Most people truly understand why I am so passionate about my ongoing advocacy efforts in patient safety and why it has been so important to me. They also seem to get why, over the years, I have felt so strongly about always striving to be an active part of the solution to preventable medical errors, not only through my work, but through the programming of The Emily Jerry Foundation. What some people often ask me though, who do not practice medicine, is exactly “why” I refer to myself not just as a patient safety advocate, but as a clinician/caregiver advocate, as well? The following, very kind and supportive email correspondence that I just received from a pharmacist this morning helps explain the answer to that question.
“I just wanted to say I’m so sorry for what happened with your daughter. I also think you are an inspiration for how you took the situation and have done such good things with it. I am a pharmacist and I see all too often companies not getting to the root of the problem. They only try to fix the face of the problem, not the cause. You are doing something so wonderful by trying to fix the broken system after the trauma you suffered—I have no words to express how wonderful that is. I also don’t have words to express my condolences and sorrow for your daughter–words can’t suffice for that type of pain, I’m so sorry. Best Wishes, Jan”
So excited about how well our meeting went with RxTOOLKIT and the Therapeutic Research Center (TRC) yesterday. Extremely pleased to say that our organizations came to an agreement to immediately begin moving forward on the final development and implementation of the Emily Jerry University for eLEARNING for pharmacy technicians. To start, we will be offering comprehensive online continuing education training for pharmacy technicians and core competency tracking in all aspects of hospital pharmacy.
Read more about this exciting new program here:
https://rxtoolkitelearning.com/about/dedication/
Really looking forward to heading to Austin, Texas for the next few days for another speaking engagement with the Texas Hospital Association! Here is an excerpt from their website discussing the goals and objectives of the program I will be taking part in.
Quality and Patient Safety Conference
April 25-26, 2017
Embassy Suites San Marcos
Hotel, Spa and Conference Center
This activity is jointly provided by AXIS Medical Education and The Texas Hospital Association.
Learning Objectives
1. Identify actionable methods that can be used to provide care to patients.
2. Review barriers to quality improvement.
3. Clarify common reporting complexities.
4. Define adequate measurement outcomes.
5. Describe the effects of patient aggression of both patient and staff safety.
6. Demonstrate how to use data to identify health disparities.
7. Identify features of a high reliability organization.
8. Discuss four guiding principles of Patient and Family Centered Care and their use in quality improvement.
9. Identify solutions to prevent medical errors.
10. Discuss best practices that are proven to minimize the “human error” component of medicine.
11. Identify three frequently reported preventable adverse events in Texas.
The Emily Jerry Foundation was honored to be represented by Christopher Jerry as part of the Pediatric Adverse Drug Event Panel discussion at the Patient Safety Movement Foundation (PSMF) on Feb. 4th during the 2017 Global Summit in California. The preparation for this important event began at the beginning of December with the drafting of a comprehensive white paper, Actionable Patient Safety Solution (APPS). Click here to download the resulting Executive Summary Checklist associated with APPS.
Dr. Nathaniel M. Sims, friend and ally of EJF, headed up and organized this very important endeavor. Dr. Sims and Chris met in June 2013, when Chris gave a keynote session at the annual Association for the Advancement of Medical Instrumentation (AAMI) 2013 Conference and Expo entitled “Changing the Culture of Medicine-A Father’s Powerful Message”. Dr. Sims asked Chris if he would be interested in participating in the Medication Errors Panel discussion at PSMF in 2014. The following is a short video that the PSMF produced, where Chris describes Emily’s story. The video was used to start the conversation. Additionally, you can also view the video of the entire Medication Errors Panel Discussion from 2014.
Three years later, flash forward to the Pediatric Adverse Drug Event Panel discussion this year, where the focus was put on saving the lives of the smallest and most vulnerable patients… babies and children. Due to the simple fact that their body weight is so variable, correctly determining the dosage and concentration for any medication is absolutely vital, and clinicians only have ONE opportunity to get it right or tragedies can occur—as in Emily Jerry’s case. Dr. Anne Lyren, Clinical Director of the SPS National Children’s Network, was the ideal moderator of this year’s panel discussion. Dr. Lyren played a vital role in establishing SPS’s Quality & Safety Program. At the beginning of this video, listen to Dr. Lyren’s opening remarks emphasizing how she truly feels about Emily’s legacy, and what we can all learn from what happened. It’s extremely powerful!
Here is a screen capture of the event during the panel discussion as we all discussed our roles in reducing medical errors and dramatically increasing patient safety.
Absolutely awesome day today speaking at St. Barnabas Hospital in NYC, where the clinician caregivers are all laser focused on patient and medication safety! St. Barnabas is a stellar example of a smaller hospital, with often limited resources, that has successfully created a true “culture of safety” at their medical facility with all of their incredible clinician caregivers. This type of culture ensures that every single one of their patients receiving healthcare have not only the best possible outcome during their course of treatment, it also significantly lowers the probability of tragic preventable medical errors from occurring.
With such a high focus on patient care, it is clear to see that St. Barnabas is a leader in its field. Regularly coming on top of results tables, the hospital continues to strive for the perfect patient experience, making it one of the best hospitals in the US to receive treatment. Many hospitals now collect data on the feedback their patients give them on their experience in the hospital (you can see this feedback software that many hospitals use). This can cover everything from medical treatment right down to bedside manner and food options. Feedback at the hospital regularly exceeds expectations, showing the high quality of care given. With many hospitals competing against each other in NYC, it says something about St. Barnabas that it has come out on top of the leaderboard not just for medical care, but for the patient experience too.
Improvements continue to be made at the hospital, ensuring that the rate of progress is not slowed at any time. It is no wonder, then, that St. Barnabas provides one of the best patient experiences in the whole of the US.
In the summer of 2014, Chuck DiTrapano, a highly esteemed pharmacist from Reading, Pennsylvania reached out to me via email. The following is an important excerpt from Chuck’s poignant message that truly made me believe that we had been brought together for a very distinct purpose.
“We share a passion to make medication preparation and administration safer for all hospital patients. You and I also share the unfortunate experience of losing a child. My boy, John Vincent DiTrapano, was born premature in 1977 when I was a young pharmacist. Unfortunately, the technology of the time only gave him 16 days on this earth. When he died, I committed the rest of my pharmacy career to his memory. I place his initials on every one of the hundreds of NICU infusion calculations that are performed at Reading (they are embedded in the template). It is imperative that we change the system! I have the knowledge, tools, and team to make a difference. I believe we can make a positive change for all the Emilys and Johns now and still to come.”
Then Chuck began to share with me his heartfelt story of how his advocacy journey, as well as, his life experience, led him to establish a very successful family owned and operated business called RxTOOLKIT. As an expert pharmacist, he went on to explain in detail his true determination and effort to prevent tragic medication errors like the one that claimed my beautiful daughter Emily’s life in 2006. Just like me, Chuck was horrified at the thought that preventable medical errors are now the third leading cause of death in America, claiming over 440,000 lives each and every year! As a leading pharmacist, he also knew that medication errors were responsible for the largest percentage of these preventable deaths. With that said, the following is the story of how RxTOOLKIT was actually born, in Chuck’s own words, and was taken from the early email correspondence we had regarding this important issue.
In 2004, I was a supervisor at Reading Hospital and saw a need for a more effective communication tool for our staff. I realized that there was a mountain of information needed in order for the staff pharmacists and myself to perform our jobs successfully in a fast paced environment. I also realized that this information had to be readily available and easy to reference. RxTOOLKIT was born. Having the correct information and the appropriate tools at our fingertips enhanced decision making, added consistency, and improved patient safety. That same year, we received the ISMP Cheers Award for our web-based application.
Over the last 10 years, besides adding literally hundreds of pages of information, we have added more than 20 different applications to RxTOOLKIT.com. Our tools are created by pharmacists through direct clinical experience and front line development. They are developed solely on needs and feedback of actual users (pharmacists, technicians, physicians, and nurses) and solve both the small and large problems that pharmacists face every day. We have developed specialized tools for the most difficult and fragile segments of our patient population, including pediatrics and the NICU. Our tools can be fully customized to meet the needs of any institution’s procedures or protocols. We continue to pursue a very aggressive development agenda.
We have just launched our brand new homepage(s) designed to illustrate the features and benefits of our web based applications. Our tools are designed and priced to help ALL patients regardless of hospital size, pharmacy capabilities, and financial constraints. We believe in our motto: Safety is Priceless, RxTOOLKIT makes it affordable.
We have also come to know Eric Cropp. I invited him to speak to our staff last year. I have been around long enough to witness tragedy and I am all too familiar with the second victim. I think it is important that he share his message—“this can happen to you”. It is so easy for even the best of professionals to get lulled into thinking “this can’t happen to me”. Although I have been spared a firsthand experience such as Eric’s, I have had “near misses”, two of which are forever embedded in my brain. After hearing Eric’s story, and getting to know him, we developed the blog medsafetyonline.org. Our goal for the blog is to increase focus on the second victim and improve patient and provider safety through the exchange of resources, ideas, and experiences within the pharmacy and clinical practice community. I believe that by expanding the dialog among health care professionals and sharing our stories we can help to increase education and make a difference from the inside out.
On November 11th of 2014, I flew to Philadelphia to meet Chuck, in person, and to give two lectures at Reading Hospital that he had arranged. The whole experience was absolutely amazing! What made it so special was the simple fact that I felt an immediate bond with Chuck because he appeared to be on exactly the same path I was, the guy was on a mission to save lives from preventable medication errors and ultimately put a stop to all of these senseless tragedies that occur with far too many patients, each and every year! Furthermore, he proved to me he was “walking the walk” when I was given an extensive tour of Reading Hospital. I subsequently learned that RxTOOLKIT software was deeply integrated into virtually every aspect of pharmacy operations at this enormous healthcare facility and had been clinically proven to prevent medication errors for almost ten years!
Shortly after my visit in 2014, Chuck and I began discussing, in detail, how our two organizations could collaborate and partner on the development of a pharmacy technician eLearning training program that would significantly improve the core competency of ALL pharmacy technicians across the United States if they enrolled and participated in the program for continuing education credits (CE). Hence, RxTOOLKIT eLearning was born (in BETA now!).
Please click here to read the very profound dedication they just made to my little Emily’s legacy!! As her Daddy, It’s in ways like these that I believe my beautiful baby girl will always live on!! I am so very proud of her! https://rxtoolkitelearning.com/about/dedication/
When my coauthor, Joni James Aldrich and I first started this endeavor to write “Advocacy Heals U – 15 Keys to Fast Track Results and Emotional Fulfillment”, this past January, we both shared a very strong sentiment and intention, we wanted to write a book that would truly help every single person that took the time to read it. When we first began this project we really had no idea, exactly, how many people and lives our new book would positively touch. As Joni began the writing, we naturally started spending countless hours and days discussing the various aspects of other advocate’s unique journeys. In particular, we focused on the lives and stories of so many of the amazing advocates we had interviewed on Advocacy Heals U, the radio show, over the years who, like Joni and I, had gone through all types of unexpected and unimaginable life events. As we continued our in depth research for this important book, Joni and I really began to see multiple distinct patterns emerge, with respect to people and how they individually responded to the adversity that they encountered in their lives. What we found was incredible! Those people who were able to take their darkest moments in their lives, those unimaginable events that nobody expected, and bring those painful experiences forward in ways that benefit and help others, ALL of them experienced an overwhelming sense of healing, as well as, so many other unexpected blessings. “Advocacy Heals U – 15 Keys to Fast Track Results and Emotional Fulfillment”, references the heartfelt stories of 95 stellar advocates, real people, who have all experienced real Emotional Fulfillment through their advocacy!
On October 22nd, Joni and I had the distinct honor of meeting former First Lady, Rosalynn Carter at a reception held for the Rosalynn Carter Institute’s Annual Global Summit in beautiful Americus, Georgia. On October 23rd, we were humbled to give our very first book presentation and subsequent book signing at the Rosalynn Carter Institute for Caregiving, with the former First Lady actually in attendance! We were told that the special dedication (pictured below) that Joni and I made at the beginning of our book, to the Former 39th President of the United States and the Former First Lady, actually brought tears to Mrs. Carter’s eyes when it was read to her the following day! Below you will find the actual dedication included in our book, the presentation we gave during the event, and a photo of the former first lady and I.
Advocacy Heals U Book Tour – Rosalynn Carter Institute’s Annual Global Summit from emilyjerryfoundation
More recently, we have been notified that our publisher, Motivational Press, has submitted our book for a Pulitzer Prize! Through this book we truly hope to inspire advocates all over the world to take control of their lives and begin the hard work of making this world a better place for others in the process.
Better Late than never is what I say! I wanted to post this great article from June about patient safety that was published on Huffington Post. I was very surprised they even mentioned me. Please spread the word about this very important issue facing our nation’s medical facilities.
This was a great way to start the work week! My good friend and esteemed board member of The Emily Jerry Foundation, Ann Oberg, made me aware of some recent articles that ran in Pharmacy Times regarding the vital national issue of pharmacy technician regulation and oversight. The following is an interview I did with Ryan Marotta from Pharmacy Times where we discussed this important topic that affects ALL of us in America! Thank you so much everyone for giving me these opportunities for interviews, public speaking engagements, etc., and most of all, for helping me to honor my beautiful daughter, Emily’s, short life here on earth in ways that ultimately save so many lives!
The Emily Jerry Foundation is determined to help make our nation’s, world renowned, medical facilities safer for everyone, beginning with our babies and children. We are accomplishing this very important objective by focusing on increasing public awareness of key patient safety related issues and identifying technology and best practices that are proven to minimize the “human error” component of medicine. Through our ongoing efforts The Emily Jerry Foundation is working hard to save lives every day.
Last Updated: March 11, 2018 by ejfadmin
Allegheny Health Network’s Medication Safety Summit Recap
Yesterday was such an amazing day at Allegheny Health Network's Medication Safety Summit in Pittsburgh. I truly felt so privileged and humbled to give the keynote to help kick things off. I was also so grateful to spend the remainder of the day surrounded by so many "like minded" AHN clinician caregivers who are just as passionate as I am, to put an end preventable medication errors! Throughout the day we all participated in various educational activities relating to improving medication safety overall, root cause analysis, etc. From all of this wonderful collaboration and input from the various modalities at AHN, I felt like we all learned so much. Bottom line, I walked away from this stellar medication safety summit with such a re-energized sense of HOPE and inspiration, that by all of us continuing to rally together, we can one day soon, achieve my somewhat audacious goal of ZERO preventable medication errors! With that said, I would genuinely like to thank AHN's Vice President of Pharmacy, Laura Mark, and her colleagues for not only making this very productive event happen but for truly "hitting it out of the park"!