National Patient Safety Goals Research Articles

Critical Value Reporting Performance Improvement Initiative: A Journey Towards Timely Patient Safety

Abstract Timely reporting of critical values serves as a quality indicator for the National Patient Safety Goal. Since the oncology inpatient unit at our institution has the highest number of critical values and often struggles to meet the targeted goal of timely results acknowledgement, this prompted a performance improvement initiative. By utilizing the Institute for Healthcare Improvement (IHI) Model for Improvement, the study aimed to decrease the time from specimen collection to acknowledgment of a complete blood count critical values (overall TAT). Three key metrics were monitored, including unit turnaround time (time from collection to receipt in laboratory; uTAT), laboratory turnaround time (time from receipt in laboratory to verified results) and timely critical value acknowledgment rate (% acknowledgement within 30 minutes). Quality improvement tools such as process maps and fishbone diagrams were employed, and two areas for improvement were identified. Firstly, it was observed that samples collected by the phlebotomists were delivered in batch to the laboratory via carts. However, samples collected by nurses were sent to the laboratory via a pneumatic tube. Hence, the uTAT varied drastically due to the different delivery methods. Secondly, the mode of alerting providers regarding critical values, which was via telephone calls from telecommunication staff, was deemed disruptive and redundant, as the providers often were already aware of the results from the electronic medical record (EPIC). Two multi-cycle Plan-Do-Study-Act (PDSA) interventions were implemented by a multidisciplinary team. The first focused on sending samples via pneumatic tube. The second PDSA intervention focused on a direct clinician acknowledgment of critical values within EPIC, by creating an auxiliary column on the EPIC patient list. Consequently, the overall TAT decreased from a median time of 167 minutes in July 2021 to 140 minutes by March 2022 in the oncology inpatient unit, with a sustained result (139 minutes) by October 2023. This reduction was driven by the standardization of pneumatic tube delivery system; the uTAT decreased from a median time of 104 minutes to 46 minutes by March 2022 and remained low at 52 minutes by January 2024. Notably, the rate of timely acknowledgment of critical value results worsened, dropping from 67% to as low as 51 % (March 2022) and improved to 64% by January 2024. It was realized that this unintended consequence was attributed to the decrease in uTAT, leading to more critical value results reported in early morning when there was less staffing. Despite the worsening in timely critical value acknowledgment, the overall TAT showed a discernible reduction. The application of IHI methodology played a pivotal role in expediting result reporting. Subsequent steps will focus on utilizing secure communication channels to augment the success rate of critical values acknowledgment within 30 minutes.

Improving Data Quality from a Hematology Unit Hand Hygiene Observation Program

Background: For United States healthcare programs to be fully compliant with Joint Commission National Patient Safety Goal (NPSG) #7, organizations must implement and maintain a hand hygiene (HH) program that follows either the current Centers for Disease Control and Prevention (CDC) or the current World Health Organization (WHO) HH guidelines. Joint Commission standard IC.03.01.01 requires these organizations to provide metrics that evaluate the effectiveness of their program and program goals. Our center utilizes the direct observation method with the use of over 550 Hand Hygiene Observers (HHO) to collect our HH compliance. HHO are trained with a computer-based course that requires passing a post-education test. During fiscal year 2023 (FY23), Infection Control surveillance noted an increase in hospital-acquired infections (HAI) Clostridioides difficile infections (CDI), catheter-associated urinary tract infections (CAUTI), and multidrug-resistant organisms (MDRO) on our hematologic malignancy units (HM), which initiated an Infection Control (IC) investigation into possible causes. Increased rounding by our Infection Preventionist (IP) observed that HH compliance was much lower than unit HHO reported rates. Inquiries into this data discrepancy revealed barriers to accurate reporting, including HHO having low confidence in identifying and reporting non-compliant behavior. To that end, we conducted mandatory re-training of all HM HHO with the primary goal of improving the quality of our HH compliance data and addressing barriers with non-compliance reporting. Our secondary goal was to identify areas of improvement in institutional HH rates. Methods: In August 2023, 252 HM staff and HHO received detailed, in-person retraining by the HM IP. Training included reviewing the discrepancy in HHO and IP observations, potential causes of discrepancy, most commonly missed HH opportunities, examples of correct and incorrect HH practices, and addressing staff questions. Results: Following mandatory re-training of HM HHO, HH compliance for our HM units from September 2023 – December 2023 ranged from 89% to 98%, with increased reporting of non-compliance (Figure 1). A detailed dashboard was created that focused on HM HH compliance, containing the HHO observations and non-compliant reports. Conclusion: A one-time in-person retraining of HM HHO by our IP has led to an improvement in data quality, which is imperative for future quality improvement initiatives. Improving our HH data quality allowed IC to identify and provide actionable feedback to HM leaders, create targeted interventions to improve HAI rates, and improve patient safety. Future goals include retaining of all HHO and a HH campaign to ensure patient safety across our institution.

Using structured communication to improve patient handoffs and reduce medical errors.

Communication errors during transfer of care from one clinician to another are a major cause of medical errors. In 2006, The Joint Commission made handoff communications a national patient safety goal. In 2014, the Association of American Medical Colleges included giving and receiving a report to transfer a patient's care as one of the 13 core entrustable professional activities required for entry into residency programs. Communication is the key to successful transfer of patient care from one clinician to another during shift change. A structured method of communication used by all clinicians in high-stakes healthcare settings can ensure all vital information about a patient is given to the receiving clinician.

Evaluating the Prevalence of Four Recommended Practices for Suicide Prevention Following Hospital Discharge

The Joint Commission's National Patient Safety Goal (NPSG) for suicide prevention (NPSG.15.01.01) requires that accredited hospitals maintain policies/procedures for follow-up care at discharge for patients identified as at risk for suicide. The proportion of hospitals meeting these requirements through use of recommended discharge practices is unknown. This cross-sectional observational study explored the prevalence of suicide prevention activities among Joint Commission-accredited hospitals. A questionnaire was sent to 1,148 accredited hospitals. The authors calculated the percentage of hospitals reporting implementation of four recommended discharge practices for suicide prevention. Of 1,148 hospitals, 346 (30.1%) responded. The majority (n = 212 [61.3%]) of hospitals had implemented formal safety planning, but few of those (n = 41 [19.3%]) included all key components of safety planning. Approximately a third of hospitals provided a warm handoff to outpatient care (n = 128 [37.0%)] or made follow-up contact with patients (n = 105 [30.3%]), and approximately a quarter (n = 97 [28.0%]) developed a plan for lethal means safety. Very few (n = 14 [4.0%]) hospitals met full criteria for implementing recommended suicide prevention activities at time of discharge. The study revealed a significant gap in implementation of recommended practices related to prevention of suicide postdischarge. Additional research is needed to identify factors contributing to this implementation gap.

Comparing Medication History Capture Rates In-Person Versus Hybrid: A Multisite Pilot Study.

Purpose: Medication history is the method many organizations use to adhere to The Joint Commission's (TJC) National Patient Safety Goal (NPSG) to communicate accurate patient medication information. Literature is sparse comparing the number of medication histories completed in-person versus virtually. Methods: This is a single system, multi-site, retrospective observational study. Patients included were admitted through the Emergency Department during October 2022. The primary aim of this study compared the percent capture rates of medication history between 2 hybrid sites to an in-person site within a health-system. Our secondary objective compared the differences in the 'medication history acuity score' (MHAS), defined as the total number of edits, additions, and deletions made during a medication history. Results: The medication history capture rate at the in-person site was 74% and at the hybrid sites were 91% and 80%. There were no differences in total medications on each medication history between in-person and hybrid (11 [5-16] vs 11 [6-16]; P = .252). There were no differences in changes made on medication histories between in-person and hybrid (4 [1-7] vs 3 [1-7]; P = .595). Conclusions: Our study demonstrates that medication history capture rates and MHAS are comparable in both in-person and hybrid environments. This similarity suggests the feasibility of implementing hybrid models for medication history services in diverse healthcare settings, potentially enhancing the capacity of health systems to meet TJC NPSG. These findings indicate that hybrid models could be an effective strategy for healthcare systems to optimize their medication history services, especially in settings with varied patient volumes and site specialties.

Addressing Veteran Health-Related Social Needs: How Joint Commission Standards Accelerated Integration and Expansion of Tools and Services in the Veterans Health Administration

The Joint Commission recently named reduction of health care disparities and improvement of health care equity as quality and safety priorities (Leadership [LD] Standard LD.04.03.08 and National Patient Safety Goal [NPSG] Standard NPSG.16.01.01). As the largest integrated health system, the Veterans Health Administration (VHA) sought to leverage these new accreditation standards to further integrate and expand existing tools and initiatives to reduce health care disparities and address health-related social needs (HRSNs). A combination of existing data tools (for example, Primary Care Equity Dashboard), resource tools (for example, Assessing Circumstances and Offering Resources for Needs tool), and a care delivery approach (for example, Whole Health) are discussed as quality improvement opportunities to further integrate and expand how VHA addresses health care disparities and HRSNs. The authors detail the development timeline, building, limitations, and future plans for these tools and initiatives. Responding to new health care equity Joint Commission standards led to new implementation strategies and deeper partnerships across VHA that facilitated expanded dissemination, technical assistance activities, and additional resources for VHA facilities to meet new standards and improve health care equity for veterans. Health care systems may learn from VHA's experiences, which include building actionable data platforms, employing user-centered design for initiative development and iteration, designing wide-reaching dissemination strategies for tools, and recognizing the importance of providing technical assistance for stakeholders. VHA continues to expand implementation of a diverse set of tools and resources to reduce health care disparities and identify and address unmet individual veteran HRSNs more widely and effectively.

Measurement Strategies for The Joint Commission Health Care Disparities Standard: Defining Hospital-Based Requirements—Part 1

Measurement Strategies for The Joint Commission Health Care Disparities Standard: Defining Hospital-Based Requirements—Part 1

Assessment of Selective and Universal Screening for Suicide Risk in a Pediatric Emergency Department.

According to National Patient Safety Goal 15.01.01, all individuals being treated or evaluated for behavioral health conditions as their primary reason for care in hospitals and behavioral health care organizations accredited by The Joint Commission should be screened for suicide risk using a validated tool. Existing suicide risk screens have minimal or no high-quality evidence of association with future suicide-related outcomes. To test the association between results of the Ask Suicide-Screening Questions (ASQ) instrument in a pediatric emergency department (ED), implemented through selective and universal screening approaches, and subsequent suicide-related outcomes. In this retrospective cohort study at an urban pediatric ED in the United States, the ASQ was administered to youths aged 8 to 18 years with behavioral and psychiatric presenting problems from March 18, 2013, to December 31, 2016 (selective condition), and then to youths aged 10 to 18 years with medical presenting problems (in addition to those aged 8-18 years with behavioral and psychiatric presenting problems) from January 1, 2017, to December 31, 2018 (universal condition). Positive ASQ screen at baseline ED visit. The main outcomes were subsequent ED visits with suicide-related presenting problems (ie, ideation or attempts) based on electronic health records and death by suicide identified through state medical examiner records. Association with suicide-related outcomes was calculated over the entire study period using survival analyses and at 3-month follow-up for both conditions using relative risk. The complete sample was 15003 youths (7044 47.0%] male; 10209 [68.0%] black; mean [SD] age, 14.5 [3.1] years at baseline). The follow-up for the selective condition was a mean (SD) of 1133.7 (433.3) days; for the universal condition, it was 366.2 (209.2) days. In the selective condition, there were 275 suicide-related ED visits and 3 deaths by suicide. In the universal condition, there were 118 suicide-related ED visits and no deaths during the follow-up period. Adjusting for demographic characteristics and baseline presenting problem, positive ASQ screens were associated with greater risk of suicide-related outcomes among both the universal sample (hazard ratio, 6.8 [95% CI, 4.2-11.1]) and the selective sample (hazard ratio, 4.8 [95% CI, 3.5-6.5]). Positive results of both selective and universal screening for suicide risk in pediatric EDs appear to be associated with subsequent suicidal behavior. Screening may be a particularly effective way to detect suicide risk among those who did not present with ideation or attempt. Future studies should examine the impact of screening in combination with other policies and procedures aimed at reducing suicide risk.Appeared originally in JAMA Netw Open 2019; 2:e1914070.

Health Equity: The Newest National Patient Safety Goal.

But how best to address patients' health-related social needs remains unclear.

Crowding in the Emergency Department: Challenges and Best Practices for the Care of Children.

Emergency department (ED) crowding has been and continues to be a national concern. ED crowding is defined as a situation in which the identified need for emergency services outstrips available resources in the ED. Crowding is associated with higher morbidity and mortality, delayed pain control, delayed time to administration of antibiotics, increased medical errors, and less-than-optimal health care. ED crowding impedes a hospital's ability to achieve national quality and patient safety goals, diminishes the effectiveness of the health care safety net, and limits the capacity of hospitals to respond to a disaster and/or sudden surge in disease. Both children and adults seeking care in emergency settings are placed at risk. Crowding negatively influences the experience for patients, families, and providers, and can impact employee turnover and well-being. No single factor is implicated in creating the issue of crowding, but elements that influence crowding can be divided into those that affect input (prehospital and outpatient care), throughput (ED), and output (hospital and outpatient care). The degree of ED crowding is difficult to quantify but has been linked to markers such as hours on ambulance diversion, hours of inpatient boarding in the emergency setting, increasing wait times, and patients who leave without being seen. A number of organizations, including the American College of Emergency Physicians, the Emergency Nurses Association, and the National Quality Forum, have convened to better define emergency metrics and definitions that help provide data for benchmarks for patient throughput performance. The Joint Commission has acknowledged that patient safety is tied to patient throughput and has developed guidance for hospitals to ensure that hospital leadership engages in the process of safe egress of the patient out of the ED and, most recently, to address efficient disposition of patients with mental health emergencies. It is important that the American Academy of Pediatrics acknowledges the potential impact on access to optimal emergency care for children in the face of ED crowding and helps guide health policy decision-makers toward effective solutions that promote the medical home and timely access to emergency care.

Mastering the Patient Handoff

Mastering the Patient Handoff

Promoting Medication Management Skills Among Home Health Occupational Therapists: A Quality Improvement Project

Medication management is a national patient safety goal for home care practice. Medication management is an occupation within the scope of occupational therapy. Occupational therapists are able to assess and provide intervention for cognitive, visual, motor, process, environmental and personal factors that impact an individual’s ability to manage their medication independently. This quality improvement project describes a program developed to promote medication management competence in occupational therapists practicing in a large, academic home health agency. The quality improvement project consisted of an online module providing education on the Performance Assessment of Self-Care Skills (PASS) and a 1-hour training session combining didactic education with case-based learning. Pre-post assessment surveys revealed a 25% increase in perceived medication management competence after the intervention. Occupational therapists identified 4 barriers to medication management practice: role ambiguity, documentation challenges, pharmacology knowledge deficit, and reconciliation process barriers.

Health System Redesign of Cardiac Monitoring Oversight to Optimize Alarm Management, Safety, and Staff Engagement.

The purpose of this quality improvement project was to improve health system patient safety by creating a cardiac monitoring structure aligned with national standards. Excessive alarms pose patient safety threats and are often false or clinically insignificant. The Joint Commission identified reduction of nonactionable alarms as a National Patient Safety Goal. The conversion to structured monitoring occurred in 4 phases: 1) defining health system monitoring structure and processes; 2) co-create sessions; 3) implementation and impact analysis; and 4) ongoing evaluation and optimization. Twenty-two clinical units participated. At the conclusion of phase 4, total 30-day alarm rates decreased by 74% at the academic hospital and by 92% and 95% at the community hospitals and were sustained for 12 months. Decreasing alarm frequency can be safely achieved in academic and community hospitals by creating a system-wide monitoring infrastructure and standardized processes that engage interdisciplinary teams.

Using a Patient Identification Checklist: How to Make This a Never Safety Event in Perioperative Services

<h3>Background Information</h3> Patient identification is one of the Joint Commission National Patient Safety Goals. Positive patient identification involves accuracy, verification and two-way communication. Occasionally, patient armbands did not match patient labels or paperwork, leading to incorrect patient identification. Safety Events were placed and reviewed at the executive level as high-risk safety events that achieved institutional support. Preoperatively, errors in patient identification can lead to potentially serious errors. The check-in area was able to identify workflow inconsistencies, interview techniques and equipment locations as opportunities for improvement. The focus was on patient wristbands during check in, leading to the development of a checklist and subsequent audits to measure compliance. <h3>Objectives of Project</h3> To maintain a trend of overall reported patient ID events, to sustain no high harm and reduce patient ID reported procedures events, as they relate to safety culture and accountability by 25% six months after training in Just Culture and accountability. <h3>Process of Implementation</h3> A review of current workflow and observation audits were completed prior to beginning the pilot. A Patient Identification Checklist supporting hospital policy was developed. Education to staff and 50 in-person audits were completed to observe the wristband check-in process, using an electronic audit. The checklist was laminated and posted at eye level of the Patient Service Coordinator (PSC). The wristband and label printer were relocated closer to the workstation for ease of use. The patient charts filing order was changed from OR room number to alphabetical order (by last name) to reduce chart adjustments. The level of lighting was also adjusted to improve visualization by patients and staff. <h3>Statement of Successful Practice</h3> The baseline data included five patient ID safety events for PACU/Preop and the implementation of the new workflow resulted in zero patient ID events after the pilot. The patient ID wristband checklist helped reduce the number of patient ID events related to wristbands but is dependent on the employee adhering to the checklist. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Not verifying patient information is a top causal factor for patient ID overall. Reminding staff about the importance of adhering to the checklist and following best practice standards for patient identification can help ensure this becomes a Never Event in Perioperative Services.

Making Healthcare Safe: The Story of the Patient Safety Movement

Making Healthcare Safe: The Story of the Patient Safety Movement

Medical Reconciliation as a Patient Safety Strategy

Patient Safety has increasingly been receiving attention over the last couple of decades due to a combination of legal suits against hospitals due to negligent care, which could have been avoided, and an increased awareness in the medical community that steps can be taken to mitigate issues which could compromise a patient’s health. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), an accrediting non-governmental body that accredits the vast majority of hospitals and other medical facilities in the United States on the quality of the medical standards, has listed comprehensive medication reconciliation as one of its 2015 National Patient Safety Goals [2]. JCAHO further states, “There is evidence that medication discrepancies can affect patient outcomes.”

Health systems turn to inventive methods to document OTCs in the EHR

What was once a relatively small selection of OTCs has expanded into more than 80 classes of OTC medications at any given pharmacy. However, this convenience is not without its drawbacks. Discrepancies in hospital OTC documentation can pose a substantial risk to patient safety, such as drug–drug interactions, accidental drug duplication, and unforeseen drug–disease complications. These risks are compounded when hospital providers are not aware of a patient's OTC usage, causing harm that often propagates throughout a patient's hospitalization, even after discharge. In recognition of this growing concern, the National Association of Chain Drug Stores Foundation convened a summit in October 2016 of several industry stakeholders to establish basic guidelines for the advancement of OTC integration into hospital electronic health records (EHRs) through the creation of an OTC medication tracking system—similar to the process utilized for prescription medication tracking through insurance metadata. However, the guidance that resulted from this summit is vague and unconstructive—a far cry from the Joint Commission's National Patient Safety Goals, for instance. It begs the question if progress has been made on any of these goals. In general, there is a common feeling among hospital pharmacists that limited progress has been made on the integration of OTC medications into EHRs, and even less on creating a universal OTC metadata registry. “Electronic health records oftentimes do not even include options for providers to add OTC medications,” said Edgar Peñaloza, PharmD, a clinical pharmacy specialist at Ascension Sacred Heart Bay Medical Center in Panama City, FL. “Since they are not commonly administered during inpatient stays, OTCs may not be entered into an EHR simply because the EHR program itself will not allow the medications to be entered in as a discrete identifier within the system.” Peñaloza went on to explain that if an OTC medication is added to a patient's medication administration record, the system does not recognize it. Oftentimes, it necessitates adding the medication through the EHRs “non-formulary” process. But profiling the medication this way bypasses the EHRs ability to run the medication through interaction programs that can help ensure patient safety. Peñaloza listed examples such as Kratom and cannabidiol-containing agents, which may consist of varying ingredients affecting a patient's response to drug therapy. The ability to have EHRs automatically integrate a patient's OTC history is a complex, multifaceted obstacle, with virtually no obvious solutions. While broadscale industry leadership may have failed to make meaningful progress on tracking OTC medication use within EHR systems, some national health systems, such as the Ascension hospital system, have been attempting to tackle the issue on their own. Ascension, one of the largest private health care systems in the United States has recently piloted a telehealth medication history program within its Texas hospital network to facilitate the accurate recording of all newly admitted patient's medications, whether prescriptions, OTCs, nutraceuticals, or herbal supplements. A review of this pilot program was published by McGinnis and colleagues in the Journal of the American Pharmacists Association in 2019. By using videoconferencing equipment installed on mobile computer carts stationed in the ED, Ascension employed highly trained, pharmacy technicians. These technicians interviewed patients about all of the medications they were taking in order to minimize as many discrepancies as possible when transferring them over to the EHR. According to McGinnis and colleagues, “The motivation for this program was the inconsistent and ineffective use of [hospital] resources to reliably conduct accurate medication histories, demonstrated by the sharp decline in medication history completion rates after removal of the site-based ED technicians and institution of a nurse-driven program.” After Ascension's pilot program was initiated, medication history completion rates continued to improve significantly. An exploratory analysis of this pilot program demonstrated pharmacy technicians were both more accurate and efficient when performing medication histories. Hopefully, as telehealth continues to permeate deeper into the clinical sphere, novel approaches to solving the safety issues of a dubious inpatient OTC medication history will continue to manifest themselves. It may have not been the exact solution hoped for, but it is certainly a step in the right direction.

Benefits of Utilizing Pharmacy Learners in an Inpatient Anticoagulation Education Service.

Objective. The 2019 Hospital National Patient Safety Goal 03.05.01 indicates education regarding anticoagulant therapy should be provided to patients and families. Previous studies assessing pharmacist and pharmacy student involvement in oral anticoagulation (OAC) education services have focused on patient-related outcomes, with limited emphasis on the additional benefit to the student. The purpose of this study was to assess the benefit of pharmacy student involvement in anticoagulation education services both clinically and through their perceptions of participating in the service. Methods. This study assessed students' knowledge and perceptions of providing OAC education before and after a 1-month learning experience, where students provided counseling 2-3 days per week. The primary endpoint was comparing each student's pre- and post-rotation OAC education knowledge assessments. Secondary endpoints included percentage change in knowledge between the prospective cohort and a historical comparator group, perceived benefit of student participation in the service, percentage of patients able to recall counseling, and number of interventions made related to OAC therapy. Results. A total of 35 pharmacy students were included in this prospective study with 277 patients receiving counseling from June 2020 through March 2021. A total of 32 pharmacy students had assessment data available for retrospective comparison. The mean pharmacy student score within the prospective cohort improved significantly (21.5%) between the pre-assessment and post-assessment. Change in pre- and post-rotation knowledge assessment was also significantly higher in the prospective cohort compared to the retrospective group. Additionally, students gained confidence in their counseling abilities and OAC knowledge through participation. Conclusion. Pharmacy student participation within anticoagulation education services significantly improved student knowledge and confidence in their counseling abilities. It also allowed for over 70% of patients to successfully recall pertinent information about their anticoagulants over a week later and improved patient care through dosing interventions.

PMH31 Universal Screening for Suicidal Thoughts and Behaviors in a Large Healthcare System's Hospital and Emergency Departments

The Joint Commission recently revised its National Patient Safety Goal requirements to include standardizing suicide screening. Sutter Health launched system-wide standardized use of the Columbia Suicide Severity Rating Scale (C-SSRS) in acute care facilities in July 2019. Describe and compare characteristics of adult patients screening positive for suicidal thoughts or behaviors (STB) including those with major depressive disorder (MDD). Electronic health record-based observational cohort study describing and comparing sociodemographic and clinical characteristics of adult patients screening positive for STB (7/1/2019-10/4/2020), including those with MDD. MDD+STB were compared to those with STB without MDD (STB-MDD) and on risk categories (no risk v any risk). Wilcoxon rank-sum tests for continuous variables and χ2 tests for categorical variables were used. Results reported are statistically significant at 0.05. 410,302/478,143 (85.8%) of adults were screened by C-SSRS, 8,416 (2.05%) had STB, 914 (10.9%) had MDD+STB, 7,502 (89.1%) had STB without MDD. Of those with STB, 3,278 (38.9%) were low risk, 1,314 (15.6%) moderate risk, and 3,824 (45.4%) high risk. Any risk vs no risk: males (46.6% v 42.3%), White (55.5% v 47.9%), mean age 41.6 v 50.3 years, homeless in last 12 months (12.0% v 2.5%), index encounter Psych unit (10.3% v 0.2%), mental health diagnoses (22.2% v 4.9%), MDD (10.9% v 1%). MDD+STB patients vs MDD-STB: mean age 38.8 v 41.9 years, female (58.6% v 52.8%), Asian (9.7% v 6.6%), income $75,000+ (45.5% v 34.0%), index encounters in Psych units (46.5% v 5.9%), substance abuse (12.1% v 3.9%), anxiety (16% v 2.2%) and documented prior suicidal ideation (3.7% v 0.5%). Screening for STB identified 2.05% with any STB and 10.9% with MDD+STB. Characteristics differed based on risk and MDD status. Highlighting demographic and clinical differences between these patient groups can guide efforts to provide mental health consultation and referrals.

Factors Influence Compliance to Medication Reconciliation Process in King Abdullah Medical City

Medication reconciliation has been recognized as an important National Patient Safety Goal by the Joint Commission. Studies have shown that hospitals with medication reconciliation Programs led by pharmacists, as part of the interdisciplinary team, may have improved outcomes in the following areas of assessment: the rates of medication errors, adverse events, and readmissions. This study aims to investigate the factors that influence the compliance to the medication reconciliation process. It is a quantitative analytical Cross-Sectional design undertaken at the specialized hospital, Makkah, Saudi Arabia. The study adopted the following independent variables (knowledge and training about medication reconciliation, Medication reconciliation policy, procedures involved in the medication reconciliation process, and organizational support) and the compliance to the medication reconciliation process in KAMC as dependent variables. Data collected from 90 pharmacists by using a self-administered questionnaire. When proving the hypothesis, the result showed that there is a positive correlation between the study variables including knowledge and training, medication reconciliation policy and procedures, and organizational management support with the compliance of medication reconciliation process. This study concluded that hospital pharmacists should be knowledgeable and have adequate training about medication reconciliation process. Proper implementations of policy and procedures with the organizational management support can contribute to improving the medication reconciliation process. However, further studies are needed to include all physicians and nurses to determine overall institutional factors that influence medication reconciliation process improvement.