An incredible article by a true patient safety advocate, Institute for Safe Medication Practices president Michael Cohen. I am incredibly thankful for the continued support he has shown our foundation and our mutual cause. Hopefully this article will touch and inspire those who it reaches.
Click on the image below to download a pdf of the actual newspaper clipping.
I received the following very nice note from Ken Hale at OSU’s Pharmacy department and wanted to share some of the awesome comments our engagement received from students…
Hi Chris.
One of our faculty members, Bonnie Spiers, collected reflections from our pharmacy students who attended your program at Ohio State on November 21st. I found their feedback to be very thoughtful and encouraging. I thought you might like to see a few specific comments:
“This lecture was beyond beneficial to my future career as a pharmacist. I will take the things I learned through this program and keep them in my mind for the rest of my life as a health care provider.”
“This talk was extremely moving. It changes how I view my future career as a pharmacist”
“This is one event that was especially touching, and I know I will carry it with me throughout my career. It opened my eyes to realizing each medication is for a person, and each person is loved.”
“This lecture was one of the most interesting, inspiring, and heartfelt events that I have ever experienced.”
“This event was extremely unique, and seeing the two of them together (Chris Jerry and Eric Cropp) advocating for safety and awareness was inspiring.”
“I loved this lecture! The College of Pharmacy should do this every year.”
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So, as you can see, it seems you achieved your goals in speaking with these future health professionals.
Below are a listing of all the speaking engagements and interviews I was a part of in 2011. I hope some of you were able to attend. Can’t wait to see what is in store for 2012. A sincere “Thank You” goes out to all those involved with making each and every one of these events a reality.
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Emily Jerry Foundation Completed Lectures and Presentations for 2011
Interview with Leon Bibb ABC WEWS “Kaleidoscope”- Cleveland, OH
Ohio Northern University School of Pharmacy – Ada, Ohio
Interview with Dr. Charles Denham of TMIT & Eric Cropp for Discovery Channel Segment “ Out of The Danger Zone”- Cleveland, OH
TMIT Webinar entitled “A Hospital Accident: Lessons Learned – A Death, A Conviction, and A Healing”
The Cleveland Clinic Foundation- Cleveland, OH
Sanford Brown College- Cleveland, OH
Pharmacy OneSource Webinar
Multiple Ongoing Webinars with Pharmcon entitled “Emily’s Act Revisited: The Pharmacist, The Family and the Medication Error that Changed Their Lives”
Summa Healthcare- Akron, OH
Catheter Connections- Salt Lake City, UT
Baxa Corporation- Englewood, CO
Union Hospital- Dover, OH
The Institute for Safe Medication Practices (ISMP) IV Patient Safety Summit- Philadelphia, PA
The Massachusetts Society of Health-System Pharmacists- Boston, MA
The Rhode Island Society of Health System Pharmacists- Providence, RI
Jewish Hospital- Louisville, KY
University Hospital’s Pediatric Pharmacy Team – Cleveland, OH
Ohio State University Medical Center- Columbus, OH
An awesome blog post by Dr. Tim Vanderveen of CareFusion. I had the pleasure of meeting Tim after the ISMP speech and it was a great experience. We hope to team up early next year on an exciting webcast. As always, I’ll keep you updated via our website. Now without further ado, here is Tim’s blog posting…
Monday, December 12, 2011
A tipping point for preventing IV compounding errors
Dr. Tim Vanderveen – Vice President, Center for Safety and Clinical Excellence, CareFusion
Last week, I attended the American Society of Health-System Pharmacists (ASHP) Midyear Annual Meeting in New Orleans. While there, I attended the Institute for Safe Medication Practices (ISMP) CHEERS awards dinner – an annual event to honor individuals, hospitals and companies who have made a difference in patient safety. The dinner event included a speaker, Christopher Jerry, who came to tell the story of his daughter, Emily, a victim of a fatal IV chemotherapy compounding error. Emily was receiving her last round of chemo when the pharmacy technician used 24% saline to compound Emily’s chemo dose instead of the 0.9% saline that was ordered. In an earlier blog, I discussed the second victim of a medication error – the clinician. Eric Cropp, the pharmacist who checked Emily’s chemo dose faced criminal charges and served a six-month jail sentence followed by six-months of house arrest. Partnering with ISMP, the CareFusion Center for Safety and Clinical Excellence hosted a recent webcast that discussed the error and Eric’s experience during his jail sentence.
I am honored to have been asked by the President of ISMP, Michael Cohen, to be their keynote speaker at the 14th Annual ISMP Cheers Awards and Dinner at ASHP Midyear Clinical Meeting. The following is excerpted from a letter by Michael Cohen…
“We at the Institute for Safe Medication Practices (ISMP) are delighted that you have agreed to be the keynote
speaker at the 14th Annual ISMP Cheers Awards and Dinner on Tuesday, December 6, 2011. The event will be held at the New Orleans Board of Trade, 316 Board of Trade Place, New Orleans, Louisiana during the 2011 American Society of Health‐System Pharmacists Midyear Clinical Meeting”.
Below is a downloadable pdf flyer that details the ISMP event. Click on the image to download…
I gave a lecture last Monday, November 21st, at Ohio State’s College of Medicine in Columbus. Eric Cropp and I did this lecture together and everything went extremely well. We had over 130 students in attendance from OSU’s medical and pharmacy schools. I always look forward to these types of lectures and presentations to our future leaders in medicine. Read the amazing testimonial from Kenneth M. Hale the Assistant Dean for Professional and External Affairs, and Clinical Associate Professor of Pharmacy Practice and Administration. It is truly one of our most powerful recommendations to date!
Thanks to all who were in attendance.
Click the image below to download a pdf of the testimonial…
A great heartfelt article was recently written by Michael Cohen, President of the Institute for Safe Medication Practices (ISMP), a non-profit healthcare organization that operates the voluntary and confidential ISMP Medication Error Reporting Program. I am very proud to be affiliated with their organization. Together we can truly change things for the better…
A dad embraces the pharmacist responsible for his daughter’s death
MONDAY, NOVEMBER 14, 2011
Emily Jerry was just two years old when she died from a medication error made by a hospital pharmacy technician in Cleveland. She had undergone surgeries and four rounds of chemotherapy to treat what doctors said was a highly curable malignant tumor at the base of her spine.
According to her parents, Emily’s previous treatments had been so successful that her last MRI showed that the tumor had miraculously disappeared. This last treatment on her second birthday was just to be sure that there were no traces of cancer left inside of her. Tragically, the technician mixed her final dose of chemotherapy improperly, in a saline solution that was 23 times more concentrated than it should have been.
Jail time, loss of licensure questioned
by Karen Blum
More than three decades later, Dennis Tribble, PharmD, is still haunted by the memory of one of the worst cases of his professional life. Now the chief pharmacy officer for Baxa Corporation, Dr. Tribble was at that time a pharmacist in a hospital he prefers not to name.
“I had been practicing for a number of years by that time. I failed to note that an adult dose of quinine had been prescribed for a pair of 10-year-old twins suffering from malaria. It put those kids into heart block and almost killed them,” said Dr. Tribble, his voice shaking.
What support did his hospital provide? “One of my bosses sat down with me and said, ‘I think you’ve already beat yourself up a whole lot more on this than I’m going to. You’re going to be a lot more careful, right?’ That was the extent of the counseling I got,” Dr. Tribble recalled. “To this day I look back on that incident in terror. I was functionally at less than half speed for about two weeks after that. I second-guessed every move I made. When this kind of thing happens, you don’t believe in yourself or in the quality of anything you do.”
A strong patient safety advocate and great guy, Dennis Tribble of Baxa recently posted a moving blog about the Emily Jerry Foundation on the American Society of Health System Pharmacists website. I am very thankful for his efforts in continuing to promote our cause and giving the foundation a larger platform in order to reach many more people. I have copied an excerpt below which I think you’ll enjoy. A link to the full post follows…
A painful experience…
Created By: Tribble, Dennis On Wed, Oct 05, 2011 09:16 AMI just did something that may be the bravest thing I ever did, or the stupidest… I relived my experience as the maker of a medication error in an article that will be published in Pharmacy Practice News. It’s amazing how clear that memory is, how immediate it is, and how it still affects me emotionally even just to talk about it. That memory is 31 years old.
I think I got started down this road as a result of spending the morning with Chris Jerry. If that name doesn’t ring a bell, he is the father of Emily Jerry, the little girl who died as the result of a tragic medication error in which 23.4% Sodium Chloride rather than 0.9% Sodium Chloride was used to reconstitute what would have been her very last, “just in case” dose of chemotherapy. Chris tells me that the radiological images showing her progress were just incredible; they had only decided to do this dose “to be certain there were no lingering cancer cells”.
Chris talked about Eric Cropp, who he has publicly forgiven, and with whom he speaks publicly about the importance of systems thinking in error prevention, as well as about the need for consideration for what Albert Wu has described as “the second victim” of a serious medical error, the healthcare provider who commits the error.
Talking about his experience brought me clearly back to the day that I learned that I had sacrificed care to the god of productivity, and very nearly killed two children. It is a mistake I never made again, but I was seriously impaired for several weeks after that.
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.
Posted: February 8, 2012 by ejfadmin
March 3 – Huntsville, Alabama 2012 PATIENT SAFETY SYMPOSIUM
I am truly excited to travel to Huntsville, Alabama this March to take part in the 2012 Patient Safety Symposium. As I have found my calling in being a Patient Safety Advocate each presentation seems to become more and more important. I am honored and humbled to have been asked to attend. This will be a great event, hopefully I’ll see some of you there!
To read all the details about the event click on the image below…
