pennsylvania patient safety authority annual report

When did the PA-PSRS guidelines go into effect?

The guidance was devel-oped to help provide consistent standards to acute healthcare facilities in Pennsylvania in determining whether occurrences within facilities meet the stat-utory definitions of serious events, incidents, and in-frastructure failures as defined in section 302 of the

What is the PSA 2020?

Like everyone, much of the PSA’s efforts in 2020 focused on COVID-19. Once news of the pandemic hit , the field staff, led by our team of infection pre-ventionists, began providing virtual consultations for healthcare facilities across Pennsylvania cov-ering everything from cleaning protocols to ob-taining additional personal protective equipment. Sometimes the team just provided emotional sup-port for frontline staff during their darkest hours.

What is an event that could have resulted or did result in harm to a patient?

An event, occurence, or condition that could have resulted or did result in harm to a patient and can be but is not necessarily the result of a defective sys-tem or process design, a system breakdown, equip-ment failure or human error. They can also include adverse events, no-harm events, near misses, and hazardous conditions.

What is a potential adverse event?

“potential adverse event”: An event which either did not reach the patient (“near miss”) or did reach the patient but the level of harm did not require addi-tional healthcare services. The legal definition from the MCARE Act: “an event, occurrence, or situation involving the clinical care of a patient in a medical facility which could have injured the patient but did not either cause an unanticipated injury or require the delivery of additional healthcare services to the patient. The term does not include a serious event.”

What is a PSA analyst?

The analyst is a member of the PSA with education and experience in medicine, nursing, pharmacy, product engineering, statistical analysis, and/or risk management. Analysts review events submit-ted through PA-PSRS and compose the majority of the articles included in the PSA’s quarterly, peer-re-viewed journal, Patient Safety.

What is an ASF hospital?

The Health Care Facilities Act (HCFA) defines an ambulatory surgical facility (ASF) as “a facility or portion thereof not located upon the premises of a hospital which provides specialty or multispecialty outpatient surgical treatment.

How long do you have to report a patient in restraints?

The Centers for Medicare & Medicaid Services (CMS) requires hospitals to report to DOH any death of patients in restraints or in seclusion, or in which restraints or seclusion were used within 24 hours of death (other than soft wrist restraints).