December 2004 Bulletin

AAOS to unveil Resident Patient Safety Curriculum

By Carolyn Rogers

The Academy is preparing to unveil its new, Web-based Patient Safety Curriculum for orthopaedic residency training programs.

The first of seven learning modules—which utilize the Orthopaedic Knowledge Online format—will be posted on the AAOS Patient Safety Web site (http://patientsafety.aaos.org) by Dec. 31, 2004.

“Once the first module is completed and posted, the others should follow in quick succession,” says Thomas Hunt, MD, chair of the Resident Patient Safety Curriculum Project Team.

Tied to ACGME’s six competencies

The Resident Patient Safety Curriculum Project Team designed the new curriculum around the Accreditation Council for Graduate Medical Education’s six core competencies for residents, Dr. Hunt says.

“The curriculum will be invaluable in helping to satisfy educational requirements in System-Based Practice and Practice-Based Learning,” he says.

Residents and the public will have free access to the curriculum through the AAOS Web site. In addition, the modules will also be distributed on a CD to all orthopaedic residency program directors.

Seven patient safety modules

The Project Team selected the seven module topics to correspond with sentinel events in orthopaedics as determined by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and based on the Agency for Healthcare Research and Quality 2001 report, Making Health Care Safer. Modules that deal with specific clinical problems and their treatments will be strictly evidence-based.

The modules, together with a brief description, are listed below:

The Basic Science of Patient Safety — This module provides an overview of the curriculum and introduces the concepts, terms and literature so critical to understanding and addressing patient safety issues. It discusses perceptions, root cause analysis, human factors engineering, event reporting and barriers to improvement.

Template for Morbidity & Mortality Conferences — Newly acquired knowledge is put into practice through a change in the structure of Morbidity & Mortality (M&M) conferences. The recommended structure for these conference emphasizes systems investigation through root cause analysis rather than “blame and shame” of the involved individual. Individual failure is recognized as a sign of deeper systems failings. Residents are provided a template to use when investigating and reporting adverse events or “close calls” at M&M conferences.

Wrong Site Surgery — Eliminating wrong site/patient/procedure surgery is no longer simply one of JCAHO’s goals—it’s a requirement. This module discusses wrong site surgery classifications, the relative incidences and reasons for occurrence, the medical-legal consequences and the appropriate responses. The AAOS “Sign your Site” program and advisory statement are outlined and evidence of success is presented.

Communications — Communication deficiencies play important roles in the generation of medical errors. This module discusses physician-physician, physician-patient, and physician-staff communication and provides strategies for the recognition of difficulties and making subsequent improvement.

Preoperative counseling includes a discussion with the patient of each component of the acronym PREPARED™ to allow for an informed decision regarding surgery:

P = recommended procedure, plan or prescription

R = reason for the recommendation

E = expectations

P = probability

A = alternatives

R = risks

E = expense of recommended plan and alternatives

D = decision (shared decision making)

The need for full disclosure is discussed, along with techniques to break bad news.

Medication Errors — Medication errors are perhaps the most common errors in medicine and in orthopaedics. This module reviews potential sources of errors and how they may be addressed utilizing technologies such as computerized medication order entry.

Surgical Site Infection — Nosocomial infection is the most common complication affecting the hospitalized patient. Surgical site infection (SSI) is a complication all orthopaedic surgeons encounter. Though SSI is most often not the result of a medical error, specific guidelines regarding choice, timing, route and duration of antibiotic use have been developed to decrease its incidence. This module reviews these guidelines especially in regard to peri-operative antibiotic coverage for patients undergoing hip or knee arthroplasty.

Venous Thromboembolism — Venous thromboembolism, a relatively common complication in the orthopaedic patient, may occur when least expected. This module reviews risk factors, incidence, and strategies for protection, surveillance and detection, and treatment of venous thromboembolism.

Development plan

The first module on Basic Science of Patient Safety was approved by the AAOS Board of Directors at their meeting earlier this month. It will be posted on line by December 31, 2004. The “OKO” format will prompt users to complete a pop-up questionnaire at the end of each module, allowing for user input.

Learners also will complete a short multiple-choice test, which will provide answers, explanations and references. Completion of the module and test scores will be recorded for later verification.

At least two of the patient safety modules will be available in time for viewing at the Patient Safety Booth during the Academy’s 2005 Annual Meeting in Washington, D.C. All seven modules should be available online by March 31, 2005.


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