Clinicians encounter distractions in healthcare settings on a nearly continuous basis, and these distractions pose a constant threat to patient safety. Analysis of events reported in 2010 and 2011 identified more than 1,000 that could be attributed to distraction, with the majority classified as medication errors.

Obesity is an increasingly prevalent problem that affects the healthcare system and patients. Class III obese patients, in particular, may often require special equipment, different policies, or extra staff in order to ensure appropriate care and patient satisfaction.

To address opioid knowledge gaps among Pennsylvania practitioners, facilities may consider assessing staff understanding of opioids and providing training, specifically regarding assessment of patients for adverse drug reactions, recognizing advancing sedation, and making timely adjustments to the plan of care based on the patient’s risk.

Proactive intervention may provide opportunities to mitigate outbreak risks. Assessment of pathogen, population, and environment (P2E) may help guide infection preventionists as to which pathogens, and in which patient populations, targeted infection prevention measures may be indicated to establish appropriate outbreak prevention strategies.

The six wrong-site procedures reported during the most recent reporting quarter were an all-time low since reporting began in mid-2004. Analysts reviewed 500 wrong-site surgery events to determine the relationship between the type of wrong-site surgery event, the procedure intended, and the location of the intended incision.

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