Discover and read the best of Twitter Threads about #PatientSafety

Most recents (24)

Dr Katy Sheehan and @ArcBroom present the pick of the posters at #OAA23ASM. 4 criteria for selection of #OBAnes abstracts. ImageImage
A positive start, with the power of positive communication on patient satisfaction, morale & culture, and #patientsafety #OBAnes #OAA23ASM ImageImageImageImage
Barriers to care. Ethnicity, Language and Socioeconomic deprivation. @mbrrace, @TheLancet, and most recently @Anaes_Journal (@LateralTilt @noolslucas @SQuashie @Marianfknight) set the stage. #OBAnes #OAA23ASM ImageImageImageImage
Read 18 tweets
@NoelleHealy (another 🇮🇪 representative - @ISOA_Ireland well represented!) presents on #OBAnes as a team sport - how do we perform better? at #OAA23ASM. Quite an inspiring quote, then setting the stage with @Fionafionakel et al #humanfactors guidelines in @Anaes_Journaltwitter.com/i/web/status/1… ImageImageImage
Why is teamwork important in OB/ #OBAnes? @mbrrace suggests some lessons to be learned. Prompt action is arguably reliant on good communication, within & between teams. Involving consultant/ specialist care early has been a theme for over a decade. #OAA23ASM ImageImageImage
@DOckendenLtd’ final report highlighted “conflicting agendas and poor teamwork” contribute to adverse maternal & neonatal outcomes? So how do we create good teams?

The @JulieAndrews approach may have the hills alive, but for #OBAnes we may need to start at the very beginning,… twitter.com/i/web/status/1… ImageImage
Read 10 tweets
@emirakur presents an update on @NAPs_RCoA NAP7 Perioperative cardiac arrest & #OBAnes at #OAA23ASM. ImageImage
The history of @NAPs_RCoA projects and key findings for #OBAnes over the years (failed intubation NAP4 1:390, recent US data 1:808 - gotten better or different methodology?) #OAA23ASM ImageImage
Cardiac arrest in pregnancy. CAPS study @BJOGTweets (I see @Marianfknight?) looked at incidence, management & outcomes in UK. #OBAnes have a significant slice of the pie. @SOAPHQ serious complication repository project (incl. @RichSmileyMD @bscottsegal) provide US data: cardiac… twitter.com/i/web/status/1… ImageImageImageImage
Read 11 tweets
Bill Kirkup presents on the independent investigation into East Kent Maternity Services at #Anaesthesia2023 #OBAnes ImageImage
Battled with how to put “In their own words…” together. 4 slides at a time doesn’t cut it. It was a very emotive experience. So I hope this works (Twitter Blue perk)
#Anaesthesia2023 #OBAnes (prelude to #OAA23ASM)
In their own words: FAMILIES.

Midwives, not nurses. They cut me open (@HofkampMichael @emilysharpe @ruthi_landau). He’s singing, then he died. We don’t talk about cesareans. Physician: I’m the doctor. Midwife: we won’t be doing that.

And that last one… apropos of @SQuashie’s… twitter.com/i/web/status/1…
Read 10 tweets
@DOckendenLtd presents at #Anaesthesia2023 on the Ockenden Report - a year on, have we made progress? #OBAnes ImageImage
What were the key messages of the Ockenden Report from @DOckendenLtd? Final report March 2022 (distributed amongst #OBAnes at @IWKHealth @DalAnesthesia - learnings valuable even across the pond): failures of quality of care & governance; failure of external bodies to monitor;… twitter.com/i/web/status/1… ImageImageImageImage
What did the media say? Overall coverage fair, balanced and commended by families.
And Nottingham? Maternity review is underway… themes continue.
#Anaesthesia2023 #OBAnes (prelude to #OAA23ASM) ImageImage
Read 12 tweets
Dr Daniel Katz presents on drug and equipment shortages at @SOAPHQ#SOAPAM2023. He’ll focus on why they occur, how we can prepare and discuss alternatives & substitutions. #OBAnes ImageImage
Why shortages occur (1): Generic drug manufacturing poses strain on supply chains, drugs require precursors (80% manufactured outside US). Supply chain has upstream and downstream components - removing precursors hampers upstream supply chain (before the drug is even… twitter.com/i/web/status/1… ImageImageImageImage
A case study: Fludarabine. Generic 2003: 12 application holders, 6 actively marketing. But who is actually making it? No real time database explaining who is making the product. All May have the precursors stocked. #SOAPAM2023 ImageImageImage
Read 12 tweets
@SOAPHQ and @ASRA_Society joint panel: A tailored approach to the management of the thrombocytopenic patient. With Dr Roulhac Toledano MD moderating Dr Lisa Leffert MD, @MelissaEBauer1 and @dr_melissabyrne Image
@MelissaEBauer1 (@DukeAnesAlumni) kicks off @SOAPHQ @ASRA_Society joint session: How low can you go? Looking at recent @SOAPHQ consensus statement. #SOAPAM2023 ImageImage
With acknowledgment that #OBAnes airway may be difficult, the use of neuraxial with lower platelet counts. 2015 sees rapid increase in literature supporting placement below 100,000. However, @SOAPHQ members requested a consensus statement as institutional policies were slow to… twitter.com/i/web/status/1… ImageImageImageImage
Read 65 tweets
1/n
Kolejny post tylko! edukacyjny (obiecany)
Paracetamol 💊💊💊w preparatach złożonych.
Jak uniknąć przedawkowania ‼️
#PatientSafety
#OpiekaFarmaceutyczna
#PrzeglądLekowy
#EdukacjaFarmacja
@DrKermitHouse @JPrzystajko @s_iwanczak Image
2/n
Wyniki obu sond, które utworzyłam tydzień temu pokazały jasno, że pacjenci nie mają świadomości istnienia paracetamolu w preparacie wieloskładnikowym.
A saszetki są smaczne i służą tylko rozgrzaniu.
Nitka zawiera większość dostępnych leków z ilością paracetamolu na dawkę.
3/n
Zacznę od dzieci.
Nazwa Kidofen Duo jest myląca.
Lek zawiera oprócz ibuprofenu (Kidofen) również paracetamol.
W KIDOFEN DUO - Paracetamol - 125 mg/ 5 ml
Jest to ważne, szczególnie w przypadku naprzemiennego podawania obu subst. w celu zbicia gorączki. Image
Read 25 tweets
@Eltonchris presents at @OAAinfo @SOAPHQ joint session on strategies to implement national & institutional change in response to CEMACH & @mbrrace findings. #OBAnes #SOAPAM2023 Image
@mbrrace the latest in a lineage of maternal mortality reports. Access the latest from November 2022. Delivered annually with a three yearly cycle of focus - #OBAnes due this year. How it works! #SOAPAM2023 ImageImageImageImage
GMC requires participation in confidential enquiries. HSIB the FBI of #patientsafety - less confidential, but mandatory participation. @NHSuk resolution requires reporting. So you know the data is robust. #OBAnes #SOAPAM2023 ImageImageImage
Read 15 tweets
Dr Veronica Gillespie-Bell presents on Addressing the Maternal Health Crisis at #SOAPAM2023 - she speaks fast so bare with a delay 😉 ImageImage
Maternal M&M is a public health crisis. Scope of problem in USA, worst performing developed country, consistently increasing. #OBAnes #SOAPAM2023 ImageImageImageImage
Racial disparity is starkly demonstrated, it’s worsening. Maternity Care deserts is a very real problem (also in Canada). Cardiovascular conditions are leading cause of pregnancy-related deaths. #SOAPAM2023 ImageImageImageImage
Read 13 tweets
"A controversy..which raises uncomfortable questions about the influence of funding from #BigPharma in...Toronto health institutions" - which Dr. Brenda Gallie & I struggled to expose for years

thestar.com/news/investiga…
#Pharma #PatientSafety
👏🙏 @rachelmendleson @TorontoStar
🧵
A long struggle
-2009: @UHN expands use of *unlicensed* drug w/out evidence of #InformedConsent obtained from patients
-2019: UHN conducts a conflicted, internal, confidential 'review' which: "if your aim was to rig the result, is exactly what you would do"
🎯@FearLoathingBTX
/2
How can @UHN claim "appropriate safe care"? During exposure to this *unlicensed* drug over years:
1- Iron levels rose in 50% over the threshold for death
2- 65% patients developed liver injury
3- 17% acquired diabetes
And again, *no informed consent*
thestar.com/news/investiga…
/3
Read 20 tweets
🔥podcast on Pharma billionaire Barry Sherman.
podcasts.apple.com/us/podcast/id1…

As @kathleengoldhar @blandrea outline: this wasn't just about a violent death, but the consequences of #Pharma "partnering" with academia.

🧵on why this matters to any who may ever need a prescription drug.
"Barry Sherman is the only person I have ever met with no redeeming features whatsoever":
🎯Dr. Morton Shulman in macleans.ca/news/canada/ba…
But this was not just a matter of an abrasive personality.
/2
In 1996, I identified problems in the safety of a drug in a clinical trial of *children*, a trial to which Sherman had provided minor funds to obtain patent rights.

He threatened 'all legal remedies' if I published.
I published anyway.

Decades of litigation were to follow.
/3 Image
Read 15 tweets
A journey which started in 2016 has led to the publication of the #PREPARE study in @TheLancet today. In this #randomised study, we show that a 12-gene panel can reduce #adverse_effects by 30%. authors.elsevier.com/c/1gX95V-4XHGbk @CDSS_Liverpool @pandtuol
A 30% reduction in adverse reactions from a single #intervention is remarkable. news.liverpool.ac.uk/2023/02/03/mat… #pharmacogenetics #personalisedmedicine #adverse_effects. The study was funded by the Horizon 2020 program by the @eu_comission
Led by @HenkJGuchelaar and @JesseSwen as part of the #UPGx consortium: upgx.eu. All #ADRs were assessed for #causality by the Liverpool Causality Assessment Tool (LCAT): journals.plos.org/plosone/articl…
Read 7 tweets
#MondayMorning 🧵

Too many stakeholders are missing the point of the #InformationBlockingRules and patient's having access to THEIR health information.

For the record:
👉It's not only about access for access sake. It's not just about seeing a result. 👀
2) 👉It's about access for ACTION's sake. 🚀
3) Ability to strategically operationalize when you have
✅chronic illness
✅life-altering, life-limiting condition
#RareDisease
#disability
makes all the difference in
👉outcomes
👉#PatientSafety
👉care coordination
👉costs
👉access to community supports
👉access to research
Read 9 tweets
“NYC’s private sector hospitals are run more like private equity firms than the nonprofits they’re meant to be. They lavish their executives with six- and seven-figure salaries and bonuses…”

nydailynews.com/opinion/ny-ope… via @NYDailyNews #NYCNurseStrike
“they jack up fees for services, and they prioritize their bottom line above patient care.

Hospital executives seem to forget that their mission is to provide quality care to the community. Nurses are here to remind them.”

nydailynews.com/opinion/ny-ope… @NYDailyNews #NYCNurseStrike
“Mount Sinai Health System alone now has more than 700 nursing vacancies. With this level of understaffing, it is nearly impossible to deliver the quality and compassionate care our patients deserve.”

nydailynews.com/opinion/ny-ope… via @NYDailyNews #NYCNurseStrike
Read 4 tweets
🧵1. Thank you to the partners who have provided financial support to the the Kidney Institute of New Mexico.

#MedTwitter #NephTwitter

unmfund.org/fund/unm-kidne…
🧵2. Your donations have directly translated into essential discoveries leading to improved human health. We appreciate the genuine relationship with our supporters and research participants.

#gadolinium #patientsafety #NephTwitter
🧵3. Financial support assisted with several publications throughout 2022, benchtop experiments, and the continuation of our clinical trials. Also, in 2022 we discovered that gadolinium-rich nanoparticles form in the human kidney from routine diagnostic care.

#MedTwitter
Read 7 tweets
🧵#PatientSafety thread🧵

(1/12) Today @ptsafetylearn have shared a new analysis of the findings of the investigation into maternity & neonatal services at the East Kent Hospitals, published last month. This thread provides a brief summary of this⬇️
pslhub.org/learn/investig…
(2/12) The investigation covered serious safety failings, avoidable patient harm and deaths between 2009 and 2020. It makes a difficult read, finding that if nationally recognised standards had been followed, the outcome could have been different in 97 of the 202 cases reviewed.
(3/12) Initial responses have understandably focused on the implications for maternity care, explored in detail by organisations such as Sands, Tommy’s & Baby Lifeline. For example the below @birthrightsorg blog👇
birthrights.org.uk/2022/11/02/bir…
Read 12 tweets
@Airwayman1 presents on #HumanFactors in #OBAnes. MedTRiM: medical trauma & resilience management - reminding us of the Declaration of Geneva #OAA3dc2022 ImageImageImageImage
The Boabab lesson (Zambia) applicable to #OBAnes #OAA3dc2022 Image
The plan for the talk. Your patient - straight after new bag sats drop…
NOT Swiss cheese (@girardDev), Emmental(?) model #OAA3dc2022 ImageImageImageImage
Read 14 tweets
@euklaas from @asznl is going to be presenting new perspectives on PDPH later this morning at #OAA3dc2022 and she sent a few teaser slides. The QR code gives you all her references (very useful things these codes) Image
@euklaas promises an interesting lecture at #OAA3dc2022 - poking the bear from the outset! I’m sure @asznl is pleased to have her amongst their #OBAnes specialists Image
Challenging new hypotheses. How does #OBAnes feel about the new? @FarberMichaela would probably pay some heed given the disease burden of PDPH with chronic headache (58.6% at 18months 🤯) and changing how we view PDPH is maybe how we change outcomes? #OAA3dc2022 Image
Read 5 tweets
@hornerdeborah1 opens up on recognizing Critical Illness in #OBAnes. Is deterioration an issue? Yes. Why does it continue to be a problem? Fix the wrong things, don’t see 🐘 in room, no national standards (anywhere), we don’t study it! #OAA3dc2022 ImageImageImageImage
PIER approach to deterioration. 4P study important (slides still embargoed @hornerdeborah1?) - take home messages are key to detecting/ recognizing deterioration #OAA3dc2022 ImageImageImageImage
Design ambitions, design processes and it looks like every other early warning chart… #OAA3dc2022 ImageImageImage
Read 8 tweets
Dr Eva Roofthooft (from @gzaziekenhuizen) talks on new drugs in #OBAnes at #OAA3dc2022 ImageImageImage
What are we really talking about? As @MarcVandeVelde6 pointed out for LEA mix is pretty standard, spinal less so? Adjuvants are #OBAnes aspiring to cocktail perfection, to address problems and achieve desires #OAA3dc2022 ImageImageImageImage
Dr Eva Roofthooft (@gzaziekenhuizen) summarizes advantage of opioids, but as these are surely standard practice (not experience of @HofkampMichael & @emilysharpe), moves on to clonidine & dexmedetomidine. Dexmedetomidine 7 x more selective than clonidine. #OAA3dc2022 ImageImageImageImage
Read 20 tweets
@FarberMichaela (@BrighamOBAnes @Harvard @SOAPHQ) presenting the mini-Ostheimer lecture “what’s new in #OBAnes?” at #OAA3dc2022 ImageImageImageImage
QR code provided links to the references/ resources much appreciated from @FarberMichaela, she also outlines how slides can be interpreted #OAA3dc2022 ImageImage
The focus of @FarberMichaela’s lecture is recognition of #OBAnes as a peri-delivery speciality in hopes of impacts on #patientsafety and decreasing OB M&M @ruthi_landau @CynthiaAWongMD @JillMhyre
A topical start! Lots to cover, so little time at #OAA3dc2022 ImageImageImageImage
Read 27 tweets
Longish Thread 👇

Most of us have heard of 'Regulatory Capture' by the industry. But have you heard of 'Capture of Law Making Process' itself?

Fasten your seatbelts.
A sordid tale of how lobbying has almost succeeded in getting its masters a free pass from accountability
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2/n
Remember this happened?
livemint.com/science/health…

During the peak pandemic period, batches of a drug called Remdesivir manufactured by a Gujarat based pharma company were found to contain bacterial endotoxins which when administered to patients manifested in severe adverse
3/n
events. Endotoxins are not supposed to be present in injectibles, the way to make sure your drugs are not contaminated is to run a series of tests prescribed in the Indian Pharmacopiea before you ship them the market. The Pharmacopiea sets the standards and tells us what
Read 18 tweets
1) Welcome to a new #accredited #tweetorial on optimizing the role of the pharmacist in managing cardiometabolic disease! Accredited for 0.50 hr for #physicians #nurses #pharmacists! Expert faculty is Snehal Bhatt PharmD @SnayCardsPharmD of @BIDMChealth. Image
2a) This educational activity is supported by grants from Bayer, Otsuka, & Boehringer Ingelheim Pharmaceuticals Inc. and Eli Lilly Company. See archived programs, all by expert authors, still available for credit at ckd-ce.com.
2b) Accreditation statement and faculty disclosures are at ckd-ce.com/disclosures/. We are your ONLY source for accredited education in CKD and #cardiorenal disease delivered wholly on Twitter. FOLLOW US!
Read 24 tweets

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