RASMAS Launches "By Community Request" Program

Feb. 5, 2008 - PRLog -- Noblis, Inc., presented its first "By Community Request" teleconference offered through the Risk And Safety Management Alert System (RASMAS). The session, "Tubing Misconnections – A Persistent and Potentially Deadly Occurrence," was hosted at Inova Health System in Falls Church and attended by more than 80 participants. It provided a forum in which participants shared their concerns on the topic, as well as insights and solutions aimed at delivering the highest possible level of patient care.  

RASMAS is a web-based subscription service that provides comprehensive notification, distribution, and management of product alerts and recalls for hospitals and healthcare organizations. Last fall, RASMAS initiated a series of teleconferences that focused on various aspects of managing alerts. This month, RASMAS further expanded its service through the "By Community Request" program. This enhancement to the service addresses topics beyond those related to product alerts and recalls, to include a variety of issues that RASMAS subscribers identify as critical to patient safety. The topic was suggested by Maureen Burke, director of risk management at Inova. Burke also served as moderator for the session.

The session focused on three primary areas:

•   Risk reduction,
•   Education, and
•   Product evaluation and selection.

Misconnection errors stem from the fact that tubes and catheters intended for different purposes share the same configuration, and therefore can be inadvertently connected to the wrong source or destination. The Joint Commission has documented a variety of misconnection errors, including intravenous infusions connected to epidural lines, infusions intended for IV administration connected to nasogastric tubes, and blood products transfused with primary intravenous tubing.

Risk reduction techniques discussed in the session included line labeling that indicates the intended destination, and line reconciliation, which ensures that the path of the line is traced each time it is connected. Educational materials developed for patients and families can emphasize important safety guidelines, such as calling a nurse for assistance rather than attempting to reconnect a line. Finally, product evaluation and purchasing can be directed toward items that offer safety advantages, such as color coding or specialized connections.

Participants in the teleconference concurred on the need to work more closely with industry to press for designs that offer increased safety. Several organizations also indicated that they have formed multidisciplinary teams to develop policies relating to managing and standardizing tubing connections, and to coordinate with purchasing departments to better define their product requirements. Organizations that have developed educational materials offered to provide them to other participants in this session.

"It appears that no one has cracked the code on tubing misconnections to find the perfect solution," observed Burke. "However, as healthcare providers who want to achieve continuous improvement, we can work together on a variety of fronts to move toward better management of this issue."

About RASMAS and the RASMAS Community

RASMAS was developed by Noblis in collaboration with the Johns Hopkins Health System and was introduced commercially in January 2004. Its product alert capability has been augmented recently by a community of practice accessed through the RASMAS Community Portal. The portal provides a hub for tools and recall related news stories. Content in the portal includes sample policies, checklists, and other resources developed by Noblis as well as from subscriber submissions.  The teleconferences are archived in the RASMAS Community Portal so that users can review them or, if they could not participate during the live session, hear them at a convenient time. For more information: http://rasmas.noblis.org or call 1-877-727-6276



About Noblis

Noblis, Inc., is a nonprofit organization that serves the public interest through application of science, technology, and strategy. Headquartered in Falls Church, Virginia, Noblis employs nearly 800 accomplished scientists, analysts, engineers, researchers, technology specialists, and management experts in offices throughout the United States. For more information: http://www.noblis.org

Website: rasmas.noblis.org