





We round up our top 10 blog posts of 2010, so that you can review what’s peaked the interest of you and your colleagues!
Policies and procedures seem to be increasingly lumped into one bucket, and they shouldn’t be! Click here to read more.
How do you find a patient captain to run your policy and procedure ship? Click here to read more.
How do the IOM’s 6 aims of improvement apply to policy management. Click here to read more.
Download the 10 qualities of good policies as a resource to help you write policies that staff will read. Click here to read more.
How to make your nurses happy to contribute to policy revisions. Click here to read more.
What happens when a patient asks a nurse to bring him/her a copy of the policy? Click here to read more.
How to navigate the difficult process of assessing your hospital’s policy management process for gaps. Click here to read more.
Why nurses don’t contribute to policy revisions, and how to overcome that. Click here to read more.
How to bring together hospital policy and practice to minimize falls. Click here to read more.
Taking a proactive culture for patient safty, outside the realms of regulatory bodies. Click here to read more.

| NEJM 2010; 362 (18):1698-1707 | May 6, 2010 |
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Background Serious medication errors are common in hospitals and often occur during order transcription or administration of medication. To help prevent such errors, technology has been developed to verify medications by incorporating bar-code verification technology within an electronic medication-administration system (bar-code eMAR).
Methods We conducted a before-and-after, quasi-experimental study in an academic medical center that was implementing the bar-code eMAR. We assessed rates of errors in order transcription and medication administration on units before and after implementation of the bar-code eMAR. Errors that involved early or late administration of medications were classified as timing errors and all others as nontiming errors. Two clinicians reviewed the errors to determine their potential to harm patients and classified those that could be harmful as potential adverse drug events.
Results We observed 14,041 medication administrations and reviewed 3082 order transcriptions. Observers noted 776 nontiming errors in medication administration on units that did not use the bar-code eMAR (an 11.5% error rate) versus 495 such errors on units that did use it (a 6.8% error rate) — a 41.4% relative reduction in errors (P<0.001).> (other than those associated with timing errors) fell from 3.1% without the use of the bar-code eMAR to 1.6% with its use, representing a 50.8% relative reduction (P<0.001).> errors in medication administration fell by 27.3% (P<0.001), but the rate of potential adverse drug events associated with timing errors did not change significantly. Transcription errors occurred at a rate of 6.1% on units that did not use the bar-code eMAR but were completely eliminated on units that did use it.
Conclusions Use of the bar-code eMAR substantially reduced the rate of errors in order transcription and in medication administration as well as potential adverse drug events, although it did not eliminate such errors. Our data show that the bar-code eMAR is an important intervention to improve medication safety. (ClinicalTrials.gov number, NCT00243373 [ClinicalTrials.gov] .)| Stanford 25: Fundamental, Technique-Dependent Physical Diagnosis Skills |
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| 1. Funduscopic exam, papilledema etc. using panoptic and regular ophthalmoscopes |
| 2. Pupillary responses and relevant anatomy |
| 3. Thyroid exam technique |
| 4. Examination of neck veins/JVD for both level (volume) and common abnormal wave forms; tricuspid regurgitation (ventricularization of ‘v’ waves); canon ‘a’ waves, etc |
| 5. Lung: Surface anatomy, percussion technique, finding upper border of liver dullness, finding Traube’s space |
| 6. Evaluation of PMI, parasternal heave, and other precordial movements |
| 7. Examination of the liver |
| 8. Palpation, percussion of spleen |
| 9. Evaluation of common gait abnormalities |
| 10. The ankle jerk: if performed in a recumbent patient, one must have the right technique for each of the reflexes. |
| 11. Stigmata of liver disease from head to foot: be able to list, identify, and demonstrate |
| 12. Internal capsule stroke: list, identify, and demonstrate common physical findings: lower facial weakness, distal motor weakness, hyperreflexia, absent abdominal reflex on that side, abnormal plantar (Babinski) and abnormal tone, etc |
| 13. Knee exam |
| 14. Cardiac second sounds: splitting, wide splitting and paradoxical spitting |
| 15. Evaluation of involuntary movements such as tremors, etc. |
| 16. The Hand in Diagnosis: recognize clubbing, cyanosis, other common nail and hand findings |
| 17. The Tongue in Diagnosis |
| 18. Shoulder exam (specifically testing rotator cuff tears, ac joint, etc.) |
| 19. Blood pressure assessment (this is more technique-driven than health care workers realize), Pulsus paradoxus assessment |
| 20. Cervical Lymph node assessment |
| 21. Ascites detection and abdominal Venous patterns |
| 22. Rectal Exam |
| 23. Evaluation of scrotal mass - differential between hydrocele, varicocele, spermatocele, testicular mass, etc. |
| 24. Cerebellar Testing |
| 25. Bedside Ultrasound ¿Quien se atreve a comentarlo? Venga, animos.....! |


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