Download PDF: Clinical Communiqué June 2020 Edition
In this edition
Editorial
Clinical Decision-Making
Working in Teams
Transferring Critically Unwell Patients
Communication in the Workplace
Fixation Errors
Learning from Influenza Epidemics
The Polygon of Patient Safety
Editorial
Welcome to the June 2020 edition of the Clinical Communiqué. In this edition we explore two cases where death occurred in secure settings - a correctional facility and a mental health facility. As the details unfolded at inquest, it became apparent that the usual layers of complexity that exist in providing care to patients with multiple physical and mental health co-morbidities in acute hospital settings were magnified. Major logistical issues included access to the facility, use of multiple providers, and personal safety concerns for the staff. What ensued in both cases were errors in the use of torsadogenic drugs that led to the suspected outcome of fatal arrhythmia.
Torsadogenic drugs are those recognised to prolong the QT interval and increase the risk of Torsades de Pointes. Translated from the French as ‘twisting of the points’, Torsades de Pointes (TdP) is a specific type of cardiac arrhythmia that may lead to sudden cardiac death. It is a polymorphic ventricular tachycardia that exhibits distinct characteristics on the electrocardiogram (ECG) where the QRS complexes ‘twist’ around the isoelectric line. Many antipsychotic and antidepressant medications are implicated in QT prolongation, so the synergistic effects of polypharmacy are very real concerns in the setting of mental health care. QT prolongation has the potential for life-threatening complications that occur abruptly and without clinical warning, but it remains an unseen danger unless an ECG is performed. It is therefore imperative that the risks are considered, especially in non-hospital settings, and patients on these medications are routinely screened for any ECG abnormalities.
We have two commentaries in this edition, one by Dr Katherine Isoardi, who outlines the drugs known to prolong the QT interval, and offers pragmatic guidance on identifying and calculating the risks associated with these drugs. Katherine is an Emergency Physician and Clinical Toxicologist based in Brisbane at the Princess Alexandra Hospital. She is also the Medical Director of the Queensland Poisons Information Centre.
In our other expert commentary, Dr Danny Sullivan presents an astute overview of the challenges in delivering mental health care in secure settings. Danny is the Executive Director of Clinical Services at the Victorian Institute of Forensic Mental Health (Forensicare), whose work extends to medicolegal and complex case assessments in criminal, coronial, and child protection cases, in all jurisdictions in Australia.
Before delving into the cases and commentaries of this edition, I wish to acknowledge the incredible work done by clinicians near and far, over the past few months. The year has been like no other, and, as a result of the COVID-19 pandemic, we have all borne witness to the best and the worst of the human spirit as the world faced these extraordinary events.
In health care, individuals and organisations strove to ready themselves, adapt quickly and share their experiences, and step well outside their comfort zones, all the while maintaining professional integrity and protecting their patients, themselves, and their families. It has been a truly remarkable moment in time.
The contributors to this edition, Dr Rohit D’Costa, Dr Katherine Isoardi, and Dr Danny Sullivan exemplified this incredible spirit by agreeing to write for us at a time when they could not have been busier preparing their own units for a potential surge of COVID-19 patients. They dedicated precious time and attention to sharing their expertise and insights with our readers to improve patient safety. I thank them for their generous contributions.
In the midst of preparing and releasing our COVID-19 editions [Clinical Communiqué COVID 2020 Vol 7, (1); Future Leaders Communiqué COVID 2020 Vol 5 (2); Residential Aged Care Communiqué COVID 2020 Vol 15 (1.2)], we launched our first podcasts and have been delighted with the positive feedback. It has made the long hours and many challenges worth our collective efforts. As we all now wait in nervous anticipation of what the ‘second wave’ of COVID-19 looks like, we must not take our eyes off what is at the core of all our health care practices, the need to continuously improve patient safety, for everyone, everywhere.