Advance planning and swift action kept Duke ahead of national peanut recall

When peanut products were first linked to a nationwide salmonella outbreak in January 2009, the logistical implications for protecting patient safety immediately registered on the radar of Brooke Berson, director of clinical resource management at Duke University Health System.

"At first the recall involved a few brands, but then it became apparent that this was going to be ongoing and massive in scope," she says.

The numbers mentioned on the evening news were striking: Nationally, five people had died and more than 400 people had become sick with salmonella poisoning after eating food containing contaminated peanuts from one Georgia plant. Some 430 products had been recalled, and the list was growing every day.

Berson learned of the contamination and subsequent recall through the Risk and Safety Management Alert System (RASMAS), an online subscription-based clearinghouse for product alerts and recalls. Duke uses RASMAS to oversee updates in 15 different categories relevant to a health care institution, from lab supplies and prosthetic limbs to the toys found in pediatrics units and the food served in hospitals.

While other health care systems have used RASMAS with mixed results, Duke took the extra step of adding an inventory control process to apply the recalls with accuracy and expediency. The action proved prescient during other headlining recalls -- for human tissue in 2006 and Heparin in 2008.

"In the previous recalls -- and now the recall for the peanut products -- RASMAS and the process Duke has developed around our inventory have proven to be an invaluable resource in protecting our patients' safety," says Michael Cuffe, MD, vice president for medical affairs.

With the newest alert from RASMAS, Food Services immediately pulled all recalled peanut items from cafeteria lines and pantry shelves throughout the health system. And as more brands and more food products joined the FDA's recall list on a daily basis, Berson and her team cast an even wider net to protect patient safety by alerting the Senior Recall & Response Team (SRRT), which Cuffe leads.

"The SRRT is made up of leaders at Duke who respond to emergent issues as they impact patient care, safety, or staff safety or process," says Berson. "With the growing peanut-product recalls, the SRRT requested that vending machines and even our gift shops be checked for affected food."

Erring on the side of caution and in anticipation that some patients and family members may have questions about the extent of the recall, most peanut-containing items were removed -- and remain out of the health system today.

"We had to hit the balance between being restrictive enough to weed out the recalled items, but not so overcautious that definitively safe items were eliminated," she says.

Three months since the first recall alert, the FDA database has ballooned to nearly 4,000 products in 18 categories representing pre-cut produce, trail mix, ice cream, cereal, and almost every grocery aisle in between.

Through RASMAS and other ongoing patient safety initiatives at Duke, Berson and the SRRT remain watchful, making sure that the threat of the peanut is one less thing for patients and their families to worry about.

The graph below illustrates the dramatic decrease in the time it takes to close an alert at Duke. As of October 2008, it took fewer than five days to close an alert.