Proactively Preventing Medical Errors: A Student-Led Approach to Patient Safety in Pre-Clinical Curriculum

Introduction: Preventable medical errors are currently the third leading cause of death in the United States following heart disease and cancer (1). This study was designed to assess the change in knowledge from earlier education of medical students during pre-clinical years. Methods: Patient safety trainings have been conducted for two years for interested first and second-year medical students and responses are assessed through a pre-test, immediate post-test, 3-month post-test, and 6-month post-test. The survey assesses student knowledge on aspects of patient safety and has Likert scale questions assessing if the training influenced students’ desire to learn about patient safety. Results: From the original data from the first training, improvements were seen in students considering themselves to be well-versed in different aspects of patient safety in the 3-month post-test (33.3%; p-value=1.00) compared to the pre-test training (11.8%). The percent of students that agreed they plan to incorporate patient safety techniques into their future practice improved from 83% in the 3-month post-test to 100% in the 6-month post-test. Data gathering is ongoing for the second group that participated in the training. Conclusion: The improvement in students who considered themselves to be knowledgeable about patient safety 3 months after the training is promising, despite the results of the 6-month post-test, as it highlights the need for long-term training and can be further assessed using data from the second training. The lack of statistically significant findings can most likely be attributed to small sample size and will likely improve with further data collection

A 3- and 6- Month Follow-Up to a Student-Led Approach to Patient Safety in Pre-Clinical Curriculum

Introduction: Preventable medical errors are currently the third leading cause of death in the United States following heart disease and cancer. In light of this, integration of formal patient safety education into undergraduate medical education has been encouraged by the World Health Organization. This study aimed to assess the change in patient safety knowledge, attitudes, and beliefs in students after early exposure to patient safety during pre-clinical years. Methods: First and second-year medical students participated in the training and responses were assessed through a pre-test, immediate post-test, 3-month post-test, and 6-month post-test. The survey assessed student knowledge on aspects of patient safety, course of action in patient safety scenarios, and Likert scale questions on patient safety interest. Results: Of the original 23 medical students, 12 and 7 students completed the 3-month and 6-month post-tests, respectively. Data showed improvement in students considering themselves to be well-versed in different aspects of patient safety in the 3-month post-test (33.3%; p-value=1.00) compared to the pre-test training (11.8%) but declined in the 6-month post-test (14.3%; p-value=1.00). The percent of students that agreed they plan to incorporate patient safety techniques into their future practice was 83% in the 3-month post-test (pre-test: 94.1%; p-value=1.00) and 100% in the 6-month post-test (p-value=1.00). Conclusion: The improvement in students who considered themselves to be knowledgeable about patient safety and the high agreement to incorporate patient safety techniques is promising. This indicates the long-term influence that patient safety training can have in preclinical years and potentially in clerkship years

Bactrim, Spironolactone and Lisinopril. Stay Away! A Dangerous Cocktail for Hyperkalemia

Introduction: Hyperkalemia is a potentially life-threatening complication of several medications, particularly in situations of polypharmacy. Trimethoprim/sulfamethoxazole (TMP-SMX) is a first line antibiotic for outpatient treatment of MRSA for skin and soft tissue infections that can enhance the hyperkalemic effects of spironolactone and Angiotensin receptor inhibitors (ACEI). Case Presentation: A 53-year-old female with history of HTN, stage 3 CKD, CHF, hypercholesterolemia and DM II, chronic left foot ulcer presented to our local hospital with generalized malaise, severe lower extremity weakness and heaviness of 2 days duration. She normally uses a walker but has had increasing difficulty standing from a seated position. Her medications included: spironolactone, carvedilol, lisinopril, amlodipine, aspirin, atorvastatin, and insulin and had been started on TMP-SMX for the management of an infected chronic ulcer. Physical exam was significant for a blood pressure of 182/87 mm Hg, BMI of 52, lethargy, dry oral mucous membranes, and nonsignificant musculoskeletal examination. The laboratory results revealed significantly elevated potassium levels at 8.6 mmol/L; GFR of 31 and creatinine: 1.79 mg/dL. EKG revealed tall, peaked T-waves with widened QRS complexes in the precordial leads and a right BBB. TMP-SMX, spironolactone and lisinopril were discontinued, and the patient was started on a hyperkalemia treatment protocol. The patient improved rapidly over the next 3 days with resolution of the ECG changes, improved muscle strength and the potassium level was back to normal limits by the time of discharge. Conclusion: Clinicians and pharmacists should be aware of the enhanced hyperkalemic effects of TMP-SMX, spironolactone and lisinopril and should avoid this combination