Newsletter
Surgical Fires: Electrosurgical Cases
Dec 31, 2011
Patient Safety Alert 5: Surgical Fires: Electrosurgical Cases (PDF)
The AMC PSO has identified a series of practices employed to address the factors that can contribute to surgical fires.
Safety Strategies: Prevention
- Interventions should be directed at the entire team rather than the provider wielding the electrosurgical unit (ESU).
- Each member of the team must be constantly aware of changing risks during the case (e.g., patient shifting causing tenting that creates an oxygen rich environment) and be empowered to identify and address these risks.
AMC PSO
Our Patient Safety Organization convenes clinical leaders to identify and mitigate emerging risks.
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More AMC PSO Content
Publications such as whitepapers and guidelines derived from the AMC PSO convenings.
No Surgical Items Left Behind
Newsletter
While the occurrence is rare, Massachusetts reported rising rates of retained surgical items over the past several years.
Periprocedural Management of Anticoagulation Therapy
Newsletter
Patient Safety Alert Issue 24: The AMC PSO recently convened to discuss this high-risk area and important patient safety issue, the contributing factors often associated with this medication event type, and the strategies to proactively mitigate this risk.
Patient Falls
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Patient Safety Alert Issue 23: The AMC PSO convened a panel of nursing leaders to review recent trends, evaluate the current literature, and discuss novel interventions aimed at mitigating the risk regarding patient falls.
Failure to Rescue
Newsletter
Patient Safety Alert Issue 22: The AMC PSO has recently assembled a panel of subject matter experts to review data, literature, and their own experiences with insufficient patient monitoring and failure to rescue.