martes, 4 de agosto de 2015

DoD Patient Safety Program Monthly eBulletin - August 2015

Patient Safety Program Monthly Learning Update header graphic

The DoD Patient Safety Program eBulletin delivers patient safety updates, news, useful tips and resources. This month’s issue spotlights patient safety in the surgical setting. You will also be able to access our latest Sentinel Event Spotlight, and update on the 2015 Quality and Patient Safety awards, information on upcoming educational events and much more. Enjoy!



  • In August, the Military Health System will focus on Preventive Health. Learn more.
  • Did you hear about our Continuing Education vendor news? Be in the know.
  • Access the National Patient Safety Foundation’s “RCA2 - Improving Root Cause Analyses and Actions to Prevent Harm” report here.
  • Access the AHRQ’s Comprehensive Unit-based Safety Program (CUSP) toolkit here.
  • SBAR is a structured communication model for providing patient information. Order SBAR posters here.
  • Access the AHRQ’s Guide to Patient and Family Engagement in Hospital Quality and Safetyhere.
  • Visit the Patient Safety Learning Center (PSLC) to access and share knowledge about patient safety, and collaborate on best practices across the MHS.
  • Featured DoD PSP Toolkit: Professional Conduct.
  • Talk to us! Do you have an update from your facility? Let us know via email or Facebook.
The DoD PSP will continue to offer ongoing learning activities throughout 2015 and will advertise them via the DoD PSP eBulletin, the DoD PSP Calendar of Events and Facebook. We look forward to your participation in these events!

Feature: Surgical Quality Improvement across the MHS – An Update

As part of the Military Health System 90-Day Review, three key milestones were established in support of surgical quality improvement efforts across...Read more

2015 Quality and Patient Safety Awards

The DoD Quality and Patient Safety Award recognizes efforts designed to decrease harm and improve the care delivered within the Military Health Systems. The awards identify...Read more

Evidence-Based Practice Guidelines for Surgical Site Infection Prevention*

To reduce surgical site infection risk, the Institute for Healthcare Improvement developed a How-to Guide: Prevent Surgical Site Infections. The guide provides...Read more

Continuing Education Update: New CE Provider Transition Process Reminder

As we transition to the new CE provider, the Postgraduate Institute for Medicine, we want to remind all instructors, course coordinators, and content planning members that you are...Read more

Sentinel Event Spotlight: Intraoperative Complication – Equipment Failure

This Sentinel Event Spotlight focuses on sentinel events within the MHS related to intraoperative equipment failure. The expanding utilization of...Read more

PSR Data Pulse Update

Released on the 16th of every month, this report offers a snapshot of PSR events reported. This one page document provides a...Read more

Upcoming Events

Attention! Effective 30 June, 2015, the Postgraduate Institute for Medicine (PIM) will begin accreditation for patient safety activities across the MHS. Learn more.

Patient Safety Learning Circles:
In-person or web-based forums focused on a specific topic
Health IT Safety Center Webinar Series – The Office of the National Coordinator for Health Information Technology
December 2014 through December 2015
This is a series covering a wide range of patient safety topics and will feature prominent quality and patient safety experts from across the U.S. Do not miss out!
Reevaluating the Safe Use of Opioids - National Patient Safety Foundation**
6 August, 2015 from 1pm to 2pm EST
Learning Objectives: At the end of the session, participants will be able to:
  • Identify safety issues associated with current pain assessment modalities
  • Identify patients at increased risk for opioid-related adverse events
  • Discuss risks/benefits/techniques of multimodal analgesia in the perioperative period
Featured Speaker:
Roy G. Soto, MD
Oakland University William Beaumont School of Medicine
Residency Program Director
Department of Anesthesiology
Implementation of TeamSTEPPS® in a High Acuity Environment: A Multifaceted Approach in MetroHealth's Emergency Department – Agency for Healthcare Research and Quality
12 August, 2015 from 1pm to 2pm EST
This complimentary AHRQ is webinar will focus on the use of the agency's teamwork training program, TeamSTEPPS. Thomas P. Noeller, MD FAAEM FACEP who holds roles as an associate professor at Case Western Reserve University School of Medicine, director of the MetroHealth Simulation Center and attending physician in the Department of Emergency Medicine at MetroHealth Medical Center and Robert L. Smith, PhD the director of Medical Staff Assistance Program at MetroHealth Medical Center will present on the following objectives:
  • Identify teamwork intervention targets in a high acuity environment
  • Apply TeamSTEPPS principles to address identified needs
  • Describe a multifaceted program that includes practical and sustainable applications of TeamSTEPPS principles.
Developing and Measuring Corrective Actions – Patient Safety Analysis Center
19 August, 2015 from 3:30pm to 4:30pm EST
After attending this Learning Circle, learners will better understand how to develop and implement stronger corrective actions to mitigate risk associated with identified factors contributing to a patient safety event.
Key elements in determining contributing factors for a patient safety event will be addressed, along with tools to assist in the development of strong, sustainable corrective actions and corresponding effectiveness measures.
Note: CE approval pending and registration info coming soon!

Patient Safety Workshops:
Instructor-led or self-paced online learning sessions focused on a specific product
Attention! As part of the transition to the new CE provider, the Postgraduate Institute of Medicine, registrants who take enduring (non-live) training activities will be required to pass a CE test at the end of the activity.

Currently affected courses include on-demand eLearning (Patient Safety Reporting System v1.1 e-Learning Course and Patient Safety Reporting: Intermediate Course) and Focused Reviews.

Until this requirement is resolved and processes established for this new requirement, those courses will be ineligible for CE credit. Certificates of completion (non-CE credit) will still be available for registrants who complete those activities.

Please stay tuned for further updates on this matter.
On-Demand eLearning: Patient Safety Reporting System v1.1 eLearning Course
This course introduces basic navigation and functionality features of the PSR system and the roles of system users, such as event reporters, event handlers, and investigators. The course can be accessed through MHS Learn.
Register now

On-Demand eLearning: Patient Safety Reporting: Intermediate Course*
Targeted to Patient Safety Managers and other MTF staff already familiar with basic functionalities of the Patient Safety Reporting System, this course is designed to help learners hone the decision-making skills needed to effectively manage patient safety event data in PSR, as part of the ongoing effort to eliminate preventable harm at MTFs.
Register now

On-Demand eLearning: Root Cause Analysis*
This self-paced module outlines the Patient Safety Program’s suggested practices for conducting a root cause analysis, from the initial reporting of a patient safety event through the formation of the RCA Team to the identification of contributing factors and root causes and the recommendation of corrective actions.
Register now

*Denotes that activity is eligible for CE credit. All CE credits are managed by Duke University Office of Continuing Medical Education. (Attention! Effective 30 June, 2015, the Postgraduate Institute for Medicine (PIM) will begin accreditation for patient safety activities across the MHS. Learn more)

**Did you know? As an NPSF Stand Up for Patient Safety member, DoD PSP receives complimentary access to webinars as a benefit of program membership. Check with your facility POC to obtain the member coupon code. 

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