Washington Hospital Center safety program seeks to catch ‘near-misses’

The safety team at Washington Hospital Center thought they had a simple solution for identifying patients at risk of falling: have them wear yellow wristbands and yellow socks with nonskid soles to prevent slipping.

Except the socks themselves turned out to be a danger. Many were too big. Instead of averting falls, they were increasing the chance of taking a tumble, officials said.

But a nurse used a new alert system to report the problem with the socks: A supply cart was stocked only with super-large yellow socks, even though a smaller size was available. Officials said the size issue would likely have gone unnoticed until a patient had fallen.

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Lori Montgomery 03 Aug, 2011

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Source: http://feeds.washingtonpost.com/click.phdo?i=262908cfcf50bbadefe0f6bc64224c5c
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