NTSB Recommends That Trucking Safety Should Be A Higher Priority

According to the U.S. National Transportation Safety Board (NTSB), highway regulators have failed to act on more than 100 recommendations to improve truck safety at a time when fatalities have risen for the last four. In a news conference on January 13, 2015, the NTSB said that priorities must change in 2015, with more anti-collision technology, better limits on driver hours and tighter regulation of trucking companies with high accident rates,

The accidents that injured comedian Tracy Morgan in June and killed four members of a college softball team in September 2014 received a tremendous amount of media attention. They cast a new light on America’s 2 million truckers, who are involved in crashes that kill almost 4,000 people a year. The NTSB said it’s time for regulators to act on its more than 100 rec¬ommendations to improve trucking safety. “There’s a whole suite of technology that’s ready for prime time now that would reduce crashes,” Donald Karol, NTSB’s director of highway safety investigations, said in an interview. The NTSB is pushing the use of sensors to warn truck drivers when they’re about to strike someone from behind or to alert when a vehicle changes lanes.

The NTSB made the plea as it unveiled its “Most Wanted List” of transportation improvements for 2015. In addition to trucking, the NTSB also said more attention should be given to rail tank-car safety, airline pilot compliance, distracted driving, and drug and alcohol impairment. Christopher Hart, NTSB’s acting chairman, said at the press conference: “The Most Wanted List is our road map for 2015. These are safety improvements for which the time is ripe for action.”

The NTSB, which investigates transportation and pipeline accidents, has no regulatory authority. It uses its annual Most Wanted list to highlight areas most in need of improvement. While transportation has become safer in recent decades, the tens of thousands of deaths each year and hundreds of thousands of injuries indicate “we have a long way to go,” Hart said.

The number of people killed in large-truck crashes increased for the fourth straight time, to 3,964 people in 2013, which includes truckers, pedestrians and the occupants of vehicles that collided with the big rigs, the U.S. Transportation Department said last month. The number represents a 17 percent increase since 2009, according to the National Highway Traffic Safety Administration (NHTSA). One issue is driver fatigue, according to the NTSB. In the crash that injured Morgan and killed fellow comedian James McNair, the driver of a Wal-Mart Stores Inc. truck hadn’t slept for at least 24 hours, according to a police complaint. The truck struck a van carrying Morgan from behind on the New Jersey Turnpike.

The safety board has recommended that trucking companies implement plans to better manage fatigue on the roads and to require screening for sleep disorders that may lead to drowsiness. Congress last year weakened regulations designed to reduce trucker fatigue. Lawmakers targeted a portion of a rule closing a loophole that kept some drivers from working 82 hours over eight days, according to Transportation Secretary Anthony Foxx. That provision won’t be enforced for at least a year as regulators conduct research to see if it had an unintended effect of forcing more trucks onto the road during rush hours.
The NTSB has also found a pattern in truck crashes of poor safety enforcement, Karol said. The safety board wants regulatory agencies to impose tighter controls on trucking companies. An average of 20 percent of truck inspections find safety violations, he said.

Source: Claims Journal


FDA Releases Draft Guidance For Risks Included On Medicine Advertisements

The Wall Street Journal (2/6, Silverman, 5.67M) blog “Pharmalot” is reporting that the FDA has issued new draft guidance requesting that drugmakers refrain from including long lists of risks and concerns associated with drugs in favor of a mild summary in print ads and promotional materials. The summary would not have to include information about all side-effect or contraindication. In the draft guidance, the agency explained that not many consumers have the technical background needed to understand some of the information described in the warnings as they exist now. The intention of the summary is to focus on the broader risks and important information instead of an exhaustive list of every possible issue.


The Deadline For Filing Claims Regarding GM Faulty Ignition Switches Passed On March 31, 2015

The AP (2/3, Krisher) is reporting that “the families of 51 people who died in crashes caused by faulty” GM ignition switches will receive money from the GM compensation fund, with another 77 to receive money for injuries, according to compensation expert Kenneth Feinberg. The deadline for filing claims was Saturday, March 31, 2015. As of Sunday there were “455 death claims and 3,447 for injuries.” Many are calling for GM to extend the deadline, “because victims do not know yet whether they can sue General Motors Co., the new company that emerged from bankruptcy protection in July 2009.”
According to The CBS Evening News (2/2, story 5, 2:30, Glor, 5.08M) Sens. Ed Markey (D-MA) and Richard Blumenthal (D-CT) are asking GM to reconsider the deadline, “as over a third of the vehicles are still not fixed.”
USA Today (2/2, Healey, 10.32M) reported that GM’s count of victims “only included people in the front seats who would have been protected, presumably,” if not for the defective switches, and only those driving or riding in models that were specifically recalled.


GM Resists Effort To Extend Deadline For Ignition Compensation Claims

The Wall Street Journal (1/29, Bennett, Subscription Publication, 5.67M) is reporting that General Motors has rejected a request from Sens. Edward Markey (D) and Richard Blumenthal (D) to extend the claims deadline for their ignition switch compensation fund. In response GM said, “Our goal is to be just and timely in compensating the families who lost loved ones and those who suffered physical injury. We have conducted extensive outreach about the program. We previously extended the deadline until January 31, and we do not plan another extension.”


Wal-Mart Settles With Family Of Comedian Killed In New Jersey Truck Wreck

The AP (1/22, Porter) is reporting that the family of James McNair, the comedian who was killed in a New Jersey Turnpike crash last summer that seriously injured Tracy Morgan, has “settled a wrongful-death claim with Wal-Mart.” According to the story, the “out-of-court settlement” is the “first stemming from the June 7 crash, in which a Wal-Mart truck slammed into a limo van” carrying Morgan and McNair. The AP notes that a preliminary investigation by the NTSB estimated that the truck driver, Kevin Roper, was “driving 65 mph in the 60 seconds before he slammed into the limo van.” The speed limit on that section of the highway is 55 mph and was lowered to 45 mph on the day of the accident due to construction. ABC News (1/22, Katersky, 3.41M) reports that the amount of the settlement is confidential.


NHTSA Scrutinizes Ford Recall

In an article appearing on the front page of its “Business Day” section, the New York Times (1/21, B1, Jensen, Ivory, Subscription Publication, 9.97M) reports that a week after NHTSA Administrator Mark R. Rosekind said he planned on being “more vigilant on safety,” the NHTSA has “taken the unusual move of revisiting the 2013 recall of Ford’s biggest pickup trucks.” The initial recall, which was issued to repair a stalling problem, was limited to nearly 3,000 trucks that were used as ambulances. However, citing several complaints from drivers, the NHTSA notified Ford that “it is now investigating whether that recall should be” expanded, to include almost “197,000 additional pickups that have similar engines but are not used as ambulances,” according to the report. The Times goes on to note that recall queries, such as the investigation into the Ford recall, are “unusual,” noting that there were only four recall queries in 2014.


NHTSA Investigates Jeep Cherokee Vehicles After Reports Of Fires

Bloomberg News (1/17, Plungis, 2.94M) reports that NHTSA has begun “a defect investigation into the latest model of the Jeep Cherokee sport-utility vehicle after an owner reported 20-foot flames shot out of its engine compartment after being parked,” which spreads across 50,415 vehicles built for the 2015 model year. The article states that NHTSA routinely starts investigations “based on a single complaint” when the agency “believes the alleged defect is especially dangerous.”
Reuters (1/17) reports that Fiat Chrysler spokesperson Eric Mayne stated the company plans to cooperate to the fullest with NHTSA.
The Auto World News (1/16, 1K) reported that NHTSA Deputy Administrator David Friedman told the press back in November that Jeep has “to get their act in gear,” adding that “They’ve got to make sure that they are getting those parts in the hands of consumers.”


Dietary Supplements Manufacturer Shuts Down After Federal Lawsuit

The Los Angeles Times (1/17, Panzar, 3.49M) reported that a pharmaceuticals manufacturer in Los Angeles “agreed to close its operations and to recall and destroy all the dietary supplements it has sold since 2011 as part of an agreement with” the FDA. According to a lawsuit filed by the DOJ and FDA, the manufacturer “distributed unapproved supplements that claimed to treat diabetes, allergies and cancer. “ The AP (1/16) and Medical Daily (1/18, Olson, 85K) also reported on the story.


Auto Parts Suppliers Step Up Quality Control

The Wall Street Journal (1/14, Kubota, Subscription Publication, 5.62M) reports that parts suppliers for automakers are working to improve their quality control process following the record recalls in 2014, including the issues with Takata’s exploding air bags and Delphi Automotive’s faulty ignition switches in GM vehicles.


Liability Claims Reduced by Hospitals in National Program

December 6, 2012 – Claims Journal
Initial results from a national perinatal improvement initiatives suggest hospitals can reduce harm to babies and mothers, and lower associated liability claims and pay-outs, through the use of high-reliability perinatal teams.
Results from Phase 1 (2008-2010) of the Premier Perinatal Safety Initiative (PPSI), a Premier healthcare alliance project, show that the 14 participating hospitals have reduced harm and liability since the program’s baseline period (2006-2007).
In relation to harm, PPSI hospitals have reduced, on average:
• Birth hypoxia and asphyxia, which can cause infant brain damage, by 25 percent.
• Neonatal birth trauma, which can range from minor bruising to nerve or brain damage, by 22 percent. In addition, all hospitals were below the 2008 AHRQ Provider Rate, a national comparative rate measuring perinatal harm.
• Complications from administrating anesthesia during labor/delivery, which include cardiac arrest and other cardiac complications, by 15 percent.
• Postpartum hemorrhage, the most common cause of perinatal maternal death in the developed world, by 5.4 percent.
• The adverse outcome index rate, which measures the number of patients with one or more of the identified adverse events as a proportion of total deliveries, by 7.5 percent.
Because of these improvements, approximately 110 fewer mothers and babies experienced these harms.
Reduced liability claims
In addition, participants decreased the number of annual liability claims filed per delivery by 39 percent vs. 10 percent at non-participating hospitals. PPSI hospitals averaged a total of 18 claims per year and project wide during the baseline period, that number dropped to 10 in 2009 and is trending to be at 8 in 2010.
Findings on liability claims and losses are current through November 2012. Because it typically takes two years or longer for a claim to be filed after an injury, final liability claims and losses will not be closed for some time. These results, however, provide clear insight into the trend in claims and losses.
Launched in 2008 by Premier and affiliate liability insurer American Excess Insurance Exchange, RRG (AEIX), PPSI participants are large and small, teaching and non-teaching, system-based and stand-alone, with employed and non-employed physicians. They represent 12 states, in which approximately 250,000 babies will be delivered over the collaborative’s five years (2008-2012).
“There’s no other area in a hospital where providers routinely treat two distinctly different patients at the same time,” said Susan DeVore, Premier president and CEO. “Even though childbirth is so complex and unique, serious adverse events during labor and delivery are rare. But they do occur – sometimes they’re preventable, but they’re always devastating for babies, mothers, families and care providers.”
“The PPSI seeks to better define preventable perinatal harm and identify care practices that can result in improved outcomes,” continued DeVore. “Our results to date suggest that doing so can lower the incidence of certain infrequent, though serious, birth injuries and their associated liability claims. And the diversity of the participating hospitals also lends well to possible replication of the project and its results nationwide.”
Leveraging knowledge gained from previous initiatives, including an Institute for Healthcare Improvement (IHI)/Ascension Health/Premier collaboration, PPSI hospitals use two powerful methods to create high-reliability healthcare teams: increased adherence to evidence-based care bundles and enhanced communication and teamwork.
Increased adherence to evidence-based care bundles
Research shows that grouping essential processes together in care bundles helps clinical staff remember to take all of the necessary steps to provide optimal care to every patient, every time. Although many hospitals have long followed some or all of these individual care practices to improve perinatal outcomes, the key is consistently using all of them in concert.
Care bundle adherence is scored in an “all-or-none” fashion; the care team must provide all elements of care in the bundle to be given credit for its use. For example, one care bundle is focused on reducing the risks associated with augmenting labor, particularly in using oxytocin, a drug that accelerates a slow labor. This bundle has four elements that must be practiced consistently. If a team neglects to estimate the fetal weight before administering the medication, it would not receive credit for the work, even if team members successfully implemented the three other elements of the bundle.
PPSI hospitals have significantly improved compliance with care bundles over the course of Phase I. These improvements led to 106,000 additional mothers receiving evidence-based care bundles.
“Over the past several years, our team has established a number of quality interventions designed to increase safety for moms and babies and reduce the incidence of already very rare perinatal injuries,” said Tiffany Kenny, RN, MSN, C-EFM, OB informatics administrator at Summa Akron City Hospital in Akron, Ohio. “By following evidence-based care models, we’ve improved the quality of our Elective Inductions, lowered the C-section rate for low-risk first time mothers and improved overall safety.”
Enhanced communications and teamwork
PPSI hospitals have implemented the following proven strategies for certain high-risk protocols:
• TeamSTEPPS: Developed by the U.S. Department of Defense and the Agency for Healthcare Research and Quality (AHRQ), TeamSTEPPS produces highly effective medical teams that optimize the use of information, people and resources to achieve the best clinical outcomes.
• Situation Background Assessment Recommendation (SBAR): An effective situational briefing strategy, used by the U.S. Navy, to communicate relevant case facts in a respectful, focused and effective manner.
• Simulation drills: Exercises featuring actresses and mannequins reacting as real patients during the birthing process.
“These principles and strategies provide a foundation of clear communications tools and close to real life scenarios for use by obstetric, NICU, anesthesia, blood bank and lab teams,” said Becky Gams, RN, MS, APNL, University of Minnesota Medical Center, Fairview, and University of Minnesota Amplatz Children’s Hospital.
The PPSI’s Baseline Phase consisted of the retrospective collection of harm outcome data from 2006 and 2007 to establish a baseline of performance. During Phase I, healthcare teams implemented interventions and actively worked on performance and perinatal safety improvement across approximately 145,000 births.
Phase II began in January 2011 and will be completed in December 2012. In June 2010, AHRQ awarded a three-year demonstration grant to PPSI participant Fairview Health Services to extend the initiative. The grant allowed for the Phase II extension, which is examining hospital bundle compliance and associated outcomes, and the role of hospital culture in perinatal performance improvement to further reduce harm and liability. The University of Minnesota School of Public Health and the National Perinatal Information Center will continue providing specialized data and analytic services during the grant phase. Premier will begin analysis of Phase II results when the PPSI concludes. Results from the entire initiative will be made public in the summer or fall of 2013.

Source: Premier healthcare alliance