Faculty Bibliography

The Centers for Medicare & Medicaid Services' regulations regarding nonpayment for hospital-acquired conditions such as pressure ulcers have prompted a marked increase in focus on preventive care. Our hospital also used this change in payment policy as an opportunity to strengthen our pressure ulcer prevention practices. We used an 8-spoke prevention wheel to develop and implement practice changes that reduced pressure ulcer incidence from 7.3% to 1.3% in 3 years. Because it is about the journey, we will describe the mechanisms we designed and implemented, and identify strategies that worked or did not work as we promulgated a quality improvement process for pressure ulcer prevention in our large urban hospital center.

The purpose of this report was to describe a case of methemoglobinemia involving different systemic complications as a result of local anesthetic injection with lidocaine in a 2-day-old female patient. Acquired methemoglobinemia is considered a major, potentially life-threatening complication. There are several reports of this complication related to anesthetic agents, most commonly prilocaine and benzocaine. It can involve patients of different ages, but it is more common in children 6-years-old and younger, particularly those younger than 3 months. Widely used in dental practices for pain management, lidocaine is considered to be one of the safest anesthetic agents. Although rare, complications of lidocaine administration need to be addressed properly, and adequate training in diagnosis and management of these complications should be provided. Providers should weigh the risk and benefit of using these agents.