Medline is correcting affected convenience kits by removing included B. Braun components containing Huons Bupivacaine Hydrochloride in Dextrose Injection, USP.

FOR IMMEDIATE RELEASE – August 19, 2026 – Houston, Texas, Optimal Balance Pharmacy is voluntarily recalling one lot of Compounded Glutathione 200 MG/ML 30 ML Multi-Dose Vials to the patient level. The product is being recalled because pharmacy testing identified elevated bacterial endotoxin levels.

It has been roughly 50 years since Jay Katz advocated for the involvement of patients in decision-making,1 yet making treatment decisions based on what matters to patients remains aspirational. Despite broad agreement that high-quality care should be of service to the patient by using shared decision-making to align treatments with patient’s goals, routine performance of shared decision-making with reliability and across specialties remains elusive. As such, a novel initiative to customise care for the individual patient, ‘What Matters’ is a primary component of the age-friendly quality improvement programmes set forth by august bodies in the USA.2–5 While this undertaking recognises important gaps in clinician–patient interactions, particularly for older adults who often prefer to avoid default life-prolonging treatment given associated burdens, it provides little guidance for enactment. Potentially, this is a great policy choice allowing end-users to establish the most...

Across the UK, there is little doubt that the provision of healthcare in prisons has changed significantly over the last 30 years. The 1996 report by Her Majesty’s Chief Inspector of Prisons for England and Wales, ‘Patient or Prisoner?’ highlighted several concerns about the provision of healthcare in prisons, notably regarding equity, standards, professional isolation and whether the Prison Service had the capacity to carry out its healthcare function adequately.1 It recommended that the responsibility of providing healthcare to prisoners should be transferred from the Prison Service to the National Health Service (NHS), as a means of improving healthcare within prisons. Ten years later, in 2006, responsibility for the commissioning of health services finally became the responsibility of the NHS.2 Another decade on, a rapid review of the changes concluded that ‘prison healthcare services have undergone "transformation" during the ten-year time period of NHS commissioning...

In 1995, Star Trek Voyager debuted with its vision of a fully autonomous, artificial intelligence (AI)-powered physician (The EMH—Emergency Medical Hologram), which was thrust into the role due to loss of the supervisory human in the loop practitioner. This vision of the future has nearly arrived. AI has been integrated into multiple aspects of healthcare, with its uptake rapid and in many cases outpacing the science behind its impact on safety and care quality. Nowhere has its impact been more dramatically seen than in documentation support. Over the last 20 years, there has been growing attention to the problems with clinician burnout and the role documentation burden plays in it.1 The maturity of large language models (LLM), especially when combined with ambient speech recognition (ASR), has led to a myriad of tools to facilitate documentation in multiple settings. Their ease of use and high demand have led...

Background

There is no low-risk surgery for frail, high-risk patients. Frailty screening helps identify these patients, enabling surgical teams to tailor treatment plans that align with patient values and mitigate risks. However, the way clinicians assess values and counsel older patients about surgical options is unclear. As part of a larger Veterans Administration (VA) quality improvement (QI) initiative to implement Surgical Pause, this pre-implementation qualitative assessment examined how outpatient surgical teams identify and use older adults’ goals, values and care preferences in elective surgery decision-making.

Methods

We triangulated pre-implementation interview, observational and focus group data to understand the clinical context, workflows and staff perspectives around preoperative goal clarification conversations. Using thematic analysis, we described clinicians’ attitudes towards integrating structured ‘What Matters’ conversations into routine preoperative care, mapped existing processes and identified barriers and opportunities for quality improvement.

Results

The final sample included 27 interviews, 75 observations and 7 focus groups across 18 outpatient clinics at four medical centres. Overall, clinicians supported discussing ‘What Matters’ with high-risk older patients considering elective surgery, but their practices varied. Participants reported inconsistent processes for integrating patient priorities into decisions. Key barriers included reliance on a ‘fix it’ care model, workflow integration and visibility, and time constraints. Facilitators included leveraging performance metrics, improving documentation and referral systems, and staff training.

Conclusions

Although surgical clinicians recognise the importance of discussing patient goals, explicit ‘What Matters’ conversations with patients rarely occurred. In contrast, frequently used implicit strategies include chart reviews, clinical assessment, discussion of treatment options, informed consent and referrals. Future work should enhance strategies to improve goal clarification and promote high-quality decision-making with frail older patients.

Objective

To estimate the incidence of avoidable healthcare-associated harm for prisoners in England.

Design

A retrospective cross-sectional case note review of prisoner healthcare records.

Setting

18 prisons in England were purposively sampled for maximum variation of characteristics based on prison category (open, local, training, high security and female), type (publicly and privately run) and population size.

Population

After screening 15 027 prisoner records, two cohorts were selected: a sample of 6294 ‘enhanced risk’ prisoners and a random sample of 853 prisoners not included in the enhanced risk sample (n=7147).

Main outcome measures

The primary outcome was the incidence of patient harm per 100 000 patient-years, judged at least probably avoidable. The secondary outcome was the incidence of patient harm judged at least possibly avoidable. Cases of avoidable harm were characterised in terms of patient impact, known as patient outcome(s), and the severity of harm experienced.

Results

Within 18 prisons, 247 cases of avoidable harm were experienced by 244 prisoners and were identified from 7147 patient records. The incidence of avoidable harm was 2241.4 (95% CI 1970.5 to 2539.0) per 100 000 patient-years, and this rate could be as high as 3412.0 (95% CI 3075.8 to 3774.9) based on the records screened during this study. Most patient outcomes involved prisoners experiencing discomfort and pain (99/247, 40.1%) and delays receiving appropriate healthcare management or assessment (91/247, 36.8%). The identified cases of avoidable healthcare-associated harm for prisoners resulted mainly in moderate harm severity (157/247 cases, 63.6%), followed by severe harm (27, 10.9%) and death (27, 10.9%).

Conclusions

Compared with community settings, people in prison experience a 41–67 times greater risk of avoidable significant healthcare-associated harm. This stark disparity underscores the urgent need for government and policy action. Delivering safe, equitable healthcare in secure environments remains a major challenge that demands focused attention.

Background

There are increasing efforts to include equity in all quality improvement (QI) initiatives. A comprehensive framework to embed equity in QI has been lacking, which acts as a barrier to the QI community from taking action to reduce healthcare inequities.

Objectives

The objectives of this scoping review were to: (1) map and summarise available equity frameworks for QI and (2) create a ‘meta-framework’ for QI leaders and practitioners, with engagement of people with lived experience of health inequities.

Methods

Articles were identified with searches of four databases (MEDLINE, Embase, PsycInfo and CINAHL) and review of reference lists from included articles. Articles that reported how equity can be meaningfully integrated into QI were included. A qualitative inductive thematic analysis and community member engagement and consultation were completed to clarify recommended strategies for embedding equity in QI.

Results

The search strategy yielded 2776 unique articles, with 40 meeting the inclusion criteria. A meta-framework for embedding equity in QI was created that has two enablers: broadening theoretic underpinnings and organisational culture, structures and leadership. The meta-framework also has six domains: (1) engage with people with lived experience of health inequities; (2) define the equity problem and aim; (3) diversify and train the QI team; (4) examine broader root causes; (5) intervene to reduce inequities; and (6) measure impacts on equity. The community member consultation identified key facilitators and common pitfalls in involving community members in QI.

Conclusion

This meta-framework is a comprehensive resource to integrate equity into all aspects of QI practice. Further study of its implementation is recommended. Revisions to QI guidelines and training curricula are also needed to drive and sustain the embedding of equity in QI.

Objective

To evaluate the effectiveness of clinician-directed default nudges for reducing overuse of tests and treatments.

Design

A systematic review was conducted to synthesise evidence from randomised controlled trials examining the effect of clinician-directed default nudges on overuse of tests or treatments, measured as a proportion of encounters or patients. Four databases and three clinical trial registries were searched up to 13 January 2025. Two reviewers screened, extracted data, assessed risk of bias and certainty of evidence using Cochrane guidance. Because there was high clinical heterogeneity, we used the Synthesis Without Meta-analysis guidelines for our overall analysis. A secondary exploratory meta-analysis was performed on a subgroup of default nudge interventions targeting opioid prescriptions.

Results

We included six trials (five cluster randomised trials and one patient randomised trial, n=767 to 21 331). Trials targeted overuse of opioids, antibiotics, high-risk medicines for older patients and imaging during palliative radiotherapy. Lowering default quantities of opioids may cause reductions in opioid overuse, but on one occasion increased overuse. It is unclear if opt-out defaults reduce antibiotic overuse in patients with sepsis eligible for de-escalation or if lowering default doses reduce overuse of high-risk medications in older patients. Reducing the default frequency of imaging probably causes large reductions in unnecessary imaging in people receiving palliative radiotherapy. A subgroup meta-analysis was only possible on one type of default for opioids. A 10-tablet default may reduce overuse of large packs of opioids (risk difference=–14.3%, 95% CI –51.4% to +22.9%, 3 trials, 18 186 encounters, very low certainty evidence).

Conclusions

Clinician-directed default nudges had inconsistent effects on overuse of healthcare, with limited and mostly low certainty evidence. High-quality trials are essential to determine whether default nudges reduce overuse or improve patient outcomes.

PROSPERO registration number

42024516423

De-implementation of low-value clinical practices requires changes in both documentation and clinician behaviour, yet documentation may not accurately reflect bedside practice. We conducted a multifaceted quality improvement de-implementation initiative in a level III neonatal intensive care unit that combined education, electronic medical record workflow modification and reinforcement of symptom-based feeding assessment to eliminate routine gastric residual (GR) checks in infants with birth weight <1500 g. Following implementation, documented GR checks declined to zero, with no increase in necrotising enterocolitis or feeding intolerance and no improvement in time to full enteral feeds.

To evaluate behavioural adoption, we performed a secondary analysis of an anonymous nursing survey. Of 56 nurses, 24 responded to the item assessing ongoing practice; 7 of 24 (29%) reported continuing GR checks without documentation. While most nurses supported the protocol change, some reported anxiety and perceived increases in emesis, abdominal imaging and feeding interruptions despite stable clinical outcomes. Less-experienced nurses were more likely to report concern about potential disciplinary consequences (OR 7.33; 95% CI 1.2 to 45; p<0.05). In sensitivity analysis, nurses who did not report continued checks demonstrated higher anxiety (OR 152; 95% CI 3.0 to 7600; p<0.001) although this post hoc finding should be interpreted cautiously.

These findings demonstrate discordance between documented and actual practice following de-implementation. Documentation alone may overestimate implementation fidelity, particularly when discontinuing practices perceived as protective, highlighting the need for measurement strategies that capture true bedside behaviour.

Reporting as a patient safety system in radiology

Radiological reporting is a central component of clinical decision-making and a patient safety-critical system. Radiology reports inform diagnosis, guide therapeutic decisions and shape interdisciplinary communication; deficiencies in how imaging findings are documented, structured or communicated therefore have direct downstream consequences for patient care.1 2

Despite this central role, radiological reporting remains vulnerable to well-documented safety risks. Variability in report structure, inconsistent terminology, omissions of relevant findings and ambiguous language can impair interpretation and increase the likelihood of diagnostic misunderstanding or delayed action. Unstructured or inconsistently structured reports have been shown to contribute to communication failures and complicate clinical decision-making in high-stakes scenarios.1–3

These vulnerabilities long predate the introduction of artificial intelligence (AI). Reporting variability and incompleteness were recognised as persistent threats to patient safety and clinical communication, prompting early efforts...

FOR IMMEDIATE RELEASE – August 19, 2026– Bethlehem, PA, B. Braun Medical Inc (B. Braun), is voluntarily recalling one lot of Excel® Lactated Ringers Injection, 1000mL to the hospital/healthcare facility level, due to the presence of particulate matter in solution identified primarily as cellulose co

BD is correcting convenience kits and procedural trays containing recalled Huons Co. sodium chloride ampules

BD is recalling certain BD Intraosseous Vascular Access System Needle Sets due to difficulty removing the obturator (stylet) following placement.

Baxter administration sets may have air bubbles in the drip chamber and tubing, which may result in air being delivered through the IV line to the patient.

Certain BD ChloraPrep Applicators in Convenience Kits manufactured by Medline may not be sterile. 

Medline is correcting affected convenience kits by removing included ICU Medical pain management components containing Huons Bupivacaine Hydrochloride in Dextrose Injection, USP. 

The ventilator breathing circuits are intended to connect a ventilator to a patient tube or mask. Obstruction may result in inadequate ventilation.

FOR IMMEDIATE RELEASE – August 10, 2026 – LAKE ZURICH, Ill.— Fresenius Kabi, an operating company of the Fresenius Group, is recalling one lot of Tyenne® (tocilizumab-aazg) Injection 400 mg/20 mL (20 mg/mL)20 mL vials to the user level. An internal investigation at the firm found the product to cont

Abiomed and Oscor have identified a potential for introducer sheath leakage in 14Fr and 23Fr Introducers that may increase the risk of access-site bleeding.