CT Center for Patient Safety
CT Center for Patient Safety Newsletter

July 2016
In This Issue
July Health Hint

Bee Stings:

According to the Mayo Clinic, ordinary bee stings that do not cause an allergic reaction can most often be treated at home. Multiple stings or an allergic reaction can be a medical emergency and may require immediate treatment.

For minor reactions, the Mayo Clinic recommends that you:
  • Remove the stinger as soon as you can, as it takes only seconds for all of the venom to enter your body. Get the stinger out any way you can, such as with your fingernails or a tweezer.
  • Wash the sting area with soap and water.
  • Apply cold compresses or ice to relieve pain and ease swelling.
For stings that have a large local reaction with swelling and itching:
  • Remove the stinger as soon as possible.
  • Wash the area with soap and water.
  • Apply cold compresses or ice.
  • Apply hydrocortisone cream or calamine lotion to ease redness, itching or swelling.
  • If itching or swelling is bothersome, take an oral antihistamine that contains diphenhydramine (Benadryl) or chlorpheniramine (Chlor-Trimeton).
  • Avoid scratching the sting area. This will worsen itching and swelling and increase your risk of infection.
This is not medical advice.  For allergic reactions or any reaction that you have a question or concern about, seek immediate medical advice.
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The Joint Commission on "Busting the Myths about Engaging Patients and Families in Patient Safety"

The Commonwealth Fund on "Controlling Rising Drug Costs"

Next Avenue on "5 Things to Do During and After a Hospital Stay"

STAT on "Butter Doesn't Increase Risk of Heart Disease at All"

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Dear Members, 

Although summertime often sees a slowdown in many sectors, we are as busy as ever! 

Our fiscal year has just ended and I can look back with great pride at the various projects that we were involved in.  Of great significance, our educational program, whereby we offer workshops on patient safety to nursing students expanded and we spoke with more future nurses than ever before.  We continue this program into the summer and are already booking workshops for the fall semester.  We are also continuing our interdisciplinary 1/2 day workshop sharing the patient perspective and patient safety strategies with medical students, nursing students and other health science students.  By educating these future leaders, we believe that we are influencing changes to the culture of patient safety in healthcare and our healthcare institutions for years to come.

Our membership is increasing all the time with new "likes" on Facebook and new followers on Twitter and more subscribers to our newsletter.  Social media is a powerful tool and we are capturing that power on an ongoing basis.  Our presence and influence is expanding through our opportunities to address larger and more diverse audiences.  Our speaking engagements this past year included giving the keynote address at the Hartford Business Journal Healthcare Heroes Award Luncheon and speaking on a panel at the Crain's New York Health Care Summit.  Later this year, I will be speaking about shared decision making at the World Congress Patient Engagement and Experience Summit. All of these opportunities advance the changing culture of health care and consequently benefit Connecticut residents.  We continue our presence speaking with policy leaders throughout the state and participating on various boards, committees and panels as well.

One additional area that we will be focusing on during this coming year will be further developing our volunteer program.  We are planning to provide patient advocate workshops and to create a team of advocates who are positioned to speak to others on patient safety issues and to better advocate for themselves, friends and family.  We welcome you to contact us if you are interested.

Wishing everyone a happy, healthy and safe summer, 
Lisa Freeman
What are Fluoroquinolones and why do they matter?
Guest Contributor, Rachel Brummert is the Executive Director of the Quinolone Vigilance Foundation

As I walked across a parking lot to my car, I felt it and heard it.
It sounded like a rubber band snapped, and searing pain radiated from my heel to my mid-calf. My right foot gave out from under me and I fell to the ground, scraping my hands as I tried to break my fall.
My Achilles tendon ruptured and balled up in my calf. After the swelling went down, I had surgery to repair it, followed by months of grueling physical therapy. 
As I was recovering from that injury, my Achilles tendon in my other ankle- my left ankle- ruptured also. A year after that second injury, I ruptured my Achilles tendon in my left ankle again; this time above the previous rupture, and I required reconstructive surgery. 
My orthopedic surgeon was baffled as to why I ruptured my Achilles tendons three times in less than three years. As we went over my medical history to try to get to the bottom of it, I mentioned the suspected sinus infection I had in 2016 and that I was given an antibiotic called Levaquin roughly a month before the first tendon rupture.
He stopped writing in my chart, sat down on the exam table next to me, and told me that Levaquin is a fluoroquinolone antibiotic and that they are linked to tendon ruptures.
When I got home from that appointment, I did some research and discovered that he was right. Neither the prescribing physician nor my pharmacist informed me of the risks, and I found out the hard way just how dangerous they can be. 
Since 2006, I have suffered ten tendon ruptures, peripheral neuropathy, cardiomyopathy, tinnitus, tremors, brain fog, memory loss, seizures, and a host of other adverse reactions from Levaquin; the most serious of which is a progressive neurodegenerative disorder. The Food and Drug Administration knew of the risk of fluoroquinolone-induced neurodegenerative disorders and never told doctors or patients of this risk. Had it not been for a Freedom of Information request, that FDA document warning of that risk may never have seen the light of day. 
Adverse reactions to fluoroquinolone antibiotics are not rare. Millions of patients around the globe have been prescribed these toxic medications and were never warned of the risks. These reactions can occur within hours with as little as one pill, or reactions can be delayed by days, weeks, months, and longer. Even patients who never suffered adverse reactions from Levaquin, Cipro, Avelox, and other fluoroquinolones in the past can suddenly suffer adverse reactions, which may be permanent. Fluoroquinolones come in a variety of forms: pills, ear drops, eye drops, IV, and  inhaled, and all carry the same risks. 
They were manufactured for the treatment of life threatening infections, yet are commonly prescribed for routine, uncomplicated infections such as sinus, urinary tract, and bronchial infections. 
So many people have become injured and disabled after taking fluoroquinolone antibiotics that the Food and Drug Administration held a hearing on November 5, 2015.  I, and other victims who gave testimony, shared how we suffered preventable, horrific harm because of an inappropriately prescribed antibiotic. On May 12, 2016, the FDA acknowledged that the risks of fluoroquinolone antibiotics outweigh the benefits for sinus, bronchial, and urinary tract infections; they issued a warning that fluoroquinolone antibiotics should not be prescribed for those conditions and should be reserved for complicated, life-threatening infections, or infections for which all other treatment options have been exhausted. You can read the actual FDA warning here: (http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm500665.htm
When it comes to healthcare and prescriptions, there should be more transparency. Patients have the right to be warned of life-altering adverse reactions associated with the medications they are prescribed. For many of us, it could have saved us from injury and disability. And it could have saved those who tragically lost their lives, and the pain of those they left behind.
Sometimes the treatment causes more harm than the illness, and that is unacceptable.
For more information, and for a comprehensive list of currently prescribed fluoroquinolone antibiotics and their associated adverse reactions, please visit:  www.SaferPills.org
Disposing of Prescription Medicines and Over-the-Counter (OTC) Products & Sharps

 Do not flush prescription medicines or OTC products down the sink or toilet!
Although using the toilet or sink prevents someone from accidentally taking the medications, disposing of them in this way causes water pollution and has adverse effects on septic systems, sewage treatment plants, fish and other aquatic wildlife. Trace amounts of all kinds of drugs have also been found in some drinking water supplies because they pass through septic systems and sewage plants untreated. 

Safe Disposal Options
Consumers have several options for disposing of prescription medications and OTC products safely. By using these options, you will protect your privacy, discourage unintended consumption of the drugs and protect our water.
Remember to follow these instructions for pet medications, too!
  • Follow the disposal instructions in English or disposal instructions in Spanish and put them in the trash. In CT, most of our trash is burned at Resource Recovery Facilities at high temperatures which destroy these products.
  • Many police stations now have a Drop Box Drug Disposal program. Residents  can discard their unwanted or unused medicines in special locked boxes any time the police department lobby is open. Residents do not need to complete forms or answer questions about the items they drop off. (Needles or liquid medications are not accepted.) Check with your local police department to see if they are participating.  A NEW pharma-disposal drop box locator tool has been developed by Citizen's Campaign for the Environment.
  • Chain pharmacies such as CVS, Walgreens and Rite Aid provide disposal envelopes for prescription and over the counter medicines for a small fee. Ask your pharmacist for details and program restrictions.  Find a pharmacy
  • Bring them to a special collection sponsored by the federal government or town. These are not regularly scheduled and are sometimes only open to residents of the sponsoring town. (Medicines are not accepted at Household Hazardous Waste collections.)
  • Sharps (insulin needles and lancets):
    • Place in a puncture-proof, hard plastic container with a screw-on cap, like a bleach or detergent bottle.
    • Seal the container with the original lid and wrap with duct tape.
    • Place the tightly sealed container in a bag and put it in your trash. DO NOT put the container in your recycling bin!
    • As an alternative, there is a product called BD Safe-ClipNeedle Clipping & Storage Device and you can look into mail back programs or check with your local hospital or pharmacist.

Resolution, When Medical Harm Occurs
Whenever I talk with a patient or a family member who has experienced medical error or negligence, they prioritize the importance of having immediate, full and honest disclosure about the event as one of the most important things to them. Most of those who have experienced this understand that regardless of how much we do to prevent them, medical errors will occur, although hopefully at a MUCH lesser rate than today. However, after an event leading to harm, or even a near miss occurs, ignoring the family by not being fully transparent simply devalues the human lives involved. 

CANDOR is one program, though by no means the only one, that addresses and spells out a process for identification, transparency, investigation, education, and resolution of these events. Many of these initiatives to respond to patient harm events are based on the immediate acknowledgement that a patient harm event has occurred and include several distinct steps.  

First, the patient must be stabilized.  This should be followed by the patient and/or their family being informed of what has occurred along with any care options that now need to be considered.  We often talk about shared decision making taking place between a patient and their health care provider before treatment options are put into place and usually occurring in the office.  However, when something goes wrong, the treatment options may change and this is again time for the patient and their family to be involved in care choices and decisions wherever possible.  From this moment forward, the patient and their family should be offered any necessary support and should be kept informed of the progress.  The healthcare provider has the responsibility to alert their superiors as well.  It is also important to acknowledge that depending on the circumstances, clinicians may also need support and the facility should be certain to offer that.  Following this, or perhaps simultaneously, an investigation should begin, often with a pre-established response team somewhat akin to the "Go Team" assembled by the NTSB when there is an airplane accident.  The family should be involved in the event review which needs to take place immediately afterwards while the environment is still intact and people's memories are still fresh. These must become learning moments that are transparent and shared so that the errors do not recur and others are not unnecessarily harmed or die.  After the facts are known, many patients want to see a resolution that can make them "whole" again.  Hospitals and physicians will undoubtedly have legal counsel throughout this process, though the emphasis should be on patient safety and achieving the highest quality of health care.  Patients should always retain the right to access their own legal counsel as well (There are some resolution programs that actually discourage this.). Our hope is that through a changing culture surrounding health care safety and one in which everyone feels safe to speak up and voice their concerns and share their experiences, learning will take place and medical harm events will become the exception rather than an all to common occurrence.
How Retail Health Clinics are Changing the Face of Health Care Delivery
Over the past year or so, as the delivery of health care has been changing, we have seen changes in the types of providers who give us care and we have seen changes in the locations where we get our care.  We have also seen the ownership of health care practices changing.  For some readers, you might remember back to childhood when your pediatrician or perhaps your family doctor not only saw you in a single provider practice, but perhaps even made house calls.  S/he or an associate was the on-call doc around the clock for urgent care.  The hospital emergency room was reserved for only the most emergent care.  Today, life is more complex, many families have two working parents, and there are other more convenient options from which to obtain health care.

Many people are finding the convenience of a walk-in retail clinic for diagnosis and treatment of common, every day illnesses the option of choice.  These locations are open longer hours than the average physician's office and they are located within our communities among the stores that we tend to go to every day.  Perhaps surprisingly, hospital emergency rooms are also a go-to for people who need care after their doctor's office is closed, although outside of real emergency care, this is not encouraged. Interestingly enough, according to a survey done by the Commonwealth Fund, Americans still get their after-hours care in emergency rooms more than those in most other industrialized nations.  To answer this problem of convenient access, may urgent care centers, often affiliated with hospitals, are popping up throughout communities.

The concern that many primary care physician groups have with these independent provider options is that they fragment care and often lack individual patient knowledge.  In response to this concern, and the obvious loss of business, primary care groups are redesigning their model of care and are doing things like expanding their hours to accommodate working parents and adults.  As medical records are becoming more portable between practices, however, the fragmentation is also slightly lessening.  There have been studies examining the quality of care that have shown that the "aggregate quality scores were similar" between retail clinics, physicians' offices and urgent care centers (2009 study in the Annals of Internal Medicine).  Yet we must remember that the majority of medical harm events involve a communication breakdown and when care is fragmented and occurring across multiple venues, the likelihood of this occurring is greater.  It is also interesting to note that while the cost per visit is lower at the retail clinics, people are using them for less severe conditions that they weren't seeking professional care for in the past.  As a result, their existence has been associated with an increase in consumer health care spending rather than an overall savings. The balancing act between convenience and appropriate care is a hard one to master and we will see new designs of health care delivery down the road to do so.