Pneumonia and other lower respiratory tract infections are the second most common infections among nursing home residents and the leading cause of death from infections in the long-term care setting

A Healthcare facilities’ CLABSI data provides focus for prevention strategies

The Pennsylvania Patient Safety Authority identified 652 events in Pennsylvania healthcare facilities in 2009

The Authority highlights the success of its Patient Safety Liaison Program and blood specimen mislabeling collaborative as well as the reduction of healthcare-associated infections in hospitals and nursing homes

One click on the Authority’s website links healthcare providers directly to the information and tools they will need to participate in the national healthcare initiative designed to prevent patient harm

The Authority has partnered with Quality Insights of Pennsylvania and consumer groups throughout the state to raise awareness of healthcare issues

The Authority provides studies supporting the data in its latest Patient Safety Advisory and encourages healthcare facilities to implement suggested risk reduction strategies

Dr. Ana Pujols-McKee is credited with helping the Authority broaden its activities beyond data collection and written guidance

New website gives healthcare professionals from around the world access to lessons learned from organizations like the Authority that are collecting data and providing guidance for preventing medical errors

Pennsylvania Patient Safety Authority data shows a significant increase in cases of norovirus and norovirus-like gastrointestinal illness particularly in nursing homes in early 2010; but the virus can be controlled as shown by Pennsylvania nursing homes who share their success stories

The Authority is honored for its educational efforts in preventing medication errors and adverse drug events

The Authority encourages healthcare facilities and consumers to educate themselves on the symptoms, risks for and prevention of Clostridium difficile (C. diff), a potentially deadly bacterium that causes infection and is increasing significantly throughout the nation and worldwide

Studies show that diagnostic errors cause twice as many adverse events as medication errors, but the subject has received little attention; Pennsylvania Patient Safety Authority reviews 100 events related to diagnostic error

Pennsylvania Patient Safety Authority data shows that healthcare clinicians’ disruptive behaviors negatively affected patient care while a Pennsylvania hospital works to reduce the number of adverse events in its facility by improving teamwork

Pennsylvania Patient Safety Authority data shows that patients experiencing a life- threatening situation in a healthcare facility may be more at risk due to a lack of correct equipment and supplies readily available to adequately treat the emergency

The Authority begins collecting the most comprehensive healthcare-associated infection (HAI) data from nursing homes in the nation and provides long-term care facilities with analytical tools to help reduce HAIs

The positions complete the educational patient safety consulting program begun by the Pennsylvania Patient Safety Authority in 2008

Pennsylvania Patient Safety Authority data shows almost 40 percent of gastrointestinal infections in nursing home patients are CDI related and bloodstream infection risk reduction strategies in PA health facilities are questioned

The Authority will promote key components for increased patient safety in healthcare facilities during Patient Safety Awareness Week March 7-13

Analysis of data related to insulin medication errors and a local hospital’s success in reducing hospital readmission costs are highlighted in quarterly journal

The complications of pregnancy and childbirth have been targeted in the Pennsylvania Patient Safety Authority’s 2009 December Supplementary Patient Safety Advisory. The special issue provides gynecologists, obstetricians, midwives and the entire obstetric team, with strategies to help them prevent the complications based upon real Pennsylvania data.

The position will be based in the southwest region with two more hires planned in the southeast completing the Patient Safety Liaison program

All Pennsylvania registered nurses can receive continuing education hours required by law by reading Patient Safety Advisory articles that are posted on the Pennsylvania State Nurses Association (PSNA) web site, www.panurses.org.

The Patient Safety Authority Encourages Older Persons and Healthcare Workers to Get Immunized and Offers New Consumer Tips Based Upon Authority Data

A shortage of Tamiflu in liquid form has contributed to some dosage errors due to staff’s unawareness of the higher concentration in the contents of the Tamiflu pill form when developing their own liquid version of the drug

The Authority provides nursing home facilities with analytical tools to study their infection data and offers a new infection prevention tips screensaver for facilities to use year-round

Pocono Medical Center and facilities in the northeast work together to reduce the number of laboratory errors due to specimen mislabeling

The Pennsylvania Patient Safety Authority has collected over one million reports from Pennsylvania healthcare facilities since June 2004. Ninety-six percent of the events are near misses or events that did not cause harm to the patient.

The Authority offers patients consumer tips and encourages facilities to implement guidance in Patient Safety Advisories for improved patient safety

Two hospitals in southeast Pennsylvania have successfully reduced or eliminated healthcare-associated infections (HAIs) for intensive care patients in their facilities and are featured in the Pennsylvania Patient Safety Authority’s 2009 June Patient Safety Advisory.

The position will be based in the south central region of PA with more hires planned throughout the state within the next several months

Over 300 nursing homes in the eastern region of Pennsylvania began reporting healthcare-associated infections (HAIs) this week to the Patient Safety Authority through its Pennsylvania Patient Safety Reporting System (PA-PSRS). Central and western regions of the state will begin reporting by the end of June.

The position will be based in the northwest region with more hires planned throughout the state within the next year

The Authority attempts to measure the level of adoption of select process and safety practices by Pennsylvania’s healthcare facilities and enhances its educational mission through its Patient Safety Liaison program

Reports Show Patients Whose Medical Conditions Are Not Detected Prior to Surgery in an ASF are at Increased Risk for Complications After Surgery that Require Hospitalization

The Pennsylvania Patient Safety Authority is raising consumer awareness during Patient Safety Awareness Week (March 8-14) by promoting its consumer tip sheets and brochures, derived from data received from healthcare facilities through the Pennsylvania Patient Safety Reporting System (PA-PSRS).

Reports show that healthcare providers, patients and their families may not understand the different meanings and consequences of living wills and DNR (do not resuscitate) orders

Educational resources for improved patient safety can be found more easily with an enhanced search engine and other features

The DEP will help the Authority improve patient safety in Pennsylvania by developing educational and training programs for healthcare providers

The Authority continues to work with federal and state health agencies to increase infection reporting in Pennsylvania and encourages consumers to educate themselves on MRSA and C. diff prevention

Analysis shows more than 3,800 medication errors may have been prevented if documented information about the patient was adequately communicated before the medication was prescribed and given to the patient

Analysis shows thoroughly washing hands or using alcohol based sanitizers provide the best prevention for healthcare providers and consumers to reduce infections

The Pennsylvania Patient Safety Authority has hired a Patient Safety Liaison for the Northeast region to help healthcare facilities that report to the Pennsylvania Patient Safety Reporting System (PA-PSRS) improve patient safety for Pennsylvania citizens.

The Authority offers patients consumers tips and encourages them to “Speak Up”™ for improved patient safety

More than 800 reports submitted from hospitals identify a variety of problems occurring at discharge; 30 percent of those patients did not receive verbal or written discharge instructions

The Authority continues monitoring and evaluating wrong-site surgeries with the numbers remaining steady; releases preview of wrong-site surgery update

The Authority in 2007 developed and began implementing a Strategic Plan while facilities continued to use guidance in Patient Safety Advisories to improve patient safety while implementation of Act 52 to eliminate infections in hospitals and nursing homes began

Analysis shows pregnant patients receive x-rays; however most believed they were not pregnant at the time of the procedure. The degree of risk varies with each case.

Consumer tips sheets distributed to encourage patients to participate in their healthcare

Analysis shows facilities can learn much from each other in regard to the right way and wrong way to prevent wrong-site surgeries

Drug mix-ups occur frequently due to packaging and sound-alike drug names

Group represents healthcare professionals from across Pennsylvania with substantial experience in infection control management and practice

Actual and Near Miss Wrong-Site Surgery is Reported Every Other Day in PA Healthcare Facilities

The results show pharmacy computer systems in Pennsylvania facilities are not detecting unsafe drug orders as well as they could be

Patient Safety Initiatives Include Educating Hospital Boards of Trustees about the Importance of Disclosure and Learning from Events

Report shows significant number of changes made in healthcare facilities as a result of guidance issued by the Authority, but more work remains for increasing patient safety within institutions and reducing preventable medical errors

Patient Safety Authority issues risk predictors and guidance to prevent the third most common cause of hospital-acquired kidney failure

The Authority will hold a public board meeting and release results from an assessment of electronic pharmacy computer systems in Pennsylvania hospitals which show opportunities for improvement

Patient Safety Authority advises orthopedic surgeons about the risks and suggests prevention strategies

Rabinowitz was named the Authority’s first Administrator in November, 2002.

The Eisenberg Award recognizes the Authority’s efforts to make the Pennsylvania Patient Safety Reporting System (PA-PSRS) into a nationally recognized resource for education and learning about patient safety.

Patient Safety Authority issues guidance to healthcare facilities to prevent painful skin injury to patients

Task Force develops standards for use of Color-Coded Wristbands

Although sometimes necessary, verbal orders can lead to errors unless safe practice protocols are in place

Research from Mandatory Reporting Drives Change in Patient Care Nearly 75% of Hospitals Have Implemented Quality Improvements as a Result of Act 13

Over 100 reports cite drug in question and include four patient deaths. Other reported data show risks involving manufacturer’s representatives, contaminated surgical instruments and look-alike packaging

New consumer web page includes a brochure with advice for patients on how they can help prevent medical errors

Reports suggest that more detailed discharge instructions and greater patient communication at discharge could help improve safety and continuity of care for recovering patients

A recent “near-miss” report submitted to the Patient Safety Authority emphasizes the need for caution by healthcare facilities

Country’s First Mandatory Reporting System for Adverse Events and Near Misses; Data Reveals Trends and Patterns to Help Enhance Patient Safety

State Agency Calls Upon Healthcare Providers to Prevent Patient Harm By Promoting Patient Safety

Hospitals May Be Eligible for Discounts in Medical Malpractice Premiums

Dr. Robert Muscalus receives award for Pennsylvania’s innovative approach to improving patient safety

Over 400 health care facilities now reporting through Pennsylvania’s Patient Safety Reporting System (PA-PSRS); Medical error reporting system is first in the nation.

First advisory issued to promote patient safety. Nearly 400 healthcare facilities to begin mandatory reporting by early summer.

Twenty-two hospitals and surgical centers participate in initial phase of mandatory statewide reporting system; Pennsylvania in the forefront in promoting patient safety.

Patient Safety Authority awards contract to implement innovative program to improve patient safety; contract awarded to Pennsylvania-based firms; Pennsylvania in the forefront