MARCH/APRIL 2011<br />
Patient Safety & Quality Healthcare<br />
N E W S · S C I E N C E · R E S E A R C H · O P I N I O N<br />
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FREE SUBSCRIPTION AT WWW.PSQH.COM<br />
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REDUCING ALARM HAZARDS<br />
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SAFER PCA THERAPY<br />
TEAM TRAINING IN OB<br />
ANESTHESIA INFORMATION SYSTEMS<br />
PATIENT MOBILIZATIONOhio Medical CorporationNPSF- National Patient Safety FoundationContents<br />
MARCH/APRIL 2011 · VOLUME 8 ISSUE 2<br />
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Features<br />
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14 Reducing Alarm Hazards: Selection and Implementation of Alarm Notification Systems <br />
Tim Gee, Bridget A. Moorman, CCE<br />
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18 Team Training in Obstetrics: Improving Care by Learning to Work Together <br />
Diane W. Shannon, MD, MPH<br />
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26 Rapid Implemen<a title="PSQH March/April 2011 page 1" href="http://viewer.zmags.com/publication/1f27c16d?page=1">MARCH/APRIL 2011Patient Safety & Quality Healthc</a> MARCH/APRIL 2011Patient Safety & Quality Healthc<a title="PSQH March/April 2011 page 2" href="http://viewer.zmags.com/publication/1f27c16d?page=2">Ohio Medical Corporation</a> Ohio Medical Corporation<a title="PSQH March/April 2011 page 3" href="http://viewer.zmags.com/publication/1f27c16d?page=3">NPSF- National Patient Safety Foundation</a> NPSF- National Patient Safety Foundation<a title="PSQH March/April 2011 page 4" href="http://viewer.zmags.com/publication/1f27c16d?page=4">ContentsMARCH/APRIL 2011 · VOLUME 8 ISSUE 2</a> ContentsMARCH/APRIL 2011 · VOLUME 8 ISSUE 2<a title="PSQH March/April 2011 page 5" href="http://viewer.zmags.com/publication/1f27c16d?page=5">University of Michigan</a> University of Michigan<a title="PSQH March/April 2011 page 6" href="http://viewer.zmags.com/publication/1f27c16d?page=6">EDITOR'S NOTEBOOKMarch/April 2011Volume 8 Issu</a> EDITOR'S NOTEBOOKMarch/April 2011Volume 8 Issu<a title="PSQH March/April 2011 page 7" href="http://viewer.zmags.com/publication/1f27c16d?page=7">EDITORIAL ADVISORY BOARD Lionheart Publishing</a> EDITORIAL ADVISORY BOARD Lionheart Publishing<a title="PSQH March/April 2011 page 8" href="http://viewer.zmags.com/publication/1f27c16d?page=8">AHRQWhat Is Your Organization’s Patient Safety</a> AHRQWhat Is Your Organization’s Patient Safety<a title="PSQH March/April 2011 page 9" href="http://viewer.zmags.com/publication/1f27c16d?page=9"> have the lowest scores.• Administration/managem</a> have the lowest scores.• Administration/managem<a title="PSQH March/April 2011 page 10" href="http://viewer.zmags.com/publication/1f27c16d?page=10">naires developed in one cultural setting cannot al</a> naires developed in one cultural setting cannot al<a title="PSQH March/April 2011 page 11" href="http://viewer.zmags.com/publication/1f27c16d?page=11">Safer Healthcare</a> Safer Healthcare<a title="PSQH March/April 2011 page 12" href="http://viewer.zmags.com/publication/1f27c16d?page=12">Health & IT QualitySeeing Is Not BelievingBa</a> Health & IT QualitySeeing Is Not BelievingBa<a title="PSQH March/April 2011 page 13" href="http://viewer.zmags.com/publication/1f27c16d?page=13">human beings process their environment. As noted a</a> human beings process their environment. As noted a<a title="PSQH March/April 2011 page 14" href="http://viewer.zmags.com/publication/1f27c16d?page=14">ISMPRoot Causes: A Roadmap to ActionBy the I</a> ISMPRoot Causes: A Roadmap to ActionBy the I<a title="PSQH March/April 2011 page 15" href="http://viewer.zmags.com/publication/1f27c16d?page=15"> name” alerts into the order entry system for acti</a> name” alerts into the order entry system for acti<a title="PSQH March/April 2011 page 16" href="http://viewer.zmags.com/publication/1f27c16d?page=16">Reducing Alarm Hazards: Selection and Implementa</a> Reducing Alarm Hazards: Selection and Implementa<a title="PSQH March/April 2011 page 17" href="http://viewer.zmags.com/publication/1f27c16d?page=17">ALARM HAZARDSAlarm notification problems can b</a> ALARM HAZARDSAlarm notification problems can b<a title="PSQH March/April 2011 page 18" href="http://viewer.zmags.com/publication/1f27c16d?page=18">ALARM HAZARDSacross the enterprise, the easier</a> ALARM HAZARDSacross the enterprise, the easier<a title="PSQH March/April 2011 page 19" href="http://viewer.zmags.com/publication/1f27c16d?page=19">ALARM HAZARDSThe most advanced alarm notificat</a> ALARM HAZARDSThe most advanced alarm notificat<a title="PSQH March/April 2011 page 20" href="http://viewer.zmags.com/publication/1f27c16d?page=20">Team Training in Obstetrics: Improving Care by L</a> Team Training in Obstetrics: Improving Care by L<a title="PSQH March/April 2011 page 21" href="http://viewer.zmags.com/publication/1f27c16d?page=21">RAPID IMPLEMENTATIONwhich had recently experie</a> RAPID IMPLEMENTATIONwhich had recently experie<a title="PSQH March/April 2011 page 22" href="http://viewer.zmags.com/publication/1f27c16d?page=22">RAPID IMPLEMENTATIONolution tools such as the </a> RAPID IMPLEMENTATIONolution tools such as the <a title="PSQH March/April 2011 page 23" href="http://viewer.zmags.com/publication/1f27c16d?page=23">RAPID IMPLEMENTATIONWinchester Hospitalate</a> RAPID IMPLEMENTATIONWinchester Hospitalate<a title="PSQH March/April 2011 page 24" href="http://viewer.zmags.com/publication/1f27c16d?page=24">Healthcare Conference AdministratorsQuality Co</a> Healthcare Conference AdministratorsQuality Co<a title="PSQH March/April 2011 page 25" href="http://viewer.zmags.com/publication/1f27c16d?page=25">Healthcare Conference AdministratorsQuality Co</a> Healthcare Conference AdministratorsQuality Co<a title="PSQH March/April 2011 page 26" href="http://viewer.zmags.com/publication/1f27c16d?page=26">RAPID IMPLEMENTATIONan interactive program. “T</a> RAPID IMPLEMENTATIONan interactive program. “T<a title="PSQH March/April 2011 page 27" href="http://viewer.zmags.com/publication/1f27c16d?page=27">RAPID IMPLEMENTATIONto change without a corres</a> RAPID IMPLEMENTATIONto change without a corres<a title="PSQH March/April 2011 page 28" href="http://viewer.zmags.com/publication/1f27c16d?page=28">Rapid Implementation of an Anesthesiology Informat</a> Rapid Implementation of an Anesthesiology Informat<a title="PSQH March/April 2011 page 29" href="http://viewer.zmags.com/publication/1f27c16d?page=29">system, the 512-bed hospital implemented the techn</a> system, the 512-bed hospital implemented the techn<a title="PSQH March/April 2011 page 30" href="http://viewer.zmags.com/publication/1f27c16d?page=30">“We knew that we would have to carefully choreogra</a> “We knew that we would have to carefully choreogra<a title="PSQH March/April 2011 page 31" href="http://viewer.zmags.com/publication/1f27c16d?page=31">was impossible to determine if the warming blanket</a> was impossible to determine if the warming blanket<a title="PSQH March/April 2011 page 32" href="http://viewer.zmags.com/publication/1f27c16d?page=32">Safer PCA TherapyPatient Safety Benefits of Cont</a> Safer PCA TherapyPatient Safety Benefits of Cont<a title="PSQH March/April 2011 page 33" href="http://viewer.zmags.com/publication/1f27c16d?page=33">The following interviews were adapted from a Novem</a> The following interviews were adapted from a Novem<a title="PSQH March/April 2011 page 34" href="http://viewer.zmags.com/publication/1f27c16d?page=34">SAFER PCA THERAPY The nurse assigned to him d</a> SAFER PCA THERAPY The nurse assigned to him d<a title="PSQH March/April 2011 page 35" href="http://viewer.zmags.com/publication/1f27c16d?page=35">CareFusion</a> CareFusion<a title="PSQH March/April 2011 page 36" href="http://viewer.zmags.com/publication/1f27c16d?page=36">SAFER PCA THERAPY Dr. Vanderveen: What is you</a> SAFER PCA THERAPY Dr. Vanderveen: What is you<a title="PSQH March/April 2011 page 37" href="http://viewer.zmags.com/publication/1f27c16d?page=37">SAFER PCA THERAPYlikely to understand the impo</a> SAFER PCA THERAPYlikely to understand the impo<a title="PSQH March/April 2011 page 38" href="http://viewer.zmags.com/publication/1f27c16d?page=38">SAFER PCA THERAPY patient’s PCA setting was D</a> SAFER PCA THERAPY patient’s PCA setting was D<a title="PSQH March/April 2011 page 39" href="http://viewer.zmags.com/publication/1f27c16d?page=39">SAFER PCA THERAPYHolmes: Policies and procedur</a> SAFER PCA THERAPYHolmes: Policies and procedur<a title="PSQH March/April 2011 page 40" href="http://viewer.zmags.com/publication/1f27c16d?page=40">SAFER PCA THERAPY Holmes: At first the nursin</a> SAFER PCA THERAPY Holmes: At first the nursin<a title="PSQH March/April 2011 page 41" href="http://viewer.zmags.com/publication/1f27c16d?page=41">Standard Register</a> Standard Register<a title="PSQH March/April 2011 page 42" href="http://viewer.zmags.com/publication/1f27c16d?page=42">Patient MobilizationBest practices improve healt</a> Patient MobilizationBest practices improve healt<a title="PSQH March/April 2011 page 43" href="http://viewer.zmags.com/publication/1f27c16d?page=43">PATIENT MOBILIZATIONcare organizations are red</a> PATIENT MOBILIZATIONcare organizations are red<a title="PSQH March/April 2011 page 44" href="http://viewer.zmags.com/publication/1f27c16d?page=44">PATIENT MOBILIZATION repositioning patients. </a> PATIENT MOBILIZATION repositioning patients. <a title="PSQH March/April 2011 page 45" href="http://viewer.zmags.com/publication/1f27c16d?page=45">UnSummit</a> UnSummit<a title="PSQH March/April 2011 page 46" href="http://viewer.zmags.com/publication/1f27c16d?page=46">Alarm Management ShowcaseBy Tom Inglesby </a> Alarm Management ShowcaseBy Tom Inglesby <a title="PSQH March/April 2011 page 47" href="http://viewer.zmags.com/publication/1f27c16d?page=47">Dalcon AlertAlimed IQ Easy AlarmProduct Sh</a> Dalcon AlertAlimed IQ Easy AlarmProduct Sh<a title="PSQH March/April 2011 page 48" href="http://viewer.zmags.com/publication/1f27c16d?page=48">ABQAURPQuality ConundrumsLynn Helmer, MD, MB</a> ABQAURPQuality ConundrumsLynn Helmer, MD, MB<a title="PSQH March/April 2011 page 49" href="http://viewer.zmags.com/publication/1f27c16d?page=49">ABQAURPAmerican Board of Quality Assurance and </a> ABQAURPAmerican Board of Quality Assurance and <a title="PSQH March/April 2011 page 50" href="http://viewer.zmags.com/publication/1f27c16d?page=50">Advertisers' GuidelinesPatient Safety and Qual</a> Advertisers' GuidelinesPatient Safety and Qual<a title="PSQH March/April 2011 page 51" href="http://viewer.zmags.com/publication/1f27c16d?page=51">ABQAURP</a> ABQAURP<a title="PSQH March/April 2011 page 52" href="http://viewer.zmags.com/publication/1f27c16d?page=52">Masimo</a> Masimo