ASHRM's 2013 ongoing theme—“Everyone is a Risk Manager” (ERM)—emphasizes the vital role that all healthcare workers hold as guardians of patient safety, every single day. Each and every employee must take ownership of risk and recognize their part in the patient safety process.

The purpose of this article is to outline the criticality of water supply in sustained operations of healthcare facilities, particularly during community emergencies, and to advocate for enhanced cross-sector support from the water utilities in meeting this need. Information and ideas presented here were developed in the course of a regional project sponsored by the Metropolitan Washington Council of Governments (MWCOG) for development of emergency water supply operations plans for critical water uses in the Washington, DC, area.

Underwater birthing has become a popular birth practice in some areas of the country. Although many of these deliveries occur in a home birth setting, the practice has also been implemented in hospitals and birthing centers. There is continued controversy about the risks and benefits of underwater birthing (as opposed to hydrotherapy during labor), and many risk managers are unaware of these potential risks and benefits. The purpose of this article is to review the significant risks and benefits of underwater birthing, to review relevant literature and several Professional Organizations' Position Statements regarding underwater birthing, and to provide a safety checklist for hospital risk managers who wish to consider adding underwater birthing to their current scope of perinatal care.

The development of systematic and sustainable surveillance systems is necessary for the creation of patient safety prevention programs and the evaluation of improvement resulting from innovations. To that end, inpatient hospital discharges collected by the Pennsylvania Health Care Cost Containment Council were used to investigate patient safety events (PSEs) in Pennsylvania in 2006. PSEs were identified using external cause of injury codes (E-codes) in combination with the Agency for Healthcare Research and Quality's patient safety indicators (PSIs). Encounters with and without PSEs were compared with regard to patient age, sex, race, length of stay, and cost. Approximately 9% of all Pennsylvania inpatient discharges had a PSE in 2006. Patients with a PSE were on average older, male, and white. The average length of stay for a PSE was 3 days longer and $35 000 more expensive than a non-PSE encounter. It was concluded that E-codes and PSIs were useful tools for the surveillance of PSEs in Pennsylvania, and that administrative data from healthcare organizations provide a consistent source of standardized data related to patient encounters, creating an opportunity to describe PSEs at the population level.

Perhaps individual wishes are not always acknowledged or accepted when it comes to end-of-life care. This possibility, in conjunction with the experiences of healthcare risk managers, should cause concern in the healthcare risk management community. One particularly concerning issue where a persistent failure to honor a patient's wishes exists is with Do Not Resuscitate (DNR) orders in the perioperative arena. Despite a strong focus on informed consent and advance directives, evidence suggests a number of healthcare organizations either have no policy in place regarding DNR orders during the perioperative period, or, for those organizations that do have a policy, many call for automatic suspension of the DNR order without consultation with the patient. This latter practice poses many ethical, medico-legal, and regulatory concerns, and healthcare organizations with such a policy in place should strongly consider revisiting this practice.