This outbreak of Legionnaires disease was associated with exposure to a decorative fountain located in a hospital public area. Routine cleaning and maintenance of fountains does not eliminate the risk of bacterial contamination. Our findings highlight the need to evaluate the safety of water fountains installed in any area of a healthcare facility.

Compared with targeted screening, universal screening increased the rate of detection of MRSA upon hospital admission but did not significantly reduce the rate of hospital-acquired MRSA infection. Universal screening was associated with higher costs of care and was not cost beneficial.

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Medical abortion with methotrexate and misoprostol is safe and effective and can be offered in a community setting.

Objective: Seven independent health care organizations in the Milwaukee, Wis, metropolitan area formed a community-based collaborative to improve patient safety. Once established, the Milwaukee Patient Safety Collaborative (MPSC) used this model to develop and implement strategies for eliminating the use of highrisk abbreviations written by physicians in both hospital and outpatient settings. Method: Using a collaborative model, strategies aimed at changing physician prescribing patterns were identified and implemented in participating organizations. Data were collected from 2003 to 2004 in 13 hospitals (measuring hospital-based physician medication orders) and 9 retail pharmacies (measuring prescriptions written by outpatient-based physicians). Results: The use of preferred documentation (without high-risk abbreviations) in medication orders written by hospital-based physicians improved significantly during the MPSC project. The use of preferred documentation in the hospital settings increased by 32.1% (from 61.65% at baseline to 81.4%, P G 0.0001). The rate of preferred documentation written by outpatient-based physicians improved by 5.6% (P = 0.11). Contributing factors to the project's success included agreement on a shared objective, endorsement by physician leaders, implementation of policies prohibiting the use of abbreviations, and individualized physician feedback.Conclusions: A collaborative model for addressing patient safety was implemented in Milwaukee, Wis. The collaborative successfully defined a shared objective, implemented methods for improvement, and measured outcomes in 22 participating sites. Significant results were achieved in the hospital setting, with limited influence on physicians in the outpatient environment. The innovative work of the MPSC was recognized with a 2004 Institute for Safe Medication Practices Cheers Award.