Discover and read the best of Twitter Threads about #PtSafety

Most recents (24)

🧵 How well do you know your dopamine antagonists? 💊💊

1/ Using these drugs safely requires that clinicians & patients appreciate their important #AdverseEffects, which are not always well understood

👉🏽ti.ubc.ca/letter139

#MedEd #prescribing #deprescribing #medsafety
2/ #AdverseEffects may include:

⚠️ Drug-induced #Parkinsonism
-↘️ or slowed movements, rigidity/tremor/unsteadiness, facial expression loss

⚠️ #Akathisia
-intense internal restlessness or desire to move (which may be mistaken for anxiety)

👉🏽Pt videos: ti.ubc.ca/letter139
3/ #AdverseEffects may include:

⚠️Acute dystonic reaction
-sudden, involuntary, often painful muscle spasm

⚠️Dyskinesia
-repetitive, involuntary movements...can be associated with cognitive decline

👉🏽Pt experience videos: ti.ubc.ca/letter139

#MedEd #ptsafety #drugsafety
Read 7 tweets
🧵 Reducing #PrescribingCascades ⬇️

1/ What are #Prescribing Cascades?

1⃣ A drug is prescribed 💊
2⃣ #AdverseEvent occurs but is misinterpreted as a new medical condition ⚠️
3⃣Another drug is prescribed for the drug-induced adverse event 💊💊

ti.ubc.ca/letter138 #MedEd Image
2/ Anticholinergics ➡️ cognitive dysfunction ➡️ drugs for #dementia

#Anticholinergic 💊 block acetylcholinergic neurotransmission in the brain, impairing cognition & memory

Can lead to new Rx or ↗️ acetylcholinesterase inhibitor doses

ti.ubc.ca/letter138 #MedEd #FOAMed Image
3/ Drugs for #dementia ➡️ incontinence ➡️ anticholinergics

Conversely, AChE-I can cause urinary or fecal incontinence, that may "cascade" to prescription of an #anticholinergic

👉🏽 full Letter here: ti.ubc.ca/letter138

#MedEd #PrescribingCascades #MedTwitter Image
Read 10 tweets
I'm sorry, I can't ignore the open tabs, so I'm back with more inadequate care.

@ASDSpectrumASD St Erme is the third report I've covered from Spectrum this month.

I keep banging on about why @chtycommission don't take action; looks like they are

api.cqc.org.uk/public/v1/repo…

1/ Front page CQC report: Spectrum (Devon and Cornwall Autistic
On 14 July @ChtyCommission issued a press release saying they were opening an inquiry due to safeguarding concerns gov.uk/government/new…

They're not a safeguarding regulator and make clear substantive safeguarding matters will be investigated by regulators and/or police

2/ The regulator is concerned that the trustees may have failed
Now we just need @ChtyCommission to open inquiries into some of the large national charities with failing provision and poor campaigning records, rather than just the smaller local ones - more here

But I guess it's good they're looking at Spectrum

3/
Read 230 tweets
THREAD: Bring it down safely! ↘️💊

1/6 6⃣tweets about our new TI Therapeutics Letter 134: Finding the lowest effective dose for non-opioid #analgesics

👉🏾 Full Letter: ti.ubc.ca/letter134

#MedEd #medsafety #prescribing #BetterPrescribing Image
2/6 Consistent evidence that minority of pts get clinically meaningful pain relief from any dose of:
#Cyclobenzaprine (at best 1/4)
#Duloxetine (at best 1/6)
#Gabapentin / #Pregabalin (at best 1/6)

👉🏾ti.ubc.ca/letter134

#MedEd #ptsafety #BetterPrescribing #prescribing Image
3/6 Gabapentin, pregabalin, duloxetine:

A 2021 Canadian systematic review found NNT (numbers needed to treat) of 6-7 for "clinically meaningful benefit" (defined as ≥30% reduction in pain or pain & function)

👉🏾ti.ubc.ca/letter134

#MedEd #BetterPrescribing #deprescribing Image
Read 7 tweets
THREAD: SGLT2 inhibitors for #diabetes

1/5 Dr. Jamie Falk @jamisonfalk presented "A Deep Dive into #SGLT2i: What Comes to the Surface for Individuals with Diabetes"

👉🏽Watch the presentation here: bit.ly/3FRCEoM 🧑🏾‍💻

#T2DM #medsafety #FOAMed #MedEd
2/5 #AdverseEffects for #SGLT2i to be aware of: genital infections, hypovolemia, DKA, amputations

✅Check out the image ⬇️ for the risk estimates
✅Watch @JamisonFalk's presentation here: bit.ly/3FRCEoM🧑🏾‍💻

#T2DM #medsafety #FOAMed #MedEd #diabetes #ptsafety
3/5 Evidence to date for #SGLT2i:

The first of the two new classes of medications for type II diabetes to reduce ↘️ risk of CV #AdverseEvents and mortality

✅Watch @JamisonFalk's presentation here: bit.ly/3FRCEoM🧑🏾‍💻

#T2DM #medsafety #FOAMed #MedEd #diabetes
Read 6 tweets
THREAD:5⃣things to know from 5 recent TI Therapeutics Letters👩🏽‍🔬

1/5: How to choose a good #mirtazapine dose? 🤔

Mirtazapine has a dose response 💊for harm but NOT for efficacy: harm ↗️ after 30mg/day but efficacy doesn't: bit.ly/361LU9E

#MedEd #deprescribing #ptsafety
2/5: Want to learn about recent @GovCanHealth #medsafety or international warnings for medications?

Read our Therapeutics Letter on international drug safety advisories: bit.ly/3wc0ar8 ⚠️ 💊

#drugsafety #SegPac #ptsafety
3/5: Do you like receiving feedback on your #prescribing?👩🏽‍⚕️💊

Read about Personal Prescribing Portraits: bit.ly/3hkf8WO

#MedEd #deprescribing
Read 6 tweets
THREAD - What if we could track and record repeat Adverse Drug Events? 🤔 💊

1/6: Register for our May 12 #BestEvidence webinar, as @corinne_hohl talks about Assessing the Impact of Information Continuity on Health Outcomes: bit.ly/3ap4FGO #MedEd
2/6: Why do Adverse Drug Events (ADEs) matter?

Each year in British Columbia, ADEs account for:
👉240,000 emergency dept (ED) visits
👉480,000 days in hospital
👉approx. 1 in 9 adult ED visits

More here: bit.ly/2Q7UGi8
#drugsafety #ptsafety #MedEd
3/6: In Canada, adverse drug events 💊 cause or contribute to almost 2⃣million emergency department visits annually 😯 🆘

See publication list here: actionade.org/referenced-art…

#MedEd #ptsafety #prescribing
Read 7 tweets
🧵 “How can I improve #PICC safety in my hospital?”

I’ve received many questions like this following the recent publication of our @BMJ_Qual_Saf paper showing how we did this in 50+ hospitals.

qualitysafety.bmj.com/content/early/…

Today, we released the formula (Thread)
@BMJ_Qual_Saf First, head over to improvePICC.com and click on “Implementation” in the top menu - this will take you to the Roadmap for Quality Improvement. Image
@BMJ_Qual_Saf Then, pause for a moment.

You’re about to go on a journey - a #qualityimprovement journey.

Look for your markers, prepare yourself for change! Image
Read 13 tweets
THREAD: Dr. John Mandrola: “The more you see, the harder the medicine gets”

1/7 Some new views on legacy prescriptions: Beta-blockers, ASA & #statins by Dr. John Mandrola

(based on @drjohnm presentation hosted by @drug_evidence Oct 17, 2020: bit.ly/32fsPiA)

#MedED
2/7 Example 1: Beta blockers in heart failure 💊♥️

Observational studies suggest beta-blockers for heart failure tx beyond 3 years are NOT associated with beneficial outcomes 😯

These findings challenge current recommendations: bit.ly/3acX9P7

#MedEd #deprescribing
3/7 Ex. 2: How about beta blockers to treat MIs, looking at research from pre-reperfusion & reperfusion eras?

Large meta-analysis of about 60 trials, with > than 100,000 pts found NO difference from using beta blockers in the reperfusion era: bit.ly/3dfvn6u

#MedEd
Read 8 tweets
THREAD: Tamiflu for #influenza prevention – the evidence

1/6 In 2019 21,000 BC citizens were prescribed Tamiflu (oseltamivir), many to prevent the flu. Flu prevention guidelines. AMMI Canada ammi.ca/?ID=171

Systematic review of Tamiflu safety: pubmed.ncbi.nlm.nih.gov/27246259/
2/6 Tamiflu for prevention ↘️ symptomatic flu (by 3%, NNT=33) with uncertain effect on asymptomatic flu.

One likely explanation is that Tamiflu has a central symptom lowering effect but may not ↘️ viral transmission.
pubmed.ncbi.nlm.nih.gov/27246259

#influenza #flu #tamiflu
3/6 Tamiflu doesn't reduce risk of developing flu-like illness though it can make people feel better (i.e. fewer self-reported symptoms) & reduces fever.

There is not enough evidence to say it prevents death, hospitalizations, or flu complications
pubmed.ncbi.nlm.nih.gov/27246259/
Read 7 tweets
THREAD: Are we using ACEIs & ARBs properly? A TI Tweetorial

1/6: British Columbia doctors give 4.5m scripts/year for ACE inhibitors (ACEIs) & angiotensin receptor blockers (ARBs) to control bp. Goal is to ↘️ mortality & morbidity, not simply to ↘️ bp.

#MedEd #hypertension
2/6 BEST EVIDENCE on ARBs & ACEI for #hypertension

3⃣@CochraneHTN systematic reviews:

ACEs v ARBs for htn bit.ly/34vS0hu

BP lowering efficacy of ACEIs for htn bit.ly/30YNIOX

BP lowering efficacy of ACEIs for htn https://t.co/u8dN378QAe

#MedEd Image
3/6 ACEIs over ARBS when considering HARMS 🤔

Both ACEIs & ARBs ↘️ blood pressure to similar extents.... BUT only ACEIs have evidence for a reduction in risk of morbidity & mortality. So they’d be your first choice 🥇

#MedEd #medsafety #ptsafety
Read 7 tweets
THREAD: Are we using ACEIs & ARBs properly? A TI Tweetorial

1/6: British Columbia doctors give 4.5m scripts/year for ACE inhibitors (ACEIs) & angiotensin receptor blockers (ARBs) to control bp. Goal is to ↘️ mortality & morbidity, not simply to ↘️ bp.

#MedEd #hypertension
2/6 BEST EVIDENCE on ARBs & ACEI for #hypertension

3⃣@CochraneHTN systematic reviews:

ACEs v ARBs for htn bit.ly/34vS0hu

BP lowering efficacy of ACEIs for htn bit.ly/30YNIOX

BP lowering efficacy of ACEIs for htn https://t.co/NCl1dfCCAO

#MedEd Image
3/6 ACEIs over ARBS when considering HARMS 🤔

Both ACEIs & ARBs ↘️ blood pressure to similar extents.... BUT only ACEIs have evidence for a reduction in risk of morbidity & mortality. So they’d be your first choice 🥇

#MedEd #medsafety #ptsafety
Read 7 tweets
THREAD: 5 Things You Need to Know About PPIs

For many years, we've dissected the research on Proton Pump Inhibitors (PPIs) 🤔

This thread captures our publications on PPIs that can help you in clinical practice: ti.ubc.ca/?s=ppis

#MedEd #medsafety #DrugEvidence #GERD
2/6 PPI COSTS VARY CONSIDERABLY 💰

Even without differences in efficacy or safety between PPIs, costs can vary x 10. The cheapest in BC? Pantoprazole Mg 40mg or Rabeprazole 10mg. Most expensive: Dexlanzoprazole

More here: ti.ubc.ca/letter99

#MedEd #DrugCosts #GERD
3/6 RESPONSE IS VARIABLE

1 in 2 pts w/ acid reflux get symptom relief with a PPI (NNT~2) w/in 4-8 wks

Responders notice symptom relief w/in 1-9 days. If no relief in ~2 wks consider 🛑 PPI. Non-acid reflux doesn’t benefit from PPI

More here: ti.ubc.ca/letter99

#MedEd
Read 7 tweets
THREAD: Ten Commandments for patient-centred treatment 🧾

1/11 A TI Tweetorial on the “Ten Commandments’ of the New Therapeutics

Revisiting timely words of medical wisdom from the BMJ
bjgp.org/content/65/639…

#MedEd #prescribing
2/11 1st Commandment:

Thou shalt have no aim except to HELP patients, according to the GOALS they wish to achieve 👩‍⚕️
bjgp.org/content/65/639…

Shared decision-making lessons from @LessIsMoreMed: lessismoremedicine.com/hands-on

#MedEd #TreatmentGoals
3/11 2nd Commandment:

Thou shalt always seek knowledge of BENEFITS, HARMS, COSTS of treatment & share this knowledge at all times
bjgp.org/content/65/639…

Try these:
ti.ubc.ca/therapeutics-l…
@thenntgroup
medi-mouse.com
pac.bluecross.ca/pharmacycompass

#MedEd #ptsafety
Read 12 tweets
THREAD: Painful Evidence: Do Common treatments for pain work❓

1/10 How effective are pain drugs? 🤔

In BC 120,000 ppl take cyclobenzaprine; 160,000 take gabapentin or pregabalin. Many others take duloxetine, venlafaxine, or amitriptyline

#MedEd #TIEvidence #painmanagement Image
2/10 SIDE EFFECTS:

Most 👨🧕on gabapentin/pregabalin/duloxetine/TCAs (e.g. amitriptyline) experience some adverse side effects like sleepiness, dizziness, nausea, dry mouth or constipation

Benefits/harms here: ti.ubc.ca/letter96

#MedEd #painmanagement Image
3/10 COCHRANE pain meds EVIDENCE:

Evidence frm 8 @cochranecollab reviews should ↘️ expectations abt likelihood+size of pain relief frm gabapentin, pregabalin, duloxetine, venlafaxine, amitriptyline, nortriptyline, imipramine, desipramine

ti.ubc.ca/letter96

#painmanagement
Read 11 tweets
Are you an academic clinician or trainee with a career focus in #QI?

Are you interested in implementing QI initiatives in an academic teaching hospital/clinic settings?

Apply for EQUIP - QI certificate program offered by @CQuIPS
(Deadline Mar 27, ‘20)

cpd.utoronto.ca/equip
Program format:

1) Two 3-day in-person sessions in Toronto, Canada
2) Longitudinal #QI project
3) Webinars for participants to receive feedback on their projects
4) Personalized coaching from expert program faculty Image
Learn from the best — here are just a few of the expert @CQuIPS faculty you will interact with if you enroll in EQUIP

cpd.utoronto.ca/equip/faculty/…
Read 14 tweets
NEW in #JAMIA:

Large assessment of 1,400 patient/family reports examining patient/family experiences and safety concerns related to visit notes.

Most common concerns:
✔️Description of symptoms
✔️Medications
✔️Health problems
academic.oup.com/jamia/advance-… #ptsafety #opennotes
@fcbourgeois @RasuShrestha @BIDMChealth @cmd418 @AtriumHealth @BostonChildrens @jhalamka @TheIHI @AMIAinformatics Paraphrase:

"About 1/4 of 😷/👨‍👩‍👦‍👦 using an online reporting system identified potential documentation inaccuracies in visit notes, of which more than half were considered 'important' by 😷/👨‍👩‍👦‍👦 AND 👩‍⚕️🏥."

👏 to @fcbourgeois and team.

#ptsafety #opennotes
@fcbourgeois @RasuShrestha @BIDMChealth @cmd418 @AtriumHealth @BostonChildrens @jhalamka @TheIHI @AMIAinformatics Why is this important?
"... highlights the possibility... clinicians & patients/families may further enhance the ability to effectively capture potential safety issues."

&

As #HealthIT transparency grows, orgs need ways to capture & respond to patient feedback about EHR errors.
Read 4 tweets
Ok #QIeducators — let’s see if we can crowdsource to see what #QI #ptsafety being taught in medical schools across Canada — thanks @sdmckay2002 @SchulichMedDent for getting us started...
We also have been teaching #QI #ptsafety across the four years of medical school at @uoftmedicine — last year we had the privilege of work with @gregswings to partner with patients and families to teach #ptsafety to our students
Read 3 tweets
It has been such a huge honour to co-direct @CQuIPS certificate course w/ 3 incredible women in med (@trey_coffey_TO, @DrAleneToulany & Olivia Ostrow) & graduate 6 cohorts of #QI clinicians & leaders. Special thanks to Eric Monteiro, Jerome Leis, Lisha, Tanya and Mohita as well!
I will be stepping down and passing the torch to @AdinaWeinerman (Medical Director or #QI and #ptsafety at @Sunnybrook) who will co-direct the @CQuIPS certificate course with Olivia Ostrow
Our awesome @CQuIPS certificate course leadership team — Olivia Ostrow, Eric Monteiro and @DrAleneToulany Image
Read 3 tweets
The #ICRE2018 debate on the #BawaGarba case tightly links issues of #MedEd and #ptsafety — in the first 10 mins, have already heard about just culture, safe supervision, learning from mistakes, diagnostic uncertainty, systems failures & 2nd victim
Here are some more #MedEd #ptsafety topics being discussed at #ICRE2018 plenary:

Speaking up
Teamwork vs teaming
Handoffs
Fatigue and its impact on clinical performance
Psychological safety
Empirical data on patient safety incidents that involve residents:

Lack of supervision (~50%) and handoff problems (~20%) among the most common contributors to serious safety problems

Landmark article from 2007:
jamanetwork.com/journals/jamai…

#ICRE2018
Read 16 tweets
Now up -- @eddeestyle leading a discussion on how to introduce discussions on human factors in residency education at #ASPIRE #ICRE2018 #ptsafety
For some, the term human factors may not be familiar. Here's a common definition:

"Human factors is the study of the interrelationship between humans, the tools and equipment they use in the workplace, and the environment in which they work."

who.int/patientsafety/…

#ICRE2018
Here's a real world example for how human factors influence behaviour and performance.

The urinal fly.

This simple intervention reduced spillage by 80% and cleaning costs by 8%.

washingtonpost.com/news/wonk/wp/2…

#ICRE2018 @eddeestyle Image
Read 7 tweets
We start with discussion of #ptsafety culture and how to introduce discussions in #MedEd. Stacy Ackroyd uses this powerful video from @MedStarHealth to trigger reflection and discussion on ones organizational safety culture #ICRE2018 #ASPIRE
One of the major challenges facing #ptsafety is a culture of disrespect. Revisiting 2012 paper by Lucien Leape in @AcadMedJournal -- highly relevant for #ICRE2018 and its focus on the learning environment this year journals.lww.com/academicmedici…
Sobering excerpt that still rings true:

"A major contributor to disrespectful behavior is the stressful health care environment, particularly the presence of “production pressure,” such as the requirement to see a high volume of patients."

#ICRE2018 #ptsafety #MedEd
Read 5 tweets
Dear #hospitals:

Your discharge planning sets #patients up for failure. How? Let me explain (again, & again, & again). #PtExp #PtSafety #PtEng #EHR #interoperability #PatientAdvocacy #medtwitter #GMDD #hcldr

Photo Credit: Rob Potter (Unsplash)
1)Follow up appts, essential to a patient’s health & recovery, are listed as part of the discharge summary. These appts are recommended to be scheduled within 7-10 days. To be best prepared, patients need their records. #healthcare #PtExp #PtSafety #PtEng #EHR #GMDD #medtwitter
2)All records from a patient's hospital admission should be AUTOMATICALLY sent to every listed follow-up physician. Hospitals, you know which drs patients need to see; it’s listed in the discharge plans. This step needs to be embedded in the workflow #PtExp #EHR #interoperability
Read 14 tweets
Burnout: a work-related constellation of signs/symptoms, often without prior psychiatric history. Marked by existential crisis, emotional exhaustion, and depersonalization. That’s academic. I described what it looks & feels like at @MassGeneralNews @acgme @TheIHI [THREAD]
Early in intern year, I was caring for Mr. V, an elderly HD patient. 1mo earlier, he was living independently & working at HR block. Now, he was admitted with delirium. I couldn't figure out why. I couldn't fix it. Weeks went by. He floundered on the service, sicker by the day.
After 14 inpatient days, we finally diagnosed Mr. V. Months before, PCP prescribed Morphine CR- normally cleared by the kidneys, but his didn't work. It made him sleepy enough that he missed HD once, the start of a downward spiral. Perhaps an error was made that day by his PCP...
Read 17 tweets

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