrs":3430,"content":3431},{"textAlign":53},[3432,3435],{"text":3382,"type":295,"marks":3433},[3434],{"type":1035},{"text":3436,"type":295},": Hypovolemic shock",{"_uid":1097,"title":1098,"ctaLeft":3438,"ctaRight":3439,"component":718,"columnLeft":3440,"columnRight":3444},[],[],{"type":12,"content":3441},[3442],{"type":15,"attrs":3443},{"textAlign":53},{"type":12,"content":3445},[3446,3453,3462],{"type":15,"attrs":3447,"content":3448},{"textAlign":53},[3449,3452],{"text":1111,"type":295,"marks":3450},[3451],{"type":1035},{"text":1115,"type":295},{"type":15,"attrs":3454,"content":3455},{"textAlign":53},[3456,3460],{"text":3457,"type":295,"marks":3458},"T80.8",[3459],{"type":1035},{"text":3461,"type":295},": Other complications following infusion, transfusion and therapeutic injection",{"type":15,"attrs":3463,"content":3464},{"textAlign":53},[3465,3469,3471,3476],{"text":3466,"type":295,"marks":3467},"Y60-Y84",[3468],{"type":1035},{"text":3470,"type":295},": Complications of medical and surgical care (refer to Appendix A of the ",{"text":1150,"type":295,"marks":3472},[3473],{"type":407,"attrs":3474},{"href":1154,"uuid":53,"anchor":53,"custom":3475,"target":714,"linktype":715},{},{"text":1157,"type":295},{"type":12,"content":3478},[3479,3487,3495],{"type":15,"attrs":3480,"content":3481},{"textAlign":53},[3482,3483],{"text":1165,"type":295},{"text":3484,"type":295,"marks":3485},"A09: Electrolyte and Fluid Imbalance",[3486],{"type":1035},{"type":15,"attrs":3488,"content":3489},{"textAlign":53},[3490,3493],{"text":1174,"type":295,"marks":3491},[3492],{"type":1035},{"text":3494,"type":295},": Electrolyte, fluid or acid–base imbalance identified during a hospital stay",{"type":15,"attrs":3496,"content":3497},{"textAlign":53},[3498,3501],{"text":1183,"type":295,"marks":3499},[3500],{"type":1035},{"text":3502,"type":295},": This clinical group excludes procedure-associated hypovolemic shock (refer to D25: Post-Procedural Shock)",{"_uid":3504,"content":3505,"component":701},"58e604c8-c1cd-4d6a-b247-f08bb0aa4d5f",[3506],{"_uid":3507,"content":3508,"component":700},"36791ca6-bcd6-4a2d-a340-52175a0e75ce",{"type":12,"content":3509},[3510,3514,3524,3529],{"type":392,"attrs":3511,"content":3512},{"level":394,"textAlign":53},[3513],{"text":1216,"type":295},{"type":392,"attrs":3515,"content":3516},{"level":437,"textAlign":53},[3517],{"text":3518,"type":295,"marks":3519},"St. Paul's Hospital, Vancouver BC",[3520],{"type":407,"attrs":3521},{"href":3522,"uuid":53,"anchor":53,"custom":3523,"target":714,"linktype":715},"https://bcmj.org/articles/quality-improvement-project-enhance-management-hyperkalemia-hospitalized-patients",{},{"type":15,"attrs":3525,"content":3526},{"textAlign":53},[3527],{"text":3528,"type":295},"Physicians at St. Paul's Hospital in Vancouver recognized that hyperkalemia occurs in up to 10 per cent of hospitalized patients, and that although it is a life-threatening condition, there is little consistency in the management of high serum potassium. They conducted a quality improvement project aimed at increasing the proportion of hy­perkalemia cases managed according to the best available evidence and reducing the cost of treatment. A pocket-sized guideline outlining the management of hyperkalemia according to the best available evidence was distributed to in­ternal medicine residents. Cases of hyperkalemia occurring in a two-week period before the guideline was distributed (observational phase) were reviewed retrospectively and compared with cases occurring in two 2-week periods after the guideline was distributed (intervention phase). A review of paper charts and electronic health records indicated that before the intervention, hyperkalemia was managed according to the best available evidence in 63 per cent of cases. After the intervention, cases were managed according to the best available evidence in 94 per cent of cases. In addition, the overall cost incurred per case declined from $16.74 to $7.51.",{"type":15,"attrs":3530,"content":3531},{"textAlign":53},[3532],{"text":3533,"type":295},"In summary, providing residents with a user-friendly guideline for hyperkalemia increased the proportion of cases managed according to best available evidence and significantly reduced the cost associated with treatment. (Rajan et al. 2012)",{"_uid":1223,"items":3535,"title":1243,"component":760,"description":3640},[3536],{"_uid":1226,"title":1227,"ctaLeft":3537,"ctaRight":3538,"component":718,"columnLeft":3539,"columnRight":3543},[],[],{"type":12,"content":3540},[3541],{"type":15,"attrs":3542},{"textAlign":53},{"type":12,"content":3544},[3545,3555,3560,3564,3576,3586,3597,3609,3620,3630],{"type":15,"attrs":3546,"content":3547},{"textAlign":53},[3548,3550],{"text":3549,"type":295},"Callum JL, Pinkerton PH, Lima A, et al. Bloody Easy 4: Blood Transfusions, Blood Alternatives and Transfusion Reactions, A Guide to Transfusion Medicine. Fourth Edition. Ontario Regional Blood Coordinating Network; 2016. ",{"text":3551,"type":295,"marks":3552},"https://transfusionontario.org/en/download/bloody-easy-4-blood-transfusions-blood-alternatives-and-transfusion-reactions-a-guide-to-transfusion-medicine-fourth-edition/",[3553],{"type":407,"attrs":3554},{"href":3551,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":715},{"type":15,"attrs":3556,"content":3557},{"textAlign":53},[3558],{"text":3559,"type":295},"Frost P. Intravenous fluid therapy in adult inpatients. BMJ. 2015;350:g7620. doi:10.1136/bmj.g7620",{"type":15,"attrs":3561,"content":3562},{"textAlign":53},[3563],{"text":1316,"type":295},{"type":15,"attrs":3565,"content":3566},{"textAlign":53},[3567,3569],{"text":3568,"type":295},"Moritz ML, Ayus JC. Maintenance Intravenous Fluids in Acutely Ill Patients. N Engl J Med. 2015;373(14):1350-1360. doi:",{"text":3570,"type":295,"marks":3571},"10.1056/NEJMra1412877",[3572],{"type":407,"attrs":3573},{"href":3574,"uuid":53,"anchor":53,"custom":3575,"target":714,"linktype":715},"https://www.nejm.org/doi/10.1056/NEJMra1412877",{},{"type":15,"attrs":3577,"content":3578},{"textAlign":53},[3579,3581],{"text":3580,"type":295},"National Institute for Health and Care Excellence (NICE). Intravenous Fluid Therapy: Intravenous Fluid Therapy in Adults in Hospital. London, UK: NICE; 2013/Updated 2017. ",{"text":3239,"type":295,"marks":3582},[3583],{"type":407,"attrs":3584},{"href":3239,"uuid":53,"anchor":53,"custom":3585,"target":714,"linktype":715},{},{"type":15,"attrs":3587,"content":3588},{"textAlign":53},[3589,3591],{"text":3590,"type":295},"National Institute for Health and Care Excellence (NICE). Intravenous Fluid Therapy: Intravenous Fluid Therapy in Adults in Hospital. London, UK: NICE; 2013. ",{"text":3592,"type":295,"marks":3593},"https://www.nice.org.uk/guidance/cg174/evidence/full-guideline-pdf-191667999",[3594],{"type":407,"attrs":3595},{"href":3592,"uuid":53,"anchor":53,"custom":3596,"target":714,"linktype":715},{},{"type":15,"attrs":3598,"content":3599},{"textAlign":53},[3600,3602],{"text":3601,"type":295},"Ogbu OC, Murphy DJ, Martin GS. How to avoid fluid overload. Curr Opin Crit Care. 2015;21(4). ",{"text":3603,"type":295,"marks":3604},"https://journals.lww.com/co-criticalcare/Fulltext/2015/08000/How_to_avoid_fluid_overload.8.aspx",[3605],{"type":407,"attrs":3606},{"href":3607,"uuid":53,"anchor":53,"custom":3608,"target":714,"linktype":715},"https://journals.lww.com/co-criticalcare/abstract/2015/08000/how_to_avoid_fluid_overload.8.aspx",{},{"type":15,"attrs":3610,"content":3611},{"textAlign":53},[3612,3614],{"text":3613,"type":295},"Patient Safety Movement. Medication Error in the Hospital Kills Two-Year Old Emily Jerry. 2014. ",{"text":3615,"type":295,"marks":3616},"https://patientsafetymovement.org/advocacy/patients-and-families/patient-stories/emily-jerry/",[3617],{"type":407,"attrs":3618},{"href":3125,"uuid":53,"anchor":53,"custom":3619,"target":714,"linktype":715},{},{"type":15,"attrs":3621,"content":3622},{"textAlign":53},[3623,3625],{"text":3624,"type":295},"Rajan T, Widmer N, Kim H, Dehghan N, Alsahafi M, Levin A. A quality improvement project to enhance the management of hyperkalemia in hospitalized patients. B C Med J. 2012;54(1):29-33.",{"text":3522,"type":295,"marks":3626},[3627],{"type":407,"attrs":3628},{"href":3522,"uuid":53,"anchor":53,"custom":3629,"target":714,"linktype":715},{},{"type":15,"attrs":3631,"content":3632},{"textAlign":53},[3633,3635],{"text":3634,"type":295},"Saskatchewan Health Authority – Saskatoon Area. Near Fatal: A Patient Safety Story. 2015. ",{"text":3111,"type":295,"marks":3636},[3637],{"type":407,"attrs":3638},{"href":3111,"uuid":53,"anchor":53,"custom":3639,"target":714,"linktype":715},{},{"type":12,"content":3641},[3642],{"type":15},{"id":16,"_uid":3644,"items":3645,"component":1413},"b4713db7-dd25-4b03-859f-5ae589ba906a",[3646],{"_uid":3647,"link":3648,"image":3653,"title":1405,"component":1406,"description":3655},"e3c9ea6e-8420-44da-97ce-d9eef9593052",[3649],{"_uid":3650,"link":3651,"label":1399,"component":1400},"bb83cc7d-7b5e-4fe8-9356-a9e99839ca88",{"id":275,"url":16,"linktype":413,"fieldtype":716,"cached_url":303,"story":3652},{"name":270,"id":274,"uuid":275,"slug":9,"url":303,"full_slug":303,"_stopResolving":301},{"id":1402,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1403,"copyright":16,"fieldtype":284,"meta_data":3654,"is_external_url":286},{},{"type":12,"content":3656},[3657],{"type":15,"attrs":3658,"content":3659},{"textAlign":53},[3660],{"text":294,"type":295},[129,150,136,122,143,115,157],[185,192,200],"electrolytes-and-fluid-imbalance","resources/electrolytes-and-fluid-imbalance",-18790,[],"401c9ccf-ab84-4e4a-928a-73913dce29ce","2025-12-15T21:49:29.746Z",[],[3671],{"path":3672,"name":3673,"lang":315,"published":301},"ressources/desequilibres-hydro-electrolytiques","Déséquilibres hydro-électrolytiques",{"name":404,"created_at":3675,"published_at":3676,"updated_at":3677,"id":415,"uuid":410,"content":3678,"slug":416,"full_slug":417,"sort_by_date":53,"position":4812,"tag_list":4813,"is_startpage":286,"parent_id":1421,"meta_data":53,"group_id":4814,"first_published_at":4815,"release_id":53,"lang":309,"path":53,"alternates":4816,"default_full_slug":417,"translated_slugs":4817},"2025-12-04T20:23:42.350Z","2026-03-10T18:20:34.922Z","2026-03-10T18:20:34.977Z",{"new":286,"seo":3679,"_uid":3682,"hero":3683,"type":174,"topics":3704,"Noindex":286,"content":3705,"audience":4810,"duration":16,"regional":4811,"component":1416},{"_uid":3680,"title":404,"plugin":339,"og_image":16,"og_title":16,"description":3681,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},"14d40382-c919-434b-a2f6-548ed734c884","The Hospital Harm Improvement Resource links measurement and improvement by providing evidence-informed practices that will support patient safety improvement efforts. ","7855a00b-1a83-4266-9178-964ce231b789",[3684],{"_uid":3685,"image":3686,"title":404,"format":3689,"component":353,"description":3692,"key_learning":3698,"prerequisite":3701},"e56911f5-863f-4ea2-8099-7069c55d8edb",{"id":1402,"alt":3687,"name":16,"focus":16,"title":16,"source":16,"filename":1403,"copyright":16,"fieldtype":284,"meta_data":3688,"is_external_url":286},"Older adult woman holding doctors hand",{"alt":3687,"title":16,"source":16,"copyright":16},{"type":12,"content":3690},[3691],{"type":15},{"type":12,"content":3693},[3694],{"type":15,"attrs":3695,"content":3696},{"textAlign":53},[3697],{"text":3681,"type":295},{"type":12,"content":3699},[3700],{"type":15},{"type":12,"content":3702},[3703],{"type":15},[76,8],[3706,3901,4253,4390,4792],{"_uid":3707,"content":3708,"component":701},"22261d06-d19d-44f9-b3e4-026f8cea7f83",[3709,3810],{"_uid":3710,"content":3711,"component":700},"e2595110-63fa-4cac-8d0a-3e4cc4d7f9e5",{"type":12,"content":3712},[3713,3717,3722,3727,3732,3737,3742,3747,3761,3766],{"type":392,"attrs":3714,"content":3715},{"level":394,"textAlign":53},[3716],{"text":404,"type":295},{"type":15,"attrs":3718,"content":3719},{"textAlign":53},[3720],{"text":3721,"type":295},"Patients expect hospital care to be safe and for most people it is. However, a small proportion of patients experience some type of unintended harm as a result of the care they receive.",{"type":15,"attrs":3723,"content":3724},{"textAlign":53},[3725],{"text":3726,"type":295},"The Canadian Institute for Health Information (CIHI) and Healthcare Excellence Canada (HEC) have collaborated on a body of work to address gaps in measuring harm and to support patient safety improvement efforts in Canadian hospitals.",{"type":15,"attrs":3728,"content":3729},{"textAlign":53},[3730],{"text":3731,"type":295},"The Hospital Harm Improvement Resource (improvement resource) was developed by HEC to complement the Hospital Harm measure developed by CIHI. It links measurement and improvement by providing evidence-informed practices that will support patient safety improvement efforts.",{"type":15,"attrs":3733,"content":3734},{"textAlign":53},[3735],{"text":3736,"type":295},"The purpose of measuring quality and safety is to improve patient care and optimize patient outcomes. The Hospital Harm measure should be used in conjunction with other sources of information about patient safety, including patient safety reporting and learning systems, chart reviews or audits, Accreditation Canada survey results, patient concerns and clinical quality improvement process measures. Together, this information can inform and optimize improvement initiatives.",{"type":15,"attrs":3738,"content":3739},{"textAlign":53},[3740],{"text":3741,"type":295},"The improvement resource is a compilation of guidance linked to each of the clinical groups within the Hospital Harm measure to help drive changes that will make care safer. Through research and consultation with clinicians, experts, and leaders in quality improvement (QI) and patient safety, the improvement resource is intended to make information on improving patient safety easily available, so teams spend less time researching and more time optimizing patient care.",{"type":392,"attrs":3743,"content":3744},{"level":394,"textAlign":53},[3745],{"text":3746,"type":295},"Using the improvement resource",{"type":15,"attrs":3748,"content":3749},{"textAlign":53},[3750,3752,3759],{"text":3751,"type":295},"The layout of the improvement resource reflects the framework of the ",{"text":3753,"type":295,"marks":3754},"Hospital Harm measure",[3755],{"type":407,"attrs":3756},{"href":3757,"uuid":53,"anchor":53,"custom":3758,"target":714,"linktype":715},"https://www.cihi.ca/sites/default/files/document/hospital-harm-indicator-frequently-asked-questions-en.pdf#page=4",{},{"text":3760,"type":295}," (Figure 1) shown on page three and focuses on actions that can be taken to decrease the likelihood of harm. The measure includes four major categories of harm; within each category is a series of individual clinical groups, or types of harm, each of which connects to evidence-informed practices for improvement.",{"type":15,"attrs":3762,"content":3763},{"textAlign":53},[3764],{"text":3765,"type":295},"For each clinical group, the improvement resource provides the following:",{"type":442,"content":3767},[3768,3775,3782,3789,3796,3803],{"type":445,"content":3769},[3770],{"type":15,"attrs":3771,"content":3772},{"textAlign":53},[3773],{"text":3774,"type":295},"an overview of the clinical group and goal for improvement",{"type":445,"content":3776},[3777],{"type":15,"attrs":3778,"content":3779},{"textAlign":53},[3780],{"text":3781,"type":295},"implications for patients experiencing the type of harm and their importance to patients and family",{"type":445,"content":3783},[3784],{"type":15,"attrs":3785,"content":3786},{"textAlign":53},[3787],{"text":3788,"type":295},"guidance for clinical and system reviews and incident analyses, including a list of resources specific to the clinical group",{"type":445,"content":3790},[3791],{"type":15,"attrs":3792,"content":3793},{"textAlign":53},[3794],{"text":3795,"type":295},"guidance on measuring improvement",{"type":445,"content":3797},[3798],{"type":15,"attrs":3799,"content":3800},{"textAlign":53},[3801],{"text":3802,"type":295},"success stories from organizations",{"type":445,"content":3804},[3805],{"type":15,"attrs":3806,"content":3807},{"textAlign":53},[3808],{"text":3809,"type":295},"references.",{"_uid":3811,"content":3812,"component":700},"5a50ad5b-3243-440e-b101-629e46480448",{"type":12,"content":3813},[3814,3819,3824,3859,3864,3888],{"type":392,"attrs":3815,"content":3816},{"level":394,"textAlign":53},[3817],{"text":3818,"type":295},"Definitions",{"type":15,"attrs":3820,"content":3821},{"textAlign":53},[3822],{"text":3823,"type":295},"As patient safety evolves it is important to be clear on the meaning and differences of specific words. For the purposes of the Hospital Harm measure, the following definitions apply:",{"type":442,"content":3825},[3826,3837,3848],{"type":445,"content":3827},[3828],{"type":15,"attrs":3829,"content":3830},{"textAlign":53},[3831,3835],{"text":3832,"type":295,"marks":3833},"Harm:",[3834],{"type":1035},{"text":3836,"type":295}," An unintended outcome of care that may be prevented with evidence-informed practices and is identified and treated in the same hospital stay.",{"type":445,"content":3838},[3839],{"type":15,"attrs":3840,"content":3841},{"textAlign":53},[3842,3846],{"text":3843,"type":295,"marks":3844},"Occurrence of harm:",[3845],{"type":1035},{"text":3847,"type":295}," Harmful event is synonymous with occurrence of harm.",{"type":445,"content":3849},[3850],{"type":15,"attrs":3851,"content":3852},{"textAlign":53},[3853,3857],{"text":3854,"type":295,"marks":3855},"Hospital Harm Measure:",[3856],{"type":1035},{"text":3858,"type":295}," Acute care hospitalizations with at least one unintended occurrence of harm that could be potentially prevented by implementing known evidence-informed practices.",{"type":15,"attrs":3860,"content":3861},{"textAlign":53},[3862],{"text":3863,"type":295},"For harm to be included in the measure, it must meet the following three criteria.",{"type":939,"attrs":3865,"content":3866},{"order":941},[3867,3874,3881],{"type":445,"content":3868},[3869],{"type":15,"attrs":3870,"content":3871},{"textAlign":53},[3872],{"text":3873,"type":295},"It is identified as having occurred after admission and within the same hospital stay.",{"type":445,"content":3875},[3876],{"type":15,"attrs":3877,"content":3878},{"textAlign":53},[3879],{"text":3880,"type":295},"It requires treatment or prolongs the patient's hospital stay.",{"type":445,"content":3882},[3883],{"type":15,"attrs":3884,"content":3885},{"textAlign":53},[3886],{"text":3887,"type":295},"It is one of the conditions from the 31 clinical groups in the Hospital Harm Framework.",{"type":15,"attrs":3889,"content":3890},{"textAlign":53},[3891,3893,3900],{"text":3892,"type":295},"If you have any feedback or suggestions for the Improvement Resource, please send your ideas to ",{"text":3894,"type":295,"marks":3895},"info@hec-esc.ca",[3896],{"type":407,"attrs":3897},{"href":3894,"uuid":53,"anchor":53,"custom":3898,"target":714,"linktype":3899},{},"email",{"text":699,"type":295},{"id":16,"_uid":3902,"title":3903,"columns":3904,"component":4168,"description":4169},"d8d13136-55a9-4a2d-8324-fa3c8bd71253","How to Use the Hospital Harm Measure for Improvement",[3905,3974,3998,4014,4037,4061,4078,4098],{"_uid":3906,"image":3907,"title":3911,"content":3912,"component":3973},"2f707474-c542-47e1-a20b-3966bc0d8760",{"type":12,"content":3908},[3909],{"type":15,"attrs":3910},{"textAlign":53},"Step 1: Prioritize quality improvement opportunities",[3913],{"_uid":3914,"content":3915,"component":700},"6b32552b-6d01-4af5-a382-0e258f197843",{"type":12,"content":3916},[3917,3922],{"type":15,"attrs":3918,"content":3919},{"textAlign":53},[3920],{"text":3921,"type":295},"Prioritize the clinical groups for review with the help of your multidisciplinary team, and by considering the following factors.",{"type":442,"content":3923},[3924,3931,3938,3945,3952,3959,3966],{"type":445,"content":3925},[3926],{"type":15,"attrs":3927,"content":3928},{"textAlign":53},[3929],{"text":3930,"type":295},"Clinical groups with a high volume of patients.",{"type":445,"content":3932},[3933],{"type":15,"attrs":3934,"content":3935},{"textAlign":53},[3936],{"text":3937,"type":295},"Severity of harm including never events, serious reportable adverse events, serious safety events, and critical incidents.",{"type":445,"content":3939},[3940],{"type":15,"attrs":3941,"content":3942},{"textAlign":53},[3943],{"text":3944,"type":295},"Clinical groups that align with:",{"type":445,"content":3946},[3947],{"type":15,"attrs":3948,"content":3949},{"textAlign":53},[3950],{"text":3951,"type":295},"Quality improvement (QI) work already underway or planned in the organization.",{"type":445,"content":3953},[3954],{"type":15,"attrs":3955,"content":3956},{"textAlign":53},[3957],{"text":3958,"type":295},"Provincial/territorial or regional priorities or ministerial directives.",{"type":445,"content":3960},[3961],{"type":15,"attrs":3962,"content":3963},{"textAlign":53},[3964],{"text":3965,"type":295},"Priorities identified through the accreditation or risk assessment process.",{"type":445,"content":3967},[3968],{"type":15,"attrs":3969,"content":3970},{"textAlign":53},[3971],{"text":3972,"type":295},"Priorities from patient safety incident reporting and learning systems, patient safety or quality assurance reviews or patient complaints.","wysiwyg-column",{"_uid":3975,"image":3976,"title":3980,"content":3981,"component":3973},"47935d0f-c046-485b-bb65-cb1a6cfe2fa6",{"type":12,"content":3977},[3978],{"type":15,"attrs":3979},{"textAlign":53},"Step 2: Identify what you want to measure",[3982],{"_uid":3983,"content":3984,"component":700},"a4e310e0-17ee-4b3c-8b62-101f74739e6f",{"type":12,"content":3985},[3986,3991,3996],{"type":15,"attrs":3987,"content":3988},{"textAlign":53},[3989],{"text":3990,"type":295},"Identify specifically what you want to measure through a chart audit. The input of experts is key in this step. Clinical groups are comprised of codes of different but related types of harm. Determine which codes contribute the most harm to the clinical group, what questions you need to answer, and what information you need to collect. The Hospital Harm improvement resource (improvement resource) lists some suggested outcome and process measures for each clinical group.",{"type":15,"attrs":3992,"content":3993},{"textAlign":53},[3994],{"text":3995,"type":295},"For example, C21: patient trauma captures in-hospital injuries such as fractures, dislocations, burns and asphyxiation. If C21 has been identified as a \"high volume\" clinical group for your facility/organization you will want to determine which codes contribute to the majority of harm (for example fracture, burns, etc.). If fractures are the focus of your audit, you may want to measure the number of fractures due to falls. To understand what contributed to the fall you may need to know where the fall occurred (from bed, wet floor, etc.) and whether the patient had a fall risk assessment, and medication review on admission, etc.",{"type":392,"attrs":3997},{"level":394,"textAlign":53},{"_uid":3999,"image":4000,"title":4003,"content":4004,"component":3973},"a7137d98-b44e-4b1a-bbd5-8b0c67b2141f",{"type":12,"content":4001},[4002],{"type":15},"Step 3: Identify your patient population ",[4005],{"_uid":4006,"content":4007,"component":700},"0bb5b465-15ac-4cc7-9ba3-a0fd5329f183",{"type":12,"content":4008},[4009],{"type":15,"attrs":4010,"content":4011},{"textAlign":53},[4012],{"text":4013,"type":295},"Once your team has identified a clinical group to explore, with the help of the multidisciplinary team you will need to identify the patient population for study. For instance, you may decide to review all cases included in the clinical group or focus on a specific unit or patient population (for example medical, surgical, obstetrical, etc.) ",{"_uid":4015,"image":4016,"title":4019,"content":4020,"component":3973},"8aa97041-109e-40ab-8aac-c9647ed03fa8",{"type":12,"content":4017},[4018],{"type":15},"Step 4: Determine your sample size for the chart audit ",[4021],{"_uid":4022,"content":4023,"component":700},"0ba3dcb1-c300-4686-91eb-e3e87e62ae73",{"type":12,"content":4024},[4025],{"type":15,"attrs":4026,"content":4027},{"textAlign":53},[4028,4030],{"text":4029,"type":295},"Sample size is at the discretion of your facility/organization. For a chart audit you may arbitrarily choose a sample size; the minimum is usually 10 to 20 charts or 10 percent of the population. For steps on determining a statistically valid sample size see The ",{"text":4031,"type":295,"marks":4032},"How’s and Why’s of Chart Audits: http://patientsafetyed.duhs.duke.edu/module_b/steps/step4.html",[4033],{"type":407,"attrs":4034},{"href":4035,"uuid":53,"anchor":53,"custom":4036,"target":714,"linktype":715},"http://josieking.org/patient-safety-quality-improvement-modules/",{},{"_uid":4038,"image":4039,"title":4042,"content":4043,"component":3973},"c18800d1-917d-47cb-8098-478a2e15b09a",{"type":12,"content":4040},[4041],{"type":15},"Step 5: Create your audit tools",[4044],{"_uid":4045,"content":4046,"component":700},"e671b5f4-b152-4437-b12c-77c78177a8ab",{"type":12,"content":4047},[4048],{"type":15,"attrs":4049,"content":4050},{"textAlign":53},[4051,4053,4059],{"text":4052,"type":295},"Determine the demographic and care processes that you want to capture in your audit. Hospitals may use existing audit tools from external organizations or create their own audit tool. Here are examples of audit tools for ",{"text":4054,"type":295,"marks":4055},"medication reconciliation",[4056],{"type":407,"attrs":4057},{"href":4058,"uuid":53,"anchor":53,"custom":53,"target":714,"linktype":715},"https://era.library.ualberta.ca/items/3c229b9d-af36-4741-8353-25d190610b07",{"text":4060,"type":295}," and preventing falls and injury from falls.",{"_uid":4062,"image":4063,"title":4067,"content":4068,"component":3973},"56160176-06df-421e-8ccb-b707b5f05c2c",{"type":12,"content":4064},[4065],{"type":15,"attrs":4066},{"textAlign":53},"Step 6: Collect your data",[4069],{"_uid":4070,"content":4071,"component":700},"694a3acd-7c17-41ef-9175-8e692885483c",{"type":12,"content":4072},[4073],{"type":15,"attrs":4074,"content":4075},{"textAlign":53},[4076],{"text":4077,"type":295},"Members of the multidisciplinary QI team can conduct the chart audit of the sample cases, or it can be done by staff familiar with conducting audits (for example health information analysts, clinical educators, risk managers).",{"_uid":4079,"image":4080,"title":4083,"content":4084,"component":3973},"a1de5e5b-c658-46c3-8848-9707e148afec",{"type":12,"content":4081},[4082],{"type":15},"Step 7: Summarize your results",[4085],{"_uid":4086,"content":4087,"component":700},"a675f02c-74fd-440b-b554-f34e0b52815d",{"type":12,"content":4088},[4089],{"type":15,"attrs":4090,"content":4091},{"textAlign":53},[4092,4094],{"text":4093,"type":295},"Summarize the chart audit results and share them with members of your team for additional insights. The input of those who provide the care on a regular basis is also very valuable at this stage. Have them reflect on:",{"text":4095,"type":295,"marks":4096},"\"Does this match what you are experiencing in your day-to-day provision of care to our patients? Does it make sense to you or surprise you?\"",[4097],{"type":929},{"_uid":4099,"image":4100,"title":4103,"content":4104,"component":3973},"52bb4e11-97c3-4145-acbc-7a9a35b8524d",{"type":12,"content":4101},[4102],{"type":15},"Step 8: Use your results to inform and launch a QI initiative",[4105],{"_uid":4106,"content":4107,"component":700},"59f64cd9-06b8-4136-ba3a-de89570dd4d1",{"type":12,"content":4108},[4109,4122,4127,4132,4137,4163],{"type":15,"attrs":4110,"content":4111},{"textAlign":53},[4112,4114,4120],{"text":4113,"type":295},"Pull together a multidisciplinary QI team inclusive of content and process experts and those who provide the care on a regular basis. Analyze the results from the chart audits to identify specific improvement opportunities. Embark on a journey using QI methodology such as the ",{"text":4115,"type":295,"marks":4116},"model for improvement",[4117],{"type":407,"attrs":4118},{"href":4119,"uuid":53,"anchor":53,"custom":53,"target":714,"linktype":715},"https://era.library.ualberta.ca/items/9d16543f-3e74-41fe-aa13-344edb67618e",{"text":4121,"type":295}," or any quality framework used at your organization.",{"type":15,"attrs":4123,"content":4124},{"textAlign":53},[4125],{"text":4126,"type":295},"Use the experiences of others to identify how to make improvements. Find out what high performing organizations are doing, and look at other resources.",{"type":15,"attrs":4128,"content":4129},{"textAlign":53},[4130],{"text":4131,"type":295},"Remember to include ongoing measurement and evaluation to understand if changes have resulted in improvement (see process measures listed for each clinical group in the improvement resource). Identify any other sources of complementary information (for example patient safety incident reporting and learning system data, ongoing quality audits, quality of care reviews).",{"type":15,"attrs":4133,"content":4134},{"textAlign":53},[4135],{"text":4136,"type":295},"If your organization would like further information on how to conduct a chart audit for quality, some helpful references include:",{"type":442,"content":4138},[4139,4151],{"type":445,"content":4140},[4141],{"type":15,"attrs":4142,"content":4143},{"textAlign":53},[4144,4146],{"text":4145,"type":295},"The retrospective chart review: important methodological considerations ",{"text":4147,"type":295,"marks":4148},"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3853868/",[4149],{"type":407,"attrs":4150},{"href":4147,"uuid":53,"anchor":53,"custom":53,"target":714,"linktype":715},{"type":445,"content":4152},[4153],{"type":15,"attrs":4154,"content":4155},{"textAlign":53},[4156,4158],{"text":4157,"type":295},"The How's and Why's of Chart Audits ",{"text":4159,"type":295,"marks":4160},"http://patientsafetyed.duhs.duke.edu/module_b/chart_audit.html",[4161],{"type":407,"attrs":4162},{"href":4159,"uuid":53,"anchor":53,"custom":53,"target":714,"linktype":715},{"type":15,"attrs":4164,"content":4165},{"textAlign":53},[4166],{"text":4167,"type":295}," ","wysiwyg-double-column",{"type":12,"content":4170},[4171,4179,4226,4235,4244],{"type":15,"attrs":4172,"content":4173},{"textAlign":53},[4174,4178],{"text":937,"type":295,"marks":4175},[4176],{"type":298,"attrs":4177},{"color":16},{"text":4167,"type":295},{"type":939,"attrs":4180,"content":4181},{"order":941},[4182,4193,4204,4215],{"type":445,"content":4183},[4184],{"type":15,"attrs":4185,"content":4186},{"textAlign":53},[4187,4192],{"text":4188,"type":295,"marks":4189},"measure and monitor the types and frequency of these occurrences",[4190],{"type":298,"attrs":4191},{"color":16},{"text":4167,"type":295},{"type":445,"content":4194},[4195],{"type":15,"attrs":4196,"content":4197},{"textAlign":53},[4198,4203],{"text":4199,"type":295,"marks":4200},"use appropriate analytical methods to understand the contributing factors",[4201],{"type":298,"attrs":4202},{"color":16},{"text":4167,"type":295},{"type":445,"content":4205},[4206],{"type":15,"attrs":4207,"content":4208},{"textAlign":53},[4209,4214],{"text":4210,"type":295,"marks":4211},"identify and implement solutions or interventions designed to prevent recurrence and reduce the risk of harm",[4212],{"type":298,"attrs":4213},{"color":16},{"text":4167,"type":295},{"type":445,"content":4216},[4217],{"type":15,"attrs":4218,"content":4219},{"textAlign":53},[4220,4225],{"text":4221,"type":295,"marks":4222},"have mechanisms in place to mitigate consequences of harm when it occurs",[4223],{"type":298,"attrs":4224},{"color":16},{"text":4167,"type":295},{"type":15,"attrs":4227,"content":4228},{"textAlign":934},[4229,4234],{"text":4230,"type":295,"marks":4231},"To develop a more in-depth understanding of the care delivered to patients, chart audits, incident analyses or prospective analyses can all be helpful in identifying quality improvement opportunities. Links to key resources for analysis methods are included in the section \"Resources for Conducting Incident and/or Prospective Analyses.\"",[4232],{"type":298,"attrs":4233},{"color":16},{"text":4167,"type":295},{"type":392,"attrs":4236,"content":4237},{"level":437,"textAlign":934},[4238,4243],{"text":4239,"type":295,"marks":4240},"Conducting a chart audit to drive quality improvement",[4241],{"type":298,"attrs":4242},{"color":16},{"text":4167,"type":295},{"type":15,"attrs":4245,"content":4246},{"textAlign":934},[4247,4252],{"text":4248,"type":295,"marks":4249},"Chart audits are recommended as a good method to develop a more in-depth understanding of the care delivered to patients identified by the Hospital Harm measure. Chart audits can also help identify quality improvement opportunities.",[4250],{"type":298,"attrs":4251},{"color":16},{"text":4167,"type":295},{"id":16,"_uid":4254,"items":4255,"title":4382,"component":760,"description":4383},"3643e093-fff3-4f34-959d-b2f6d64e5d88",[4256],{"_uid":4257,"title":773,"ctaLeft":4258,"ctaRight":4259,"component":718,"columnLeft":4260,"columnRight":4263},"431d8542-e216-4e28-9d4e-7fa1991a393e",[],[],{"type":12,"content":4261},[4262],{"type":15},{"type":12,"content":4264},[4265,4270,4286,4291,4321,4335,4340,4344,4353,4358,4363,4372,4377],{"type":392,"attrs":4266,"content":4267},{"level":1531,"textAlign":53},[4268],{"text":4269,"type":295},"Resources for conducting incident and prospective analyses",{"type":15,"attrs":4271,"content":4272},{"textAlign":53},[4273],{"text":4274,"type":295,"marks":4275},"Canadian Incident Analysis Framework",[4276],{"type":407,"attrs":4277},{"href":4278,"uuid":4279,"anchor":53,"custom":4280,"target":412,"linktype":413,"story":4281},"/resources/patient-safety-incident-analysis","8094c23a-c722-4bc4-8de1-f5474d690e2d","[object Object]",{"name":4282,"id":4283,"uuid":4279,"slug":4284,"url":4285,"full_slug":4285,"_stopResolving":301},"Patient Safety Incident Analysis",113880425582084,"patient-safety-incident-analysis","resources/patient-safety-incident-analysis",{"type":15,"attrs":4287,"content":4288},{"textAlign":53},[4289],{"text":4290,"type":295},"The Canadian Incident Analysis Framework is a resource to support those responsible for, or involved in, managing, analyzing, and learning from patient safety incidents in any healthcare setting. It provides analysis methods (comprehensive, concise, and multi-incident) and tools to assist in answering the following questions.",{"type":442,"content":4292},[4293,4300,4307,4314],{"type":445,"content":4294},[4295],{"type":15,"attrs":4296,"content":4297},{"textAlign":53},[4298],{"text":4299,"type":295},"What happened?",{"type":445,"content":4301},[4302],{"type":15,"attrs":4303,"content":4304},{"textAlign":53},[4305],{"text":4306,"type":295},"How and why did it happen?",{"type":445,"content":4308},[4309],{"type":15,"attrs":4310,"content":4311},{"textAlign":53},[4312],{"text":4313,"type":295},"What can be done to reduce the likelihood of recurrence and make care safer?",{"type":445,"content":4315},[4316],{"type":15,"attrs":4317,"content":4318},{"textAlign":53},[4319],{"text":4320,"type":295},"What was learned?",{"type":15,"attrs":4322,"content":4323},{"textAlign":53},[4324],{"text":4325,"type":295,"marks":4326},"Patient Safety and Incident Management Toolkit",[4327],{"type":407,"attrs":4328},{"href":4329,"uuid":4330,"anchor":53,"custom":4280,"target":412,"linktype":413,"story":4331},"/resources/patient-safety-and-incident-management-toolkit","a435d8be-066f-4225-b67f-87e078ea10e8",{"name":4325,"id":4332,"uuid":4330,"slug":4333,"url":4334,"full_slug":4334,"_stopResolving":301},113880277560800,"patient-safety-and-incident-management-toolkit","resources/patient-safety-and-incident-management-toolkit",{"type":15,"attrs":4336,"content":4337},{"textAlign":53},[4338],{"text":4339,"type":295},"This web resource is based on the Canadian Incident Analysis Framework but extends the focus beyond incident analysis to look at the broader spectrum of patient safety and incident management. Resources, tools and references from Canada and international sources are available at the fingertips of users through links and downloadable documents.",{"type":392,"attrs":4341,"content":4342},{"level":1531,"textAlign":53},[4343],{"text":3165,"type":295},{"type":15,"attrs":4345,"content":4346},{"textAlign":53},[4347],{"text":4348,"type":295,"marks":4349},"Global Trigger Tool",[4350],{"type":407,"attrs":4351},{"href":4352,"uuid":53,"anchor":53,"custom":53,"target":714,"linktype":715},"http://www.ihi.org/knowledge/Pages/Tools/IHIGlobalTriggerToolforMeasuringAEs.aspx",{"type":15,"attrs":4354,"content":4355},{"textAlign":53},[4356],{"text":4357,"type":295},"The IHI Global Trigger Tool for Measuring Adverse Events (AEs) provides instructions for training reviewers in this methodology and conducting a retrospective review of patient records using triggers to identify possible AEs. This tool includes a list of known AE triggers as well as instructions for selecting records, training information, and appendices with references and common questions.",{"type":392,"attrs":4359,"content":4360},{"level":1531,"textAlign":53},[4361],{"text":4362,"type":295},"Institute for Safe Medication Practices Canada (ISMP Canada)",{"type":15,"attrs":4364,"content":4365},{"textAlign":53},[4366],{"text":4367,"type":295,"marks":4368},"Canadian Failure Mode and Effects Analysis Framework©",[4369],{"type":407,"attrs":4370},{"href":4371,"uuid":53,"anchor":53,"custom":53,"target":714,"linktype":715},"https://www.ismp-canada.org/fmea.htm",{"type":15,"attrs":4373,"content":4374},{"textAlign":53},[4375],{"text":4376,"type":295},"Failure modes and effects analysis (FMEA) is a proactive safety technique that helps to identify process and product problems before they occur. It is one of several types of prospective risk assessment that can be used in healthcare settings. It is also widely used as an integral aspect of improving quality and safety in other industries (e.g., automotive, aviation, and nuclear power).",{"type":15,"attrs":4378,"content":4379},{"textAlign":53},[4380],{"text":4381,"type":295},"ISMP Canada has developed the Canadian Failure Mode and Effects Analysis Framework — Proactively Assessing Risk in Healthcare©, with assistance from healthcare and human factors engineering consultants. It can be applied to all healthcare processes, such as medication use, patient identification, specimen labelling, emergency room triage, identification of risk of patient falls.","Learning from Harm",{"type":12,"content":4384},[4385],{"type":15,"attrs":4386,"content":4387},{"textAlign":53},[4388],{"text":4389,"type":295},"Healthcare Excellence Canada offers numerous resources to support reporting, responding, and learning from patient harm. ",{"id":4391,"_uid":4392,"items":4393,"title":4784,"component":760,"description":4785},"general","e053fac0-9648-4fa5-bedf-bce73e63e152",[4394],{"_uid":4395,"title":773,"ctaLeft":4396,"ctaRight":4397,"component":718,"columnLeft":4398,"columnRight":4401},"e1311fdc-b639-4bde-8865-cd2889f014c8",[],[],{"type":12,"content":4399},[4400],{"type":15},{"type":12,"content":4402},[4403,4408,4413,4428,4433,4449,4454,4469,4474,4489,4494,4509,4517,4527,4532,4541,4554,4570,4575,4585,4590,4605,4610,4626,4631,4636,4641,4651,4668,4680,4692,4702,4712,4722,4732,4742,4752,4764,4774],{"type":15,"attrs":4404,"content":4405},{"textAlign":53},[4406],{"text":4407,"type":295},"Below is a list of patient safety, quality improvement and measurement resources that can be used by quality improvement teams, as well as resources for leaders.",{"type":15,"attrs":4409,"content":4410},{"textAlign":53},[4411],{"text":4412,"type":295},"Here is a sample of the resources available from Healthcare Excellence Canada to support your healthcare improvement efforts:",{"type":15,"attrs":4414,"content":4415},{"textAlign":53},[4416],{"text":4417,"type":295,"marks":4418},"A Guide to Patient Safety Improvement",[4419],{"type":407,"attrs":4420},{"href":4421,"uuid":4422,"anchor":53,"custom":4423,"target":412,"linktype":413,"story":4424},"/resources/a-guide-to-patient-safety-improvement","262cf0d7-5be4-494d-a2ac-ecf6d3ac4f02",{},{"name":4417,"id":4425,"uuid":4422,"slug":4426,"url":4427,"full_slug":4427,"_stopResolving":301},113880383167991,"a-guide-to-patient-safety-improvement","resources/a-guide-to-patient-safety-improvement",{"type":15,"attrs":4429,"content":4430},{"textAlign":53},[4431],{"text":4432,"type":295},"This resource has been designed to support teams across all healthcare sectors in using a knowledge translation and quality improvement integrated approach to change that will impact patient safety outcomes. This Guide for Patient Safety Improvement is intended to accompany current best available evidence change ideas, and tools and resources for your specific project. It includes ideal practice changes (\"the what\") and strategies (\"the how\") that create the evidence-informed intervention. Adaptations are expected and important considerations for implementation will be provided in this guide.",{"type":15,"attrs":4434,"content":4435},{"textAlign":53},[4436],{"text":4437,"type":295,"marks":4438},"Change Package Template",[4439],{"type":407,"attrs":4440},{"href":4441,"uuid":4442,"anchor":53,"custom":4443,"target":412,"linktype":413,"story":4444},"/resources/improvement-charter","4c8f8b2f-345c-4049-8f2f-f12791819936",{},{"name":4445,"id":4446,"uuid":4442,"slug":4447,"url":4448,"full_slug":4448,"_stopResolving":301},"Improvement Charter",113880348311022,"improvement-charter","resources/improvement-charter",{"type":15,"attrs":4450,"content":4451},{"textAlign":53},[4452],{"text":4453,"type":295},"A change package is a toolkit of information that can inform the planning, implementation and evaluation of a healthcare improvement initiative that aims to create lasting benefits to patient, family, or caregiver experience, health and work life of providers.",{"type":15,"attrs":4455,"content":4456},{"textAlign":53},[4457],{"text":4458,"type":295,"marks":4459},"Enhanced Recovery Canada",[4460],{"type":407,"attrs":4461},{"href":4462,"uuid":4463,"anchor":53,"custom":4464,"target":412,"linktype":413,"story":4465},"/resources/enhanced-recovery-canada","54b58755-28d1-4361-834e-ae9bc6b14736",{},{"name":4458,"id":4466,"uuid":4463,"slug":4467,"url":4468,"full_slug":4468,"_stopResolving":301},113880478223892,"enhanced-recovery-canada","resources/enhanced-recovery-canada",{"type":15,"attrs":4470,"content":4471},{"textAlign":53},[4472],{"text":4473,"type":295},"Enhanced Recovery Canada is leading the drive to improve surgical safety across the country and is based on Enhanced Recovery After Surgery (ERAS) surgical best practices. These evidence-informed principles support better outcomes for surgical patients including: an improved patient experience, reduced length of stay, decreased complication rates, and fewer hospital readmissions.",{"type":15,"attrs":4475,"content":4476},{"textAlign":53},[4477],{"text":4478,"type":295,"marks":4479},"Engaging Patients in Patient Safety – a Canadian Guide",[4480],{"type":407,"attrs":4481},{"href":4482,"uuid":4483,"anchor":53,"custom":4484,"target":412,"linktype":413,"story":4485},"/resources/engaging-patients-in-patient-safety-a-canadian-guide","6b1655df-9d02-45e3-9d11-66f07ce31af4",{},{"name":4478,"id":4486,"uuid":4483,"slug":4487,"url":4488,"full_slug":4488,"_stopResolving":301},113881420570413,"engaging-patients-in-patient-safety-a-canadian-guide","resources/engaging-patients-in-patient-safety-a-canadian-guide",{"type":15,"attrs":4490,"content":4491},{"textAlign":53},[4492],{"text":4493,"type":295},"Patient safety is the most important aspect of care according to patients and families. Patients, providers, and leaders agree that when patients participate as partners in their own care and in patient safety improvements at an organizational or system level, harm can be prevented, and incidents can be better managed. This guide is an extensive resource, based on evidence and leading practices, that aims to help patients and families, providers, and leaders partner more effectively to improve patient safety. The guide is regularly revised to include the most current evidence, resources, and guidance to shape policies, practices and meet required standards.",{"type":15,"attrs":4495,"content":4496},{"textAlign":53},[4497],{"text":4498,"type":295,"marks":4499},"Essential Together",[4500],{"type":407,"attrs":4501},{"href":4502,"uuid":4503,"anchor":53,"custom":4504,"target":412,"linktype":413,"story":4505},"/programs/essential-together","5121c67b-655c-4fe2-b0d7-d8d6193f6aaf",{},{"name":4498,"id":4506,"uuid":4503,"slug":4507,"url":4508,"full_slug":4508,"_stopResolving":301},123451112281264,"essential-together","programs/essential-together",{"type":15,"attrs":4510,"content":4511},{"textAlign":53},[4512,4514],{"text":4513,"type":295},"Through Essential Together, we're working with health and care organizations to support them in re-integrating, welcoming, and engaging essential care partners as part of care teams, during COVID-19 and beyond",{"text":699,"type":295,"marks":4515},[4516],{"type":1035},{"type":15,"attrs":4518,"content":4519},{"textAlign":53},[4520],{"text":4521,"type":295,"marks":4522},"Healthcare Improvement Planner",[4523],{"type":407,"attrs":4524},{"href":4441,"uuid":4442,"anchor":53,"custom":4525,"target":412,"linktype":413,"story":4526},{},{"name":4445,"id":4446,"uuid":4442,"slug":4447,"url":4448,"full_slug":4448,"_stopResolving":301},{"type":15,"attrs":4528,"content":4529},{"textAlign":53},[4530],{"text":4531,"type":295},"This Healthcare Improvement Planner helps with documenting plans and actions to implement a healthcare improvement initiative that aims to create lasting improvement in patient, family, or caregiver experience, health, and work life of providers.",{"type":15,"attrs":4533,"content":4534},{"textAlign":53},[4535],{"text":4536,"type":295,"marks":4537},"Improvement Frameworks Getting Started Kit",[4538],{"type":407,"attrs":4539},{"href":4540,"uuid":53,"anchor":53,"custom":53,"target":714,"linktype":715},"https://era.library.ualberta.ca/items/8668c9ce-f0a7-413b-b1e6-048e3db55dc7",{"type":15,"attrs":4542,"content":4543},{"textAlign":53},[4544,4546,4552],{"text":4545,"type":295},"Improvement comes from the application of knowledge. It also comes from action: from developing, testing, and implementing changes which alter how work or activity is done or the makeup of a product or service. The ",{"text":4547,"type":295,"marks":4548},"Improvement Frameworks Getting Started Kit ",[4549],{"type":407,"attrs":4550},{"href":4540,"uuid":53,"anchor":53,"custom":4551,"target":714,"linktype":715},{},{"text":4553,"type":295},"provides an introduction to various improvement science methodologies and provides the foundational knowledge necessary for applying the Model for Improvement to an improvement project.",{"type":15,"attrs":4555,"content":4556},{"textAlign":53},[4557],{"text":4558,"type":295,"marks":4559},"Long Term Success and Sustainability of Healthcare Improvement Guide",[4560],{"type":407,"attrs":4561},{"href":4562,"uuid":4563,"anchor":53,"custom":4564,"target":412,"linktype":413,"story":4565},"/resources/long-term-success-tool","40e42d9a-ca76-4d39-af5d-a2ba05cf2d7a",{},{"name":4566,"id":4567,"uuid":4563,"slug":4568,"url":4569,"full_slug":4569,"_stopResolving":301},"Long Term Success Tool",113880409030143,"long-term-success-tool","resources/long-term-success-tool",{"type":15,"attrs":4571,"content":4572},{"textAlign":53},[4573],{"text":4574,"type":295},"The Long Term Success and Sustainability of Healthcare Improvement Guide provides tips and resources to support a healthcare improvement initiative through its implementation, evaluation, sustainability, and spread.",{"type":15,"attrs":4576,"content":4577},{"textAlign":53},[4578],{"text":4579,"type":295,"marks":4580},"The Measurement and Monitoring of Safety Framework",[4581],{"type":407,"attrs":4582},{"href":4583,"uuid":53,"anchor":53,"custom":4584,"target":714,"linktype":715},"https://www.health.org.uk/reports-and-analysis/reports/the-measurement-and-monitoring-of-safety",{},{"type":15,"attrs":4586,"content":4587},{"textAlign":53},[4588],{"text":4589,"type":295},"The Measurement and Monitoring Safety Framework, created by Professor Charles Vincent and colleagues from the Health Foundation, consists of five dimensions that organizations, units, or individuals including leaders, providers, patients, and families can use to understand, guide, and improve patient safety. This new approach assesses and evaluates safety from \"ward to board\" by providing a comprehensive and accurate real-time view of patient safety. The Framework helps users move from \"assurance\" to \"inquiry\" by shifting away from a focus on past cases of harm towards current performance, future risks, and organizational resiliency.",{"type":15,"attrs":4591,"content":4592},{"textAlign":53},[4593],{"text":4594,"type":295,"marks":4595},"Spotlight Series",[4596],{"type":407,"attrs":4597},{"href":4598,"uuid":4599,"anchor":53,"custom":4600,"target":412,"linktype":413,"story":4601},"/resources/spotlight-series","315e6a38-175b-4cba-8f4f-4cc171165b36",{},{"name":4594,"id":4602,"uuid":4599,"slug":4603,"url":4604,"full_slug":4604,"_stopResolving":301},131520014968245,"spotlight-series","resources/spotlight-series",{"type":15,"attrs":4606,"content":4607},{"textAlign":53},[4608],{"text":4609,"type":295},"Our most pressing challenges in healthcare require focused, constructive discussions. Sharing openly and listening to diverse perspectives and experiences. At Healthcare Excellence Canada, we've developed the Spotlight Series to do just that. It's about connecting people to have conversations with a purpose. Responding quickly to current issues by featuring strategies for improvement that are transferable. 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or patient with dementia, where protocols were not followed to ensure the patient was left in a safe environment (Canadian Patient Safety Institute 2015)",{"type":12,"content":4872},[4873],{"type":15},{"type":12,"content":4875},[4876],{"type":15},[76,8],[4879,4891,5202,5538,5575,5633,5905,5936,6344],{"_uid":4880,"link":4881,"image":4882,"title":374,"video_id":16,"component":375,"media_type":376,"description":4884,"video_title":16},"a1dc6419-a139-4580-84d6-4e257794c91a",[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":284,"meta_data":4883},{},{"type":12,"content":4885},[4886],{"type":15,"attrs":4887,"content":4888},{"textAlign":53},[4889],{"text":4890,"type":295},"To prevent in-hospital patient injury such as fractures, dislocations, burns, asphyxia etc. from occurring in patients.",{"_uid":4892,"content":4893,"component":701},"9b6ec9c3-714c-4400-8e82-f11d32ce7dd1",[4894],{"_uid":4895,"content":4896,"component":700},"4cc04458-ea0b-4911-ab76-4fd37213fb3e",{"type":12,"content":4897},[4898,4903,4914,4933,4953,4958,4963,4968,4991,4996,5001,5006,5011,5016,5021,5026,5049,5054,5059,5124,5129,5134,5178,5182,5187,5192,5197],{"type":392,"attrs":4899,"content":4900},{"level":394,"textAlign":53},[4901],{"text":4902,"type":295},"Overview",{"type":15,"attrs":4904,"content":4905},{"textAlign":53},[4906,4907,4913],{"text":402,"type":295},{"text":404,"type":295,"marks":4908},[4909],{"type":407,"attrs":4910},{"href":409,"uuid":410,"anchor":53,"custom":4911,"target":412,"linktype":413,"story":4912},{},{"name":404,"id":415,"uuid":410,"slug":416,"url":417,"full_slug":417,"_stopResolving":301},{"text":419,"type":295},{"type":15,"attrs":4915,"content":4916},{"textAlign":53},[4917,4919,4931],{"text":4918,"type":295},"According to the report ",{"text":4920,"type":295,"marks":4921},"Never Events for Hospital Care in Canada",[4922],{"type":407,"attrs":4923},{"href":4924,"uuid":4925,"anchor":53,"custom":4926,"target":412,"linktype":413,"story":4927},"/resources/never-events-for-hospital-care-in-canada","353ed3d3-5c43-4326-b261-bb8a60d5b02e",{},{"name":4920,"id":4928,"uuid":4925,"slug":4929,"url":4930,"full_slug":4930,"_stopResolving":301},113881462050616,"never-events-for-hospital-care-in-canada","resources/never-events-for-hospital-care-in-canada",{"text":4932,"type":295},", three of the fifteen never events are associated with patient trauma during hospitalization:",{"type":442,"content":4934},[4935,4941,4947],{"type":445,"content":4936},[4937],{"type":15,"attrs":4938,"content":4939},{"textAlign":53},[4940],{"text":4856,"type":295},{"type":445,"content":4942},[4943],{"type":15,"attrs":4944,"content":4945},{"textAlign":53},[4946],{"text":4863,"type":295},{"type":445,"content":4948},[4949],{"type":15,"attrs":4950,"content":4951},{"textAlign":53},[4952],{"text":4870,"type":295},{"type":15,"attrs":4954,"content":4955},{"textAlign":53},[4956],{"text":4957,"type":295},"Additionally, evidence from the Canadian Adverse Event Study, indicates that adverse events classified as 'Other', including burns and falls was the sixth leading cause of an adverse event in Canada (Baker, Norton, et al, 2004).",{"type":392,"attrs":4959,"content":4960},{"level":437,"textAlign":53},[4961],{"text":4962,"type":295},"Falls",{"type":15,"attrs":4964,"content":4965},{"textAlign":53},[4966],{"text":4967,"type":295},"A fall is defined as a sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor, the ground or other surface (e.g. mat). Injuries sustained by visitor slips, trips, and falls can result in significant harm and costs. Falls can be classified as:",{"type":442,"content":4969},[4970,4977,4984],{"type":445,"content":4971},[4972],{"type":15,"attrs":4973,"content":4974},{"textAlign":53},[4975],{"text":4976,"type":295},"Anticipatory (patients exhibit clinical signs that contribute to increased falls risk),",{"type":445,"content":4978},[4979],{"type":15,"attrs":4980,"content":4981},{"textAlign":53},[4982],{"text":4983,"type":295},"Unanticipated (physiological falls that cannot be predicted before first occurrence) and",{"type":445,"content":4985},[4986],{"type":15,"attrs":4987,"content":4988},{"textAlign":53},[4989],{"text":4990,"type":295},"Accidental (result of mishaps) ",{"type":15,"attrs":4992,"content":4993},{"textAlign":53},[4994],{"text":4995,"type":295},"Anticipated falls can be prevented through screening for falls risk factors, communication and in-depth assessment and implementation of targeted prevention strategies (HIROC 2016). ",{"type":15,"attrs":4997,"content":4998},{"textAlign":53},[4999],{"text":5000,"type":295},"A range of risk factors (>400) have been identified as influencing whether individuals are likely to fall. The BBSE MODEL of fall-related risk factors identifies biological (intrinsic), behavioural, social and economic and environmental (extrinsic) risk factors. The more risk factors an individual has, the greater the risk of falling (Safer Healthcare Now! 2013; RNAO 2017).",{"type":15,"attrs":5002,"content":5003},{"textAlign":53},[5004],{"text":5005,"type":295},"Falls may cause considerable physical harm, including fractures, soft tissue injuries, haematomas, lacerations and pressure sores due to subsequent immobility; as well as psychological distress such as fear of falling and humiliation and potentially resulting in chronic pain, loss of independence, reduced quality of life, and even death (Johal 2009; Public Health Agency of Canada 2014; Accreditation Canada, CIHI, CPSI 2014). ",{"type":15,"attrs":5007,"content":5008},{"textAlign":53},[5009],{"text":5010,"type":295},"Studies in acute care settings show that fall rates range from 1.3 to 8.9 falls per 1,000 patient days, with higher rates in units that focus on geriatric care, neurology, and rehabilitation (Oliver 2010). Research shows that close to one-third of falls can be prevented (Ganz, et al. 2013/2018).",{"type":392,"attrs":5012,"content":5013},{"level":437,"textAlign":53},[5014],{"text":5015,"type":295},"Burns/Scald",{"type":15,"attrs":5017,"content":5018},{"textAlign":53},[5019],{"text":5020,"type":295},"Burns to skin (or other organs) is a function of both temperature and duration. Even moderate heat applied for a long duration is capable of producing burns. There are three key conditions that predispose patients to burns including insensitivity to pain/temperature, unresponsiveness, or inability to communicate. In addition, impaired ability for the vasculature to help dissipate heat from the skin may predispose a patient to a burn (Patient Safety Solutions 2010).",{"type":15,"attrs":5022,"content":5023},{"textAlign":53},[5024],{"text":5025,"type":295},"Hospital emergency rooms and operating rooms contain the three primary elements needed to ignite a fire:",{"type":442,"content":5027},[5028,5035,5042],{"type":445,"content":5029},[5030],{"type":15,"attrs":5031,"content":5032},{"textAlign":53},[5033],{"text":5034,"type":295},"An oxidizer (anesthesia products such as oxygen and nitrous oxide).",{"type":445,"content":5036},[5037],{"type":15,"attrs":5038,"content":5039},{"textAlign":53},[5040],{"text":5041,"type":295},"Fuel (surgical drapes, alcohol swabs, etc.).",{"type":445,"content":5043},[5044],{"type":15,"attrs":5045,"content":5046},{"textAlign":53},[5047],{"text":5048,"type":295},"An ignition source (lasers, electrosurgical devices such as a cautery knife, etc.)",{"type":15,"attrs":5050,"content":5051},{"textAlign":53},[5052],{"text":5053,"type":295},"Fires that ignite in or around a patient during surgery are a real danger and are especially devastating if open oxygen sources are present during surgery of the head, face, neck, and upper chest (ECRI 2016).",{"type":15,"attrs":5055,"content":5056},{"textAlign":53},[5057],{"text":5058,"type":295},"A search of patient safety reporting/alert systems revealed that the potential causes of accidental burns include:",{"type":442,"content":5060},[5061,5068,5075,5082,5089,5096,5103,5110,5117],{"type":445,"content":5062},[5063],{"type":15,"attrs":5064,"content":5065},{"textAlign":53},[5066],{"text":5067,"type":295},"A hot towel prepared in a plastic bag coming in contact with patient's body during bed-bath (Japan Council for Quality Health Care 2010).",{"type":445,"content":5069},[5070],{"type":15,"attrs":5071,"content":5072},{"textAlign":53},[5073],{"text":5074,"type":295},"Use of a hot water bottle (Japan Council for Quality Health Care 2010).",{"type":445,"content":5076},[5077],{"type":15,"attrs":5078,"content":5079},{"textAlign":53},[5080],{"text":5081,"type":295},"Fire and the use of Alcohol-based hand cleansers (New South Wales Department of Health 2007).",{"type":445,"content":5083},[5084],{"type":15,"attrs":5085,"content":5086},{"textAlign":53},[5087],{"text":5088,"type":295},"Water temperature too hot during bathing (Japan Council for Quality Health Care 2007).",{"type":445,"content":5090},[5091],{"type":15,"attrs":5092,"content":5093},{"textAlign":53},[5094],{"text":5095,"type":295},"Vaseline and treatment with oxygen (European Union Network for Patient Safety 2011).",{"type":445,"content":5097},[5098],{"type":15,"attrs":5099,"content":5100},{"textAlign":53},[5101],{"text":5102,"type":295},"Heat therapy such as heating pads or hot packs (Data snapshot 2009).",{"type":445,"content":5104},[5105],{"type":15,"attrs":5106,"content":5107},{"textAlign":53},[5108],{"text":5109,"type":295},"Food preparation and hot liquid spills (Data snapshot 2009).",{"type":445,"content":5111},[5112],{"type":15,"attrs":5113,"content":5114},{"textAlign":53},[5115],{"text":5116,"type":295},"Burns Caused by the Tip of a Light Source Cable during Surgery (Japan Council for Quality Health Care 2012).",{"type":445,"content":5118},[5119],{"type":15,"attrs":5120,"content":5121},{"textAlign":53},[5122],{"text":5123,"type":295},"Risk of skin-prep related fire in operating theatres (National Health Service Commissioning Board 2012).",{"type":392,"attrs":5125,"content":5126},{"level":437,"textAlign":53},[5127],{"text":5128,"type":295},"Asphyxiation",{"type":15,"attrs":5130,"content":5131},{"textAlign":53},[5132],{"text":5133,"type":295},"Asphyxia is severe hypoxia leading to hypoxemia and hypercapnia, loss of consciousness, and, if not corrected, death. There are many circumstances that can induce asphyxia; some of the more common causes are drowning, electrical shock, aspiration of vomitus, lodging of a foreign body in the respiratory tract, inhalation of toxic gas or smoke, and poisoning (Mosby's Medical Dictionary 2009). A search of patient safety reporting/alert systems revealed that the potential causes of iatrogenic asphyxia include:",{"type":442,"content":5135},[5136,5143,5150,5157,5164,5171],{"type":445,"content":5137},[5138],{"type":15,"attrs":5139,"content":5140},{"textAlign":53},[5141],{"text":5142,"type":295},"Restraints; (Registered Nurses' Association of Ontario 2017).",{"type":445,"content":5144},[5145],{"type":15,"attrs":5146,"content":5147},{"textAlign":53},[5148],{"text":5149,"type":295},"Positional asphyxia. 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Care bundles to reduce inpatient falls. London, UK;; 2015. ",{"text":6304,"type":295,"marks":6305},"https://www.rcplondon.ac.uk/file/917/download?token=pOnsnWKo",[6306],{"type":407,"attrs":6307},{"href":6304,"uuid":53,"anchor":53,"custom":6308,"target":714,"linktype":715},{},{"type":15,"attrs":6310},{"textAlign":53},{"type":445,"content":6312},[6313,6324],{"type":15,"attrs":6314,"content":6315},{"textAlign":53},[6316,6318],{"text":6317,"type":295},"Segen's Medical Dictionary. © 2012 Farlex, Inc. All rights reserved. ",{"text":6319,"type":295,"marks":6320},"https://medical-dictionary.thefreedictionary.com/Positional+Asphyxia",[6321],{"type":407,"attrs":6322},{"href":6319,"uuid":53,"anchor":53,"custom":6323,"target":714,"linktype":715},{},{"type":15,"attrs":6325},{"textAlign":53},{"type":445,"content":6327},[6328,6339],{"type":15,"attrs":6329,"content":6330},{"textAlign":53},[6331,6333],{"text":6332,"type":295},"U.S. Food and Drug Administration. Safety Concerns about Bed Rails. 2018. ",{"text":6334,"type":295,"marks":6335},"https://www.fda.gov/medical-devices/bed-rail-safety/safety-concerns-about-bed-rails",[6336],{"type":407,"attrs":6337},{"href":6334,"uuid":53,"anchor":53,"custom":6338,"target":714,"linktype":715},{},{"type":15,"attrs":6340},{"textAlign":53},{"type":12,"content":6342},[6343],{"type":15},{"id":16,"_uid":6345,"items":6346,"component":1413},"87981281-d1b1-40e7-b3d1-b9344fd9f056",[6347],{"_uid":6348,"link":6349,"image":6354,"title":1405,"component":1406,"description":6356},"d4243309-57ff-4650-8981-87a82e8dc0af",[6350],{"_uid":6351,"link":6352,"label":1399,"component":1400},"73da3ae0-0578-40d6-81e8-3dfcb4b05e22",{"id":275,"url":16,"linktype":413,"fieldtype":716,"cached_url":303,"story":6353},{"name":270,"id":274,"uuid":275,"slug":9,"url":303,"full_slug":303,"_stopResolving":301},{"id":1402,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1403,"copyright":16,"fieldtype":284,"meta_data":6355,"is_external_url":286},{},{"type":12,"content":6357},[6358],{"type":15,"attrs":6359,"content":6360},{"textAlign":53},[6361],{"text":294,"type":295},[115,143,122,129,136,150,157],[185,192,200],"patient-trauma","resources/patient-trauma",-18910,[],"ea7ab623-e816-44bc-88c4-ea7056be2fae","2025-12-11T14:18:32.045Z",[],[6372],{"path":6373,"name":6374,"lang":315,"published":301},"ressources/traumatismes-subis-par-les-patients","Traumatismes subis par les patients",{"name":6376,"created_at":6377,"published_at":6378,"updated_at":6379,"id":6380,"uuid":6381,"content":6382,"slug":7451,"full_slug":7452,"sort_by_date":53,"position":6366,"tag_list":7453,"is_startpage":286,"parent_id":1421,"meta_data":53,"group_id":7454,"first_published_at":7455,"release_id":53,"lang":309,"path":53,"alternates":7456,"default_full_slug":7452,"translated_slugs":7457},"Laceration","2025-12-09T20:29:14.075Z","2026-03-10T16:20:47.105Z","2026-03-10T16:20:47.188Z",121333981619000,"0e58830e-fe82-4d52-9445-81e1606d6704",{"new":286,"seo":6383,"_uid":4831,"hero":6385,"type":174,"topics":6409,"Noindex":286,"content":6410,"audience":7449,"duration":16,"regional":7450,"component":1416},{"_uid":6384,"title":6376,"plugin":339,"og_image":16,"og_title":16,"description":340,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},"32b99bc7-c19e-4d4e-a832-b6a207f8d4ed",[6386],{"_uid":4834,"image":6387,"title":6389,"format":6390,"component":353,"description":6393,"key_learning":6403,"prerequisite":6406},{"id":346,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":347,"copyright":16,"fieldtype":284,"meta_data":6388,"is_external_url":286},{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: Laceration",{"type":12,"content":6391},[6392],{"type":15},{"type":12,"content":6394},[6395],{"type":15,"attrs":6396,"content":6397},{"textAlign":53},[6398],{"text":6399,"type":295,"marks":6400},"Surgery and other invasive procedures carry risk of complication and mortality (Magee et al., 2018). Unintentional or accidental cuts, punctures or perforations can occur in both surgical and medical procedures.",[6401],{"type":298,"attrs":6402},{"color":5499},{"type":12,"content":6404},[6405],{"type":15},{"type":12,"content":6407},[6408],{"type":15},[76,8],[6411,6422,6702,7157,7189,7249,7268,7431],{"_uid":4880,"link":6412,"image":6413,"title":374,"video_id":16,"component":375,"media_type":376,"description":6415,"video_title":16},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":284,"meta_data":6414},{},{"type":12,"content":6416},[6417],{"type":15,"attrs":6418,"content":6419},{"textAlign":53},[6420],{"text":6421,"type":295},"Reduce the incidence of inadvertent laceration/puncture.",{"_uid":4892,"content":6423,"component":701},[6424],{"_uid":4895,"content":6425,"component":700},{"type":12,"content":6426},[6427,6431,6442,6447,6452,6503,6508,6513,6518,6523,6528,6533,6538,6543,6567,6578,6583,6614,6619,6624,6629,6634,6639,6644,6649,6654,6659,6663,6668,6672,6682,6687,6692,6697],{"type":392,"attrs":6428,"content":6429},{"level":394,"textAlign":53},[6430],{"text":4902,"type":295},{"type":15,"attrs":6432,"content":6433},{"textAlign":53},[6434,6435,6441],{"text":402,"type":295},{"text":404,"type":295,"marks":6436},[6437],{"type":407,"attrs":6438},{"href":409,"uuid":410,"anchor":53,"custom":6439,"target":412,"linktype":413,"story":6440},{},{"name":404,"id":415,"uuid":410,"slug":416,"url":417,"full_slug":417,"_stopResolving":301},{"text":419,"type":295},{"type":15,"attrs":6443,"content":6444},{"textAlign":53},[6445],{"text":6446,"type":295},"A 10-year review of medico-legal cases in Canada between 2004 and 2013 found that incidents of laceration, puncture, hemorrhage and burns accounted for 66 per cent of surgical incidents reported to the Canadian Medical Protective Association and 44 per cent of surgical incidents reported to the Healthcare Insurance Reciprocal of Canada (Canadian Medical Protective Association (CMPA) & Healthcare Insurance Reciprocal of Canada (HIROC), 2016). A review of high harm events reported to Pennsylvania Patient Safety Reporting System (PA-PSRS) as a complication following surgery or invasive procedure, revealed that more than a third of the cases (n=34/101) involved punctures, lacerations, or tears (Magee et al., 2018). A review of a sample of reports submitted to PA-PSRS involving unintended lacerations or punctures during surgery found that 78 per cent of the reports described injuries to the colon (mostly during colonoscopy), the bladder (mostly during hysterectomy), or the uterus (mostly during hysteroscopy). ",{"type":15,"attrs":6448,"content":6449},{"textAlign":53},[6450],{"text":6451,"type":295},"A search of publicly available patient safety alerts revealed the following examples of accidental lacerations and punctures:",{"type":442,"content":6453},[6454,6461,6468,6475,6482,6489,6496],{"type":445,"content":6455},[6456],{"type":15,"attrs":6457,"content":6458},{"textAlign":53},[6459],{"text":6460,"type":295},"bladder laceration during a cesarean section (Wallace, 2016)",{"type":445,"content":6462},[6463],{"type":15,"attrs":6464,"content":6465},{"textAlign":53},[6466],{"text":6467,"type":295},"splenic laceration during a colonoscopy which required an emergent splenectomy (Magee et al., 2018)",{"type":445,"content":6469},[6470],{"type":15,"attrs":6471,"content":6472},{"textAlign":53},[6473],{"text":6474,"type":295},"pulmonary artery laceration during robotic-assisted lobectomy (Dubeck, 2014)",{"type":445,"content":6476},[6477],{"type":15,"attrs":6478,"content":6479},{"textAlign":53},[6480],{"text":6481,"type":295},"injury to the heart and stomach during the placement of the chest tubes (Pennsylvania Patient Safety Authority, 2007)",{"type":445,"content":6483},[6484],{"type":15,"attrs":6485,"content":6486},{"textAlign":53},[6487],{"text":6488,"type":295},"tear to a child's atrium upon post-operative removal of an atrial pacing wire (McClurken, 2006)",{"type":445,"content":6490},[6491],{"type":15,"attrs":6492,"content":6493},{"textAlign":53},[6494],{"text":6495,"type":295},"stomach perforation and subsequent needle decompression resulted in a lacerated liver, during an endoscopy procedure (Manitoba Health, Healthy Living & Seniors (MHHLS), 2017)",{"type":445,"content":6497},[6498],{"type":15,"attrs":6499,"content":6500},{"textAlign":53},[6501],{"text":6502,"type":295},"rectal perforation related to use of a glycerin enema (Japan Council for Quality Health Care, 2007)",{"type":392,"attrs":6504,"content":6505},{"level":437,"textAlign":53},[6506],{"text":6507,"type":295},"Potential causes of accidental laceration/puncture",{"type":15,"attrs":6509,"content":6510},{"textAlign":53},[6511],{"text":6512,"type":295},"A search of patient safety reporting/alert systems revealed that the potential causes of accidental laceration/puncture during a medical or surgical procedure may include:",{"type":392,"attrs":6514,"content":6515},{"level":437,"textAlign":53},[6516],{"text":6517,"type":295},"Distractions",{"type":15,"attrs":6519,"content":6520},{"textAlign":53},[6521],{"text":6522,"type":295},"Distraction is a threat to patient safety. Distraction is defined as having one's attention drawn or directed \"to a different object or in different directions at the same time.\" The impact of distraction is influenced by multiple variables, including the characteristics of the primary task, the distractions themselves, and the environment. Distractions are expected in healthcare, due to the constant communication and coordination that is required. It is important to note that that distraction due to interruptions that are purposeful and share important information may improve care by appropriately refocusing attention and improving problem identification, collaboration, and communication. However, distractions due to non-purposeful interruptions or operational failures that impair performance and contribute to error are concerning and risk patient safety.",{"type":15,"attrs":6524,"content":6525},{"textAlign":53},[6526],{"text":6527,"type":295},"Distraction is particularly detrimental to performance of complex tasks that require high levels of cognitive processing. Such tasks are encountered often in the operating room (OR) due to the complex nature of each work system factor: the physical environment, teamwork and communication, tools and technology, tasks and workload, and organizational processes. Even minor distractions in the OR can have a cascade effect that ultimately results in major events and patient harm. Engagement of surgeons and multidisciplinary teams is necessary to address the problem of distractions in the OR (Feil, 2014).",{"type":392,"attrs":6529,"content":6530},{"level":437,"textAlign":53},[6531],{"text":6532,"type":295},"Equipment Related",{"type":15,"attrs":6534,"content":6535},{"textAlign":53},[6536],{"text":6537,"type":295},"From simple lighting to technologically-advanced medical devices and surgical instruments, medical equipment is integral to the delivery of quality patient care. Although the potential for patient safety incidents related to equipment malfunction or failure exists, such incidents can be difficult to predict or prevent.",{"type":15,"attrs":6539,"content":6540},{"textAlign":53},[6541],{"text":6542,"type":295},"During a CMPA review of medico-legal cases arising from equipment problems, three predominant equipment-related issues were identified:",{"type":939,"attrs":6544,"content":6545},{"order":941},[6546,6553,6560],{"type":445,"content":6547},[6548],{"type":15,"attrs":6549,"content":6550},{"textAlign":53},[6551],{"text":6552,"type":295},"equipment malfunctions and failures;",{"type":445,"content":6554},[6555],{"type":15,"attrs":6556,"content":6557},{"textAlign":53},[6558],{"text":6559,"type":295},"wrong application, improper use, or unapproved use of equipment during a procedure or during medication delivery by physicians and other healthcare professionals; and",{"type":445,"content":6561},[6562],{"type":15,"attrs":6563,"content":6564},{"textAlign":53},[6565],{"text":6566,"type":295},"new equipment issues, including training and supervision deficiencies.",{"type":15,"attrs":6568,"content":6569},{"textAlign":53},[6570,6572,6576],{"text":6571,"type":295},"Patient injury resulting from equipment-related misadventures was a recurrent theme. Burns, ",{"text":6573,"type":295,"marks":6574},"lacerations, and perforations",[6575],{"type":1035},{"text":6577,"type":295}," were the most prevalent injuries.",{"type":15,"attrs":6579,"content":6580},{"textAlign":53},[6581],{"text":6582,"type":295},"Examples of equipment deficiencies during a procedure include:",{"type":939,"attrs":6584,"content":6585},{"order":941},[6586,6593,6600,6607],{"type":445,"content":6587},[6588],{"type":15,"attrs":6589,"content":6590},{"textAlign":53},[6591],{"text":6592,"type":295},"breakage of surgical instruments (e.g. needles, scalpel blades)",{"type":445,"content":6594},[6595],{"type":15,"attrs":6596,"content":6597},{"textAlign":53},[6598],{"text":6599,"type":295},"malfunctioning equipment or equipment failure (e.g. misfiring of a stapler)",{"type":445,"content":6601},[6602],{"type":15,"attrs":6603,"content":6604},{"textAlign":53},[6605],{"text":6606,"type":295},"defective equipment (e.g. rupture of a catheter balloon)",{"type":445,"content":6608},[6609],{"type":15,"attrs":6610,"content":6611},{"textAlign":53},[6612],{"text":6613,"type":295},"detachment of equipment (e.g. ureteric stone basket)",{"type":15,"attrs":6615,"content":6616},{"textAlign":53},[6617],{"text":6618,"type":295},"(CMPA, 2012)",{"type":392,"attrs":6620,"content":6621},{"level":437,"textAlign":53},[6622],{"text":6623,"type":295},"Central Line Related",{"type":15,"attrs":6625,"content":6626},{"textAlign":53},[6627],{"text":6628,"type":295},"Central lines are widely and effectively used in clinical medicine. The cannulation of major veins allows physicians to manage and monitor inpatients and outpatients. The ability to place these lines safely crosses many specialties and includes trainees. Complications such as vessel laceration, pneumothorax, neurological injury, atrial perforation, retroperitoneal hematoma, venous thrombosis, and infection are infrequent, but can have serious consequences for patients (CMPA, 2011).",{"type":392,"attrs":6630,"content":6631},{"level":437,"textAlign":53},[6632],{"text":6633,"type":295},"Fetal Lacerations Associated with Caesarean Section",{"type":15,"attrs":6635,"content":6636},{"textAlign":53},[6637],{"text":6638,"type":295},"The Pennsylvania Health Authority has reported on fetal lacerations, associated with cesarean sections. Most of the lacerations were reported to be superficial, however some have required suturing and/or plastic surgery intervention. Risk factors identified with these patient safety incidents were: ruptured membranes prior to C-section, low transverse uterine incision, active labour, emergency/urgent C-section, inexperience of the surgeon (Pennsylvania Patient Safety Authority, 2004a).",{"type":392,"attrs":6640,"content":6641},{"level":437,"textAlign":53},[6642],{"text":6643,"type":295},"Lacerations from scissor-related injuries",{"type":15,"attrs":6645,"content":6646},{"textAlign":53},[6647],{"text":6648,"type":295},"Lacerations have resulted from scissor-related injuries obtained during the provision of care. Scissor-related injuries have ranged from superficial nicks to lacerations requiring closure with adhesive strips or sutures. An analysis of the circumstances involved in these reports indicates the following patterns. Difficulty removing adhesive tape (during IV or dressing changes) was documented in 38 per cent of the reports, while removing patient identification bands was involved in 31 per cent of the reports. Other factors cited in these reports included: bandage removal; obstructed view of the area in which scissors were used; and use of scissors when other equipment may have been safer (such as using scissors to remove excessive hair from an area) (Pennsylvania Patient Safety Advisory, 2004b).",{"type":392,"attrs":6650,"content":6651},{"level":437,"textAlign":53},[6652],{"text":6653,"type":295},"Puncture from chest tube insertion",{"type":15,"attrs":6655,"content":6656},{"textAlign":53},[6657],{"text":6658,"type":295},"The insertion of a chest tube is required to remove air, blood, pus or fluid from the pleural cavity, and is used in patients with a collapsed lung, malignancies, chest trauma or after surgery. Improper insertion of a chest drain may puncture major organs such as heart, lungs, liver and spleen, causing significant harm to the patient. Common themes from a review of incidents include: supervision of junior doctors and levels of experience of clinicians inserting chest drains; failure to follow manufacturer's instructions; improper selection of the site of insertion, poor positioning; improper use of dilators; anatomical anomalies and the patient's clinical condition; inadequate pre procedural or post placement imaging; lack of knowledge of existing clinical guidelines for chest tube insertion (National Patient Safety Agency (NPSA), 2008).",{"type":392,"attrs":6660,"content":6661},{"level":394,"textAlign":53},[6662],{"text":759,"type":295},{"type":15,"attrs":6664,"content":6665},{"textAlign":53},[6666],{"text":6667,"type":295},"​Unintentional punctures or lacerations during surgical or medical procedures may cause unintended injuries or death. With appropriate interventions and appropriate reporting and related learning, such incidents may be reduced or prevented. Effective communication with patients and their families, including disclosure discussions when injuries occur is an important aspect of improvement efforts for safer surgical care (Lefebvre et al., 2018).",{"type":392,"attrs":6669,"content":6670},{"level":437,"textAlign":53},[6671],{"text":1812,"type":295},{"type":15,"attrs":6673,"content":6674},{"textAlign":53},[6675],{"text":6676,"type":295,"marks":6677},"Felecia Gerardi: No one would listen!!",[6678],{"type":407,"attrs":6679},{"href":6680,"uuid":53,"anchor":53,"custom":6681,"target":714,"linktype":715},"https://www.ctcps.org/f-gerardi.cfm",{},{"type":15,"attrs":6683,"content":6684},{"textAlign":53},[6685],{"text":6686,"type":295}," Connecticut Center for Patient Safety",{"type":15,"attrs":6688,"content":6689},{"textAlign":53},[6690],{"text":6691,"type":295},"\"…following a routine laparoscopic hysterectomy, I knew there was a problem. A very disgusting odor discharge was coming out my body. No tests were ordered and I was catheterized three days after the initial surgery. Dr McDonnell who performed my surgery knew that I was still in the hospital but didn't come to see me till Tuesday. She called in a Urologist who discovered I had a severed right ureter. I was brought to the O.R. opened up he discovered pus pockets in my abdomen. I could not be repaired at this time so he had a tube placed in my right kidney to drain the urine.",{"type":15,"attrs":6693,"content":6694},{"textAlign":53},[6695],{"text":6696,"type":295},"I was getting sicker and sicker. I kept asking why am I still leaking stuff and why is it green? Could I have an intestinal leak? My doctor and others brought in on my case treated me as if I were crazy. Finally eight or nine days later when I tried to eat a piece of food it came out clumpy green stuff. I insisted on being tested; looked like feces to me. Only then did they test me and I was right - there were two holes in my small intestine.",{"type":15,"attrs":6698,"content":6699},{"textAlign":53},[6700],{"text":6701,"type":295},"I was in the fight for my life. What was supposed to be a one-day surgery had become 30 days hospitalized; tubes, and bags for five months and several more repair surgeries were required. I still have chronic pain from a large piece of mesh that had to be put into my abdomen from developing a surgical hernia, and I have a lot of fear of ending up back in the hospital. I've already been back for an obstruction in my bowel because of scar tissue from all my repair surgeries which can happen again. This experience has given me a determination to work for patients' voices to be heard!!\" (Connecticut Center for Patient Safety, n.d.).",{"_uid":5203,"items":6703,"title":918,"component":760,"description":7114},[6704],{"_uid":5206,"title":773,"ctaLeft":6705,"ctaRight":6706,"component":718,"columnLeft":6707,"columnRight":6720},[],[],{"type":12,"content":6708},[6709],{"type":15,"attrs":6710,"content":6711},{"textAlign":53},[6712,6713,6719],{"text":782,"type":295},{"text":787,"type":295,"marks":6714},[6715],{"type":407,"attrs":6716},{"href":409,"uuid":410,"anchor":53,"custom":6717,"target":412,"linktype":413,"story":6718},{},{"name":404,"id":415,"uuid":410,"slug":416,"url":417,"full_slug":417,"_stopResolving":301},{"text":699,"type":295},{"type":12,"content":6721},[6722,6727],{"type":15,"attrs":6723,"content":6724},{"textAlign":53},[6725],{"text":6726,"type":295},"If your review reveals that your cases of laceration-puncture are linked to specific processes or procedures, you may find these resources helpful:",{"type":442,"content":6728},[6729,6756,6800,6829,6864,6892,6952,7025],{"type":445,"content":6730},[6731,6741],{"type":15,"attrs":6732,"content":6733},{"textAlign":53},[6734,6736],{"text":6735,"type":295},"Agency for Healthcare Research and Quality - ",{"text":1863,"type":295,"marks":6737},[6738],{"type":407,"attrs":6739},{"href":1863,"uuid":53,"anchor":53,"custom":6740,"target":714,"linktype":715},{},{"type":442,"content":6742},[6743],{"type":445,"content":6744},[6745],{"type":15,"attrs":6746,"content":6747},{"textAlign":53},[6748,6750],{"text":6749,"type":295},"Toolkit for using the AHRQ quality indicators:  How to improve hospital quality and safety. Selected best practices and suggestions for improvement PSI 15: Accidental puncture or laceration (Last reviewed 2017). ",{"text":6751,"type":295,"marks":6752},"https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4l_combo_psi15-accidentalpuncturelaceration-bestpractices.pdf",[6753],{"type":407,"attrs":6754},{"href":6751,"uuid":53,"anchor":53,"custom":6755,"target":714,"linktype":715},{},{"type":445,"content":6757},[6758,6770],{"type":15,"attrs":6759,"content":6760},{"textAlign":53},[6761,6763],{"text":6762,"type":295},"Association of periOperative Nurses (AORN) - ",{"text":6764,"type":295,"marks":6765},"www.aorn.org",[6766],{"type":407,"attrs":6767},{"href":6768,"uuid":53,"anchor":53,"custom":6769,"target":714,"linktype":715},"http://www.aorn.org",{},{"type":442,"content":6771},[6772,6786,6793],{"type":445,"content":6773},[6774],{"type":15,"attrs":6775,"content":6776},{"textAlign":53},[6777,6784],{"text":6778,"type":295,"marks":6779},"Can you hear me? 3 Reminders to reduce OR distractions",[6780],{"type":407,"attrs":6781},{"href":6782,"uuid":53,"anchor":53,"custom":6783,"target":714,"linktype":715},"https://www.aorn.org/article/2019-12-11-Reduce-OR-Distractions",{},{"text":6785,"type":295},". (2019). ",{"type":445,"content":6787},[6788],{"type":15,"attrs":6789,"content":6790},{"textAlign":53},[6791],{"text":6792,"type":295},"AORN Position statement on managing distractions and noise during perioperative patient care (2020).",{"type":445,"content":6794},[6795],{"type":15,"attrs":6796,"content":6797},{"textAlign":53},[6798],{"text":6799,"type":295},"AORN Position statement on patient safety (2017). https://www.aorn.org/-/media/aorn/guidelines/position-statements/posstat_pt_safety.pdf",{"type":445,"content":6801},[6802,6813],{"type":15,"attrs":6803,"content":6804},{"textAlign":53},[6805,6807],{"text":6806,"type":295},"Canadian Medical Protective Association - ",{"text":6808,"type":295,"marks":6809},"https://www.cmpa-acpm.ca/en/home",[6810],{"type":407,"attrs":6811},{"href":6808,"uuid":53,"anchor":53,"custom":6812,"target":714,"linktype":715},{},{"type":442,"content":6814},[6815,6822],{"type":445,"content":6816},[6817],{"type":15,"attrs":6818,"content":6819},{"textAlign":53},[6820],{"text":6821,"type":295},"Working with medical equipment - Reducing the risks. 2012. Available at: https://www.cmpa-acpm.ca/en/safety/-/asset_publisher/N6oEDMrzRbCC/content/working-with-medical-equipment-reducing-the-risks",{"type":445,"content":6823},[6824],{"type":15,"attrs":6825,"content":6826},{"textAlign":53},[6827],{"text":6828,"type":295},"Managing the medico-legal risks of placing a central line. 2011. Available at: https://www.cmpa-acpm.ca/en/duties-and-responsibilities/-/asset_publisher/bFaUiyQG069N/content/managing-the-medico-legal-risks-of-placing-a-central-line",{"type":445,"content":6830},[6831,6836],{"type":15,"attrs":6832,"content":6833},{"textAlign":53},[6834],{"text":6835,"type":295},"Canadian Patient Safety Institute ",{"type":442,"content":6837},[6838,6850],{"type":445,"content":6839},[6840],{"type":15,"attrs":6841,"content":6842},{"textAlign":53},[6843],{"text":6844,"type":295,"marks":6845},"Surgical Safety Checklist",[6846],{"type":407,"attrs":6847},{"href":6848,"uuid":53,"anchor":53,"custom":6849,"target":714,"linktype":715},"https://ualberta.scholaris.ca/items/349553ff-b39d-447c-863e-f5d61dfc3a3f",{},{"type":445,"content":6851},[6852],{"type":15,"attrs":6853,"content":6854},{"textAlign":53},[6855,6862],{"text":6856,"type":295,"marks":6857},"Surgical Safety in Canada: A 10-year review of CMPA and HIROC medico-legal data",[6858],{"type":407,"attrs":6859},{"href":6860,"uuid":53,"anchor":53,"custom":6861,"target":714,"linktype":715},"https://ualberta.scholaris.ca/items/e276465c-47e4-4969-95ef-997856ff9abe",{},{"text":6863,"type":295},". 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DVT occurs when an abnormal blood clot forms inside a vein deep in the leg. DVT may cause leg pain and/or swelling but is often clinically silent. PE occurs when all or part of a DVT breaks away from its site in a vein and travels through the venous system to lodge in the lungs. PE may cause chest pain, shortness of breath, tachycardia, hemoptysis, or pre-syncope but is often clinically silent. In clinical practice, about two-thirds of VTE episodes manifest as DVT and one-third as PE with or without DVT (Nicholson, et al., 2020).  ",{"type":12,"content":7484},[7485],{"type":15},{"type":12,"content":7487},[7488],{"type":15},[76,8],[7491,7502,7634,8046,8078,8285,8329,8464],{"_uid":4880,"link":7492,"image":7493,"title":374,"video_id":16,"component":375,"media_type":376,"description":7495,"video_title":16},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":284,"meta_data":7494},{},{"type":12,"content":7496},[7497],{"type":15,"attrs":7498,"content":7499},{"textAlign":53},[7500],{"text":7501,"type":295},"To prevent VTE in hospitalized adult and obstetrical patients by implementing strategies which increase the use of evidence-based thromboprophylaxis.",{"_uid":4892,"content":7503,"component":701},[7504],{"_uid":4895,"content":7505,"component":700},{"type":12,"content":7506},[7507,7511,7522,7527,7532,7537,7542,7546,7551,7556,7600,7604,7614,7619,7629],{"type":392,"attrs":7508,"content":7509},{"level":394,"textAlign":53},[7510],{"text":4902,"type":295},{"type":15,"attrs":7512,"content":7513},{"textAlign":53},[7514,7515,7521],{"text":402,"type":295},{"text":404,"type":295,"marks":7516},[7517],{"type":407,"attrs":7518},{"href":409,"uuid":410,"anchor":53,"custom":7519,"target":412,"linktype":413,"story":7520},{},{"name":404,"id":415,"uuid":410,"slug":416,"url":417,"full_slug":417,"_stopResolving":301},{"text":419,"type":295},{"type":15,"attrs":7523,"content":7524},{"textAlign":53},[7525],{"text":7526,"type":295},"Venous Thromboembolism (VTE) is the third most common cause of vascular mortality worldwide and comprises deep-vein thrombosis (DVT) and pulmonary embolism (PE) (Nicholson, et al., 2020). DVT occurs when an abnormal blood clot forms inside a vein deep in the leg. DVT may cause leg pain and/or swelling but is often clinically silent. PE occurs when all or part of a DVT breaks away from its site in a vein and travels through the venous system to lodge in the lungs. PE may cause chest pain, shortness of breath, tachycardia, hemoptysis, or pre-syncope but is often clinically silent. In clinical practice, about two-thirds of VTE episodes manifest as DVT and one-third as PE with or without DVT (Nicholson, et al., 2020).  ",{"type":15,"attrs":7528,"content":7529},{"textAlign":53},[7530],{"text":7531,"type":295},"About 50 per cent of all VTE events occur because of a current or recent hospital admission for surgery or acute medical illness. Hospital-acquired VTE is preventable, with interventions including anticoagulants and mechanical measures, including compression stockings and intermittent pneumatic compression (Schünemann et al., 2018). In addition, VTE remains an important cause of maternal morbidity and mortality in Canada with an overall incidence of DVT and PE of 12.1 per 10,000 and 5.4 per 10,000 pregnancies, respectively. VTE occurs at a rate of 4.3 per 10,000 pregnancies postpartum (Chan et al., 2014).",{"type":392,"attrs":7533,"content":7534},{"level":394,"textAlign":53},[7535],{"text":7536,"type":295},"Risk Factors",{"type":15,"attrs":7538,"content":7539},{"textAlign":53},[7540],{"text":7541,"type":295},"Risk factors for VTE can be subdivided into factors that promote venous stasis, factors that promote blood hypercoagulability, and factors causing endothelial injury or inflammation. A clear understanding of the risk factors for VTE is vital to identify patients at risk of VTE who would benefit from thromboprophylaxis. An individual patient's risk of VTE depends on intrinsic, patient-specific factors (such as genetic risk factors, age, or body mass index) and acquired risk due to the unique context or situation (such as hospitalization, surgery, cancer, or pregnancy). Risk factors are also frequently categorized by \"transient vs. persistent\" and \"major vs. minor\" (Nicholson et al., 2020; Chan et al., 2014).",{"type":392,"attrs":7543,"content":7544},{"level":394,"textAlign":53},[7545],{"text":759,"type":295},{"type":15,"attrs":7547,"content":7548},{"textAlign":53},[7549],{"text":7550,"type":295},"Hospital-acquired VTE (blood clots) is preventable (Schünemann et al., 2018).",{"type":15,"attrs":7552,"content":7553},{"textAlign":53},[7554],{"text":7555,"type":295},"One of the most important things you can do to prevent blood clots is to know if you are at risk. Some risk factors are hospitalization, surgery, pregnancy, or cancer. Other things you can do to reduce your risks and protect yourself from life-threatening blood clots include:",{"type":442,"content":7557},[7558,7565,7572,7579,7586,7593],{"type":445,"content":7559},[7560],{"type":15,"attrs":7561,"content":7562},{"textAlign":53},[7563],{"text":7564,"type":295},"Recognize the signs and symptoms of blood clots (DVT: swelling, pain, skin warm to the touch, redness; PE: difficulty breathing, chest pain, coughing, blood in sputum, rapid or irregular pulse).",{"type":445,"content":7566},[7567],{"type":15,"attrs":7568,"content":7569},{"textAlign":53},[7570],{"text":7571,"type":295},"Tell your doctor if you have risk factors for blood clots.",{"type":445,"content":7573},[7574],{"type":15,"attrs":7575,"content":7576},{"textAlign":53},[7577],{"text":7578,"type":295},"Before any surgery, talk with your doctor about blood clots.",{"type":445,"content":7580},[7581],{"type":15,"attrs":7582,"content":7583},{"textAlign":53},[7584],{"text":7585,"type":295},"Tell your doctor or nurse if you have any symptoms of a blood clot.",{"type":445,"content":7587},[7588],{"type":15,"attrs":7589,"content":7590},{"textAlign":53},[7591],{"text":7592,"type":295},"Mobilize as recommended by your health care provider.",{"type":445,"content":7594},[7595],{"type":15,"attrs":7596,"content":7597},{"textAlign":53},[7598],{"text":7599,"type":295},"Don't smoke or quit smoking",{"type":392,"attrs":7601,"content":7602},{"level":394,"textAlign":53},[7603],{"text":5191,"type":295},{"type":15,"attrs":7605,"content":7606},{"textAlign":53},[7607],{"text":7608,"type":295,"marks":7609},"How a Drawing Saved My Life: Lori's Story",[7610],{"type":407,"attrs":7611},{"href":7612,"uuid":53,"anchor":53,"custom":7613,"target":714,"linktype":715},"https://www.stoptheclot.org/patient-stories/loris-story/",{},{"type":15,"attrs":7615,"content":7616},{"textAlign":53},[7617],{"text":7618,"type":295},"In August 2014, I was overwhelmed with joy after delivering my baby boy, Jack. He was perfect, the delivery was pretty easy, and I was ready to go home. During a brief moment of quiet during his nap, I perused through the endless literature provided by the hospital. A hand drawing of a leg, with a red mark and arrow pointing to the calf describing deep vein thrombosis (DVT) struck me. I had a weird Charley horse in my leg, right in the same spot, but I thought it was no big deal. I mentioned it to the nurse, and we decided it was harmless. I went home with my bundle of joy. (Stop the Clot, nd).",{"type":15,"attrs":7620,"content":7621},{"textAlign":53},[7622],{"text":7623,"type":295,"marks":7624},"Maury Lieberman's story",[7625],{"type":407,"attrs":7626},{"href":7627,"uuid":53,"anchor":53,"custom":7628,"target":714,"linktype":715},"https://www.stoptheclot.org/about-clots/cancer-and-blood-clots/",{},{"type":15,"attrs":7630,"content":7631},{"textAlign":53},[7632],{"text":7633,"type":295},"Maury Lieberman, National Blood Clot Alliance (NBCA) Board member, discusses his experience with cancer and blood clots: (Stop the Clot, 2015) Video",{"_uid":5203,"items":7635,"title":918,"component":760,"description":8004},[7636],{"_uid":5206,"title":773,"ctaLeft":7637,"ctaRight":7638,"component":718,"columnLeft":7639,"columnRight":7652},[],[],{"type":12,"content":7640},[7641],{"type":15,"attrs":7642,"content":7643},{"textAlign":53},[7644,7645,7651],{"text":782,"type":295},{"text":787,"type":295,"marks":7646},[7647],{"type":407,"attrs":7648},{"href":409,"uuid":410,"anchor":53,"custom":7649,"target":412,"linktype":413,"story":7650},{},{"name":404,"id":415,"uuid":410,"slug":416,"url":417,"full_slug":417,"_stopResolving":301},{"text":699,"type":295},{"type":12,"content":7653},[7654,7659,8002],{"type":15,"attrs":7655,"content":7656},{"textAlign":53},[7657],{"text":7658,"type":295},"If your review reveals that your cases of VTE are linked to specific processes or procedures, you may find these resources helpful:",{"type":442,"content":7660},[7661,7684,7738,7821,7851,7879,7907,7936,7949,7977,7989],{"type":445,"content":7662},[7663,7675],{"type":15,"attrs":7664,"content":7665},{"textAlign":53},[7666,7668],{"text":7667,"type":295},"American Society of Clinical Oncology ",{"text":7669,"type":295,"marks":7670},"www.asco.org",[7671],{"type":407,"attrs":7672},{"href":7673,"uuid":53,"anchor":53,"custom":7674,"target":714,"linktype":715},"http://www.asco.org",{},{"type":442,"content":7676},[7677],{"type":445,"content":7678},[7679],{"type":15,"attrs":7680,"content":7681},{"textAlign":53},[7682],{"text":7683,"type":295},"Venous Thromboembolism Prophylaxis and Treatment in Patients with Cancer Update https://www.asco.org/research-guidelines/quality-guidelines/guidelines/supportive-care-and-treatment-related-issues#/9911",{"type":445,"content":7685},[7686,7697],{"type":15,"attrs":7687,"content":7688},{"textAlign":53},[7689,7691],{"text":7690,"type":295},"American Society of Hematology ",{"text":7692,"type":295,"marks":7693},"https://www.hematology.org/",[7694],{"type":407,"attrs":7695},{"href":7692,"uuid":53,"anchor":53,"custom":7696,"target":714,"linktype":715},{},{"type":442,"content":7698},[7699,7712,7725],{"type":445,"content":7700},[7701],{"type":15,"attrs":7702,"content":7703},{"textAlign":53},[7704,7706],{"text":7705,"type":295},"2019 Guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients ",{"text":7707,"type":295,"marks":7708},"https://ashpublications.org/bloodadvances/article/3/23/3898/429211/American-Society-of-Hematology-2019-guidelines-for",[7709],{"type":407,"attrs":7710},{"href":7707,"uuid":53,"anchor":53,"custom":7711,"target":714,"linktype":715},{},{"type":445,"content":7713},[7714],{"type":15,"attrs":7715,"content":7716},{"textAlign":53},[7717,7719],{"text":7718,"type":295},"2018 Guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients (Schünemann) ",{"text":7720,"type":295,"marks":7721},"https://ashpublications.org/bloodadvances/article/2/22/3198/16115/American-Society-of-Hematology-2018-guidelines-for\\",[7722],{"type":407,"attrs":7723},{"href":7720,"uuid":53,"anchor":53,"custom":7724,"target":714,"linktype":715},{},{"type":445,"content":7726},[7727],{"type":15,"attrs":7728,"content":7729},{"textAlign":53},[7730,7732],{"text":7731,"type":295},"2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy (Bates) ",{"text":7733,"type":295,"marks":7734},"https://ashpublications.org/bloodadvances/article/2/22/3317/16094/American-Society-of-Hematology-2018-guidelines-for?searchresult=1",[7735],{"type":407,"attrs":7736},{"href":7733,"uuid":53,"anchor":53,"custom":7737,"target":714,"linktype":715},{},{"type":445,"content":7739},[7740,7752],{"type":15,"attrs":7741,"content":7742},{"textAlign":53},[7743,7745],{"text":7744,"type":295},"CHEST – American College 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",{"text":7802,"type":295,"marks":7803},"https://journal.chestnet.org/article/S0012-3692(12)60126-3/fulltext?_ga=2.191914723.810240998.1611603389-2133843351.1611603389",[7804],{"type":407,"attrs":7805},{"href":7802,"uuid":53,"anchor":53,"custom":7806,"target":714,"linktype":715},{},{"type":445,"content":7808},[7809],{"type":15,"attrs":7810,"content":7811},{"textAlign":53},[7812,7814],{"text":7813,"type":295},"Prevention, Diagnosis, and Treatment of VTE in Patients with Coronavirus Disease 2019 CHEST ",{"text":7815,"type":295,"marks":7816},"chestnet.org",[7817],{"type":407,"attrs":7818},{"href":7819,"uuid":53,"anchor":53,"custom":7820,"target":714,"linktype":715},"http://chestnet.org",{},{"type":445,"content":7822},[7823,7835],{"type":15,"attrs":7824,"content":7825},{"textAlign":53},[7826,7828],{"text":7827,"type":295},"International Society on Thrombosis and Haemostasis ",{"text":7829,"type":295,"marks":7830},"isth.org",[7831],{"type":407,"attrs":7832},{"href":7833,"uuid":53,"anchor":53,"custom":7834,"target":714,"linktype":715},"http://isth.org",{},{"type":442,"content":7836},[7837,7844],{"type":445,"content":7838},[7839],{"type":15,"attrs":7840,"content":7841},{"textAlign":53},[7842],{"text":7843,"type":295},"Full list of Published Guidance - International Society on Thrombosis and Haemostasis, Inc. (isth.org)",{"type":445,"content":7845},[7846],{"type":15,"attrs":7847,"content":7848},{"textAlign":53},[7849],{"text":7850,"type":295},"Spyropoulos, A.C., Levy, J.H., Ageno, W., Connors, J.M., Hunt, B.J., Iba, T., Levi, M., Samama, C.M., Thachil, J., Giannis, D., Douketis, J.D. and (2020), Scientific and Standardization Committee Communication: Clinical Guidance on the Diagnosis, Prevention and Treatment of Venous Thromboembolism in Hospitalized Patients with COVID‐19. J Thromb Haemost. Author Accepted Manuscript. ",{"type":445,"content":7852},[7853,7864],{"type":15,"attrs":7854,"content":7855},{"textAlign":53},[7856,7858],{"text":7857,"type":295},"Journal of Clinical Medicine ",{"text":7859,"type":295,"marks":7860},"https://www.mdpi.com/journal/jcm",[7861],{"type":407,"attrs":7862},{"href":7859,"uuid":53,"anchor":53,"custom":7863,"target":714,"linktype":715},{},{"type":442,"content":7865},[7866],{"type":445,"content":7867},[7868],{"type":15,"attrs":7869,"content":7870},{"textAlign":53},[7871,7873],{"text":7872,"type":295},"Nicholson M, Chan N, Bhagirath V, Ginsberg, J. Prevention of Venous Thromboembolism in 2020 and Beyond. J. Clin. Med. 2020, 9, 2467-2494. 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The Johns Hopkins Hospital, a 1,000-bed academic medical center in Baltimore.",{"type":15,"attrs":8315,"content":8316},{"textAlign":53},[8317],{"text":8318,"type":295},"The issue: Administering venous thromboembolism (VTE) prophylaxis as prescribed.",{"type":15,"attrs":8320,"content":8321},{"textAlign":53},[8322],{"text":8323,"type":295},"Background: Hospitalists know the importance of medications for VTE prophylaxis, but 12.7 per cent of prescribed doses were not administered in a study of 75 patients at Johns Hopkins Hospital, published in March 2018 by the American Journal of Health-System Pharmacy. Because the most commonly cited reason for non-administration was patient refusal, the Johns Hopkins VTE Collaborative decided to tackle the problem with patient education.",{"type":15,"attrs":8325,"content":8326},{"textAlign":53},[8327],{"text":8328,"type":295},"\"Our first step was to ask patients what they wanted to learn,\" said Elliott R. Haut, MD, PhD, vice chair of quality, safety, and service in the department of surgery at Johns Hopkins Medicine. After collecting patient input, the research group developed a patient education bundle composed of a two-page form about blood-clot prevention, a 10-minute video of patients' stories (shown on a hospital tablet, the TV, or a patient's personal device), and in-person support from a nurse educator... 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Society of Obstetricians and Gynaecologists of Canada (SOGC) Clinical Practice Guidelines: Venous thromboembolism and antithrombotic therapy in pregnancy. J Obstet Gynaecol Can. 2014; 36 (6): 527–553. http://sogc.org/guidelines/venous-thromboembolism-antithrombotic-therapy-pregnancy/",{"type":15,"attrs":8359},{"textAlign":53},{"type":445,"content":8361},[8362],{"type":15,"attrs":8363,"content":8364},{"textAlign":53},[8365],{"text":8366,"type":295},"Frost M. American College of Physicians. Getting patients on board with VTE prophylaxis. ACP Hospitalist Success Story, February 2019. https://acphospitalist.org/archives/2019/02/success-story-getting-patients-on-board-with-vte-prophylaxis.htm",{"type":445,"content":8368},[8369,8380],{"type":15,"attrs":8370,"content":8371},{"textAlign":53},[8372,8374],{"text":8373,"type":295},"Institute for Healthcare Improvement (IHI). How-to Guide: Prevent Harm from High-Alert Medications. Cambridge, MA: IHI; 2012. 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Blood Advances, 2, 3198-3225. https://doi.org/10.1182/bloodadvances.2018022954, 10.1182/bloodadvances.2018022954",{"type":15,"attrs":8418},{"textAlign":53},{"type":445,"content":8420},[8421,8431],{"type":15,"attrs":8422,"content":8423},{"textAlign":53},[8424,8426],{"text":8425,"type":295},"Stop the clot – Cancer and Blood Clots. Maury Lieberman's Experience. Video, 2015: ",{"text":7627,"type":295,"marks":8427},[8428],{"type":407,"attrs":8429},{"href":7627,"uuid":53,"anchor":53,"custom":8430,"target":714,"linktype":715},{},{"type":15,"attrs":8432},{"textAlign":53},{"type":445,"content":8434},[8435,8445],{"type":15,"attrs":8436,"content":8437},{"textAlign":53},[8438,8440],{"text":8439,"type":295},"Stop the clot – Patient Story. How A Drawing Saved My Life: Lori's Story. 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(retrieved January 2021) ",{"text":7944,"type":295,"marks":8455},[8456],{"type":407,"attrs":8457},{"href":7944,"uuid":53,"anchor":53,"custom":8458,"target":714,"linktype":715},{},{"type":15,"attrs":8460},{"textAlign":53},{"type":12,"content":8462},[8463],{"type":15},{"id":16,"_uid":8465,"items":8466,"component":1413},"6eb4e51c-bf24-41b1-9d59-7bad51888e07",[8467],{"_uid":8468,"link":8469,"image":8474,"title":1405,"component":1406,"description":8476},"53576ed1-d241-4755-a3d6-be730772819e",[8470],{"_uid":8471,"link":8472,"label":1399,"component":1400},"e0217179-bbaa-4d57-b4e5-70649fe00704",{"id":275,"url":16,"linktype":413,"fieldtype":716,"cached_url":303,"story":8473},{"name":270,"id":274,"uuid":275,"slug":9,"url":303,"full_slug":303,"_stopResolving":301},{"id":1402,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1403,"copyright":16,"fieldtype":284,"meta_data":8475,"is_external_url":286},{},{"type":12,"content":8477},[8478],{"type":15,"attrs":8479,"content":8480},{"textAlign":53},[8481],{"text":294,"type":295},[115,143,122,129,136,150,157],[185,192,200],-18930,[],"5ae9abc6-19aa-407f-a12e-60e29f3c3669","2025-12-09T20:06:32.766Z",[],[8490],{"path":8491,"name":8492,"lang":315,"published":301},"ressources/thrombo-embolie-veineuse","Thrombo-embolie veineuse",{"name":8494,"created_at":8495,"published_at":8496,"updated_at":8497,"id":8498,"uuid":8499,"content":8500,"slug":10367,"full_slug":10368,"sort_by_date":53,"position":10369,"tag_list":10370,"is_startpage":286,"parent_id":1421,"meta_data":53,"group_id":10371,"first_published_at":10372,"release_id":53,"lang":309,"path":53,"alternates":10373,"default_full_slug":10368,"translated_slugs":10374},"Selected Serious Events","2025-12-11T20:05:38.926Z","2026-03-10T16:17:55.822Z","2026-03-10T16:17:55.897Z",122035973931866,"a521e7fd-2c55-4795-8396-ac7294c79fb3",{"new":286,"seo":8501,"_uid":4831,"hero":8503,"type":174,"topics":8527,"Noindex":286,"content":8528,"audience":10365,"duration":16,"regional":10366,"component":1416},{"_uid":8502,"title":8494,"plugin":339,"og_image":16,"og_title":16,"description":340,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},"f70e690b-22b5-4336-83e1-8dee277ec0d4",[8504],{"_uid":4834,"image":8505,"title":8507,"format":8508,"component":353,"description":8511,"key_learning":8521,"prerequisite":8524},{"id":346,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":347,"copyright":16,"fieldtype":284,"meta_data":8506,"is_external_url":286},{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: Selected Serious Events",{"type":12,"content":8509},[8510],{"type":15},{"type":12,"content":8512},[8513],{"type":15,"attrs":8514,"content":8515},{"textAlign":53},[8516],{"text":8517,"type":295,"marks":8518},"Patients expect safe care, and healthcare providers strive to deliver care that results in better health and safe, effective outcomes for patients. However, events that harm patients do occur while care is being provided, or as a result of that care. While risk is an inherent part of care, we know that many of these events that cause harm can be prevented using current knowledge and practices. Many of these events occur only rarely, but all can have a severe impact on the lives and well-being of patients.",[8519],{"type":298,"attrs":8520},{"color":5499},{"type":12,"content":8522},[8523],{"type":15},{"type":12,"content":8525},[8526],{"type":15},[76,8],[8529,8540,8845,9711,9743,9952,10064,10347],{"_uid":4880,"link":8530,"image":8531,"title":374,"video_id":16,"component":375,"media_type":376,"description":8533,"video_title":16},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":284,"meta_data":8532},{},{"type":12,"content":8534},[8535],{"type":15,"attrs":8536,"content":8537},{"textAlign":53},[8538],{"text":8539,"type":295},"Reduce the incidence of serious selected events captured in this clinical group.",{"_uid":4892,"content":8541,"component":701},[8542],{"_uid":4895,"content":8543,"component":700},{"type":12,"content":8544},[8545,8549,8560,8565,8570,8658,8663,8668,8673,8678,8683,8692,8701,8710,8715,8720,8725,8730,8735,8751,8755,8760,8765,8769,8774,8778,8783,8787,8796,8801,8806,8815,8817,8821,8826,8830,8840],{"type":392,"attrs":8546,"content":8547},{"level":394,"textAlign":53},[8548],{"text":4902,"type":295},{"type":15,"attrs":8550,"content":8551},{"textAlign":53},[8552,8553,8559],{"text":402,"type":295},{"text":404,"type":295,"marks":8554},[8555],{"type":407,"attrs":8556},{"href":409,"uuid":410,"anchor":53,"custom":8557,"target":412,"linktype":413,"story":8558},{},{"name":404,"id":415,"uuid":410,"slug":416,"url":417,"full_slug":417,"_stopResolving":301},{"text":419,"type":295},{"type":15,"attrs":8561,"content":8562},{"textAlign":53},[8563],{"text":8564,"type":295},"Health Quality Ontario (HQO), and the Canadian Patient Safety Institute (CPSI) partnered with several jurisdictions and organizations in Canada to create a list of 15 Never Events (NE). Never Events are patient safety incidents that result in serious patient harm or death and that are preventable using organizational checks and balances (HQO & CPSI, 2015).",{"type":15,"attrs":8566,"content":8567},{"textAlign":53},[8568],{"text":8569,"type":295},"The selected serious events included in this resource are:",{"type":442,"content":8571},[8572,8637,8644,8651],{"type":445,"content":8573},[8574,8579],{"type":15,"attrs":8575,"content":8576},{"textAlign":53},[8577],{"text":8578,"type":295},"Failure of sterile precautions during surgical and medical care during:",{"type":442,"content":8580},[8581,8588,8595,8602,8609,8616,8623,8630],{"type":445,"content":8582},[8583],{"type":15,"attrs":8584,"content":8585},{"textAlign":53},[8586],{"text":8587,"type":295},"surgical operation*",{"type":445,"content":8589},[8590],{"type":15,"attrs":8591,"content":8592},{"textAlign":53},[8593],{"text":8594,"type":295},"infusion or transfusion",{"type":445,"content":8596},[8597],{"type":15,"attrs":8598,"content":8599},{"textAlign":53},[8600],{"text":8601,"type":295},"kidney dialysis or other perfusion",{"type":445,"content":8603},[8604],{"type":15,"attrs":8605,"content":8606},{"textAlign":53},[8607],{"text":8608,"type":295},"injection or immunization",{"type":445,"content":8610},[8611],{"type":15,"attrs":8612,"content":8613},{"textAlign":53},[8614],{"text":8615,"type":295},"endoscopic examination",{"type":445,"content":8617},[8618],{"type":15,"attrs":8619,"content":8620},{"textAlign":53},[8621],{"text":8622,"type":295},"heart catheterization",{"type":445,"content":8624},[8625],{"type":15,"attrs":8626,"content":8627},{"textAlign":53},[8628],{"text":8629,"type":295},"aspiration, puncture, and other catheterization",{"type":445,"content":8631},[8632],{"type":15,"attrs":8633,"content":8634},{"textAlign":53},[8635],{"text":8636,"type":295},"Contaminated medical or biological substances",{"type":445,"content":8638},[8639],{"type":15,"attrs":8640,"content":8641},{"textAlign":53},[8642],{"text":8643,"type":295},"Failure in suture or ligature during surgical operation",{"type":445,"content":8645},[8646],{"type":15,"attrs":8647,"content":8648},{"textAlign":53},[8649],{"text":8650,"type":295},"Endotracheal tube wrongly placed during anesthetic procedure",{"type":445,"content":8652},[8653],{"type":15,"attrs":8654,"content":8655},{"textAlign":53},[8656],{"text":8657,"type":295},"Performance of inappropriate operation*",{"type":15,"attrs":8659,"content":8660},{"textAlign":53},[8661],{"text":8662,"type":295},"* Correspond with Never Events #1 and #4: NE #1 surgery on the wrong body part or the wrong patient or conducting the wrong procedure. NE #4 patient death or serious harm arising from the use of improperly sterilized instruments or equipment provided by the healthcare facility.",{"type":392,"attrs":8664,"content":8665},{"level":437,"textAlign":53},[8666],{"text":8667,"type":295},"Failure of sterile precautions",{"type":15,"attrs":8669,"content":8670},{"textAlign":53},[8671],{"text":8672,"type":295},"The purpose of maintaining sterile precautions is to reduce the number of microbes present to as few as possible. The sterile field is used in many situations outside the operating room as well as inside the operating room when performing surgical cases. Sterile fields should be used outside the operating room when performing any procedure that could introduce microbes into a patient. A few examples of this would be inserting a foley catheter, an arterial line, and a central line. Inside the operating room, sterile fields are created relative to the back table, the mayo stand, and finally the patient and the surgical site itself (Tennant, 2021). Failure of sterile precautions during medical and surgical procedures has resulted in the spread of infection and disease transmission. This has led to increased morbidity and mortality for patients as well as increased length of stay and increased costs (Siegel, Rhinehart, Chiarello et al., 2007, Ontario Agency for Health Protection and Promotion, 2013). ",{"type":392,"attrs":8674,"content":8675},{"level":437,"textAlign":53},[8676],{"text":8677,"type":295},"Aseptic, Sterile, and clean techniques",{"type":15,"attrs":8679,"content":8680},{"textAlign":53},[8681],{"text":8682,"type":295},"Historically, the practice of protecting patients from contamination and infection during clinical procedures has generated an inaccurate and confusing paradigm based on the terminology of sterile, aseptic, and clean techniques. The use of accurate terminology is important in order to promote clarity in practice (National Health and Medical Research Council - NHMRC, 2019). The Australian Guidelines for the Prevention and Control of Infection in Healthcare (NHMRC, 2019) offers the following definitions:",{"type":15,"attrs":8684,"content":8685},{"textAlign":53},[8686,8690],{"text":8687,"type":295,"marks":8688},"Sterile 'Free from microorganisms'",[8689],{"type":1035},{"text":8691,"type":295}," Due to the natural multitude of organisms in the atmosphere it is not possible to achieve a sterile technique in a typical healthcare setting. Near sterile techniques can only be achieved in controlled environments such as a laminar air flow cabinet or a specially equipped theatre. The commonly used term, 'sterile technique' (i.e., the instruction to maintain sterility of equipment exposed to air), is obviously not possible and is often applied inaccurately.",{"type":15,"attrs":8693,"content":8694},{"textAlign":53},[8695,8699],{"text":8696,"type":295,"marks":8697},"Asepsis 'Freedom from infection or infectious (pathogenic) material'",[8698],{"type":1035},{"text":8700,"type":295}," An aseptic technique aims to prevent pathogenic organisms, in sufficient quantity to cause infection, from being introduced to susceptible sites by hands, surfaces and equipment. Therefore, unlike sterile techniques, aseptic techniques are possible and can be achieved in typical hospital and community settings.",{"type":15,"attrs":8702,"content":8703},{"textAlign":53},[8704,8708],{"text":8705,"type":295,"marks":8706},"Clean 'Free from dirt, marks or stains' ",[8707],{"type":1035},{"text":8709,"type":295},"Although cleaning followed by drying of equipment and surfaces can be very effective it does not necessarily meet the quality standard of asepsis. However, the action of cleaning is an important component in helping render equipment and skin aseptic, especially when there are high levels of contamination that require removal or reduction. To be confident of achieving asepsis an application of a skin or hard surface disinfectant is required either during cleaning or afterwards.",{"type":15,"attrs":8711,"content":8712},{"textAlign":53},[8713],{"text":8714,"type":295},"The aim of any aseptic technique is asepsis.",{"type":15,"attrs":8716,"content":8717},{"textAlign":53},[8718],{"text":8719,"type":295},"As defined above, aseptic technique is the purposeful prevention of transfer of microorganisms from the patient's body surface to a normally sterile body site or from one person to another by keeping the microbe count to an irreducible minimum. Aseptic techniques are measures designed to render the patient's skin, supplies and surfaces maximally free from microorganisms. Such practices are used when performing procedures that expose the patient's normally sterile sites (e.g., intravascular system, spinal canal, subdural space, urinary tract) in such a manner as to keep them free from microorganisms (NHMRC, 2019; PHAC, 2012).",{"type":15,"attrs":8721,"content":8722},{"textAlign":53},[8723],{"text":8724,"type":295},"To practice safely it is essential that healthcare workers understand the principles and practice of aseptic technique. An example of an aseptic technique is Aseptic Non-Touch Technique (ANTT), a comprehensively defined practice framework for aseptic technique developed by the Association for Safe Aseptic Practice (The-ASAP, 2015). ",{"type":15,"attrs":8726,"content":8727},{"textAlign":53},[8728],{"text":8729,"type":295},"Sterilizations of medical and surgical instruments and equipment: Infection is a major risk of surgery and despite modern technologies and procedures, infections related to improper equipment reprocessing still occur.",{"type":15,"attrs":8731,"content":8732},{"textAlign":53},[8733],{"text":8734,"type":295},"Achieving effective disinfection and sterilization is essential for ensuring that medical and surgical equipment/devices do not transmit infectious pathogens to clients/patients/residents or staff. The goals of safe reprocessing of medical equipment/devices include:",{"type":442,"content":8736},[8737,8744],{"type":445,"content":8738},[8739],{"type":15,"attrs":8740,"content":8741},{"textAlign":53},[8742],{"text":8743,"type":295},"preventing transmission of microorganisms to personnel and clients/patients/ residents.",{"type":445,"content":8745},[8746],{"type":15,"attrs":8747,"content":8748},{"textAlign":53},[8749],{"text":8750,"type":295},"minimizing damage to medical equipment/devices from foreign material (e.g., blood, body fluids, saline, and medications) or inappropriate handling (Ontario Agency for Health Protection and Promotion, 2013).",{"type":392,"attrs":8752,"content":8753},{"level":437,"textAlign":53},[8754],{"text":8636,"type":295},{"type":15,"attrs":8756,"content":8757},{"textAlign":53},[8758],{"text":8759,"type":295},"The tainted blood tragedy is one of the worst public health disasters that Canada has ever faced. When AIDS appeared in the early 1980s and soon became an epidemic, the entire Canadian blood supply system was affected. More than 1,100 transfused Canadians were infected by HIV, of whom 700 had hemophilia and other bleeding disorders, and 400 were transfusion recipients for other reasons (trauma, surgery, childbirth, cancer). Up to 20,000 were infected with the hepatitis C virus (HCV) through blood and blood products before testing was introduced in 1990 (Canadian Hemophilia Society, retrieved April 2021). This tragedy led to the Royal Commission of Inquiry on the Blood System in Canada, led by Justice Horace Krever. In 1997, Justice Krever tabled his report in the House of Commons, putting forward a set of 50 recommendations that, to this day, guide the blood system to ensure safety for all Canadians (Canadian Blood Services-Transfusion, 2019).",{"type":15,"attrs":8761,"content":8762},{"textAlign":53},[8763],{"text":8764,"type":295},"The transplantation of a human tissue allograft introduces the risk of complications to the recipient including the fatal and nonfatal transmission of infectious organisms such as bacteria, fungi, viruses, parasites, and prions. Tissue banks are considered to be manufacturers of human biologics where donor tissue is processed and enhanced using good manufacturing practices and good tissue practices to optimize safety and clinical outcomes. As biological manufacturers of tissue allografts that present a risk of disease transmission, tissue bank practices that reduce and eliminate infectious organisms must be effective, evidence-based and validated (Canadian Blood Services- Organs and Tissues, 2016).",{"type":392,"attrs":8766,"content":8767},{"level":437,"textAlign":53},[8768],{"text":8643,"type":295},{"type":15,"attrs":8770,"content":8771},{"textAlign":53},[8772],{"text":8773,"type":295},"Most of the knot and suture failures exist due to technical errors in tying and wrong selection of sutures or knots in different scenarios. Common failure modes of knots and sutures are suture breakage, knot loosening, knot breakage, and tissue breakage. Failure of any of these factors can destroy the repair construct (Öçgüder, 2018).",{"type":392,"attrs":8775,"content":8776},{"level":437,"textAlign":53},[8777],{"text":8650,"type":295},{"type":15,"attrs":8779,"content":8780},{"textAlign":53},[8781],{"text":8782,"type":295},"Endotracheal intubation is a routine procedure in anesthetic care. Immediate verification of endotracheal placement of the ETT is necessary as esophageal or endobronchial intubation is a significant source of avoidable anesthetic-related morbidity and mortality (Miller, 2015). Serious complications can occur from inadvertent placement of the endotracheal tube in a main stem bronchus, such as hypoxemia caused by atelectasis formation in the unventilated lung and hyperinflation and barotrauma with development of a pneumothorax of the intubated lung. Proper positioning of the endotracheal tube in relation to the carina is clinically important (Sitzwohl et al, 2010).",{"type":392,"attrs":8784,"content":8785},{"level":437,"textAlign":53},[8786],{"text":8657,"type":295},{"type":15,"attrs":8788,"content":8789},{"textAlign":53},[8790,8794],{"text":8791,"type":295,"marks":8792},"Surgery on the wrong body part or the wrong patient or conducting the wrong procedure:",[8793],{"type":1035},{"text":8795,"type":295}," Surgery is one area of healthcare in which preventable medical errors and near misses can occur. Of great concern is wrong-site surgery (WSS), which encompasses surgery performed on the wrong side or site of the body, wrong surgical procedure performed, and surgery performed on the wrong patient. WSS has also been defined as a sentinel event (i.e., an unexpected occurrence involving death or serious physical or psychological injures, or the risk thereof) by the Joint Commission, which found WSS to be the third-highest-ranking event (Mulloy & Huges, 2008).  ",{"type":15,"attrs":8797,"content":8798},{"textAlign":53},[8799],{"text":8800,"type":295},"Wrong site surgeries have been associated with the failure to identify incorrect information in the documents related to surgery, such as the schedule, consent, and patient's history and physical examination. The opportunities for wrong site surgery are minimized when all the information is in agreement, and when all members of the operating room (OR) team assume a personal responsibility for the procedure (Pennsylvania Patient Safety Authority, 2007). The Pennsylvania Patient Safety Authority study (Yonash, 2020) showed that the frequency of WSS varied according to a range of variables, including error type (e.g., wrong side, wrong site, wrong procedure, wrong patient); year; facility type; hospital bed size; hospital procedure location; procedure; body region; body part; and clinician specialty. Many clinicians, patient safety professionals, and organizations take the position that WSS events are preventable and should never occur (Yonash, 2020).",{"type":15,"attrs":8802,"content":8803},{"textAlign":53},[8804],{"text":8805,"type":295},"Distractions and/or interruptions related to human communication, equipment such as surgical alarms or technology (e.g., phone calls, pagers) are a threat to patient safety in the OR as they have been found to contribute to patient safety incidents and have been reported to be linked to wrong-side surgery and wrong-site surgery. Guidelines and tools have been developed by perioperative professional associations and patient safety agencies to limit and/or ameliorate the negative impact of distraction and these include application of the \"sterile cockpit\" concept from aviation, reducing distractions from technology and noise, use of surgical safety checklists and briefings and teamwork training. Engagement of surgeons and multidisciplinary teams is necessary to address the problem of distractions in the OR (Pennsylvania Patient Safety Authority, 2014).",{"type":15,"attrs":8807,"content":8808},{"textAlign":53},[8809,8813],{"text":8810,"type":295,"marks":8811},"Unnecessary/obsolete procedure ",[8812],{"type":1035},{"text":8814,"type":295},"involves the performance of a surgery that was deemed unnecessary given the clinical situation. It may also involve the performance of a procedure or the use of a technique that is no longer considered to be standard. The performance of an unnecessary or an obsolete procedure may be related the failure of monitoring individual surgeon's practices or due to a misinterpretation of diagnostic tests (HIROC, 2016).",{"type":15,"attrs":8816},{"textAlign":53},{"type":392,"attrs":8818,"content":8819},{"level":394,"textAlign":53},[8820],{"text":759,"type":295},{"type":15,"attrs":8822,"content":8823},{"textAlign":53},[8824],{"text":8825,"type":295},"Patients expect hospital care to be safe, and for most hospital stays it is. However, a small proportion of patients experience some type of unintended harm as a result of the care they receive. Hospital patients are particularly vulnerable because many are very frail and hospital care is increasingly complex. When patients are harmed in hospital, they can experience increased length of stay and are at an increased risk for morbidity and mortality. In addition to what these patients and their families go through, their continued need for treatment also has a cost to the system, in that it keeps other people from getting the help they need (CIHI & CPSI, 2016).  Patients need to take an active role in their healthcare to prevent errors. Although wrong-site surgery is rare it still can occur. Communication between the healthcare team and the patient is important (Pennsylvania Patient Safety Authority, 2018).",{"type":392,"attrs":8827,"content":8828},{"level":437,"textAlign":53},[8829],{"text":5191,"type":295},{"type":15,"attrs":8831,"content":8832},{"textAlign":53},[8833],{"text":8834,"type":295,"marks":8835},"Brampton Civic Hospital operates on wrong leg",[8836],{"type":407,"attrs":8837},{"href":8838,"uuid":53,"anchor":53,"custom":8839,"target":714,"linktype":715},"http://healthcare-professionals-canada.blogspot.ca/2007/12/brampton-civic-hospital-operates-wrong.html",{},{"type":15,"attrs":8841,"content":8842},{"textAlign":53},[8843],{"text":8844,"type":295},"A Brampton family is frustrated after their 72-year-old grandmother had the wrong leg cut open during surgery on Christmas Day at the city's new hospital. Amar Kaur Brar, 72, fractured her thigh bone when she slipped from the stairs at the family's Brampton home, her granddaughter Kanwaljot Brar, 21, told The Sun yesterday. \"In the operating room, doctors cut Amar's right leg open,\" Brar said, adding the cut ran almost the entire length of her grandmother's thigh. When they realized that the bone in Amar's right leg was okay, they stitched her up and performed surgery on her left leg….",{"_uid":5203,"items":8846,"title":918,"component":760,"description":9673},[8847],{"_uid":5206,"title":773,"ctaLeft":8848,"ctaRight":8849,"component":718,"columnLeft":8850,"columnRight":8863},[],[],{"type":12,"content":8851},[8852],{"type":15,"attrs":8853,"content":8854},{"textAlign":53},[8855,8856,8862],{"text":782,"type":295},{"text":787,"type":295,"marks":8857},[8858],{"type":407,"attrs":8859},{"href":409,"uuid":410,"anchor":53,"custom":8860,"target":412,"linktype":413,"story":8861},{},{"name":404,"id":415,"uuid":410,"slug":416,"url":417,"full_slug":417,"_stopResolving":301},{"text":699,"type":295},{"type":12,"content":8864},[8865,8870],{"type":15,"attrs":8866,"content":8867},{"textAlign":53},[8868],{"text":8869,"type":295},"If your review reveals that your cases of selected serious events are linked to specific processes or procedures, you may find these resources helpful:",{"type":442,"content":8871},[8872,8900,8928,8956,8970,9005,9027,9062,9091,9114,9127,9173,9214,9230,9243,9271,9284,9313,9341,9396,9403,9432,9455,9468,9482,9562,9591,9614,9642],{"type":445,"content":8873},[8874,8885],{"type":15,"attrs":8875,"content":8876},{"textAlign":53},[8877,8879],{"text":8878,"type":295},"Agency for Healthcare Research and Quality (AHRQ) ",{"text":1859,"type":295,"marks":8880},[8881],{"type":407,"attrs":8882},{"href":8883,"uuid":53,"anchor":53,"custom":8884,"target":714,"linktype":715},"http://www.ahrq.gov",{},{"type":442,"content":8886},[8887],{"type":445,"content":8888},[8889],{"type":15,"attrs":8890,"content":8891},{"textAlign":53},[8892,8894],{"text":8893,"type":295},"Never events [Internet]. 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",{"text":9586,"type":295,"marks":9587},"http://publications.gc.ca/collections//collection_2013/aspc-phac/HP40-83-2013-eng.pdf",[9588],{"type":407,"attrs":9589},{"href":9586,"uuid":53,"anchor":53,"custom":9590,"target":714,"linktype":715},{},{"type":445,"content":9592},[9593,9605],{"type":15,"attrs":9594,"content":9595},{"textAlign":53},[9596,9598,9604],{"text":9597,"type":295},"Public Health Ontario ",{"text":9599,"type":295,"marks":9600},"https://www.publichealthontario.ca/",[9601],{"type":407,"attrs":9602},{"href":9599,"uuid":53,"anchor":53,"custom":9603,"target":714,"linktype":715},{},{"text":9141,"type":295},{"type":442,"content":9606},[9607],{"type":445,"content":9608},[9609],{"type":15,"attrs":9610,"content":9611},{"textAlign":53},[9612],{"text":9613,"type":295},"Provincial Infectious Diseases Advisory Committee.",{"type":445,"content":9615},[9616,9627],{"type":15,"attrs":9617,"content":9618},{"textAlign":53},[9619,9620,9626],{"text":2317,"type":295},{"text":2319,"type":295,"marks":9621},[9622],{"type":407,"attrs":9623},{"href":9624,"uuid":53,"anchor":53,"custom":9625,"target":714,"linktype":715},"http://www.rcoa.ac.uk",{},{"text":7039,"type":295},{"type":442,"content":9628},[9629],{"type":445,"content":9630},[9631],{"type":15,"attrs":9632,"content":9633},{"textAlign":53},[9634,9636],{"text":9635,"type":295},"Safety, standards, and quality. ",{"text":9637,"type":295,"marks":9638},"https://www.rcoa.ac.uk/safety-standards-quality",[9639],{"type":407,"attrs":9640},{"href":9637,"uuid":53,"anchor":53,"custom":9641,"target":714,"linktype":715},{},{"type":445,"content":9643},[9644,9656],{"type":15,"attrs":9645,"content":9646},{"textAlign":53},[9647,9649],{"text":9648,"type":295},"World Health Organization (WHO) ",{"text":9650,"type":295,"marks":9651},"www.who.int",[9652],{"type":407,"attrs":9653},{"href":9654,"uuid":53,"anchor":53,"custom":9655,"target":714,"linktype":715},"http://www.who.int",{},{"type":442,"content":9657},[9658],{"type":445,"content":9659},[9660,9671],{"type":15,"attrs":9661,"content":9662},{"textAlign":53},[9663,9665],{"text":9664,"type":295},"WHO guidelines for safe surgery: Safe surgery saves lives 2009. Geneva: WHO; 2009. ",{"text":9666,"type":295,"marks":9667},"http://apps.who.int/iris/bitstream/10665/44185/1/9789241598552_eng.pdf",[9668],{"type":407,"attrs":9669},{"href":9666,"uuid":53,"anchor":53,"custom":9670,"target":714,"linktype":715},{},{"type":15,"attrs":9672},{"textAlign":53},{"type":12,"content":9674},[9675,9680,9684],{"type":15,"attrs":9676,"content":9677},{"textAlign":53},[9678],{"text":9679,"type":295},"Given the broad range of potential causes of hospital associated selected serious events, clinical and system reviews should be conducted to identify latent causes and determine appropriate recommendations.",{"type":15,"attrs":9681,"content":9682},{"textAlign":934},[9683],{"text":937,"type":295},{"type":939,"attrs":9685,"content":9686},{"order":941},[9687,9693,9699,9705],{"type":445,"content":9688},[9689],{"type":15,"attrs":9690,"content":9691},{"textAlign":53},[9692],{"text":949,"type":295},{"type":445,"content":9694},[9695],{"type":15,"attrs":9696,"content":9697},{"textAlign":53},[9698],{"text":956,"type":295},{"type":445,"content":9700},[9701],{"type":15,"attrs":9702,"content":9703},{"textAlign":53},[9704],{"text":963,"type":295},{"type":445,"content":9706},[9707],{"type":15,"attrs":9708,"content":9709},{"textAlign":53},[9710],{"text":970,"type":295},{"_uid":5539,"items":9712,"title":1009,"component":1010,"description":9737},[9713,9719,9725,9731],{"_uid":5542,"image":9714,"title":980,"component":981,"description":9716},{"id":977,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":978,"copyright":16,"fieldtype":284,"meta_data":9715,"is_external_url":286},{},{"type":12,"content":9717},[9718],{"type":15},{"_uid":5549,"image":9720,"title":989,"component":981,"description":9722},{"id":977,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":978,"copyright":16,"fieldtype":284,"meta_data":9721,"is_external_url":286},{},{"type":12,"content":9723},[9724],{"type":15},{"_uid":5556,"image":9726,"title":997,"component":981,"description":9728},{"id":977,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":978,"copyright":16,"fieldtype":284,"meta_data":9727,"is_external_url":286},{},{"type":12,"content":9729},[9730],{"type":15},{"_uid":5563,"image":9732,"title":1005,"component":981,"description":9734},{"id":977,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":978,"copyright":16,"fieldtype":284,"meta_data":9733,"is_external_url":286},{},{"type":12,"content":9735},[9736],{"type":15},{"type":12,"content":9738},[9739],{"type":15,"attrs":9740,"content":9741},{"textAlign":53},[9742],{"text":1017,"type":295},{"_uid":5576,"items":9744,"title":1158,"component":760,"description":9932},[9745,9835],{"_uid":5579,"title":1023,"ctaLeft":9746,"ctaRight":9747,"component":718,"columnLeft":9748,"columnRight":9812},[],[],{"type":12,"content":9749},[9750,9757,9762,9767,9772,9777,9782,9787,9792,9797,9802,9807],{"type":15,"attrs":9751,"content":9752},{"textAlign":53},[9753],{"text":9754,"type":295,"marks":9755},"Codes",[9756],{"type":1035},{"type":15,"attrs":9758,"content":9759},{"textAlign":53},[9760],{"text":9761,"type":295},"Y62.0",{"type":15,"attrs":9763,"content":9764},{"textAlign":53},[9765],{"text":9766,"type":295},"Y62.1",{"type":15,"attrs":9768,"content":9769},{"textAlign":53},[9770],{"text":9771,"type":295},"Y62.2",{"type":15,"attrs":9773,"content":9774},{"textAlign":53},[9775],{"text":9776,"type":295},"Y62.3",{"type":15,"attrs":9778,"content":9779},{"textAlign":53},[9780],{"text":9781,"type":295},"Y62.4",{"type":15,"attrs":9783,"content":9784},{"textAlign":53},[9785],{"text":9786,"type":295},"Y62.5",{"type":15,"attrs":9788,"content":9789},{"textAlign":53},[9790],{"text":9791,"type":295},"Y62.6",{"type":15,"attrs":9793,"content":9794},{"textAlign":53},[9795],{"text":9796,"type":295},"Y64.–",{"type":15,"attrs":9798,"content":9799},{"textAlign":53},[9800],{"text":9801,"type":295},"Y65.2",{"type":15,"attrs":9803,"content":9804},{"textAlign":53},[9805],{"text":9806,"type":295},"Y65.3",{"type":15,"attrs":9808,"content":9809},{"textAlign":53},[9810],{"text":9811,"type":295},"Y65.5",{"type":12,"content":9813},[9814,9821],{"type":15,"attrs":9815,"content":9816},{"textAlign":53},[9817],{"text":9818,"type":295,"marks":9819},"Conditions",[9820],{"type":1035},{"type":15,"attrs":9822,"content":9823},{"textAlign":53},[9824,9826,9829,9831],{"text":9825,"type":295},"Identified as diagnosis type (9) ",{"text":5678,"type":295,"marks":9827},[9828],{"type":1035},{"text":9830,"type":295}," at least 1 additional diagnosis coded as diagnosis type (2) ",{"text":9832,"type":295,"marks":9833},"in the same diagnosis cluster",[9834],{"type":1035},{"_uid":7217,"title":1063,"ctaLeft":9836,"ctaRight":9837,"component":718,"columnLeft":9838,"columnRight":9842},[],[],{"type":12,"content":9839},[9840],{"type":15,"attrs":9841},{"textAlign":53},{"type":12,"content":9843},[9844,9852,9860,9868,9876,9884,9892,9900,9908,9916,9924],{"type":15,"attrs":9845,"content":9846},{"textAlign":53},[9847,9850],{"text":9761,"type":295,"marks":9848},[9849],{"type":1035},{"text":9851,"type":295},": Failure of sterile precautions during surgical and medical care; during surgical operation",{"type":15,"attrs":9853,"content":9854},{"textAlign":53},[9855,9858],{"text":9766,"type":295,"marks":9856},[9857],{"type":1035},{"text":9859,"type":295},": Failure of sterile precautions during surgical and medical care; during infusion or transfusion",{"type":15,"attrs":9861,"content":9862},{"textAlign":53},[9863,9866],{"text":9771,"type":295,"marks":9864},[9865],{"type":1035},{"text":9867,"type":295},": Failure of sterile precautions during surgical and medical care; during kidney dialysis, or other perfusion",{"type":15,"attrs":9869,"content":9870},{"textAlign":53},[9871,9874],{"text":9776,"type":295,"marks":9872},[9873],{"type":1035},{"text":9875,"type":295},": Failure of sterile precautions during surgical and medical care; during injection or immunization",{"type":15,"attrs":9877,"content":9878},{"textAlign":53},[9879,9882],{"text":9781,"type":295,"marks":9880},[9881],{"type":1035},{"text":9883,"type":295},": Failure of sterile precautions during surgical and medical care; during endoscopic examination",{"type":15,"attrs":9885,"content":9886},{"textAlign":53},[9887,9890],{"text":9786,"type":295,"marks":9888},[9889],{"type":1035},{"text":9891,"type":295},": Failure of sterile precautions during surgical and medical care; during heart catheterization",{"type":15,"attrs":9893,"content":9894},{"textAlign":53},[9895,9898],{"text":9791,"type":295,"marks":9896},[9897],{"type":1035},{"text":9899,"type":295},": Failure of sterile precautions during surgical and medical care; during aspiration, puncture, and other catheterization",{"type":15,"attrs":9901,"content":9902},{"textAlign":53},[9903,9906],{"text":9796,"type":295,"marks":9904},[9905],{"type":1035},{"text":9907,"type":295},": Contaminated medical or biological substances",{"type":15,"attrs":9909,"content":9910},{"textAlign":53},[9911,9914],{"text":9801,"type":295,"marks":9912},[9913],{"type":1035},{"text":9915,"type":295},": Failure in suture or ligature during surgical operation",{"type":15,"attrs":9917,"content":9918},{"textAlign":53},[9919,9922],{"text":9806,"type":295,"marks":9920},[9921],{"type":1035},{"text":9923,"type":295},": Endotracheal tube wrongly placed during anesthetic procedure",{"type":15,"attrs":9925,"content":9926},{"textAlign":53},[9927,9930],{"text":9811,"type":295,"marks":9928},[9929],{"type":1035},{"text":9931,"type":295},": Performance of inappropriate operation",{"type":12,"content":9933},[9934,9942,9947],{"type":15,"attrs":9935,"content":9936},{"textAlign":53},[9937,9938],{"text":1165,"type":295},{"text":9939,"type":295,"marks":9940},"D26: Selected Serious Events",[9941],{"type":1035},{"type":15,"attrs":9943,"content":9944},{"textAlign":53},[9945],{"text":9946,"type":295},"Concept: Harm to patients resulting from failure of sterile precautions, contaminated medical or biological substances, failure in suture or ligature, wrong placement of endotracheal tube or performance of inappropriate operation.",{"type":15,"attrs":9948,"content":9949},{"textAlign":53},[9950],{"text":9951,"type":295},"Notes: This clinical group includes serious, largely preventable patient safety events that should not occur.",{"_uid":5906,"content":9953,"component":701},[9954],{"_uid":5909,"content":9955,"component":700},{"type":12,"content":9956},[9957,9962,9967,9972,9977,9982,9987,9992,9997,10002,10007,10012,10022,10027,10032,10049,10054,10059],{"type":392,"attrs":9958,"content":9959},{"level":394,"textAlign":53},[9960],{"text":9961,"type":295}," Success Stories",{"type":15,"attrs":9963,"content":9964},{"textAlign":53},[9965],{"text":9966,"type":295},"At the foundation of successful patient safety and quality improvement efforts is a culture of patient safety within the hospital or surgical center. A strong safety culture can help minimize medical errors and strong support from leadership is crucial to truly moving the needle on patient safety and quality.",{"type":15,"attrs":9968,"content":9969},{"textAlign":53},[9970],{"text":9971,"type":295},"Minnesota hospitals and ambulatory surgery centers performed 2 .6 million invasive procedures during the 2012-13 reporting year, including procedures in the operating room, radiology, diagnostic/labs, and other settings. Dr. Mark Migliori, chair of the perioperative safety committee at Abbott Northwestern Hospital in Minneapolis, part of Allina Health, believes a culture of safety is a prerequisite for delivering good care for every patient, every procedure, every time.",{"type":15,"attrs":9973,"content":9974},{"textAlign":53},[9975],{"text":9976,"type":295},"\"Patients deserve for safety to be front and center,\" said Dr. Migliori. \"It is the essential first step. They are entrusting us with their care and implicit in that trust is that we will be their guardian when they are under our care.\" He believes surgeon leadership is critical in building a culture of safety in the operating room. While Minnesota hospitals and surgical centers have done a great job of developing multidisciplinary teams where everyone has a voice, some traditional hierarchies still persist.",{"type":15,"attrs":9978,"content":9979},{"textAlign":53},[9980],{"text":9981,"type":295},"\"On one hand, the surgeon should have the same role as other team members in building a culture of safety,\" said Dr. Migliori. \"In reality though, the surgeon has the capability to level the hierarchy within the operating room. By acting as a servant leader yourself — sharing power, putting the needs of others first and helping people develop and perform as highly as possible — it sends the message to the rest of the team that their professionalism demands the emphasis on safety.\" By fostering a culture that enables staff to feel comfortable to speak up, Dr. Migliori feels listening goes a long way in giving people a voice.",{"type":15,"attrs":9983,"content":9984},{"textAlign":53},[9985],{"text":9986,"type":295},"\"One of the most obvious steps we can take is to listen — to let staff talk,\" he says. \"We create so many barriers to let someone give their opinion. We need to break down those barriers and then give them a place to carry their idea forward.\" As a leader, Dr. Migliori hears the suggestion or concern and then gives the staff member ownership to carry the idea forward. He also feels it is important to recognize people when they speak up, as it creates a positive outcome. That's why he feels it is important to talk about near misses and recognize the person who caught it. \"It sends the message that people are watching and this is important,\" says Dr. Migliori.",{"type":15,"attrs":9988,"content":9989},{"textAlign":53},[9990],{"text":9991,"type":295},"Dr. Migliori gives the example of the early days of implementing one of components of the Universal Protocol — the team briefing process. As chief of staff, he embraced the concept, yet was initially resistant to the idea that everyone needed to introduce themselves, feeling that people on the team already knew one another. Others felt strongly about its importance and so the team kept that critical piece of the protocol in place. He soon realized its significance. \"It helps people talk. When the tech introduces herself, it gives her a reason to talk. So next time there's a reason to speak up for safety, she's less intimidated to do so,\" he explained. \"When you don't know someone well, you're less likely to speak up and question them.\"",{"type":15,"attrs":9993,"content":9994},{"textAlign":53},[9995],{"text":9996,"type":295},"Dr. Migliori says a strong leader is one who has balance. Balance between confidence and humility; competence and being unsure enough to look at a situation from a different angle; and someone who is passionate and yet can observe and allow others to impact. A strong leader is always looking to give a voice to those who don't have one, and advocating for those who are the most vulnerable, whether it is staff, a patient or someone else.",{"type":15,"attrs":9998,"content":9999},{"textAlign":53},[10000],{"text":10001,"type":295},"Building a culture of safety takes continuous improvement. Hospitals and staff must be willing to constantly re-evaluate what they're doing and say, what can we do to make it better? Dr. Migliori feels it's good to have the awareness that mistakes can happen at any time. It's realizing that while you're good, it's not good enough. \"Any organization that does safety work has glimpses of a safety culture,\" he says. \"It's maintaining it that is hard. And that takes energy and humility.\"",{"type":15,"attrs":10003,"content":10004},{"textAlign":53},[10005],{"text":10006,"type":295},"Collaboration and communication are key to driving forward a culture of safety. Dr. Migliori encourages surgeon leaders to discard old approaches where members of the team are separate and instead create opportunities for groups to come together and have a dialogue around safety. \"We must create the constant message that we're in this together. It all falls to communication and doing everything you can to enable voices to be heard,\" he says. \"I'm so appreciative of the effort to make safety culture bigger than hospital versus hospital, but rather something that if we want to provide care in Minnesota, this is the standard.\"",{"type":15,"attrs":10008,"content":10009},{"textAlign":53},[10010],{"text":10011,"type":295},"(Minnesota Department of Health, 2014)",{"type":392,"attrs":10013,"content":10014},{"level":437,"textAlign":53},[10015],{"text":10016,"type":295,"marks":10017},"Utilization of Safety Crosses as a Quality Management Tool in Sterile Processing Department",[10018],{"type":407,"attrs":10019},{"href":10020,"uuid":53,"anchor":53,"custom":10021,"target":714,"linktype":715},"https://healthstandards.org/leading-practice/utilization-of-safety-crosses-as-a-quality-management-tool-in-sterile-processing-department/",{},{"type":15,"attrs":10023,"content":10024},{"textAlign":53},[10025],{"text":10026,"type":295},"At Markham Stouffville Hospital the Sterile Processing Department is responsible for the decontamination, cleaning, reprocessing and sterilization of instruments and equipment for the entire hospital. The Sterile Processing Department follows stringent criteria, best practice guidelines and standards to ensure the delivery of quality safe services to stakeholders such as the Operating Room and the Emergency Department. The department's commitment to safety and quality aligns with the hospital's belief statement \"we must deliver safe, high quality care\".",{"type":15,"attrs":10028,"content":10029},{"textAlign":53},[10030],{"text":10031,"type":295},"Although the department strives to exceed standards of practice, frontline staff identified the following two gaps:",{"type":939,"attrs":10033,"content":10034},{"order":941},[10035,10042],{"type":445,"content":10036},[10037],{"type":15,"attrs":10038,"content":10039},{"textAlign":53},[10040],{"text":10041,"type":295},"Audit results such as instrument set error rate, missing chemical indicators, sterilization record accuracy and the frequency of sharps being found on used/soiled trays were inconsistently tracked and shared with frontline staff.",{"type":445,"content":10043},[10044],{"type":15,"attrs":10045,"content":10046},{"textAlign":53},[10047],{"text":10048,"type":295},"The lack of a systematic process such as a weekly audit tool to capture all reprocessing volume/activities, including thermal and high level disinfection, sterilization, weekly testing, and maintenance, and descaling of reprocessing equipment such as instrument, ultrasonic and cart washers.",{"type":15,"attrs":10050,"content":10051},{"textAlign":53},[10052],{"text":10053,"type":295},"Simultaneously, while the Sterile Processing Department was exploring solutions to the above concerns, some of the acute inpatient units were implementing Releasing Time to Care. Releasing Time to Care is a process used to capture and report quality outcome indicators such as falls and pressure ulcer rates. The Sterile Processing Department, after visiting these acute inpatient units, adopted the Safety Crosses as a format to capture and disseminate the audits results as outlined above in Gap 1. The team also developed a weekly departmental audit tool to monitor and report their various departmental reprocessing volumes and activities as noted above in Gap 2.",{"type":15,"attrs":10055,"content":10056},{"textAlign":53},[10057],{"text":10058,"type":295},"After many months of hard work, the department now boasts a quality board that proudly displays their four Safety Crosses: instrument/set errors, missing chemical indicators (internal and external), sterilization completion and accuracy rates and sharps sent to the Sterile Processing Department by end-users. The quality board also serves as a mode to track and report the department's weekly reprocessing activities and volume. Staff now has immediate access to reports and audits results. They are also a part of the process because they actively complete the Safety Crosses on a daily basis. Through education, completion of iReports and direct follow-ups with sending departments, the team has noticed a decline in the frequency in which sharps are returned to Sterile Processing Department.",{"type":15,"attrs":10060,"content":10061},{"textAlign":53},[10062],{"text":10063,"type":295},"(Health Standards Organization, 2013)",{"_uid":5937,"items":10065,"title":1243,"component":760,"description":10344},[10066],{"_uid":5940,"title":1227,"ctaLeft":10067,"ctaRight":10068,"component":718,"columnLeft":10069,"columnRight":10073},[],[],{"type":12,"content":10070},[10071],{"type":15,"attrs":10072},{"textAlign":53},{"type":12,"content":10074},[10075],{"type":442,"content":10076},[10077,10091,10106,10121,10130,10147,10162,10169,10186,10200,10214,10229,10244,10259,10274,10287,10301,10314,10329],{"type":445,"content":10078},[10079,10089],{"type":15,"attrs":10080,"content":10081},{"textAlign":53},[10082,10084],{"text":10083,"type":295},"Association for Safe Aseptic Practice (The-ASAP). Aseptic non touch technique: The ANTT clinical practice framework. London; The-ASAP; 2015. ",{"text":9000,"type":295,"marks":10085},[10086],{"type":407,"attrs":10087},{"href":9000,"uuid":53,"anchor":53,"custom":10088,"target":714,"linktype":715},{},{"type":15,"attrs":10090},{"textAlign":53},{"type":445,"content":10092},[10093,10104],{"type":15,"attrs":10094,"content":10095},{"textAlign":53},[10096,10098],{"text":10097,"type":295},"Canadian Hemophilia Society. Commemoration of the tainted blood tragedy. Retrieved from website April 2021. ",{"text":10099,"type":295,"marks":10100},"https://www.hemophilia.ca/commemoration-of-the-tainted-blood-tragedy/",[10101],{"type":407,"attrs":10102},{"href":10099,"uuid":53,"anchor":53,"custom":10103,"target":714,"linktype":715},{},{"type":15,"attrs":10105},{"textAlign":53},{"type":445,"content":10107},[10108,10119],{"type":15,"attrs":10109,"content":10110},{"textAlign":53},[10111,10113],{"text":10112,"type":295},"Canadian Institute for Health Information (CIHI), Canadian Patient Safety Institute. Measuring patient harm in Canadian hospitals. Ottawa, ON: CIHI; 2016. ",{"text":10114,"type":295,"marks":10115},"https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC3312",[10116],{"type":407,"attrs":10117},{"href":10114,"uuid":53,"anchor":53,"custom":10118,"target":714,"linktype":715},{},{"type":15,"attrs":10120},{"textAlign":53},{"type":445,"content":10122},[10123,10128],{"type":15,"attrs":10124,"content":10125},{"textAlign":53},[10126],{"text":10127,"type":295},"Health Quality Ontario, Canadian Patient Safety Institute (CPSI). Never events for hospital care in Canada: Safer care for patients. Edmonton, AB: CPSI; 2015.",{"type":15,"attrs":10129},{"textAlign":53},{"type":445,"content":10131},[10132,10145],{"type":15,"attrs":10133,"content":10134},{"textAlign":53},[10135,10137,10143],{"text":10136,"type":295},"Healthcare Insurance Reciprocal of Canada (HIROC). Risk reference sheet: Unnecessary/obsolete procedures. Toronto, ON: HIROC; 2016. ",{"text":10138,"type":295,"marks":10139},"https://www.hiroc.com/getmedia/45537195-5d6d-45c7-8c7d-87132c6e15df/30_Unnecessary-Obsolete-Procedures.pdf.aspx?ext=.pdf",[10140],{"type":407,"attrs":10141},{"href":10138,"uuid":53,"anchor":53,"custom":10142,"target":714,"linktype":715},{},{"text":10144,"type":295}," (accessed January 2018; inactive June 2021)",{"type":15,"attrs":10146},{"textAlign":53},{"type":445,"content":10148},[10149],{"type":15,"attrs":10150,"content":10151},{"textAlign":53},[10152,10154,10160],{"text":10153,"type":295},"Healthcare Insurance Reciprocal of Canada (HIROC). Risk reference sheet: Surgical inadequate sterility. Toronto, ON: HIROC; 2012. ",{"text":10155,"type":295,"marks":10156},"https://www.hiroc.com/getmedia/ef3098cb-9026-41c0-8c5e-dc2ce1a5891f/29-Inadequate-Sterility-Risk-Reference-Sheet.pdf.aspx?ext=.pdf",[10157],{"type":407,"attrs":10158},{"href":10155,"uuid":53,"anchor":53,"custom":10159,"target":714,"linktype":715},{},{"text":10161,"type":295},"(accessed January 2018; inactive June 2021)",{"type":445,"content":10163},[10164],{"type":15,"attrs":10165,"content":10166},{"textAlign":53},[10167],{"text":10168,"type":295},"Healthcare Insurance Reciprocal of Canada (HIROC). Risk reference sheet: Wrong patient/site/procedure. Toronto, ON: HIROC; 2016. ",{"type":445,"content":10170},[10171,10180,10184],{"type":15,"attrs":10172,"content":10173},{"textAlign":53},[10174],{"text":10175,"type":295,"marks":10176},"https://www.hiroc.com/getmedia/22f0e351-4066-4c39-84d5-1560f20084d1/31_Wrong-Patient-Site-Procedure.pdf.aspx?ext=.pdf",[10177],{"type":407,"attrs":10178},{"href":10175,"uuid":53,"anchor":53,"custom":10179,"target":714,"linktype":715},{},{"type":15,"attrs":10181,"content":10182},{"textAlign":53},[10183],{"text":10144,"type":295},{"type":15,"attrs":10185},{"textAlign":53},{"type":445,"content":10187},[10188,10198],{"type":15,"attrs":10189,"content":10190},{"textAlign":53},[10191,10193],{"text":10192,"type":295},"Institute for Healthcare Improvement (IHI). How-to guide: Prevent harm from high-alert medications. Cambridge, MA: IHI; 2012. ",{"text":6111,"type":295,"marks":10194},[10195],{"type":407,"attrs":10196},{"href":6111,"uuid":53,"anchor":53,"custom":10197,"target":714,"linktype":715},{},{"type":15,"attrs":10199},{"textAlign":53},{"type":445,"content":10201},[10202,10212],{"type":15,"attrs":10203,"content":10204},{"textAlign":53},[10205,10207],{"text":10206,"type":295},"Health Standards Organization Leading Practices. Utilization of safety crosses as a quality management tool in sterile processing department Markham Stouffville Hospital Corporation. Ottawa, ON: Health Standards Organization; 2013.  ",{"text":10020,"type":295,"marks":10208},[10209],{"type":407,"attrs":10210},{"href":10020,"uuid":53,"anchor":53,"custom":10211,"target":714,"linktype":715},{},{"type":15,"attrs":10213},{"textAlign":53},{"type":445,"content":10215},[10216,10227],{"type":15,"attrs":10217,"content":10218},{"textAlign":53},[10219,10221],{"text":10220,"type":295},"Mulloy DF, Huges RG. Chapter 36: Wrong-site surgery: A preventable medical error. In: Patient safety and quality: An evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality; 2008.  ",{"text":10222,"type":295,"marks":10223},"https://www.ncbi.nlm.nih.gov/books/NBK2678/pdf/Bookshelf_NBK2678.pdf",[10224],{"type":407,"attrs":10225},{"href":10222,"uuid":53,"anchor":53,"custom":10226,"target":714,"linktype":715},{},{"type":15,"attrs":10228},{"textAlign":53},{"type":445,"content":10230},[10231,10242],{"type":15,"attrs":10232,"content":10233},{"textAlign":53},[10234,10236],{"text":10235,"type":295},"National Health and Medical Research Council (NHMRC). Australian guidelines for the prevention and control of infection in healthcare. Commonwealth of Australia; 2019. ",{"text":10237,"type":295,"marks":10238},"https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-prevention-and-control-infection-healthcare-2019",[10239],{"type":407,"attrs":10240},{"href":10237,"uuid":53,"anchor":53,"custom":10241,"target":714,"linktype":715},{},{"type":15,"attrs":10243},{"textAlign":53},{"type":445,"content":10245},[10246,10257],{"type":15,"attrs":10247,"content":10248},{"textAlign":53},[10249,10251],{"text":10250,"type":295},"Öçgüder A., Medvecky M. (2018) Failure Modes of Knots and Sutures. In: Akgun U., Karahan M., Randelli P., Espregueira-Mendes J. (eds) Knots in Orthopedic Surgery. Springer, Berlin, Heidelberg. ",{"text":10252,"type":295,"marks":10253},"https://doi.org/10.1007/978-3-662-56108-9_5",[10254],{"type":407,"attrs":10255},{"href":10252,"uuid":53,"anchor":53,"custom":10256,"target":714,"linktype":715},{},{"type":15,"attrs":10258},{"textAlign":53},{"type":445,"content":10260},[10261,10272],{"type":15,"attrs":10262,"content":10263},{"textAlign":53},[10264,10266],{"text":10265,"type":295},"Ontario Agency for Health Protection and Promotion, Public Health Ontario, Provincial Infectious Diseases Advisory Committee, Infection Prevention and Control. Best practices for cleaning, disinfection, and sterilization of medical equipment/devices in all health care settings (3rd ed.) Toronto, ON: Queen's Printer for Ontario; 2013. ",{"text":10267,"type":295,"marks":10268},"http://www.publichealthontario.ca/en/eRepository/PIDAC_Cleaning_Disinfection_and_Sterilization_2013.pdf",[10269],{"type":407,"attrs":10270},{"href":10267,"uuid":53,"anchor":53,"custom":10271,"target":714,"linktype":715},{},{"type":15,"attrs":10273},{"textAlign":53},{"type":445,"content":10275},[10276,10285],{"type":15,"attrs":10277,"content":10278},{"textAlign":53},[10279,10280],{"text":9542,"type":295},{"text":9544,"type":295,"marks":10281},[10282],{"type":407,"attrs":10283},{"href":9544,"uuid":53,"anchor":53,"custom":10284,"target":714,"linktype":715},{},{"type":15,"attrs":10286},{"textAlign":53},{"type":445,"content":10288},[10289,10299],{"type":15,"attrs":10290,"content":10291},{"textAlign":53},[10292,10294],{"text":10293,"type":295},"Pennsylvania Patient Safety Authority. Patient safety topics – Wrong Site Surgery. 2018 ",{"text":9505,"type":295,"marks":10295},[10296],{"type":407,"attrs":10297},{"href":9505,"uuid":53,"anchor":53,"custom":10298,"target":714,"linktype":715},{},{"type":15,"attrs":10300},{"textAlign":53},{"type":445,"content":10302},[10303,10312],{"type":15,"attrs":10304,"content":10305},{"textAlign":53},[10306,10307],{"text":9584,"type":295},{"text":9586,"type":295,"marks":10308},[10309],{"type":407,"attrs":10310},{"href":9586,"uuid":53,"anchor":53,"custom":10311,"target":714,"linktype":715},{},{"type":15,"attrs":10313},{"textAlign":53},{"type":445,"content":10315},[10316,10327],{"type":15,"attrs":10317,"content":10318},{"textAlign":53},[10319,10321],{"text":10320,"type":295},"Siegel JD, Rhinehart E, Jackson M, Chiarello L, Healthcare Infection Control Practices Advisory Committee. 2007 guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. Centers for Disease Control and Prevention (CDC); 2007. ",{"text":10322,"type":295,"marks":10323},"http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf",[10324],{"type":407,"attrs":10325},{"href":10322,"uuid":53,"anchor":53,"custom":10326,"target":714,"linktype":715},{},{"type":15,"attrs":10328},{"textAlign":53},{"type":445,"content":10330},[10331,10342],{"type":15,"attrs":10332,"content":10333},{"textAlign":53},[10334,10336],{"text":10335,"type":295},"Sitzwohl C, Langheinrich A, Schober A, et al. Endobronchial intubation detected by insertion depth of endotracheal tube, bilateral auscultation, or observation of chest movements: randomised trial. BMJ. 2010; 341: c5943. doi: 10.1136/bmj.c5943. ",{"text":10337,"type":295,"marks":10338},"https://www.bmj.com/content/341/bmj.c5943.long",[10339],{"type":407,"attrs":10340},{"href":10337,"uuid":53,"anchor":53,"custom":10341,"target":714,"linktype":715},{},{"type":15,"attrs":10343},{"textAlign":53},{"type":12,"content":10345},[10346],{"type":15},{"id":16,"_uid":10348,"items":10349,"component":1413},"adb144e7-de96-4dff-a076-4e5f2fcb9989",[10350],{"_uid":10351,"link":10352,"image":10357,"title":1405,"component":1406,"description":10359},"184e93a3-c17d-4fae-ac00-8873149699ce",[10353],{"_uid":10354,"link":10355,"label":1399,"component":1400},"55bcf2c5-5811-448b-bd61-5c9cc1c943d0",{"id":275,"url":16,"linktype":413,"fieldtype":716,"cached_url":303,"story":10356},{"name":270,"id":274,"uuid":275,"slug":9,"url":303,"full_slug":303,"_stopResolving":301},{"id":1402,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1403,"copyright":16,"fieldtype":284,"meta_data":10358,"is_external_url":286},{},{"type":12,"content":10360},[10361],{"type":15,"attrs":10362,"content":10363},{"textAlign":53},[10364],{"text":294,"type":295},[115,143,122,129,136,150,157],[185,192,200],"selected-serious-events","resources/selected-serious-events",-18950,[],"d4718664-7142-426f-9e70-45e55c46f75f","2025-12-12T14:31:47.816Z",[],[10375],{"path":10376,"name":10377,"lang":315,"published":301},"ressources/accidents-graves-selectionnes","Accidents graves sélectionnés",{"name":10379,"created_at":10380,"published_at":10381,"updated_at":10382,"id":10383,"uuid":10384,"content":10385,"slug":11147,"full_slug":11148,"sort_by_date":53,"position":11149,"tag_list":11150,"is_startpage":286,"parent_id":1421,"meta_data":53,"group_id":11151,"first_published_at":11152,"release_id":53,"lang":309,"path":53,"alternates":11153,"default_full_slug":11148,"translated_slugs":11154},"Pressure Ulcer","2025-12-11T14:57:40.899Z","2026-03-10T16:16:52.898Z","2026-03-10T16:16:52.952Z",121960288027478,"2f9e7679-619b-44f7-b4b9-403209ee131a",{"new":286,"seo":10386,"_uid":4831,"hero":10387,"type":174,"topics":10411,"Noindex":286,"content":10412,"audience":11145,"duration":16,"regional":11146,"component":1416},{"_uid":8502,"title":10379,"plugin":339,"og_image":16,"og_title":16,"description":340,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},[10388],{"_uid":4834,"image":10389,"title":10391,"format":10392,"component":353,"description":10395,"key_learning":10405,"prerequisite":10408},{"id":346,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":347,"copyright":16,"fieldtype":284,"meta_data":10390,"is_external_url":286},{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: Pressure Ulcer",{"type":12,"content":10393},[10394],{"type":15},{"type":12,"content":10396},[10397],{"type":15,"attrs":10398,"content":10399},{"textAlign":53},[10400],{"text":10401,"type":295,"marks":10402},"A pressure ulcer is a localized injury to the skin and/or underlying tissue, usually over a bony prominence as a result of pressure, or pressure in combination with shear and or friction (IHI, n.d.; RNAO, 2011).",[10403],{"type":298,"attrs":10404},{"color":5499},{"type":12,"content":10406},[10407],{"type":15},{"type":12,"content":10409},[10410],{"type":15},[76,8],[10413,10424,10579,10845,10877,10931,10955,11127],{"_uid":4880,"link":10414,"image":10415,"title":374,"video_id":16,"component":375,"media_type":376,"description":10417,"video_title":16},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":284,"meta_data":10416},{},{"type":12,"content":10418},[10419],{"type":15,"attrs":10420,"content":10421},{"textAlign":53},[10422],{"text":10423,"type":295},"To reduce the incidence of new or worsening pressure ulcers in hospital.",{"_uid":4892,"content":10425,"component":701},[10426],{"_uid":4895,"content":10427,"component":700},{"type":12,"content":10428},[10429,10433,10444,10449,10454,10500,10505,10510,10515,10519,10524,10526,10531,10536,10541,10545,10557,10562,10574],{"type":392,"attrs":10430,"content":10431},{"level":394,"textAlign":53},[10432],{"text":4902,"type":295},{"type":15,"attrs":10434,"content":10435},{"textAlign":53},[10436,10437,10443],{"text":402,"type":295},{"text":404,"type":295,"marks":10438},[10439],{"type":407,"attrs":10440},{"href":409,"uuid":410,"anchor":53,"custom":10441,"target":412,"linktype":413,"story":10442},{},{"name":404,"id":415,"uuid":410,"slug":416,"url":417,"full_slug":417,"_stopResolving":301},{"text":419,"type":295},{"type":15,"attrs":10445,"content":10446},{"textAlign":53},[10447],{"text":10448,"type":295},"A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated (European Pressure Ulcer Advisory Panel et al., 2019). Pressure ulcers cause considerable harm to patients, hindering functional recovery, frequently causing pain, and the development of serious infections. Pressure ulcers have also been associated with an extended length of stay, sepsis, and mortality (IHI, n.d.).",{"type":15,"attrs":10450,"content":10451},{"textAlign":53},[10452],{"text":10453,"type":295},"Pressure ulcers are also known as bed sores and are categorized in four stages:",{"type":442,"content":10455},[10456,10467,10478,10489],{"type":445,"content":10457},[10458],{"type":15,"attrs":10459,"content":10460},{"textAlign":53},[10461,10465],{"text":10462,"type":295,"marks":10463},"Stage I",[10464],{"type":1035},{"text":10466,"type":295},": The skin is a slightly different colour, but there are no open wounds",{"type":445,"content":10468},[10469],{"type":15,"attrs":10470,"content":10471},{"textAlign":53},[10472,10476],{"text":10473,"type":295,"marks":10474},"Stage II",[10475],{"type":1035},{"text":10477,"type":295},": The skin breaks open and an ulcer forms",{"type":445,"content":10479},[10480],{"type":15,"attrs":10481,"content":10482},{"textAlign":53},[10483,10487],{"text":10484,"type":295,"marks":10485},"Stage III",[10486],{"type":1035},{"text":10488,"type":295},": The sore becomes worse and creates a crater in the tissue",{"type":445,"content":10490},[10491],{"type":15,"attrs":10492,"content":10493},{"textAlign":53},[10494,10498],{"text":10495,"type":295,"marks":10496},"Stage IV",[10497],{"type":1035},{"text":10499,"type":295},": The sore is very deep causing extensive damage; these sores can harm muscle, bone, and tendons",{"type":15,"attrs":10501,"content":10502},{"textAlign":53},[10503],{"text":10504,"type":295},"Any stage III or stage IV pressure ulcer acquired after admission to hospital are designated as 'Never Events'. Stage III and IV ulcers can lead to serious complications such as infections of the bone or blood (sepsis) (CPSI, 2015).",{"type":15,"attrs":10506,"content":10507},{"textAlign":53},[10508],{"text":10509,"type":295},"Pressure ulcers (PU) continue to be a significant health concern as the population ages and the complexity of care increases across all care settings (RNAO, 2011). A literature review done in Canada in 2004 found that the overall prevalence of pressure ulcers across all institutions studied was 26 per cent. Although 50 per cent of these were Stage 1 ulcers, this data is still disturbing (Woodbury & Houghton, 2004). The total net adjusted hospitalization cost of a hospital-acquired PU in Ontario was CA $44,000 to $90,000, compared with CA $11,000 to $18,500 for a pre-admission PU (Chan et al., 2013).",{"type":15,"attrs":10511,"content":10512},{"textAlign":53},[10513],{"text":10514,"type":295},"Accreditation Canada has included pressure ulcer prevention as a Required Organizational Practices (ROP) in its 2020 handbook, the guidelines specify that pressure ulcer prevention strategies require an inter-disciplinary approach and support from all levels of an organization. It is useful to develop a plan to support comprehensive education on pressure ulcer prevention, and to designate individuals to facilitate the implementation of a standardized approach to risk assessments, the uptake of best practice guidelines, and the coordination of healthcare teams (Accreditation Canada, 2020).",{"type":392,"attrs":10516,"content":10517},{"level":437,"textAlign":53},[10518],{"text":7536,"type":295},{"type":15,"attrs":10520,"content":10521},{"textAlign":53},[10522],{"text":10523,"type":295},"Assessment of certain categories of patients requires that the clinician be aware of and assess for specific factors that may increase risk for skin breakdown or affect healing of pressure injuries. Advancing age, decline of general nutritional and mental status, decreased mobility, sensory perception deficits, incontinence and the changing characteristics of the skin have been identified as a predictor of pressure-related injuries. Risk is increased for those with hypotension, contractures, or a history of cerebral vascular accident. Pressure injury incidence and prevalence rates remain higher in critical care areas due to the numbers of severely compromised patients. In the severely obese it can be challenging to assess skin and visualize all bony prominences. Surgical patients have an especially high risk of developing intra-operative pressure injuries due to the prolonged pressure from immobility during the intra-operative and immediate post-operative periods. In many terminally ill patients, multiple factors and co-morbid conditions increase their risk for the development of pressure injuries and need to be identified (Norton et al., 2018).",{"type":15,"attrs":10525},{"textAlign":53},{"type":392,"attrs":10527,"content":10528},{"level":394,"textAlign":53},[10529],{"text":10530,"type":295},"Importance to Patients and Families ",{"type":15,"attrs":10532,"content":10533},{"textAlign":53},[10534],{"text":10535,"type":295},"Patients rightfully expect safe care, and healthcare providers strive to deliver care that results in better health and safe, effective outcomes for patients. Unfortunately, events that harm patients do occur while care is being provided, or as a result of that care. While risk is an inherent part of care, we know that many of these events that cause harm can be prevented using current knowledge and practices. (CPSI, 2015).",{"type":15,"attrs":10537,"content":10538},{"textAlign":53},[10539],{"text":10540,"type":295},"Patients and families are aware that pressure ulcers are painful and slow to heal; and that ulcers are often seen as an indication of poor quality of care. When caregivers practice the best care every time, patients can avoid needless suffering (IHI, 2012).",{"type":392,"attrs":10542,"content":10543},{"level":437,"textAlign":53},[10544],{"text":1812,"type":295},{"type":15,"attrs":10546,"content":10547},{"textAlign":53},[10548,10555],{"text":10549,"type":295,"marks":10550},"The Swans' Story (patient video)",[10551],{"type":407,"attrs":10552},{"href":10553,"uuid":53,"anchor":53,"custom":10554,"target":714,"linktype":715},"https://www.youtube.com/watch?feature=player_embedded&v=IJ8FEhE561Y",{},{"text":10556,"type":295}," (NHS Midlands and East, 2012)",{"type":15,"attrs":10558,"content":10559},{"textAlign":53},[10560],{"text":10561,"type":295},"Richard developed an avoidable pressure ulcer during respite at a nursing home. The experience has inspired him, together with his caregiver and wife Doreen, to help inform and educate in the hope that together we can eliminate avoidable pressure ulcers.",{"type":15,"attrs":10563,"content":10564},{"textAlign":53},[10565,10572],{"text":10566,"type":295,"marks":10567},"Pressure Injury Prevention – Jessie's Story (patient video) ",[10568],{"type":407,"attrs":10569},{"href":10570,"uuid":53,"anchor":53,"custom":10571,"target":714,"linktype":715},"https://www.youtube.com/watch?v=crh9ALyiC5Y",{},{"text":10573,"type":295},"(AHS Channel, 2019)",{"type":15,"attrs":10575,"content":10576},{"textAlign":53},[10577],{"text":10578,"type":295},"Jessie tells his story of his spinal cord injury leading to his experience with multiple pressure injuries and prevention.",{"_uid":5203,"items":10580,"title":918,"component":760,"description":10807},[10581],{"_uid":5206,"title":773,"ctaLeft":10582,"ctaRight":10583,"component":718,"columnLeft":10584,"columnRight":10597},[],[],{"type":12,"content":10585},[10586],{"type":15,"attrs":10587,"content":10588},{"textAlign":53},[10589,10590,10596],{"text":782,"type":295},{"text":787,"type":295,"marks":10591},[10592],{"type":407,"attrs":10593},{"href":409,"uuid":410,"anchor":53,"custom":10594,"target":412,"linktype":413,"story":10595},{},{"name":404,"id":415,"uuid":410,"slug":416,"url":417,"full_slug":417,"_stopResolving":301},{"text":699,"type":295},{"type":12,"content":10598},[10599,10604],{"type":15,"attrs":10600,"content":10601},{"textAlign":53},[10602],{"text":10603,"type":295},"If your review reveals that your cases of Pressure Ulcer/Injury are linked to specific processes or procedures, you may find these resources helpful:",{"type":442,"content":10605},[10606,10645,10668,10684,10738,10778],{"type":445,"content":10607},[10608,10617],{"type":15,"attrs":10609,"content":10610},{"textAlign":53},[10611,10612],{"text":8878,"type":295},{"text":1863,"type":295,"marks":10613},[10614],{"type":407,"attrs":10615},{"href":1863,"uuid":53,"anchor":53,"custom":10616,"target":714,"linktype":715},{},{"type":442,"content":10618},[10619,10632],{"type":445,"content":10620},[10621],{"type":15,"attrs":10622,"content":10623},{"textAlign":53},[10624,10626],{"text":10625,"type":295},"Chou R, Dana T, Bougatsos C, Blazina I, Starmer A, Reitel K. et al. Pressure ulcer risk assessment and prevention: comparative effectiveness. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ); 2013. ",{"text":10627,"type":295,"marks":10628},"http://www.ncbi.nlm.nih.gov/books/NBK143579/",[10629],{"type":407,"attrs":10630},{"href":10627,"uuid":53,"anchor":53,"custom":10631,"target":714,"linktype":715},{},{"type":445,"content":10633},[10634],{"type":15,"attrs":10635,"content":10636},{"textAlign":53},[10637,10639],{"text":10638,"type":295},"Preventing Pressure Ulcers in Hospital (content last reviewed 2014) ",{"text":10640,"type":295,"marks":10641},"https://www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/index.html",[10642],{"type":407,"attrs":10643},{"href":10640,"uuid":53,"anchor":53,"custom":10644,"target":714,"linktype":715},{},{"type":445,"content":10646},[10647,10652],{"type":15,"attrs":10648,"content":10649},{"textAlign":53},[10650],{"text":10651,"type":295},"British Columbia Provincial Nursing Skin and Wound Committee. https://www.clwk.ca/communities-of-practice/skin-wound-community-of-practice/",{"type":442,"content":10653},[10654,10661],{"type":445,"content":10655},[10656],{"type":15,"attrs":10657,"content":10658},{"textAlign":53},[10659],{"text":10660,"type":295},"Guideline: Prevention of Pressure Injury in Adults & Children, BC; 2018. https://www.clwk.ca/buddydrive/file/guideline-prevention-of-pressure-injuries-2017-november-final/",{"type":445,"content":10662},[10663],{"type":15,"attrs":10664,"content":10665},{"textAlign":53},[10666],{"text":10667,"type":295},"Guideline: Prevention of skin breakdown due to pressure, friction, shear, and moisture in adults & children. BC; 2016. https://www.clwk.ca/buddydrive/file/guideline-prevention-of-skin-breakdown-2016-october/       ",{"type":445,"content":10669},[10670,10675],{"type":15,"attrs":10671,"content":10672},{"textAlign":53},[10673],{"text":10674,"type":295},"Ontario Neurotrauma Foundation https://onf.org/",{"type":442,"content":10676},[10677],{"type":445,"content":10678},[10679],{"type":15,"attrs":10680,"content":10681},{"textAlign":53},[10682],{"text":10683,"type":295},"Houghton PE, Campbell KE, CPG Panel. Canadian Best Practice Guidelines for the Prevention and Management of Pressure Ulcers in People with Spinal Cord Injury: A Resource Handbook for Clinicians. 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Implementation of Turning Clocks for Pressure Ulcer Prevention and Management. HSO Leading Practices Library. Published January 8, 2015. Accessed January 1, 2021. ",{"text":10948,"type":295,"marks":11047},[11048],{"type":407,"attrs":11049},{"href":10948,"uuid":53,"anchor":53,"custom":11050,"target":714,"linktype":715},{},{"type":15,"attrs":11052},{"textAlign":53},{"type":445,"content":11054},[11055,11060],{"type":15,"attrs":11056,"content":11057},{"textAlign":53},[11058],{"text":11059,"type":295},"Institute for Healthcare Improvement. How-to Guide: Prevent Pressure Ulcers. Cambridge, MA: IHI; 2011. http://www.ihi.org:80/resources/Pages/Tools/HowtoGuidePreventPressureUlcers.aspx",{"type":15,"attrs":11061},{"textAlign":53},{"type":445,"content":11063},[11064,11069],{"type":15,"attrs":11065,"content":11066},{"textAlign":53},[11067],{"text":11068,"type":295},"Institute for Healthcare Improvement. IHI Improvement Map: Prevention of Pressure Ulcers. Cambridge, MA: IHI; 2012. 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