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Study ties feeding tube use to patient race and location
Patient safety goals an area of focus for JCAHO's 2004 unannounced surveys
Researchers track medical errors in cardiovascular patients

Patient Safety Monitor Alert, July 8, 2003

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STUDY TIES FEEDING TUBE USE TO PATIENT RACE AND LOCATION

Senile nursing home patients are more likely to be put on feeding tubes--instead of being hand fed--if they are black or Asian, according to a recent study by the Journal of the American Medical Association. Groups such as the Alzheimer's Association generally oppose tube feeding because it can create other medical problems and it also removes the human contact of hand feeding and reduces the likelihood of an aide spotting medical problems while caring for a resident, according to the New York Times.

The study also found an increased us of feeding tubes among patients recieving treatment in urban facilities, for-profit facilies, and facilities without a special unit for the very senile. The study, which surveyed residents in every licensed nursing home across the nation, offers the following possible reasons for an increase in feeding tube usage for these groups:

- Black or Asian residents may have more difficulty communicating with nursing home staff
- Minority patients and their families sometimes mistrust the medical establishment
- For-profit nursing homes have a fiscal incentive to use feeding tubes
- White patients are more likely to sign statements to refuse tubes or other interventions

PATIENT SAFETY GOALS AN AREA OF FOCUS FOR JCAHO'S 2004 UNNANOUNCED SURVEYS

Hospitals picked for a random unannounced survey next year can expect surveyors from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to scrutinize their patient safety programs. These surprise one day visits include inspections of fixed and variable elements.The National Patient Safety Goals will be a fixed performance area during the surprise visits in 2004, the JCAHO announced yesterday in a press release. Staffing, infection control, and medication management comprise the rest of the fixed performance areas.

In addition, the JCAHO will consider the latter three topics"critical focus areas." As part of the Shared Visions--New Pathways initiative, surveyors will organize their reports of standards compliance by these areas rather than the previously used grid element, also called the performance category, level.

RESEARCHERS TRACK MEDICAL ERRORS IN CARDIOVASCULAR PATIENTS

Many medical errors in the cardiovascular unit occur because physicians do not know what medications patients were taking prior to admission, researchers reported in a study published in the June issue of the Archives of Internal Medicine. In addition, the errors increased at times when staff were in transition.

Researchers from Duke University Medical Center reviewed the experience of a clinical pharmacist on the cardiology wards at the hospital for about five years. During that time, they found a medication error rate of about 24 errors per 100 admissions. They suggest the following methods for reducing medication errors on cardiology wards:

- Better knowledge of the medicaitons patients took prior to admission
- Improved education and support for new interns
- Pharmacist participation on patient rounds

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