Maryland Patient Safety Centerâ€™s Annual MEDSAFE Conference

Maryland Patient Safety Center’sAnnual MEDSAFE Conference:

Taking Charge of Your Medication Safety Challenges

November 3, 2011The Conference Center at the Maritime Institute

Maryland Results for the 2011 ISMP Medication Safety Self Assessment® for Hospitals with Comparisons to

2010 and National Results

Allen J. Vaida, PharmDExecutive Vice President

Institute for Safe Medication Practices

Objectives

• Summarize the results of the 2011 ISMP Medication Safety Self Assessment® for Hospitals within Maryland MEDSAFE hospitals.

• Compare Maryland MEDSAFE results for 2011 to 2010 and national results.

• Identify opportunities for improvement in medication safety within their organization.

2

2011 ISMP Medication Safety Self Assessment® for Hospitals

3

Structure

• Ten elements (domains) that most significantly influence safe medication use (ISMP’s Ten Key Elements of the Medication Use System)

• Twenty core distinguishing characteristics of a safe medication system within the domains

• Representative self-assessment items (practices) within the core characteristics

4

I. Patient InformationII. Drug InformationIII. Communication of Drug Orders and Other Drug Info.IV. Drug Labeling, Packaging, and NomenclatureV. Drug Standardization, Storage, and DistributionVI. Medication Device Acquisition, Use, and MonitoringVII. Environmental Factors, Workflow, and Staffing PatternsVIII.Staff Competency and EducationIX. Patient EducationX. Quality Processes and Risk Management

Key Elements of the Medication Use System

5

Individual Items Weighted According to Impact on the System

• Scale of 4 to 16 with higher weights on items that:

Target the system not workforce

Simplify complex processes

Solve several error-prone problems

Do not rely heavily on human memory or vigilance

6

DEMOGRAPHICS

7

MD MEDSAFE 2011 Demographics Hospital Characteristic Category Frequency (%) n=42

Location

Rural 17 (40%)

Urban 25 (60%)

Bed Size

Fewer than 100 beds 9 (22%)

100 to 299 beds 22 (52%)

Over 300 beds 11 (26%)

8

MD MEDSAFE 2011 Demographics

Hospital Characteristic Category Frequency (%) n=42

Other Services Provided

Oncology services 36 (86%)

Pediatric services 37 (88%)

Neonatal intensive care unit 20 (48%)

Trauma services 15 (36%)

Transplant services 2 (5%)

Behavioral health 26 (62%)

9


Physician residency-training program

(ACGME approved)

Yes 16 (38%)

No 26 (62%)

Pharmacy residency-training program

(ASHP accredited/pending accreditation in 2011-2012)

Yes 9 (21%)

No 33 (79%)

Students(from an accredited program)

Nursing 38 (90%)

Pharmacy 33 (79%)

Medical 21 (50%)

Other 12 (29%)

10


Employ or contract hospitalists

Yes – Full-time coverage 33 (79%)

Yes – Part-time coverage 4 (10%)

No 5 (12%)

Full-time or part-time clinical informatics practitioner

(dedicated to medication-related technology)

Yes 29 (69%)

No 13 (31%)

Full-time or part-time medication safety officer/manager

Yes 18 (43%)

No 24 (57%)

11

KEY ELEMENTS

12

2010 and 2011 MD Median Scores by Key Element(as a % of the ISMP maximum weighted score)

Key Element2010

(n=41)2011

(n=42)%

Change

I Patient Information 79% 68% -11%

II Drug Information 85% 81% -4%

III Communication of Drug Orders and Other Drug Info. 79% 76% -3%

IV Drug Labeling, Packaging, and Nomenclature 93% 84% -9%

V Drug Standardization, Storage, and Distribution 93% 87% -6%

VI Medication Device Acquisition, Use, and Monitoring 91% 76% -15%

VII Environmental Factors, Workflow, & Staffing Patterns 88% 83% -5%

VIII Staff Competency and Education 85% 71% -14%

IX Patient Education 82% 77% -5%

X Quality Processes and Risk Management 88% 80% -8%

Total 86% 79% -7%

13

2010 and 2011 MD Median Scoresby Lowest Key Element in 2011(as a % of the ISMP maximum weighted score)

Key Element2010

(n=41)2011

(n=42)%

Change

I Patient Information 79% 68% -11%

VIII Staff Competency and Education 85% 71% -14%

VI Medication Device Acquisition, Use, and Monitoring 91% 76% -15%

III Communication of Drug Orders and Other Drug Info. 79% 76% -3%

IX Patient Education 82% 77% -5%

X Quality Processes and Risk Management 88% 80% -8%

II Drug Information 85% 81% -4%

VII Environmental Factors, Workflow, & Staffing Patterns 88% 83% -5%

IV Drug Labeling, Packaging, and Nomenclature 93% 84% -9%

V Drug Standardization, Storage, and Distribution 93% 87% -6%

14

2011 MD and National Mean Scores by Key Element

(as a % of the ISMP maximum weighted score)

Key ElementMD

(n=42)National(n=1338)

I Patient Information 65% 60%

II Drug Information 77% 67%

III Communication of Drug Orders and Other Drug Info. 77% 74%

IV Drug Labeling, Packaging, and Nomenclature 83% 74%

V Drug Standardization, Storage, and Distribution 86% 81%

VI Medication Device Acquisition, Use, and Monitoring 72% 70%

VII Environmental Factors, Workflow, and Staffing Patterns 82% 78%

VIII Staff Competency and Education 71% 64%

IX Patient Education 73% 67%

X Quality Processes and Risk Management 77% 72%

Total 77% 71%

15

CORE CHARACTERISTICS

16

2010 and 2011 MD MEDSAFE Median Scores by Core Characteristic


Key ElementCore

Characteristic2010

(n=41)2011

(n=42)% Change

I 1 79% 68% -11%

II 2 81% 76% -5%

II 3 95% 92% -3%

III 4 79% 76% -3%

IV 5 93% 81% -12%

IV 6 93% 83% -10%

V 7 85% 99% +14%

V 8 92% 89% -3%

V 9 97% 85% -12%

V 10 100% 96% -4%

17

2010 and 2011 MD MEDSAFE Median Scoresby Core Characteristic (cont.)


Key ElementCore

Characteristic2010

(n=41)2011

(n=42)% Change

VI 11 91% 76% -15%

VII 12 90% 84% -6%

VII 13 90% 84% -6%

VIII 14 85% 73% -12%

VIII 15 84% 68% -16%

IX 16 82% 77% -5%

X 17 87% 77% -10%

X 18 91% 82% -9%

X 19 81% 72% -9%

X 20 100% 96% -4%

18

2010 and 2011 MD MEDSAFE Median Scores by Lowest Core Characteristic in 2011


Key Core Characteristic2010

(n=41)2011

(n=42)%

Change

VIII 15

Practitioners involved in medication use are provided with ongoing education about medication error prevention and the safe use of drugs that have the greatest potential to cause harm if misused.

84% 68% -16%

I 1

Essential patient information is obtained, readily available in useful form, and considered when prescribing, dispensing, and administering medications, and when monitoring the effects of medications.

79% 68% -11%

19

2010 and 2011 MD MEDSAFE Median Scores by Lowest Core Characteristic in 2011 (cont.)



(n=41)2011

(n=42)%

Change

X 19

Redundancies that support a system of independent double checks or an automated verification process are used for vulnerable parts of the medication system to detect and correct serious errors before they reach patients.

81% 72% -9%

VIII 14

Practitioners receive sufficient orientation to medication use and undergo baseline and annual competency evaluation of knowledge and skills related to safe medication practices.

85% 73% -12%

20

2010 and 2011 MD MEDSAFE Median Scores by Lowest Core Characteristic in 2011 (cont.)



(n=41)2011

(n=42)%

Change

VI 11

The potential for human error is mitigated through careful procurement, maintenance, use, and standardization of devices used to prepare and deliver medications.

91% 76% -15%

II 2Essential drug information is readily available inuseful form and considered when ordering, dispensing, and administering medications.

81% 76% -5%

III 4

Methods of communicating drug orders and other drug information are streamlined, standardized, and automated to minimize the risk for error.

79% 76% -3%

21

2011 MD MEDSAFE and National Mean Scores by Core Characteristic


Key Core CharacteristicMD MEDSAFE


I 1 65% 60%

II 2 74% 66%

II 3 87% 72%

III 4 77% 74%

IV 5 81% 71%

IV 6 85% 80%

V 7 95% 88%

V 8 89% 81%

V 9 83% 80%

V 10 86% 79%

22

2011 MD MEDSAFE and National Mean Scores by Core Characteristic (cont.)


Key Core CharacteristicMD MEDSAFE


VI 11 72% 70%

VII 12 80% 74%

VII 13 82% 80%

VIII 14 74% 67%

VIII 15 67% 59%

IX 16 73% 67%

X 17 74% 71%

X 18 82% 73%

X 19 73% 68%

X 20 93% 86%

23

2011 MD MEDSAFE and National Mean Scores by Core Characteristic


Key Core CharacteristicMD


I 1

Essential patient information is obtained, readily available in useful form, and considered when prescribing, dispensing, and administering medications, and when monitoring the effects of medications.

65% 60%

II 2

Essential drug information is readily available in useful form and considered when prescribing, dispensing,and administering medications, and when monitoring the effects of medications.

74% 66%

II 3

A controlled drug formulary system is established to limit choice to essential drugs, minimize the number of drugs with which practitioners must be familiar, and provide adequate time for designing safe processes for the use of new drugs added to the formulary.

87% 72%

24

2011 MD MEDSAFE and National Mean Scoresby Core Characteristic (cont.)




III 4Methods of communicating drug orders and other drug information are streamlined, standardized, and automated to minimize the risk for error.

77% 74%

IV 5

Strategies are undertaken to minimize the possibility of errors with drug products that have similar or confusing manufacturer labeling/packaging and/or drug names that look and/or sound alike.

81% 71%

IV 6Readable labels that clearly identify drugs are on all drug containers, and drugs remain labeled up to the point of actual drug administration.

85% 80%

25





V 7IV solutions, drug concentrations, doses, and administration times are standardized whenever possible.

95% 88%

V 8

Medications are provided to patient care units in a safe and secure manner and available for administration within a time frame that meets essential patient needs.

89% 81%

V 9 Unit stock is restricted. 83% 80%

V 10Hazardous chemicals are safely sequestered from patients and not accessible in drug preparation areas.

86% 79%

26





VI 11

The potential for human error is mitigated through careful procurement, maintenance, use, and standardization of devices used to prepare and deliver medications.

72% 70%

VII 12

Medications are prescribed, transcribed, prepared, dispensed, and administered within an efficient and safe workflow and in a physical environment that offers adequate space and lighting, and allows practitioners to remain focused on medication use without distractions.

80% 74%

VII 13The complement of qualified, well-rested practitioners matches the clinical workload without compromising patient safety.

82% 80%

27





VIII 14

Practitioners receive sufficient orientation to medication use and undergo baseline and annual competency evaluation of knowledge and skills related to safe medication practices.

74% 67%

VIII 15

Practitioners involved in medication use are provided with ongoing education about medication errorprevention and the safe use of drugs that have the greatest potential to cause harm if misused.

67% 59%

IX 16Patients are included as active partners in their care through education about their medications and ways to avert errors.

73% 67%

28





X 17

A safety-supportive Just Culture and model of shared accountability for safe system design and making safe behavioral choices is in place and supported by management, senior administration, and the Board of Trustees/Directors.

74% 71%

X 18

Practitioners are stimulated to detect and report adverse events, errors (including close calls), hazards, and observed at-risk behaviors, and interdisciplinary teams regularly analyze these reports as well as reports of errors that have occurred in other organizations to mitigate future risks.

82% 73%

29





X 19

Redundancies that support a system of independentdouble checks or an automated verification process are used for vulnerable parts of the medication system to detect and correct serious errors beforethey reach patients.

73% 68%

X 20Proven infection control practices are followed when storing, preparing, and administering medications.

93% 86%

30

SELF-ASSESSMENT ITEMS2010 and 2011 MD MEDSAFE Scores

31

2010 and 2011 MD MEDSAFE % Implementedby Self-Assessment Item

K # Self-Assessment Item MD MEDSAFENone(A+B)

Partial(C+D)

Full(E)

II 37

Standards of practice have been established and are followed for the appropriate use of postoperative IV solutions used to hydrate pediatric patients, along with protocols to identify, treat, and monitor pediatric patients with hyponatremia, water intoxication, and/or syndrome of inappropriate antidiuretic hormone secretion (SIADH). Scoring guideline: Choose Not Applicable if postoperative care is not provided to pediatric patients.

2010 NEW

2011n=29

N/A=13 (31%)69% 17% 14%

K = Key Element; N/A = Not Applicable32

2010 and 2011 MD MEDSAFE % Implementedby Self-Assessment Item (cont.)

K # Self-Assessment ItemMD

MEDSAFENone(A+B)

Partial(C+D)

Full(E)

I 6

An active computer surveillance system (e.g., data-monitoring software) is used to monitor available data sources to optimize therapy and identify patients at risk of harm related to medication therapy (e.g., decreased platelet count in a patient receiving heparin, resistant bacteria to current antibiotic therapy), and to notify practitioners of intervention opportunities in real time as soon as the information is available.

2010 NEW

2011n=42

67% 14% 19%

K = Key Element33


K # 2011(MD #)

Self-Assessment ItemMD

MEDSAFENone(A+B)

Partial(C+D)

Full(E)

VII 173(160)

During orientation, nurses spend time in the pharmacy (and with clinical pharmacists) to become familiar with the order entry and/or verification process, drug preparation and dispensing, availability of drug information resources, ways to access these resources, and various medication safety initiatives.

2010n=41

49% 27% 24%

2011n=42

60% 26% 14%

% Change +11% -1% -10%

K = Key Element34


K # 2011(MD #)


MEDSAFENone(A+B)

Partial(C+D)

Full(E)

IX 202(184)

Criteria have been established (e.g., selected high-alert drugs, high-risk patient populations) to trigger an automatic consultation with a pharmacist for patient education.

2010n=41

48% 33% 20%

2011n=42

55% 31% 14%

% Change +7% -2% -6%

X 246(217)

Patient representatives from the community are invited to participate in patient safety committees or informal ad-hoc meetings to solicit regular input on medication safety issues and expand the community’s awareness of the culture of safety in the organization.

2010n=41

63% 25% 13%

2011n=42

55% 17% 29%

% Change -8% -8% +16%

K = Key Element35



MEDSAFENone(A+B)

Partial(C+D)

Full(E)

I 13

Computer order entry systems have a tiered severity rating for allergies, based on the patient’s reaction to the drug, which is used to limit alert fatigue from drug intolerances that are not true allergies.

2010 NEW

2011n=42

52% 21% 26%

36K = Key Element



MEDSAFENone(A+B)

Partial(C+D)

Full(E)

VI 148

If smart pump technology is used, the drug library is updated via wireless technology. Scoring guideline: Choose Not Applicableif your organization does not have smart pump technology.

2010 NEW

2011n=31

N/A=11 (26%)52% 3% 45%

37K = Key Element; N/A = Not Applicable


K # 2011(MD #)


MEDSAFENone(A+B)

Partial(C+D)

Full(E)

I 24(18)

Medication orders cannot be entered into the computer order entry system until the patient’s weight has been entered (i.e., orders cannot be entered until the weight field has been populated).

2010n=41

41% 27% 32%

2011n=42

50% 19% 31%

% Change +9% -8% -1%

K = Key Element38



MEDSAFENone(A+B)

Partial(C+D)

Full(E)

VI 146

If smart pump technology is used, an interdisciplinary team, which includes pharmacists, nurses, and physician representatives, reviews data for soft and hard dose and volume limits that have been bypassed, and the findings are used to take action to reduce the number of bypassed clinically significant warnings or to modify dosing limits when necessary. Scoring guideline: Choose Not Applicable if your organization does not have smartpump technology.

2010 NEW

2011n=32

N/A=10 (24%)50% 13% 38%



K # 2011(MD #)


MEDSAFENone(A+B)

Partial(C+D)

Full(E)

X 226(201)

One or more trained practitioners are employed specifically to enhance detection of medication errors, oversee analysis of their causes, and coordinate an effective error-reduction plan (0.5 or 1 full-time equivalent qualified practitioner is employed for this purpose alone).

2010n=41

17% 7% 76%

2011n=42

50% 7% 43%

% Change +33% 0% -33%

X 259(231)

Machine-readable coding (e.g., bar-coding) is used to verify drug selection prior to dispensing drugs (includes robotic dispensing).

2010n=41

33% 45% 23%

2011n=42

50% 38% 12%

% Change +17% -7% -11%K = Key Element

40


K # 2011(MD #)


MEDSAFENone(A+B)

Partial(C+D)

Full(E)

I 17(20)

Enhanced monitoring beyond pulse oximetry (e.g., capnography, apnea alarms) is required for patients who receive PCA or other IV opioid infusions to treat pain whenever risk factors such as obesity or low body weight, sleep apnea, the use of basal infusions or concomitant medications that potentiate the effects of opioids, or conditions such as asthma exist, and/or when nurse-controlled analgesia is employed.

2010n=41

40% 37% 24%

2011n=42

45% 38% 17%

% Change +5% +1% -7%

K = Key Element41


K # 2011(MD #)


MEDSAFENone(A+B)

Partial(C+D)

Full(E)

II 44(35)

A designated pharmacist routinely reviews, for quality improvement purposes, reports of selected computer order entry system warnings (e.g., maximum dose alerts, serious drug interactions, allergy alerts) that are overridden.

2010n=41

37% 29% 34%

2011n=42

45% 21% 33%

% Change +8% -8% -1%

K = Key Element42



MEDSAFENone(A+B)

Partial(C+D)

Full(E)

VI 145

If smart pump technology is used, the percent of infusions with medications that are administered using full functionality of the safety software (i.e., drug library and dose-checking software) is monitored, and the findings are used to increase compliance. Scoring guideline: Choose NotApplicable if your organization does not have smart pump technology.

2010 NEW

2011n=32

N/A=10 (24%)44% 16% 41%

43

K = Key Element; N/A = Not Applicable


K # 2011(MD #)


MEDSAFENone(A+B)

Partial(C+D)

Full(E)

III 61(55)

Prescribers enter medication orders into a computer system that is electronically interfaced with the pharmacy computer system.

2010n=41

37% 17% 46%

2011n=42

43% 26% 31%

% Change +6% +9% -15%

K = Key Element44


K # 2011(MD #)


MEDSAFENone(A+B)

Partial(C+D)

Full(E)

X 219(196)

Units with a high error reporting rate are praised for detecting and reporting errors.

2010n=41

20% 37% 44%

2011n=42

43% 33% 24%

% Change +23% -4% -20%

X 232(207)

Trusted nurse, pharmacist, and physician representatives facilitate periodic, announced, focus groups of frontline practitioners for “off the record” discussions to learn about perceived problems and risks with the medication use system.

2010n=41

22% 32% 46%

2011n=42

43% 17% 40%

% Change +21% -15% -6%

K = Key Element45


K # 2011(MD #)


MEDSAFENone(A+B)

Partial(C+D)

Full(E)

X 260(233)

Machine-readable coding (e.g., bar-coding) is used at the point of care to verify drug selection prior to administering medications.

2010n=41

35% 28% 38%

2011n=42

43% 29% 29%

% Change +8% +1% -9%

K = Key Element46


K # 2011(MD #)


MEDSAFENone(A+B)

Partial(C+D)

Full(E)

X 258a(230a)

Some form of end product testing (e.g., refractometer, weighing, lab confirmation) of complex intravenous admixtures (e.g., TPNs, cardioplegic solutions, pediatric electrolyte solutions) is used to check the contents before the pharmacy dispenses the solution.

2010 42% 21% 37%

2011n=22 (52%)

41% 18% 41%

% Change -1% -3% +4%

X 258b(230b)

All complex solutions are outsourced to a company that provides documentation of end product testing.

2010 0% 0% 100%

2011n=20 (48%)

0% 0% 100%

% Change 0% 0% 0%K = Key Element

47



MEDSAFENone(A+B)

Partial(C+D)

Full(E)

VI 147

If smart pump technology is used, an interdisciplinary team, which includes pharmacists, nurses, and physician representatives, develops and tests the drug library, and reviews and updates the library at least quarterly. Scoring guideline: Choose Not Applicable if your organization does not have smart pump technology.

2010 NEW

MDn=32

N/A=10 (24%)41% 19% 41%


OTHER SELF-ASSESSMENT ITEMS2010 and 2011 MD MEDSAFE Scores

49



MEDSAFENone(A+B)

Partial(C+D)

Full(E)

I 25

All weights and heights are measured and documented in written and electronic systems in metric units (i.e., grams or kilograms for weight, centimeters for height).

2010 NEW

2011n=42

10% 45% 45%

I 26Scales used to weigh patients only measure in metric units or default to metric units.

2010 NEW

2011n=42

31% 36% 33%

K = Key Element50


K #2011(MD#)


MEDSAFENone(A+B)

Partial(C+D)

Full(E)

I 11(9)

Medication orders cannot be entered into the computer order entry system until the patient’s allergies have been entered and coded (i.e., orders cannot be entered until the allergy field has been populated).

2010n=41

24% 76%

2011n=42

43% 57%

% Change +19% -19%

I 10(22)

Information technology systems require verification of archived allergy information that auto-populates an allergy field from a prior admission and/or the patient’s ambulatory record.

2010n=41

21% 10% 69%

2011n=42

33% 17% 50%

% Change +12% +7% -19%K = Key Element

51


K #2011(MD#)


MEDSAFENone(A+B)

Partial(C+D)

Full(E)

II 34*(45)

High-alert drugs used within the organization have been identified, high-leverage error-reduction strategies have been established for these drugs, and these have been communicated to all practitioners who prescribe, dispense, and administer the products, and/or monitor their effects.

2010n=41

0% 0% 100%

2011n=42

0% 14% 86%

% Change 0% +14% -14%

K = Key Element

*Item worded differently in the 2004 and 2011 assessments

52


K #2011(MD#)


MEDSAFENone(A+B)

Partial(C+D)

Full(E)

II 35(28)

Current protocols, guidelines, dosing scales, and/or checklists for high-alert drugs (e.g., chemotherapy, anticoagulants, opioids, insulin) are readily accessible to prescribers, pharmacists, and nurses, and used when high-alert drugs are prescribed, dispensed, and administered.

2010n=41

0% 12% 88%

2011n=42

0% 24% 76%

% Change 0% +12% -12%

K = Key Element53



MEDSAFENone(A+B)

Partial(C+D)

Full(E)

II 36

Equianalgesic dosing charts for oral, parenteral, and transdermal (e.g., fentaNYL patches) opioids have been established and are easily accessible to all practitioners when prescribing, dispensing, and administering opioids.

2010 NEW

2011n=42

26% 26% 48%

K = Key Element54

2010 and 2011 MD MEDSAFE % Implemented by Self-Assessment Item (cont.)

K #2011(MD#)


MEDSAFENone(A+B)

Partial(C+D)

Full(E)

III 68*(60)

Verbal (face-to-face) orders from prescribers who are onsite in the hospital are never accepted, except in emergencies or during sterile procedures where ungloving would be impractical.

2010n=41

2% 29% 68%

2011n=42

5% 52% 43%

% Change +3% +23% -25%

K = Key Element


55


K #2011(MD#)


MEDSAFENone(A+B)

Partial(C+D)

Full(E)

III 69(61)

Verbal or telephone orders are never accepted for oral or parenteral chemotherapy, including chemotherapeutic agents used for non-oncologic indications (e.g., methotrexate used to treat rheumatoid arthritis). Scoring guideline: Choose Not Applicable if chemotherapy (including oral agents) is never prescribed.

2010n=41

6% 94%

2011n=37

N/A=5 (12%)11% 89%

% Change +5% -5%

K = Key Element56


K #2011(MD#)


MEDSAFENone(A+B)

Partial(C+D)

Full(E)

III 72*(64)

Current paper or electronic MARs or the original order are available during medication selection/preparation and at (or taken to) the patient’s bedside (or anteroom for isolation patients) for reference during drug administration. Exception: Emergency lifesaving medication preparation and administration.

2010n=41

0% 8% 93%

2011n=42

0% 19% 81%

% Change 0% +11% -12%

K = Key Element


57


K #2011(MD#)


MEDSAFENone(A+B)

Partial(C+D)

Full(E)

IV 91*(85)

All medications, medication containers (including syringes, basins, or other vessels used to store drugs), and other solutions on and off the sterile field in perioperative and other procedural settings are labeled even when just one product/solution is present.

2010n=41

0% 23% 78%

2011n=42

2% 10% 88%

% Change +2% -13% +10%

K = Key Element


58


K #2011(MD#)


MEDSAFENone(A+B)

Partial(C+D)

Full(E)

IV 93(87)

Syringes of medications prepared for use during anesthesia are labeled with the drug name,strength/concentration, and date of expiration or time of expiration if expiration occurs in less than 24 hours.

2010n=41

0% 19% 81%

2011n=42

5% 17% 79%

% Change +5% -2% -2%

K = Key Element59

60

Questions

Maryland Patient Safety Centerâ€™s Annual MEDSAFE Conference

Documents

Transcript of Maryland Patient Safety Centerâ€™s Annual MEDSAFE Conference