Spotlighting Patient Safety Risks from Retained Guidewire Fragments

New Patient Safety E-lert available for free from ECRI Institute PSO

PLYMOUTH MEETING, Pa., Sept. 8 /PRNewswire-USNewswire/ -- One of the most important ways to prevent healthcare events from happening is to learn about problems that have occurred in other organizations and to use that information to prevent similar incidents elsewhere.

In response to adverse event reports received by ECRI Institute PSO and to promote such learning, ECRI Institute PSO has begun disseminating periodic Patient Safety E-lerts to participating organizations. The Patient Safety E-lert will bring attention to these issues and is concisely formatted to stimulate discussion and action by interdisciplinary committees focused on reducing the risk of healthcare events.

The first E-lert highlights a patient safety issue regarding retained guidewire fragments, a topic brought to ECRI Institute PSO's attention through reports submitted by participating healthcare providers. ECRI Institute PSO received four reported cases of retained guidewire fragments between December 2009 and March 2010. Despite the short reporting time period, ECRI Institute analysts recognized the value in learning from these events. The E-lert recommends that widely accepted patient safety techniques used in the operating room (OR), such as instrument inspection, should be utilized when interventional procedures are performed outside the OR. The full E-lert is being offered for free to the public in order to improve patient safety throughout the healthcare community.

ECRI Institute PSO, a component of ECRI Institute, has been officially listed by the U.S. Department of Health and Human Services as a federal PSO under the Patient Safety and Quality Improvement Act of 2005. ECRI Institute PSO directly serves as a PSO for providers. It also serves as the program of choice for numerous statewide PSO reporting programs.

For more information about ECRI Institute PSO, visit www.ecri.org/pso; contact [email protected]; call (610) 825-6000, ext. 5558; or mail ECRI Institute, 5200 Butler Pike, Plymouth Meeting, PA 19462-1298, USA. 

ECRI Institute has investigated a large number of guidewire problems over several decades; if your institution needs assistance with a guidewire failure or another event, please contact our Accident and Forensic Investigation group at (610) 825-6000 or by email at [email protected].

ECRI Institute (www.ecri.org), a nonprofit organization, dedicates itself to bringing the discipline of applied scientific research to healthcare to discover which medical procedures, devices, drugs, and processes are best to enable improved patient care. As pioneers in this science for more than 40 years, ECRI Institute marries experience and independence with the objectivity of evidence-based research. Strict conflict-of-interest guidelines ensure objectivity. ECRI Institute is designated a Collaborating Center of the World Health Organization and an Evidence-based Practice Center by the U.S. Agency for Healthcare Research and Quality. ECRI Institute PSO, listed as a federally certified Patient Safety Organization by the U.S. Department of Health and Human Services, strives to achieve the highest levels of safety and quality in healthcare by collecting and analyzing patient safety information and sharing lessons learned and best practices.

SOURCE ECRI Institute