ECRI Institute identifies potential sources of danger that warrant the greatest attention
Approximately 70 percent of accidents involving a medical device can be attributed to user error or the technique of use, according to ECRI Institute, a nonprofit organization focusing on technology innovation, safety and consulting.
Each year, the organization’s Health Devices Group publishes the Top 10 Health Technology Hazards, intended to identify the potential sources of danger that ECRI believes warrant the greatest attention for the coming year.
ECRI’s Top 10 Health Technology Hazards for 2016 are:
- Inadequate cleaning of flexible endoscopes before disinfection.
- Missed alarms, that is, failure to recognize and respond to an actionable clinical alarm condition, either because the medical device fails to detect an alarm condition, or the staff fails to address the alarm appropriately.
- Failure to effectively monitor postoperative patients for opioid-induced respiratory depression.
- Inadequate surveillance of monitored patients in a telemetry setting. Reasons include the incorrect assumption that monitoring systems can reliably detect all potentially lethal arrhythmias, or the fact that patient monitoring information is solely at the central station, where events can be missed.
- Insufficient training of clinicians on operating room technologies.
- Poor alignment between the configuration of a health IT system and a facility’s workflow, increasing the opportunity for medical errors.
- Unsafe injection practices, such as reusing a needle or syringe, sharing an insulin pen among patients (even if a new needle is used), using a single-dose medication vial for multiple patients, or failure to use aseptic techniques when preparing, handling and injecting medications.
- Gamma camera mechanical failures.
- Failure to appropriately operate intensive care ventilators.
- Misuse of USB ports, that is, plugging unauthorized devices or accessories into USB ports on medical devices.
For more information on ECRI Institute’s report, go to www.ecri.org/2016hazards.