Certain labels used with i.V.Station automated compounding systems may not be detected, leading to mislabeled sterile filled syringes

Arrow International is removing dialysis catheter kits containing recalled Merit Medical Splittable Sheath Introducers

Certain Codman Disposable Perforators may disassemble during or after use, increasing the risk of brain injury, hemorrhage, or prolonged surgery.

The adaptor on Namic RA syringes may unwind during use. The resulting loose connection or disconnection may lead to infection, blood loss, or air embolism.

Tandem is correcting Mobi insulin pumps operating on affected software versions (7.6.0.1, 7.6.0.3, and 7.7.0.1) which may incorrectly detect a motor issue.

What if the biggest threat to sustainable improvement in healthcare is not failing to learn—but failing to forget?

Sustainability is not static maintenance; it is evolution. Health systems that can adapt, discard and relearn, retaining what matters and deliberately forgetting what no longer serves patients, can sustain high-value care and continually move beyond low-value practices.

When learning is not enough: why health systems must learn to forget

Healthcare prides itself on being a learning system. We collect data, consider the context, analyse outcomes and iterate improvement cycles. Yet, true sustainability—the ability to embed and maintain improvement over time—requires more than learning: it demands deliberate unlearning. Outdated order sets, decision rules and routines have the potential to shape care long after evidence has evolved.1 A paradox of improvement is that systems cannot sustain what is new until they have let go of what is old....

Patient safety huddles have been employed across healthcare settings to boost safety culture and improve patient outcomes. However, there is a dearth of literature pertaining to physicians’ levels of interest in participating in these huddles, as well as the impact of physician presence on patient care dynamics. Multidisciplinary huddles aimed at identifying and addressing patient safety issues related to the electronic health record (EHR), for example, were helpful for promoting discussion of EHR-related safety concerns.1 Furthermore, there is a robust literature demonstrating the patient safety benefits of perioperative time-outs in the surgical literature, as well as structured handoffs at the time of care transfer.2–5 Yet hospitalist physicians were not always routinely a key part of these huddles, even though representatives from the medical and surgical services were among the 40 roles that attended some huddles in these studies.

As people age, so do their kidneys.1 The average decline in renal function is approximately 1 mL/min/year after 30 years old.2 3 Over 40% of people >70 years meet the Kidney Disease Improving Global Outcomes definition of chronic kidney disease (CKD), reflecting the increased prevalence of this condition in older people.4 5 Renal function decline is further accelerated through conditions such as hypertension, atherosclerosis, diabetes and cardiovascular disease, which are common comorbidities in older people.6 Safe prescribing of medication for older people with reduced kidney function is an ongoing challenge. Reduced renal excretion of medications eliminated through the kidney exposes people to increased drug plasma levels and increases the risk of medication-related harm leading to adverse drug events, increased hospitalisations and increased mortality.1 7 The presence of polypharmacy, among other issues, in this age...

Background

In 2017, the PREDICT (Paediatric Research in Emergency Departments International Collaborative) network conducted a cluster randomised controlled trial (cRCT) at 26 Australian and New Zealand hospitals to improve bronchiolitis care. Findings demonstrated that targeted interventions significantly improved adherence with five evidence-based low-value bronchiolitis practices (no chest radiography, salbutamol, glucocorticoids, antibiotics and epinephrine) in the first 24 hours of hospitalisation (adjusted risk difference, 14.1%; 95% CI: 6.5% to 21.7%; p<0.001). During the intervention year (2017), intervention hospital (n=13) compliance was 85.1% (95% CI: 82.6% to 89.7%). This study aimed to determine if improvements in bronchiolitis management were sustained at intervention hospitals 2 years post-trial completion.

Methods

International, multicentre follow-up study of hospitals in Australia and New Zealand that participated in a cRCT of de-implementation of low-value bronchiolitis practices, 1 year (2018) and 2 years (2019) post-trial completion, obtained retrospectively from medical audits. Sustainability was defined a priori as no more than a <7% decrease to any level of improvement in adherence for all five low-value practices (composite outcome) from the cRCT intervention year.

Results

Of the 26 hospitals, 11 intervention and 10 control hospitals agreed to participate in the follow-up study. Data were collected on 3299 infants with bronchiolitis 1 year (intervention and control hospitals) and 1689 infants 2 years post-trial (intervention hospitals). Adherence with no use of the five low-value practices 2 years post-trial completion was 80.9% (adjusted predicted adherence, 80.8%, 95% CI: 77.4% to 84.2%; estimated risk difference from cRCT outcome –3.9%, 95% CI: –8.6% to 0.8%) at intervention hospitals, fulfilling the a priori definition of sustainability.

Discussion

Targeted interventions, delivered over one bronchiolitis season, resulted in sustained improvements in bronchiolitis management in infants 2 years later. This follow-up study provides evidence for sustainability in de-implementing low-value care in bronchiolitis management.

Trial registration details

Australian and New Zealand Clinical Trials Registry No: ACTRN12621001287820.

Background

The 2017 Paediatric Research in Emergency Departments International Collaborative (PREDICT) Bronchiolitis Knowledge Translation (KT) Study, a cluster randomised trial in 26 Australasian hospitals, found targeted interventions provided over one bronchiolitis season effectively de-implemented five low-value practices (salbutamol, glucocorticoids, chest radiography, antibiotics and epinephrine) by 14.1% (adjusted risk difference, 95% CI 6.5% to 21.7%; p<0.001). A 2-year follow-up study found de-implementation was sustained. This process evaluation aimed to identify factors that influenced sustainability of de-implementation of these five low-value practices in PREDICT Bronchiolitis KT Study intervention hospitals and examine fidelity and/or adaptation of the targeted interventions over 4 years post intervention delivery (sustainment).

Methods

Semistructured qualitative interviews were conducted, over 2021 and 2022, with a purposive sample of emergency department (ED) and paediatric inpatient clinicians. Data were analysed thematically into facilitators and barriers using the Consolidated Framework for Sustainability Constructs in Healthcare (CFSCH). The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies was used to explore fidelity and adaptation.

Results

50 clinicians (nurses: n=26; doctors: n=24) from 12 intervention hospitals were interviewed. Eight themes were identified and mapped to three CFSCH domains: (1) organisational setting; (2) initiative design and delivery and (3) people involved. Facilitators were a culture of evidence-based practice, ongoing multimodal education, strong clinical leadership as unofficial champions and the previous effectiveness of the PREDICT Bronchiolitis KT Study interventions. Barriers were lack of paediatric trained ED staff, assumptions by senior clinicians that junior doctors can provide evidence-based bronchiolitis management, bronchiolitis not a current improvement priority and lack of bronchiolitis education sessions. Use of the targeted interventions reduced over time and, when used, was adapted locally.

Conclusion

This study provides insights into factors influencing the sustainability of de-implementation of low-value care in acute care settings. Fostering an evidence-based practice culture, supported by senior leadership and ongoing multimodal education, supports sustainability of improvements in this setting.

Trial registration number

Australian and New Zealand Clinical Trials Registry No: ACTRN12621001287820.

Background

Medical safety huddles are short, structured meetings for physicians to proactively discuss and respond to profession-specific patient safety concerns, with the goal of decreasing future adverse events. Prior observational studies found associations with improved patient safety outcomes, but no randomised controlled studies have been conducted.

Objective

The primary objective was to determine the impact of medical safety huddles on adverse events. Secondary objectives included the fidelity of huddle implementation and the impact on patient safety culture among physicians.

Design

Stepped-wedge cluster randomised trial with four sequences, and each hospital site was a cluster.

Setting

Inpatient oncology, surgery and rehabilitation programmes in four academic hospitals.

Participants

Physicians in participating programmes.

Intervention

Medical safety huddles were adapted for local context and implemented sequentially based on a computer-generated random sequence every 2 months after a 4-month control period. All sites remained in the intervention phase for at least 9 months.

Main outcome and measures

The primary outcome was the rate of adverse events, as determined through blinded chart audits of 912 randomly selected patients. The fidelity of implementation was assessed through the huddle attendance rate, number of safety issues raised in the huddles and number of actions taken in response. Patient safety culture was assessed using the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety.

Results

The adjusted rate of adverse events (per 1000 patient days) in the postintervention phase was 12% lower compared with preintervention (RR: 0.88; 95% CI: 0.80 to 0.98; p=0.016). The odds of having adverse events posthuddle implementation were 17% lower in the postintervention period compared with preintervention (OR intervention vs control: 0.83; 95% CI: 0.80 to 0.87; p<0.001). The mean huddle attendance rate at each site ranged from 30% to 85%, and the mean number of issues raised per huddle and the mean number of actions taken per huddle ranged from 1.6 to 3.1. The mean (SD) overall patient safety rating increased from 2.3 (0.53) to 2.8 (0.88), p=0.010. The mean per cent (SD) positive score for the composite measures of ‘Organisational learning’ increased significantly from 35% (26%) to 54% (23%), p=0.00, ‘Response to error’ 37% (24%) to 52% (22%), p=0.025 and ‘Communication about error’ 36% (28%) to 64% (42%), p=0.016 after implementation.

Conclusions and relevance

Medical safety huddles decreased adverse events and may improve patient safety culture through engaging physicians.

Trial registration number

NCT05365516.

Objectives

To capture experiences of people self-reporting harm and contrast responses and actions between those who do or do not take formal action.

Design

Semi-structured qualitative interview study.

Setting

People self-reporting harm experienced in the National Health Service (NHS) or their family/friends identified from a general Great British population survey.

Participants

49 participants.

Results

There were commonalities in experiences after harm whether formal action (including making a formal complaint or litigation) was taken or not. Many participants reported raising concerns informally with NHS staff, trying to access explanations or support, but were usually unsuccessful. Decision-making on action was complex. There were multiple reasons for not pursuing formal action, including fears of damaging relationships with clinicians, being occupied coping with the consequences of the harm or not wanting to take action against the NHS. NHS advocacy services were not regarded as helpful. Knowledge of how to proceed and feeling entitled to do so, along with proactive social networks, could facilitate action, but often only after people were spurred on by anger and frustration about not receiving an explanation, apology or support for recovery from the NHS. Those from marginalised groups were more likely to feel disempowered to act or be discouraged by family or social contacts, which could lead to self-distancing and reduced trust in services.

Conclusions

People actively seek resolution and recovery after harm but often face multiple barriers in having their needs for explanations, apologies and support addressed. Open and compassionate engagement, especially with those from more marginalised communities, plus tailored support to address needs, could promote recovery, decrease compounded harm and reduce use of grievance services where other provision may be more helpful.

Background

Increasing age is associated with reductions in kidney function and increasing polypharmacy. Most medicines are eliminated through the kidney, meaning older patients are at risk of medication accumulation and toxicity. This scoping review synthesised: (1) the prevalence at which older patients with reduced kidney function in primary care are exposed to inappropriate prescribing; (2) its associated harms; (3) the reasons for this occurring; and (4) the interventions used to improve prescribing practices.

Methods

This scoping review searched ‘Medline’, ‘Embase’, ‘PsycINFO’, ‘CINAHL’ and ‘Web of Science’ for publications before October 2024. References were managed on EndNote V.X5 and thematic data analysis was undertaken on Microsoft Excel. Common themes were identified, summary statistics were calculated and insights were summarised through a narrative technique.

Results

43 relevant studies explored the scale of inappropriate prescribing, estimating prevalences of patient exposure ranging from 0.6% to 49.1% (median 24.9%). Five studies explored the associated harm from inappropriate prescribing, but only one study assessed harm as a primary outcome. Eight studies that assessed difficulties in following prescribing guidelines in reduced kidney function suggested that a lack of awareness and trusted guidelines are fundamental problems. While 13 studies evaluated interventions for improving prescribing in reduced kidney function, only two demonstrated evidence of effectiveness and only one intervention was theoretically informed.

Conclusions

Despite significant heterogeneity in study characteristics, it is clear that the prevalence of inappropriate prescribing for older people is uncomfortably high. There is a lack of evidence linking this to associated adverse outcomes, as well as identifying the causative issues driving this behaviour and the preventative interventions that could prevent harm.

I have heard faculty members complain, on occasion, that students develop bad habits at these clinics because of inadequate supervision. Certainly the quality of care and the ethics of students ‘practicing’ on those who cannot afford other care should be reviewed.

-E. Poulsen, JAMA (1995)1

Introduction

Student-run clinics (SRCs), in which medical and health professions students take responsibility for operational and logistics management of charitable clinics,2 are a powerful expression of service-based learning: students hone clinical and administrative skills while communities receive essential medical services that might otherwise be unavailable. Yet over the past 20 years, these clinics have begun globalising2–5 and increasing in complexity.5 This is happening within a landscape of limited evidence,5 6 growing concerns about ethics and substandard care,7–13

On April 02, 2026, Aligned Medical Solutions, Billings, MT, initiated a nationwide recall of two convenience kits that contain the Medline Namic Angiographic Rotating Adapter(RA) 10CC Syringe. Associated kits are AMS6908E Angio Pack and AMS6908F Angio Pack.

The adaptor on Namic RA syringes may unwind during use. The resulting loose connection or disconnection may lead to infection, blood loss, or air embolism.

The adaptor on Namic RA syringes may unwind during use. The resulting loose connection or disconnection may lead to infection, blood loss, or air embolism.

Stryker is updating use instructions for TMJ Unilateral and Bilateral Implants due to a discrepancy in the positioning of the screw hole.

Philips Trilogy Evo Ventilators may not function as intended if used with certain nebulizers.

Percussionaire Corporation issues updated instructions for ventilator tubes due to design defect that could cause hypoventilation, respiratory failure