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Summary: Background: Multi-modal hand hygiene programmes that include patient empowerment are promoted as a necessary component of hand hygiene compliance. However, the question still remains, do we have enough information to determine if, and under what conditions, patients will be able to play an immediate role in healthcare workers’ hand hygiene behaviour? Aim: To review the current literature on patient willingness to be empowered, barriers to empowerment, and hand hygiene programmes that include patient empowerment and hand hygiene improvement. Methods: A Medline (Ovid) search of all English-language papers for 1997–2007 and 2008–2012 was conducted using the following keywords alone and in various combinations: ‘patient participation’, ‘involvement’, ‘empowerment’, ‘education’, ‘decision-making’, ‘professional–patient relations’, ‘behavioural change’, ‘culture of safety’, ‘social marketing’, ‘consumer awareness’, ‘leadership’, ‘institutional climate’, ‘hand hygiene’ and ‘patient reminders’. The 1997–2007 review was conducted as part of the World Health Organization's Guidelines on Hand Hygiene in Health Care, and updated with the 2008–2012 review. Findings: Several studies show that, in principle, patients are willing to be empowered. However, there is variation in the actual number of patients that practice empowerment for hand hygiene, ranging from 5% to 80%. The actual performance of patient empowerment can be increased when a patient is given explicit permission by a healthcare worker. Conclusion: There is ongoing support from patients that they are willing to be empowered. There is a need to develop programmes that empower both healthcare workers and patients so that they become more comfortable in their roles. [Copyright &y& Elsevier]

BACKGROUND: Philadelphia's rate of malpractice filings per population is just over double the national median. Plaintiffs prevail in 44% of verdicts in Philadelphia compared with 20% for all US jury verdicts, with 24% of awarded verdicts in excess of $1 million. OBJECTIVE: To determine patient and procedure demographic data for malpractice claims involving health care-acquired infections (HAIs) in Philadelphia. METHODS: Risk managers representing 60 acute care hospitals, members of Pennsylvania Trial Lawyers Association, and a random sample of 560 lawyers representing plaintiff and defense cases obtained from the Philadelphia Court of Common Pleas database (1996-2002) were surveyed. The survey included the following: number of HAI cases by specialty, body site, isolate, and outcome. RESULTS: Overall response rate was 25% (n = 154 cases). The highest numbers of cases were in the specialties of orthopedics (69), general surgery (20), and cardiothoracic (20). Sites infected most often were as follows: knees (26), back (26), sternum (18), and harvest site (10). Methicillin-resistant Staphylococcus aureus (MRSA) was responsible for 45 of cases, S epidermidis for 27, methicillin-susceptible S aureus (MSSA) for 14, and Pseudomonas for 16. Twenty-seven of the cases were withdrawn, 27 settled, 11 pending, 9 plaintiff verdict, and 5 defense verdict. CONCLUSIONS: Although 72% of HAI malpractice cases in Philadelphia were either withdrawn or settled, when brought to trial, the plaintiff was more likely to succeed with a verdict. Our findings also suggest that the most frequent type of infection (class I-surgical site) and isolate (MRSA) are more likely to be seen as preventable HAIs because of National Nosocomial Infection Surveillance data showing lower infection rates for this class of surgery and therefore seen as easier for the plaintiff to show that the defendant failed to adhere to the standard of care for infection control. [ABSTRACT FROM AUTHOR]

ISSUE: Medication errors are the single most common type of adverse event. The Institute for Safe Medication Practices reported in 2002 that one out of every 20 prescriptions filled in a pharmacy has an error. While many hospitals and pharmacies are trying to reduce the prevalence of medication errors in a variety of ways, consumers must take an active role in protecting themselves from potential errors of this kind. Therefore, we evaluated how actively involved consumers are in protecting themselves against medication errors by observing their behavior when picking up prescriptions. PROJECT: Observed all individuals who came to pick up a prescription at a specific selection of pharmacies in and around an urban academic institution. By blending into the waiting area, we noted a selection of characteristics about each consumer including: gender, age, race, whether the consumer looked in his medicine bag during the time in which he was visible to us, whether the consumer asked questions of the pharmacist, whether the pharmacist asked the consumer if he had any questions, and whether there were any other significant, distinguishing characteristics about each interaction. RESULTS: The sample size for this study consisted of 220 observed interactions. Fourteen percent (14%) of observed consumers looked in their medicine bags before leaving the pharmacy, and 18% of observed consumers asked medication questions of their pharmacist. Some pharmacists were better than others about actively asking consumers if they had any questions about their medication. Overall, 23% of observed pharmacists asked the consumers if they had any questions about their medication. Other factors such as workload and the number of other pharmacists available influenced whether or not the pharmacists engaged with the consumers and whether or not the consumers had a chance to ask questions. LESSONS LEARNED: The majority of observed consumers did not play an active role in preventing medication errors, suggesting a need for a new, more active protocol to get the average consumer more interested in their own healthcare. A simple reminder poster or card on the counter where the interaction between the pharmacist and consumer takes place may decrease medication errors. [Copyright &y& Elsevier]

BACKGROUND: The American Medical Association (AMA) has defined six necessary components of an informed consent document: diagnosis, nature, purpose, risks, benefits of proposed and alternative treatment or procedure, and risks and benefits of no treatment or procedure. It remains unclear whether the general public''s knowledge before entering the hospital setting is in fact “informed.” OBJECTIVES: To evaluate the public''s knowledge of “informed consent,” healthcare-acquired infections (HAIs) and factors considered in choosing a hospital. METHODS: An inner-city university population was surveyed through convenience sampling utilizing yes/no and open-ended responses as well as an online survey representing a random population. RESULTS: Seventy-one percent of respondents identified all six of the AMA''s criteria for informed consent to be information needed before signing the document. Thirty-five percent of respondents ranked a physician''s procedure mortality rate to be most important. However, no respondent ranked a physician''s infection rate to be the most important information. Variables of post-procedure well-being (pain, recovery time) were most important, and malpractice record and insurance coverage were least important. Eighty-five percent of respondents were aware of HAIs, and 81% knew the importance of hand hygiene. Only 17% of respondents felt there was a need to know infection rates prior to hospitalization. In fact, when choosing a hospital, infection rates ranked 10th in a list of 13 important factors, but were the number one reason consumers said they would leave a hospital system. Eighty-four percent of respondents were willing to pay additional money for infection control programs that were designed to allow them to take a pro active approach to their own care. CONCLUSIONS: Although there is an understanding of the components of an informed consent document, respondents did not identify infection rates to be important before signing a consent form or entering a hospital although they indicated they would leave a hospital system if the rates were high. These findings strongly suggest there is a critical need for consumer education about infection rates in light of state mandatory reporting program for HAIs. [Copyright &y& Elsevier]