Sample records for improve prescribing safety

  1. Improving quality and safety of care using "technovigilance": an ethnographic case study of secondary use of data from an electronic prescribing and decision support system. (United States)

    Dixon-Woods, Mary; Redwood, Sabi; Leslie, Myles; Minion, Joel; Martin, Graham P; Coleman, Jamie J


    "Meaningful use" of electronic health records to improve quality of care has remained understudied. We evaluated an approach to improving patients' safety and quality of care involving the secondary use of data from a hospital electronic prescribing and decision support system (ePDSS). We conducted a case study of a large English acute care hospital with a well-established ePDSS. Our study was based on ethnographic observations of clinical settings (162 hours) and meetings (28 hours), informal conversations with clinical staff, semistructured interviews with ten senior executives, and the collection of relevant documents. Our data analysis was based on the constant comparative method. This hospital's approach to quality and safety could be characterized as "technovigilance." It involved treating the ePDSS as a warehouse of data on clinical activity and performance. The hospital converted the secondary data into intelligence about the performance of individuals, teams, and clinical services and used this as the basis of action for improvement. Through a combination of rapid audit, feedback to clinical teams, detailed and critical review of apparent omissions in executive-led meetings, a focus on personal professional responsibility for patients' safety and quality care, and the correction of organizational or systems defects, technovigilance was-based on the hospital's own evidence-highly effective in improving specific indicators. Measures such as the rate of omitted doses of medication showed marked improvement. As do most interventions, however, technovigilance also had unintended consequences. These included the risk of focusing attention on aspects of patient safety made visible by the system at the expense of other, less measurable but nonetheless important, concerns. The secondary use of electronic data can be effective for improving specific indicators of care if accompanied by a range of interventions to ensure proper interpretation and appropriate action

  2. The primary care prescribing psychologist model: medical provider ratings of the safety, impact and utility of prescribing psychology in a primary care setting. (United States)

    Shearer, David S; Harmon, S Cory; Seavey, Brian M; Tiu, Alvin Y


    Family medicine providers at a large family medicine clinic were surveyed regarding their impression of the impact, utility and safety of the Primary Care Prescribing Psychologist (PCPP) model in which a prescribing psychologist is embedded in a primary care clinic. This article describes the model and provides indications of its strengths and weaknesses as reported by medical providers who have utilized the model for the past 2 years. A brief history of prescribing psychology and the challenges surrounding granting psychologists the authority to prescribe psychotropic medication is summarized. Results indicate family medicine providers agree that having a prescribing psychologist embedded in the family medicine clinic is helpful to their practice, safe for patients, convenient for providers and for patients, and improves patient care. Potential benefits of integrating prescribing psychology into primary care are considered and directions for future research are discussed.

  3. Prescribing Patterns and Safety of Mezclitas for Respiratory Illnesses (United States)

    Quevedo, Juan; Marsh, Wallace; Yulfo, Jessica; Alvarez, Olga; Felici, Marcos; Rojas, Maria E


    Objectives To evaluate the prescribing patterns of compound mixtures of cough and cold liquid medications, known as mezclitas, which are prescribed to patients with respiratory illnesses in Puerto Rico. Secondary objectives include assessing the potential safety of these mixtures and patients’ perception of them. Methods Using a cross sectional study approach, a convenience sample was obtained from five pharmacies in Puerto Rico, from October 2008 to October 2009. Patients were asked to complete a 9-item questionnaire of demographic information, in addition to their mezclita prescription data. Results The mean age of patients was 43 years with a range of less than 12 months to 101 years. For children ≤ four years of age, 71% were prescribed cough and cold medications. Sixty-four percent of the prescriptions were given to females. The most prevalent ingredient employed was guaifenesin, which appeared in about 77% of the mezclitas. ‘Common cold’ was the principal diagnosis for 62% of the prescriptions, of which 75% of these prescriptions contained a corticosteroid and 17% contained a beta2 agonist bronchodilator. The top medical prescribing specialty was general medicine (51%). Thirty-eight percent of hypertensive patients were prescribed a decongestant. The majority of diabetic patients (60%) were dispensed a corticosteroid. Most (74%) patients reported that they had a rapid and good response to their mezclita. Conclusion Mezclitas were most commonly prescribed for acute symptoms of upper respiratory illness by general physicians, despite possible side effects. This study suggests that the prescription patterns of mezclitas do not always consider evidence-based medicine treatment guidelines. PMID:23038886

  4. How can we improve antibiotic prescribing in primary care?

    NARCIS (Netherlands)

    Dyar, Oliver J.; Beović, Bojana; Vlahović-Palčevski, Vera; Verheij, Theo; Pulcini, Céline


    Antibiotic stewardship is a necessity given the worldwide antimicrobial resistance crisis. Outpatient antibiotic use represents around 90% of total antibiotic use, with more than half of these prescriptions being either unnecessary or inappropriate. Efforts to improve antibiotic prescribing need to

  5. How can we improve antibiotic prescribing in primary care?

    NARCIS (Netherlands)

    Dyar, Oliver J.; Beović, Bojana; Vlahović-Palčevski, Vera; Verheij, Theo; Pulcini, Céline


    Antibiotic stewardship is a necessity given the worldwide antimicrobial resistance crisis. Outpatient antibiotic use represents around 90% of total antibiotic use, with more than half of these prescriptions being either unnecessary or inappropriate. Efforts to improve antibiotic prescribing need to

  6. Factor analysis improves the selection of prescribing indicators

    DEFF Research Database (Denmark)

    Rasmussen, Hanne Marie Skyggedal; Søndergaard, Jens; Sokolowski, Ineta


    OBJECTIVE: To test a method for improving the selection of indicators of general practitioners' prescribing. METHODS: We conducted a prescription database study including all 180 general practices in the County of Funen, Denmark, approximately 472,000 inhabitants. Principal factor analysis was used...... indicators directly quantifying choice of coxibs, indicators measuring expenditure per Defined Daily Dose, and indicators taking risk aspects into account, (2) "Frequent NSAID prescribing", comprising indicators quantifying prevalence or amount of NSAID prescribing, and (3) "Diverse NSAID choice", comprising...... appropriate and inappropriate prescribing, as revealed by the correlation of the indicators in the first factor. CONCLUSION: Correlation and factor analysis is a feasible method that assists the selection of indicators and gives better insight into prescribing patterns....

  7. An evaluation of the appropriateness and safety of nurse and midwife prescribing in Ireland.

    LENUS (Irish Health Repository)

    Naughton, Corina


    AIM: To evaluate the clinical appropriateness and safety of nurse and midwife prescribing practice. BACKGROUND: The number of countries introducing nurse and midwife prescribing is increasing; however, concerns over patient safety remain. DESIGN: A multi-site documentation evaluation was conducted using purposeful and random sampling. The sample included 142 patients\\' records and 208 medications prescribed by 25 Registered Nurse Prescribers. METHODS: Data were extracted from patient and prescription records between March-May 2009. Two expert reviewers applied the modified Medication Appropriate Index tool (8 criteria) to each drug. The percentage of appropriate or inappropriate responses for each criterion was reported. Reviewer concordance was measured using the Cohen\\'s kappa statistic (inter-rater reliability). RESULTS: Nurse or midwife prescribers from eight hospitals working in seventeen different areas of practice were included. The reviewers judged that 95-96% of medicines prescribed were indicated and effective for the diagnosed condition. Criteria relating to dosage, directions, drug-drugs or disease-condition interaction, and duplication of therapy were judged appropriate in 87-92% of prescriptions. Duration of therapy received the lowest value at 76%. Overall, reviewers indicated that between 69 (reviewer 2)-80% (reviewer 1) of prescribing decisions met all eight criteria. CONCLUSION: The majority of nurse and midwife prescribing decisions were deemed safe and clinically appropriate. However, risk of inappropriate prescribing with the potential for drug errors was detected. Continuing education and evaluation of prescribing practice, especially related to drug and condition interactions, is required to maximize appropriate and safe prescribing.

  8. Improving prescribing practices with rapid diagnostic tests (RDTs)

    DEFF Research Database (Denmark)

    Burchett, Helen E D; Leurent, Baptiste; Baiden, Frank


    OBJECTIVES: The overuse of antimalarial drugs is widespread. Effective methods to improve prescribing practice remain unclear. We evaluated the impact of 10 interventions that introduced rapid diagnostic tests for malaria (mRDTs) on the use of tests and adherence to results in different contexts....


    DEFF Research Database (Denmark)

    Bagger, Bettan; Taylor Kelly, Hélène; Hørdam, Britta


    Every year millions of patients worldwide suffer injury or death due to unsafe care, thus improving patient safety is both a national and international priority. A developmental project involving University College Zealand and clinical partners in the region focused upon the improvement of patient...... safety by optimizing the theory-practice connection with respect to the development of students’ competencies and the reporting of clinical errors. Population: 2nd year nursing students at University College Zealand (N: 56). Informed consent and full anonymity. Aims: - To increase patient safety...... errors. An interesting finding though is that despite the legal requirements concerning the mandatory reporting of all clinical errors, 37% of the students participating in this study report that they perhaps would be reluctant to report an eventual clinical error. Further initiatives are thus necessary...

  10. Identification of features of electronic prescribing systems to support quality and safety in primary care using a modified Delphi process

    Directory of Open Access Journals (Sweden)

    O'Neill Jennifer A


    Full Text Available Abstract Background Electronic prescribing is increasingly being used in primary care and in hospitals. Studies on the effects of e-prescribing systems have found evidence for both benefit and harm. The aim of this study was to identify features of e-prescribing software systems that support patient safety and quality of care and that are useful to the clinician and the patient, with a focus on improving the quality use of medicines. Methods Software features were identified by a literature review, key informants and an expert group. A modified Delphi process was used with a 12-member multidisciplinary expert group to reach consensus on the expected impact of the features in four domains: patient safety, quality of care, usefulness to the clinician and usefulness to the patient. The setting was electronic prescribing in general practice in Australia. Results A list of 114 software features was developed. Most of the features relate to the recording and use of patient data, the medication selection process, prescribing decision support, monitoring drug therapy and clinical reports. The expert group rated 78 of the features (68% as likely to have a high positive impact in at least one domain, 36 features (32% as medium impact, and none as low or negative impact. Twenty seven features were rated as high positive impact across 3 or 4 domains including patient safety and quality of care. Ten features were considered "aspirational" because of a lack of agreed standards and/or suitable knowledge bases. Conclusions This study defines features of e-prescribing software systems that are expected to support safety and quality, especially in relation to prescribing and use of medicines in general practice. The features could be used to develop software standards, and could be adapted if necessary for use in other settings and countries.

  11. Interventions to improve antibiotic prescribing practices for hospital inpatients. (United States)

    Davey, Peter; Marwick, Charis A; Scott, Claire L; Charani, Esmita; McNeil, Kirsty; Brown, Erwin; Gould, Ian M; Ramsay, Craig R; Michie, Susan


    Antibiotic resistance is a major public health problem. Infections caused by multidrug-resistant bacteria are associated with prolonged hospital stay and death compared with infections caused by susceptible bacteria. Appropriate antibiotic use in hospitals should ensure effective treatment of patients with infection and reduce unnecessary prescriptions. We updated this systematic review to evaluate the impact of interventions to improve antibiotic prescribing to hospital inpatients. To estimate the effectiveness and safety of interventions to improve antibiotic prescribing to hospital inpatients and to investigate the effect of two intervention functions: restriction and enablement. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), MEDLINE, and Embase. We searched for additional studies using the bibliographies of included articles and personal files. The last search from which records were evaluated and any studies identified incorporated into the review was January 2015. We included randomised controlled trials (RCTs) and non-randomised studies (NRS). We included three non-randomised study designs to measure behavioural and clinical outcomes and analyse variation in the effects: non- randomised trials (NRT), controlled before-after (CBA) studies and interrupted time series (ITS) studies. For this update we also included three additional NRS designs (case control, cohort, and qualitative studies) to identify unintended consequences. Interventions included any professional or structural interventions as defined by the Cochrane Effective Practice and Organisation of Care Group. We defined restriction as 'using rules to reduce the opportunity to engage in the target behaviour (or increase the target behaviour by reducing the opportunity to engage in competing behaviours)'. We defined enablement as 'increasing means/reducing barriers to increase capability or opportunity'. The main comparison was between intervention and

  12. The Challenges of Electronic Health Records and Diabetes Electronic Prescribing: Implications for Safety Net Care for Diverse Populations

    Directory of Open Access Journals (Sweden)

    Neda Ratanawongsa


    Full Text Available Widespread electronic health record (EHR implementation creates new challenges in the diabetes care of complex and diverse populations, including safe medication prescribing for patients with limited health literacy and limited English proficiency. This review highlights how the EHR electronic prescribing transformation has affected diabetes care for vulnerable patients and offers recommendations for improving patient safety through EHR electronic prescribing design, implementation, policy, and research. Specifically, we present evidence for (1 the adoption of RxNorm; (2 standardized naming and picklist options for high alert medications such as insulin; (3 the widespread implementation of universal medication schedule and language-concordant labels, with the expansion of electronic prescription 140-character limit; (4 enhanced bidirectional communication with pharmacy partners; and (5 informatics and implementation research in safety net healthcare systems to examine how EHR tools and practices affect diverse vulnerable populations.

  13. Initiatives to improve appropriate antibiotic prescribing in primary care. (United States)

    Harris, Diane J


    Influencing clinicians' prescribing behaviour is important because inappropriate use and overuse of antibiotics are major drivers of antibiotic resistance. A systematic review of interventions for promoting prudent prescribing of antibiotics by general practitioners suggests that multifaceted interventions will maximize acceptability. This article reports how this type of approach has been used successfully in Derbyshire, UK over the last 4 years. The range of interventions that have been used includes educational meetings (both open group events and others targeted at higher prescribers in the surgery) using a supportive and guiding ethos; the provision of support materials aimed at empowering avoidance or delayed antibiotic prescribing, where appropriate, and improving patients' knowledge and confidence in self-management; and the production of different treatment guidelines incorporating key messages with evidence, indicating where antibiotics are unlikely to be of benefit. Education on antibiotics in schools was a novel approach, which was developed in North Derbyshire to increase public awareness of the appropriate treatment for common illnesses without using antibiotics.

  14. Interventions to improve antibiotic prescribing practices for hospital inpatients. (United States)

    Davey, Peter; Brown, Erwin; Charani, Esmita; Fenelon, Lynda; Gould, Ian M; Holmes, Alison; Ramsay, Craig R; Wiffen, Philip J; Wilcox, Mark


    included any professional or structural interventions as defined by EPOC. The intervention had to include a component that aimed to improve antibiotic prescribing to hospital inpatients, either by increasing effective treatment or by reducing unnecessary treatment. The results had to include interpretable data about the effect of the intervention on antibiotic prescribing or microbial outcomes or relevant clinical outcomes. Two authors extracted data and assessed quality. We performed meta-regression of ITS studies to compare the results of persuasive and restrictive interventions. Persuasive interventions advised physicians about how to prescribe or gave them feedback about how they prescribed. Restrictive interventions put a limit on how they prescribed; for example, physicians had to have approval from an infection specialist in order to prescribe an antibiotic. We standardized the results of some ITS studies so that they are on the same scale (percent change in outcome), thereby facilitating comparisons of different interventions. To do this, we used the change in level and change in slope to estimate the effect size with increasing time after the intervention (one month, six months, one year, etc) as the percent change in level at each time point. We did not extrapolate beyond the end of data collection after the intervention. The meta-regression was performed using standard weighted linear regression with the standard errors of the coefficients adjusted where necessary. For this update we included 89 studies that reported 95 interventions. Of the 89 studies, 56 were ITSs (of which 4 were controlled ITSs), 25 were RCT (of which 5 were cluster-RCTs), 5 were CBAs and 3 were CCTs (of which 1 was a cluster-CCT).Most (80/95, 84%) of the interventions targeted the antibiotic prescribed (choice of antibiotic, timing of first dose and route of administration). The remaining 15 interventions aimed to change exposure of patients to antibiotics by targeting the decision to treat

  15. Decision Support System Design and Implementation for Outpatient Prescribing: The Safety in Prescribing Study (United States)


    upon 2001–2002 data. We targeted the following medication interactions: Warfarin and acetaminophen, or trimethoprim/sulfamethoxazole, fluconazole...Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130(6):461–70. Advances in Patient Safety: Vol. 3 50 27. Soumerai SB

  16. Antimicrobial stewardship: Improving antibiotic prescribing practice in a respiratory ward. (United States)

    Yeo, Jing Ming


    International efforts have mandated guidelines on antibiotic use and prescribing, therefore the focus is now on encouraging positive behavioral changes in antibiotic prescribing practice. Documentation of indication and intended duration of antibiotic use in drug charts is an evidence-based method of reducing inappropriate antibiotic prescribing. It is also a standard detailed in our local antimicrobial guidelines. We collected baseline data on compliance with documentation of indication and duration in drug charts in a respiratory ward which revealed compliance rates of 24% and 39% respectively. We introduced interventions to improve accessibility to the guideline and to increase awareness by distributing antibiotic guardian pocket cards with a three-point checklist and strategically-placed mini-posters. We also aim to increase team motivation by obtaining their feedback in multidisciplinary team meetings and by introducing certificates for their involvement in the quality improvement process. The results of the second cycle post-intervention showed an increase in compliance rates for documentation of indication and duration of 97% and 69% respectively. After a further awareness and discussion session at the multidisciplinary team meeting with the local antimicrobial management team audit nurses, a third cycle showed compliance rates of 94% and 71% for indication and duration respectively. This project has highlighted the importance of improving accessibility and of encouraging interventions that would bring about a change in personal value and subsequently in behavior and individual practice.


    DEFF Research Database (Denmark)

    Bagger, Bettan; Taylor Kelly, Hélène; Hørdam, Britta


    , social and cultural factors have resulted in a greater emphasis upon digital technology. Attempts to improve patient safety by optimizing students’ competencies in relation to the reporting of clinical errors, has resulted in the development of an interdisciplinary e-learning concept. The program makes......Improving patient safety is both a national and international priority as millions of patients Worldwide suffer injury or death every year due to unsafe care. University College Zealand employs innovative pedagogical approaches in educational design. Regional challenges related to geographic...... it possible for the students to train and test their knowledge and understanding independent of time and place. Data accumulated from the e-learning program will be used to further develop digital learning initiatives....

  18. Safety and quality of nurse independent prescribing: a national study of experiences of education, continuing professional development clinical governance. (United States)

    Smith, Alesha; Latter, Sue; Blenkinsopp, Alison


    To determine the adequacy of initial nurse independent prescribing education and identify continuing professional development and clinical governance strategies in place for non-medical prescribing. In 2006, new legislation in England enabled nurses with an independent prescribing qualification to prescribe, within their competence. In 2006, non-medical prescribing policies released by the Department of Health outlined the recommendations for education, continuing professional development and governance of non-medical prescribing; however, there was no evidence on a national scale about the extent of implementation and effectiveness of these strategies. National surveys of: (i) nurse independent prescribers; and (ii) non-medical prescribing leaders in England. Questionnaire surveys (August 2008-February 2009) covering educational preparation, prescribing practice (nurse independent prescribers) and structures/processes for support and governance (non-medical prescribing leaders). Response rates were 65% (976 prescribers) and 52% (87 leaders). Most nurses felt their prescribing course met their learning needs and stated course outcomes and that they had adequate development and support for prescribing to maintain patient safety. Some types of community nurse prescribers had less access to support and development. The prescribing leaders reported lacking systems to ensure continuity of non-medical prescribing and monitoring patient experience. Educational programmes of preparation for nurse prescribing were reported to be operating satisfactorily and providing fit-for-purpose preparation for the expansion to the scope of nurse independent prescribing. Most clinical governance and risk management strategies for prescribing were in place in primary and secondary care. © 2014 John Wiley & Sons Ltd.

  19. Medication safety and chronic kidney disease in older adults prescribed metformin: a cross-sectional analysis


    Huang, Deborah L.; Abrass, Itamar B; Young, Bessie A.


    Background Medication safety in patients with chronic kidney disease (CKD) is a growing concern. This is particularly relevant in older adults due to underlying CKD. Metformin use is contraindicated in patients with abnormal kidney function; however, many patients are potentially prescribed metformin inappropriately. We evaluated the prevalence of CKD among older adults prescribed metformin for type 2 diabetes mellitus using available equations to estimate kidney function and examined demogra...

  20. Study protocol of a mixed-methods evaluation of a cluster randomized trial to improve the safety of NSAID and antiplatelet prescribing: data-driven quality improvement in primary care

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    Grant Aileen


    Full Text Available Abstract Background Trials of complex interventions are criticized for being ‘black box’, so the UK Medical Research Council recommends carrying out a process evaluation to explain the trial findings. We believe it is good practice to pre-specify and publish process evaluation protocols to set standards and minimize bias. Unlike protocols for trials, little guidance or standards exist for the reporting of process evaluations. This paper presents the mixed-method process evaluation protocol of a cluster randomized trial, drawing on a framework designed by the authors. Methods/design This mixed-method evaluation is based on four research questions and maps data collection to a logic model of how the data-driven quality improvement in primary care (DQIP intervention is expected to work. Data collection will be predominately by qualitative case studies in eight to ten of the trial practices, focus groups with patients affected by the intervention and quantitative analysis of routine practice data, trial outcome and questionnaire data and data from the DQIP intervention. Discussion We believe that pre-specifying the intentions of a process evaluation can help to minimize bias arising from potentially misleading post-hoc analysis. We recognize it is also important to retain flexibility to examine the unexpected and the unintended. From that perspective, a mixed-methods evaluation allows the combination of exploratory and flexible qualitative work, and more pre-specified quantitative analysis, with each method contributing to the design, implementation and interpretation of the other. As well as strengthening the study the authors hope to stimulate discussion among their academic colleagues about publishing protocols for evaluations of randomized trials of complex interventions. Data-driven quality improvement in primary care trial registration NCT01425502

  1. Examining variations in prescribing safety in UK general practice: cross sectional study using the Clinical Practice Research Datalink (United States)

    Kontopantelis, Evangelos; Akbarov, Artur; Rodgers, Sarah; Avery, Anthony J; Ashcroft, Darren M


    patients receiving warfarin. What this study adds The high prevalence for certain indicators emphasises existing prescribing risks and the need for their appropriate consideration within primary care, particularly for older patients and those taking multiple medications. The high variation between practices indicates potential for improvement through targeted practice level intervention. Funding, competing interests, data sharing National Institute for Health Research through the Greater Manchester Primary Care Patient Safety Translational Research Centre (grant No GMPSTRC-2012-1). Data from CPRD cannot be shared because of licensing restrictions. PMID:26537416

  2. Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case study. (United States)

    Swinglehurst, Deborah; Greenhalgh, Trisha; Russell, Jill; Myall, Michelle


    To describe, explore, and compare organisational routines for repeat prescribing in general practice to identify contributors and barriers to safety and quality. Ethnographic case study. Four urban UK general practices with diverse organisational characteristics using electronic patient records that supported semi-automation of repeat prescribing. 395 hours of ethnographic observation of staff (25 doctors, 16 nurses, 4 healthcare assistants, 6 managers, and 56 reception or administrative staff), and 28 documents and other artefacts relating to repeat prescribing locally and nationally. Potential threats to patient safety and characteristics of good practice. Observation of how doctors, receptionists, and other administrative staff contributed to, and collaborated on, the repeat prescribing routine. Analysis included mapping prescribing routines, building a rich description of organisational practices, and drawing these together through narrative synthesis. This was informed by a sociological model of how organisational routines shape and are shaped by information and communications technologies. Results Repeat prescribing was a complex, technology-supported social practice requiring collaboration between clinical and administrative staff, with important implications for patient safety. More than half of requests for repeat prescriptions were classed as "exceptions" by receptionists (most commonly because the drug, dose, or timing differed from what was on the electronic repeat list). They managed these exceptions by making situated judgments that enabled them (sometimes but not always) to bridge the gap between the idealised assumptions about tasks, roles, and interactions that were built into the electronic patient record and formal protocols, and the actual repeat prescribing routine as it played out in practice. This work was creative and demanded both explicit and tacit knowledge. Clinicians were often unaware of this input and it did not feature in policy

  3. Improved safety at CERN

    CERN Multimedia


    As announced in Weekly Bulletin No. 43/2006, a new approach to the implementation of Safety at CERN has been decided, which required taking some managerial decisions. The guidelines of the new approach are described in the document 'New approach to Safety implementation at CERN', which also summarizes the main managerial decisions I have taken to strengthen compliance with the CERN Safety policy and Rules. To this end I have also reviewed the mandates of the Safety Commission and the Safety Policy Committee (SAPOCO). Some details of the document 'Safety Policy at CERN' (also known as SAPOCO42) have been modified accordingly; its essential principles, unchanged, remain the basis for the safety policy of the Organisation. I would also like to inform you that I have appointed Dr M. Bona as the new Head of the Safety Commission until 31.12.2008, and that I will proceed soon to the appointment of the members of the new Safety Policy Committee. All members of the personnel are deemed to have taken note of the d...

  4. Impact of the introduction of electronic prescribing on staff perceptions of patient safety and organizational culture. (United States)

    Davies, James; Pucher, Philip H; Ibrahim, Heba; Stubbs, Ben


    Electronic prescribing (EP) systems are online technology platforms by which medicines can be prescribed, administered, and stock controlled. The actual impact of EP on patient safety is not truly understood. This study seeks to assess the impact of the implementation of an EP system on safety culture, as well as assessing differences between clinical respondent groups and considering their implications. Staff completed a modified Safety Attitudes Questionnaire survey, 6 weeks following the introduction of EP across surgical services in a hospital in Dorset, England. Responses were assessed and differences between respondent groups compared. Rates of self-reported adverse events were compared before and after implementation. Overall response rate was 34.5%. There was no significant difference between usage patterns and previous experience with EP between user groups. Overall safety was felt to have been reduced by the introduction of EP. Significant differences between clinician and nonclinicians were seen in ability to discuss errors (3.23 ± 0.5 versus 2.8 ± 0.69, P = 0.004), drug chart access, and ease of medication prescribing. Regression analysis did not identify any confounding factors. Despite a significant reduction in the adverse event rate in other divisions of the hospital that did not implement EP at the same time, this same reduction was not seen in the surgical department. This is the first study to assess the impact of EP on safety culture using a validated assessment tool (Safety Attitudes Questionnaire). Overall safety culture deteriorated following introduction of EP. Problems with system usability/intuitiveness, nonstandardized implementation, and competence assessment strategies may have all contributed to this result. Centers seeking to implement EP in future must consider these factors to ensure a positive impact on patient safety and outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Improving Food Safety

    Institute of Scientific and Technical Information of China (English)


    The government takes a tougher stance on processors and producers violating food safety standards Awave of recent contaminated food incidents,exemplified by an E.coli outbreak in Germany and the discovery of industrial plasticizers in

  6. An evaluation of the Essential Medicines List, Standard Treatment Guidelines and prescribing restrictions, as an integrated strategy to enhance quality, efficacy and safety of and improve access to essential medicines in Papua New Guinea. (United States)

    Joshua, Isaac B; Passmore, Phillip R; Sunderland, Bruce V


    The World Health Organization (WHO) has advocated the development and use of country specific Standard Treatment Guidelines (STGs) and Essential Medicines Lists (EML) as strategies to promote the rational use of medicines. When implemented effectively STGs offer many health advantages. Papua New Guinea (PNG) has official STGs and a Medical and Dental Catalogue (MDC) which serves as a national EML for use at different levels of health facilities. This study evaluated consistency between the PNG Adult STGs (2003 and 2012) and those for children (2005 and 2011) with respect to the MDCs (2002, 2012) for six chronic and/or acute diseases: asthma, arthritis, diabetes, hypertension, pneumonia and psychosis. Additionally, the potential impact of prescriber level restrictions on rational medicines use for patient's living in rural areas, where no medical officer is present, was evaluated. Almost all drugs included in the STGs for each disease state evaluated were listed in the MDCs. However, significant discrepancies occurred between the recommended treatments in the STGs with the range of related medicines listed in the MDCs. Many medicines recommended in the STGs for chronic diseases had prescriber level restrictions hindering access for most of the PNG population who live in rural and remote areas. In addition many more medicines were listed in the MDCs which are commonly used to treat arthritis, high blood pressure and psychosis than were recommended in the STGs contributing to inappropriate prescribing. We recommend the public health and rational use of medicines deficiencies associated with these findings are addressed requiring: reviewing prescriber level restrictions; updating the STGs; aligning the MDC to reflect recommendations in the STGs; establishing the process where the MDC would automatically be updated based on any changes made to the STGs; and developing STGs for higher levels of care.

  7. The Hidden Role of Community Pharmacy Technicians in Ensuring Patient Safety with the Use of E-Prescribing (United States)

    Odukoya, Olufunmilola K.; Schleiden, Loren J.; Chui, Michelle A.


    Objectives It has been reported that supportive personnel, such as pharmacy technicians, are key participants in the use of health information technology. The purpose of this study was to describe how pharmacy technicians use e-prescribing and to explore the characteristics of technicians that support pharmacists in ensuring patient safety. Methods This was a qualitative study that used observations, interviews, and focus groups to understand the role of pharmacy technicians in e-prescribing. Fourteen pharmacy technicians and 13 pharmacists from five community pharmacies participated. Observations lasted about nine hours in each pharmacy. Follow-up interviews and two separate focus groups were later conducted. Observation field notes and audio recordings were transcribed and thematically analyzed. Results Pharmacy technicians were primarily responsible for all steps leading up to pharmacist review of the e-prescription and dispensing of medications to the patient. Technician characteristics, including experience, certification status, and knowledge of appropriate medication use, were reported as important factors in supporting a pharmacist’s role in ensuring patient safety with the use of e-prescribing. Conclusion Study findings indicate that pharmacy technicians have an important role in supporting pharmacists to prevent medication errors. Certain characteristics of pharmacy technicians were identified with the potential to improve the e-prescription medication dispensing process and decrease patient harm through the identification and resolution of errors. PMID:27525221

  8. Elevating standards, improving safety. (United States)

    Clarke, Richard


    In our latest 'technical guidance' article, Richard Clarke, sales and marketing director at one of the UK's leading lift and escalator specialists, Schindler, examines some of the key issues surrounding the specification, maintenance, and operation of lifts in hospitals to help ensure the highest standards of safety and reliability.

  9. Quality Improvement Initiative to Decrease Variability of Emergency Physician Opioid Analgesic Prescribing

    Directory of Open Access Journals (Sweden)

    John H. Burton


    Full Text Available Introduction: Addressing pain is a crucial aspect of emergency medicine. Prescription opioids are commonly prescribed for moderate to severe pain in the emergency department (ED; unfortunately, prescribing practices are variable. High variability of opioid prescribing decisions suggests a lack of consensus and an opportunity to improve care. This quality improvement (QI initiative aimed to reduce variability in ED opioid analgesic prescribing. Methods: We evaluated the impact of a three-part QI initiative on ED opioid prescribing by physicians at seven sites. Stage 1: Retrospective baseline period (nine months. Stage 2: Physicians were informed that opioid prescribing information would be prospectively collected and feedback on their prescribing and that of the group would be shared at the end of the stage (three months. Stage 3: After physicians received their individual opioid prescribing data with blinded comparison to the group means (from Stage 2 they were informed that individual prescribing data would be unblinded and shared with the group after three months. The primary outcome was variability of the standard error of the mean and standard deviation of the opioid prescribing rate (defined as number of patients discharged with an opioid divided by total number of discharges for each provider. Secondary observations included mean quantity of pills per opioid prescription, and overall frequency of opioid prescribing. Results: The study group included 47 physicians with 149,884 ED patient encounters. The variability in prescribing decreased through each stage of the initiative as represented by the distributions for the opioid prescribing rate: Stage 1 mean 20%; Stage 2 mean 13% (46% reduction, p<0.01, and Stage 3 mean 8% (60% reduction, p<0.01. The mean quantity of pills prescribed per prescription was 16 pills in Stage 1, 14 pills in Stage 2 (18% reduction, p<0.01, and 13 pills in Stage 3 (18% reduction, p<0.01. The group mean

  10. Learning curves, taking instructions, and patient safety: using a theoretical domains framework in an interview study to investigate prescribing errors among trainee doctors. (United States)

    Duncan, Eilidh M; Francis, Jill J; Johnston, Marie; Davey, Peter; Maxwell, Simon; McKay, Gerard A; McLay, James; Ross, Sarah; Ryan, Cristín; Webb, David J; Bond, Christine


    Prescribing errors are a major source of morbidity and mortality and represent a significant patient safety concern. Evidence suggests that trainee doctors are responsible for most prescribing errors. Understanding the factors that influence prescribing behavior may lead to effective interventions to reduce errors. Existing investigations of prescribing errors have been based on Human Error Theory but not on other relevant behavioral theories. The aim of this study was to apply a broad theory-based approach using the Theoretical Domains Framework (TDF) to investigate prescribing in the hospital context among a sample of trainee doctors. Semistructured interviews, based on 12 theoretical domains, were conducted with 22 trainee doctors to explore views, opinions, and experiences of prescribing and prescribing errors. Content analysis was conducted, followed by applying relevance criteria and a novel stage of critical appraisal, to identify which theoretical domains could be targeted in interventions to improve prescribing. Seven theoretical domains met the criteria of relevance: "social professional role and identity," "environmental context and resources," "social influences," "knowledge," "skills," "memory, attention, and decision making," and "behavioral regulation." From critical appraisal of the interview data, "beliefs about consequences" and "beliefs about capabilities" were also identified as potentially important domains. Interrelationships between domains were evident. Additionally, the data supported theoretical elaboration of the domain behavioral regulation. In this investigation of hospital-based prescribing, participants' attributions about causes of errors were used to identify domains that could be targeted in interventions to improve prescribing. In a departure from previous TDF practice, critical appraisal was used to identify additional domains that should also be targeted, despite participants' perceptions that they were not relevant to

  11. Learning curves, taking instructions, and patient safety: using a theoretical domains framework in an interview study to investigate prescribing errors among trainee doctors

    Directory of Open Access Journals (Sweden)

    Duncan Eilidh M


    Full Text Available Abstract Background Prescribing errors are a major source of morbidity and mortality and represent a significant patient safety concern. Evidence suggests that trainee doctors are responsible for most prescribing errors. Understanding the factors that influence prescribing behavior may lead to effective interventions to reduce errors. Existing investigations of prescribing errors have been based on Human Error Theory but not on other relevant behavioral theories. The aim of this study was to apply a broad theory-based approach using the Theoretical Domains Framework (TDF to investigate prescribing in the hospital context among a sample of trainee doctors. Method Semistructured interviews, based on 12 theoretical domains, were conducted with 22 trainee doctors to explore views, opinions, and experiences of prescribing and prescribing errors. Content analysis was conducted, followed by applying relevance criteria and a novel stage of critical appraisal, to identify which theoretical domains could be targeted in interventions to improve prescribing. Results Seven theoretical domains met the criteria of relevance: “social professional role and identity,” “environmental context and resources,” “social influences,” “knowledge,” “skills,” “memory, attention, and decision making,” and “behavioral regulation.” From critical appraisal of the interview data, “beliefs about consequences” and “beliefs about capabilities” were also identified as potentially important domains. Interrelationships between domains were evident. Additionally, the data supported theoretical elaboration of the domain behavioral regulation. Conclusions In this investigation of hospital-based prescribing, participants’ attributions about causes of errors were used to identify domains that could be targeted in interventions to improve prescribing. In a departure from previous TDF practice, critical appraisal was used to identify additional domains

  12. Clinical Pharmacist Patient-Safety Initiative to Reduce Against-Label Prescribing of Statins With Cyclosporine. (United States)

    Lamprecht, Donald G; Todd, Brittany A; Denham, Anne M; Ruppe, Leslie K; Stadler, Sheila L


    Against-label prescribing of statins with interacting drugs, such as cyclosporine, represents an important patient safety concern. To implement and evaluate the effectiveness of a clinical pharmacist patient-safety initiative to minimize against-label prescribing of statins with cyclosporine. Kaiser Permanente Colorado clinical pharmacists identified patients receiving both cyclosporine and against-label statin through prescription claims data. Academic detailing on this interaction was provided to health care providers. Clinical pharmacists collaborated with physicians to facilitate conversion to on-label statin. Conversion rates along with changes in low-density lipoprotein cholesterol (LDL-C) were assessed. Of the 157 patients identified as taking cyclosporine, 48 were receiving concurrent statin therapy. Of these 48 patients, 33 (69%) were on an against-label statin regimen; 25 (76%) of these patients were converted to on-label statin. Overall, patients converted to on-label statin had a mean LDL-C prior to conversion of 82.9 (±26.4) mg/dL and mean LDL-C after conversion of 90.7 (±31.2) mg/dL ( P = 0.21). In all, 17 patients (68%) were switched to pravastatin 20 mg daily and 8 patients (32%) to rosuvastatin 5 mg daily. In patients converted to pravastatin 20 mg daily, the mean LDL-C was 13.5 mg/dL higher than prior to conversion ( P = 0.066). In patients converted to rosuvastatin 5 mg daily, the mean LDL-C was 3.8 mg/dL lower than prior to conversion ( P = 0.73). Utilizing a patient-safety-centered approach, clinical pharmacists were able to reduce the number of patients on against-label statin with cyclosporine while maintaining a comparable level of LDL-C control.

  13. Does educational intervention improve doctors’ knowledge and perceptions of generic medicines and their generic prescribing rate? A study from Malaysia (United States)

    Wong, Zhi Yen; Alrasheedy, Alian A.; Saleem, Fahad; Mohamad Yahaya, Abdul Haniff; Aljadhey, Hisham


    Objectives: To investigate the impact of an educational intervention on doctors’ knowledge and perceptions towards generic medicines and their generic (international non-proprietary name) prescribing practice. Methods: This is a single-cohort pre-/post-intervention pilot study. The study was conducted in a tertiary care hospital in Perak, Malaysia. All doctors from the internal medicine department were invited to participate in the educational intervention. The intervention consisted of an interactive lecture, an educational booklet and a drug list. Doctors’ knowledge and perceptions were assessed by using a validated questionnaire, while the international non-proprietary name prescribing practice was assessed by screening the prescription before and after the intervention. Results: The intervention was effective in improving doctors’ knowledge towards bioequivalence, similarity of generic medicines and safety standards required for generic medicine registration (p = 0.034, p = 0.034 and p = 0.022, respectively). In terms of perceptions towards generic medicines, no significant changes were noted (p > 0.05). Similarly, no impact on international non-proprietary name prescribing practice was observed after the intervention (p > 0.05). Conclusion: Doctors had inadequate knowledge and misconceptions about generic medicines before the intervention. Moreover, international non-proprietary name prescribing was not a common practice. However, the educational intervention was only effective in improving doctors’ knowledge of generic medicines. PMID:26770747

  14. Does educational intervention improve doctors’ knowledge and perceptions of generic medicines and their generic prescribing rate? A study from Malaysia

    Directory of Open Access Journals (Sweden)

    Mohamed Azmi Hassali


    Full Text Available Objectives: To investigate the impact of an educational intervention on doctors’ knowledge and perceptions towards generic medicines and their generic (international non-proprietary name prescribing practice. Methods: This is a single-cohort pre-/post-intervention pilot study. The study was conducted in a tertiary care hospital in Perak, Malaysia. All doctors from the internal medicine department were invited to participate in the educational intervention. The intervention consisted of an interactive lecture, an educational booklet and a drug list. Doctors’ knowledge and perceptions were assessed by using a validated questionnaire, while the international non-proprietary name prescribing practice was assessed by screening the prescription before and after the intervention. Results: The intervention was effective in improving doctors’ knowledge towards bioequivalence, similarity of generic medicines and safety standards required for generic medicine registration (p = 0.034, p = 0.034 and p = 0.022, respectively. In terms of perceptions towards generic medicines, no significant changes were noted (p > 0.05. Similarly, no impact on international non-proprietary name prescribing practice was observed after the intervention (p > 0.05. Conclusion: Doctors had inadequate knowledge and misconceptions about generic medicines before the intervention. Moreover, international non-proprietary name prescribing was not a common practice. However, the educational intervention was only effective in improving doctors’ knowledge of generic medicines.

  15. Intervention to improve the quality of antimicrobial prescribing for urinary tract infection: a cluster randomized trial. (United States)

    Vellinga, Akke; Galvin, Sandra; Duane, Sinead; Callan, Aoife; Bennett, Kathleen; Cormican, Martin; Domegan, Christine; Murphy, Andrew W


    Overuse of antimicrobial therapy in the community adds to the global spread of antimicrobial resistance, which is jeopardizing the treatment of common infections. We designed a cluster randomized complex intervention to improve antimicrobial prescribing for urinary tract infection in Irish general practice. During a 3-month baseline period, all practices received a workshop to promote consultation coding for urinary tract infections. Practices in intervention arms A and B received a second workshop with information on antimicrobial prescribing guidelines and a practice audit report (baseline data). Practices in intervention arm B received additional evidence on delayed prescribing of antimicrobials for suspected urinary tract infection. A reminder integrated into the patient management software suggested first-line treatment and, for practices in arm B, delayed prescribing. Over the 6-month intervention, practices in arms A and B received monthly audit reports of antimicrobial prescribing. The proportion of antimicrobial prescribing according to guidelines for urinary tract infection increased in arms A and B relative to control (adjusted overall odds ratio [OR] 2.3, 95% confidence interval [CI] 1.7 to 3.2; arm A adjusted OR 2.7, 95% CI 1.8 to 4.1; arm B adjusted OR 2.0, 95% CI 1.3 to 3.0). An unintended increase in antimicrobial prescribing was observed in the intervention arms relative to control (arm A adjusted OR 2.2, 95% CI 1.2 to 4.0; arm B adjusted OR 1.4, 95% CI 0.9 to 2.1). Improvements in guideline-based prescribing were sustained at 5 months after the intervention. A complex intervention, including audit reports and reminders, improved the quality of prescribing for urinary tract infection in Irish general practice., no. NCT01913860. © 2016 Canadian Medical Association or its licensors.

  16. Pharmacists' views on integrated electronic prescribing systems: associations between usefulness, pharmacological safety, and barriers to technology use. (United States)

    Rahimi, Bahlol; Timpka, Toomas


    Integrated electronic prescribing systems (IEPSs) are expected to improve efficiency and safety in the management of pharmaceuticals throughout the healthcare sector. In Sweden (population 9 million), more than 25 million e-prescriptions each year are processed in the National IEPS. We set out to examine the introduction of an IEPS into pharmacists' practice with regard to impact on work efficiency and pharmacological safety. A questionnaire was distributed to all pharmacists (n = 74) in a Swedish municipality (population 145,000), where an IEPS had recently been introduced. The response rate was 70%. The IEPS was in general perceived to have expedited the processing of prescriptions and reduced the risk for prescription errors as well as the handing over of erroneous medications to patients. We found that there was a positive correlation between usefulness of the IEPS system for work efficacy and pharmacological safety, respectively (r =0 .524, p IEPS for work efficacy and perception of barriers to technology use (r = -0.010, p > 0.05). We also found that there was a negative correlation between IEPS usefulness for pharmacological safety and that barriers to IEPS technology use were experienced (r = 0.031, p > 0.05). The results indicate that reduction of system unavailability due to technical issues will increase the perceived usefulness of IEPSs for pharmacists with regard to both work efficacy and pharmacological safety. We conclude that the introduction of an IEPS was well received by pharmacists; however, barriers to full acceptance remained, in particular, system unavailability due to technical problems.

  17. Improving antibiotic prescribing in primary care: a cluster-randomized controlled trial


    Teixeira Rodrigues, António; Roque,Fátima; Soares, Sara; Figueiras, Adolfo; Herdeiro, Maria Teresa


    Aiming to improve antibiotic prescribing and to diminish the misuse of antibiotics, an educational intervention was performed targeting physicians’ attitudes, knowledge and perceptions about antibiotic prescribing and antimicrobial resistances. Methods The educational intervention was developed in the Centre Health Region of Portugal, with a sample size of 1168 primary care physicians. Clusters were randomly selected as control (4 clusters, 35 primary care facilities, n=862) and interv...

  18. Identifying targets for quality improvement in hospital antibiotic prescribing

    NARCIS (Netherlands)

    Spreuwel, P.C. van; Blok, H.; Langelaar, M.F.; Kullberg, B.J.; Mouton, J.W.; Natsch, S.S.


    OBJECTIVES: To audit antibiotic use in a university hospital and to identify targets for quality improvement in a setting with low antibiotic use and resistance rates. METHODOLOGY: A point-prevalence survey (PPS), using a patient-based audit tool for antibiotic use, was executed in the Radboud Unive

  19. Attention-deficit hyperactivity disorder medication use: factors involved in prescribing, safety aspects and outcomes (United States)

    Martinez-Raga, Jose; Ferreros, Amparo; Knecht, Carlos; de Alvaro, Raquel; Carabal, Eloisa


    While treatment of patients with attention-deficit hyperactivity disorder (ADHD) is based on a multimodal approach that combines medication with specific psychological interventions, pharmacotherapy alone is generally considered an essential and cost-effective element. This paper aims to comprehensively and critically review factors involved in prescribing and medication use in individuals diagnosed with ADHD, focusing on the difficulties facing patients with ADHD seeking treatment, as well as the safety and tolerability aspects of ADHD pharmacotherapies, with particular attention on the cardiovascular adverse events and the potential risk of misuse or diversion of ADHD medications. A comprehensive and systematic literature search of PubMed/MEDLINE database was conducted to identify studies published in peer-reviewed journals until 1 August 2016. Children, adolescents and adults often encounter significant difficulties in the process of accessing specialist assessment and treatment for ADHD as a consequence of disparities in service organization and available treatment provision. Despite the well-established efficacy and overall safety profile, ADHD medications are not exempt from adverse events. The cardiovascular safety of pharmacotherapies used for treating individuals with ADHD has raised particular concerns; however there is little evidence of serious cardiovascular adverse events, including no serious corrected QT (QTc) abnormalities associated with stimulants, atomoxetine or α2-adrenergic receptor agonists. Although the abuse of prescription stimulant drugs, particularly, short-acting stimulants is a prevalent and growing problem, nonmedical use of prescription stimulants within the clinical context is very limited. In addition, nonstimulant ADHD medications lack any reinforcing effects and consequently any abuse potential.

  20. Improving Pre-emptive Prescribing to Relieve Patient Discomfort Occurring Out of Hours. (United States)

    Williams, Rhys; Herbert, Fiona; Orme, Amy; Casswell, Georgina


    Junior doctors are commonly asked to prescribe simple medications for symptom relief for patients out of hours. Unfortunately, time constraints and other pressures may lead to delays before the medications are prescribed. A quality improvement project was conducted at a large university teaching hospital to establish the extent of the problem, with the aim of finding measures to improve preemptive prescribing for patients. Baseline data was gathered over three busy wards to calculate the total of new prescriptions made over the course of a weekend. There were 24 new prescriptions required over the weekend, a percentage increase of 14.9% compared to the existing prescriptions on a Friday. Following the first intervention this decreased to 10.2%, and by the second intervention the rate was 4.9%. Data collected several months later confirmed that the interventions remained successful, and preemptive prescribing continued. Overall, our interventions have shown that the number of new prescriptions required out of hours can be reduced by educating junior doctors on preemptive prescribing.

  1. Sustained benefits of a community dietetics intervention designed to improve oral nutritional supplement prescribing practices. (United States)

    Kennelly, S; Kennedy, N P; Corish, C A; Flanagan-Rughoobur, G; Glennon-Slattery, C; Sugrue, S


    Healthcare professionals working in the community do not always prescribe oral nutritional supplements (ONS) according to best practice guidelines for the management of malnutrition. The present study aimed to determine the impact of a community dietetics intervention on ONS prescribing practices and expenditure 1 year later. The intervention involved general practitioners (GPs), practice nurses, nurses in local nursing homes and community nurses. It comprised an education programme together with the provision of a new community dietetics service. Changes in health care professionals' nutrition care practices were determined by examining community dietetics records. ONS prescribing volume and expenditure on ONS were assessed using data from the Primary Care Reimbursement Service of the Irish Health Service Executive. Seven out of 10 principal GPs participated in the nutrition education programme. One year later, screening for malnutrition risk was better, dietary advice was provided more often, referral to the community dietetics service improved and ONS were prescribed for a greater proportion of patients at 'high risk' of malnutrition than before (88% versus 37%; P dietetics intervention improved ONS prescribing practices by GPs and nurses, in accordance with best practice guidelines, without increasing expenditure on ONS during the year after intervention. © 2011 The Authors. Journal of Human Nutrition and Dietetics © 2011 The British Dietetic Association Ltd.

  2. An interprofessional approach to improving paediatric medication safety

    Directory of Open Access Journals (Sweden)

    Kennedy Neil


    Full Text Available Abstract Background Safe drug prescribing and administration are essential elements within undergraduate healthcare curricula, but medication errors, especially in paediatric practice, continue to compromise patient safety. In this area of clinical care, collective responsibility, team working and communication between health professionals have been identified as key elements in safe clinical practice. To date, there is limited research evidence as to how best to deliver teaching and learning of these competencies to practitioners of the future. Methods An interprofessional workshop to facilitate learning of knowledge, core competencies, communication and team working skills in paediatric drug prescribing and administration at undergraduate level was developed and evaluated. The practical, ward-based workshop was delivered to 4th year medical and 3rd year nursing students and evaluated using a pre and post workshop questionnaire with open-ended response questions. Results Following the workshop, students reported an increase in their knowledge and awareness of paediatric medication safety and the causes of medication errors (p Conclusion This study has helped bridge the knowledge-skills gap, demonstrating how an interprofessional approach to drug prescribing and administration has the potential to improve quality and safety within healthcare.

  3. Appropriate prescribing in the elderly: an investigation of two screening tools, Beers criteria considering diagnosis and independent of diagnosis and improved prescribing in the elderly tool to identify inappropriate use of medicines in the elderly in primary care in Ireland.

    LENUS (Irish Health Repository)

    Ryan, C


    Elderly patients are particularly vulnerable to inappropriate prescribing, with increased risk of adverse drug reactions and consequently higher rates of morbidity and mortality. A large proportion of inappropriate prescribing is preventable by adherence to prescribing guidelines, suitable monitoring and regular medication review. As a result, screening tools have been developed to help clinicians improve their prescribing.

  4. The value of clinical judgement analysis for improving the quality of doctors' prescribing decisions

    NARCIS (Netherlands)

    Denig, P; Wahlstrom, R; de Saintonge, MC; Haaijer-Ruskamp, F; Wahlström, R.; de Saintonge, Mark Chaput


    Background Many initiatives are taken to improve prescribing decisions. Educational strategies for doctors have been effective in at least 50% of cases. Some reflection on one's own performance seems to be a common feature of the most effective strategies. So far, such reflections have mainly focuse

  5. Improving appropriateness of antibiotic prescribing for lower respiratory tract infections. The physician's decision

    NARCIS (Netherlands)

    Engel, M.F.


    Stud­ies suggest that increasing appropriate use of antimicrobials leads to a reduced pressure on the development of antimicrobial resistance. In this thesis we evaluated several different strategies with the aim to improve the quality of antibiotic prescribing for community-acquired pneumonia (CAP)

  6. Improving appropriateness of antibiotic prescribing for lower respiratory tract infections. The physician's decision

    NARCIS (Netherlands)

    Engel, M.F.


    Stud­ies suggest that increasing appropriate use of antimicrobials leads to a reduced pressure on the development of antimicrobial resistance. In this thesis we evaluated several different strategies with the aim to improve the quality of antibiotic prescribing for community-acquired pneumonia (CAP)

  7. Augmented reality for improved safety

    CERN Multimedia

    Stefania Pandolfi


    Sometimes, CERN experts have to operate in low visibility conditions or in the presence of possible hazards. Minimising the duration of the operation and reducing the risk of errors is therefore crucial to ensuring the safety of personnel. The EDUSAFE project integrates different technologies to create a wearable personnel safety system based on augmented reality.    The EDUSAFE integrated safety system uses a camera mounted on the helmet to monitor the working area.  In its everyday operation of machines and facilities, CERN adopts a whole set of measures and safety equipment to ensure the safety of its personnel, including personal wearable safety devices and access control systems. However, sometimes, scheduled and emergency maintenance work needs to be done in zones with potential cryogenic hazards, in the presence of radioactive equipment or simply in demanding conditions where visibility is low and moving around is difficult. The EDUSAFE Marie Curie Innovative&...

  8. Prescriber preferences for behavioural economics interventions to improve treatment of acute respiratory infections: a discrete choice experiment (United States)

    Gong, Cynthia L; Hay, Joel W; Meeker, Daniella; Doctor, Jason N


    Objective To elicit prescribers' preferences for behavioural economics interventions designed to reduce inappropriate antibiotic prescribing, and compare these to actual behaviour. Design Discrete choice experiment (DCE). Setting 47 primary care centres in Boston and Los Angeles. Participants 234 primary care providers, with an average 20 years of practice. Main outcomes and measures Results of a behavioural economic intervention trial were compared to prescribers' stated preferences for the same interventions relative to monetary and time rewards for improved prescribing outcomes. In the randomised controlled trial (RCT) component, the 3 computerised prescription order entry-triggered interventions studied included: Suggested Alternatives (SA), an alert that populated non-antibiotic treatment options if an inappropriate antibiotic was prescribed; Accountable Justifications (JA), which prompted the prescriber to enter a justification for an inappropriately prescribed antibiotic that would then be documented in the patient's chart; and Peer Comparison (PC), an email periodically sent to each prescriber comparing his/her antibiotic prescribing rate with those who had the lowest rates of inappropriate antibiotic prescribing. A DCE study component was administered to determine whether prescribers felt SA, JA, PC, pay-for-performance or additional clinic time would most effectively reduce their inappropriate antibiotic prescribing. Willingness-to-pay (WTP) was calculated for each intervention. Results In the RCT, PC and JA were found to be the most effective interventions to reduce inappropriate antibiotic prescribing, whereas SA was not significantly different from controls. In the DCE however, regardless of treatment intervention received during the RCT, prescribers overwhelmingly preferred SA, followed by PC, then JA. WTP estimates indicated that each intervention would be significantly cheaper to implement than pay-for-performance incentives of $200/month

  9. Prescribing patterns and safety monitoring of duloxetine using the Danish Register of Medicinal Product Statistics as a source. (United States)

    Johansen, Anja Nygaard; Stenzhorn, Annette Aalykke; Rosenzweig, Mary; Thirstrup, Steffen; Gazerani, Parisa


    The safety and pattern of use of a medicinal product cannot be fully studied prior to its marketing. In Denmark, the Danish Health and Medicines Authority (DHMA) monitors marketed drugs. An available source is the Register of Medicinal Product Statistics (RMPS), which can possibly be used for these purposes. To investigate utilisation and potential safety issues of relatively new antidepressants containing the active ingredient duloxetine (Cymbalta(®) and Xeristar(®)) by using dispensing data available in the RMPS. A retrospective study using dispensing data was designed to estimate the size and composition of the user population and patterns of use of the antidepressants Cymbalta(®) and Xeristar(®) (active ingredient: duloxetine) in the period from 1 January 2005 to 31 December 2010. Data were retrieved from Epikur, a register subset of the RMPS. Both women and men in different age groups used duloxetine for depression. Some users switched to another antidepressant. Prescription of the drug for persons below the age of 18 years revealed a potential safety issue. Concomitant treatment with Cymbalta(®) or Xeristar(®) and fluvoxamine, isocarboxazid, Yentreve(®), or ciprofloxacin also revealed potential safety issues. The present study indicated that the RMPS is applicable in monitoring the pattern of use and potential safety issues related to duloxetine when it is prescribed for depression. Switching to other antidepressants could reflect some potential safety issues. Use of duloxetine for persons below the age of 18 years and its concomitant use with contraindicated drugs also indicated potential safety issues.

  10. How Medicare Part D, Medicaid, electronic prescribing, and ICD-10 could improve public health (but only if CMS lets them). (United States)

    Herbst, Jennifer L


    A simple change to the Medicare and Medicaid outpatient prescription drug billing systems could improve patient safety and the systems' long-term fiscal stability. Including diagnosis codes on prescription drug claims (codes already in use for other billing purposes) would transform the Medicare Part D and Medicaid prescription drug claims databases into powerful public health research tools--ones that could provide much-needed (and, to date, elusive) information on how prescription drugs work in vulnerable patient populations underrepresented in clinical research. Achieving the full potential of this proposal, though, depends upon the federal agency responsible for Medicare and Medicaid, the Centers for Medicare and Medicaid Services (CMS), maintaining its current reimbursement policy, which is perhaps best characterized as one of benign neglect of the statutory standard for coverage. If, instead of continuing coverage for the vast majority of prescription drugs, CMS decided to deny payment for the millions of prescriptions falling short of the statutory standard (and thus avoid spending billions of federal health care dollars), prescribers would find themselves in an ethical dilemma between truth-telling and effectively treating their patients. Due to the systemic incentives for prescribers and pharmacists to miscode diagnoses in order to get CMS to pay for the prescription drugs needed by patients, the decision to treat patients effectively in the short-term under a strict coverage enforcement policy would undermine the potential to more effectively treat vulnerable patients, reduce prescription errors, and properly allocate federal health care dollars in the future. Even in the midst of a financial crisis, or perhaps especially because of our current financial crisis, we cannot afford to sacrifice improved patient safety and better informed long-term management of federal health care dollars for a short-term reduction in federal spending on prescription drugs.

  11. Capitation combined with pay-for-performance improves antibiotic prescribing practices in rural China. (United States)

    Yip, Winnie; Powell-Jackson, Timothy; Chen, Wen; Hu, Min; Fe, Eduardo; Hu, Mu; Jian, Weiyan; Lu, Ming; Han, Wei; Hsiao, William C


    Pay-for-performance in health care holds promise as a policy lever to improve the quality and efficiency of care. Although the approach has become increasingly popular in developing countries in recent years, most policy designs do not permit the rigorous evaluation of its impact. Thus, evidence of its effect is limited. In collaboration with the government of Ningxia Province, a predominantly rural area in northwest China, we conducted a matched-pair cluster-randomized experiment between 2009 and 2012 to evaluate the effects of capitation with pay-for-performance on primary care providers' antibiotic prescribing practices, health spending, outpatient visit volume, and patient satisfaction. We found that the intervention led to a reduction of approximately 15 percent in antibiotic prescriptions and a small reduction in total spending per visit to village posts-essentially, community health clinics. We found no effect on other outcomes. Our results suggest that capitation with pay-for-performance can improve drug prescribing practices by reducing overprescribing and inappropriate prescribing. Our study also shows that rigorous evaluations of health system interventions are feasible when conducted in close collaboration with the government.

  12. Metabolic drug interactions - the impact of prescribed drug regimens on the medication safety.

    NARCIS (Netherlands)

    Fialova, D.; Vrbensky, K.; Topinkova, E.; Vlcek, J.; Soerbye, L.W.; Wagner, C.; Bernabei, R.


    Background and objective: Risk/benefit profile of prescribed drug regimens is unkown. Over 60% of commonly used medications interact on metabolic pathways (cytochrom P450 (CYP450), uridyl-glucuronyl tranferasis (UGT I, II) and P-glycoprotein (PGP) transport). Using an up-to-date knowledge on metabo

  13. Can we Improve Patient Safety?

    Directory of Open Access Journals (Sweden)

    Martin Thomas Corbally


    Full Text Available Despite greater awareness of patient safety issues especially in the operating room and the widespread implementation of surgical time out (WHO,errors, especially wrong site surgery, continue. Most such errors are due to lapses in communication where decision makers fail to consult or confirm operative findings but worryingly where parental concerns over the planned procedure are ignored or not followed through. The WHO surgical pause / Time Out aims to capture these errors and prevent them but the combination of human error and complex hospital environments can overwhelm even robust safety structures and simple common sense. Parents are the ultimate repository of information on their child's condition and planned surgery but are traditionally excluded from the process of Surgical pause and Time Out perhaps to avoid additional stress. In addition surgeons, like pilots, are subject to the phenomenon of plan continue fail with potentially disastrous outcomes.

  14. Inappropriate prescribing in the elderly: a comparison of the Beers criteria and the improved prescribing in the elderly tool (IPET) in acutely ill elderly hospitalized patients.

    LENUS (Irish Health Repository)

    Barry, P J


    BACKGROUND: In appropriate prescribing is a significant and persistent problem in elderly people, both in hospital and the community and has been described in several countries in Europe and also the USA. The problem of inappropriate prescribing has not been quantified in the Republic of Ireland. The most commonly used criteria for the identification of inappropriate prescribing are the Beers\\' criteria [both independent of diagnosis (ID) and considering diagnosis (CD) - 2003 version]. The Beers\\' criteria ID includes 48 different categories of either single medications or multiple medications of a similar class identified as inappropriate prescriptions and the Beers\\' criteria CD contains 19 different categories containing possible drug-disease interactions. A second tool, the improved prescribing in the elderly tool (IPET) has also been validated and used in hospital and community studies and has 14 categories of either explicitly contraindicated medications or possible drug-disease interactions. OBJECTIVES: The primary aim of the study is to measure the incidence of inappropriate prescribing among older community-dwelling individuals presenting to an acute hospital in the Republic of Ireland. A secondary aim of this study was also therefore to compare the efficacy of the above two tools in identifying inappropriate prescribing. METHODS: A prospective, consecutive observational cohort study was carried out over a 4-month period. The setting was an urban-based university hospital acute geriatric medicine assessment unit. Subjects in this study (n = 350) were consecutively screened on admission to hospital (mean age = 80.3 +\\/- 6.1 years) and all patients had both Beers\\' criteria ID and CD and IPET applied to their list of prescription drugs on admission, cross-referenced with their list of current active medical diagnosis. RESULTS: The results of the study identified a high rate of inappropriate prescribing among this population of community

  15. Strategy Improvement for Concurrent Safety Games

    CERN Document Server

    Chatterjee, Krishnendu; Henzinger, Thomas A


    We consider concurrent games played on graphs. At every round of the game, each player simultaneously and independently selects a move; the moves jointly determine the transition to a successor state. Two basic objectives are the safety objective: ``stay forever in a set F of states'', and its dual, the reachability objective, ``reach a set R of states''. We present in this paper a strategy improvement algorithm for computing the value of a concurrent safety game, that is, the maximal probability with which player 1 can enforce the safety objective. The algorithm yields a sequence of player-1 strategies which ensure probabilities of winning that converge monotonically to the value of the safety game. The significance of the result is twofold. First, while strategy improvement algorithms were known for Markov decision processes and turn-based games, as well as for concurrent reachability games, this is the first strategy improvement algorithm for concurrent safety games. Second, and most importantly, the impro...

  16. Health IT for Patient Safety and Improving the Safety of Health IT. (United States)

    Magrabi, Farah; Ong, Mei-Sing; Coiera, Enrico


    Alongside their benefits health IT applications can pose new risks to patient safety. Problems with IT have been linked to many different types of clinical errors including prescribing and administration of medications; as well as wrong-patient, wrong-site errors, and delays in procedures. There is also growing concern about the risks of data breach and cyber-security. IT-related clinical errors have their origins in processes undertaken to design, build, implement and use software systems in a broader sociotechnical context. Safety can be improved with greater standardization of clinical software and by improving the quality of processes at different points in the technology life cycle, spanning design, build, implementation and use in clinical settings. Oversight processes can be set up at a regional or national level to ensure that clinical software systems meet specific standards. Certification and regulation are two mechanisms to improve oversight. In the absence of clear standards, guidelines are useful to promote safe design and implementation practices. Processes to identify and mitigate hazards can be formalised via a safety management system. Minimizing new patient safety risks is critical to realizing the benefits of IT.

  17. Prescribing Data in General Practice Demonstration (PDGPD project - a cluster randomised controlled trial of a quality improvement intervention to achieve better prescribing for chronic heart failure and hypertension

    Directory of Open Access Journals (Sweden)

    Williamson Margaret


    Full Text Available Abstract Background Research literature consistently documents that scientifically based therapeutic recommendations are not always followed in the hospital or in the primary care setting. Currently, there is evidence that some general practitioners in Australia are not prescribing appropriately for patients diagnosed with 1 hypertension (HT and 2 chronic heart failure (CHF. The objectives of this study were to improve general practitioner’s drug treatment management of these patients through feedback on their own prescribing and small group discussions with peers and a trained group facilitator. The impact evaluation includes quantitative assessment of prescribing changes at 6, 9, 12 and 18 months after the intervention. Methods A pragmatic multi site cluster RCT began recruiting practices in October 2009 to evaluate the effects of a multi-faceted quality improvement (QI intervention on prescribing practice among Australian general practitioners (GP in relation to patients with CHF and HT. General practices were recruited nationally through General Practice Networks across Australia. Participating practices were randomly allocated to one of three groups: two groups received the QI intervention (the prescribing indicator feedback reports and small group discussion with each group undertaking the clinical topics (CHF and HT in reverse order to the other. The third group was waitlisted to receive the intervention 6 months later and acted as a “control” for the other two groups. De-identified data on practice, doctor and patient characteristics and their treatment for CHF and HT are extracted at six-monthly intervals before and after the intervention. Post-test comparisons will be conducted between the intervention and control arms using intention to treat analysis and models that account for clustering of practices in a Network and clustering of patients within practices and GPs. Discussion This paper describes the study protocol for a

  18. The benefits of improved car secondary safety. (United States)

    Broughton, Jeremy


    The term 'secondary safety' refers to the protection that a vehicle provides its occupants when involved in an accident. This paper studies information from the British database of road accident reports between 1980 and 1998, to estimate the reduction in the number of occupant casualties over these years which may be attributed to improvements to secondary safety in cars. The paper shows that the proportion of driver casualties who are killed or seriously injured (KSI) is lower for modern cars than for older cars. The reduction of this proportion is used to assess the improvement in secondary safety. Statistical models are developed to represent the proportion with 'year of first registration' as one of the independent variables, although only an incomplete assessment of the benefits of improved secondary safety can be made with the available data. The assessment compares the number of casualties that would have been expected if secondary safety had remained at the level found in cars first registered in 1980 with the actual casualty numbers. It is estimated that improved secondary safety reduced the number of drivers KSI by at least 19.7% in 1998, in comparison with what might have occurred if all cars had had that lower level of secondary safety. This figure relates to all cars on the road in 1998, and rises to 33%, when confined to the most modern cars (those which were first registered in 1998).

  19. Trends in depression and antidepressant prescribing in children and adolescents: a cohort study in The Health Improvement Network (THIN.

    Directory of Open Access Journals (Sweden)

    Linda P M M Wijlaars

    Full Text Available BACKGROUND: In 2003, the Committee on Safety of Medicines (CSM advised against treatment with selective serotonin reuptake inhibitors (SSRIs other than fluoxetine in children, due to a possible increased risk of suicidal behaviour. This study examined the effects of this safety warning on general practitioners' depression diagnosing and prescription behaviour in children. METHODS AND FINDINGS: We identified a cohort of 1,502,753 children (6 m in The Health Improvement Network (THIN UK primary care database. Trends in incidence of depression diagnoses, symptoms and antidepressant prescribing were examined 1995-2009, accounting for deprivation, age and gender. We used segmented regression analysis to assess changes in prescription rates. Overall, 45,723 (3% children had ≥ 1 depression-related entry in their clinical records. SSRIs were prescribed to 16,925 (1% of children. SSRI prescription rates decreased from 3.2 (95%CI:3.0,3.3 per 1,000 person-years at risk (PYAR in 2002 to 1.7 (95%CI:1.7,1.8 per 1,000 PYAR in 2005, but have since risen to 2.7 (95%CI:2.6,2.8 per 1,000 PYAR in 2009. Prescription rates for CSM-contraindicated SSRIs citalopram, sertraline and especially paroxetine dropped dramatically after 2002, while rates for fluoxetine and amitriptyline remained stable. After 2005 rates for all antidepressants, except paroxetine and imipramine, started to rise again. Rates for depression diagnoses dropped from 3.0 (95%CI:2.8,3.1 per 1,000 PYAR in 2002 to 2.0 (95%CI:1.9,2.1 per 1,000 PYAR in 2005 and have been stable since. Recording of symptoms saw a steady increase from 1.0 (95%CI:0.8,1.2 per 1,000 PYAR in 1995 to 4.7 (95%CI:4.5,4.8 per 1,000 PYAR in 2009. CONCLUSIONS: The rates of depression diagnoses and SSRI prescriptions showed a significant drop around the time of the CSM advice, which was not present in the recording of symptoms. This could indicate caution on the part of GPs in making depression diagnoses and prescribing

  20. Inappropriate prescribing: criteria, detection and prevention.

    LENUS (Irish Health Repository)

    O'Connor, Marie N


    Inappropriate prescribing is highly prevalent in older people and is a major healthcare concern because of its association with negative healthcare outcomes including adverse drug events, related morbidity and hospitalization. With changing population demographics resulting in increasing proportions of older people worldwide, improving the quality and safety of prescribing in older people poses a global challenge. To date a number of different strategies have been used to identify potentially inappropriate prescribing in older people. Over the last two decades, a number of criteria have been published to assist prescribers in detecting inappropriate prescribing, the majority of which have been explicit sets of criteria, though some are implicit. The majority of these prescribing indicators pertain to overprescribing and misprescribing, with only a minority focussing on the underprescribing of indicated medicines. Additional interventions to optimize prescribing in older people include comprehensive geriatric assessment, clinical pharmacist review, and education of prescribers as well as computerized prescribing with clinical decision support systems. In this review, we describe the inappropriate prescribing detection tools or criteria most frequently cited in the literature and examine their role in preventing inappropriate prescribing and other related healthcare outcomes. We also discuss other measures commonly used in the detection and prevention of inappropriate prescribing in older people and the evidence supporting their use and their application in everyday clinical practice.

  1. Documentation-based clinical decision support to improve antibiotic prescribing for acute respiratory infections in primary care: a cluster randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Jeffrey Linder


    Conclusions The ARI Smart Form neither reduced overall antibiotic prescribing nor significantly improved the appropriateness of antibiotic prescribing for ARIs, but it was not widely used. When used, the ARI Smart Form may improve diagnostic accuracy compared to administrative diagnoses and may reduce antibiotic prescribing for certain diagnoses.

  2. [Effectiveness of interventions for improving drug prescribing in Primary Health Care]. (United States)

    Zavala-González, Marco Antonio; Cabrera-Pivaral, Carlos Enrique; Orozco-Valerio, María de Jesús; Ramos-Herrera, Igor Martín


    To determine the effectiveness of interventions for improving drug prescribing in Primary Health Care units. Systematic review and meta-analysis. Searches were made in MedLine(©), ScienceDirect(©), Springer(©), SciELO(©), Dialnet(©), RedALyC(©) and Imbiomed(©), in Spanish, English and Portuguese, using keywords "drug prescribing", "intervention studies" and "primary health care", indexed in each data base up to August 2014. Experimental and quasi-experimental studies were included that had a CASP-score>5 and that evaluated effect of any type intervention on the quality of drug prescription in Primary Health Care. A total of 522 articles were found, and an analysis was performed on 12 that reported 17 interventions: 64.7% educational, 23.5% incorporating pharmacists into the health team, and 11.8% on the use of computer applications. The strong "intervention/improvement" associations were educational interventions OR=2.47 (95% CI; 2.28 - 2.69), incorporation of pharmacists OR=3.28 (95% CI; 2.58 4.18), and use of computer applications OR=10.16 (95% CI; 8.81 -11.71). The use of interventions with computer applications showed to be more effective than educational interventions and incorporation pharmacists into the health team. Future studies are required that include economic variables such as, implementation costs, drug costs and other expenses associated with health care and treatment of diseases. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  3. Review of ongoing initiatives to improve prescribing efficiency in China; angiotensin receptor blockers as a case history. (United States)

    Zeng, Wenjie; Gustafsson, Lars L; Bennie, Marion; Finlayson, Alexander E; Godman, Brian


    Pharmaceutical expenditure is rising by 16% per annum in China and is now 46% of total expenditure. Initiatives to moderate growth include drug pricing regulations and encouraging international non-proprietary name prescribing. However, there is no monitoring of physician prescribing quality and perverse incentives. Assess changes in angiotensin receptor blocker (ARB) utilization and expenditure as more generics become available; compare findings to Europe. Observational retrospective study of ARB utilization and expenditure between 2006 and 2012 in the largest hospital in Chongqing district. Variable and low use of generics versus originators with a maximum of 31% among single ARBs. Similar for fixed dose combinations. Prices typically reduced over time, greatest for generic telmisartan (-54%), mirroring price reductions in some European countries. However, no preferential increase in prescribing of lower cost generics. Accumulated savings of 33 million CNY for this large provider if they adopted European practices. Considerable opportunities to improve prescribing efficiency in China.

  4. Using primary care prescribing data to improve GP awareness of antidepressant adherence issues

    Directory of Open Access Journals (Sweden)

    Thusitha Mabotuwana


    Conclusions Prescribing data identifies substantial adherence issues in antidepressant therapy. Clinicians should consider adherence issues as part of the overall treatment regime and discuss such issues during consultations.

  5. Sustained benefits of a community dietetics intervention designed to improve oral nutritional supplement prescribing practices.

    LENUS (Irish Health Repository)

    Kennelly, S


    Healthcare professionals working in the community do not always prescribe oral nutritional supplements (ONS) according to best practice guidelines for the management of malnutrition. The present study aimed to determine the impact of a community dietetics intervention on ONS prescribing practices and expenditure 1 year later.

  6. An observational postmarketing safety registry of patients in the UK, Germany, and Switzerland, who have been prescribed Sativex® (THC:CBD, nabiximols oromucosal spray

    Directory of Open Access Journals (Sweden)

    Etges T


    Full Text Available Tilden Etges, Kari Karolia, Thomas Grint, Adam Taylor, Heather Lauder, Brian Daka, Stephen Wright GW Pharmaceuticals, Cambridge, UK Abstract: The global exposure of Sativex® (Δ9-tetrahydrocannabinol [THC]:cannabidiol [CBD], nabiximols is estimated to be above 45,000 patient-years since it was given marketing approval for treating treatment-resistant spasticity in multiple sclerosis (MS. An observational registry to collect safety data from patients receiving THC:CBD was set up following its approval in the UK, Germany, and Switzerland, with the aim of determining its long-term safety in clinical practice. Twice a year, the Registry was opened to prescribing physicians to voluntarily report data on patients’ use of THC:CBD, clinically significant adverse events (AEs, and special interest events. The Registry contains data from 941 patients with 2,213.98 patient-years of exposure. Within this cohort, 60% were reported as continuing treatment, while 83% were reported as benefiting from the treatment. Thirty-two percent of patients stopped treatment, with approximately one third citing lack of effectiveness and one quarter citing AEs. Psychiatric AEs of clinical significance were reported in 6% of the patients, 6% reported falls requiring medical attention, and suicidality was reported in 2%. Driving ability was reported to have worsened in 2% of patients, but improved in 7%. AEs were more common during the first month of treatment. The most common treatment-related AEs included dizziness (2.3% and fatigue (1.7%. There were no signals to indicate abuse, diversion, or dependence. The long-term risk profile from the Registry is consistent with the known (labeled safety profile of THC:CBD, and therefore supports it being a well-tolerated and beneficial medication for the treatment of MS spasticity. No evidence of new long-term safety concerns has emerged. Keywords: cannabidiol, tetrahydrocannabinol, non-interventional, multiple sclerosis

  7. Creating effective leadership for improving patient safety. (United States)

    Mohr, Julie J; Abelson, Herbert T; Barach, Paul


    Leadership has emerged as a key theme in the rapidly growing movement to improve patient safety. Leading an organization that is committed to providing safer care requires overcoming the common traps in thinking about error, such as blaming individuals, ignoring the underlying systems factors, and blaming the bureaucracy of the organization. Leaders must address the system issues that are at work within their organizations to allow individual and organizational learning to occur.

  8. Improved obstetric safety through programmatic collaboration. (United States)

    Goffman, Dena; Brodman, Michael; Friedman, Arnold J; Minkoff, Howard; Merkatz, Irwin R


    Healthcare safety and quality are critically important issues in obstetrics, and society, healthcare providers, patients and insurers share a common goal of working toward safer practice, and are continuously seeking strategies to facilitate improvements. To this end, 4 New York City voluntary hospitals with large maternity services initiated a unique collaborative quality improvement program. It was facilitated by their common risk management advisors, FOJP Service Corporation, and their professional liability insurer, Hospitals Insurance Company. Under the guidance of 4 obstetrics and gynecology departmental chairmen, consensus best practices for obstetrics were developed which included: implementation of evidence based protocols with audit and feedback; standardized educational interventions; mandatory electronic fetal monitoring training; and enhanced in-house physician coverage. Each institution developed unique safety related expertise (development of electronic documentation, team training, and simulation education), and experiences were shared across the collaborative. The collaborative group developed robust systems for audit of outcomes and documentation quality, as well as enforcement mechanisms. Ongoing feedback to providers served as a key component of the intervention. The liability carrier provided financial support for these patient safety innovations. As a result of the interventions, the overall AOI for our institutions decreased 42% from baseline (January-June 2008) to the most recently reviewed time period (July-December 2011) (10.7% vs 6.2%, p < 0.001). The Weighted Adverse Outcome Score (WAOS) also decreased during the same time period (3.9 vs 2.3, p = 0.001.) Given the improved outcomes noted, our unique program and the process by which it was developed are described in the hopes that others will recognize collaborative partnering with or without insurers as an opportunity to improve obstetric patient safety.

  9. Speech Recognition Interfaces Improve Flight Safety (United States)


    "Alpha, Golf, November, Echo, Zulu." "Sierra, Alpha, Golf, Echo, Sierra." "Lima, Hotel, Yankee." It looks like some strange word game, but the combinations of words above actually communicate the first three points of a flight plan from Albany, New York to Florence, South Carolina. Spoken by air traffic controllers and pilots, the aviation industry s standard International Civil Aviation Organization phonetic alphabet uses words to represent letters. The first letter of each word in the series is combined to spell waypoints, or reference points, used in flight navigation. The first waypoint above is AGNEZ (alpha for A, golf for G, etc.). The second is SAGES, and the third is LHY. For pilots of general aviation aircraft, the traditional method of entering the letters of each waypoint into a GPS device is a time-consuming process. For each of the 16 waypoints required for the complete flight plan from Albany to Florence, the pilot uses a knob to scroll through each letter of the alphabet. It takes approximately 5 minutes of the pilot s focused attention to complete this particular plan. Entering such a long flight plan into a GPS can pose a safety hazard because it can take the pilot s attention from other critical tasks like scanning gauges or avoiding other aircraft. For more than five decades, NASA has supported research and development in aviation safety, including through its Vehicle Systems Safety Technology (VSST) program, which works to advance safer and more capable flight decks (cockpits) in aircraft. Randy Bailey, a lead aerospace engineer in the VSST program at Langley Research Center, says the technology in cockpits is directly related to flight safety. For example, "GPS navigation systems are wonderful as far as improving a pilot s ability to navigate, but if you can find ways to reduce the draw of the pilot s attention into the cockpit while using the GPS, it could potentially improve safety," he says.

  10. Nurse prescribing: a vehicle for improved collaboration, or a stumbling block to inter-professional working? (United States)

    Fisher, Richard


    Prescribing by community nurses is established practice in the UK National Health Service. Although much has been written about the technical aspects of prescribing, little published work addresses the ways in which prescribing might affect relationships. Part of a PhD project set in southern England, this ethnographic project used semistructured interviews with a purposive sample of district nurses (n = 17), staff nurses (n = 4), pharmacists (n = 2) and a general practitioner to investigate the real world of nurse prescribing. Using theories of domination, power and legitimacy from Weber and Foucault, this paper sets out to demonstrate that despite government efforts to encourage collaborative working, power relationships still play an important part in some areas of practice. Analysis, building from Morrell's notion of naïve functionalism, reveals strategies used by actors in community practice to manage such relationships.

  11. Reducing Inappropriate Antibiotic Prescribing for Adults With Acute Bronchitis in an Urgent Care Setting: A Quality Improvement Initiative. (United States)

    Link, Tamara L; Townsend, Mary L; Leung, Eugene; Kommu, Sekhar; Vega, Rhonda Y; Hendrix, Cristina C

    Acute bronchitis is a predominantly viral illness and, according to clinical practice guidelines, should not be treated with antibiotics. Despite clear guidelines, acute bronchitis continues to be the most common acute respiratory illness for which antibiotics are incorrectly prescribed. Although the national benchmark for antibiotic prescribing for adults with acute bronchitis is 0%, a preliminary record review before implementing the intervention at the project setting showed that 96% (N = 30) of adults with acute bronchitis in this setting were prescribed an antibiotic. This quality improvement project utilized a single-group, pre-post design. The setting for this project was a large urgent care network with numerous locations in central North Carolina. The purpose was to determine whether nurse practitioners and physician assistants, after participating in a multifaceted provider education session, would reduce inappropriate antibiotic prescribing for healthy adults with acute uncomplicated bronchitis. Twenty providers attended 1 of 4 training sessions offered in October and November 2015. The face-to-face interactive training sessions focused on factors associated with inappropriate antibiotic prescribing, current clinical practice guidelines, and patient communication skills. Retrospective medical record review of 217 pretraining and 335 posttraining encounters for acute bronchitis by 19 eligible participating providers demonstrated a 61.9% reduction in immediate antibiotic prescribing from 91.7% to 29.8%. Delayed prescribing, which accounted for a small percentage of the total prescriptions given, had a small but significant increase of 9.3% after training. Overall, this multifaceted, interactive provider training resulted in significant reductions in inappropriate prescriptions.

  12. Improving antimicrobial prescribing: implementation of an antimicrobial i.v.-to-oral switch policy. (United States)

    McCallum, A D; Sutherland, R K; Mackintosh, C L


    Antimicrobial stewardship programmes reduce the risk of hospital associated infections (HAI) and antimicrobial resistance, and include early intravenous-to-oral switch (IVOS) as a key stewardship measure. We audited the number of patients on intravenous antimicrobials suitable for oral switch, assessed whether prescribing guidelines were followed and reviewed prescribing documentation in three clinical areas in the Western General Hospital, Edinburgh, in late 2012. Following this, the first cycle results and local guidelines were presented at a local level and at the hospital grand rounds, posters with recommendations were distributed, joint infection consult and antimicrobial rounds commenced and an alert antimicrobial policy was introduced before re-auditing in early 2013. We demonstrate suboptimal prescribing of intravenous antimicrobials, with 43.9% (43/98) of patients eligible for IVOS at the time of auditing. Only 56.1% (55/98) followed empiric prescribing recommendations. Documentation of antimicrobial prescribing was poor with stop dates recorded in 14.3%, indication on prescription charts in 18.4% and in the notes in 90.8%. The commonest reason for deferring IVOS was deteriorating clinical condition or severe sepsis. Further work to encourage prudent antimicrobial prescribing and earlier consideration of IVOS is required.

  13. BRICS: opportunities to improve road safety. (United States)

    Hyder, Adnan A; Vecino-Ortiz, Andres I


    Brazil, the Russian Federation, India, China and South Africa--the countries known as BRICS--are currently undergoing a deep epidemiological transition that is mainly driven by rapid economic growth and technological change. The changes being observed in the distribution of the burden of diseases and injuries--such as recent increases in the incidence of road traffic injuries--are matters of concern. BRICS may need stronger institutional capacity to address such changes in a timely way. In this paper, we present data on road traffic injuries in BRICS and illustrate the enormous challenge that these countries currently face in reducing the incidence of such injuries. There is an urgent need to improve road safety indicators in every country constituting BRICS. It is imperative for BRICS to invest in system-wide road safety interventions and reduce the mortality and morbidity from road traffic injuries.

  14. [Improving patient safety through voluntary peer review]. (United States)

    Kluge, S; Bause, H


    The intensive care unit (ICU) is one area of the hospital in which processes and communication are of primary importance. Errors in intensive care units can lead to serious adverse events with significant consequences for patients. Therefore quality and risk-management are important measures when treating critically ill patients. A pragmatic approach to support quality and safety in intensive care is peer review. This approach has gained significant acceptance over the past years. It consists of mutual visits by colleagues who conduct standardised peer reviews. These reviews focus on the systematic evaluation of the quality of an ICU's structure, its processes and outcome. Together with different associations, the State Chambers of Physicians and the German Medical Association have developed peer review as a standardized tool for quality improvement. The common goal of all stakeholders is the continuous and sustainable improvement in intensive care with peer reviews significantly increasing and improving communication between professions and disciplines. Peer reviews secure the sustainability of planned change processes and consequently lead the way to an improved culture of quality and safety.

  15. Improving Nutritional Support of Burn Service Patients by Increasing the Number of Days When 100% of Prescribed Formula Is Given. (United States)

    Conrad, Peggie F; Liberio, Julie; Aleem, Razia; Halerz, Marcia M; Mosier, Michael J; Sanford, Arthur P; Gamelli, Richard L


    The authors sought to increase the number of days when burn service patients receive 100% of prescribed enteral nutrition. The authors first performed a retrospective review of 37 patients (group 1) receiving enteral nutrition. The authors then created and implemented a nurse-directed feeding algorithm, placing patients into three age groups addressing maximum hourly infusion rates, high residual limits, initiating feeding, refeeding residuals, and replacing formula. The authors then performed a prospective review of 37 patients (group 2) fed utilizing the new algorithm. The amount of prescribed, infused, discarded, and missed feeds were recorded, as well as admitting diagnosis, age, gender, length of stay, ventilator days, infections, and mortality. All patients in group 1 (n = 37) received 100% of feeds 59.9% of prescribed days vs 76.5% in group 2 (n = 37; P = .003). Burn patients in group 1 (n = 26) received 100% of feeds 61.6% of prescribed days vs 85.4% in group 2 (n = 21; P < .001). Mean hours feeds were held for surgery, procedures, clogged or dislodged tubes for both groups was similar. While there was a significant difference in burn size between groups (6.24 vs 18.39%, P = .01), there were no statistically significant differences in length of stay, ventilator days, or mortality. Implementation of a nurse-directed feeding algorithm improved delivery of enteral nutrition for all burn service patients, increasing the number of days when 100% of prescribed enteral nutrition is given.

  16. Quality circles to improve prescribing of primary care physicians. Three comparative studies.

    NARCIS (Netherlands)

    Wensing, M.J.P.; Broge, B.; Riens, B.; Kaufmann-Kolle, P.; Akkermans, R.P.; Grol, R.P.T.M.; Szecsenyi, J.


    PURPOSE: To determine the effectiveness of quality circles on prescribing patterns of primary care physicians in Germany and to explore the influence of specific factors on changes. METHODS: Three large non-randomised comparative studies were performed in primary care in Germany, with baseline measu

  17. Evaluation and Improvement of Food Safety Satisfaction Based on QFD

    Directory of Open Access Journals (Sweden)

    Pu Jin


    Full Text Available In view of the social phenomenon of people's generally low satisfaction with food safety, we introduced the QFD method to make evaluation and guidance for improvement. Based on scientific and reasonable evaluation index system of food safety satisfaction and the “quality house” of QFD core tool, a food safety satisfaction evaluation model was constructed. On the basis of the evaluation results, we analyzed the public food safety requirements and constructed the quality house between the public food safety requirements and the food safety satisfaction improvement measures, so as to determine the priority of configuration sequence of improvement measures.

  18. Rational Prescribing in Primary care (RaPP: process evaluation of an intervention to improve prescribing of antihypertensive and cholesterol-lowering drugs

    Directory of Open Access Journals (Sweden)

    Oxman Andrew D


    Full Text Available Abstract Background A randomised trial of a multifaceted intervention for improving adherence to clinical practice guidelines for the pharmacological management of hypertension and hypercholesterolemia increased prescribing of thiazides, butdetected no impact onthe use of cardiovascular risk assessment toolsor achievement of treatment targets. We carried out a predominantly quantitative process evaluation to help explain and interpret the trial-findings. Methods Several data-sources were used including: questionnaires completed by pharmacists immediately after educational outreach visits, semi-structured interviews with physicians subjected to the intervention, and data extracted from their electronic medical records. Multivariate regression analyses were conducted to explore the association between possible explanatory variables and the observed variation across practices for the three main outcomes. Results The attendance rate during the educational sessions in each practice was high; few problems were reported, and the physicians were perceived as being largely supportive of the recommendations we promoted, except for some scepticism regarding the use of thiazides as first-line antihypertensive medication. Multivariate regression models could explain only a small part of the observed variation across practices and across trial-outcomes, and key factors that might explain the observed variation in adherence to the recommendations across practices were not identified. Conclusion This study did not provide compelling explanations for the trial results. Possible reasons for this include a lack of statistical power and failure to include potential explanatory variables in our analyses, particularly organisational factors. More use of qualitative research methods in the course of the trial could have improved our understanding.

  19. District nurses prescribing as nurse independent prescribers. (United States)

    Downer, Frances; Shepherd, Chew Kim


    Nurse prescribing has been established in the UK since 1994, however, limited focus has been placed on the experiences of district nurses adopting this additional role. This phenomenological study explores the experiences of district nurses prescribing as nurse independent prescribers across the West of Scotland. A qualitative Heideggarian approach examined the every-day experiences of independent prescribing among district nurses. A purposive sample was used and data collected using audio taped one-to-one informal interviews. The data was analysed thematically using Colaizzi's seven procedural steps. Overall these nurses reported that nurse prescribing was a predominantly positive experience. Participants identified improvements in patient care, job satisfaction, level of autonomy and role development. However, some of the participants indicated that issues such as support, record keeping, confidence and ongoing education are all major influences on prescribing practices.

  20. Health innovation for patient safety improvement

    Directory of Open Access Journals (Sweden)

    Renukha Sellappans


    Full Text Available Medication error has been identified as a major factor affecting patient safety. Many innovative efforts such as Computerised Physician Order Entry (CPOE, a Pharmacy Information System, automated dispensing machines and Point of Administration Systems have been carried out with the aim of improving medication safety. However, areas remain that require urgent attention. One main area will be the lack of continuity of care due to the breakdown of communication between multiple healthcare providers. Solutions may include consideration of “health smart cards” that carry vital patient medical information in the form of a “credit card” or use of the Malaysian identification card. However, costs and technical aspects associated with the implementation of this health smart card will be a significant barrier. Security and confidentiality, on the other hand, are expected to be of primary concern to patients. Challenges associated with the implementation of a health smart card might include physician buy-in for use in his or her everyday practice. Training and technical support should also be available to ensure the smooth implementation of this system. Despite these challenges, implementation of a health smart card moves us closer to seamless care in our country, thereby increasing the productivity and quality of healthcare.

  1. 77 FR 18298 - Improvements to the Compliance, Safety, Accountability (CSA) Motor Carrier Safety Measurement... (United States)


    ...) regulations; 4. Aligning violations that are included in SMS with the Commercial Vehicle Safety Alliance (CVSA... configuration better identified carriers with a high risk of future HM safety violations. The analysis found... Federal Motor Carrier Safety Administration Improvements to the Compliance, Safety, Accountability (CSA...

  2. Improving patient safety culture in general practice: An interview study

    NARCIS (Netherlands)

    N.J. Verbakel (Natasha J.); A.A. de Bont (Antoinette); T.J. Verheij; C. Wagner (Cordula); D.L.M. Zwart (Dorien Lyd Marieke)


    textabstractBackground When improving patient safety a positive safety culture is key. As little is known about improving patient safety culture in primary care, this study examined whether administering a culture questionnaire with or without a complementary workshop could be used as an interventio

  3. Cultivating change door to door: Educational outreach to improve prescribing practices in rural veterans with posttraumatic stress disorder. (United States)

    Montaño, Macgregor; Bernardy, Nancy C; Sherrieb, Kathleen


    Clinical guidelines for the management of posttraumatic stress disorder (PTSD) recommend against the use of benzodiazepines. Benzodiazepines and PTSD are both associated with addiction-related risks. The Department of Veterans Affairs (VA) prescribing trends show continued use of benzodiazepines and polysedative use in veterans with PTSD, particularly in rural areas. The authors examine the use of an educational intervention to improve pharmacologic management of veterans with PTSD in rural clinics. The VA Academic Detailing Service Informatics Toolset provides prescribing, demographic and risk factor data for veterans with PTSD treated at the White River Junction VA Medical Center (WRJ VA) and affiliated rural clinics in Vermont and New Hampshire. Individualized academic detailing visits were provided to clinicians identified by the informatics tool with the aim of increasing guideline-concordant care. Other educational efforts included traditional, didactic group education on evidence-based PTSD care and the development and dissemination of educational materials for clinicians and patients. Prescribing trends of benzodiazepines, off-label atypical antipsychotics, and prazosin were collected quarterly for 3 years (October 1, 2013, to September 30, 2016). Prescribing rates of benzodiazepines during the educational intervention decreased from 13% to 9.3%. Use of off-label atypical antipsychotics, a class of medications not recommended for PTSD, stayed relatively flat at about 10%. Prescribing of prazosin, a medication recommended for treatment of trauma nightmares, increased from 9.8% to 14.3%. Academic detailing and other educational programming appear to be effective for addressing gaps and lag in quality PTSD care and are associated with a positive trend of decreased benzodiazepine use. Efforts will continue, now with added focus on concurrent use of benzodiazepines and opioids and the use of off-label atypical antipsychotics in rural veterans with PTSD.

  4. Improved technical specifications and related improvements to safety in commercial Nuclear power plants

    Energy Technology Data Exchange (ETDEWEB)

    Hoffman, D.R.; Demitrack, T.; Schiele, R.; Jones, J.C. [EXCEL Services Corporation, 11921 Rockville Pike, Suite 100, Rockville, MD 20852 (United States)]. e-mail:


    Many of the commercial nuclear power plants in the United States (US) have been converting a portion of the plant operating license known as the Technical Specifications (TS) in accordance with a document published by the US Nuclear Regulatory Commission (NRC). The TS prescribe commercial nuclear power plant operating requirements. There are several types of nuclear power plants in the US, based on the technology of different vendors, and there is an NRC document that supports each of the five different vendor designs. The NRC documents are known as the Improved Standard Technical Specifications (ISTS) and are contained in a separate document (NUREG series) for each one of the designs. EXCEL Services Corporation (hereinafter EXCEL) has played a major role in the development of the ISTS and in the development, licensing, and implementation of the plant specific Improved Technical Specifications (ITS) (which is based on the ISTS) for the commercial nuclear power plants in the US that have elected to make this conversion. There are currently 103 operating commercial nuclear power plants in the US and 68 of them have successfully completed the conversion to the ITS and are now operating in accordance with their plant specific ITS. The ISTS is focused mainly on safety by ensuring the commercial nuclear reactors can safely shut down and mitigate the consequences of any postulated transient and accident. It accomplishes this function by including requirements directly associated with safety in a document structured systematically and taking into account some key human factors and technical initiatives. This paper discusses the ISTS including its format, content, and detail, the history of the ISTS, the ITS development, licensing, and implementation process, the safety improvements resulting from a plant conversion to ITS, and the importance of the ITS Project to the industry. (Author)

  5. Improving the appropriateness of antipsychotic prescribing in nursing homes: a mixed-methods process evaluation of an academic detailing intervention. (United States)

    Desveaux, L; Saragosa, M; Rogers, J; Bevan, L; Loshak, H; Moser, A; Feldman, S; Regier, L; Jeffs, L; Ivers, N M


    In 2014, nursing home administration and government officials were facing increasing public and media scrutiny around the variation of antipsychotic medication (APM) prescribing across Ontario nursing homes. In response, policy makers partnered to test an academic detailing (AD) intervention to address appropriate prescribing of APM in nursing homes in a cluster-randomized trial. This mixed-methods study aimed to explore how and why the AD intervention may have resulted in changes in the nursing home context. The objectives were to understand how the intervention was implemented, explore contextual factors associated with implementation, and examine impact of the intervention on prescribing. Administrative data for the primary outcome of the full randomized trial will not be available for a minimum of 1 year. Therefore, this paper reports the findings of a planned, quantitative interim trial analysis assessed mean APM dose and prescribing prevalence at baseline and 3 and 6 months across 40 nursing homes (18 intervention, 22 control). Patient-level administrative data regarding prescribing were analyzed using generalized linear mixed effects regression. Semi-structured interviews were conducted with nursing home staff from the intervention group to explore opinions and experiences of the AD intervention. Interviews were analyzed using the framework method, with constructs from the Consolidated Framework for Implementation Research (CFIR) applied as pre-defined deductive codes. Open coding was applied when emerging themes did not align with CFIR constructs. Qualitative and quantitative findings were triangulated to examine points of divergence to understand how the intervention may work and to identify areas for future opportunities and areas for improvement. No significant differences were observed in prescribing outcomes. A total of 22 interviews were conducted, including four academic detailers and 18 nursing home staff. Constructs within the CFIR domains of

  6. Optimization of electronic prescribing in pediatric patients

    NARCIS (Netherlands)

    Maat, B.


    Improving pediatric patient safety by preventing medication errors that may result in adverse drug events and consequent healthcare expenditure,is a worldwide challenge to healthcare. In pediatrics, reported medication error rates in general, and prescribing error rates in particular, vary between s

  7. Electronic Prescribing (United States)

    ... Do you prescribe electronically?” For more information about electronic prescribing, call 1-800-MEDICARE (1-800-633- ... TTY users should call 1-877-486-2048 . Electronic eRx Prescribing I went to the pharmacy, and ...

  8. Chemotherapy e-prescribing: opportunities and challenges

    Directory of Open Access Journals (Sweden)

    Elsaid KA


    Full Text Available Khaled A Elsaid,1,2 Steven Garguilo,1 Christine M Collins2 1Department of Pharmaceutical Sciences, School of Pharmacy, MCPHS University, Boston, MA, 2Pharmacy Services, Rhode Island Hospital, Providence, RI, USA Abstract: Chemotherapy drugs are characterized by low therapeutic indices and significant toxicities at clinically prescribed doses, raising serious issues of drug safety. The safety of the chemotherapy medication use process is further challenged by regimen complexity and need to tailor treatment to patient status. Errors that occur during chemotherapy prescribing are associated with serious and life-threatening outcomes. Computerized provider order entry (CPOE systems were shown to reduce overall medication errors in ambulatory and inpatient settings. The adoption of chemotherapy CPOE is lagging due to financial cost and cultural and technological challenges. Institutions that adopted infusional or oral chemotherapy electronic prescribing modified existing CPOE systems to allow chemotherapy prescribing, implemented chemotherapy-specific CPOE systems, or developed home-grown chemotherapy electronic prescribing programs. Implementation of chemotherapy electronic prescribing was associated with a significant reduction in the risk of prescribing errors, most significantly dose calculation and adjustment errors. In certain cases, implementation of chemotherapy CPOE was shown to improve the chemotherapy use process. The implementation of chemotherapy CPOE may increase the risk of new types of errors, especially if processes are not redesigned and adapted to CPOE. Organizations aiming to implement chemotherapy CPOE should pursue a multidisciplinary approach engaging all stakeholders to guide system selection and implementation. Following implementation, organizations should develop and use a risk assessment process to identify and evaluate unanticipated consequences and CPOE-generated errors. The results of these analyses should serve to

  9. Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety. (United States)

    McFadden, Kathleen L; Stock, Gregory N; Gowen, Charles R


    Successful amelioration of medical errors represents a significant problem in the health care industry. There is a need for greater understanding of the factors that lead to improved process quality and patient safety outcomes in hospitals. We present a research model that shows how transformational leadership, safety climate, and continuous quality improvement (CQI) initiatives are related to objective quality and patient safety outcome measures. The proposed framework is tested using structural equation modeling, based on data collected for 204 hospitals, and supplemented with objective outcome data from the Centers for Medicare and Medicaid Services. The results provide empirical evidence that a safety climate, which is connected to the chief executive officer's transformational leadership style, is related to CQI initiatives, which are linked to improved process quality. A unique finding of this study is that, although CQI initiatives are positively associated with improved process quality, they are also associated with higher hospital-acquired condition rates, a measure of patient safety. Likewise, safety climate is directly related to improved patient safety outcomes. The notion that patient safety climate and CQI initiatives are not interchangeable or universally beneficial is an important contribution to the literature. The results confirm the importance of using CQI to effectively enhance process quality in hospitals, and patient safety climate to improve patient safety outcomes. The overall pattern of findings suggests that simultaneous implementation of CQI initiatives and patient safety climate produces greater combined benefits.

  10. Evaluation and Improvement of Food Safety Satisfaction Based on QFD


    Pu Jin; Lu Qiang


    In view of the social phenomenon of people's generally low satisfaction with food safety, we introduced the QFD method to make evaluation and guidance for improvement. Based on scientific and reasonable evaluation index system of food safety satisfaction and the “quality house” of QFD core tool, a food safety satisfaction evaluation model was constructed. On the basis of the evaluation results, we analyzed the public food safety requirements and constructed the quality house between the publi...

  11. Role Of Biopreservation In Improving Food Safety And Storage


    Swarnadyuti Nath; Chowdhury, S.


    Biopreservation refers to the use of antagonistic microorganisms or their metabolic products to inhibit or destroy undesired microorganisms in foods to enhance food safety and extend shelf life. In order to achieve improved food safety and to harmonize consumer demands with the necessary safety standards, traditional means of controlling microbial spoilage and safety hazards in foods are being replaced by combinations of innovative technologies that include biological antimicrobial systems su...

  12. The awareness of employees in safety culture through the improved nuclear safety culture evaluation method

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Ga; Sung, Chan Ho; Jung, Yeon Sub [KHNP Central Research Institute, Daejeon (Korea, Republic of)


    After the Chernobyl nuclear accident in 1986, nuclear safety culture terminology was at first introduced emphasizing the importance of employees' attitude and organizational safety. The concept of safety culture was spread by INSAG 4 published in 1991. From that time, IAEA had provided the service of ASCOT for the safety culture assessment. However, many people still are thinking that safety culture is abstract and is not clear. It is why the systematic and reliable assessment methodology was not developed. Assessing safety culture is to identify what is the basic assumption for any organization to accept unconsciously. Therefore, it is very difficult to reach a meaningful conclusion by a superficial investigation alone. KHNP had been doing the safety culture assessment which was based on ASCOT methodology every 2 years. And this result had contributed to improving safety culture. But this result could not represent the level of organization's safety culture due to the limitation of method. So, KHNP has improved the safety culture method by benchmarking the over sea assessment techniques in 2011. The effectiveness of this improved methodology was validated through a pilot assessment. In this paper, the level of employees' safety culture awareness was analyzed by the improved method and reviewed what is necessary for the completeness and objectivity of the nuclear safety culture assessment methodology.

  13. Educating nonmedical prescribers. (United States)

    Stewart, Derek; MacLure, Katie; George, Johnson


    The last decade has seen developments in nonmedical prescribing, with the introduction of prescribing rights for healthcare professionals. In this article, we focus on the education, training and practice of nonmedical prescribers in the UK. There are around 20,000 nurse independent prescribers, 2400 pharmacist supplementary/independent prescribers, several hundred allied health professional supplementary prescribers and almost 100 optometrist supplementary/independent prescribers. Many are active prescribers, managing chronic conditions or acute episodes of infections and minor ailments. Key aims of nonmedical prescribing are as follows: to improve patient care; to increase patient choice in accessing medicines; and to make better use of the skills of health professionals. Education and training are provided by higher education institutions accredited by UK professional bodies/regulators,namely, the Nursing and Midwifery Council, General Pharmaceutical Council, Health Professions Council and General Optical Council. The programme comprises two main components: a university component equivalent to 26 days full-time education and a period of learning in practice of 12 days minimum under the supervision of a designated medical practitioner. Course content focuses on the following factors: consultation, decision making, assessment and review; psychology of prescribing; prescribing in team context; applied therapeutics; evidence-based practice and clinical governance; legal, policy, professional and ethical aspects; and prescribing in the public health context. Nonmedical prescribers must practise within their competence, demonstrating continuing professional development to maintain the quality engendered during training. Despite the substantial progress, there are several issues of strategy, capacity, sustainability and a research evidence base which require attention to fully integrate nonmedical prescribing within healthcare. © 2012 The Authors. British Journal of

  14. Process safety improvement--quality and target zero. (United States)

    Van Scyoc, Karl


    Process safety practitioners have adopted quality management principles in design of process safety management systems with positive effect, yet achieving safety objectives sometimes remain a distant target. Companies regularly apply tools and methods which have roots in quality and productivity improvement. The "plan, do, check, act" improvement loop, statistical analysis of incidents (non-conformities), and performance trending popularized by Dr. Deming are now commonly used in the context of process safety. Significant advancements in HSE performance are reported after applying methods viewed as fundamental for quality management. In pursuit of continual process safety improvement, the paper examines various quality improvement methods, and explores how methods intended for product quality can be additionally applied to continual improvement of process safety. Methods such as Kaizen, Poke yoke, and TRIZ, while long established for quality improvement, are quite unfamiliar in the process safety arena. These methods are discussed for application in improving both process safety leadership and field work team performance. Practical ways to advance process safety, based on the methods, are given.

  15. Process safety improvement-Quality and target zero

    Energy Technology Data Exchange (ETDEWEB)

    Van Scyoc, Karl [Det Norske Veritas (U.S.A.) Inc., DNV Energy Solutions, 16340 Park Ten Place, Suite 100, Houston, TX 77084 (United States)], E-mail:


    Process safety practitioners have adopted quality management principles in design of process safety management systems with positive effect, yet achieving safety objectives sometimes remain a distant target. Companies regularly apply tools and methods which have roots in quality and productivity improvement. The 'plan, do, check, act' improvement loop, statistical analysis of incidents (non-conformities), and performance trending popularized by Dr. Deming are now commonly used in the context of process safety. Significant advancements in HSE performance are reported after applying methods viewed as fundamental for quality management. In pursuit of continual process safety improvement, the paper examines various quality improvement methods, and explores how methods intended for product quality can be additionally applied to continual improvement of process safety. Methods such as Kaizen, Poke yoke, and TRIZ, while long established for quality improvement, are quite unfamiliar in the process safety arena. These methods are discussed for application in improving both process safety leadership and field work team performance. Practical ways to advance process safety, based on the methods, are given.

  16. Improving the safety of LWR power plants. Final report

    Energy Technology Data Exchange (ETDEWEB)


    This report documents the results of the Study to identify current, potential research issues and efforts for improving the safety of Light Water Reactor (LWR) power plants. This final report describes the work accomplished, the results obtained, the problem areas, and the recommended solutions. Specifically, for each of the issues identified in this report for improving the safety of LWR power plants, a description is provided in detail of the safety significance, the current status (including information sources, status of technical knowledge, problem solution and current activities), and the suggestions for further research and development. Further, the issues are ranked for action into high, medium, and low priority with respect to primarily (a) improved safety (e.g. potential reduction in public risk and occupational exposure), and secondly (b) reduction in safety-related costs (improving or maintaining level of safety with simpler systems or in a more cost-effective manner).

  17. Improving road safety: Experiences from the Netherlands

    NARCIS (Netherlands)

    Hagenzieker, M.P.


    Dr. Hagenzieker's research and education activities focus on the road safety effects of the transport system, with particular interest in road user behaviour aspects. Her PhD-research was on the effects of rewards on road user behaviour.

  18. How Stereochemistry Considerations can Improve Pesticide Safety (United States)

    About 30% of pesticides are chiral molecules and therefore exist as two or more stereoisomers, which can differ significantly in their toxicity, biodegradation, and persistence. Such differences can impact their relative safety to humans and environmental species. Enantiomers, mi...

  19. Improving the safety features of general practice computer systems


    Anthony Avery; Boki Savelyich; Sheila Teasdale


    General practice computer systems already have a number of important safety features. However, there are problems in that general practitioners (GPs) have come to rely on hazard alerts when they are not foolproof. Furthermore, GPs do not know how to make best use of safety features on their systems. There are a number of solutions that could help to improve the safety features of general practice computer systems and also help to improve the abilities of healthcare professionals to use these ...

  20. EUROSAFE Forum for nuclear safety. Towards Convergence of Technical Nuclear Safety Practices in Europe. Safety Improvements - Reasons, Strategies, Implementation

    Energy Technology Data Exchange (ETDEWEB)

    Erven, Ulrich (ed.) [Gesellschaft fuer Anlagen- und Reaktorsicherheit, GRS mbH, Schwertnergasse 1, 50667 Koeln (Germany); Cherie, Jean-Bernard (ed.) [Institut de Radioprotection et de Surete Nucleaire, IRSN, BP 17, 92262 Fontenay-aux-Roses Cedex (France); Boeck, Benoit De (ed.) [Association Vincotte Nuclear, AVN, Rue Walcourt 148, 1070 Bruxelles (Belgium)


    The EUROSAFE Forum for Nuclear Safety is part of the EUROSAFE approach, which consists of two further elements: the EUROSAFE Tribune and the EUROSAFE Web site. The general aim of EUROSAFE is to contribute to fostering the convergence of technical nuclear safety practices in a broad European context. This is done by providing technical safety and research organisations, safety authorities, power utilities, the rest of the industry and non-governmental organisations mainly from the European Union and East-European countries, and international organisations with a platform for the presentation of recent analyses and R and D in the field of nuclear safety. The goal is to share experiences, to exchange technical and scientific opinions, and to conduct debates on key issues in the fields of nuclear safety and radiation protection. The EUROSAFE Forum on 2005 focused on Safety Improvements, Reasons - Strategies - Implementation, from the point of view of the authorities, TSOs and industry. Latest work in nuclear installation safety and research, waste management, radiation safety as well as nuclear material and nuclear facilities security carried out by GRS, IRSN, AVN and their partners in the European Union, Switzerland and Eastern Europe are presented. A high level of nuclear safety is a priority for the countries of Europe. The technical safety organisations play an important role in contributing to that objective through appropriate approaches to major safety issues as part of their assessments and research activities. The challenges to nuclear safety are international. Changes in underlying technologies such as instrumentation and control, the impact of electricity market deregulation, demands for improved safety and safety management, the ageing of nuclear facilities, waste management, maintaining and improving scientific and technical knowledge, and the need for greater transparency - these are all issues where the value of an international approach is gaining

  1. Processing and storage of blood components: strategies to improve patient safety

    Directory of Open Access Journals (Sweden)

    Pietersz RNI


    Full Text Available Ruby NI Pietersz, Pieter F van der Meer Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, the Netherlands Abstract: This review focuses on safety improvements of blood processing of various blood components and their respective storage. A solid quality system to ensure safe and effective blood components that are traceable from a donor to the patient is the foundation of a safe blood supply. To stimulate and guide this process, National Health Authorities should develop guidelines for blood transfusion, including establishment of a quality system. Blood component therapy enabled treatment of patients with blood constituents that were missing, only thus preventing reactions to unnecessarily transfused elements. Leukoreduction prevents many adverse reactions and also improves the quality of the blood components during storage. The safety of red cells and platelets is improved by replacement of plasma with preservative solutions, which results in the reduction of isoantibodies and plasma proteins. Automation of blood collection, separation of whole blood into components, and consecutive processing steps, such as preparation of platelet concentrate from multiple donations, improves the consistent composition of blood components. Physicians can better prescribe the number of transfusions and therewith reduce donor exposure and/or the risk of pathogen transmission. Pathogen reduction in cellular blood components is the latest development in improving the safety of blood transfusions for patients. Keywords: blood components, red cell concentrates, platelet concentrates, plasma, transfusion, safety 

  2. Improving the safety and quality of cancer care. (United States)

    Burke, Harry B


    The cancer community is increasingly interested in improving its safety and quality. Improvement will be driven by the expansion of safety and quality research and by a commitment to publish studies that advance high-quality, safe cancer care. Cancer 2017;123:549-550. © 2016 American Cancer Society. © 2016 American Cancer Society.

  3. Gap Analysis Approach for Construction Safety Program Improvement

    Directory of Open Access Journals (Sweden)

    Thanet Aksorn


    Full Text Available To improve construction site safety, emphasis has been placed on the implementation of safety programs. In order to successfully gain from safety programs, factors that affect their improvement need to be studied. Sixteen critical success factors of safety programs were identified from safety literature, and these were validated by safety experts. This study was undertaken by surveying 70 respondents from medium- and large-scale construction projects. It explored the importance and the actual status of critical success factors (CSFs. Gap analysis was used to examine the differences between the importance of these CSFs and their actual status. This study found that the most critical problems characterized by the largest gaps were management support, appropriate supervision, sufficient resource allocation, teamwork, and effective enforcement. Raising these priority factors to satisfactory levels would lead to successful safety programs, thereby minimizing accidents.

  4. A word from the DG: Improved safety at CERN

    CERN Multimedia


    One of the important objectives of my term of office is improving safety at CERN. My consideration of safety issues over the last few months, in conjunction with the Safety Commission and the Heads of Department, has led me to define a new approach for the implementation of safety policy at CERN. It is not a question of changing the safety policy and the basic safety rules laid down in document 'Safety Policy at CERN' (SAPOCO 42) but, rather, of improving the way they are applied by clarifying the roles of everyone concerned. The existing safety policy and rules have yet to be fully implemented. Some people continue to think, for example, that safety implementation only concerns the Safety Commission (SC). In reality, as SAPOCO 42 clearly specifies, safety is the responsibility of each and every individual. This means that each person in charge of a task is also responsible for guaranteeing its safe completion by implementing all the necessary measures. To enhance the awareness of this responsibility and t...

  5. Measuring and improving patient safety through health information technology: The Health IT Safety Framework. (United States)

    Singh, Hardeep; Sittig, Dean F


    Health information technology (health IT) has potential to improve patient safety but its implementation and use has led to unintended consequences and new safety concerns. A key challenge to improving safety in health IT-enabled healthcare systems is to develop valid, feasible strategies to measure safety concerns at the intersection of health IT and patient safety. In response to the fundamental conceptual and methodological gaps related to both defining and measuring health IT-related patient safety, we propose a new framework, the Health IT Safety (HITS) measurement framework, to provide a conceptual foundation for health IT-related patient safety measurement, monitoring, and improvement. The HITS framework follows both Continuous Quality Improvement (CQI) and sociotechnical approaches and calls for new measures and measurement activities to address safety concerns in three related domains: 1) concerns that are unique and specific to technology (e.g., to address unsafe health IT related to unavailable or malfunctioning hardware or software); 2) concerns created by the failure to use health IT appropriately or by misuse of health IT (e.g. to reduce nuisance alerts in the electronic health record (EHR)), and 3) the use of health IT to monitor risks, health care processes and outcomes and identify potential safety concerns before they can harm patients (e.g. use EHR-based algorithms to identify patients at risk for medication errors or care delays). The framework proposes to integrate both retrospective and prospective measurement of HIT safety with an organization's existing clinical risk management and safety programs. It aims to facilitate organizational learning, comprehensive 360 degree assessment of HIT safety that includes vendor involvement, refinement of measurement tools and strategies, and shared responsibility to identify problems and implement solutions. A long term framework goal is to enable rigorous measurement that helps achieve the safety

  6. Will Banning Begging Improve Traffic Safety?

    Institute of Scientific and Technical Information of China (English)


    On August 2,Zhuhai,a city in south China’s Guangdong Province, issued road safety regulations banning begging in vehicle lanes. The new regulations allow the police to impose fines on beggers.Drivers who buy anything from vendors or give money to beg- gars will also be fined.

  7. Recipe Modification Improves Food Safety Practices during Cooking of Poultry. (United States)

    Maughan, Curtis; Godwin, Sandria; Chambers, Delores; Chambers Iv, Edgar


    Many consumers do not practice proper food safety behaviors when preparing food in the home. Several approaches have been taken to improve food safety behaviors among consumers, but there still is a deficit in actual practice of these behaviors. The objective of this study was to assess whether the introduction of food safety instructions in recipes for chicken breasts and ground turkey patties would improve consumers' food safety behaviors during preparation. In total, 155 consumers in two locations (Manhattan, KS, and Nashville, TN) were asked to prepare a baked chicken breast and a ground turkey patty following recipes that either did or did not contain food safety instructions. They were observed to track hand washing and thermometer use. Participants who received recipes with food safety instructions (n = 73) demonstrated significantly improved food safety preparation behaviors compared with those who did not have food safety instructions in the recipe (n = 82). In addition, the majority of consumers stated that they thought the recipes with instructions were easy to use and that they would be likely to use similar recipes at home. This study demonstrates that recipes could be a good source of food safety information for consumers and that they have the potential to improve behaviors to reduce foodborne illness.

  8. Using standardized insulin orders to improve patient safety in a tertiary care centre. (United States)

    Doyle, Mary-Anne; Brez, Sharon; Sicoli, Silvana; De Sousa, Filomena; Keely, Erin; Malcom, Janine C


    To standardize insulin prescribing practices for inpatients, improve management of hypoglycemia, reduce reliance on sliding scales, increase use of basal-bolus insulin and improve patient safety. Patients with diabetes were admitted to 2 pilot inpatient units followed by corporate spread to all insulin-treated patients on noncritical care units in a Canadian tertiary care multicampus teaching hospital. Standardized preprinted insulin and hypoglycemia management orders, decision support tools and multidisciplinary education strategies were developed, tested and implemented by way of the Model for Improvement and The Ottawa Model for Research Process. Clinical and balance measures were evaluated through statistical process control. Patient safety was improved through a reduction in hypoglycemia and decreased dependence on correctional scales. Utilization of the preprinted orders approached the target of 70% at the end of the test period and was sustained at 89% corporately 3 years post-implementation. The implementation of a standardized, preprinted insulin order set facilitates best practices for insulin therapy, improves patient safety and is highly supported by treating practitioners. The utilization of formal quality-improvement methodology promoted efficiency, enhanced sustainability, increased support among clinicians and senior administrators, and was effective in instituting sustained practice change in a complex care centre. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

  9. Changing physician prescribing behaviour. (United States)

    Gray, J


    Didactic approaches to educating physicians and/or other health professionals do not produce changes in learner behaviour. Similarly, printed materials and practice guidelines have not been shown to change prescribing behaviour. Evidence-based educational approaches that do have an impact on provider behaviour include: teaching aimed at identified learning needs; interactive educational activities; sequenced and multifaceted interventions; enabling tools such as patient education programs, flow charts, and reminders; educational outreach or academic detailing; and audit and feedback to prescribers. Dr. Jean Gray reflects over the past 25 years on how there has been a transformation in the types of activities employed to improve prescribing practices in Nova Scotia. The evolution of Continuing Medical Education (CME) has resulted in the creation of the Drug Evaluation Alliance of Nova Scotia (DEANS) program, which is one exemplar of an evidence-based educational approach to improving physician prescribing in that province. Key words: Evidence-based, education, prescribing.

  10. Using game theory to improve safety within chemical industrial parks

    CERN Document Server

    Reniers, Genserik


    Though the game-theoretic approach has been vastly studied and utilized in relation to economics of industrial organizations, it has hardly been used to tackle safety management in multi-plant chemical industrial settings. Using Game Theory for Improving Safety within Chemical Industrial Parks presents an in-depth discussion of game-theoretic modelling which may be applied to improve cross-company prevention and -safety management in a chemical industrial park.   By systematically analyzing game-theoretic models and approaches in relation to managing safety in chemical industrial parks, Using Game Theory for Improving Safety within Chemical Industrial Parks explores the ways game theory can predict the outcome of complex strategic investment decision making processes involving several adjacent chemical plants. A number of game-theoretic decision models are discussed to provide strategic tools for decision-making situations.   Offering clear and straightforward explanations of methodologies, Using Game Theor...

  11. Learning to prescribe – pharmacists' experiences of supplementary prescribing training in England

    Directory of Open Access Journals (Sweden)

    Hutchinson Allen


    Full Text Available Abstract Background The introduction of non-medical prescribing for professions such as pharmacy and nursing in recent years offers additional responsibilities and opportunities but attendant training issues. In the UK and in contrast to some international models, becoming a non-medical prescriber involves the completion of an accredited training course offered by many higher education institutions, where the skills and knowledge necessary for prescribing are learnt. Aims: to explore pharmacists' perceptions and experiences of learning to prescribe on supplementary prescribing (SP courses, particularly in relation to inter-professional learning, course content and subsequent use of prescribing in practice. Methods A postal questionnaire survey was sent to all 808 SP registered pharmacists in England in April 2007, exploring demographic, training, prescribing, safety culture and general perceptions of SP. Results After one follow-up, 411 (51% of pharmacists responded. 82% agreed SP training was useful, 58% agreed courses provided appropriate knowledge and 62% agreed that the necessary prescribing skills were gained. Clinical examination, consultation skills training and practical experience with doctors were valued highly; pharmacology training and some aspects of course delivery were criticised. Mixed views on inter-professional learning were reported – insights into other professions being valued but knowledge and skills differences considered problematic. 67% believed SP and recent independent prescribing (IP should be taught together, with more diagnostic training wanted; few pharmacists trained in IP, but many were training or intending to train. There was no association between pharmacists' attitudes towards prescribing training and when they undertook training between 2004 and 2007 but earlier cohorts were more likely to be using supplementary prescribing in practice. Conclusion Pharmacists appeared to value their SP training and

  12. Improving patient safety through education: how visual recognition skills may reduce medication errors on surgical wards

    Directory of Open Access Journals (Sweden)

    Christopher R. Davis


    Full Text Available Medication errors compromise patient safety and cost £500m per annum in the UK. Patients who forget the name of their medication may describe the appearance to the doctor. Nurses use recognition skills to assist in safe administration of medications. This study quantifies healthcare professionals’ accuracy in visually identifying medications. Members of the multidisciplinary team were asked to identify five commonly prescribed medications. Mean recognition rate (MRR was defined as the percentage of correct responses. Dunn’s multiple comparison tests quantified inter-professional variation. Fifty-six participants completed the study (93% response rate. MRRs were: pharmacists 61%; nurses 35%; doctors 19%; physiotherapists 11%. Pharmacists’ MRR were significantly higher than both doctors and physiotherapists (P<0.001. Nurses’ MRR was statistically comparable to pharmacists (P>0.05. The majority of healthcare professionals cannot accurately identify commonly prescribed medications on direct visualization. By increasing access to medication identification resources and improving undergraduate education and postgraduate training for all healthcare professionals, errors may be reduced and patient safety improved.

  13. Improving Patient Safety Culture in Primary Care: A Systematic Review

    NARCIS (Netherlands)

    Verbakel, Natasha J.; Langelaan, Maaike; Verheij, Theo J. M.; Wagner, Cordula; Zwart, Dorien L. M.


    Background: Patient safety culture, described as shared values, attitudes and behavior of staff in a health-care organization, gained attention as a subject of study as it is believed to be related to the impact of patient safety improvements. However, in primary care, it is yet unknown, which effec

  14. Nature-based strategies for improving urban health and safety (United States)

    Michelle C. Kondo; Eugenia C. South; Charles C. Branas


    Place-based programs are being noticed as key opportunities to prevent disease and promote public health and safety for populations at-large. As one key type of place-based intervention, nature-based and green space strategies can play an especially large role in improving health and safety for dwellers in urban environments such as US legacy cities that lack nature...

  15. A tool for safety evaluations of road improvements. (United States)

    Peltola, Harri; Rajamäki, Riikka; Luoma, Juha


    Road safety impact assessments are requested in general, and the directive on road infrastructure safety management makes them compulsory for Member States of the European Union. However, there is no widely used, science-based safety evaluation tool available. We demonstrate a safety evaluation tool called TARVA. It uses EB safety predictions as the basis for selecting locations for implementing road-safety improvements and provides estimates of safety benefits of selected improvements. Comparing different road accident prediction methods, we demonstrate that the most accurate estimates are produced by EB models, followed by simple accident prediction models, the same average number of accidents for every entity and accident record only. Consequently, advanced model-based estimates should be used. Furthermore, we demonstrate regional comparisons that benefit substantially from such tools. Comparisons between districts have revealed significant differences. However, comparisons like these produce useful improvement ideas only after taking into account the differences in road characteristics between areas. Estimates on crash modification factors can be transferred from other countries but their benefit is greatly limited if the number of target accidents is not properly predicted. Our experience suggests that making predictions and evaluations using the same principle and tools will remarkably improve the quality and comparability of safety estimations.

  16. Toward improved construction health, safety, and ergonomics in ...

    African Journals Online (AJOL)

    Toward improved construction health, safety, and ergonomics in South Africa: A ... positioned in the action research (AR) paradigm and used focus-group (FG) ... use of the core model relies on appropriate knowledge of architectural designers.

  17. Rationalising prescribing

    DEFF Research Database (Denmark)

    Wadmann, Sarah; Bang, Lia Evi


    with chronic care management in Denmark. We demonstrate how attempts to rationalise prescribing by informing GPs about drug effects, adverse effects and price do not satisfy GPs' knowledge needs. We argue that, for GPs, 'rational' prescribing cannot be understood in separation from the processes that enable...... of GPs as a need for practice-relevant knowledge and argue that industry sales representatives are granted opportunity to access general practice because they understand this need of GPs....

  18. A cluster randomized controlled trial aimed at implementation of local quality improvement collaboratives to improve prescribing and test ordering performance of general practitioners: Study Protocol

    Directory of Open Access Journals (Sweden)

    Winkens Ron


    Full Text Available Abstract Background The use of guidelines in general practice is not optimal. Although evidence-based methods to improve guideline adherence are available, variation in physician adherence to general practice guidelines remains relatively high. The objective for this study is to transfer a quality improvement strategy based on audit, feedback, educational materials, and peer group discussion moderated by local opinion leaders to the field. The research questions are: is the multifaceted strategy implemented on a large scale as planned?; what is the effect on general practitioners' (GPs test ordering and prescribing behaviour?; and what are the costs of implementing the strategy? Methods In order to evaluate the effects, costs and feasibility of this new strategy we plan a multi-centre cluster randomized controlled trial (RCT with a balanced incomplete block design. Local GP groups in the south of the Netherlands already taking part in pharmacotherapeutic audit meeting groups, will be recruited by regional health officers. Approximately 50 groups of GPs will be randomly allocated to two arms. These GPs will be offered two different balanced sets of clinical topics. Each GP within a group will receive comparative feedback on test ordering and prescribing performance. The feedback will be discussed in the group and working agreements will be created after discussion of the guidelines and barriers to change. The data for the feedback will be collected from existing and newly formed databases, both at baseline and after one year. Discussion We are not aware of published studies on successes and failures of attempts to transfer to the stakeholders in the field a multifaceted strategy aimed at GPs' test ordering and prescribing behaviour. This pragmatic study will focus on compatibility with existing infrastructure, while permitting a certain degree of adaptation to local needs and routines. Trial registration Nederlands Trial Register ISRCTN40008171


    Energy Technology Data Exchange (ETDEWEB)



    This paper describes the results of a year-long project, sponsored by the Energy Facility Contractors Group (EFCOG) and designed to improve overall electrical safety performance throughout Department of Energy (DOE)-owned sites and laboratories. As evidenced by focused metrics, the Project was successful primarily due to the joint commitment of contractor and DOE electrical safety experts, as well as significant support from DOE and contractor senior management. The effort was managed by an assigned project manager, using classical project-management principles that included execution of key deliverables and regular status reports to the Project sponsor. At the conclusion of the Project, the DOE not only realized measurable improvement in the safety of their workers, but also had access to valuable resources that will enable them to do the following: evaluate and improve electrical safety programs; analyze and trend electrical safety events; increase electrical safety awareness for both electrical and non-electrical workers; and participate in ongoing processes dedicated to continued improvement.

  20. Improving Knowledge of General Dental Practitioners on Antibiotic Prescribing by Raising Awareness of the Faculty of General Dental Practice (UK Guidelines

    Directory of Open Access Journals (Sweden)

    Sana Zahabiyoun


    Full Text Available Objectives: Cases of antimicrobial resistance are increasing, partly due to inappropriate prescribing practices by dentists. The purpose of this study was to investigate the prescrib- ing practices and knowledge of dentists with regards to antibiotics. Moreover, this study aimed to determine whether the prescriptions comply with the recommended guidelines and whether clinical audit can alter the prescribing practices of dentists leading to better use of antibiotics in the dental service.Materials and Methods: A clinical audit (before/after non-controlled trial was carried out in two dental clinics in the northeast of England. Retrospective data were collected from 30 antibiotic prescriptions, analysed and compared with the recommended guide- lines. Data collected included age and gender of patients, type of prescribed antibiotics and their dosage, frequency and duration, clinical condition and reason for prescribing. The principles of appropriate prescribing based on guidance by the Faculty of General Dental Practice in the United Kingdom (UK, FGDP, were discussed with the dental clini- cians. Following this, prospective data were collected and similarly managed. Pre and post audit data were then compared. Changes were tested for significance using McNemar's test and P value<0.05 was considered statistically significant.Results: After intervention, data revealed that antibiotic prescribing practices of dentists improved, as there was an increase in the percentage of prescriptions that were in accor- dance with the FGDP (UK guidelines.Conclusion: In view of the limited data collected, this study concludes that there are inap- propriate antibiotic prescribing practices amongst general dental practitioners and that clinical audit can address this situation, leading to a more rational use of antibiotics in dental practice.

  1. Developing Unique Engineering Solutions to Improve Patient Safety

    Directory of Open Access Journals (Sweden)

    Bradley V. Watts


    Full Text Available Many efforts to improve healthcare safety have focused on redesigning processes of care or retraining clinicians. Far less attention has been focused on the use of new technologies to improve safety. We present the results of a unique collaboration between the VA National Center for Patient Safety (NCPS and the Thayer School of Engineering at Dartmouth College. Each year, the NCPS identifies safety problems across the VA that could be addressed with newly-engineered devices. Teams of Thayer students and faculty participating in a senior design course evaluate and engineer a solution for one of the problems. Exemplar projects have targeted surgical sponge retention, nosocomial infections, surgical site localization, and remote monitoring of hospitalized patients undergoing diagnostic testing and procedures. The program has served as an avenue for engineering students and health care workers to solve problems together. The success of this academic-clinical partnership could be replicated in other settings.

  2. Improving health and safety through greater cooperation: A labor perspective

    Energy Technology Data Exchange (ETDEWEB)

    Main, J.A.


    There has been considerable effort in the coal mining industry to improve the future of mining operations and the health and safety conditions through improved labor and management relations. The United Mine Workers of America has been a major part of that effort.

  3. Safety Computer Vision Rules for Improved Sensor Certification

    DEFF Research Database (Denmark)

    Mogensen, Johann Thor Ingibergsson; Kraft, Dirk; Schultz, Ulrik Pagh


    to be certified, but no specific standards exist for computer vision systems, and the concept of safe vision systems remains largely unexplored. In this paper we present a novel domain-specific language that allows the programmer to express image quality detection rules for enforcing safety constraints....... The language allows developers to increase trustworthiness in the robot perception system, which we argue would increase compliance with safety standards. We demonstrate the usage of the language to improve reliability in a perception pipeline, thus allowing the vision expert to concisely express the safety...

  4. ASSET (Age/Sex Standardised Estimates of Treatment: a research model to improve the governance of prescribing funds in Italy.

    Directory of Open Access Journals (Sweden)

    Giampiero Favato

    Full Text Available BACKGROUND: The primary objective of this study was to make the first step in the modelling of pharmaceutical demand in Italy, by deriving a weighted capitation model to account for demographic differences among general practices. The experimental model was called ASSET (Age/Sex Standardised Estimates of Treatment. METHODS AND MAJOR FINDINGS: Individual prescription costs and demographic data referred to 3,175,691 Italian subjects and were collected directly from three Regional Health Authorities over the 12-month period between October 2004 and September 2005. The mean annual prescription cost per individual was similar for males (196.13 euro and females (195.12 euro. After 65 years of age, the mean prescribing costs for males were significantly higher than females. On average, costs for a 75-year-old subject would be 12 times the costs for a 25-34 year-old subject if male, 8 times if female. Subjects over 65 years of age (22% of total population accounted for 56% of total prescribing costs. The weightings explained approximately 90% of the evolution of total prescribing costs, in spite of the pricing and reimbursement turbulences affecting Italy in the 2000-2005 period. The ASSET weightings were able to explain only about 25% of the variation in prescribing costs among individuals. CONCLUSIONS: If mainly idiosyncratic prescribing by general practitioners causes the unexplained variations, the introduction of capitation-based budgets would gradually move practices with high prescribing costs towards the national average. It is also possible, though, that the unexplained individual variation in prescribing costs is the result of differences in the clinical characteristics or socio-economic conditions of practice populations. If this is the case, capitation-based budgets may lead to unfair distribution of resources. The ASSET age/sex weightings should be used as a guide, not as the ultimate determinant, for an equitable allocation of prescribing

  5. ASSET (Age/Sex Standardised Estimates of Treatment): a research model to improve the governance of prescribing funds in Italy. (United States)

    Favato, Giampiero; Mariani, Paolo; Mills, Roger W; Capone, Alessandro; Pelagatti, Matteo; Pieri, Vasco; Marcobelli, Alberico; Trotta, Maria G; Zucchi, Alberto; Catapano, Alberico L


    The primary objective of this study was to make the first step in the modelling of pharmaceutical demand in Italy, by deriving a weighted capitation model to account for demographic differences among general practices. The experimental model was called ASSET (Age/Sex Standardised Estimates of Treatment). Individual prescription costs and demographic data referred to 3,175,691 Italian subjects and were collected directly from three Regional Health Authorities over the 12-month period between October 2004 and September 2005. The mean annual prescription cost per individual was similar for males (196.13 euro) and females (195.12 euro). After 65 years of age, the mean prescribing costs for males were significantly higher than females. On average, costs for a 75-year-old subject would be 12 times the costs for a 25-34 year-old subject if male, 8 times if female. Subjects over 65 years of age (22% of total population) accounted for 56% of total prescribing costs. The weightings explained approximately 90% of the evolution of total prescribing costs, in spite of the pricing and reimbursement turbulences affecting Italy in the 2000-2005 period. The ASSET weightings were able to explain only about 25% of the variation in prescribing costs among individuals. If mainly idiosyncratic prescribing by general practitioners causes the unexplained variations, the introduction of capitation-based budgets would gradually move practices with high prescribing costs towards the national average. It is also possible, though, that the unexplained individual variation in prescribing costs is the result of differences in the clinical characteristics or socio-economic conditions of practice populations. If this is the case, capitation-based budgets may lead to unfair distribution of resources. The ASSET age/sex weightings should be used as a guide, not as the ultimate determinant, for an equitable allocation of prescribing resources to regional authorities and general practices.

  6. Role Of Biopreservation In Improving Food Safety And Storage

    Directory of Open Access Journals (Sweden)

    Swarnadyuti Nath


    Full Text Available Biopreservation refers to the use of antagonistic microorganisms or their metabolic products to inhibit or destroy undesired microorganisms in foods to enhance food safety and extend shelf life. In order to achieve improved food safety and to harmonize consumer demands with the necessary safety standards, traditional means of controlling microbial spoilage and safety hazards in foods are being replaced by combinations of innovative technologies that include biological antimicrobial systems such as lactic acid bacteria (LAB and/or their metabolites. Bacillus spp. have an antimicrobial action against Gram positive and Gram negative bacteria, as well as fungi, can therefore be used as a potential biopreservative in food processing due to its wide antimicrobial spectra. Bacteriocins are peptides or complex proteins biologically active with antimicrobial action against other bacteria, principally closely related species. Bacteriocins produced by lactic acid bacteria (LAB have received particular attention in recent years due to their potential application in food industry as natural preservatives. Bacteriocin production in Bacillus spp. has been studied over the past few decades which include Subtilin from B. subtilis, Megacin from B. megaterium and Thermacin from B. stearothermophilus. Bio-preservation may be effectively used in combination with other preservative factors (called hurdles to inhibit microbial growth and achieve food safety. Using an adequate mix of hurdles is not only economically attractive; it also serves to improve microbial stability and safety, as well as the sensory and nutritional qualities of a food.

  7. Improving hypertension management through pharmacist prescribing; the rural alberta clinical trial in optimizing hypertension (Rural RxACTION: trial design and methods

    Directory of Open Access Journals (Sweden)

    Campbell Norman RC


    Full Text Available Abstract Background Patients with hypertension continue to have less than optimal blood pressure control, with nearly one in five Canadian adults having hypertension. Pharmacist prescribing is gaining favor as a potential clinically efficacious and cost-effective means to improve both access and quality of care. With Alberta being the first province in Canada to have independent prescribing by pharmacists, it offers a unique opportunity to evaluate outcomes in patients who are prescribed antihypertensive therapy by pharmacists. Methods The study is a randomized controlled trial of enhanced pharmacist care, with the unit of randomization being the patient. Participants will be randomized to enhanced pharmacist care (patient identification, assessment, education, close follow-up, and prescribing/titration of antihypertensive medications or usual care. Participants are patients in rural Alberta with undiagnosed/uncontrolled blood pressure, as defined by the Canadian Hypertension Education Program. The primary outcome is the change in systolic blood pressure between baseline and 24 weeks in the enhanced-care versus usual-care arms. There are also three substudies running in conjunction with the project examining different remuneration models, investigating patient knowledge, and assessing health-resource utilization amongst patients in each group. Discussion To date, one-third of the required sample size has been recruited. There are 15 communities and 17 pharmacists actively screening, recruiting, and following patients. This study will provide high-level evidence regarding pharmacist prescribing. Trial Registration NCT00878566.

  8. [Strategies for patient participation in continuing improvement of clinical safety]. (United States)

    Saturno, Pedro J


    Strategies for patient participation in quality improvement, as an active part of processes or providing relevant information when asked, have progressed to a great extent for the last few years, influenced by the emphasis on patient-focused care as a key dimension for quality and, lately, by the emphasis on patient safety -a dimension for which the patient contribution can not be ignored. However, these strategies have not been fully implemented and used in most quality management systems. This article aims to make it easier to select the appropriate strategies for a given context, by describing them, grouped in three main themes (mobilising patients for patient safety; promoting active participation of patients in the prevention of safety incidents; requesting and using the relevant information for quality improvement that patients can provide), illustrating them with examples, and pointing out some of the obstacles for implementing them.

  9. Why improving the safety climate doesn't always improve the safety performance

    NARCIS (Netherlands)

    Groeneweg, J.; Hudson, P.T.W.; Vandevis, T.; Lancioni, G.E.


    This paper will discuss the results of a study outside the petrochemical industry (Vandevis (2008), but the results may have a profound effect on the way organizations try to influence their safety climate by setting so called SMART goals. It was conducted within the electrical high voltage contract

  10. Improving Aviation Safety in Indonesia: How Many More Accidents?

    Directory of Open Access Journals (Sweden)

    Ridha Aditya Nugraha


    Full Text Available Numerous and consecutive aircraft accidents combined with a consistent failure to meet international safety standards in Indonesia, namely from the International Civil Aviation Organization and the European Aviation Safety Agency have proven a nightmare for the country’s aviation safety reputation. There is an urgent need for bureaucracy reform, harmonization of legislation, and especially ensuring legal enforcement, to bring Indonesian aviation safety back to world standards. The Indonesian Aviation Law of 2009 was enacted to reform the situation in Indonesia. The law has become the ground for drafting legal framework under decrees of the Minister of Transportation, which have allowed the government to perform follow-up actions such as establishing a single air navigation service provider and guaranteeing the independency of the Indonesian National Transportation Safety Committee. A comparison with Thailand is made to enrich the perspective. Finally, foreign aviation entities have a role to assist states, in this case Indonesia, in improving its aviation safety, considering the global nature of air travel.

  11. Safety risks associated with the lack of integration and interfacing of hospital health information technologies: a qualitative study of hospital electronic prescribing systems in England. (United States)

    Cresswell, Kathrin M; Mozaffar, Hajar; Lee, Lisa; Williams, Robin; Sheikh, Aziz


    Substantial sums of money are being invested worldwide in health information technology. Realising benefits and mitigating safety risks is however highly dependent on effective integration of information within systems and/or interfacing to allow information exchange across systems. As part of an English programme of research, we explored the social and technical challenges relating to integration and interfacing experienced by early adopter hospitals of standalone and hospital-wide multimodular integrated electronic prescribing (ePrescribing) systems. We collected longitudinal qualitative data from six hospitals, which we conceptualised as case studies. We conducted 173 interviews with users, implementers and software suppliers (at up to three different times), 24 observations of system use and strategic meetings, 17 documents relating to implementation plans, and 2 whole-day expert round-table discussions. Data were thematically analysed initially within and then across cases, drawing on perspectives surrounding information infrastructures. We observed that integration and interfacing problems obstructed effective information transfer in both standalone and multimodular systems, resulting in threats to patient safety emerging from the lack of availability of timely information and duplicate data entry. Interfacing problems were immediately evident in some standalone systems where users had to cope with multiple log-ins, and this did not attenuate over time. Multimodular systems appeared at first sight to obviate such problems. However, with these systems, there was a perceived lack of data coherence across modules resulting in challenges in presenting a comprehensive overview of the patient record, this possibly resulting from the piecemeal implementation of modules with different functionalities. Although it was possible to access data from some primary care systems, we found poor two-way transfer of data between hospitals and primary care necessitating

  12. Supporting the improvement and management of prescribing for urinary tract infections (SIMPle): protocol for a cluster randomized trial.

    LENUS (Irish Health Repository)

    Duane, Sinead


    The overuse of antimicrobials is recognized as the main selective pressure driving the emergence and spread of antimicrobial resistance in human bacterial pathogens. Urinary tract infections (UTIs) are among the most common infections presented in primary care and empirical antimicrobial treatment is currently recommended. Previous research has identified that a substantial proportion of Irish general practitioners (GPs) prescribe antimicrobials for UTIs that are not in accordance with the Guidelines for Antimicrobial Prescribing in Primary Care in Ireland. The aim of this trial is to design, implement and evaluate the effectiveness of a complex intervention on GP antimicrobial prescribing and adult (18 years of age and over) patients\\' antimicrobial consumption when presenting with a suspected UTI.

  13. Confidence improvement of disosal safety bydevelopement of a safety case for high-level radioactive waste disposal

    Energy Technology Data Exchange (ETDEWEB)

    Baik, Min Hoon; Ko, Nak Youl; Jeong, Jong Tae; Kim, Kyung Su [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)


    Many countries have developed a safety case suitable to their own countries in order to improve the confidence of disposal safety in deep geological disposal of high-level radioactive waste as well as to develop a disposal program and obtain its license. This study introduces and summarizes the meaning, necessity, and development process of the safety case for radioactive waste disposal. The disposal safety is also discussed in various aspects of the safety case. In addition, the status of safety case development in the foreign countries is briefly introduced for Switzerland, Japan, the United States of America, Sweden, and Finland. The strategy for the safety case development that is being developed by KAERI is also briefly introduced. Based on the safety case, we analyze the efforts necessary to improve confidence in disposal safety for high-level radioactive waste. Considering domestic situations, we propose and discuss some implementing methods for the improvement of disposal safety, such as construction of a reliable information database, understanding of processes related to safety, reduction of uncertainties in safety assessment, communication with stakeholders, and ensuring justice and transparency. This study will contribute to the understanding of the safety case for deep geological disposal and to improving confidence in disposal safety through the development of the safety case in Korea for the disposal of high-level radioactive waste.


    Energy Technology Data Exchange (ETDEWEB)



    The aim of this paper is to demonstrate the integration of safety methodology, quality tools, leadership, and teamwork at Hanford and their significant positive impact on safe performance of work. Dashboards, Leading Indicators, Control charts, Pareto Charts, Dr. W. Edward Deming's Red Bead Experiment, and Dr. Deming's System of Profound Knowledge have been the principal tools and theory of an integrated management system. Coupled with involved leadership and teamwork, they have led to significant improvements in worker safety and protection, and environmental restoration at one of the nation's largest nuclear cleanup sites.

  15. Danish initiatives to improve the safety of meat products

    DEFF Research Database (Denmark)

    Wegener, Henrik Caspar


    pathogens which are resistant to antibiotics has been a new area of attention in the recent decade, and recently, the increasing globalization of the domestic food supply has called for a complete rethinking of the national food safety strategies. The implementations of a ‘‘case-by-case” risk assessment......During the last two decades the major food safety problems in Denmark, as determined by the number of human patients, has been associated with bacterial infections stemming from meat products and eggs. The bacterial pathogens causing the majority of human infections has been Salmonella...... and Campylobacter, and to a lesser extent Yersinia, Escherichia coli O157 and Listeria. Danish initiatives to improve the safety of meat products have focused on the entire production chain from the farm to the consumer, with a special emphasis on the pre-harvest stage of production. The control of bacterial...

  16. Development of the Continued Improvement System for Nuclear Safety Culture

    Energy Technology Data Exchange (ETDEWEB)

    Park, H. C.; Park, H. G.; Park, Y. W.; Park, J. Y. [KAIST, Daejeon (Korea, Republic of)


    It has been found that almost 80 % of the incidents and accidents occurred recently, such as the Fukushima Daiichi disaster and Domestic SBO accident etc. were analyzed to be caused from human errors. (IAEA NES NG-G-2.1) Which strongly claims the importance of the safety culture system. Accordingly, it should be away from a cursory approach like one-off field survey or Snap shop which were being conducted at present for the continued improvement of safety culture. This study introduces an analytical methodology which approaches the generic form of the safety both consciously and unconsciously expressed with behavior, thoughts, and attitude etc. This study was implemented only for open materials such as Inspection report, incidents and accidents reports, QA documents because of the limitation in accessibility to data. More effective use with securing operational data will be possible in future.

  17. Prescription for antibiotics at drug shops and strategies to improve quality of care and patient safety

    DEFF Research Database (Denmark)

    Mbonye, Anthony K; Buregyeya, Esther; Rutebemberwa, Elizeus


    OBJECTIVES: The main objective of this study was to assess practices of antibiotic prescription at registered drug shops with a focus on upper respiratory tract infections among children in order to provide data for policy discussions aimed at improving quality of care and patient safety in the p......OBJECTIVES: The main objective of this study was to assess practices of antibiotic prescription at registered drug shops with a focus on upper respiratory tract infections among children in order to provide data for policy discussions aimed at improving quality of care and patient safety......, available antibiotics, knowledge on treatment of pneumonia in children aged antibiotic. RESULTS: A total of 170 registered drug shops were surveyed between August and October 2014. The majority of drug shops, 93.......5% were prescribing antibiotics, especially amoxicillin and trimethoprim-sulfamethoxazole (septrin). The professional qualification of a provider was significantly associated with this practice, p=0.04; where lower cadre staff (nursing assistants and enrolled nurses) overprescribed antibiotics. A third...

  18. Improving safety and quality: how can education help? (United States)

    Walton, Merrilyn M; Elliott, Susan L


    National efforts to improve the quality and safety of health care present challenges for medical education and training. Today's doctors need to be skilled communicators who know how to identify, prevent and manage adverse events and near misses, how to use evidence and information, how to work safely in a team, how to practise ethically, and how to be workplace teachers and learners. These competencies (knowledge, skills and attitudes) are set out in the National Patient Safety Education Framework (NPSF) of the Australian Council for Safety and Quality in Health Care. The NPSF is designed to help medical schools, vocational colleges, health organisations and private practitioners develop curricula to enable health professionals to work safely. The NPSF describes what doctors (depending on their level of knowledge and experience) can do to demonstrate competencies in a range of quality and safety activities. Medical schools, vocational colleges, health organisations and private practitioners need to work collaboratively with one another and with other health professionals to ensure that patient safety and quality curricula are implemented and evaluated, and that valid and reliable assessments of learning outcomes are developed. Interdisciplinary and vertically integrated education and training are needed, incorporating innovative methods, to create a safer health care system.

  19. Nature-Based Strategies for Improving Urban Health and Safety. (United States)

    Kondo, Michelle C; South, Eugenia C; Branas, Charles C


    Place-based programs are being noticed as key opportunities to prevent disease and promote public health and safety for populations at-large. As one key type of place-based intervention, nature-based and green space strategies can play an especially large role in improving health and safety for dwellers in urban environments such as US legacy cities that lack nature and greenery. In this paper, we describe the current understanding of place-based influences on public health and safety. We focus on nonchemical environmental factors, many of which are related to urban abandonment and blight. We then review findings from studies of nature-based interventions regarding impacts on health, perceptions of safety, and crime. Based on our findings, we suggest that further research in this area will require (1) refined measures of green space, nature, and health and safety for cities, (2) interdisciplinary science and cross-sector policy collaboration, (3) observational studies as well as randomized controlled experiments and natural experiments using appropriate spatial counterfactuals and mixed methods, and (4) return-on-investment calculations of potential economic, social, and health costs and benefits of urban greening initiatives.

  20. The role of individual diligence in improving safety. (United States)

    Corbett, Angus; Travaglia, Jo; Braithwaite, Jeffrey


    This paper aims to be a theoretical examination of the role of individuals in sponsoring and facilitating effective, systemic change in organisations. Using reports of a number of high-profile initiatives to improve patient safety, it seeks to analyse the role of individual health care professionals in developing and facilitating new systems of care that improve safety and quality. The paper uses recent work in sociology that is concerned with the phenomenon of "sociological citizenship". The authors test whether successful initiators of change in health care can be described as sociological citizens. This notion of sociological citizens is applied to a number of highly successful initiatives to improve safety and quality to extrapolate the factors associated with individual clinician leadership, which may have affected the success of such endeavours. In each of the examples analysed the initiators of change can be characterised as sociological citizens. In reviewing the roles of these charismatic individuals it is evident that they see the relational interdependence between the individuals and organisations and that they use this information to achieve both professional and organisational objectives. The paper uses a case study method to investigate the usefulness of the role of sociological citizenship in interventions that aim to improve patient safety. The paper reviews the key concepts and uses of the concept of sociological citizenship to produce a framework against which the case studies were assessed. The authors suggest that a goal of policy for improving patient safety should be directed to the problem of how hospitals and health care organisations can create the conditions for encouraging the individual diligence and care that is needed to support reliable, safe health care practices. Improving the safety and quality of health care is an important public health initiative. It has also proven to be difficult to achieve sustained reductions in the harm

  1. Improving the Safety of Oral Chemotherapy at an Academic Medical Center (United States)

    Casella, Erica; Capozzi, Donna; McGettigan, Suzanne; Gangadhar, Tara C.; Schuchter, Lynn; Myers, Jennifer S.


    Purpose: Over the last decade, the use of oral chemotherapy (OC) for the treatment of cancer has dramatically increased. Despite their route of administration, OCs pose many of the same risks as intravenous agents. In this quality improvement project, we sought to examine our current process for the prescription of OC at the Abramson Cancer Center of the University of Pennsylvania and to improve on its safety. Methods: A multidisciplinary team that included oncologists, advanced-practice providers, and pharmacists was formed to analyze the current state of our OC practice. Using Lean Six Sigma quality improvement tools, we identified a lack of pharmacist review of the OC prescription as an area for improvement. To address these deficiencies, we used our electronic medical system to route OC orders placed by treating providers to an oncology-specific outpatient pharmacist at the Abramson Cancer Center for review. Results: Over 7 months, 63 orders for OC were placed for 45 individual patients. Of the 63 orders, all were reviewed by pharmacists, and, as a result, 22 interventions were made (35%). Types of interventions included dosage adjustment (one of 22), identification of an interacting drug (nine of 22), and recommendations for additional drug monitoring (12 of 22). Conclusion: OC poses many of the same risks as intravenous chemotherapy and should be prescribed and reviewed with the same oversight. At our institution, involvement of an oncology-trained pharmacist in the review of OC led to meaningful interventions in one third of the orders. PMID:26733627

  2. Do clinical safety charts improve paramedic key performance indicator results? (A clinical improvement programme evaluation). (United States)

    Ebbs, Phillip; Middleton, Paul M; Bonner, Ann; Loudfoot, Allan; Elliott, Peter


    Is the Clinical Safety Chart clinical improvement programme (CIP) effective at improving paramedic key performance indicator (KPI) results within the Ambulance Service of New South Wales? The CIP intervention area was compared with the non-intervention area in order to determine whether there was a statistically significant improvement in KPI results. The CIP was associated with a statistically significant improvement in paramedic KPI results within the intervention area. The strategies used within this CIP are recommended for further consideration.

  3. Implementing electronic handover: interventions to improve efficiency, safety and sustainability. (United States)

    Alhamid, Sharifah Munirah; Lee, Desmond Xue-Yuan; Wong, Hei Man; Chuah, Matthew Bingfeng; Wong, Yu Jun; Narasimhalu, Kaavya; Tan, Thuan Tong; Low, Su Ying


    Effective handovers are critical for patient care and safety. Electronic handover tools are increasingly used today to provide an effective and standardized platform for information exchange. The implementation of an electronic handover system in tertiary hospitals can be a major challenge. Previous efforts in implementing an electronic handover tool failed due to poor compliance and buy-in from end-users. A new electronic handover tool was developed and incorporated into the existing electronic medical records (EMRs) for medical patients in Singapore General Hospital (SGH). There was poor compliance by on-call doctors in acknowledging electronic handovers, and lack of adherence to safety rules, raising concerns about the safety and efficiency of the electronic handover tool. Urgent measures were needed to ensure its safe and sustained use. A quality improvement group comprising stakeholders, including end-users, developed multi-faceted interventions using rapid PDSA (P-Plan, D-Do, S-Study, A-Act ) cycles to address these issues. Innovative solutions using media and online software provided cost-efficient measures to improve compliance. The percentage of unacknowledged handovers per day was used as the main outcome measure throughout all PDSA cycles. Doctors were also assessed for improvement in their knowledge of safety rules and their perception of the electronic handover tool. An electronic handover tool complementing daily clinical practice can be successfully implemented using solutions devised through close collaboration with end-users supported by the senior leadership. A combined 'bottom-up' and 'top-down' approach with regular process evaluations is crucial for its long-term sustainability. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail:

  4. Chest drain care bundle: Improving documentation and safety. (United States)

    Hutton, Joe; Graham, Selina


    Chest drain insertion is a common advanced procedure with a significant associated risk of pain, distress, and complications. Nationally, audit and recommendations from leading bodies have highlighted a number of safety concerns around chest drain insertion. Audit work has demonstrated poor levels of documentation; particularly around use of premedication, use of ultrasound guidance and consent. This has obvious potential consequences for patient safety and thus is an important target for improvement work. This project quantifies current standards of documentation and aims to improve this through a combination of accessible and easy to read guidelines, education, and the introduction of a chest drain insertion bundle. National best practice standards were identified through review of national guidance. Drain insertion was prospectively analysed over a three month period to establish baseline standards of documentation. This initial work was presented and a bundle and clinical guidelines produced. Chest drain insertion was then reaudited and assessed for improvement. Results demonstrated an improvement in many areas of documentation, pushing local results above the national average. However, only 40% of cases used the new bundle due to a mixture of staff rotation and an unexpectedly high proportion of drains inserted in non targeted areas including the emergency department, theatre, and intensive care. Despite this, the introduction of accessible guidance and bundle has significantly improved chest drain insertion documentation to the benefit of all.

  5. Trends in depression and antidepressant prescribing in children and adolescents: a cohort study in The Health Improvement Network (THIN).


    Wijlaars, L. P.; I. Nazareth; Petersen, I.


    In 2003, the Committee on Safety of Medicines (CSM) advised against treatment with selective serotonin reuptake inhibitors (SSRIs) other than fluoxetine in children, due to a possible increased risk of suicidal behaviour. This study examined the effects of this safety warning on general practitioners' depression diagnosing and prescription behaviour in children.

  6. Quality assurance of radiotherapy in cancer treatment: toward improvement of patient safety and quality of care. (United States)

    Ishikura, Satoshi


    The process of radiotherapy (RT) is complex and involves understanding of the principles of medical physics, radiobiology, radiation safety, dosimetry, radiation treatment planning, simulation and interaction of radiation with other treatment modalities. Each step in the integrated process of RT needs quality control and quality assurance (QA) to prevent errors and to give high confidence that patients will receive the prescribed treatment correctly. Recent advances in RT, including intensity-modulated and image-guided RT, focus on the need for a systematic RTQA program that balances patient safety and quality with available resources. It is necessary to develop more formal error mitigation and process analysis methods, such as failure mode and effect analysis, to focus available QA resources optimally on process components. External audit programs are also effective. The International Atomic Energy Agency has operated both an on-site and off-site postal dosimetry audit to improve practice and to assure the dose from RT equipment. Several countries have adopted a similar approach for national clinical auditing. In addition, clinical trial QA has a significant role in enhancing the quality of care. The Advanced Technology Consortium has pioneered the development of an infrastructure and QA method for advanced technology clinical trials, including credentialing and individual case review. These activities have an impact not only on the treatment received by patients enrolled in clinical trials, but also on the quality of treatment administered to all patients treated in each institution, and have been adopted globally; by the USA, Europe and Japan also.

  7. Using total quality management approach to improve patient safety by preventing medication error incidences(*). (United States)

    Yousef, Nadin; Yousef, Farah


    Whereas one of the predominant causes of medication errors is a drug administration error, a previous study related to our investigations and reviews estimated that the incidences of medication errors constituted 6.7 out of 100 administrated medication doses. Therefore, we aimed by using six sigma approach to propose a way that reduces these errors to become less than 1 out of 100 administrated medication doses by improving healthcare professional education and clearer handwritten prescriptions. The study was held in a General Government Hospital. First, we systematically studied the current medication use process. Second, we used six sigma approach by utilizing the five-step DMAIC process (Define, Measure, Analyze, Implement, Control) to find out the real reasons behind such errors. This was to figure out a useful solution to avoid medication error incidences in daily healthcare professional practice. Data sheet was used in Data tool and Pareto diagrams were used in Analyzing tool. In our investigation, we reached out the real cause behind administrated medication errors. As Pareto diagrams used in our study showed that the fault percentage in administrated phase was 24.8%, while the percentage of errors related to prescribing phase was 42.8%, 1.7 folds. This means that the mistakes in prescribing phase, especially because of the poor handwritten prescriptions whose percentage in this phase was 17.6%, are responsible for the consequent) mistakes in this treatment process later on. Therefore, we proposed in this study an effective low cost strategy based on the behavior of healthcare workers as Guideline Recommendations to be followed by the physicians. This method can be a prior caution to decrease errors in prescribing phase which may lead to decrease the administrated medication error incidences to less than 1%. This improvement way of behavior can be efficient to improve hand written prescriptions and decrease the consequent errors related to administrated

  8. A leadership initiative to improve communication and enhance safety. (United States)

    Donahue, Moreen; Miller, Matthew; Smith, Lisa; Dykes, Patricia; Fitzpatrick, Joyce J


    The EMPOWER project was a collaborative effort to promote a culture of patient safety at Danbury Hospital through an interdisciplinary leadership-driven communication program. The "EMPOWER" component includes Educating and Mentoring Paraprofessionals On Ways to Enhance Reporting of changes in patient status. Specifically, the EMPOWER program was designed to prepare paraprofessional staff (PPS) to communicate changes in patient status using SBAR (situation, background, assessment, recommendations) structured communication. The specific project goals included (a) translation of SBAR structured communication methods for use with PPS, (b) reduction of cultural and educational barriers to interdisciplinary communication, and (c) examination of the effect of the EMPOWER intervention on the PPS communication practices and perceptions of the patient safety culture. Results of the project indicate a change in the use of SBAR throughout the institution, with particular improvement in communication from PPS to professional staff.

  9. Pharmacist independent prescribing in secondary care: opportunities and challenges. (United States)

    Bourne, Richard S; Baqir, Wasim; Onatade, Raliat


    In recent years a number of countries have extended prescribing rights to pharmacists in a variety of formats. The latter includes independent prescribing, which is a developing area of practice for pharmacists in secondary care. Potential opportunities presented by wide scale implementation of pharmacist prescribing in secondary care include improved prescribing safety, more efficient pharmacist medication reviews, increased scope of practice with greater pharmacist integration into acute patient care pathways and enhanced professional or job satisfaction. However, notable challenges remain and these need to be acknowledged and addressed if a pharmacist prescribing is to develop sufficiently within developing healthcare systems. These barriers can be broadly categorised as lack of support (financial and time resources), medical staff acceptance and the pharmacy profession itself (adoption, implementation strategy, research resources, second pharmacist clinical check). Larger multicentre studies that investigate the contribution of hospital-based pharmacist prescribers to medicines optimisation and patient-related outcomes are still needed. Furthermore, a strategic approach from the pharmacy profession and leadership is required to ensure that pharmacist prescribers are fully integrated into future healthcare service and workforce strategies.

  10. Does lean management improve patient safety culture? An extensive evaluation of safety culture in a radiotherapy institute. (United States)

    Simons, Pascale A M; Houben, Ruud; Vlayen, Annemie; Hellings, Johan; Pijls-Johannesma, Madelon; Marneffe, Wim; Vandijck, Dominique


    The importance of a safety culture to maximize safety is no longer questioned. However, achieving sustainable culture improvements are less evident. Evidence is growing for a multifaceted approach, where multiple safety interventions are combined. Lean management is such an integral approach to improve safety, quality and efficiency and therefore, could be expected to improve the safety culture. This paper presents the effects of lean management activities on the patient safety culture in a radiotherapy institute. Patient safety culture was evaluated over a three year period using triangulation of methodologies. Two surveys were distributed three times, workshops were performed twice, data from an incident reporting system (IRS) was monitored and results were explored using structured interviews with professionals. Averages, chi-square, logistical and multi-level regression were used for analysis. The workshops showed no changes in safety culture, whereas the surveys showed improvements on six out of twelve dimensions of safety climate. The intention to report incidents not reaching patient-level decreased in accordance with the decreasing number of reports in the IRS. However, the intention to take action in order to prevent future incidents improved (factorial survey presented β: 1.19 with p: 0.01). Due to increased problem solving and improvements in equipment, the number of incidents decreased. Although the intention to report incidents not reaching patient-level decreased, employees experienced sustained safety awareness and an increased intention to structurally improve. The patient safety culture improved due to the lean activities combined with an organizational restructure, and actual patient safety outcomes might have improved as well. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Selection of indicators for continuous monitoring of patient safety: recommendations of the project 'safety improvement for patients in Europe'

    DEFF Research Database (Denmark)

    Kristensen, Solvejg; Mainz, Jan; Bartels, Paul


    BACKGROUND: Initiatives to improve patient safety have high priority among health professionals and politicians in most developed countries. Currently, however, assessment of patient safety problems relies mainly on case-based methodologies. The evidence for their efficiency and reproducibility......, proving that safety of care has improved with their usage, is questionable. The exact incidence and prevalence of patient safety quality problems are unknown. Therefore, there is a need for firm, evidence-based methods to survey and develop patient safety and derived activities. OBJECTIVE: The objective...... of this paper is to describe a method to select patient safety indicators and present the indicators derived through this process. METHODS: The patient safety indicators were derived and recommended for use in a formalized consensus process based on literature review, targeted information gathering, expert...

  12. Improved analysis of bias in Monte Carlo criticality safety (United States)

    Haley, Thomas C.


    Criticality safety, the prevention of nuclear chain reactions, depends on Monte Carlo computer codes for most commercial applications. One major shortcoming of these codes is the limited accuracy of the atomic and nuclear data files they depend on. In order to apply a code and its data files to a given criticality safety problem, the code must first be benchmarked against similar problems for which the answer is known. The difference between a code prediction and the known solution is termed the "bias" of the code. Traditional calculations of the bias for application to commercial criticality problems are generally full of assumptions and lead to large uncertainties which must be conservatively factored into the bias as statistical tolerances. Recent trends in storing commercial nuclear fuel---narrowed regulatory margins of safety, degradation of neutron absorbers, the desire to use higher enrichment fuel, etc.---push the envelope of criticality safety. They make it desirable to minimize uncertainty in the bias to accommodate these changes, and they make it vital to understand what assumptions are safe to make under what conditions. A set of improved procedures is proposed for (1) developing multivariate regression bias models, and (2) applying multivariate regression bias models. These improved procedures lead to more accurate estimates of the bias and much smaller uncertainties about this estimate, while also generally providing more conservative results. The drawback is that the procedures are not trivial and are highly labor intensive to implement. The payback in savings in margin to criticality and conservatism for calculations near regulatory and safety limits may be worth this cost. To develop these procedures, a bias model using the statistical technique of weighted least squares multivariate regression is developed in detail. Problems that can occur from a weak statistical analysis are highlighted, and a solid statistical method for developing the bias

  13. Improving antibiotic prescribing for adults with community acquired pneumonia: Does a computerised decision support system achieve more than academic detailing alone? – a time series analysis

    Directory of Open Access Journals (Sweden)

    Black James F


    Full Text Available Abstract Background The ideal method to encourage uptake of clinical guidelines in hospitals is not known. Several strategies have been suggested. This study evaluates the impact of academic detailing and a computerised decision support system (CDSS on clinicians' prescribing behaviour for patients with community acquired pneumonia (CAP. Methods The management of all patients presenting to the emergency department over three successive time periods was evaluated; the baseline, academic detailing and CDSS periods. The rate of empiric antibiotic prescribing that was concordant with recommendations was studied over time comparing pre and post periods and using an interrupted time series analysis. Results The odds ratio for concordant therapy in the academic detailing period, after adjustment for age, illness severity and suspicion of aspiration, compared with the baseline period was OR = 2.79 [1.88, 4.14], p Conclusion Deployment of a computerised decision support system was associated with an early improvement in antibiotic prescribing practices which was greater than the changes seen with academic detailing. The sustainability of this intervention requires further evaluation.

  14. [Walkrounds and briefings in the improvement of the patient safety]. (United States)

    Menéndez, M D; Martínez, A B; Fernandez, M; Ortega, N; Díaz, J M; Vazquez, F


    Training, to increase the safety culture, the reporting of adverse events, and to implement improvements using WalkRounds and Briefings. Monte Naranco Hospital, hospital with 200 beds and mainly with geriatric patients. Patient safety surveys and evaluations of the leaders. face-to-face 1/2h interviews with the healthworkers (3-5 people), and in the changes of shifts from 2004-2009. Analysis tools: a) Patient safety surveys (University of Texas and Agency for Healthcare Research and Quality - AHRQ); b) WalkRounds and Briefings forms; c) classification of contributory factors, and the severity of adverse events. Surveys were conduted on 36.9% and 33.8% of the healthworkers, respectively). WalkRounds training: 84 healthworkers. Number of WalkRounds: with Pharmacy Service (493), and with Patient Complaints Service (147), and Briefings: 307. Reporting of adverse events: Medication errors (71.1%), equipment (7.2%), others (21.7%). Contributory factors Working environment (30.1%), work team (29.2%), others (40.7%). In the post-briefing survey 86.7% of the healthworkers thought that it was a useful tool. New needs: feedback of the personnel with control charts. WalkRounds and Briefings allow a higher number of adverse events (more than 20%) to be detected, and are useful for the training of healthworkers. There is better feedback and there was less problems with equipment and outpatient units. Face-to-face communication with the healthworkers is a key element in patient safety and helps to know the needs to the front line wards.

  15. 78 FR 55257 - Patient Safety and Quality Improvement: Civil Money Penalty Inflation Adjustment (United States)


    ... HUMAN SERVICES Patient Safety and Quality Improvement: Civil Money Penalty Inflation Adjustment AGENCY... provisions of the Patient Safety and Quality Improvement Rule is not required at this time. FOR FURTHER... and Quality and Improvement Act of 2005 (Patient Safety Act), 42 U.S.C. 299b-21 to 299b-26, amended...

  16. Vector Design for Improved DNA Vaccine Efficacy, Safety and Production

    Directory of Open Access Journals (Sweden)

    James A. Williams


    Full Text Available DNA vaccination is a disruptive technology that offers the promise of a new rapidly deployed vaccination platform to treat human and animal disease with gene-based materials. Innovations such as electroporation, needle free jet delivery and lipid-based carriers increase transgene expression and immunogenicity through more effective gene delivery. This review summarizes complementary vector design innovations that, when combined with leading delivery platforms, further enhance DNA vaccine performance. These next generation vectors also address potential safety issues such as antibiotic selection, and increase plasmid manufacturing quality and yield in exemplary fermentation production processes. Application of optimized constructs in combination with improved delivery platforms tangibly improves the prospect of successful application of DNA vaccination as prophylactic vaccines for diverse human infectious disease targets or as therapeutic vaccines for cancer and allergy.

  17. Using a Training Video to Improve Agricultural Workers' Knowledge of On-Farm Food Safety (United States)

    Mathiasen, Lisa; Morley, Katija; Chapman, Benjamin; Powell, Douglas


    A training video was produced and evaluated to assess its impact on the food safety knowledge of agricultural workers. Increasing food safety knowledge on the farm may help to improve the safety of fresh produce. Surveys were used to measure workers' food safety knowledge before and after viewing the video. Focus groups were used to determine…

  18. Using a Training Video to Improve Agricultural Workers' Knowledge of On-Farm Food Safety (United States)

    Mathiasen, Lisa; Morley, Katija; Chapman, Benjamin; Powell, Douglas


    A training video was produced and evaluated to assess its impact on the food safety knowledge of agricultural workers. Increasing food safety knowledge on the farm may help to improve the safety of fresh produce. Surveys were used to measure workers' food safety knowledge before and after viewing the video. Focus groups were used to determine…

  19. South Ukraine NPP: Safety improvements through Plant Computer upgrade

    Energy Technology Data Exchange (ETDEWEB)

    Brenman, O. [Westinghouse Electric Company, 4350 Northern Pike, Monroeville, PA 15146 (United States); Chernyshov, M. A. [Westron, LLC, 1 Acad. Proskura St., Kharkiv 61070 (Ukraine); Denning, R. S. [Battelle, 505 King Ave, Columbus, OH 43201 (United States); Kolesov, S. A. [NAEK Energoatom, 3 Vetrov Str., Kiev, 01032 (Ukraine); Balakan, H. H.; Bilyk, B. I.; Kuznetsov, V. I. [PO South Ukraine NPP, NAEK Energoatom, Mylolayv Region, 55000 (Ukraine); Trosman, G. [US Dept. of Energy, International Nuclear Safety Program, Washington, DC 20585 (United States)


    This paper summarizes some results of the Plant Computer upgrade at the Units 2 and 3 of South Ukraine Nuclear Power Plant (NPP). A Plant Computer, which is also called the Computer Information System (CIS), is one of the key safety-related systems at VVER-1000 nuclear plants. The main function of the CIS is information support for the plant operators during normal and emergency operational modes. Before this upgrade, South Ukraine NPP operated out-of-date and obsolete systems. This upgrade project wax founded by the U.S. DOE in the framework of the International Nuclear Safety Program (INSP). The most efficient way to improve the quality and reliability of information provided to the plant operator is to upgrade the Human-System Interface (HSI), which is the Upper Level (UL) CIS. The upgrade of the CIS data-acquisition system (DAS), which is the Lower Level (LL) CIS, would have less effect on the unit safety. Generally speaking, the lifetime of the LL CIS is much higher than one of the UL CIS. Unlike Plant Computers at the Western-designed plants, the functionality of the WER-1000 CISs includes a control function (Centralized Protection Testing) and a number of the plant equipment monitoring functions, for example, Protection and Interlock Monitoring and Turbo-Generator Temperature Monitoring. The new system is consistent with a historical migration of the format by which information is presented to the operator away from the traditional graphic displays, for example, Piping and Instrument Diagrams (P and ID's), toward Integral Data displays. The cognitive approach to information presentation is currently limited by some licensing issues, but is adapted to a greater degree with each new system. The paper provides some lessons learned on the management of the international team. (authors)

  20. Building a Safer NHS for Patient. Improving Medication Safety

    Directory of Open Access Journals (Sweden)

    Laura Murianni


    Full Text Available

    Medication errors occur in all health care systems and in all health care settings. If the errors are identified through an active management and effective reporting system they can be removed before they can cause harm to patients. In order to reduce the risk it is important to understand the causes of medication errors.

    The NHS Report aims to provide a guide to current knowledge of the frequency, nature and causes of errors, the risk factors inherent in current medication processes and helping the NHS organizations and health professionals in achieving a reduction in serious medication errors. In July 2001 the UK Government established the National Patient Safety Agency (NPSA, http:// which, in 2004, implemented a national reporting and learning system to enable the NHS to report all type of adverse incidents including those involving medicines. The NPSA core purpose is to improve patient safety and to accomplish this task; it looks at the identification of patterns and trends in avoidable adverse events so that the NHS can entrust practice and management to reduce the risk of recurrence. Before the establishment of the NPSA, there had been no attempt to establish a unified mechanism for reporting and analyzing medication errors. Despite the many published studies there is no clear definition for medication errors and thus they do not distinguish between errors and adverse drug reactions. The Report defines and highlights the differences between medical errors and drug reactions.

  1. Application of Bow-tie methodology to improve patient safety. (United States)

    Abdi, Zhaleh; Ravaghi, Hamid; Abbasi, Mohsen; Delgoshaei, Bahram; Esfandiari, Somayeh


    Purpose - The purpose of this paper is to apply Bow-tie methodology, a proactive risk assessment technique based on systemic approach, for prospective analysis of the risks threatening patient safety in intensive care unit (ICU). Design/methodology/approach - Bow-tie methodology was used to manage clinical risks threatening patient safety by a multidisciplinary team in the ICU. The Bow-tie analysis was conducted on incidents related to high-alert medications, ventilator associated pneumonia, catheter-related blood stream infection, urinary tract infection, and unwanted extubation. Findings - In total, 48 potential adverse events were analysed. The causal factors were identified and classified into relevant categories. The number and effectiveness of existing preventive and protective barriers were examined for each potential adverse event. The adverse events were evaluated according to the risk criteria and a set of interventions were proposed with the aim of improving the existing barriers or implementing new barriers. A number of recommendations were implemented in the ICU, while considering their feasibility. Originality/value - The application of Bow-tie methodology led to practical recommendations to eliminate or control the hazards identified. It also contributed to better understanding of hazard prevention and protection required for safe operations in clinical settings.

  2. [Human factors and crisis resource management: improving patient safety]. (United States)

    Rall, M; Oberfrank, S


    A continuing high number of patients suffer harm from medical treatment. In 60-70% of the cases the sources of harm can be attributed to the field of human factors (HFs) and teamwork; nevertheless, those topics are still neither part of medical education nor of basic and advanced training even though it has been known for many years and it has meanwhile also been demonstrated for surgical specialties that training in human factors and teamwork considerably reduces surgical mortality.Besides the medical field, the concept of crisis resource management (CRM) has already proven its worth in many other industries by improving teamwork and reducing errors in the domain of human factors. One of the best ways to learn about CRM and HFs is realistic simulation team training with well-trained instructors in CRM and HF. The educational concept of the HOTT (hand over team training) courses for trauma room training offered by the DGU integrates these elements based on the current state of science. It is time to establish such training for all medical teams in emergency medicine and operative care. Accompanying safety measures, such as the development of a positive culture of safety in every department and the use of effective critical incident reporting systems (CIRs) should be pursued.

  3. Suboptimal Use of Oral Anticoagulants in Atrial Fibrillation: Has the Introduction of Direct Oral Anticoagulants Improved Prescribing Practices? (United States)

    Alamneh, Endalkachew A; Chalmers, Leanne; Bereznicki, Luke R


    Atrial fibrillation (AF) and the associated risk of stroke are emerging epidemics throughout the world. Suboptimal use of oral anticoagulants for stroke prevention has been widely reported from observational studies. In recent years, direct oral anticoagulants (DOACs) have been introduced for thromboprophylaxis. We conducted a systematic literature review to evaluate current practices of anticoagulation in AF, pharmacologic features and adoption patterns of DOACs, their impacts on proportion of eligible patients with AF who receive oral anticoagulants, persisting challenges and future prospects for optimal anticoagulation. In conducting this review, we considered the results of relevant prospective and retrospective observational studies from real-world practice settings. PubMed (MEDLINE), Scopus (RIS), Google Scholar, EMBASE and Web of Science were used to source relevant literature. There were no date limitations, while language was limited to English. Selection was limited to articles from peer reviewed journals and related to our topic. Most studies identified in this review indicated suboptimal use of anticoagulants is a persisting challenge despite the availability of DOACs. Underuse of oral anticoagulants is apparent particularly in patients with a high risk of stroke. DOAC adoption trends are quite variable, with slow integration into clinical practice reported in most countries; there has been limited impact to date on prescribing practice. Available data from clinical practice suggest that suboptimal oral anticoagulant use in patients with AF and poor compliance with guidelines still remain commonplace despite transition to a new era of anticoagulation featuring DOACs.

  4. Improvement of driving safety in road traffic system

    Institute of Scientific and Technical Information of China (English)

    Li Ke-Ping; Gao Zi-You


    A road traffic system is a complex system in which humans participate directly. In this system, human factors play a very important role. In this paper, a kind of control signal is designated at a given site (i.e., signal point) of the road. Under the effect of the control signal, the drivers will decrease their velocities when their vehicles pass the signal point. Our aim is to transit the traffic flow states from disorder to order, and then improve the traffic safety.We have tested this technique for the two-lane traffic model that is based on the deterministic Nagel-Schreckenberg (NaSch) traffic model. The simulation results indicate that the traffic flow states can be transited from disorder to order. Different order states can be observed in the system, and these states are safer.

  5. Material Gradients in Oxygen System Components Improve Safety (United States)

    Forsyth, Bradley S.


    Oxygen system components fabricated by Laser Engineered Net Shaping (TradeMark) (LENS(TradeMark)) could result in improved safety and performance. LENS(TradeMark) is a near-net shape manufacturing process fusing powdered materials injected into a laser beam. Parts can be fabricated with a variety of elemental metals, alloys, and nonmetallic materials without the use of a mold. The LENS(TradeMark) process allows the injected materials to be varied throughout a single workpiece. Hence, surfaces exposed to oxygen could be constructed of an oxygen-compatible material while the remainder of the part could be one chosen for strength or reduced weight. Unlike conventional coating applications, a compositional gradient would exist between the two materials, so no abrupt material boundary exists. Without an interface between dissimilar materials, there is less tendency for chipping or cracking associated with thermal-expansion mismatches.

  6. European consumer response to packaging technologies for improved beef safety. (United States)

    Van Wezemael, Lynn; Ueland, Øydis; Verbeke, Wim


    Beef packaging can influence consumer perceptions of beef. Although consumer perceptions and acceptance are considered to be among the most limiting factors in the application of new technologies, there is a lack of knowledge about the acceptability to consumers of beef packaging systems aimed at improved safety. This paper explores European consumers' acceptance levels of different beef packaging technologies. An online consumer survey was conducted in five European countries (n=2520). Acceptance levels among the sample ranged between 23% for packaging releasing preservative additives up to 73% for vacuum packaging. Factor analysis revealed that familiar packaging technologies were clearly preferred over non-familiar technologies. Four consumer segments were identified: the negative (31% of the sample), cautious (30%), conservative (17%) and enthusiast (22%) consumers, which were profiled based on their attitudes and beef consumption behaviour. Differences between consumer acceptance levels should be taken into account while optimising beef packaging and communicating its benefits.

  7. Improving the safety of remote site emergency airway management. (United States)

    Wijesuriya, Julian; Brand, Jonathan


    Airway management, particularly in non-theatre settings, is an area of anaesthesia and critical care associated with significant risk of morbidity & mortality, as highlighted during the 4th National Audit Project of the Royal College of Anaesthetists (NAP4). A survey of junior anaesthetists at our hospital highlighted a lack of confidence and perceived lack of safety in emergency airway management, especially in non-theatre settings. We developed and implemented a multifaceted airway package designed to improve the safety of remote site airway management. A Rapid Sequence Induction (RSI) checklist was developed; this was combined with new advanced airway equipment and drugs bags. Additionally, new carbon dioxide detector filters were procured in order to comply with NAP4 monitoring recommendations. The RSI checklists were placed in key locations throughout the hospital and the drugs and advanced airway equipment bags were centralised in the Intensive Care Unit (ICU). It was agreed with the senior nursing staff that an appropriately trained ICU nurse would attend all emergency situations with new airway resources upon request. Departmental guidelines were updated to include details of the new resources and the on-call anaesthetist's responsibilities regarding checks and maintenance. Following our intervention trainees reported higher confidence levels regarding remote site emergency airway management. Nine trusts within the Northern Region were surveyed and we found large variations in the provision of remote site airway management resources. Complications in remote site airway management due lack of available appropriate drugs, equipment or trained staff are potentially life threatening and completely avoidable. Utilising the intervention package an anaesthetist would be able to safely plan and prepare for airway management in any setting. They would subsequently have the drugs, equipment, and trained assistance required to manage any difficulties or complications

  8. Investigating and improving pedestrian safety in an urban environment. (United States)

    Pollack, Keshia M; Gielen, Andrea C; Mohd Ismail, Mohd Nasir; Mitzner, Molly; Wu, Michael; Links, Jonathan M


    Prompted by a series of fatal and nonfatal pedestrian-vehicle collisions, university leadership from one urban institution collaborated with its academic injury research center to investigate traffic-related hazards facing pedestrians. This descriptive epidemiologic study used multiple data collection strategies to determine the burden of pedestrian injury in the target area. Data were collected in 2011 through a review of university crash reports from campus police; a systematic environmental audit and direct observations using a validated instrument and trained raters; and focus groups with faculty, students, and staff. Study findings were synthesized and evidence-informed recommendations were developed and disseminated to university leadership. Crash reports provided some indication of the risks on the streets adjacent to the campus. The environmental audit identified a lack of signage posting the speed limit, faded crosswalks, issues with traffic light and walk sign synchronization, and limited formal pedestrian crossings, which led to jaywalking. Focus groups participants described dangerous locations and times, signal controls and signage, enforcement of traffic laws, use of cell phones and iPods, and awareness of pedestrian safety. Recommendations to improve pedestrian safety were developed in accordance with the three E's of injury prevention (education, enforcement, and engineering), and along with plans for implementation and evaluation, were presented to university leadership. These results underscore the importance of using multiple methods to understand fully the problem, developing pragmatic recommendations that align with the three E's of injury prevention, and collaborating with leadership who have the authority to implement recommended injury countermeasures. These lessons are relevant for the many colleges and universities in urban settings where a majority of travel to offices, classrooms, and surrounding amenities are by foot.

  9. Improving the safety of oral immunotherapy for food allergy. (United States)

    Vazquez-Ortiz, Marta; Turner, Paul J


    Food allergy is a major public health problem in children, impacting upon the affected individual, their families and others charged with their care, for example educational establishments, and the food industry. In contrast to most other paediatric diseases, there is no established cure: current management is based upon dietary avoidance and the provision of rescue medication in the event of accidental reactions, which are common. This strategy has significant limitations and impacts adversely on health-related quality of life. In the last decade, research into disease-modifying treatments for food allergy has emerged, predominantly for peanut, egg and cow's milk. Most studies have used the oral route (oral immunotherapy, OIT), in which increasing amounts of allergen are given over weeks-months. OIT has proven effective to induce immune modulation and 'desensitization' - that is, an increase in the amount of food allergen that can be consumed, so long as regular (typically daily) doses are continued. However, its ability to induce permanent tolerance once ongoing exposure has stopped seems limited. Additionally, the short- and long-term safety of OIT is often poorly reported, raising concerns about its implementation in routine practice. Most patients experience allergic reactions and, although generally mild, severe reactions have occurred. Long-term adherence is unclear, which rises concerns given the low rates of long-term tolerance induction. Current research focuses on improving current limitations, especially safety. Strategies include alternative routes (sublingual, epicutaneous), modified hypoallergenic products and adjuvants (anti-IgE, pre-/probiotics). Biomarkers of safe/successful OIT are also under investigation.

  10. Rational prescribing in primary care (RaPP: economic evaluation of an intervention to improve professional practice.

    Directory of Open Access Journals (Sweden)

    Atle Fretheim


    761,998 US dollars, or 540 US dollars per practice after 2 y. In this scenario the savings exceeded the costs in all but two of the sensitivity analyses we conducted, and the cost-effectiveness was estimated to be 183 US dollars. CONCLUSIONS: We found a significant shift in prescribing of antihypertensive drugs towards the use of thiazides in our trial. A major reason to promote the use of thiazides is their lower price compared to other drugs. The cost of the intervention was more than twice the savings within the time frame of our study. However, we predict modest savings over a 2-y period.

  11. Process evaluation of the Data-driven Quality Improvement in Primary Care (DQIP) trial: case study evaluation of adoption and maintenance of a complex intervention to reduce high-risk primary care prescribing (United States)

    Dreischulte, Tobias; Guthrie, Bruce


    Objective To explore how different practices responded to the Data-driven Quality Improvement in Primary Care (DQIP) intervention in terms of their adoption of the work, reorganisation to deliver the intended change in care to patients, and whether implementation was sustained over time. Design Mixed-methods parallel process evaluation of a cluster trial, reporting the comparative case study of purposively selected practices. Setting Ten (30%) primary care practices participating in the trial from Scotland, UK. Results Four practices were sampled because they had large rapid reductions in targeted prescribing. They all had internal agreement that the topic mattered, made early plans to implement including assigning responsibility for work and regularly evaluated progress. However, how they internally organised the work varied. Six practices were sampled because they had initial implementation failure. Implementation failure occurred at different stages depending on practice context, including internal disagreement about whether the work was worthwhile, and intention but lack of capacity to implement or sustain implementation due to unfilled posts or sickness. Practice context was not fixed, and most practices with initial failed implementation adapted to deliver at least some elements. All interviewed participants valued the intervention because it was an innovative way to address on an important aspect of safety (although one of the non-interviewed general practitioners in one practice disagreed with this). Participants felt that reviewing existing prescribing did influence their future initiation of targeted drugs, but raised concerns about sustainability. Conclusions Variation in implementation and effectiveness was associated with differences in how practices valued, engaged with and sustained the work required. Initial implementation failure varied with practice context, but was not static, with most practices at least partially implementing by the end of the

  12. Prescribing of Rosiglitazone and Pioglitazone Following Safety Signals Analysis of Trends in Dispensing Patterns in the Netherlands from 1998 to 2008

    NARCIS (Netherlands)

    Ruiter, Rikje; Visser, Loes E.; van Herk-Sukel, Myrthe P. P.; Geelhoed-Duijvestijn, Petronella H.; de Bie, Sandra; Straus, Sabine M. J. M.; Mol, Peter G. M.; Romio, Silvana A.; Herings, Ron M. C.; Stricker, Bruno H. Ch.


    Background: Relevant safety signals in the EU are regularly communicated in so-called 'Direct Healthcare Professional Communications' (DHPCs) or European Medicines Agency (EMA) press releases. Trends of a decrease in the use of rosiglitazone following regulatory safety warnings have been described i

  13. Prescribing of Rosiglitazone and Pioglitazone Following Safety Signals Analysis of Trends in Dispensing Patterns in the Netherlands from 1998 to 2008

    NARCIS (Netherlands)

    Ruiter, Rikje; Visser, Loes E.; van Herk-Sukel, Myrthe P. P.; Geelhoed-Duijvestijn, Petronella H.; de Bie, Sandra; Straus, Sabine M. J. M.; Mol, Peter G. M.; Romio, Silvana A.; Herings, Ron M. C.; Stricker, Bruno H. Ch.


    Background: Relevant safety signals in the EU are regularly communicated in so-called 'Direct Healthcare Professional Communications' (DHPCs) or European Medicines Agency (EMA) press releases. Trends of a decrease in the use of rosiglitazone following regulatory safety warnings have been described

  14. Improving appropriate polypharmacy for older people in primary care: selecting components of an evidence-based intervention to target prescribing and dispensing. (United States)

    Cadogan, Cathal A; Ryan, Cristín; Francis, Jill J; Gormley, Gerard J; Passmore, Peter; Kerse, Ngaire; Hughes, Carmel M


    The use of multiple medicines (polypharmacy) is increasingly common in older people. Ensuring that patients receive the most appropriate combinations of medications (appropriate polypharmacy) is a significant challenge. The quality of evidence to support the effectiveness of interventions to improve appropriate polypharmacy is low. Systematic identification of mediators of behaviour change, using the Theoretical Domains Framework (TDF), provides a theoretically robust evidence base to inform intervention design. This study aimed to (1) identify key theoretical domains that were perceived to influence the prescribing and dispensing of appropriate polypharmacy to older patients by general practitioners (GPs) and community pharmacists, and (2) map domains to associated behaviour change techniques (BCTs) to include as components of an intervention to improve appropriate polypharmacy in older people in primary care. Semi-structured interviews were conducted with members of each healthcare professional (HCP) group using tailored topic guides based on TDF version 1 (12 domains). Questions covering each domain explored HCPs' perceptions of barriers and facilitators to ensuring the prescribing and dispensing of appropriate polypharmacy to older people. Interviews were audio-recorded and transcribed verbatim. Data analysis involved the framework method and content analysis. Key domains were identified and mapped to BCTs based on established methods and discussion within the research team. Thirty HCPs were interviewed (15 GPs, 15 pharmacists). Eight key domains were identified, perceived to influence prescribing and dispensing of appropriate polypharmacy: 'Skills', 'Beliefs about capabilities', 'Beliefs about consequences', 'Environmental context and resources', 'Memory, attention and decision processes', 'Social/professional role and identity', 'Social influences' and 'Behavioural regulation'. Following mapping, four BCTs were selected for inclusion in an intervention for

  15. Improvement of worker safety through the investigation of the site response to rockbursts

    CSIR Research Space (South Africa)

    Hagan, TO


    Full Text Available The objective of this investigation is to improve worker safety through a better understanding of mine excavation response to rockbursts. The improved understanding should lead to improved mine layout and support design. The project is continuation...

  16. [Improving patient safety: Usefulness of safety checklists in a neonatal unit]. (United States)

    Arriaga Redondo, María; Sanz López, Ester; Rodríguez Sánchez de la Blanca, Ana; Marsinyach Ros, Itziar; Collados Gómez, Laura; Díaz Redondo, Alicia; Sánchez Luna, Manuel


    Due to the complexity and characteristics of their patients, neonatal units are risk areas for the development of adverse events (AE). For this reason, there is a need to introduce and implement some tools and strategies that will help to improve the safety of the neonatal patient. Safety check-lists have shown to be a useful tool in other health areas but they are not sufficiently developed in Neonatal Units. A quasi-experimental prospective study was conducted on the design and implementation of the use of a checklist and evaluation of its usefulness for detecting incidents. The satisfaction of the health professionals on using the checklist tool was also assessed. The compliance rate in the neonatal intensive care unit (NICU) was 56.5%, with 4.03 incidents per patient being detected. One incident was detected for every 5.3 checklists used. The most frequent detected incidents were those related to medication, followed by inadequate alarm thresholds, adjustments of the monitors, and medication pumps. The large majority (75%) of the NICU health professionals considered the checklist useful or very useful, and 68.75% considered that its use had managed to avoid an AE. The overall satisfaction was 83.33% for the professionals with less than 5 years working experience, and 44.4% of the professionals with more than 5 years of experience were pleased or very pleased. The checklists have shown to be a useful tool for the detection of incidents, especially in NICU, with a positive assessment from the health professionals of the unit. Copyright © 2016. Publicado por Elsevier España, S.L.U.

  17. The discomfort caused by patient pressure on the prescribing decisions of hospital prescribers. (United States)

    Lewis, Penny J; Tully, Mary P


    , focusing on managing patient demands and improving prescribers' coping strategies. Copyright © 2011 Elsevier Inc. All rights reserved.

  18. Intelligent tires for improved tire safety using wireless strain measurement (United States)

    Matsuzaki, Ryosuke; Todoroki, Akira


    From a traffic safety point-of-view, there is an urgent need for intelligent tires as a warning system for road conditions, for optimized braking control on poor road surfaces and as a tire fault detection system. Intelligent tires, equipped with sensors for monitoring applied strain, are effective in improving reliability and control systems such as anti-lock braking systems (ABSs). In previous studies, we developed a direct tire deformation or strain measurement system with sufficiently low stiffness and high elongation for practical use, and a wireless communication system between tires and vehicle that operates without a battery. The present study investigates the application of strain data for an optimized braking control and road condition warning system. The relationships between strain sensor outputs and tire mechanical parameters, including braking torque, effective radius and contact patch length, are calculated using finite element analysis. Finally, we suggested the possibility of optimized braking control and road condition warning systems. Optimized braking control can be achieved by keeping the slip ratio constant. The road condition warning would be actuated if the recorded friction coefficient at a certain slip ratio is lower than a 'safe' reference value.

  19. [Errors in surgery. Strategies to improve surgical safety]. (United States)

    Arenas-Márquez, Humberto; Anaya-Prado, Roberto


    Surgery is an extreme experience for both patient and surgeon. The patient has to be rescued from something so serious that it may justify the surgeon to violate his/her integrity in order to resolve the problem. Nevertheless, both physician and patient recognize that the procedure has some risks. Medical errors are the 8th cause of death in the U.S., and malpractice can be documented in >50% of the legal prosecutions in Mexico. Of special interest is the specialty of general surgery where legal responsibility can be confirmed in >80% of the cases. Interest in mortality attributed to medical errors has existed since the 19th century; clearly identifying the lack of knowledge, abilities, and poor surgical and diagnostic judgment as the cause of errors. Currently, poor organization, lack of team work, and physician/ patient-related factors are recognized as the cause of medical errors. Human error is unavoidable and health care systems and surgeons should adopt the culture of error analysis openly, inquisitively and permanently. Errors should be regarded as an opportunity to learn that health care should to be patient centered and not surgeon centered. In this review, we analyze the causes of complications and errors that can develop during routine surgery. Additionally, we propose measures that will allow improvements in the safety of surgical patients.

  20. The impact of interventions to improve the quality of prescribing and use of antibiotics in primary care patients with respiratory tract infections: a systematic review protocol. (United States)

    Martínez-González, Nahara Anani; Coenen, Samuel; Plate, Andreas; Colliers, Annelies; Rosemann, Thomas; Senn, Oliver; Neuner-Jehle, Stefan


    Respiratory tract infections (RTIs) are the most common reason for primary care (PC) consultations and for antibiotic prescribing and use. The majority of RTIs have a viral aetiology however, and antibiotic consumption is ineffective and unnecessary. Inappropriate antibiotic use contributes greatly to antibiotic resistance (ABR) leading to complications, increased adverse events, reconsultations and costs. Improving antibiotic consumption is thus crucial to containing ABR, which has become an urgent priority worldwide. We will systematically review the evidence about interventions aimed at improving the quality of antibiotic prescribing and use for acute RTI. We will include primary peer-reviewed and grey literature of studies conducted on in-hours and out-of-hours PC patients (adults and children): (1) randomised controlled trials (RCTs), quasi-RCTs and/or cluster-RCTs evaluating the effectiveness, feasibility and acceptability of patient-targeted and clinician-targeted interventions and (2) RCTs and other study designs evaluating the effectiveness of public campaigns and regulatory interventions. We will search MEDLINE (EBSCOHost), EMBASE (Elsevier), the Cochrane Library (Wiley), CINHAL (EBSCOHost), PsychINFO (EBSCOHost), Web of Science, LILACS (Latin American and Caribbean Literature on Health Sciences), TRIP (Turning Research Into Practice) and without language restriction. We will also search the reference lists of included studies and relevant reviews. Primary outcomes include the rates of (guideline-recommended) antibiotics prescribed and/or used. Secondary outcomes include immediate or delayed use of antibiotics, and feasibility and acceptability outcomes. We will assess study eligibility and risk of bias, and will extract data. Data permitting, we will perform meta-analyses. This is a systematic review protocol and so formal ethical approval is not required. We will not collect confidential, personal or primary data. The findings of this


    Energy Technology Data Exchange (ETDEWEB)

    Vierow, Karen


    This project is investigating countercurrent flow and “flooding” phenomena in light water reactor systems to improve reactor safety of current and future reactors. To better understand the occurrence of flooding in the surge line geometry of a PWR, two experimental programs were performed. In the first, a test facility with an acrylic test section provided visual data on flooding for air-water systems in large diameter tubes. This test section also allowed for development of techniques to form an annular liquid film along the inner surface of the “surge line” and other techniques which would be difficult to verify in an opaque test section. Based on experiences in the air-water testing and the improved understanding of flooding phenomena, two series of tests were conducted in a large-diameter, stainless steel test section. Air-water test results and steam-water test results were directly compared to note the effect of condensation. Results indicate that, as for smaller diameter tubes, the flooding phenomena is predominantly driven by the hydrodynamics. Tests with the test sections inclined were attempted but the annular film was easily disrupted. A theoretical model for steam venting from inclined tubes is proposed herein and validated against air-water data. Empirical correlations were proposed for air-water and steam-water data. Methods for developing analytical models of the air-water and steam-water systems are discussed, as is the applicability of the current data to the surge line conditions. This report documents the project results from July 1, 2005 through June 30, 2008.

  2. Improving outpatient safety through effective electronic communication: a study protocol

    Directory of Open Access Journals (Sweden)

    Espadas Donna


    Full Text Available Abstract Background Health information technology and electronic medical records (EMRs are potentially powerful systems-based interventions to facilitate diagnosis and treatment because they ensure the delivery of key new findings and other health related information to the practitioner. However, effective communication involves more than just information transfer; despite a state of the art EMR system, communication breakdowns can still occur. 123 In this project, we will adapt a model developed by the Systems Engineering Initiative for Patient Safety (SEIPS to understand and improve the relationship between work systems and processes of care involved with electronic communication in EMRs. We plan to study three communication activities in the Veterans Health Administration's (VA EMR: electronic communication of abnormal imaging and laboratory test results via automated notifications (i.e., alerts; electronic referral requests; and provider-to-pharmacy communication via computerized provider order entry (CPOE. Aim Our specific aim is to propose a protocol to evaluate the systems and processes affecting outcomes of electronic communication in the computerized patient record system (related to diagnostic test results, electronic referral requests, and CPOE prescriptions using a human factors engineering approach, and hence guide the development of interventions for work system redesign. Design This research will consist of multiple qualitative methods of task analysis to identify potential sources of error related to diagnostic test result alerts, electronic referral requests, and CPOE; this will be followed by a series of focus groups to identify barriers, facilitators, and suggestions for improving the electronic communication system. Transcripts from all task analyses and focus groups will be analyzed using methods adapted from grounded theory and content analysis.

  3. Improving Safety, Quality and Efficiency through the Management of Emerging Processes: The TenarisDalmine Experience (United States)

    Bonometti, Patrizia


    Purpose: The aim of this contribution is to describe a new complexity-science-based approach for improving safety, quality and efficiency and the way it was implemented by TenarisDalmine. Design/methodology/approach: This methodology is called "a safety-building community". It consists of a safety-behaviour social self-construction process…


    Energy Technology Data Exchange (ETDEWEB)



    This paper describes dramatic improvements in the safety record of the Soil and Groundwater Remediation Project (SGRP) at the Hanford Site in southeast Washington state over the past four years. During a period of enormous growth in project work and scope, contractor Fluor Hanford reduced injuries, accidents, and other safety-related incidents and enhanced a safety culture that earned the SGRP Star Status in the Department of Energy's (DOE's) Voluntary Protection Program (VPP) in 2007. This paper outlines the complex and multi-faceted work of Fluor Hanford's SGRP and details the steps taken by the project's Field Operations and Safety organizations to improve safety. Holding field safety meetings and walkdowns, broadening safety inspections, organizing employee safety councils, intensively flowing down safety requirements to subcontractors, and adopting other methods to achieve remarkable improvement in safety are discussed. The roles of management, labor and subcontractors are detailed. Finally, SGRP's safety improvements are discussed within the context of overall safety enhancements made by Fluor Hanford in the company's 11 years of managing nuclear waste cleanup at the Hanford Site.

  5. Improving Safety, Quality and Efficiency through the Management of Emerging Processes: The TenarisDalmine Experience (United States)

    Bonometti, Patrizia


    Purpose: The aim of this contribution is to describe a new complexity-science-based approach for improving safety, quality and efficiency and the way it was implemented by TenarisDalmine. Design/methodology/approach: This methodology is called "a safety-building community". It consists of a safety-behaviour social self-construction…

  6. Improving Safety, Quality and Efficiency through the Management of Emerging Processes: The TenarisDalmine Experience (United States)

    Bonometti, Patrizia


    Purpose: The aim of this contribution is to describe a new complexity-science-based approach for improving safety, quality and efficiency and the way it was implemented by TenarisDalmine. Design/methodology/approach: This methodology is called "a safety-building community". It consists of a safety-behaviour social self-construction…

  7. Improvement of teamwork and safety climate following implementation of the WHO surgical safety checklist at a university hospital in Japan. (United States)

    Kawano, Takashi; Taniwaki, Miki; Ogata, Kimiyo; Sakamoto, Miwa; Yokoyama, Masataka


    With the aim to optimize surgical safety, the World Health Organization (WHO) introduced the Surgical Safety Checklist (SSCL) in 2008. The SSCL has been piloted in many countries worldwide and shown to improve both safety attitudes within surgical teams and patient outcomes. In the study reported here we investigated whether implementation of the SSCL improved the teamwork and safety climate at a single university hospital in Japan. All surgical teams at the hospital implemented the SSCL in all surgical procedures with strict adherence to the SSCL implementation manual developed by WHO. Changes in safety attitudes were evaluated using the modified operating-room version of the Safety Attitudes Questionnaire (SAQ). A before and after design was used, with the questionnaire administered before and 3 months after SSCL implementation. Our analysis revealed that the mean scores on the SAQ had significantly improved 3 months after implementation of the SSCL compared to those before implementation. This finding implies that effective implementation of the SSCL could improve patient outcomes in Japan, similar to the findings of the WHO pilot study.

  8. Creating an improvement culture for enhanced patient safety: service improvement learning in pre-registration education. (United States)

    Christiansen, Angela; Robson, Linda; Griffith-Evans, Christine


    The present study reports a descriptive survey of nursing students' experience of service improvement learning in the university and practice setting. Opportunities to develop service improvement capabilities were embedded into pre-registration programmes at a university in the Northwest of England to ensure future nurses have key skills for the workplace. A cross-sectional survey designed to capture key aspects of students' experience was completed by nursing students (n = 148) who had undertaken a service improvement project in the practice setting. Work organizations in which a service improvement project was undertaken were receptive to students' efforts. Students reported increased confidence to undertake service improvement and service improvement capabilities were perceived to be important to future career development and employment prospects. Service improvement learning in pre-registration education appears to be acceptable, effective and valued by students. Further research to identify the impact upon future professional practice and patient outcomes would enhance understanding of this developing area. Nurse Managers can play an active role in creating a service culture in which innovation and improvement can flourish to enhance patient outcomes, experience and safety. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

  9. Applying Sensor-Based Technology to Improve Construction Safety Management (United States)

    Zhang, Mingyuan; Cao, Tianzhuo; Zhao, Xuefeng


    Construction sites are dynamic and complicated systems. The movement and interaction of people, goods and energy make construction safety management extremely difficult. Due to the ever-increasing amount of information, traditional construction safety management has operated under difficult circumstances. As an effective way to collect, identify and process information, sensor-based technology is deemed to provide new generation of methods for advancing construction safety management. It makes the real-time construction safety management with high efficiency and accuracy a reality and provides a solid foundation for facilitating its modernization, and informatization. Nowadays, various sensor-based technologies have been adopted for construction safety management, including locating sensor-based technology, vision-based sensing and wireless sensor networks. This paper provides a systematic and comprehensive review of previous studies in this field to acknowledge useful findings, identify the research gaps and point out future research directions. PMID:28800061

  10. Applying Sensor-Based Technology to Improve Construction Safety Management. (United States)

    Zhang, Mingyuan; Cao, Tianzhuo; Zhao, Xuefeng


    Construction sites are dynamic and complicated systems. The movement and interaction of people, goods and energy make construction safety management extremely difficult. Due to the ever-increasing amount of information, traditional construction safety management has operated under difficult circumstances. As an effective way to collect, identify and process information, sensor-based technology is deemed to provide new generation of methods for advancing construction safety management. It makes the real-time construction safety management with high efficiency and accuracy a reality and provides a solid foundation for facilitating its modernization, and informatization. Nowadays, various sensor-based technologies have been adopted for construction safety management, including locating sensor-based technology, vision-based sensing and wireless sensor networks. This paper provides a systematic and comprehensive review of previous studies in this field to acknowledge useful findings, identify the research gaps and point out future research directions.

  11. Measuring and Improving Physician Knowledge of Safety Risks Using Traditional and Online Methods in Pharmacovigilance. (United States)

    Liede, Alexander; Amelio, Justyna; Bennett, James; Goodman, Helen; Peters, Pamela M; Barber, Rebecca; Kehler, Elizabeth; Michael Sprafka, J


    Traditional methods for assessing prescriber knowledge can take several years to deliver results. This study was undertaken to obtain insights into the potential for using existing online communities to educate prescribers on therapy-related safety risks. The aim of this study was to describe approaches to measuring prescribers' knowledge of safety risk (osteonecrosis of the jaw) outlined in the European Medicine Agency's summary of product characteristics for denosumab (XGEVA(®)). Short multiple-choice online instruments were administered as (1) a two-round cross-sectional survey fielded in January 2013-May 2015 (traditional, nine European countries, study duration: 3 years), (2) a survey targeting the online Medscape community (seven European countries, study duration: 3 weeks), and (3) a continuing medical education module with pre-/post-assessment in an online Medscape community (Medscape Education, USA). All respondents were oncologists; treated five or more patients with bone metastases from solid tumours in the previous 3 months; and prescribed denosumab within the previous 12 months. Medscape (a WebMD company, New York, NY, USA) is the leading online medical information resource, serving approximately 3 million physicians worldwide and 400,000 within Europe. In the traditional 29-month study, 420 (n = 210 per round; 14% of screened physicians) individuals participated. Knowledge levels exceeded 75% correct on five questions (incidence of osteonecrosis of the jaw, concomitant risk factors and prevention of osteonecrosis of the jaw during denosumab treatment, importance of ensuring oral hygiene, and care for patients who have or develop osteonecrosis of the jaw) with less awareness of optimal osteonecrosis of the jaw treatment. The Medscape survey (n = 207; 32.1% of 645 eligible) provided similar results in a 3-week post-survey launch. The Medscape Education study (n = 264) documented knowledge acquisition. Assessments that target physicians through online

  12. Taking up national safety alerts to improve patient safety in hospitals: The perspective of healthcare quality and risk managers. (United States)

    Pfeiffer, Yvonne; Schwappach, David


    National safety alert systems publish relevant information to improve patient safety in hospitals. However, the information has to be transformed into local action to have an effect on patient safety. We studied three research questions: How do Swiss healthcare quality and risk managers (qm/rm(1)) see their own role in learning from safety alerts issued by the Swiss national voluntary reporting and analysis system? What are their attitudes towards and evaluations of the alerts, and which types of improvement actions were fostered by the safety alerts? A survey was developed and applied to Swiss healthcare risk and quality managers, with a response rate of 39 % (n=116). Descriptive statistics are presented. The qm/rm disseminate and communicate with a broad variety of professional groups about the alerts. While most respondents felt that they should know the alerts and their contents, only a part of them felt responsible for driving organizational change based on the recommendations. However, most respondents used safety alerts to back up their own patient safety goals. The alerts were evaluated positively on various dimensions such as usefulness and were considered as standards of good practice by the majority of the respondents. A range of organizational responses was applied, with disseminating information being the most common. An active role is related to using safety alerts for backing up own patient safety goals. To support an active role of qm/rm in their hospital's learning from safety alerts, appropriate organizational structures should be developed. Furthermore, they could be given special information or training to act as an information hub on the issues discussed in the alerts. Copyright © 2016. Published by Elsevier GmbH.

  13. Improving staff perception of a safety climate with crew resource management training. (United States)

    Kuy, SreyRam; Romero, Ramon A L


    Communication failure is one of the top root causes in patient safety adverse events. Crew resource management (CRM) is a team building communication process intended to improve patient safety by improving team dynamics. First, to describe implementation of CRM in a Veterans Affair (VA) surgical service. Second, to assess whether staff CRM training is related to improvement in staff perception of a safety climate. Mandatory CRM training was implemented for all surgical service staff at a VA Hospital at 0 and 12 mo. Safety climate questionnaires were completed by operating room staff at a baseline, 6 and 12 mo after the initial CRM training. Participants reported improvement on all 27 points on the safety climate questionnaire at 6 mo compared with the baseline. At 12 mo, there was sustained improvement in 23 of the 27 areas. This is the first published report about the effect of CRM training on staff perception of a safety climate in a VA surgical service. We demonstrate that CRM training can be successfully implemented widespread in a surgical program. Overall, there was improvement in 100% of areas assessed on the safety climate questionnaire at 6 mo after CRM training. By 1 y, this improvement was sustained in 23 of 27 areas, with the areas of greatest improvement being the performance of briefings, collaboration between nurses and doctors, valuing nursing input, knowledge about patient safety, and institutional promotion of a patient safety climate. Published by Elsevier Inc.

  14. Improving prescribing of antihypertensive and cholesterol-lowering drugs: a method for identifying and addressing barriers to change

    Directory of Open Access Journals (Sweden)

    Flottorp Signe


    Full Text Available Abstract Background We describe a simple approach we used to identify barriers and tailor an intervention to improve pharmacological management of hypertension and hypercholesterolaemia. We also report the results of a post hoc exercise and survey we carried out to evaluate our approach for identifying barriers and tailoring interventions. Methods We used structured reflection, searched for other relevant trials, surveyed general practitioners and talked with physicians during pilot testing of the intervention. The post hoc exercise was carried out as focus groups of international researchers in the field of quality improvement in health care. The post hoc survey was done by telephone interviews with physicians allocated to the experimental group of a randomised trial of our multifaceted intervention. Results A wide range of barriers was identified and several interventions were suggested through structured reflection. The survey led to some adjustments. Studying other trials and pilot testing did not lead to changes in the design of the intervention. Neither the post hoc focus groups nor the post hoc survey revealed important barriers or interventions that we had not considered or included in our tailored intervention. Conclusions A simple approach to identifying barriers to change appears to have been adequate and efficient. However, we do not know for certain what we would have gained by using more comprehensive methods and we do not know whether the resulting intervention would have been more effective if we had used other methods. The effectiveness of our multifaceted intervention is under evaluation in a randomised controlled trial.

  15. Causes and consequences of e-prescribing errors in community pharmacies

    Directory of Open Access Journals (Sweden)

    Abramson EL


    Full Text Available Erika L Abramson Departments of Pediatrics and Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA Abstract: Major national policy forces are promoting the adoption and use of health information technology (health IT to improve the quality, safety, and efficiency of health care delivery. One such health IT is electronic prescribing (e-prescribing, which is the direct transmission of prescription information from a provider to a pharmacy. Given research showing that handwritten prescriptions are unsafe and associated errors can lead to tremendous inefficiency for patients and pharmacists, e-prescribing has many potential benefits. However, as with the introduction of any new technology, unintended, adverse consequences may result. The purpose of this review is to explore the causes and consequences of e-prescribing errors in community pharmacies, which are pharmacies not affiliated with a hospital or clinic. Many new types of errors – including provider order entry errors, transcription errors, and dispensing errors – appear to result from e-prescribing. These lead to important consequences for pharmacies, including safety threats to patients, reduced efficiency for pharmacists, processing delays, and increased pharmacy cost. Increased attention to system design and pharmacist training, as well as additional research in this area, will be critical to realize the full benefits of e-prescribing. Keywords: electronic prescribing, medication errors, community pharmacies 

  16. Evaluation of Patient Safety Culture and Organizational Culture as a Step in Patient Safety Improvement in a Hospital in Jakarta, Indonesia


    Afrisya Iriviranty; Dumilah Ayuningtyas; Misnaniarti Misnaniarti


    Introduction: Establishment of patient safety culture is the first step in the improvement of patient safety. As such, assessment of patient safety culture in hospitals is of paramount importance. Patient safety culture is an inherent component of organizational culture, so that the study of organizational culture is required in developing patient safety. This study aimed to evaluate patient safety culture among the clinical staff of a hospital in Jakarta, Indonesia and identify organizationa...

  17. Improving prescribing practices with rapid diagnostic tests (RDTs): synthesis of 10 studies to explore reasons for variation in malaria RDT uptake and adherence (United States)

    Leurent, Baptiste; Baiden, Frank; Baltzell, Kimberly; Björkman, Anders; Bruxvoort, Katia; Clarke, Siân; DiLiberto, Deborah; Elfving, Kristina; Goodman, Catherine; Hopkins, Heidi; Lal, Sham; Liverani, Marco; Magnussen, Pascal; Mårtensson, Andreas; Mbacham, Wilfred; Mbonye, Anthony; Onwujekwe, Obinna; Roth Allen, Denise; Shakely, Delér; Staedke, Sarah; Vestergaard, Lasse S; Whitty, Christopher J M; Wiseman, Virginia; Chandler, Clare I R


    Objectives The overuse of antimalarial drugs is widespread. Effective methods to improve prescribing practice remain unclear. We evaluated the impact of 10 interventions that introduced rapid diagnostic tests for malaria (mRDTs) on the use of tests and adherence to results in different contexts. Design A comparative case study approach, analysing variation in outcomes across different settings. Setting Studies from the ACT Consortium evaluating mRDTs with a range of supporting interventions in 6 malaria endemic countries. Providers were governmental or non-governmental healthcare workers, private retail sector workers or community volunteers. Each study arm in a distinct setting was considered a case. Participants 28 cases from 10 studies were included, representing 148 461 patients seeking care for suspected malaria. Interventions The interventions included different mRDT training packages, supervision, supplies and community sensitisation. Outcome measures Analysis explored variation in: (1) uptake of mRDTs (% febrile patients tested); (2) provider adherence to positive mRDTs (% Plasmodium falciparum positive prescribed/given Artemisinin Combination Treatment); (3) provider adherence to negative mRDTs (% P. falciparum negative not prescribed/given antimalarial). Results Outcomes varied widely across cases: 12–100% mRDT uptake; 44–98% adherence to positive mRDTs; 27–100% adherence to negative mRDTs. Providers appeared more motivated to perform well when mRDTs and intervention characteristics fitted with their own priorities. Goodness of fit of mRDTs with existing consultation and diagnostic practices appeared crucial to maximising the impact of mRDTs on care, as did prior familiarity with malaria testing; adequate human resources and supplies; possible alternative treatments for mRDT-negative patients; a more directive intervention approach and local preferences for ACTs. Conclusions Basic training and resources are essential but insufficient to maximise

  18. Improving radiopharmaceutical supply chain safety by implementing bar code technology. (United States)

    Matanza, David; Hallouard, François; Rioufol, Catherine; Fessi, Hatem; Fraysse, Marc


    The aim of this study was to describe and evaluate an approach for improving radiopharmaceutical supply chain safety by implementing bar code technology. We first evaluated the current situation of our radiopharmaceutical supply chain and, by means of the ALARM protocol, analysed two dispensing errors that occurred in our department. Thereafter, we implemented a bar code system to secure selected key stages of the radiopharmaceutical supply chain. Finally, we evaluated the cost of this implementation, from overtime, to overheads, to additional radiation exposure to workers. An analysis of the events that occurred revealed a lack of identification of prepared or dispensed drugs. Moreover, the evaluation of the current radiopharmaceutical supply chain showed that the dispensation and injection steps needed to be further secured. The bar code system was used to reinforce product identification at three selected key stages: at usable stock entry; at preparation-dispensation; and during administration, allowing to check conformity between the labelling of the delivered product (identity and activity) and the prescription. The extra time needed for all these steps had no impact on the number and successful conduct of examinations. The investment cost was reduced (2600 euros for new material and 30 euros a year for additional supplies) because of pre-existing computing equipment. With regard to the radiation exposure to workers there was an insignificant overexposure for hands with this new organization because of the labelling and scanning processes of radiolabelled preparation vials. Implementation of bar code technology is now an essential part of a global securing approach towards optimum patient management.

  19. An open cluster-randomized, 18-month trial to compare the effectiveness of educational outreach visits with usual guideline dissemination to improve family physician prescribing. (United States)

    Pinto, Daniel; Heleno, Bruno; Rodrigues, David S; Papoila, Ana Luísa; Santos, Isabel; Caetano, Pedro A


    The Portuguese National Health Directorate has issued clinical practice guidelines on prescription of anti-inflammatory drugs, acid suppressive therapy, and antiplatelets. However, their effectiveness in changing actual practice is unknown. The study will compare the effectiveness of educational outreach visits regarding the improvement of compliance with clinical guidelines in primary care against usual dissemination strategies. A cost-benefit analysis will also be conducted. We will carry out a parallel, open, superiority, randomized trial directed to primary care physicians. Physicians will be recruited and allocated at a cluster-level (primary care unit) by minimization. Data will be analyzed at the physician level. Primary care units will be eligible if they use electronic prescribing and have at least four physicians willing to participate. Physicians in intervention units will be offered individual educational outreach visits (one for each guideline) at their workplace during a six-month period. Physicians in the control group will be offered a single unrelated group training session. Primary outcomes will be the proportion of cyclooxygenase-2 inhibitors prescribed in the anti-inflammatory class, and the proportion of omeprazole in the proton pump inhibitors class at 18 months post-intervention. Prescription data will be collected from the regional pharmacy claims database. We estimated a sample size of 110 physicians in each group, corresponding to 19 clusters with a mean size of 6 physicians. Outcome collection and data analysis will be blinded to allocation, but due to the nature of the intervention, physicians and detailers cannot be blinded. This trial will attempt to address unresolved issues in the literature, namely, long term persistence of effect, the importance of sequential visits in an outreach program, and cost issues. If successful, this trial may be the cornerstone for deploying large scale educational outreach programs within the Portuguese

  20. Stereochemistry Considerations Can Improve Pesticide Safety and Sustainability (United States)

    About 30% of pesticides are chiral molecules and therefore exist as two or more stereoisomers, which can differ significantly in their toxicity, biodegradation, and persistence. Such differences determine their relative safety to humans and environmental species. Enantiomers, mir...

  1. Selling safety: the use of celebrities in improving awareness of safety in commercial aviation. (United States)

    Molesworth, Brett R C; Seneviratne, Dimuth; Burgess, Marion


    The aim of this study was to investigate the influential power of a celebrity to convey key safety messages in commercial aviation using a pre-flight safety briefing video. In addition, the present research sought to examine the effectiveness of subtitles in aiding the recall of these important messages as well as how in-cabin aircraft noise affects recall of this information. A total of 101 participants were randomly divided into four groups (no noise without subtitles, no noise with subtitles, noise without subtitles and noise with subtitles) and following exposure to a pre-recorded pre-flight safety briefing video were tested for recall of key safety messages within that video. Participants who recognised and recalled the name of the celebrity in the safety briefing video recalled significantly more of the messages than participants who did not recognise the celebrity. Subtitles were also found to be effective, however, only in the presence of representative in-cabin aircraft noise. Practitioner Summary: Passenger attention to pre-flight safety briefings on commercial aircraft is poor. Utilising the celebrity status of a famous person may overcome this problem. Results suggest that celebrities do increase the recall of safety-related information.

  2. The Armstrong Institute: An Academic Institute for Patient Safety and Quality Improvement, Research, Training, and Practice. (United States)

    Pronovost, Peter J; Holzmueller, Christine G; Molello, Nancy E; Paine, Lori; Winner, Laura; Marsteller, Jill A; Berenholtz, Sean M; Aboumatar, Hanan J; Demski, Renee; Armstrong, C Michael


    Academic medical centers (AMCs) could advance the science of health care delivery, improve patient safety and quality improvement, and enhance value, but many centers have fragmented efforts with little accountability. Johns Hopkins Medicine, the AMC under which the Johns Hopkins University School of Medicine and the Johns Hopkins Health System are organized, experienced similar challenges, with operational patient safety and quality leadership separate from safety and quality-related research efforts. To unite efforts and establish accountability, the Armstrong Institute for Patient Safety and Quality was created in 2011.The authors describe the development, purpose, governance, function, and challenges of the institute to help other AMCs replicate it and accelerate safety and quality improvement. The purpose is to partner with patients, their loved ones, and all interested parties to end preventable harm, continuously improve patient outcomes and experience, and eliminate waste in health care. A governance structure was created, with care mapped into seven categories, to oversee the quality and safety of all patients treated at a Johns Hopkins Medicine entity. The governance has a Patient Safety and Quality Board Committee that sets strategic goals, and the institute communicates these goals throughout the health system and supports personnel in meeting these goals. The institute is organized into 13 functional councils reflecting their behaviors and purpose. The institute works daily to build the capacity of clinicians trained in safety and quality through established programs, advance improvement science, and implement and evaluate interventions to improve the quality of care and safety of patients.

  3. A participatory model for improving occupational health and safety: improving informal sector working conditions in Thailand. (United States)

    Manothum, Aniruth; Rukijkanpanich, Jittra; Thawesaengskulthai, Damrong; Thampitakkul, Boonwa; Chaikittiporn, Chalermchai; Arphorn, Sara


    The purpose of this study was to evaluate the implementation of an Occupational Health and Safety Management Model for informal sector workers in Thailand. The studied model was characterized by participatory approaches to preliminary assessment, observation of informal business practices, group discussion and participation, and the use of environmental measurements and samples. This model consisted of four processes: capacity building, risk analysis, problem solving, and monitoring and control. The participants consisted of four local labor groups from different regions, including wood carving, hand-weaving, artificial flower making, and batik processing workers. The results demonstrated that, as a result of applying the model, the working conditions of the informal sector workers had improved to meet necessary standards. This model encouraged the use of local networks, which led to cooperation within the groups to create appropriate technologies to solve their problems. The authors suggest that this model could effectively be applied elsewhere to improve informal sector working conditions on a broader scale.

  4. Antibiotic Prescribing among Pediatric Inpatients with Potential Infections in Two Private Sector Hospitals in Central India: e0142317

    National Research Council Canada - National Science Library

    Megha Sharma; Anna Damlin; Ashish Pathak; Cecilia Stålsby Lundborg


    .... Pediatric patients are commonly prescribed antibiotics for non-bacterial infections. Monitoring of local antibiotic prescribing with respect to the diagnosis is necessary to improve the prescribing practices...

  5. Modelling of safety barriers including human and organisational factors to improve process safety

    DEFF Research Database (Denmark)

    Markert, Frank; Duijm, Nijs Jan; Thommesen, Jacob


    explosion, and the Mont Blanc Tunnel Fire, such an approach may have helped to maintain the integrity of the designed provisions against major deviations resulting in these disasters. In order to make this paradigm operational, safety management and in particular risk assessment tools need to be refined....... A valuable approach is the inclusion of human and organisational factors into the simulation of the reliability of the technical system using event trees and fault trees and the concept of safety barriers. This has been demonstrated e.g. in the former European research project ARAMIS (Accidental Risk...... Assessment Methodology for IndustrieS, see Salvi et al 2006). ARAMIS employs the bow-tie approach to modelling hazardous scenarios, and it suggests the outcome of auditing safety management to be connected to a semi-quantitative assessment of the quality of safety barriers. ARAMIS discriminates a number...

  6. Research on the improvement of nuclear safety -Thermal hydraulic tests for reactor safety system-

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Moon Kee; Park, Choon Kyung; Yang, Sun Kyoo; Chun, Se Yung; Song, Chul Hwa; Jun, Hyung Kil; Jung, Heung Joon; Won, Soon Yun; Cho, Yung Roh; Min, Kyung Hoh; Jung, Jang Hwan; Jang, Suk Kyoo; Kim, Bok Deuk; Kim, Wooi Kyung; Huh, Jin; Kim, Sook Kwan; Moon, Sang Kee; Lee, Sang Il [Korea Atomic Energy Research Institute, Taejon (Korea, Republic of)


    The present research aims at the development of the thermal hydraulic verification test technology for the safety system of the conventional and advanced nuclear power plant and the development of the advanced thermal hydraulic measuring techniques. In this research, test facilities simulating the primary coolant system and safety system are being constructed for the design verification tests of the existing and advanced nuclear power plant. 97 figs, 14 tabs, 65 refs. (Author).

  7. Mines Systems Safety Improvement Using an Integrated Event Tree and Fault Tree Analysis (United States)

    Kumar, Ranjan; Ghosh, Achyuta Krishna


    Mines systems such as ventilation system, strata support system, flame proof safety equipment, are exposed to dynamic operational conditions such as stress, humidity, dust, temperature, etc., and safety improvement of such systems can be done preferably during planning and design stage. However, the existing safety analysis methods do not handle the accident initiation and progression of mine systems explicitly. To bridge this gap, this paper presents an integrated Event Tree (ET) and Fault Tree (FT) approach for safety analysis and improvement of mine systems design. This approach includes ET and FT modeling coupled with redundancy allocation technique. In this method, a concept of top hazard probability is introduced for identifying system failure probability and redundancy is allocated to the system either at component or system level. A case study on mine methane explosion safety with two initiating events is performed. The results demonstrate that the presented method can reveal the accident scenarios and improve the safety of complex mine systems simultaneously.


    Al-Adhami, Noor; Whitfield, Karen; North, Angela


    To eliminate the prescribing of codeine and codeine combination products postpartum to improve safety in breast fed infants.Concerns have been raised over the use of codeine and codeine combination products during breast feeding after the death of a neonate whose mother had been prescribed codeine postpartum. High concentrations of morphine were found in the infant's blood and this was attributed to the mother being a CYP2D6 ultrafast metaboliser.1 METHODS: The evidence surrounding the safety of codeine and codeine combination products in children, during the postpartum period and specifically for breast fed infants was collated. The evidence was presented to key stakeholders including obstetricians, midwives, safety and quality representatives, nurse unit managers and acute pain team representatives. Postpartum analgesia was discussed and an agreed protocol developed. Training and education sessions were undertaken to obstetric medical and nursing staff. The evidence that was presented to key stakeholders included:▸ Reports over the safety concerns surrounding the use of codeine and codeine combination products during breast feeding▸ Guidelines and contraindications about the use of codeine in children that had been issued by international regulatory bodies (US Food and Drug Administration and European Medicines Agency).▸ Recommendations from the Australian Medicines Handbook to avoid in breast feeding2 ▸ Recommendations from Hale's Medications and Mothers Milk that reported limited data and had made a recent re-classification from L3 (limited data-probably compatible) to L4 (limited data-possibly hazardous).3 Before presenting the evidence to key stakeholders and undertaking training to nursing and medical staff, more than 90% of postpartum women were prescribed a codeine containing product as part of their 'as required' analgesic regimen.Since the intervention, codeine combination products have now been almost completely eliminated on medication

  9. Nurse-police coalition: improves safety in acute psychiatric hospital. (United States)

    Allen, Diane E; Harris, Frank N; de Nesnera, Alexander


    Although police officers protect and secure the safety of citizens everywhere, nurses are the primary guardians of patient safety within the treatment milieu. At New Hampshire Hospital, both nurses and police officers share ownership of this responsibility, depending on the needs that arise specific to each profession. Psychiatric nurses take pride in their ability to de-escalate agitated and potentially aggressive patients; however, times arise when the best efforts of nurses fail, or when a situation requires intervention from police officers. Nurses and police officers at New Hampshire Hospital have worked together for many years to develop a trusting, respectful alliance. This coalition has resulted in a safe, clear, orderly process for transfer of authority from nurses to police during violent, clinically unmanageable psychiatric emergencies. Nurses and police officers work collaboratively toward the common goal of ensuring safety for patients and staff, while also acknowledging the unique strengths of each profession.

  10. Leveraging Safety Programs to Improve and Support Security Programs

    Energy Technology Data Exchange (ETDEWEB)

    Leach, Janice [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Snell, Mark K. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Pratt, R. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Sandoval, S. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)


    There has been a long history of considering Safety, Security, and Safeguards (3S) as three functions of nuclear security design and operations that need to be properly and collectively integrated with operations. This paper specifically considers how safety programmes can be extended directly to benefit security as part of an integrated facility management programme. The discussion will draw on experiences implementing such a programme at Sandia National Laboratories’ Annular Research Reactor Facility. While the paper focuses on nuclear facilities, similar ideas could be used to support security programmes at other types of high-consequence facilities and transportation activities.

  11. Improving organisational safety through better learning from incidents and accidents

    NARCIS (Netherlands)

    Drupsteen-Sint, L.


    The main objective of this dissertation is to contribute to better learning from safety related incidents and accidents in organisations. The dissertation provides a method to systematically study learning from incidents, by using a model of five phases that represent the actions necessary to succes

  12. New reactor technology: safety improvements in nuclear power systems. (United States)

    Corradini, M L


    Almost 450 nuclear power plants are currently operating throughout the world and supplying about 17% of the world's electricity. These plants perform safely, reliably, and have no free-release of byproducts to the environment. Given the current rate of growth in electricity demand and the ever growing concerns for the environment, nuclear power can only satisfy the need for electricity and other energy-intensive products if it can demonstrate (1) enhanced safety and system reliability, (2) minimal environmental impact via sustainable system designs, and (3) competitive economics. The U.S. Department of Energy with the international community has begun research on the next generation of nuclear energy systems that can be made available to the market by 2030 or earlier, and that can offer significant advances toward these challenging goals; in particular, six candidate reactor system designs have been identified. These future nuclear power systems will require advances in materials, reactor physics, as well as thermal-hydraulics to realize their full potential. However, all of these designs must demonstrate enhanced safety above and beyond current light water reactor systems if the next generation of nuclear power plants is to grow in number far beyond the current population. This paper reviews the advanced Generation-IV reactor systems and the key safety phenomena that must be considered to guarantee that enhanced safety can be assured in future nuclear reactor systems.

  13. Improving occupational safety and health by integration into product development

    DEFF Research Database (Denmark)

    Broberg, Ole


    A cross-sectional case study was performed in a large company producing electro-mechanical products for industrial application. The objectives were: (i) to study the product development process and the role of key actors', (ii) to identify current practice on integrating occupational safety and h...

  14. A report on developing a checklist to assess company plans focused on improving safety awareness, safe behaviour and safety culture : final report

    NARCIS (Netherlands)

    Steijger, N.; Starren, H.; Keus, M.; Gort, J.; Vervoort, M.


    This report describes the process of developing a checklist to asses company plans focused on improving safety awareness, safe behaviour and safety culture. These plans are part of a programme initiated by the Ministry of Social Affairs and Employment aiming at improving the safety performance of co

  15. Packaging Evaluation Approach to Improve Cosmetic Product Safety

    Directory of Open Access Journals (Sweden)

    Benedetta Briasco


    Full Text Available In the Regulation 1223/2009, evaluation of packaging has become mandatory to assure cosmetic product safety. In fact, the safety assessment of a cosmetic product can be successfully carried out only if the hazard deriving from the use of the designed packaging for the specific product is correctly evaluated. Despite the law requirement, there is too little information about the chemical-physical characteristics of finished packaging and the possible interactions between formulation and packaging; furthermore, different from food packaging, the cosmetic packaging is not regulated and, to date, appropriate guidelines are still missing. The aim of this work was to propose a practical approach to investigate commercial polymeric containers used in cosmetic field, especially through mechanical properties’ evaluation, from a safety point of view. First of all, it is essential to obtain complete information about raw materials. Subsequently, using an appropriate full factorial experimental design, it is possible to investigate the variables, like polymeric density, treatment, or type of formulation involved in changes to packaging properties or in formulation-packaging interaction. The variation of these properties can greatly affect cosmetic safety. In particular, mechanical properties can be used as an indicator of pack performances and safety. As an example, containers made of two types of polyethylene with different density, low-density polyethylene (LDPE and high-density polyethylene (HDPE, are investigated. Regarding the substances potentially extractable from the packaging, in this work the headspace solid-phase microextraction method (HSSPME was used because this technique was reported in the literature as suitable to detect extractables from the polymeric material here employed.

  16. Internet-Based Training to Improve Preschool Playground Safety: Evaluation of the Stamp-in-Safety Programme (United States)

    Schwebel, David C.; Pennefather, Jordan; Marquez, Brion; Marquez, Jessie


    Objective: Playground injuries result in over 200,000 US pediatric emergency department visits annually. One strategy to reduce injuries is improved adult supervision. The Stamp-in-Safety programme, which involves supervisors stamping rewards for children playing safely, has been demonstrated in preliminary classroom-based work to reduce child…

  17. Concomitant prescribing and dispensing errors at a Brazilian hospital: a descriptive study

    Directory of Open Access Journals (Sweden)

    Maria das Dores Graciano Silva


    Full Text Available OBJECTIVE: To analyze the prevalence and types of prescribing and dispensing errors occurring with high-alert medications and to propose preventive measures to avoid errors with these medications. INTRODUCTION: The prevalence of adverse events in health care has increased, and medication errors are probably the most common cause of these events. Pediatric patients are known to be a high-risk group and are an important target in medication error prevention. METHODS: Observers collected data on prescribing and dispensing errors occurring with high-alert medications for pediatric inpatients in a university hospital. In addition to classifying the types of error that occurred, we identified cases of concomitant prescribing and dispensing errors. RESULTS: One or more prescribing errors, totaling 1,632 errors, were found in 632 (89.6% of the 705 high-alert medications that were prescribed and dispensed. We also identified at least one dispensing error in each high-alert medication dispensed, totaling 1,707 errors. Among these dispensing errors, 723 (42.4% content errors occurred concomitantly with the prescribing errors. A subset of dispensing errors may have occurred because of poor prescription quality. The observed concomitancy should be examined carefully because improvements in the prescribing process could potentially prevent these problems. CONCLUSION: The system of drug prescribing and dispensing at the hospital investigated in this study should be improved by incorporating the best practices of medication safety and preventing medication errors. High-alert medications may be used as triggers for improving the safety of the drug-utilization system.

  18. Designing a Safety Reporting Smartphone Application to Improve Patient Safety After Total Hip Arthroplasty. (United States)

    Krumsvik, Ole Andreas; Babic, Ankica


    This paper presents a safety reporting smartphone application which is expected to reduce the occurrence of postoperative adverse events after total hip arthroplasty (THA). A user-centered design approach was utilized to facilitate optimal user experience. Two main implemented functionalities capture patient pain levels and well-being, the two dimensions of patient status that are intuitive and commonly checked. For these and other functionalities, mobile technology could enable timely safety reporting and collection of patient data out of a hospital setting. The HCI expert, and healthcare professionals from the Haukeland University Hospital in Bergen have assessed the design with respect to the interaction flow, information content, and self-reporting functionalities. They have found it to be practical, intuitive, sufficient and simple for users. Patient self-reporting could help recognizing safety issues and adverse events.

  19. A prescribed Chinese herbal medicine improves glucose profile and ameliorates oxidative stress in Goto-Kakisaki rats fed with high fat diet.

    Directory of Open Access Journals (Sweden)

    Lin Wu

    Full Text Available Oxidative stress (OS plays a role in hyperglycemia induced islet β cell dysfunction, however, studies on classic anti-oxidants didn't show positive results in treating diabetes. We previously demonstrated that the prescribed Chinese herbal medicine preparation "Qing Huo Yi Hao" (QHYH improved endothelial function in type 2 diabetic patients. QHYH protected endothelial cells from high glucose-induced damages by scavenging superoxide anion and reducing production of reactive oxygen species. Its active component protected C2C12 myotubes against palmitate-induced oxidative damage and mitochondrial dysfunction. In the present study, we investigated whether QHYH protected islet β cell function exacerbated by high fat diet (HFD in hyperglycemic GK rats. 4-week-old male rats were randomly divided into high HFD feeding group (n = 20 and chow diet feeding group (n = 10. Each gram of HFD contained 4.8 kcal of energy, 52% of which from fat. Rats on HFD were further divided into 2 groups given either QHYH (3 ml/Kg/d or saline through gastric tube. After intervention, serum glucose concentrations were monitored; IPGTTs were performed without anesthesia on 5 fasting rats randomly chosen from each group on week 4 and 16. Serum malondialdehyde (MDA concentrations and activities of serum antioxidant enzymes were measured on week 4 and 16. Islet β cell mass and OS marker staining was done by immunohistochemistry on week 16. QHYH prevented the exacerbation of hyperglycemia in HFD feeding GK rats for 12 weeks. On week 16, it improved the exacerbated glucose tolerance and prevented the further loss of islet β cell mass induced by HFD. QHYH markedly decreased serum MDA concentration, increased serum catalase (CAT and SOD activities on week 4. However, no differences of serum glucose concentration or OS were observed on week 16. We concluded that QHYH decreased hyperglycemia exacerbated by HFD in GK rats by improving β cell function partly via its

  20. Research on the improvement of nuclear safety -Improvement of level 1 PSA computer code package-

    Energy Technology Data Exchange (ETDEWEB)

    Park, Chang Kyoo; Kim, Tae Woon; Kim, Kil Yoo; Han, Sang Hoon; Jung, Won Dae; Jang, Seung Chul; Yang, Joon Un; Choi, Yung; Sung, Tae Yong; Son, Yung Suk; Park, Won Suk; Jung, Kwang Sub; Kang Dae Il; Park, Jin Heui; Hwang, Mi Jung; Hah, Jae Joo [Korea Atomic Energy Research Institute, Taejon (Korea, Republic of)


    This year is the third year of the Government-sponsored mid- and long-term nuclear power technology development project. The scope of this sub project titled on `The improvement of level-1 PSA computer codes` is divided into three main activities : (1) Methodology development on the underdeveloped fields such as risk assessment technology for plant shutdown and low power situations, (2) Computer code package development for level-1 PSA, (3) Applications of new technologies to reactor safety assessment. At first, in this area of shutdown risk assessment technology development, plant outage experiences of domestic plants are reviewed and plant operating states (POS) are decided. A sample core damage frequency is estimated for over draining event in RCS low water inventory i.e. mid-loop operation. Human reliability analysis and thermal hydraulic support analysis are identified to be needed to reduce uncertainty. Two design improvement alternatives are evaluated using PSA technique for mid-loop operation situation: one is use of containment spray system as backup of shutdown cooling system and the other is installation of two independent level indication system. Procedure change is identified more preferable option to hardware modification in the core damage frequency point of view. Next, level-1 PSA code KIRAP is converted to PC-windows environment. For the improvement of efficiency in performing PSA, the fast cutest generation algorithm and an analytical technique for handling logical loop in fault tree modeling are developed. 48 figs, 15 tabs, 59 refs. (Author).

  1. Crew resource management improved perception of patient safety in the operating room. (United States)

    Gore, Dennis C; Powell, Jennifer M; Baer, Jennifer G; Sexton, Karen H; Richardson, C Joan; Marshall, David R; Chinkes, David L; Townsend, Courtney M


    To improve safety in the operating theater, a company of aviation pilots was employed to guide implementation of preprocedural briefings. A 5-point Likert scale survey that assessed the attitudes of operating room personnel toward patient safety was distributed before and 6 months following implementation of the briefings. Using Mann-Whitney analysis, the survey showed a significant (P perception of patient safety, which was largely demonstrated by nursing personnel.

  2. Safety in the Marketplace: A Program for the Improvement of Consumer Product Safety. (United States)

    National Business Council for Consumer Affairs, Washington, DC.

    Prepared under the auspices of the National Business Council for Consumer Affairs by its Sub-Council on Product Safety, this report is part of a program to advise the federal government on voluntary activities by the business community which would help consumers. Contents include analysis, conclusions and recommendations relating to manufacturers,…

  3. New research opportunities for roadside safety barriers improvement (United States)

    Cantisani, Giuseppe; Di Mascio, Paola; Polidori, Carlo


    Among the major topics regarding the protection of roads, restraint systems still represent a big opportunity in order to increase safety performances. When accidents happen, in fact, the infrastructure can substantially contribute to the reduction of consequences if its marginal spaces are well designed and/or effective restraint systems are installed there. Nevertheless, basic concepts and technology of road safety barriers have not significantly changed for the last two decades. The paper proposes a new approach to the study aimed to define possible enhancements of restraint safety systems performances, by using new materials and defining innovative design principles. In particular, roadside systems can be developed with regard to vehicle-barrier interaction, vehicle-oriented design (included low-mass and extremely low-mass vehicles), traffic suitability, user protection, working width reduction. In addition, thanks to sensors embedded into the barriers, it is also expected to deal with new challenges related to the guidance of automatic vehicles and I2V communication.

  4. A cluster randomized trial to assess the impact of opinion leader endorsed evidence summaries on improving quality of prescribing for patients with chronic cardiovascular disease: rationale and design [ISRCTN26365328

    Directory of Open Access Journals (Sweden)

    Tsuyuki Ross T


    Full Text Available Abstract Background Although much has been written about the influence of local opinion leaders on clinical practice, there have been few controlled studies of their effect, and almost none have attempted to change prescribing in the community for chronic conditions such as heart failure (HF or ischemic heart disease (IHD. These two conditions are common and there is very good evidence about how to best prevent morbidity and mortality – and good evidence that quality of care is, in general, suboptimal. Practice audits have demonstrated that about one-half of eligible HF patients are prescribed ACE inhibitors (with fewer still reaching appropriate target doses and less than one-third of patients with established IHD are prescribed statins (with many fewer reaching recommended cholesterol targets. It is apparent that interventions to improve quality of prescribing are urgently needed. We hypothesized that an intervention that consisted of patient-specific one-page evidence summaries, generated and then endorsed by local opinion leaders, would be able to change prescribing practices of community-based primary care physicians. Methods (study design A pragmatic single-centre cluster randomized controlled trial comparing an opinion leader-based intervention to usual care for patients with HF or IHD. Randomization will be clustered at the level of the primary care physician; as the design effect is anticipated to be negligible, the unit of analysis will be the patient. Patients with HF or IHD (not receiving ACE inhibitors or statins, respectively will be recruited from community pharmacies and allocated to intervention or usual care based on the randomization status of their primary care physician. The primary outcome is improvement in prescription of proven efficacious therapies for HF (ACE inhibitors or IHD (statins within 6 months of the intervention. Conclusion If the methods used in this intervention are found to improve prescribing practices

  5. Improving safety culture on adult medical units through multidisciplinary teamwork and communication interventions: the TOPS Project. (United States)

    Blegen, M A; Sehgal, N L; Alldredge, B K; Gearhart, S; Auerbach, A A; Wachter, R M


    The goal of this project was to improve unit-based safety culture through implementation of a multidisciplinary (pharmacy, nursing, medicine) teamwork and communication intervention. The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture was used to determine the impact of the training with a before-after design. Surveys were returned from 454 healthcare staff before the training and 368 staff 1 year later. Five of eleven safety culture subscales showed significant improvement. Nurses perceived a stronger safety culture than physicians or pharmacists. While it is difficult to isolate the effects of the team training intervention from other events occurring during the year between training and postevaluation, overall the intervention seems to have improved the safety culture on these medical units.

  6. Knowledge representation in safety assessment: improving transparency and traceability

    Energy Technology Data Exchange (ETDEWEB)

    Lemos, F.L. de [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil); Sullivan, T. [Brookhaven National Laboratory (BNL), Upton, NY (United States); Ross, T. [University of New Mexico (UNM), Albuquerque, NM (United States); Guimaraes, L.N.F. [Instituto de Estudos Avancados (IEAv/CTA), Sao Jose dos Campos, SP (Brazil)


    Transparency and traceability are key factors for confidence building, acceptability, and quality enhancement of the safety assessment, and safety case for a radioactive waste disposal facility. In order to facilitate analysis and promote discussions, all of the information used to make decisions should be readily available to stake holders. The information should convey a good understanding of the intermediate decisions processes, allowing examination of alternatives and 'what if questions'. In an ideal situation all stake holders, including scientists and the public, should be able to follow the path of a certain parameter, from the beginning where it was defined, its assumptions and uncertainties, throughout the calculations until the final results of the safety assessment. One of the main challenges, to achieving such a transparency and traceability, is that stake holders are a very diverse audience, with very different backgrounds. This could require preparation of various versions of the same documentation, which would be impractical. While the linguistic information is of crucial importance to understanding the reasoning, it is very difficult to convey the supporting conditions, and consequent uncertainties for the selection of parameters values. Even scientists involved in the process can become confused due to the overwhelming amount of information that is used to support parameter value selection. The amount of details makes it difficult to track the decisions, which lead to the selection of a certain parameter, throughout the calculations. This paper presents a methodology to represent the linguistic information used in the safety assessment in terms of mathematical expressions by using the fuzzy sets and fuzzy logic tools. This methodology aims to help information to be readily available while keeping, as much as possible, the original meaning of the linguistic expressions and, consequently, to be available at any time as a quick reference

  7. Changing doctor prescribing behaviour

    DEFF Research Database (Denmark)

    Gill, P.S.; Mäkelä, M.; Vermeulen, K.M.


    The aim of this overview was to identify interventions that change doctor prescribing behaviour and to derive conclusions for practice and further research. Relevant studies (indicating prescribing as a behaviour change) were located from a database of studies maintained by the Cochrane Collabora......The aim of this overview was to identify interventions that change doctor prescribing behaviour and to derive conclusions for practice and further research. Relevant studies (indicating prescribing as a behaviour change) were located from a database of studies maintained by the Cochrane...

  8. National Space Agencies vs. Commercial Space: Towards Improved Space Safety (United States)

    Pelton, J.


    Traditional space policies as developed at the national level includes many elements but they are most typically driven by economic and political objectives. Legislatively administered programs apportion limited public funds to achieve "gains" that can involve employment, stimulus to the economy, national defense or other advancements. Yet political advantage is seldom far from the picture.Within the context of traditional space policies, safety issues cannot truly be described as "afterthoughts", but they are usually, at best, a secondary or even tertiary consideration. "Space safety" is often simply assumed to be "in there" somewhere. The current key question is can "safety and risk minimization", within new commercial space programs actually be elevated in importance and effectively be "designed in" at the outset. This has long been the case with commercial aviation and there is at least reasonable hope that this could also be the case for the commercial space industry in coming years. The cooperative role that the insurance industry has now played for centuries in the shipping industry and for decades in aviation can perhaps now play a constructive role in risk minimization in the commercial space domain as well. This paper begins by examining two historical case studies in the context of traditional national space policy development to see how major space policy decisions involving "manned space programs" have given undue primacy to "political considerations" over "safety" and other factors. The specific case histories examined here include first the decision to undertake the Space Shuttle Program (i.e. 1970-1972) and the second is the International Space Station. In both cases the key and overarching decisions were driven by political, schedule and cost considerations, and safety seems absence as a prime consideration. In publicly funded space programs—whether in the United States, Europe, Russia, Japan, China, India or elsewhere—it seems realistic to

  9. Efficacy of live feedback to improve objectively monitored compliance to prescribed, home-based, exercise therapy-dosage in 15 to 19 year old adolescents with patellofemoral pain

    DEFF Research Database (Denmark)

    Riel, Henrik; Matthews, Mark; Vicenzino, Bill


    feedback from a sensor (BandCizer™) and an iPad will improve the ability of adolescents with PFP to perform exercises as prescribed. METHODS: This study is a randomized, controlled, participant-blinded, superiority trial with a 2-group parallel design. Forty 15 to 19 year old adolescents......Pad. The adolescents perform the exercises twice a week unsupervised and once a week during a supervised group training session. The primary outcome will be the mean deviation of the prescribed time under tension per repetition in seconds during the course of the intervention. DISCUSSION: Low compliance is a major...

  10. What do primary care physicians and researchers consider the most important patient safety improvement strategies?

    NARCIS (Netherlands)

    Gaal, S.; Verstappen, W.H.J.M.; Wensing, M.J.P.


    BACKGROUND: Although it has been increasingly recognised that patient safety in primary care is important, little is known about the feasibility and effectiveness of different strategies to improve patient safety in primary care. In this study, we aimed to identify the most important strategies by

  11. What do primary care physicians and researchers consider the most important patient safety improvement strategies?

    NARCIS (Netherlands)

    Gaal, S.; Verstappen, W.H.J.M.; Wensing, M.J.P.


    BACKGROUND: Although it has been increasingly recognised that patient safety in primary care is important, little is known about the feasibility and effectiveness of different strategies to improve patient safety in primary care. In this study, we aimed to identify the most important strategies by c

  12. Characteristics, resource utilization and safety profile of patients prescribed with neuropathic pain treatments: a real-world evidence study on general practices in Europe - the role of the lidocaine 5% medicated plaster. (United States)

    Katz, Pablo; Pegoraro, Valeria; Liedgens, Hiltrud


    To identify characteristics, resource utilization, and safety profile of patients prescribed with lidocaine 5% medicated plaster, pregabalin, gabapentin, amitriptyline and duloxetine when experiencing pain in the real-world setting of general practitioners (GPs) in Europe. Retrospective analysis on real world data from IMS Health Longitudinal Patient Database. Patients with at least one prescription of the drugs of interest during 2014 were selected and those with a non-neuropathic pain-related diagnosis were excluded. Patients' demographic and clinical characteristics, resource utilization data and adverse drug reactions (ADRs) as described in the leaflet were extracted. The association between treatments and ADR occurrence was evaluated applying multivariate logistic models. A total of 70,515 patients were selected from Italy, Germany, the UK, Spain and Belgium. Lidocaine 5% medicated plaster patients were the oldest in Italy, the UK and Spain and the most health impaired in Italy, Spain and Belgium. No relevant differences in the number of co-prescriptions, specialist visits, examinations and hospitalizations were found. Significantly less lidocaine 5% plasters patients experienced ADRs, with odds ratios in favor of lidocaine 5% medicated plasters ranging from 3.41 (p = .036) to 52.33 (p plaster patients showing a better safety profile, but also a comparable level of resource utilization. A possible re-evaluation of the scientific value coming from this retrospective study in building up a diagnostic as well as a therapeutic algorithm is suggested.

  13. Safety Margins in Older Adults Increase with Improved Control of a Dynamic Object

    Directory of Open Access Journals (Sweden)

    Christopher James Hasson


    Full Text Available Older adults face decreasing motor capabilities due to pervasive neuromuscular degradations. As a consequence errors in movement control increase. Thus, older individuals should maintain larger safety margins than younger adults. While this has been shown for object manipulation tasks, several reports on whole-body activities, such as posture and locomotion, however demonstrate age-related reductions in safety margins. This is despite increased costs for control errors, such as a fall. We posit that this paradox could be explained by the dynamic challenge presented by the body or an external object, and that age-related reductions in safety margins are in part due to a decreased ability to control dynamics. To test this conjecture we used a virtual ball-in-cup task that had challenging dynamics, yet afforded an explicit rendering of the physics and safety margin. The hypotheses were: 1 When manipulating an object with challenging dynamics, older adults have smaller safety margins than younger adults. 2 Older adults increase their safety margins with practice. Nine young and 10 healthy older adults practiced moving the virtual ball-in-cup to a target location in exactly two seconds. The accuracy and precision of the timing error quantified skill and the ball energy relative to an escape threshold quantified the safety margin. Compared to the young adults, older adults had increased timing errors, greater variability, and decreased safety margins. With practice, both young and older adults improved their ability to control the object with decreased timing errors and variability, and increased their safety margins. These results suggest that safety margins are related to the ability to control dynamics, and may explain why in tasks with simple dynamics older adults use adequate safety margins, but in more complex tasks, safety margins may be inadequate. Further, the results indicate that task-specific training may improve safety margins in older

  14. [Role of reporting and learning systems in the improvement of patient safety]. (United States)

    Lám, Judit; Sümegi, Viktória; Surján, Cecília; Kullmann, Lajos; Belicza, Éva


    The principles and requirements of a patient safety related reporting and learning system were defined by the World Health Organization Draft Guidelines for Adverse Event Reporting and Learning Systems published in 2005. Since then more and more Hungarian health care organizations aim to improve their patient safety culture. In order to support this goal the NEVES reporting and learning system and the series of Patient Safety Forums for training and consultation were launched in 2006 and significantly renewed recently. Current operative modifications to the Health Law emphasize patient safety, making the introduction of these programs once again necessary.

  15. Empirical estimation of school siting parameter towards improving children's safety (United States)

    Aziz, I. S.; Yusoff, Z. M.; Rasam, A. R. A.; Rahman, A. N. N. A.; Omar, D.


    Distance from school to home is a key determination in ensuring the safety of hildren. School siting parameters are made to make sure that a particular school is located in a safe environment. School siting parameters are made by Department of Town and Country Planning Malaysia (DTCP) and latest review was on June 2012. These school siting parameters are crucially important as they can affect the safety, school reputation, and not to mention the perception of the pupil and parents of the school. There have been many studies to review school siting parameters since these change in conjunction with this ever-changing world. In this study, the focus is the impact of school siting parameter on people with low income that live in the urban area, specifically in Johor Bahru, Malaysia. In achieving that, this study will use two methods which are on site and off site. The on site method is to give questionnaires to people and off site is to use Geographic Information System (GIS) and Statistical Product and Service Solutions (SPSS), to analyse the results obtained from the questionnaire. The output is a maps of suitable safe distance from school to house. The results of this study will be useful to people with low income as their children tend to walk to school rather than use transportation.

  16. Improving E-Bike Safety on Urban Highways in China

    Directory of Open Access Journals (Sweden)

    Linjun Lu


    Full Text Available This paper aims to examine characteristics of e-bike fatal crashes on urban highways in China. Crash data were retrieved from the three-year crash reports (2010–2012 of Taixing City. Descriptive analysis was conducted to examine characteristics of e-bike riders, drivers, and crashes. The important findings include the following: (1 most fatal crashes were related to e-bike riders’ aberrant driving behaviors, including driving in motorized lanes, red-light running, driving against the direction of traffic, inattentive driving, and drunk driving; (2 e-bike riders with lower educational background tended to perform illegal or inattentive driving behaviors in fatal crashes; (3 most drivers were not found to commit any faults and very few drivers were found to commit drunk driving offences; (4 most nighttime fatal crashes were related to absence of street lightings; (5 heavy good vehicles (HGVs and small passenger cars were the two vehicle types that were mostly involved in the e-bike fatal crashes. This study provides useful information that can help traffic engineers better understand e-bike safety in China and develop safety countermeasures.

  17. Model for improving safety in transporting dangerous goods for the Serbian Army

    Directory of Open Access Journals (Sweden)

    Dragan S. Kostadinović


    Full Text Available Design and improvement of the safety of transport of dangerous goods is a multidimensional and dynamic process which can be implemented using several different methods and techniques. In defining the model of improving the safety of transport of dangerous goods for the purposes of the Serbian Army, the Deming's approach to quality management system has been used. The analysis of the existing organization of transport of dangerous goods in the Army of Serbia has established the basic causes that affect the reduction in security as well as specific measures to be taken to improve the safety of transport of dangerous goods in the Serbian Army. The benchmark concept, widely used in the world, especially among organizations dealing with the same kind of logistic services, has been applied to indentify measures to improve the safety of transport of dangerous goods in the Serbian Army.

  18. What has change management in industry got to do with improving patient safety? (United States)

    Noble, Douglas J; Lemer, Claire; Stanton, Emma


    Healthcare is often in a constant state of change - for political, technological, patient related, and scientific reasons. Yet, for a business where change is the norm, too little time is spent thinking theoretically about how change occurs. One area where change is still needed is in patient safety. Presented is an analysis of the literature on change to suggest how this may inform patient safety. No one change approach guarantees success in patient safety. Success very much depends on selecting the best fit change framework and adapting it to local context. Well regarded change models, like that of Kotter, are not well tested within a healthcare context. Those that are, such as Pettigrew, do not specifically address all the issues associated with patient safety. Kotter's phases of change may be applied in a healthcare context to enhance patient safety. Kotter's model is well studied in non-healthcare contexts and has potential to be adapted for improving patient safety.

  19. Improving the effectiveness of road safety campaigns: Current and new practices

    Directory of Open Access Journals (Sweden)

    Tamara Hoekstra


    Full Text Available The evaluation of campaigns aimed at improving road safety is still the exception rather than the rule. Because of this, ineffective campaigns and campaign techniques are allowed to continue to be utilised without question, while new methods of behaviour modification are often ignored. Therefore, the necessity and advantages of formally evaluating road safety campaign efforts are discussed. This article also describes the pros and cons of some of the more common campaign strategies and introduces a number of new methods that show a great deal of promise for the purpose of road safety campaigns. In order to infuse the field of road safety campaigning with such new insights into road user behaviour and behavioural modification, one should look beyond the confines of road safety campaign standards and learn from the knowledge gained in other disciplines such as economics and social psychology. These new insights are discussed in terms of their implications for the future of road safety campaigns.

  20. CNE article: safety culture in Australian intensive care units: establishing a baseline for quality improvement. (United States)

    Chaboyer, Wendy; Chamberlain, Di; Hewson-Conroy, Karena; Grealy, Bernadette; Elderkin, Tania; Brittin, Maureen; McCutcheon, Catherine; Longbottom, Paula; Thalib, Lukman


    Workplace safety culture is a crucial ingredient in patients' outcomes and is increasingly being explored as a guide for quality improvement efforts. To establish a baseline understanding of the safety culture in Australian intensive care units. In a nationwide study of physicians and nurses in 10 Australian intensive care units, the Safety Attitudes Questionnaire intensive care unit version was used to measure safety culture. Descriptive statistics were used to summarize the mean scores for the 6 subscales of the questionnaire, and generalized-estimation-equations models were used to test the hypotheses that safety culture differed between physicians and nurses and between nurse leaders and bedside nurses. A total of 672 responses (50.6% response rate) were received: 513 (76.3%) from nurses, 89 (13.2%) from physicians, and 70 (10.4%) from respondents who did not specify their professional group. Ratings were highest for teamwork climate and lowest for perceptions of hospital management and working conditions. Four subscales, job satisfaction, teamwork climate, safety climate, and working conditions, were rated significantly higher by physicians than by nurses. Two subscales, working conditions and perceptions of hospital management, were rated significantly lower by nurse leaders than by bedside nurses. Measuring the baseline safety culture of an intensive care unit allows leaders to implement targeted strategies to improve specific dimensions of safety culture. These strategies ultimately may improve the working conditions of staff and the care that patients receive.

  1. Identification of priorities for improvement of medication safety in primary care: a PRIORITIZE study. (United States)

    Tudor Car, Lorainne; Papachristou, Nikolaos; Gallagher, Joseph; Samra, Rajvinder; Wazny, Kerri; El-Khatib, Mona; Bull, Adrian; Majeed, Azeem; Aylin, Paul; Atun, Rifat; Rudan, Igor; Car, Josip; Bell, Helen; Vincent, Charles; Franklin, Bryony Dean


    Medication error is a frequent, harmful and costly patient safety incident. Research to date has mostly focused on medication errors in hospitals. In this study, we aimed to identify the main causes of, and solutions to, medication error in primary care. We used a novel priority-setting method for identifying and ranking patient safety problems and solutions called PRIORITIZE. We invited 500 North West London primary care clinicians to complete an open-ended questionnaire to identify three main problems and solutions relating to medication error in primary care. 113 clinicians submitted responses, which we thematically synthesized into a composite list of 48 distinct problems and 45 solutions. A group of 57 clinicians randomly selected from the initial cohort scored these and an overall ranking was derived. The agreement between the clinicians' scores was presented using the average expert agreement (AEA). The study was conducted between September 2013 and November 2014. The top three problems were incomplete reconciliation of medication during patient 'hand-overs', inadequate patient education about their medication use and poor discharge summaries. The highest ranked solutions included development of a standardized discharge summary template, reduction of unnecessary prescribing, and minimisation of polypharmacy. Overall, better communication between the healthcare provider and patient, quality assurance approaches during medication prescribing and monitoring, and patient education on how to use their medication were considered the top priorities. The highest ranked suggestions received the strongest agreement among the clinicians, i.e. the highest AEA score. Clinicians identified a range of suggestions for better medication management, quality assurance procedures and patient education. According to clinicians, medication errors can be largely prevented with feasible and affordable interventions. PRIORITIZE is a new, convenient, systematic, and replicable method

  2. Measurable improvement in patient safety culture: A departmental experience with incident learning. (United States)

    Kusano, Aaron S; Nyflot, Matthew J; Zeng, Jing; Sponseller, Patricia A; Ermoian, Ralph; Jordan, Loucille; Carlson, Joshua; Novak, Avrey; Kane, Gabrielle; Ford, Eric C


    Rigorous use of departmental incident learning is integral to improving patient safety and quality of care. The goal of this study was to quantify the impact of a high-volume, departmental incident learning system on patient safety culture. A prospective, voluntary, electronic incident learning system was implemented in February 2012 with the intent of tracking near-miss/no-harm incidents. All incident reports were reviewed weekly by a multiprofessional team with regular department-wide feedback. Patient safety culture was measured at baseline with validated patient safety culture survey questions. A repeat survey was conducted after 1 and 2 years of departmental incident learning. Proportional changes were compared by χ(2) or Fisher exact test, where appropriate. Between 2012 and 2014, a total of 1897 error/near-miss incidents were reported, representing an average of 1 near-miss report per patient treated. Reports were filed by a cross section of staff, with the majority of incidents reported by therapists, dosimetrists, and physicists. Survey response rates at baseline and 1 and 2 years were 78%, 80%, and 80%, respectively. Statistically significant and sustained improvements were noted in several safety metrics, including belief that the department was openly discussing ways to improve safety, the sense that reports were being used for safety improvement, and the sense that changes were being evaluated for effectiveness. None of the surveyed dimensions of patient safety culture worsened. Fewer punitive concerns were noted, with statistically significant decreases in the worry of embarrassment in front of colleagues and fear of getting colleagues in trouble. A comprehensive incident learning system can identify many areas for improvement and is associated with significant and sustained improvements in patient safety culture. These data provide valuable guidance as incident learning systems become more widely used in radiation oncology. Copyright © 2015

  3. Organisational learning and continuous improvement of health and safety in certified manufacturers

    DEFF Research Database (Denmark)

    Granerud, Lise; Rocha, Robson Sø


    Certified management systems have increasingly been applied by firms in recent decades and now cover the management of health and safety, principally through the OHSAS 18001 standard. In order to become certified, firms must not only observe the relevant legislation, but also improve performance...... processes. The model is applied to five cases from a qualitative study of Danish manufacturers with certified health and safety management systems. The cases illustrate the wide variation in health and safety management among certified firms. Certification is found to support lower levels of continuous...... that certified health and safety management does not obstruct learning, and can support advanced learning. Improvement practices with regard to health and safety are mainly dependent upon the firm’s overall organisational processes and do not automatically arise from the standard alone....

  4. Annotated Bibliography: Understanding Ambulatory Care Practices in the Context of Patient Safety and Quality Improvement. (United States)

    Montano, Maria F; Mehdi, Harshal; Nash, David B


    The ambulatory care setting is an increasingly important component of the patient safety conversation. Inpatient safety is the primary focus of the vast majority of safety research and interventions, but the ambulatory setting is actually where most medical care is administered. Recent attention has shifted toward examining ambulatory care in order to implement better health care quality and safety practices. This annotated bibliography was created to analyze and augment the current literature on ambulatory care practices with regard to patient safety and quality improvement. By providing a thorough examination of current practices, potential improvement strategies in ambulatory care health care settings can be suggested. A better understanding of the myriad factors that influence delivery of patient care will catalyze future health care system development and implementation in the ambulatory setting.

  5. Current Status of Obstetric Anaesthesia: Improving Satisfaction and Safety

    Directory of Open Access Journals (Sweden)

    J Sudharma Ranasinghe


    Full Text Available The Centers for Disease Control and Prevention (CDC reported in 2003 that although the maternal mortal-ity rate has decreased by 99% since 1900, there has been no further decrease in the last two decades [1] . A more recent report indicates a rate of 11.8 per 100,000 live births [2] , although anaesthesia-related maternal mortality and morbidity has considerably decreased over the lastfew decades. Despite the growing complexity of problems and increasing challenges such as pre-existing maternal disease, obesity, and the increasing age of pregnant mothers, anaesthesia related maternal mortality is extremely rare in the developed world. The current safety has been achievedthrough changes in training, service, technical advances and multidisciplinary approach to care. The rates of general anaesthesia for cesarean delivery have decreased and neuraxial anaesthetics have become the most commonly used techniques. Neuraxial techniques are largely safe and effective, but potential complications, though rare, can be severe.

  6. Organisational learning and continuous improvement of health and safety in certified manufacturers

    DEFF Research Database (Denmark)

    Granerud, Lise; Rocha, Robson Sø


    and raise goals within health and safety on a continuous basis. The article examines how certified occupational and health management systems influence this process to evaluate how far they hinder or support learning. It presents a model with which it is possible to identify and analyse improvement...... that certified health and safety management does not obstruct learning, and can support advanced learning. Improvement practices with regard to health and safety are mainly dependent upon the firm’s overall organisational processes and do not automatically arise from the standard alone....

  7. Improving mine safety technology and training in the U.S. recommendations of the Mine Safety Technology and Training Commission

    Institute of Scientific and Technical Information of China (English)

    GRAYSON R. Larry


    The key issues studied focused on underground coal mining and included (1)prevention of explosions in sealed areas, (2) better emergency preparedness and re-sponse, (3) improvement of miners' ability to escape, (4) better protection of miners beforeand after a fire or explosion, (5) improved provision of oxygen, and (6) development andimplementation of more robust post-incident communication. The U.S. Congress passedthe Mine Improvement and New Emergency Response Act of 2006, which mandated newlaws to address the issues. Concurrent with investigations and congressional deliberations,the National Mining Association formed the independent Mine Safety Technology andTraining Commission to study the state-of-the-art relative to technology and training thatcould address the vulnerabilities exposed by the mine disasters. As discussed, the reportoutlined persistent vulnerabilities linked with significant hazards in underground coal mines,and made recommendations to provide a path for addressing them. Overall the commis-sion report made 75 recommendations in the areas of risk-based design and management,communications technology, emergency response and mine rescue procedures, trainingfor preparedness, and escape and protection strategies. In its deliberations, the commis-sion importantly noted that mine safety in the U.S. needs to follow a new paradigm for en-suring mine safety and developing a culture of prevention that supports safe production atthe business core. In the commission's viewpoint, the bottom line in protecting coal minersis not only adopting a culture of prevention but also systematically pursuing mitigation ofsignificant risks.

  8. Improvement of Level-1 PSA computer code package -A study for nuclear safety improvement-

    Energy Technology Data Exchange (ETDEWEB)

    Park, Chang Kyu; Kim, Tae Woon; Ha, Jae Joo; Han, Sang Hoon; Cho, Yeong Kyun; Jeong, Won Dae; Jang, Seung Cheol; Choi, Young; Seong, Tae Yong; Kang, Dae Il; Hwang, Mi Jeong; Choi, Seon Yeong; An, Kwang Il [Korea Atomic Energy Res. Inst., Taejon (Korea, Republic of)


    This year is the second year of the Government-sponsored Mid- and Long-Term Nuclear Power Technology Development Project. The scope of this subproject titled on `The Improvement of Level-1 PSA Computer Codes` is divided into three main activities : (1) Methodology development on the under-developed fields such as risk assessment technology for plant shutdown and external events, (2) Computer code package development for Level-1 PSA, (3) Applications of new technologies to reactor safety assessment. At first, in the area of PSA methodology development, foreign PSA reports on shutdown and external events have been reviewed and various PSA methodologies have been compared. Level-1 PSA code KIRAP and CCF analysis code COCOA are converted from KOS to Windows. Human reliability database has been also established in this year. In the area of new technology applications, fuzzy set theory and entropy theory are used to estimate component life and to develop a new measure of uncertainty importance. Finally, in the field of application study of PSA technique to reactor regulation, a strategic study to develop a dynamic risk management tool PEPSI and the determination of inspection and test priority of motor operated valves based on risk importance worths have been studied. (Author).


    CERN Document Server

    Niels Dupont


    CERN Safety rules and Radiation Protection at CMS The CERN Safety rules are defined by the Occupational Health & Safety and Environmental Protection Unit (HSE Unit), CERN’s institutional authority and central Safety organ attached to the Director General. In particular the Radiation Protection group (DGS-RP1) ensures that personnel on the CERN sites and the public are protected from potentially harmful effects of ionising radiation linked to CERN activities. The RP Group fulfils its mandate in collaboration with the CERN departments owning or operating sources of ionising radiation and having the responsibility for Radiation Safety of these sources. The specific responsibilities concerning "Radiation Safety" and "Radiation Protection" are delegated as follows: Radiation Safety is the responsibility of every CERN Department owning radiation sources or using radiation sources put at its disposition. These Departments are in charge of implementing the requi...

  10. Review: Pharmaceutical policies : effects of financial incentives for prescribers

    NARCIS (Netherlands)

    Sturm, H.; Austvoll-Dahlgren, A.; Aaserud, M.; Oxman, A. D.; Ramsay, C.; Vernby, A.; Koesters, J. P.


    Background Pharmaceuticals, while central to medical therapy, pose a significant burden to health care budgets. Therefore regulations to control prescribing costs and improve quality of care are implemented increasingly. These include the use of financial incentives for prescribers, namely increased

  11. Large scale organisational intervention to improve patient safety in four UK hospitals: mixed method evaluation. (United States)

    Benning, Amirta; Ghaleb, Maisoon; Suokas, Anu; Dixon-Woods, Mary; Dawson, Jeremy; Barber, Nick; Franklin, Bryony Dean; Girling, Alan; Hemming, Karla; Carmalt, Martin; Rudge, Gavin; Naicker, Thirumalai; Nwulu, Ugochi; Choudhury, Sopna; Lilford, Richard


    To conduct an independent evaluation of the first phase of the Health Foundation's Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Mixed method evaluation involving five substudies, before and after design. NHS hospitals in the United Kingdom. Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. The SPI1 was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration--monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)--there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for "difference in difference" 2

  12. Steam Pressure-Reducing Station Safety and Energy Efficiency Improvement Project

    Energy Technology Data Exchange (ETDEWEB)

    Lower, Mark D [ORNL; Christopher, Timothy W [ORNL; Oland, C Barry [ORNL


    The Facilities and Operations (F&O) Directorate is sponsoring a continuous process improvement (CPI) program. Its purpose is to stimulate, promote, and sustain a culture of improvement throughout all levels of the organization. The CPI program ensures that a scientific and repeatable process exists for improving the delivery of F&O products and services in support of Oak Ridge National Laboratory (ORNL) Management Systems. Strategic objectives of the CPI program include achieving excellence in laboratory operations in the areas of safety, health, and the environment. Identifying and promoting opportunities for achieving the following critical outcomes are important business goals of the CPI program: improved safety performance; process focused on consumer needs; modern and secure campus; flexibility to respond to changing laboratory needs; bench strength for the future; and elimination of legacy issues. The Steam Pressure-Reducing Station (SPRS) Safety and Energy Efficiency Improvement Project, which is under the CPI program, focuses on maintaining and upgrading SPRSs that are part of the ORNL steam distribution network. This steam pipe network transports steam produced at the ORNL steam plant to many buildings in the main campus site. The SPRS Safety and Energy Efficiency Improvement Project promotes excellence in laboratory operations by (1) improving personnel safety, (2) decreasing fuel consumption through improved steam system energy efficiency, and (3) achieving compliance with applicable worker health and safety requirements. The SPRS Safety and Energy Efficiency Improvement Project being performed by F&O is helping ORNL improve both energy efficiency and worker safety by modifying, maintaining, and repairing SPRSs. Since work began in 2006, numerous energy-wasting steam leaks have been eliminated, heat losses from uninsulated steam pipe surfaces have been reduced, and deficient pressure retaining components have been replaced. These improvements helped ORNL

  13. Improving safety behaviour and accident rates of professional drivers: the Dead Sea project. (United States)

    Calé, Michael H


    It was the aim of the Dead Sea project to change and improve traffic safety behaviour and lower the accident rates of professional drivers by applying principles and techniques known from social and traffic psychology. All interventions were based on a sample of 48 workers from one company. Extensive changes in attitudes were obtained by manipulating the workers' behaviour and causing them to publicly represent positive safety attitudes and values. The results show significant improvements in safety behaviour and reductions of accident rates. In spite of the fact that only a small minority of the workers in this plant directly participated in the programme, many others were influenced and improved their safety behaviour on the road. Therefore, the employed method seems to be not only effective but also very cost efficient.

  14. Characterization and improvement of the nuclear safety culture through self-assessment

    Energy Technology Data Exchange (ETDEWEB)

    Levin, H.A. [Synergy Consulting Services Corp., Great Falls, VA (United States); McGehee, R.B. [Wise Carter Child & Caraway, Jackson, MS (United States); Cottle, W.T. [Houston Lighting & Power, Wadsworth, TX (United States)


    Organizational culture has a powerful influence on overall corporate performance. The ability to sustain superior results in ensuring the public`s health and safety is predicated on an organization`s deeply embedded values and behavioral norms and how these affect the ability to change and seek continuous improvement. The nuclear industry is developing increased recognition of the relationship of culture to nuclear safety performance as a critical element of corporate strategy. This paper describes a self-assessment methodology designed to characterize and improve the nuclear safety culture, including processes for addressing employee concerns. This methodology has been successfully applied on more than 30 occasions in the last several years, resulting in measurable improvements in safety performance and quality and employee motivation, productivity, and morale. Benefits and lessons learned are also presented.

  15. Rationale, design and organization of the delayed antibiotic prescription (DAP) trial: a randomized controlled trial of the efficacy and safety of delayed antibiotic prescribing strategies in the non-complicated acute respiratory tract infections in general practice (United States)


    Background Respiratory tract infections are an important burden in primary care and it’s known that they are usually self-limited and that antibiotics only alter its course slightly. This together with the alarming increase of bacterial resistance due to increased use of antimicrobials calls for a need to consider strategies to reduce their use. One of these strategies is the delayed prescription of antibiotics. Methods Multicentric, parallel, randomised controlled trial comparing four antibiotic prescribing strategies in acute non-complicated respiratory tract infections. We will include acute pharyngitis, rhinosinusitis, acute bronchitis and acute exacerbation of chronic bronchitis or chronic obstructive pulmonary disease (mild to moderate). The therapeutic strategies compared are: immediate antibiotic treatment, no antibiotic treatment, and two delayed antibiotic prescribing (DAP) strategies with structured advice to use a course of antibiotics in case of worsening of symptoms or not improving (prescription given to patient or prescription left at the reception of the primary care centre 3 days after the first medical visit). Discussion Delayed antibiotic prescription has been widely used in Anglo-Saxon countries, however, in Southern Europe there has been little research about this topic. The DAP trial wil evaluate two different delayed strategies in Spain for the main respiratory infections in primary care. Trial registration This trial is registered with, number http://NCT01363531. PMID:23682979

  16. Evidence-Based Quality Improvement: A recipe for improving medication safety and handover of care

    NARCIS (Netherlands)

    Smeulers, M.


    In healthcare we strive to provide the highest possible quality of care. Even though healthcare professionals work together with the intention to provide safe care, medical errors still threaten patient safety. Patient safety has received considerable attention since the beginning of this century,

  17. Opportunities for Using Building Information Modeling to Improve Worker Safety Performance

    Directory of Open Access Journals (Sweden)

    Kasim Alomari


    Full Text Available Building information modelling (BIM enables the creation of a digital representation of a designed facility combined with additional information about the project attributes, performance criteria, and construction process. Users of BIM tools point to the ability to visualize the final design along with the construction process as a beneficial feature of using BIM. Knowing the construction process in relationship to a facility’s design benefits both safety professionals when planning worker safety measures for a project and designers when creating a project’s design. Success in using BIM to enhance safety partly depends on the familiarity of project personnel with BIM tools and the extent to which the tools can be used to identify and eliminate safety hazards. In a separate, ongoing study, the authors investigated the connection between BIM and safety to document the opportunities, barriers, and impacts. Utilizing an on-line survey of project engineers who work for construction firms together with a comprehensive literature review, the study found those who use BIM feel that it aids in communication of project information and project delivery, both of which have been found to have positive impacts on construction site safety. Further, utilizing the survey results, the authors apply the binary logistic regression econometric framework to better understand the factors that lead to safety professionals believing that BIM increases safety in the work place. In addition, according to the survey results, a large percentage of the engineers who use BIM feel that ultimately it helps to eliminate safety hazards and improve worker safety. The study findings suggest that improvements in safety performance across the construction industry may be due in part to increased use of BIM in the construction industry.

  18. Nurse prescribing: radicalism or tokenism? (United States)

    McCartney, W; Tyrer, S; Brazier, M; Prayle, D


    The creation of The Medical Products (Prescription by Nurses, etc.) Act 1992 has been generally welcomed by the nursing profession. This article seeks to introduce a note of scepticism about the assumed motivations for its introduction through an analysis of various legal, ethical, economic and political dimensions. In reviewing the position of nursing vis-à-vis medicine it is argued that one of the ways that nursing has sought to improve its professional position is to take on work previously done by doctors, and nurse prescribing can be seen in the context of the concurrent de-regulation of medicines, allowing greater access to medicines and therefore greater consumer choice. This de-regulation stems from the liberation ideology of the previous Conservative government. Viewed in this way nurse prescribing, particularly with reference to the limited nature of the nursing formulary, can be seen to be anomalous. In the light of this analysis, the reasons generally put forward (notably in the Crown Report 1989) for the introduction of nurse prescribing could be seen to be peripheral to its real purpose. It is argued that the most convincing reasons for its introduction relate to the medical profession as a social institution. It is proposed that the three primary aims behind the introduction of nurse prescribing are: the saving of money; the transfer of routine medical work to nursing; and a challenge to the professional monolith of medicine.

  19. The association between event learning and continuous quality improvement programs and culture of patient safety. (United States)

    Mazur, Lukasz; Chera, Bhishamjit; Mosaly, Prithima; Taylor, Kinley; Tracton, Gregg; Johnson, Kendra; Comitz, Elizabeth; Adams, Robert; Pooya, Pegah; Ivy, Julie; Rockwell, John; Marks, Lawrence B


    To present our approach and results from our quality and safety program and to report their possible impact on our culture of patient safety. We created an event learning system (termed a "good catch" program) and encouraged staff to report any quality or safety concerns in real time. Events were analyzed to assess the utility of safety barriers. A formal continuous quality improvement program was created to address these reported events and make improvements. Data on perceptions of the culture of patient safety were collected using the Agency for Health Care Research and Quality survey administered before, during, and after the initiatives. Of 560 good catches reported, 367 could be ascribed to a specific step on our process map. The calculated utility of safety barriers was highest for those embedded into the pretreatment quality assurance checks performed by physicists and dosimetrists (utility score 0.53; 93 of 174) and routine checks done by therapists on the initial day of therapy. Therapists and physicists reported the highest number of good catches (24% each). Sixty-four percent of events were caused by performance issues (eg, not following standardized processes, including suboptimal communications). Of 31 initiated formal improvement events, 26 were successfully implemented and sustained, 4 were discontinued, and 1 was not implemented. Most of the continuous quality improvement program was conducted by nurses (14) and therapists (7). Percentages of positive responses in the patient safety culture survey appear to have increased on all dimensions (p quality improvement programs can be successfully implemented and that there are contemporaneous improvements in the culture of safety. Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  20. Dietary strategies for improving iron status: balancing safety and efficacy (United States)

    Mendoza, Yery A.; Pereira, Dora; Cerami, Carla; Wegmuller, Rita; Constable, Anne; Spieldenner, Jörg


    In light of evidence that high-dose iron supplements lead to a range of adverse events in low-income settings, the safety and efficacy of lower doses of iron provided through biological or industrial fortification of foodstuffs is reviewed. First, strategies for point-of-manufacture chemical fortification are compared with biofortification achieved through plant breeding. Recent insights into the mechanisms of human iron absorption and regulation, the mechanisms by which iron can promote malaria and bacterial infections, and the role of iron in modifying the gut microbiota are summarized. There is strong evidence that supplemental iron given in nonphysiological amounts can increase the risk of bacterial and protozoal infections (especially malaria), but the use of lower quantities of iron provided within a food matrix, ie, fortified food, should be safer in most cases and represents a more logical strategy for a sustained reduction of the risk of deficiency by providing the best balance of risk and benefits. Further research into iron compounds that would minimize the availability of unabsorbed iron to the gut microbiota is warranted. PMID:27974599

  1. Prescribing Practices and Polypharmacy in Kitovu Hospital ...

    African Journals Online (AJOL)


    This audit of prescribing practices explores recent trends at Kitovu Hospital, Uganda. The average ... patient essential knowledge indicators were greatly improved but only modest reduction ..... management of childhood illness strategy.

  2. Using mobile devices to improve the safety of medication administration processes. (United States)

    Navas, H; Graffi Moltrasio, L; Ares, F; Strumia, G; Dourado, E; Alvarez, M


    Within preventable medical errors, those related to medications are frequent in every stage of the prescribing cycle. Nursing is responsible for maintaining each patients safety and care quality. Moreover, nurses are the last people who can detect an error in medication before its administration. Medication administration is one of the riskiest tasks in nursing. The use of information and communication technologies is related to a decrease in these errors. Including mobile devices related to 2D code reading of patients and medication will decrease the possibility of error when preparing and administering medication by nurses. A cross-platform software (iOS and Android) was developed to ensure the five Rights of the medication administration process (patient, medication, dose, route and schedule). Deployment in November showed 39% use.

  3. [An approach to care indicators benchmarking. Learning to improve patient safety]. (United States)

    de Andrés Gimeno, B; Salazar de la Guerra, R M; Ferrer Arnedo, C; Revuelta Zamorano, M; Ayuso Murillo, D; González Soria, J


    Improvements in clinical safety can be achieved by promoting a safety culture, professional training, and learning through benchmarking. The aim of this study was to identify areas for improvement after analysing the safety indicators in two public Hospitals in North-West Madrid Region. Descriptive study performed during 2011 in Hospital Universitario Puerta de Hierro Majadahonda (HUPHM) and Hospital de Guadarrama (HG). The variables under study were 40 indicators on nursing care related to patient safety. Nineteen of them were defined in the SENECA project as care quality standards in order to improve patient safety in the hospitals. The data collected were clinical history, Madrid Health Service assessment reports, care procedures, and direct observation Within the 40 indicators: 22 of them were structured (procedures), HUPHM had 86%, and HG 95% 14 process indicators (training and protocols compliance) with similar results in both hospitals, apart from the care continuity reports and training in hand hygiene. The 4 results indicators (pressure ulcer, falls and pain) showed different results. The analysis of the indicators allowed the following actions to be taken: to identify improvements to be made in each hospital, to develop joint safety recommendations in nursing care protocols in prevention and treatment of chronic wound, to establish systematic pain assessments, and to prepare continuity care reports on all patients transferred from HUPHM to HG. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

  4. Safety

    CERN Multimedia


    Please note that the safety codes A9, A10 AND A11 (ex annexes of SAPOCO/42) entitled respectively "Safety responsibilities in the divisions" "The safety policy committee (SAPOCO) and safety officers' committees" and "Administrative procedure following a serious accident or incident" are available on the web at the following URLs: Code A9: Code A10: Code A11: Paper copies can also be obtained from the TIS divisional secretariat, e-mail: TIS Secretariat

  5. When Medication Is Prescribed (United States)

    ... page please turn Javascript on. Feature: Depression When Medication Is Prescribed Past Issues / Fall 2009 Table of ... you have about the medicine. —NIMH Types of Medications There are several types of medications used to ...

  6. What do primary care physicians and researchers consider the most important patient safety improvement strategies? (United States)

    Gaal, Sander; Verstappen, Wim; Wensing, Michel


    Although it has been increasingly recognised that patient safety in primary care is important, little is known about the feasibility and effectiveness of different strategies to improve patient safety in primary care. In this study, we aimed to identify the most important strategies by consulting an international panel of primary care physicians and researchers. A web-based survey was undertaken in an international panel of 58 individuals from eight countries with a strong primary care system. The questionnaire consisted of 38 strategies to improve patient safety. We asked the respondents whether these strategies were currently used in their own country, and whether they felt them to be important. Most of the 38 presented strategies were seen as important by a majority of the participants, but the use of strategies in daily practice varied widely. Strategies that yielded the highest scores (>70%) regarding importance included a good medical record system (82% felt this was very important, while 83% said it was implemented in more than half of the practices), good telephone access (71% importance, 83% implementation), standards for record keeping (75% importance, 62% implementation), learning culture (74% importance, 10% implementation), vocational training on patient safety for GPs (81% importance, 24% implementation) and the presence of a patient safety guideline (81% importance, 15% implementation). An international panel of primary care physicians and researchers felt that many different strategies to improve patient safety were important. Highly important strategies with poor implementation included a culture that is positive for patient safety, education on patient safety for physicians, and the presence of a patient safety guideline.

  7. What do primary care physicians and researchers consider the most important patient safety improvement strategies?

    Directory of Open Access Journals (Sweden)

    Wensing Michel


    Full Text Available Abstract Background Although it has been increasingly recognised that patient safety in primary care is important, little is known about the feasibility and effectiveness of different strategies to improve patient safety in primary care. In this study, we aimed to identify the most important strategies by consulting an international panel of primary care physicians and researchers. Methods A web-based survey was undertaken in an international panel of 58 individuals from eight countries with a strong primary care system. The questionnaire consisted of 38 strategies to improve patient safety. We asked the respondents whether these strategies were currently used in their own country, and whether they felt them to be important. Results Most of the 38 presented strategies were seen as important by a majority of the participants, but the use of strategies in daily practice varied widely. Strategies that yielded the highest scores (>70% regarding importance included a good medical record system (82% felt this was very important, while 83% said it was implemented in more than half of the practices, good telephone access (71% importance, 83% implementation, standards for record keeping (75% importance, 62% implementation, learning culture (74% importance, 10% implementation, vocational training on patient safety for GPs (81% importance, 24% implementation and the presence of a patient safety guideline (81% importance, 15% implementation. Conclusion An international panel of primary care physicians and researchers felt that many different strategies to improve patient safety were important. Highly important strategies with poor implementation included a culture that is positive for patient safety, education on patient safety for physicians, and the presence of a patient safety guideline.

  8. Improving truck safety: Potential of weigh-in-motion technology

    Directory of Open Access Journals (Sweden)

    Bernard Jacob


    Full Text Available Trucks exceeding the legal mass limits increase the risk of traffic accidents and damage to the infrastructure. They also result in unfair competition between transport modes and companies. It is therefore important to ensure truck compliance to weight regulation. New technologies are being developed for more efficient overload screening and enforcement. Weigh-in-Motion (WIM technologies allow trucks to be weighed in the traffic flow, without any disruption to operations. Much progress has been made recently to improve and implement WIM systems, which can contribute to safer and more efficient operation of trucks.

  9. 16 CFR 1500.88 - Exemptions from lead limits under section 101 of the Consumer Product Safety Improvement Act for... (United States)


    ... 101 of the Consumer Product Safety Improvement Act for certain electronic devices. 1500.88 Section 1500.88 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION FEDERAL HAZARDOUS SUBSTANCES ACT... from lead limits under section 101 of the Consumer Product Safety Improvement Act for...

  10. A study in improvement of administrative system in the nuclear safety regulation

    Energy Technology Data Exchange (ETDEWEB)

    Yook, Dong Il; Kuk, Doe Hyeong; Lee, Seong Min; Kim, Jong Sam; Hwang, Sun Ho [Chungnam National Univ., Taejon (Korea, Republic of)


    One of the most important tasks to improve nuclear safety regulation system is to separate nuclear regulatory institutes from public agencies which promote the development nuclear power. Moreover, nuclear safety regulation should be not only specialized but optimized to be adapted for new environments such as high-tech information age. Especially, it is necessary to reform the current nuclear safety regulation systems both to be effective under the local self-administration which began to operate in recent years and to be supported by local residents.

  11. Coating Strategies to Improve Lithium-ion Battery Safety

    Energy Technology Data Exchange (ETDEWEB)

    Travis, Jonathan [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States); Orendorff, Christopher J. [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States)


    This work investigated the effects of Al2O3 ALD coatings on the performance and thermal abuse tolerance of graphite based anodes and Li(NixMnyCoz)O2 (NMC) based cathodes. It was found that 5 cycles of Al2O3 ALD on the graphite anode increased the onset temperature of thermal runaway by approximately 20 °C and drastically reduced the anode’s contribution to the overall amount of heat released during thermal runaway. Although Al2O3 ALD improves the cycling stability of NMC based cathodes, the thermal abuse tolerance was not greatly improved. A series of conductive aluminum oxide/carbon composites were created and characterized as potential thicker protective coatings for use on NMC based cathode materials. A series of electrodes were coated with manganese monoxide ALD to test the efficacy of an oxygen scavenging coating on NMC based cathodes.

  12. Changing Operating Room Culture: Implementation of a Post-Operative Debrief and Improved Safety Culture. (United States)

    Magill, Stephen T; Wang, Doris D; Rutledge, W Caleb; Lau, Darryl; Berger, Mitchel S; Sankaran, Sujatha; Lau, Catherine Y; Imershein, Sarah G


    Patient safety is foundational to neurosurgical care. Post-procedural "debrief" checklists have been proposed to improve patient safety, but there is limited data about their use in neurosurgery. Here, we implemented an initiative to routinely perform post-operative debriefs and evaluated the impact of debriefing on operating room (OR) safety culture. A 10-question safety attitude questionnaire (SAQ) was sent to neurosurgical operating room staff at a major academic medical center before and 18-months after implementation of a post-operative debriefing initiative. Rates of debrief compliance and changes in attitudes before and after the survey were evaluated. The survey utilized a Likert scale and analyzed with standard statistical methods. After the debrief initiative, the rate of debriefing increased from 51% to 86% of cases for the neurosurgery service. Baseline SAQ responses found that neurosurgeons had a more favorable perception of OR safety than anesthesiologists and nurses. Following implementation of the post-operative debriefing process, perceptions of OR safety significantly improved for neurosurgeons, anesthesiologists and nurses. Furthermore, the disparity between nurses and surgeons was no longer significant. After debrief implementation, neurosurgical OR staff had improved perceptions of patient safety compared to surgical services that did not commonly perform debriefing. Debriefing identified OR efficiency concerns in 26.9% of cases and prevention of potential adverse events/near misses were reported in 8% of cases. Post-operative debriefing can be effectively introduced into the operating room and improves the safety culture after implementation. Debriefing is an effective tool to identify OR inefficiencies and potential adverse events. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Enhancing patient safety: improving the patient handoff process through appreciative inquiry. (United States)

    Shendell-Falik, Nancy; Feinson, Michael; Mohr, Bernard J


    Patient transfers from one care giver to another are an area of high safety consequence, as is evident by many studies and the Joint Commission on Accreditation of Healthcare Organization's Patient Safety Goals. The authors describe how one hospital made measurable improvements in a patient handoff process by using an unconventional approach to change called appreciative inquiry. Rather than identifying the root causes of ineffective handoffs, appreciative inquiry was used to engage staff in identifying and building on their most effective handoff experiences.

  14. 76 FR 67073 - Safety and Health Requirements Related to Camp Cars (United States)


    ... Federal Railroad Administration 49 CFR Part 228 RIN 2130-AC13 Safety and Health Requirements Related to... prescribing minimum safety and health requirements for camp cars that a railroad provides as sleeping quarters... final rule primarily to help satisfy the requirements of section 420 of the Rail Safety Improvement Act...

  15. Improving patient safety and optimizing nursing teamwork using crew resource management techniques. (United States)

    West, Priscilla; Sculli, Gary; Fore, Amanda; Okam, Nwoha; Dunlap, Cleveland; Neily, Julia; Mills, Peter


    This project describes the application of the "sterile cockpit rule," a crew resource management (CRM) technique, targeted to improve efficacy and safety for nursing assistants in the performance of patient care duties. Crew resource management techniques have been successfully implemented in the aviation industry to improve flight safety. Application of these techniques can improve patient safety in medical settings. The Veterans Affairs (VA) National Center for Patient Safety conducted a CRM training program in select VA nursing units. One unit developed a novel application of the sterile cockpit rule to create protected time for certified nursing assistants (CNAs) while they collected vital signs and blood glucose data at the beginning of each shift. The typical nursing authority structure was reversed, with senior nurses protecting CNAs from distractions. This process led to improvements in efficiency and communication among nurses, with the added benefit of increased staff morale. Crew resource management techniques can be used to improve efficiency, morale, and patient safety in the healthcare setting.

  16. Driving forces behind the Chinese public's demand for improved environmental safety. (United States)

    Wen, Ting; Wang, Jigan; Ma, Zongwei; Bi, Jun


    Over the past decades, the public demand for improved environmental safety keeps increasing in China. This study aims to assess the driving forces behind the increasing public demand for improved environmental safety using a provincial and multi-year (1995, 2000, 2005, 2010, and 2014) panel data and the Stochastic Impacts by Regression on Population, Affluence, and Technology (STIRPAT) model. The potential driving forces investigated included population size, income levels, degrees of urbanization, and educational levels. Results show that population size and educational level are positively (Pdemand for improved environmental safety. No significant impact on demand was found due to the degree of urbanization. For the impact due to income level, an inverted U-shaped curve effect with the turning point of ~140,000 CNY GDP per capita is indicated. Since per capita GDP of 2015 in China was approximately 50,000 CNY and far from the turning point, the public demand for improved environmental safety will continue rising in the near future. To meet the increasing public demand for improved environmental safety, proactive and risk prevention based environmental management systems coupled with effective environmental risk communication should be established. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Medication safety in hospitals. (United States)

    Kirke, C


    Medication error and adverse drug reactions occur frequently, leading to a high burden of patient harm in the hospital setting. Many Irish hospitals have established medication safety initiatives, designed to encourage reporting and learning to improve medication use processes and therefore patient safety. Eight Irish hospitals or hospital networks provided data from voluntary medication safety incident and near miss reporting programmes for pooled analysis of events occurring between 1st January 2006 and 30th June 2007. 6179 reports were received in total (mean 772 per hospital; range 96-1855). 95% of reports did not involve patient harm. Forty seven percent of reports related to the prescribing stage of the medication use process, 40% to the administration stage and 9% to the pharmacy dispensing stage. This data is published to increase awareness of this key patient safety issue, to share learning from these incidents and near misses and to encourage a more open patient safety culture.

  18. Multi-approach model for improving agrochemical safety among rice farmers in Pathumthani, Thailand

    Directory of Open Access Journals (Sweden)

    Siriwong W


    Full Text Available Buppha Raksanam,1,2 Surasak Taneepanichskul,2 Wattasit Siriwong,2 Mark Robson3,41Sirindhorn College of Public Health, Trang, 2College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand; 3School of Environmental and Biological Sciences, Rutgers University, 4School of Public Health, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ, USAAbstract: The large-scale use of agrochemicals has raised environmental and human health concerns. A comprehensive intervention strategy for improving agrochemical safety among rice farmers in Thailand is lacking. The objective of this study is to develop a model in order to improve farmers’ health and prevent them from being exposed to agrochemical hazards, in addition to evaluating the effectiveness of the intervention in terms of agrochemical safety. This study was conducted between October 2009 and January 2011. It measures changes in the mean scores of agrochemical knowledge, health beliefs, agrochemical use behaviors, and in-home pesticide safety. Knowledge of agrochemical use constitutes a basic knowledge of agrochemicals and agrochemical safety behaviors. Health beliefs constitute perceived susceptibility, severity, benefits, and barriers to using agrochemicals. Agrochemical use behaviors include self-care practices in terms of personal health at specific times including before spraying, while spraying, during storage, transportation, waste management, and health risk management. Fifty rice farmers from Khlong Seven Community (study group and 51 rice farmers from Bueng Ka Sam community (control group were randomly recruited with support from community leaders. The participants were involved in a combination of home visits (ie, pesticide safety assessments at home and community participatory activities regarding agrochemical safety. This study reveals that health risk behaviors regarding agrochemical exposure in the study area are mainly caused by lack of attention to

  19. Modeling of outpatient prescribing process in iran: a gateway toward electronic prescribing system. (United States)

    Ahmadi, Maryam; Samadbeik, Mahnaz; Sadoughi, Farahnaz


    Implementation of electronic prescribing system can overcome many problems of the paper prescribing system, and provide numerous opportunities of more effective and advantageous prescribing. Successful implementation of such a system requires complete and deep understanding of work content, human force, and workflow of paper prescribing. The current study was designed in order to model the current business process of outpatient prescribing in Iran and clarify different actions during this process. In order to describe the prescribing process and the system features in Iran, the methodology of business process modeling and analysis was used in the present study. The results of the process documentation were analyzed using a conceptual model of workflow elements and the technique of modeling "As-Is" business processes. Analysis of the current (as-is) prescribing process demonstrated that Iran stood at the first levels of sophistication in graduated levels of electronic prescribing, namely electronic prescription reference, and that there were problematic areas including bottlenecks, redundant and duplicated work, concentration of decision nodes, and communicative weaknesses among stakeholders of the process. Using information technology in some activities of medication prescription in Iran has not eliminated the dependence of the stakeholders on paper-based documents and prescriptions. Therefore, it is necessary to implement proper system programming in order to support change management and solve the problems in the existing prescribing process. To this end, a suitable basis should be provided for reorganization and improvement of the prescribing process for the future electronic systems.

  20. Human factors perspective on the prescribing behavior of recent medical graduates: implications for educators

    Directory of Open Access Journals (Sweden)

    Gordon M


    Full Text Available Morris Gordon,1,2 Ken Catchpole,3 Paul Baker1,41Faculty of Health and Social Care, University of Salford, Salford, UK; 2Department of Paediatrics, Fairfield General Hospital, Bury, UK; 3Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA; 4North Western Deanery, Manchester, UKBackground: Junior doctors are at high risk of involvement in medication errors. Educational interventions to enhance human factors and specifically nontechnical skills in health care are increasingly reported, but there is no work in the context of prescribing improvement to guide such education. We set out to determine the elements that influence prescribing from a human factors perspective by recent medical graduates and use this to guide education in this area.Methods: A total of 206 recent medical graduates of the North Western Foundation School were asked to describe their views on safety practices and behaviors. Free text data regarding prescribing behaviors were collected 1, 2, and 4 months after starting their posts. A 94.1% response rate was achieved. Qualitative analysis of data was completed using the constant comparison method. Five initial categories were developed, and the researchers subsequently developed thematic indices according to their understanding of the emerging content of the data. Further data were collected through group interviews 8–9 months into the placement to ensure thematic saturation.Results: Six themes were established at the axial coding level, ie, contributors to inappropriate prescribing, contributors to appropriate prescribing, professional responsibility, prescribing error, current practices, and methods for improvement of prescribing. Utilizing appropriate theoretical elements, we describe how recent medical graduates employ situational and error awareness to guide risk assessment.Conclusion: We have modeled the human factors of prescribing behavior by recent medical graduates. As these factors are related to

  1. Evaluating the quality of antimicrobial prescribing: is standardisation possible? (United States)

    Retamar, Pilar; Martín, M Luisa; Molina, José; del Arco, Alfonso


    The quality of antimicrobial prescribing refers to the optimal way to use antibiotics in regard to their benefits, safety (e.g., resistance generation and toxicity) and cost. Evaluating the quality of antimicrobial prescribing in a way that focuses not only on reducing antimicrobial consumption but also on using them in a more optimal way allows us to understand patterns of use and to identify targets for intervention. The lack of standardisation is the primary problem to be addressed when planning an evaluation of antimicrobial prescribing. There is little information specifically describing an evaluation methodology. Information related to prescription evaluation can be obtained from the guidelines of Antimicrobial Stewardship Programs (ASPs) and from local and international experience. The criteria used to evaluate the quality of prescription should include the indication for antimicrobial therapy, the timeliness of initiation, the correct antibiotic choice (according to local guidelines), the dosing, the duration, the route of administration and the time at which to switch to oral administration. A locally developed guideline on antimicrobial therapy should preferably be the gold standard by which to evaluate the appropriatenes of prescriptions. Various approaches used to carry out the evaluations have been described in the literature. Repeated point-prevalence surveys (PPS) have been proven to be effective in identifying targets for quality improvement. Continuous prospective monitoring allows the identification of more precise intervention points at different times during prescription. The design of the study chosen to perform the evaluation should be adapted according to the resources available in each centre. Evaluating the quality of antimicrobial prescribing should be the first step to designing ASPs, as well as to evaluating their impact and the changes in prescribing trends over time. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  2. Structural Safety Monitoring of High Arch Dam Using Improved ABC-BP Model

    Directory of Open Access Journals (Sweden)

    Yantao Zhu


    Full Text Available The establishment of a structural safety monitoring model of a dam is necessary for the evaluation of the dam’s deformation status. The structural safety monitoring method based on the monitoring data is widely used in traditional research. On the basis of the analysis of the high arch dam’s deformation principles, this study proposes a structural safety monitoring method derived from the dam deformation monitoring data. The method first analyzes and establishes the spatial and temporal distribution of high arch dam’s safety monitoring, overcoming the standard artificial bee colony (ABC algorithm’s shortcoming of easily falling into the local optimum by adopting the adaptive proportion and average Euclidean distance afterwards. The improved ABC algorithm is used to optimize the backpropagation (BP neural network’s initial weight and threshold. The application example proves that ABC-BP model’s improvement method is important for the establishment of a high arch deformation safety monitoring model and can effectively improve the model’s fitting and forecasting ability. This method provides a reference for the establishment of a structural safety monitoring model of dam and provides guidance for the establishment of a forecasting model in other fields.

  3. Implementation Science: A Neglected Opportunity to Accelerate Improvements in the Safety and Quality of Surgical Care. (United States)

    Hull, Louise; Athanasiou, Thanos; Russ, Stephanie


    The aim of this review was to emphasize the importance of implementation science in understanding why efforts to integrate evidence-based interventions into surgical practice frequently fail to replicate the improvements reported in early research studies. Over the past 2 decades, numerous patient safety initiatives have been developed to improve the quality and safety of surgical care. The surgical community is now faced with translating "promising" initiatives from the research environment into clinical practice-the World Health Organization (WHO) has described this task as one of the greatest challenges facing the global health community and has identified the importance of implementation science in scaling up evidence-based interventions. Using the WHO surgical safety checklist, a prominent example of a rapidly and widely implemented surgical safety intervention of the past decade, a review of literature, spanning surgery, and implementation science, was conducted to identify and describe a broad range of factors affecting implementation success, including contextual factors, implementation strategies, and implementation outcomes. Our current approach to conceptualizing and measuring the "effectiveness" of interventions has resulted in factors critical to implementing surgical safety interventions successfully being neglected. Improvements in the safety and quality of surgical care can be accelerated by drawing more heavily upon implementation science and that until this rapidly evolving field becomes more firmly embedded into surgical research and implementation efforts, our understanding of why interventions such as the checklist "work" in some settings and appear "not to work" in other settings will be limited.

  4. Perceptions and experiences of the implementation, management, use and optimisation of electronic prescribing systems in hospital settings: protocol for a systematic review of qualitative studies


    Farre, Albert; Bem, Danai; Heath, Gemma; Shaw, Karen; Cummins, Carole


    Introduction There is increasing evidence that electronic prescribing (ePrescribing) or computerised provider/physician order entry (CPOE) systems can improve the quality and safety of healthcare services. However, it has also become clear that their implementation is not straightforward and may create unintended or undesired consequences once in use. In this context, qualitative approaches have been particularly useful and their interpretative synthesis could make an important and timely con...

  5. Improving health care quality and safety: the role of collective learning

    Directory of Open Access Journals (Sweden)

    Singer SJ


    Full Text Available Sara J Singer,1–4 Justin K Benzer,4–6 Sami U Hamdan4,6 1Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA; 2Department of Medicine, Harvard Medical School, Boston, MA, USA; 3Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA; 4Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA; 5VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; 6Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA Abstract: Despite decades of effort to improve quality and safety in health care, this goal feels increasingly elusive. Successful examples of improvement are infrequently replicated. This scoping review synthesizes 76 empirical or conceptual studies (out of 1208 originally screened addressing learning in quality or safety improvement, that were published in selected health care and management journals between January 2000 and December 2014 to deepen understanding of the role that collective learning plays in quality and safety improvement. We categorize learning activities using a theoretical model that shows how leadership and environmental factors support collective learning processes and practices, and in turn team and organizational improvement outcomes. By focusing on quality and safety improvement, our review elaborates the premise of learning theory that leadership, environment, and processes combine to create conditions that promote learning. Specifically, we found that learning for quality and safety improvement includes experimentation (including deliberate experimentation, improvisation, learning from failures, exploration, and exploitation, internal and external knowledge acquisition, performance monitoring and comparison, and training. Supportive learning environments are characterized by team characteristics like psychological

  6. Improving Sedative-Hypnotic Prescribing in Older Hospitalized Patients: Provider-Perceived Benefits and Barriers of a Computer-Based Reminder


    Agostini, Joseph V.; Concato, John; Inouye, Sharon


    Background: Older adults are commonly prescribed sedative-hypnotic (SH) medications when hospitalized, yet these drugs are associated with important adverse effects such as falls and delirium. Objective: To identify provider-perceived benefits or barriers of a computer-based reminder regarding appropriate use of SH medications. Design: Qualitative study using semi-structured interviews. Participants and setting: Thirty-six house staff physicians at a university hospital. Measurements: Informa...

  7. Pulse lavage washing in decontamination of allografts improves safety. (United States)

    Hirn, M; Laitinen, M; Vuento, R


    We analyzed the bacterial contamination rate of 140 femoral head allografts after rinsing the allografts in different decontamination solutions. Bacterial screening methods and cleansing effect of antibiotics (cefuroxime and rifampicin) and pulse lavage were compared. Swabbing and taking small pieces of bone for culture were the screening methods used. Both methods proved to be quite unreliable. Approximately one-fourth of the results were false negative. Culturing small pieces of bone gave the most accurate and reliable results and, therefore, can be recommended as a bacterial screening method. The use of antibiotics in allograft decontamination is controversial. In prophylactic use antibiotics include risks of allergic reactions and resistant development and our results in the present study show that antibiotics do not improve the decontamination any better than low-pressure pulse lavage with sterile saline solution. Therefore, pulse lavage with sterile saline solution can be recommended for allograft decontamination. Our results demonstrate that it decreases bacterial bioburden as effectively as the antibiotics without persisting the disadvantages.

  8. Overarching goals: a strategy for improving healthcare quality and safety? (United States)

    Nanji, Karen C; Ferris, Timothy G; Torchiana, David F; Meyer, Gregg S


    The management literature reveals that many successful organisations have strategic plans that include a bold 'stretch-goal' to stimulate progress over a ten-to-thirty-year period. A stretch goal is clear, compelling and easily understood. It serves as a unifying focal point for organisational efforts. The ambitiousness of such goals has been emphasised with the phrase Big Hairy Audacious Goal ('BHAG'). President Kennedy's proclamation in 1961 that 'this Nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to earth' provides a famous example. This goal energised the US National Aeronautics and Space Administration, and it captured the attention of the American public and resulted in one of the largest accomplishments of any organisation. The goal set by Sony, a small, cash-strapped electronics company in the 1950s, to change the poor image of Japanese products around the world represents a classic BHAG. Few examples of quality goals that conform to the BHAG definition exist in the healthcare literature. However, the concept may provide a useful framework for organisations seeking to transform the quality of care they deliver. This review examines the merits and cautions of setting overarching quality goals to catalyse quality improvement efforts, and assists healthcare organisations with determining whether to adopt these goals.

  9. A Quantitative Feasibility Study on Potential Safety Improvement Effects of Advanced Safety Features in APR-1400 when Applied to OPR-1000

    Energy Technology Data Exchange (ETDEWEB)

    Ualikhan Zhiyenbayev [KAIST, Daejeon (Korea, Republic of); Chung, Dae Wook [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)


    This study aims to test the feasibility of the applications using Probabilistic Safety Assessment (PSA). Particularly, three of those advanced safety features are selected as follows: 1. Providing an additional Emergency Diesel Generator (EDG); 2. Increasing the capacity of Class 1E batteries; 3. Placing a Refueling Water Storage Tank (RWST) inside containment, i.e., change from RWST to IRWST. The Advanced Power Reactor 1400 (APR-1400) adopts several advanced safety features compared to its predecessor, the Optimized Power Reactor 1000 (OPR-1000), which includes an additional Emergency Diesel Generator, increase in battery capacity, in-containment refueling water storage tank (IRWST), and so on. Considering the remarkable advantages of these safety features in safety improvement and the design similarities between APR-1400 and OPR-1000, it is feasible to apply key advanced safety features of APR-1400 to OPR-1000 to enhance the safety. The selected safety features are incorporated into OPR-1000 PSA model using the Advanced Information Management System (AIMS) for PSA and CDFs are re-evaluated for each application and combination of three applications. Based on current results, it is concluded that three of key advanced safety features of APR-1400 can be effectively applied to OPR-1000, resulting in considerable safety improvement. In aggregate, three advanced safety features, which are an additional EDG, increased battery capacity and IRWST, can reduce the CDF of OPR-1000 by more than 15% when applied altogether.

  10. Effect of a "Lean" intervention to improve safety processes and outcomes on a surgical emergency unit. (United States)

    McCulloch, Peter; Kreckler, Simon; New, Steve; Sheena, Yezen; Handa, Ashok; Catchpole, Ken


    Emergency surgical patients are at high risk for harm because of errors in care. Quality improvement methods that involve process redesign, such as “Lean,” appear to improve service reliability and efficiency in healthcare. Interrupted time series. The emergency general surgery ward of a university hospital in the United Kingdom. Seven safety relevant care processes. A Lean intervention targeting five of the seven care processes relevant to patient safety. 969 patients were admitted during the four month study period before the introduction of the Lean intervention (May to August 2007), and 1114 were admitted during the four month period after completion of the intervention (May to August 2008). Compliance with the five process measures targeted for Lean intervention (but not the two that were not) improved significantly (relative improvement 28% to 149%; PLean can substantially and simultaneously improve compliance with a bundle of safety related processes. Given the interconnected nature of hospital care, this strategy might not translate into improvements in safety outcomes unless a system-wide approach is adopted to remove barriers to change.

  11. Improving patient safety through a multi-faceted internal surveillance program. (United States)

    Matlow, Anne; Stevens, Polly; Urmson, Lynn; Wray, Rick


    Surveillance, a method used in epidemiology to study the incidence, distribution and control of disease, is an important means of gathering and analyzing information that can be used as needed to effect change. Surveillance has been an important component of the Blueprint for Patient Safety at the Hospital for Sick Children to identify potential and existing vulnerabilities and failures and put measures in place to avoid and mitigate any harm. Reviewing internal reports and actively seeking vulnerabilities has allowed us to make important changes to improve patient safety at the hospital. In this article, we review four internal surveillance strategies that have been particularly successful in driving change - safety reports, morbidity and mortality reviews, patient safety walkarounds and shoe leather infection control rounds - and discuss the successes and challenges we have experienced.

  12. The SAFER guides: empowering organizations to improve the safety and effectiveness of electronic health records. (United States)

    Sittig, Dean F; Ash, Joan S; Singh, Hardeep


    Electronic health records (EHRs) have potential to improve quality and safety of healthcare. However, EHR users have experienced safety concerns from EHR design and usability features that are not optimally adapted for the complex work flow of real-world practice. Few strategies exist to address unintended consequences from implementation of EHRs and other health information technologies. We propose that organizations equipped with EHRs should consider the strategy of "proactive risk assessment" of their EHR-enabled healthcare system to identify and address EHR-related safety concerns. In this paper, we describe the conceptual underpinning of an EHR-related self-assessment strategy to provide institutions a foundation upon which they could build their safety efforts. With support from the Office of the National Coordinator for Health Information Technology (ONC), we used a rigorous, iterative process to develop a set of 9 self-assessment tools to optimize the safety and safe use of EHRs. These tools, referred to as the Safety Assurance Factors for EHR Resilience (SAFER) guides, could be used to self-assess safety and effectiveness of EHR implementations, identify specific areas of vulnerability, and create solutions and culture change to mitigate risks. A variety of audiences could conduct these assessments, including frontline clinicians or care teams in different practices, or clinical, quality, or administrative leaders within larger institutions. The guides use a multifaceted systems-based approach to assess risk and empower organizations to work with internal or external stakeholders (eg, EHR developers) on optimizing EHR functionality and using EHRs to drive improvements in the quality and safety of healthcare.

  13. Improving food safety within the dairy chain: an application of conjoint analysis. (United States)

    Valeeva, N I; Meuwissen, M P M; Lansink, A G J M Oude; Huirne, R B M


    This study determined the relative importance of attributes of food safety improvement in the production chain of fluid pasteurized milk. The chain was divided into 4 blocks: "feed" (compound feed production and its transport), "farm" (dairy farm), "dairy processing" (transport and processing of raw milk, delivery of pasteurized milk), and "consumer" (retailer/catering establishment and pasteurized milk consumption). The concept of food safety improvement focused on 2 main groups of hazards: chemical (antibiotics and dioxin) and microbiological (Salmonella, Escherichia coli, Mycobacterium paratuberculosis, and Staphylococcus aureus). Adaptive conjoint analysis was used to investigate food safety experts' perceptions of the attributes' importance. Preference data from individual experts (n = 24) on 101 attributes along the chain were collected in a computer-interactive mode. Experts perceived the attributes from the "feed" and "farm" blocks as being more vital for controlling the chemical hazards; whereas the attributes from the "farm" and "dairy processing" were considered more vital for controlling the microbiological hazards. For the chemical hazards, "identification of treated cows" and "quality assurance system of compound feed manufacturers" were considered the most important attributes. For the microbiological hazards, these were "manure supply source" and "action in salmonellosis and M. paratuberculosis cases". The rather high importance of attributes relating to quality assurance and traceability systems of the chain participants indicates that participants look for food safety assurance from the preceding participants. This information has substantial decision-making implications for private businesses along the chain and for the government regarding the food safety improvement of fluid pasteurized milk.

  14. Assessing EM Patient Safety and Quality Improvement Milestones Using a Novel Debate Format. (United States)

    Mamtani, Mira; Scott, Kevin R; DeRoos, Francis J; Conlon, Lauren W


    Graduate medical education is increasingly focused on patient safety and quality improvement; training programs must adapt their curriculum to address these changes. We propose a novel curriculum for emergency medicine (EM) residency training programs specifically addressing patient safety, systems-based management, and practice-based performance improvement, called "EM Debates." Following implementation of this educational curriculum, we performed a cross-sectional study to evaluate the curriculum through resident self-assessment. Additionally, a cross-sectional study to determine the ED clinical competency committee's (CCC) ability to assess residents on specific competencies was performed. Residents were overall very positive towards the implementation of the debates. Of those participating in a debate, 71% felt that it improved their individual performance within a specific topic, and 100% of those that led a debate felt that they could propose an evidence-based approach to a specific topic. The CCC found that it was easier to assess milestones in patient safety, systems-based management, and practice-based performance improvement (sub-competencies 16, 17, and 19) compared to prior to the implementation of the debates. The debates have been a helpful venue to teach EM residents about patient safety concepts, identifying medical errors, and process improvement.

  15. Pharmaco-epistemology for the prescribing geriatrician. (United States)

    Le Couteur, David G; Kendig, Hal


    Clinicians are becoming more reliant on their interpretation of clinical trial information to guide prescribing rather than their clinical skills. Thus to improve prescribing, it is increasingly important for clinicians to have an appreciation of epistemology (the science of knowledge and its interpretation) and the broader social context of knowledge. The insights of epistemologists can be useful in understanding the different ways in which clinical trials data are interpreted.

  16. Are your employees sick of hearing about safety? Ways to improve how safety is communicated at your company

    Energy Technology Data Exchange (ETDEWEB)

    Pollari, Roger A.


    Companies that care about their employees care about their employees’ safety and will go to great lengths to communicate the importance of working safely. Monthly safety meetings, creative safety contests, safety websites, sharing lessons learned—safety communicators tend to use a variety of methods to distribute procedures and critical safety information to help employees plan and perform work. However, the safety message falls on deaf ears in some cases, especially when employees feel they’re being overloaded with safety information to the point where they are sick of hearing about it. This poses a conundrum for safety communicators: Should they keep pouring on the safety, or should they lighten up? How much is the right amount?

  17. Using technology and collaborative working for a positive patient experience and to improve safety. (United States)

    Desai, Usha


    Clinicians who treat patients with wounds need access to the resources that will enable them to deliver the best and most appropriate treatments. A partnership working initiative between Greenwich CCG Medicines management (commissioner), Oxleas NHS Foundation Trust (provider) and ConvaTec (commercial partner) was set up to provide wound-care dressings and products to patients via the community services. It lead to improved access, greater patient benefits, a reduction in dressings waste, and an increase in clinical confidence to make cost-effective, evidence-based prescribing decisions. This inspired the commissioners to collaborate with BlueBay (technology partner) to 'trailblaze' the development and introduction of an electronic wound care template for practice nurses and doctors in primary care to use in conjunction with VISION and EMIS, clinical software systems used in GP practices. This interoperability of clinical systems to improve wound care is, to date, the only one of its kind in the UK.

  18. Matrix with Prescribed Eigenvectors (United States)

    Ahmad, Faiz


    It is a routine matter for undergraduates to find eigenvalues and eigenvectors of a given matrix. But the converse problem of finding a matrix with prescribed eigenvalues and eigenvectors is rarely discussed in elementary texts on linear algebra. This problem is related to the "spectral" decomposition of a matrix and has important technical…

  19. Opioid Prescribing PSA (:60)

    Centers for Disease Control (CDC) Podcasts


    This 60 second public service announcement is based on the July 2017 CDC Vital Signs report. Higher opioid prescribing puts patients at risk for addiction and overdose. Learn what can be done about this serious problem.  Created: 7/6/2017 by Centers for Disease Control and Prevention (CDC).   Date Released: 7/6/2017.

  20. Qualitative analysis of multi-disciplinary round-table discussions on the acceleration of benefits and data analytics through hospital electronic prescribing (ePrescribing) systems. (United States)

    Cresswell, Kathrin; Coleman, Jamie; Smith, Pam; Swainson, Charles; Slee, Ann; Sheikh, Aziz


    Electronic systems that facilitate prescribing, administration and dispensing of medicines (ePrescribing systems) are at the heart of international efforts to improve the safety, quality and efficiency of medicine management. Considering the initial costs of procuring and maintaining ePrescribing systems, there is a need to better understand how to accelerate and maximise the financial benefits associated with these systems. We sought to investigate how different sectors are approaching the realisation of returns on investment from ePrescribing systems in U.K. hospitals and what lessons can be learned for future developments and implementation strategies within healthcare settings. We conducted international, multi-disciplinary, round-table discussions with 21 participants from different backgrounds including policy makers, healthcare organisations, academic researchers, vendors and patient representatives. The discussions were audio-recorded, transcribed and then thematically analysed with the qualitative analysis software NVivo10. There was an over-riding concern that realising financial returns from ePrescribing systems was challenging. The underlying reasons included substantial fixed costs of care provision, the difficulties in radically changing the medicines management process and the lack of capacity within NHS hospitals to analyse and exploit the digital data being generated. Any future data strategy should take into account the need to collect and analyse local and national data (i.e. within and across hospitals), setting comparators to measure progress (i.e. baseline measurements) and clear standards guiding data management so that data are comparable across settings. A more coherent national approach to realising financial benefits from ePrescribing systems is needed as implementations progress and the range of tools to collect information will lead to exponential data growth. The move towards more sophisticated closed-loop systems that integrate

  1. Development of an adhesive surgical ward round checklist: a technique to improve patient safety.

    LENUS (Irish Health Repository)

    Dhillon, P


    Checklists have been shown to improve patient outcomes. Checklist use is seen in the pre-operative to post-operative phases of the patient pathway. An adhesive checklist was developed for ward rounds due to the positive impact it could have on improving patient safety. Over an eight day period data were collected from five consultant-led teams that were randomly selected from the surgical department and divided into sticker groups and control groups. Across the board percentage adherence to the Good Surgical Practice Guidelines (GSPG) was markedly higher in the sticker study group, 1186 (91%) in comparison with the control group 718 (55%). There was significant improvement of documentation across all areas measured. An adhesive checklist for ward round note taking is a simple and cost-effective way to improve documentation, communication, hand-over, and patient safety. Successfully implemented in a tertiary level centre in Dublin, Ireland it is easily transferable to other surgical departments globally.

  2. An improved car-following model considering variable safety headway distance (United States)

    Jia, Yu-han; Du, Yi-man; Wu, Jian-ping


    Considering high speed following on expressway or highway, an improved car-following model is developed in this paper by introducing variable safety headway distance. Stability analysis of the new model is carried out using the control theory method. Finally, numerical simulations are implemented and the results show good consistency with theoretical study.

  3. Toward a sustainable cement industry in 2020 : improvement of the environmental, health & safety performance

    NARCIS (Netherlands)


    This background document concentrates on technical and managerial aspects of Environmental, Health & Safety Performance (EHS) control in the cement industry. It gives an overview of options for improvement toward a sustainable cement production in 2020. Energy consumption and use of alternative fuel

  4. Improving the governance of patient safety in emergency care: a systematic review of interventions

    NARCIS (Netherlands)

    Hesselink, G.J.; Berben, S.A.; Beune, T.; Schoonhoven, L.


    OBJECTIVES: To systematically review interventions that aim to improve the governance of patient safety within emergency care on effectiveness, reliability, validity and feasibility. DESIGN: A systematic review of the literature. METHODS: PubMed, EMBASE, Cumulative Index to Nursing and Allied Health

  5. Improving Hospital Quality and Patient Safety an Examination of Organizational Culture and Information Systems (United States)

    Gardner, John Wallace


    This dissertation examines the effects of safety culture, including operational climate and practices, as well as the adoption and use of information systems for delivering high quality healthcare and improved patient experience. Chapter 2 studies the influence of both general and outcome-specific hospital climate and quality practices on process…

  6. Evaluating the Effectiveness of an Educational Intervention to Improve the Patient Safety Attitudes of Intern Pharmacists (United States)

    Fois, Romano A.; McLachlan, Andrew J.; Chen, Timothy F.


    Objective. To evaluate the effectiveness of a face-to-face educational intervention in improving the patient safety attitudes of intern pharmacists. Methods. A patient safety education program was delivered to intern pharmacists undertaking The University of Sydney Intern Training Program in 2014. Their patient safety attitudes were evaluated immediately prior to, immediately after, and three-months post-intervention. Underlying attitudinal factors were identified using exploratory factor analysis. Changes in factor scores were examined using analysis of variance. Results. Of the 120 interns enrolled, 95 (78.7%) completed all three surveys. Four underlying attitudinal factors were identified: attitudes towards addressing errors, questioning behaviors, blaming individuals, and reporting errors. Improvements in all attitudinal factors were evident immediately after the intervention. However, only improvements in attitudes towards blaming individuals involved in errors were sustained at three months post-intervention. Conclusion. The educational intervention was associated with short-term improvements in pharmacist interns’ patient safety attitudes. However, other factors likely influenced their attitudes in the longer term. PMID:28289295

  7. Improving Hospital Quality and Patient Safety an Examination of Organizational Culture and Information Systems (United States)

    Gardner, John Wallace


    This dissertation examines the effects of safety culture, including operational climate and practices, as well as the adoption and use of information systems for delivering high quality healthcare and improved patient experience. Chapter 2 studies the influence of both general and outcome-specific hospital climate and quality practices on process…

  8. (Mis)Perceptions of Continuing Education: Insights from Knowledge Translation, Quality Improvement, and Patient Safety Leaders (United States)

    Kitto, Simon C.; Bell, Mary; Goldman, Joanne; Peller, Jennifer; Silver, Ivan; Sargeant, Joan; Reeves, Scott


    Introduction: Minimal attention has been given to the intersection and potential collaboration among the domains of continuing education (CE), knowledge translation (KT), quality improvement (QI), and patient safety (PS), despite their overlapping objectives. A study was undertaken to examine leaders' perspectives of these 4 domains and their…

  9. An improved car-following model considering variable safety headway distance


    Jia, Yuhan; Wu, Jianping; Du, Yiman


    Considering high speed following on expressway or highway, an improved car-following model is developed in this paper by introducing variable safety headway distance. Stability analysis of the new model is carried out using the control theory method. Finally, numerical simulations are implemented and the results show good consistency with theoretical study.

  10. Evaluating the Effectiveness of an Educational Intervention to Improve the Patient Safety Attitudes of Intern Pharmacists. (United States)

    Walpola, Ramesh L; Fois, Romano A; McLachlan, Andrew J; Chen, Timothy F


    Objective. To evaluate the effectiveness of a face-to-face educational intervention in improving the patient safety attitudes of intern pharmacists. Methods. A patient safety education program was delivered to intern pharmacists undertaking The University of Sydney Intern Training Program in 2014. Their patient safety attitudes were evaluated immediately prior to, immediately after, and three-months post-intervention. Underlying attitudinal factors were identified using exploratory factor analysis. Changes in factor scores were examined using analysis of variance. Results. Of the 120 interns enrolled, 95 (78.7%) completed all three surveys. Four underlying attitudinal factors were identified: attitudes towards addressing errors, questioning behaviors, blaming individuals, and reporting errors. Improvements in all attitudinal factors were evident immediately after the intervention. However, only improvements in attitudes towards blaming individuals involved in errors were sustained at three months post-intervention. Conclusion. The educational intervention was associated with short-term improvements in pharmacist interns' patient safety attitudes. However, other factors likely influenced their attitudes in the longer term.

  11. A Comprehensive Approach to Identifying Intervention Targets for Patient-Safety Improvement in a Hospital Setting (United States)

    Cunningham, Thomas R.; Geller, E. Scott


    Despite differences in approaches to organizational problem solving, healthcare managers and organizational behavior management (OBM) practitioners share a number of practices, and connecting healthcare management with OBM may lead to improvements in patient safety. A broad needs-assessment methodology was applied to identify patient-safety…

  12. Hotspots identification and ranking for road safety improvement: an alternative approach. (United States)

    Coll, Bronagh; Moutari, Salissou; Marshall, Adele H


    During the last decade, the concept of composite performance index, brought from economic and business statistics, has become a popular practice in the field of road safety, namely for the identification and classification of worst performing areas or time slots also known as hotspots. The overall quality of a composite index depends upon the complexity of phenomena of interest as well as the relevance of the methodological approach used to aggregate the various indicators into a single composite index. However, current aggregation methods used to estimate the composite road safety performance index suffer from various deficiencies at both the theoretical and operational level; these include the correlation and compensability between indicators, the weighting of the indicators as well as their high "degree of freedom" which enables one to readily manipulate them to produce desired outcomes (Munda and Nardo, 2003, 2005, 2009). The objective of this study is to contribute to the ongoing research effort on the estimation of road safety composite index for hotspots' identification and ranking. The aggregation method for constructing the composite road safety performance index introduced in this paper, strives to minimize the aforementioned deficiencies of the current approaches. Furthermore, this new method can be viewed as an intelligent decision support system for road safety performance evaluation, in order to prioritize interventions for road safety improvement.

  13. Observation and measurement of hand hygiene and patient identification improve compliance with patient safety practices. (United States)

    Rosenthal, Tom; Erbeznik, Mary; Padilla, Tony; Zaroda, Teresa; Nguyen, Daniel H; Rodriguez, Marcela


    Measurement, a crucial step in any quality improvement activity, is difficult in two important patient safety processes: hand hygiene and patient identification. This study describes a program at the UCLA Medical Center, called Measure to Achieve Patient Safety (MAPS), which uses undergraduate student volunteers to carry out observations in the hospital. This program has been an important part of UCLA's efforts for quality improvement in patient safety efforts. Since 2004, approximately 20 students per year plus two student leaders have been selected to participate in the MAPS program. They were trained in techniques of measuring and observation and in professional behavior. They participated in weekly and monthly meetings with program leadership, received continuing education from the UCLA patient safety staff, and were trained in observational measurement. The students' observational results have been systematically reported to clinicians and departmental and hospital leadership. Handwashing increased from 50% to 93%, and nurses' checking of two identifiers at the time of medication administration increased from 50% to 95%. Compliance with proper patient identification at the time of nurse-to-transporter handoffs of patients for procedures increased to >90%. This unique program has made a significant contribution to UCLA's quality, safety, and service programs. MAPS has been widely accepted by the clinical staff and has also been valuable to the student volunteers. Such an approach is easily adaptable to other academic medical centers.

  14. Introduction to the STS National Database Series: Outcomes Analysis, Quality Improvement, and Patient Safety. (United States)

    Jacobs, Jeffrey P; Shahian, David M; Prager, Richard L; Edwards, Fred H; McDonald, Donna; Han, Jane M; D'Agostino, Richard S; Jacobs, Marshall L; Kozower, Benjamin D; Badhwar, Vinay; Thourani, Vinod H; Gaissert, Henning A; Fernandez, Felix G; Wright, Cam; Fann, James I; Paone, Gaetano; Sanchez, Juan A; Cleveland, Joseph C; Brennan, J Matthew; Dokholyan, Rachel S; O'Brien, Sean M; Peterson, Eric D; Grover, Frederick L; Patterson, G Alexander


    The Society of Thoracic Surgeons (STS) National Database is the foundation for most of the Society's quality, research, and patient safety activities. Beginning in January 2016 and repeating each year, The Annals of Thoracic Surgery will publish a monthly Database series of scholarly articles on outcomes analysis, quality improvement, and patient safety. Six articles will be directly derived from the STS National Database and will be published every other month: three articles on outcomes and quality (one each from the STS Adult Cardiac Surgery Database, the STS Congenital Heart Surgery Database, and the STS General Thoracic Surgery Database), and three articles on research (one from each of these three specialty databases). These six articles will alternate with five additional articles on topics related to patient safety. The final article, to be published in December, will provide a summary of the prior 11 manuscripts. This series will allow STS and its Workforces on National Databases, Research Development, and Patient Safety to convey timely information aimed at improving the quality and safety of cardiothoracic surgery. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.


    Tsyben, Anastasia; Gooding, Nigel; Kelsall, Wilf


    Prescribing audits have shown that the Women's and Children's Directorate reported higher number of prescription errors on the paediatric and neonatal wards compared to other areas in the Trust. Over the last three years a multidisciplinary prescribing team (PT), which included senior clinicians, pharmacists and trainees introduced a number of initiatives to improve the quality of prescribing. Strategies included structured departmental inductions, setting up of designated prescribing areas and reviewing errors with the prescriber. Year on year there were fewer prescribing errors.1 With the introduction of a new electronic prescribing system in October 2014 prescribing error rates were expected to decrease further, eradicating omissions around allergy recording, ward location and drug names. The aim of this abstract is to highlight the impact of the new system and describe lessons learned. In the summer of 2014, all inpatient drug charts across the department were reviewed on three non-consecutive days over a period of three weeks. Prescribing errors were identified by the ward pharmacist. Errors were grouped according to type and further analyzed by the PT. Errors deemed to have no clinical significance were excluded. Error rates were compared to the previous audits performed with identical methodology. Following the introduction of the electronic prescribing system, the ward pharmacists continued to review prescription charts on daily basis and generate regular error reports to notify the staff of new challenges. There were 174 (14%) errors out of 1225 prescriptions on 181 drug charts. The most commonly made mistakes included drug name errors, strength of preparation, allergies and ward documentation, prescriber's signature omissions, and antibiotic review and end dates. The introduction of an electronic system has eliminated drug name, strength of preparation, allergy recording and ward errors. However, serious challenges have been identified: entering of an

  16. Improving teamwork, trust and safety: an ethnographic study of an interprofessional initiative. (United States)

    Jones, Aled; Jones, Delyth


    This study explored the perceptions of staff in an interprofessional team based on a medical rehabilitation ward for older people, following the introduction of a service improvement programme designed to promote better teamworking. The study aimed to address a lack of in-depth qualitative research that could explain the day-to-day realities of interprofessional teamworking in healthcare. All members of the team participated, (e.g. nurses, doctors, physiotherapists, social worker, occupational therapists), and findings suggest that interprofessional teamworking improved over the 12-month period. Four themes emerged from the data offering insights into the development and effects of better interprofessional teamworking: the emergence of collegial trust within the team, the importance of team meetings and participative safety, the role of shared objectives in conflict management and the value of autonomy within the team. Reductions in staff sickness/absence levels and catastrophic/major patient safety incidents were also detected following the introduction of the service improvement programme.

  17. Phosphazene Based Additives for Improvement of Safety and Battery Lifetimes in Lithium-Ion Batteries

    Energy Technology Data Exchange (ETDEWEB)

    Mason K Harrup; Kevin L Gering; Harry W Rollins; Sergiy V Sazhin; Michael T Benson; David K Jamison; Christopher J Michelbacher


    There need to be significant improvements made in lithium-ion battery technology, principally in the areas of safety and useful lifetimes to truly enable widespread adoption of large format batteries for the electrification of the light transportation fleet. In order to effect the transition to lithium ion technology in a timely fashion, one promising next step is through improvements to the electrolyte in the form of novel additives that simultaneously improve safety and useful lifetimes without impairing performance characteristics over wide temperature and cycle duty ranges. Recent efforts in our laboratory have been focused on the development of such additives with all the requisite properties enumerated above. We present the results of the study of novel phosphazene based electrolytes additives.

  18. Teaching internal medicine residents quality improvement and patient safety: a lean thinking approach. (United States)

    Kim, Christopher S; Lukela, Michael P; Parekh, Vikas I; Mangrulkar, Rajesh S; Del Valle, John; Spahlinger, David A; Billi, John E


    Patient safety (PS) and quality improvement (QI) are among the highest priorities for all health systems. Resident physicians are often at the front lines of providing care for patients. In many instances, however, QI and PS initiatives exclude trainees. By aligning the goals of the health system with those of the residency program to engage residents in QI and PS projects, there is a unique opportunity to fulfill both a corporate and educational mission to improve patient care. Here, the authors briefly describe one residency program's educational curriculum to provide foundational knowledge in QI and PS to all its trainees and highlight a resident team-based project that applied principles of lean thinking to evaluate the process of responding to an in-hospital cardiopulmonary arrest. This approach provided residents with a practical experience but also presented an opportunity for trainees to align with the health system's approach to improving quality and safety.

  19. Coal mine safety production forewarning based on improved BP neural network

    Institute of Scientific and Technical Information of China (English)

    Wang Ying; Lu Cuijie; Zuo Cuiping


    Firstly, the early warning index system of coal mine safety production was given from four aspects as per-sonnel, environment, equipment and management. Then, improvement measures which are additional momentum method, adaptive learning rate, particle swarm optimization algorithm, variable weight method and asynchronous learning factor, are used to optimize BP neural network models. Further, the models are applied to a comparative study on coal mine safety warning instance. Results show that the identification precision of MPSO-BP network model is higher than GBP and PSO-BP model, and MPSO-BP model can not only effectively reduce the possibility of the network falling into a local minimum point, but also has fast convergence and high precision, which will provide the scientific basis for the forewarning management of coal mine safety production.

  20. The SHIELD (Safety & Health Improvement: Enhancing Law Enforcement Departments Study: Feasibility and Findings

    Directory of Open Access Journals (Sweden)

    Kerry Stephen Kuehl


    Full Text Available This randomized prospective trial aimed to assess the feasibility and efficacy of a team-based worksite health and safety intervention for law enforcement personnel. Four-hundred and eight subjects were enrolled and half were randomized to meet participants met for weekly, peer-led sessions delivered from a scripted team-based health and safety curriculum. Curriculum addressed: exercise, nutrition, stress, sleep, body weight, injury, and other unhealthy lifestyle behaviours such as smoking and heavy alcohol use. Health and safety questionnaires administered before and after the intervention found significant improvements for increased fruit and vegetable consumption, overall healthy eating, increased sleep quantity and sleep quality, and reduced personal stress.

  1. Electrolytes with Improved Safety Characteristics for High Voltage, High Specific Energy Li-ion Cells (United States)

    Smart, M. C.; Krause, F. C.; Hwang, C.; West, W. C.; Soler, J.; Whitcanack, L. W.; Prakash, G. K. S.; Ratnakumar, B. V.


    (1) NASA is actively pursuing the development of advanced electrochemical energy storage and conversion devices for future lunar and Mars missions; (2) The Exploration Technology Development Program, Energy Storage Project is sponsoring the development of advanced Li-ion batteries and PEM fuel cell and regenerative fuel cell systems for the Altair Lunar Lander, Extravehicular Activities (EVA), and rovers and as the primary energy storage system for Lunar Surface Systems; (3) At JPL, in collaboration with NASA-GRC, NASA-JSC and industry, we are actively developing advanced Li-ion batteries with improved specific energy, energy density and safety. One effort is focused upon developing Li-ion battery electrolyte with enhanced safety characteristics (i.e., low flammability); and (4) A number of commercial applications also require Li-ion batteries with enhanced safety, especially for automotive applications.

  2. Civilian primary care prescribing psychologist in an army medical center. (United States)

    Shearer, David S


    The present article discusses the integration of a civilian prescribing psychologist into a primary care clinic at Madigan Army Medical Center. A description of the role of the prescribing psychologist in this setting is provided. The author asserts that integrating prescribing psychology into primary care can improve patient access to skilled behavioral health services including psychotherapeutic and psychopharmacologic treatment. Potential benefits to the primary care providers (PCPs) working in primary care clinics are discussed. The importance of collaboration between the prescribing psychologist and PCP is emphasized. Initial feedback indicates that integration of a prescribing psychologist into primary care has been well received in this setting.

  3. IRQN award paper: Operational rounds: a practical administrative process to improve safety and clinical services in radiology. (United States)

    Donnelly, Lane F; Dickerson, Julie M; Lehkamp, Todd W; Gessner, Kevin E; Moskovitz, Jay; Hutchinson, Sally


    As part of a patient safety program in the authors' department of radiology, operational rounds have been instituted. This process consists of radiology leaders' visiting imaging divisions at the site of imaging and discussing frontline employees' concerns about patient safety, the quality of care, and patient and family satisfaction. Operational rounds are executed at a time to optimize the number of attendees. Minutes that describe the issues identified, persons responsible for improvement, and updated improvement plan status are available to employees online. Via this process, multiple patient safety and other issues have been identified and remedied. The authors believe that the process has improved patient safety, the quality of care, and the efficiency of operations. Since the inception of the safety program, the mean number of days between serious safety events involving radiology has doubled. The authors review the background around such walk rounds, describe their particular program, and give multiple illustrative examples of issues identified and improvement plans put in place.

  4. Recommendations to Improve the Implementation Compliance of Surgical Safety Checklist in Surgery Rooms

    Directory of Open Access Journals (Sweden)

    Juliana Sandrawati


    Full Text Available Background: Surgical Safety Checklist has been adopted in surgery room as a tool to improve safe surgery. Its implementation during 2012 was low (33.9% so was the completeness of filling it (57.3%. Objective: To increase the implementation of Surgical Safety Checklist (SSC through analyzing the effect of policy, procedures, patient safety culture, and individual factors on compliance SSC implementation in the surgery room. Methods: Cross-sectional study with descriptive observational approach was done to find influencing factors of health care personnels’ compliance to fill SSC. Sample consisted of all surgery room nurses (45 nurses, 10 surgeons and 4 anesthesists. Data collection was made use of questionnaires, surgical medical records and SSC form. Results:The compliance to fill SSC in April 2013 was still low (55.9%. Written policy on patient safety was absent and awareness of respondents about the procedure was low. Respondents’ assessment showed that patient safety culture in surgery room was good, except management and stress recognition dimensions. Likewise, the respondents’ knowledge about SSC was low (61.0%. Conclusion: The study conclude that influencing factors of compliance implementation SSC is absence of the written policy in patient safety, lack of socialization of Standar Prosedur Operasional to health care personnels, lack of knowledge about SSC, lack awareness about the importance of SSC, shortage of surgery room nurses, and innappropriate perception about filling SSC as workload. Recomendation:The study will be making of written policy in patient safety and SSC, followed by socialization to health care personnels, training about SSC implementation, empowering and advocating surgery room nurses and use of reminders.

  5. Fire safety improvement of para-aramid fiber in thermoplastic polyurethane elastomer

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Xilei; Wang, Wenduo; Li, Shaoxiang; Jiao, Chuanmei, E-mail:


    Highlights: • Fire safety of para-aramid fiber on TPU has been investigated. • Para-aramid fiber has excellent flame retardant abilities and smoke suppression properties on TPU. • A new technique to improve the fire safety polymer is provided in this article. - Abstract: This article mainly studied fire safety effects of para-aramid fiber (AF) in thermoplastic polyurethane (TPU). The TPU/AF composites were prepared by molten blending method, and then the fire safety effects of all TPU composites were tested using cone calorimeter test (CCT), microscale combustion colorimeter test (MCC), smoke density test (SDT), and thermogravimetric/fourier transform infrared spectroscopy (TG-IR). The CCT test showed that AF could improve the fire safety of TPU. Remarkably, the peak value of heat release rate (pHRR) and the peak value of smoke production rate (pSPR) for the sample with 1.0 wt% content of AF were decreased by 52.0% and 40.5% compared with pure TPU, respectively. The MCC test showed that the HRR value of AF-2 decreased by 27.6% compared with pure TPU. TG test showed that AF promoted the char formation in the degradation process of TPU; as a result the residual carbon was increased. The TG-IR test revealed that AF had increased the thermal stability of TPU at the beginning and reduced the release of CO{sub 2} with the decomposition going on. Through the analysis of the results of this experiment, it will make a great influence on the study of the para-aramid fiber in the aspect of fire safety of polymer.

  6. Five Topics Health Care Simulation Can Address to Improve Patient Safety

    DEFF Research Database (Denmark)

    Sollid, Stephen J M; Dieckmann, Peter; Aase, Karina


    OBJECTIVES: There is little knowledge about which elements of health care simulation are most effective in improving patient safety. When empirical evidence is lacking, a consensus statement can help define priorities in, for example, education and research. A consensus process was therefore init......-day consensus meeting at the Utstein Abbey in Norway. The goals of stage 4 were to agree on the top 5 topics in health care simulation that contribute the most to patient safety, identify the patient safety problems they relate to, and suggest solutions with implementation strategies...... for these problems. RESULTS: The expert group agreed on the following topics: technical skills, nontechnical skills, system probing, assessment, and effectiveness. For each topic, 5 patient safety problems were suggested that each topic might contribute to solve. Solutions to these problems and implementation....... CONCLUSIONS: The expert group recommends that the 5 topics identified in this consensus process should be the main focus when health care simulation is implemented in patient safety curricula.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial...

  7. Patient safety oriented to improve patient retention in oral health services

    Directory of Open Access Journals (Sweden)

    Tri Erri Astoeti


    Full Text Available Background: Oral health service systems should be designed to promote patient health, protection, and must be in compliance with Indonesian laws that help protect patients from misuse of personal information. Patient safety is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical or dental error that often lead to adverse healthcare events. Purpose: To describe correlation that patient safety would improve patent retention in oral health. Patient safety is an essential component of quality oral health care and dentist is encouraged to consider thoughtfully the environment in which they deliver dental care, while at the same time services and to implement practices that decrease a patient’s risk of injury or harm during the delivery of care. Reviews: Designing oral health care systems that focus on preventing errors is critical to assure patient safety. Some possible sources of error in oral health services are miscommunication, failure to review the patient’s medical history, and lack of standardized records, abbreviations, and processes. Conclusion: Patient safety would support patient satisfaction; therefore oral health services can increase patient retention.

  8. [Process management in the hospital pharmacy for the improvement of the patient safety]. (United States)

    Govindarajan, R; Perelló-Juncá, A; Parès-Marimòn, R M; Serrais-Benavente, J; Ferrandez-Martí, D; Sala-Robinat, R; Camacho-Calvente, A; Campabanal-Prats, C; Solà-Anderiu, I; Sanchez-Caparrós, S; Gonzalez-Estrada, J; Martinez-Olalla, P; Colomer-Palomo, J; Perez-Mañosas, R; Rodríguez-Gallego, D


    To define a process management model for a hospital pharmacy in order to measure, analyse and make continuous improvements in patient safety and healthcare quality. In order to implement process management, Igualada Hospital was divided into different processes, one of which was the Hospital Pharmacy. A multidisciplinary management team was given responsibility for each process. For each sub-process one person was identified to be responsible, and a working group was formed under his/her leadership. With the help of each working group, a risk analysis using failure modes and effects analysis (FMEA) was performed, and the corresponding improvement actions were implemented. Sub-process indicators were also identified, and different process management mechanisms were introduced. The first risk analysis with FMEA produced more than thirty preventive actions to improve patient safety. Later, the weekly analysis of errors, as well as the monthly analysis of key process indicators, permitted us to monitor process results and, as each sub-process manager participated in these meetings, also to assume accountability and responsibility, thus consolidating the culture of excellence. The introduction of different process management mechanisms, with the participation of people responsible for each sub-process, introduces a participative management tool for the continuous improvement of patient safety and healthcare quality. Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.

  9. 78 FR 10181 - Global Quality Systems-An Integrated Approach To Improving Medical Product Safety; Public Workshop (United States)


    ... ``Global Quality Systems--An Integrated Approach to Improving Medical Product Safety.'' This 2-day public... HUMAN SERVICES Food and Drug Administration Global Quality Systems--An Integrated Approach To Improving Medical Product Safety; Public Workshop AGENCY: Food and Drug Administration, HHS. ACTION: Notice of...

  10. Risk analysis in support of improved safety at US department of energy hot cell facilities

    Energy Technology Data Exchange (ETDEWEB)

    Felder, F.A.; Golay, M.W. [Massachusetts Inst. of Tech., Cambridge, MA (United States). Dept. of Nuclear Engineering; Phillips, Jerold; Leahy, Timothy


    The US Department of Energy (US-DOE) manages diverse facilities ranging from laboratory complexes to nuclear reactors and waste repositories. It is self-regulating in the areas of radiological safety, occupational protection and environmental disturbances. In these areas the US-DOE has obtained mostly good results, but at high expense by using conservative and unsystematic approaches. In an effort to improve both safety and use of resources a project has been undertaken to understand better how to utilize risk assessment techniques to obtain improved safety outcomes and their regulation. The example of the Test Reactor Area Hot Cell (TRAHC) at the Idaho National Engineering and Environmental Laboratory (INEEL) is the subject of a simple probabilistic risk assessment (PRA) in the areas of radiological releases to the environment and of occupational hazards. To our knowledge this is the first attempt to utilize quantitative risk analyses for management of non-radiological occupational risks. Its purpose is to examine the feasibility of utilizing risk assessment as a technique to supplant the currently employed, less formal, hazard analysis as the basis for allocating safety-related resources. Problems of data and modeling adequacy have proven to be important; results to-date indicate areas where revised resource allocation should be considered. (author)

  11. Safety improvement issues for mission aborts of future space transportation systems. (United States)

    Mayrhofer, M; Wächter, M; Sachs, G


    Two-stage winged space access vehicles consisting of a carrier stage with airbreathing turbo/ram jet engines and a rocket propelled orbital stage which may significantly reduce space transport costs and have additional advantages offer a great potential for mission safety improvements. Formulating the nominal mission and abort scenarios caused by engine malfunctions as an optimal control problem allows full exploitation of safety capabilities. The shaping of the nominal mission has a significant impact on the prospective safety. For this purpose, most relevant mission aborts are considered together with the nominal mission, treating them as an optimization problem of branched trajectories where the branching point is not fixed. The applied procedure yields a safety improved nominal trajectory, showing the feasibility of the included mission aborts with minimum payload penalty. The other mission aborts can be separately treated, with the initial condition given by the state of the nominal trajectory at the time when a failure occurs. A mission abort plan is set up, covering all emergency scenarios.

  12. You can't improve what you don't measure: Safety climate measures available in the German-speaking countries to support safety culture development in healthcare. (United States)

    Manser, Tanja; Brösterhaus, Mareen; Hammer, Antje


    Safety climate measurement is a key input into safety culture development. The aim of this review is to provide an overview of the safety climate measures that have been evaluated for their psychometric properties in a German-speaking country and to make recommendations on how to use them in quality and patient safety improvement. A systematic search strategy was implemented to obtain relevant articles. PubMed and Web of Science databases were searched, and 128 abstracts were identified. After application of limits, 33 full texts were retrieved for subsequent evaluation. Studies were included on the basis of predetermined inclusion criteria and independent assessment by two reviewers. Publications were reviewed concerning healthcare setting, target group, safety culture dimensions covered and results of their psychometric evaluation. This review identified 11 instruments for safety climate assessment in different healthcare settings (i. e. hospitals, nursing homes, primary care, dental care and community pharmacy) for which acceptable to good internal consistency was reported. We observed wide variability concerning the number of dimensions (1 to 14; in some cases including outcome dimensions) and items (9 to 128) that the instruments were comprised of. Nevertheless, consistency with regard to the thematic areas covered was rather high. While there is clear evidence that we can assess safety climate in healthcare, the application of safety climate measures by quality and patient safety practitioners has so far been rather limited. This review bridges this gap between research and improvement practice by highlighting the central role of safety climate assessment in a mixed methods approach to inform safety culture development. Copyright © 2016. Published by Elsevier GmbH.

  13. Completion plug design provides improved operational efficiency and safety while minimizing environmental risks

    Energy Technology Data Exchange (ETDEWEB)

    Dum, Frank [T.D. Williamson, Inc., Tulsa, OK (United States)


    Pipeline repair standards have been raised with recent improvements for completion plugs when used with a brand new setting tool, resulting in lower environmental risks, improved operational efficiency and safety. The design changes were originally made to serve in an offshore environment in order to minimize the diver's time in the water and simplify steps by the diver to execute pipeline repair operations in cold, dark conditions. Enhancements in the design include fewer number of fittings, plugs, o-rings and gaskets isolating the pipeline product found inside the pipe. The new design is a step toward meeting strict operational and safety standards demanded in the field of pipeline maintenance and repair. (author)

  14. Issues to improve the safety of 18K370 steam turbine operation

    Directory of Open Access Journals (Sweden)

    Bzymek Grzegorz


    Full Text Available The paper presents the process of improving the safety and reliability of operation the 18K370 steam turbines Opole Power Plant since the first failure in 2010 [1], up to install the on-line monitoring system [2]. It shows how the units work and how to analyse the contol stage as a critical node in designing the turbine. Selected results of the analysis of the strength of CSD (Computational Solid Dynamic and the nature of the flow in different operating regimes - thanks to CFD (Computational Fluid Dynamic analysis have been included. We have also briefly discussed the way of lifecycle management of individual elements [2,3]. The presented actions could be considered satisfactory, and improve the safety of operating steam turbines of type 18K370.


    Directory of Open Access Journals (Sweden)

    Tri Basuki JOEWONO


    Three aspects of an improvement agenda are proposed based on the perception data, namely technology, management, and institution. This agenda is clarified by a set of action plans incorporating the responsible parties and a time frame. The action plan is divided into three terms to define a clear goal for each step. The short-term action focuses on the hardware and on preparing further steps, whereas the medium-term action focuses on developing and improving the standard of safety and security. The long-term action focuses on advancing safety and security practices. The effectiveness of this agenda and action plan rests upon a set of assumptions, such as the degree of seriousness from the authoritative institution, fair distribution of information, the availability of reasonable resources, and coordinated and collaborative action from all parties involved to reach the objective.

  16. SAFETY

    CERN Multimedia

    M. Plagge, C. Schaefer and N. Dupont


    Fire Safety – Essential for a particle detector The CMS detector is a marvel of high technology, one of the most precise particle measurement devices we have built until now. Of course it has to be protected from external and internal incidents like the ones that can occur from fires. Due to the fire load, the permanent availability of oxygen and the presence of various ignition sources mostly based on electricity this has to be addressed. Starting from the beam pipe towards the magnet coil, the detector is protected by flooding it with pure gaseous nitrogen during operation. The outer shell of CMS, namely the yoke and the muon chambers are then covered by an emergency inertion system also based on nitrogen. To ensure maximum fire safety, all materials used comply with the CERN regulations IS 23 and IS 41 with only a few exceptions. Every piece of the 30-tonne polyethylene shielding is high-density material, borated, boxed within steel and coated with intumescent (a paint that creates a thick co...

  17. SAFETY

    CERN Multimedia

    C. Schaefer and N. Dupont


      “Safety is the highest priority”: this statement from CERN is endorsed by the CMS management. An interpretation of this statement may bring you to the conclusion that you should stop working in order to avoid risks. If the safety is the priority, work is not! This would be a misunderstanding and misinterpretation. One should understand that “working safely” or “operating safely” is the priority at CERN. CERN personnel are exposed to different hazards on many levels on a daily basis. However, risk analyses and assessments are done in order to limit the number and the gravity of accidents. For example, this process takes place each time you cross the road. The hazard is the moving vehicle, the stake is you and the risk might be the risk of collision between both. The same principle has to be applied during our daily work. In particular, keeping in mind the general principles of prevention defined in the late 1980s. These principles wer...

  18. Processing and storage of blood components: strategies to improve patient safety


    Pietersz RNI; van der Meer PF


    Ruby NI Pietersz, Pieter F van der Meer Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, the Netherlands Abstract: This review focuses on safety improvements of blood processing of various blood components and their respective storage. A solid quality system to ensure safe and effective blood components that are traceable from a donor to the patient is the foundation of a safe blood supply. To stimulate and guide this process, National Health Authorities should d...

  19. Processing and storage of blood components: strategies to improve patient safety


    Pietersz RNI; van der Meer PF


    Ruby NI Pietersz, Pieter F van der Meer Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, the Netherlands Abstract: This review focuses on safety improvements of blood processing of various blood components and their respective storage. A solid quality system to ensure safe and effective blood components that are traceable from a donor to the patient is the foundation of a safe blood supply. To stimulate and guide this process, National Health Authorities should d...

  20. Improvement of Road Safety using Geospatial open data and collaborative users information


    Gómez Castaño, José; Cabrera García, Juan José


    This project solve the problem of warning to drivers in advance to take precautions when they are approaching a road risk. This notice cannot be sent too close or too far and it is made by icons, text and audio. The main goal is to use geospatial information in a collaborative way to improve road safety taken relevant information from vehicles, cyclists andpedestrians.

  1. Multidisciplinary centres for safety and quality improvement: learning from climate change science (United States)

    Batalden, Paul; Davidoff, Frank


    Effective improvement and research rely on sustained multidisciplinary collaboration, but few examples are available of centres with the broad range of disciplines and practical experience that are needed to sustain long-term improvement in healthcare quality and safety. In a number of respects, the parlous state of the quality and safety of medical care resembles the problem of climate change. Both constitute a profoundly serious man-made threat to the public good which have until recently been both ignored and denied but are increasingly being recognised, taken seriously and acted on. Among the most interesting and important responses to the challenge of climate change has been the creation of Centres of Climate Change in which experts from multiple diverse disciplines are brought together to tackle the problem. Such centres, while science-based, express their vision in solid pragmatic terms and embrace policy, public engagement and education as essential components of that vision. Cross-discipline collaboration has unfortunately not achieved the same effectiveness or visibility in healthcare quality and safety as it has in the area of climate change. The authors argue that there is a need to create multidisciplinary centres in healthcare to accelerate the improvement of safety and quality, and provide the necessary theoretical and empirical foundations. Such centres would draw on disciplines such as epidemiology, statistics and relevant clinical disciplines but equally from psychology, engineering, ergonomics, sociology, economics, organisational development in addition to engaging with patients and citizens and leaders with practical experience of improvement in the field. In this paper, we address some of the pragmatic challenges of creating such centres and consider how the right groups and networks of researchers and practitioners might be assembled. PMID:21450778

  2. Road accident rates: strategies and programmes for improving road traffic safety. (United States)

    Goniewicz, K; Goniewicz, M; Pawłowski, W; Fiedor, P


    Nowadays, the problem of road accident rates is one of the most important health and social policy issues concerning the countries in all continents. Each year, nearly 1.3 million people worldwide lose their life on roads, and 20-50 million sustain severe injuries, the majority of which require long-term treatment. The objective of the study was to identify the most frequent, constantly occurring causes of road accidents, as well as outline actions constituting a basis for the strategies and programmes aiming at improving traffic safety on local and global levels. Comparative analysis of literature concerning road safety was performed, confirming that although road accidents had a varied and frequently complex background, their causes have changed only to a small degree over the years. The causes include: lack of control and enforcement concerning implementation of traffic regulation (primarily driving at excessive speed, driving under the influence of alcohol, and not respecting the rights of other road users (mainly pedestrians and cyclists), lack of appropriate infrastructure and unroadworthy vehicles. The number of fatal accidents and severe injuries, resulting from road accidents, may be reduced through applying an integrated approach to safety on roads. The strategies and programmes for improving road traffic should include the following measures: reducing the risk of exposure to an accident, prevention of accidents, reduction in bodily injuries sustained in accidents, and reduction of the effects of injuries by improvement of post-accident medical care.

  3. Aluminum hypophosphite microencapsulated to improve its safety and application to flame retardant polyamide 6

    Energy Technology Data Exchange (ETDEWEB)

    Ge, Hua [State Key Laboratory of Fire Science, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026 (China); Tang, Gang [School of Architecture and Civil Engineering, Anhui University of Technology, 59 Hudong Road, Ma’anshan, Anhui 243002 (China); Hu, Wei-Zhao; Wang, Bi-Bo; Pan, Ying [State Key Laboratory of Fire Science, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026 (China); Song, Lei, E-mail: [State Key Laboratory of Fire Science, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026 (China); Hu, Yuan, E-mail: [State Key Laboratory of Fire Science, University of Science and Technology of China, 96 Jinzhai Road, Hefei, Anhui 230026 (China); Suzhou Key Laboratory of Urban Public Safety, Suzhou Institute for Advanced Study, University of Science and Technology of China, 166 Ren’ai Road, Suzhou, Jiangsu 215123 (China)


    Highlights: • MCAHP was prepared and applied in polyamide 6. • MCA as the capsule material can improve the fire safety of AHP. • Flame retardant polyamide 6 composites with MCAHP show good flame retardancy. - Abstract: Aluminum hypophosphite (AHP) is an effective phosphorus-containing flame retardant. But AHP also has fire risk that it will decompose and release phosphine which is spontaneously flammable in air and even can form explosive mixtures with air in extreme cases. In this paper, AHP has been microencapsulated by melamine cyanurate (MCA) to prepare microencapsulated aluminum hypophosphite (MCAHP) with the aim of enhancing the fire safety in the procedure of production, storage and use. Meanwhile, MCA was a nitrogen-containing flame retardant that can work with AHP via the nitrogen-phosphorus synergistic effect to show improved flame-retardant property than other capsule materials. After microencapsulation, MCA presented as a protection layer inhibit the degradation of AHP and postpone the generation of phosphine. Furthermore, the phosphine concentration could be effectively diluted by inert decomposition products of MCA. These nonflammable decomposition products of MCA could separate phosphine from air delay the oxidizing reaction with oxygen and decrease the heat release rate, which imply that the fire safety of AHP has been improved. Furthermore, MCAHP was added into polyamide 6 to prepare flame retardant polyamide 6 composites (FR-PA6) which show good flame retardancy.

  4. Use of the Home Safety Self-Assessment Tool (HSSAT) within Community Health Education to Improve Home Safety. (United States)

    Horowitz, Beverly P; Almonte, Tiffany; Vasil, Andrea


    This exploratory research examined the benefits of a health education program utilizing the Home Safety Self-Assessment Tool (HSSAT) to increase perceived knowledge of home safety, recognition of unsafe activities, ability to safely perform activities, and develop home safety plans of 47 older adults. Focus groups in two senior centers explored social workers' perspectives on use of the HSSAT in community practice. Results for the health education program found significant differences between reported knowledge of home safety (p = .02), ability to recognize unsafe activities (p = .01), safely perform activities (p = .04), and develop a safety plan (p = .002). Social workers identified home safety as a major concern and the HSSAT a promising assessment tool. Research has implications for reducing environmental fall risks.

  5. Codifying knowledge to improve patient safety: a qualitative study of practice-based interventions. (United States)

    Turner, Simon; Higginson, Juliet; Oborne, C Alice; Thomas, Rebecca E; Ramsay, Angus I G; Fulop, Naomi J


    Although it is well established that health care professionals use tacit and codified knowledge to provide front-line care, less is known about how these two forms of knowledge can be combined to support improvement related to patient safety. Patient safety interventions involving the codification of knowledge were co-designed by university and hospital-based staff in two English National Health Service (NHS) hospitals to support the governance of medication safety and mortality and morbidity (M&M) meetings. At hospital A, a structured mortality review process was introduced into three clinical specialities from January to December 2010. A qualitative approach of observing M&M meetings (n = 30) and conducting interviews (n = 40) was used to examine the impact on meetings and on front-line clinicians and hospital managers. At hospital B, a medication safety 'scorecard' was administered on a general medicine and elderly care ward from September to November 2011. Weekly feedback meetings were observed (n = 18) and interviews with front-line staff conducted (n = 10) to examine how knowledge codification influenced behaviour. Codification was shown to support learning related to patient safety at the micro (front-line service) level by structuring the sharing of tacit knowledge, but the presence of professional and managerial boundaries at the organisational level affected the codification initiatives' implementation. The findings suggest that codifying knowledge to support improvement presents distinct challenges at the group and organisational level; translating knowledge across these levels is contingent on the presence of enabling organisational factors, including the alignment of learning from clinical practice with its governance.

  6. Harnessing implementation science to improve care quality and patient safety: a systematic review of targeted literature. (United States)

    Braithwaite, Jeffrey; Marks, Danielle; Taylor, Natalie


    Getting greater levels of evidence into practice is a key problem for health systems, compounded by the volume of research produced. Implementation science aims to improve the adoption and spread of research evidence. A linked problem is how to enhance quality of care and patient safety based on evidence when care settings are complex adaptive systems. Our research question was: according to the implementation science literature, which common implementation factors are associated with improving the quality and safety of care for patients? We conducted a targeted search of key journals to examine implementation science in the quality and safety domain applying PRISMA procedures. Fifty-seven out of 466 references retrieved were considered relevant following the application of exclusion criteria. Included articles were subjected to content analysis. Three reviewers extracted and documented key characteristics of the papers. Grounded theory was used to distil key features of the literature to derive emergent success factors. Eight success factors of implementation emerged: preparing for change, capacity for implementation-people, capacity for implementation-setting, types of implementation, resources, leverage, desirable implementation enabling features, and sustainability. Obstacles in implementation are the mirror image of these: for example, when people fail to prepare, have insufficient capacity for implementation or when the setting is resistant to change, then care quality is at risk, and patient safety can be compromised. This review of key studies in the quality and safety literature discusses the current state-of-play of implementation science applied to these domains. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  7. The Prescribed Velocity Method

    DEFF Research Database (Denmark)

    Nielsen, Peter Vilhelm

    The- velocity level in a room ventilated by jet ventilation is strongly influenced by the supply conditions. The momentum flow in the supply jets controls the air movement in the room and, therefore, it is very important that the inlet conditions and the numerical method can generate a satisfactory...... description of this momentum flow. The Prescribed Velocity Method is a practical method for the description of an Air Terminal Device which will save grid points close to the opening and ensure the right level of the momentum flow....

  8. Does the judicious use of safety behaviors improve the efficacy and acceptability of exposure therapy for claustrophobic fear? (United States)

    Deacon, Brett J; Sy, Jennifer T; Lickel, James J; Nelson, Elizabeth A


    Exposure therapy is traditionally conducted with an emphasis on the elimination of safety behaviors. However, theorists have recently suggested that the judicious use of safety behaviors may improve the tolerability of this treatment without reducing its efficacy. The present study tested this notion by randomly assigning participants with high claustrophobic fear to receive a single-session intervention with or without access to safety aids during early exposure trials. Improvement was generally equivalent between the treatment conditions, and no reliable benefits or drawbacks were associated with the judicious use of safety behaviors. The theoretical and clinical implications of these findings are discussed.

  9. Multi-physics Modeling for Improving Li-Ion Battery Safety; NREL (National Renewable Energy Laboratory)

    Energy Technology Data Exchange (ETDEWEB)

    Pesaran, A.; Kim, G.; Santhanagopalan, S.; Yang, C.


    Battery performance, cost, and safety must be further improved for larger market share of HEVs/PEVs and penetration into the grid. Significant investment is being made to develop new materials, fine tune existing ones, improve cell and pack designs, and enhance manufacturing processes to increase performance, reduce cost, and make batteries safer. Modeling, simulation, and design tools can play an important role by providing insight on how to address issues, reducing the number of build-test-break prototypes, and accelerating the development cycle of generating products.

  10. Evaluation of Patient Safety Culture and Organizational Culture as a Step in Patient Safety Improvement in a Hospital in Jakarta, Indonesia

    Directory of Open Access Journals (Sweden)

    Afrisya Iriviranty


    Full Text Available Introduction: Establishment of patient safety culture is the first step in the improvement of patient safety. As such, assessment of patient safety culture in hospitals is of paramount importance. Patient safety culture is an inherent component of organizational culture, so that the study of organizational culture is required in developing patient safety. This study aimed to evaluate patient safety culture among the clinical staff of a hospital in Jakarta, Indonesia and identify organizational culture profile. Materials and Methods: This cross-sectional, descriptive, qualitative study was conducted in a hospital in Jakarta, Indonesia in 2014. Sample population consisted of nurses, midwives, physicians, pediatricians, obstetrics and gynecology specialists, laboratory personnel, and pharmacy staff (n=152. Data were collected using the Hospital Survey on Patient Safety Culture developed by the Agency for Healthcare Research and Quality (AHRQ and Organizational Culture Assessment Instrument (OCAI. Results: Teamwork within units” was the strongest dimension of patient safety culture (91.7%, while “staffing” and “non-punitive response to error” were the weakest dimensions (22.7%. Moreover, clan culture was the most dominant type of organizational culture in the studied hospital. This culture serves as a guide for the changes in the healthcare organization, especially in the development of patient safety culture. Conclusion: According to the results of this study, healthcare providers were positively inclined toward the patient safety culture within the organization. As such, the action plan was designed through consensus decision-making and deemed effective in articulating patient safety in the vision and mission of the organization.

  11. Moving Toward Improved Teamwork in Cancer Care: The Role of Psychological Safety in Team Communication. (United States)

    Jain, Anshu K; Fennell, Mary L; Chagpar, Anees B; Connolly, Hannah K; Nembhard, Ingrid M


    Effective communication is a requirement in the teamwork necessary for improved coordination to deliver patient-centered, value-based cancer care. Communication is particularly important when care providers are geographically distributed or work across organizations. We review organizational and teams research on communication to highlight psychological safety as a key determinant of high-quality communication within teams. We first present the concept of psychological safety, findings about its communication effects for teamwork, and factors that affect it. We focus on five factors applicable to cancer care delivery: familiarity, clinical hierarchy-related status differences, geographic dispersion, boundary spanning, and leader behavior. To illustrate how these factors facilitate or hinder psychologically safe communication and teamwork in cancer care, we review the case of a patient as she experiences the treatment-planning process for early-stage breast cancer in a community setting. Our analysis is summarized in a key principle: Teamwork in cancer care requires high-quality communication, which depends on psychological safety for all team members, clinicians and patients alike. We conclude with a discussion of the implications of psychological safety in clinical care and suggestions for future research.

  12. Patient safety and quality improvement: a ‘CLER’ time to move beyond peripheral participation

    Directory of Open Access Journals (Sweden)

    Daniel J. Schumacher


    Full Text Available In the United States, the Accreditation Council for Graduate Medical Education (ACGME has instituted a new program, the Clinical Learning Environment Review (CLER, that places focus in six important areas of the resident and fellow working and learning environment. Two of these areas are patient safety and quality improvement (QI. In their early CLER reviews of institutions housing ACGME-accredited training programs, ACGME has found that despite significant progress in patient safety and QI to date much work remains, especially when it comes to meaningful engagement of medical trainees in this work. In this article, the authors argue that peripheral involvement of trainees in patient safety and QI work does not allow the experiential learning that is necessary for professional development and the ultimate ability to execute performance that meets the needs of patients in contemporary clinical practice. Rather, as leaders in patient safety and QI have advocated since early in this movement, embedded and immersed experiences are necessary for learning and success.

  13. Patient safety and quality improvement: a 'CLER' time to move beyond peripheral participation. (United States)

    Schumacher, Daniel J; Frohna, John G


    In the United States, the Accreditation Council for Graduate Medical Education (ACGME) has instituted a new program, the Clinical Learning Environment Review (CLER), that places focus in six important areas of the resident and fellow working and learning environment. Two of these areas are patient safety and quality improvement (QI). In their early CLER reviews of institutions housing ACGME-accredited training programs, ACGME has found that despite significant progress in patient safety and QI to date much work remains, especially when it comes to meaningful engagement of medical trainees in this work. In this article, the authors argue that peripheral involvement of trainees in patient safety and QI work does not allow the experiential learning that is necessary for professional development and the ultimate ability to execute performance that meets the needs of patients in contemporary clinical practice. Rather, as leaders in patient safety and QI have advocated since early in this movement, embedded and immersed experiences are necessary for learning and success.

  14. Leveraging Trainees to Improve Quality and Safety at the Point of Care: Three Models for Engagement. (United States)

    Johnson Faherty, Laura; Mate, Kedar S; Moses, James M


    Trainees, as frontline providers who are acutely aware of quality improvement (QI) opportunities and patient safety (PS) issues, are key partners in achieving institutional quality and safety goals. However, as academic medical centers accelerate their initiatives to prioritize QI and PS, trainees have not always been engaged in these efforts. This article describes the development of an organizing framework with three suggested models of varying scopes and time horizons to effectively involve trainees in the quality and safety work of their training institutions. The proposed models, which were developed through a literature review, expert interviews with key stakeholders, and iterative testing, are (1) short-term, team-based, rapid-cycle initiatives; (2) medium-term, unit-based initiatives; and (3) long-term, health-system-wide initiatives. For each, the authors describe the objective, scope, duration, role of faculty leaders, steps for implementation in the clinical setting, pros and cons, and examples in the clinical setting. There are many barriers to designing the ideal training environments that fully engage trainees in QI/PS efforts, including lack of protected time for faculty mentors, time restrictions due to rotation-based training, and structural challenges. However, one of the most promising strategies for overcoming these barriers is integrating QI/PS principles into routine clinical care. These models provide opportunities for trainees to successfully learn and apply quality and safety principles to routine clinical care at the team, unit, and system level.

  15. The Probabilistic Safety Analysis during low power and shutdown, framework to improve safety; El APS a baja potencia en parada, marco para la mejora de la seguridad

    Energy Technology Data Exchange (ETDEWEB)

    Nos, V.


    Historically Probabilistic Safety Analysis (PSA) has been focused exclusively at full power operation, nevertheless, operational experience has revealed that events occurred during low power and shutdown can also present threats for the safety of the plant. Through qualitative assessment (NUMARC 91-06) about the configuration in shutdown have been internationally accepted, the benefits of Low Power and Shutdown PSA have been demonstrated as fundamental framework of quantitative understanding for improving safety and risk management in the above mentioned operative conditions of the plant. (Author)

  16. Best Practices for Chemotherapy Administration in Pediatric Oncology: Quality and Safety Process Improvements (2015). (United States)

    Looper, Karen; Winchester, Kari; Robinson, Deborah; Price, Andrea; Langley, Rachel; Martin, Gina; Jones, Sally; Holloway, Jodi; Rosenberg, Susanne; Flake, Susan


    The administration of chemotherapy to children with cancer is a high-risk process that must be performed in a safe and consistent manner with high reliability. Clinical trials play a major role in the treatment of children with cancer; conformance to chemotherapy protocol requirements and accurate documentation in the medical record are critical. Inconsistencies in the administration and documentation of chemotherapy were identified as opportunities for errors to occur. A major process improvement was initiated to establish best practices for nurses who administer chemotherapy to children. An interdisciplinary team was formed to evaluate the current process and to develop best practices based on current evidence, protocol requirements, available resources, and safety requirements. The process improvement focused on the establishment of standardized and safe administration techniques, exact administration times, and consistent electronic documentation that could easily be retrieved in medical record audits. Quality improvement tools including SBAR (Situation, Background, Assessment, Recommendation), process mapping, PDSA (Plan, Do. Study, Act) cycles, and quality metrics were used with this process improvement. The team established best practices in chemotherapy administration to children that have proven to be safe and reliable. Follow-up data have demonstrated that the project was highly successful and improved accuracy, patient and nurse safety, and effectiveness of chemotherapy administration.

  17. Improving efficiency and safety in external beam radiation therapy treatment delivery using a Kaizen approach. (United States)

    Kapur, Ajay; Adair, Nilda; O'Brien, Mildred; Naparstek, Nikoleta; Cangelosi, Thomas; Zuvic, Petrina; Joseph, Sherin; Meier, Jason; Bloom, Beatrice; Potters, Louis


    Modern external beam radiation therapy treatment delivery processes potentially increase the number of tasks to be performed by therapists and thus opportunities for errors, yet the need to treat a large number of patients daily requires a balanced allocation of time per treatment slot. The goal of this work was to streamline the underlying workflow in such time-interval constrained processes to enhance both execution efficiency and active safety surveillance using a Kaizen approach. A Kaizen project was initiated by mapping the workflow within each treatment slot for 3 Varian TrueBeam linear accelerators. More than 90 steps were identified, and average execution times for each were measured. The time-consuming steps were stratified into a 2 × 2 matrix arranged by potential workflow improvement versus the level of corrective effort required. A work plan was created to launch initiatives with high potential for workflow improvement but modest effort to implement. Time spent on safety surveillance and average durations of treatment slots were used to assess corresponding workflow improvements. Three initiatives were implemented to mitigate unnecessary therapist motion, overprocessing of data, and wait time for data transfer defects, respectively. A fourth initiative was implemented to make the division of labor by treating therapists as well as peer review more explicit. The average duration of treatment slots reduced by 6.7% in the 9 months following implementation of the initiatives (P = .001). A reduction of 21% in duration of treatment slots was observed on 1 of the machines (P Kaizen approach has the potential to improve operational efficiency and safety with quick turnaround in radiation therapy practice by addressing non-value-adding steps characteristic of individual department workflows. Higher effort opportunities are identified to guide continual downstream quality improvements. Copyright © 2017. Published by Elsevier Inc.

  18. Surgical safety checklist is associated with improved operating room safety culture, reduced wound complications, and unplanned readmissions in a pilot study in neurosurgery. (United States)

    Lepänluoma, M; Takala, R; Kotkansalo, A; Rahi, M; Ikonen, T S


    The World Health Organization's surgical safety checklist is designed to improve adherence to operating room safety standards, and its use has been shown to reduce complications among surgical patients. The objective of our study was to assess the impact of the implementation of the checklist on safety-related issues in the operating room and on postoperative adverse events in neurosurgery. From structured questionnaires delivered to operating room personnel, answers were analyzed to evaluate communication and safety-related issues during 89 and 73 neurosurgical operations before and after the checklist implementation, respectively. From the analyzed operations, 83 and 67 patients, respectively, were included in a retrospective analysis of electronic patient records to compare the length of hospital stay, reported adverse events, and readmissions. In addition, the consistency of operating room documentation and patient records was assessed. Communication between the surgeon and the anesthesiologist was enhanced, and safety-related issues were better covered when the checklist was used. Unplanned readmissions fell from 25% to 10% after the checklist implementation (p = 0.02). Wound complications decreased from 19% to 8% (p = 0.04). The consistency of documentation of the diagnosis and the procedure improved. The use of the checklist improved safety-related performance and, contemporarily, reduced numbers of wound complications, and readmissions were observed.

  19. Food Quality Safety Evaluation Model in College Canteens Based on the Improved AHP-taking Bengbu College as an Example

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    Huaxi Chen


    Full Text Available Based on the results of investigation and the suggestion from the experts, the factors influencing the college canteen food quality and safety are found and assessment system for university cafeteria food quality and safety is constructed. With the improved Analytic Hierarchy Process (AHP to the various indexes for the empowerment and the fuzzy comprehensive evaluation method, the university canteen food quality and safety evaluation method is created. Then based on the example from Bengbu College, the solution of the model is provided, thus it is concluded that the process management factors, food factors and environmental factors, make the biggest influence on the canteen food quality and safety. Meanwhile, the extent of the influence of the second level factor on the canteen food quality and safety is identified and further it should be paid a greater attention to the several factors in order to improve the status of the food quality and safety condition.

  20. Learning from Aviation to Improve Safety in the Operating Room - a Systematic Literature Review

    Directory of Open Access Journals (Sweden)

    Linda S. G. L. Wauben


    Full Text Available Lessons learned from other high-risk industries could improve patient safety in the operating room (OR. This review describes similarities and differences between high-risk industries and describes current methods and solutions within a system approach to reduce errors in the OR. PubMed and Scopus databases were systematically searched for relevant articles written in the English language published between 2000 and 2011. In total, 25 articles were included, all within the medical domain focusing on the comparison between surgery and aviation. In order to improve safety in the OR, multiple interventions have to be implemented. Additionally, the healthcare organization has to become a ‘learning organization’ and the OR team has to become a team with shared responsibilities and flat hierarchies. Interpersonal and technical skills can be trained by means of simulation and can be supported by implementing team briefings, debriefings and cross-checks. However, further development and research is needed to prove if these solutions are useful, practical, and actually increase safety.

  1. [Earthquakes and healthcare. Considerations and proposals for improving seismic safety of hospitals]. (United States)

    Polesani, L; Cocuzza, S; Nachiero, D


    The Italian territory faces a high seismic risk. Moreover the high vulnerability of health facilities increases the danger for the population. This study departs from an analysis of the state of conservation of the national hospitals and builds upon the data gathered on the recent earthquakes that have shaken Italy. Indeed, the study provides a bulk of preventive measures directed to improve seismic safety of both the national health system and the hospitals strategic value. The focus is mainly centered on emergency management aspects and the maintenance of the functionality of the medical services necessary to overcome the health crisis following an earthquake of high intensity. The research is conducted considering how these issues were addressed in foreign countries. In particular; California represents a central case study, since the high seismicity of the territory requires heavy investments to deal with the seismic safety of the hospitals.

  2. Blood transfusions in critical care: improving safety through technology & process analysis. (United States)

    Aulbach, Rebecca K; Brient, Kathy; Clark, Marie; Custard, Kristi; Davis, Carolyn; Gecomo, Jonathan; Ho, Judy Ong


    A multidisciplinary safety initiative transformed blood transfusion practices at St. Luke's Episcopal Hospital in Houston, Texas. An intense analysis of a mistransfusion using the principles of a Just Culture and the process of Cause Mapping identified system and human performance factors that led to the transfusion error. Multiple initiatives were implemented including technology, education and human behaviour change. The wireless technology of Pyxis Transfusion Verification by CareFusion is effective with the rapid infusion module efficient for use in critical care. Improvements in blood transfusion safety were accomplished by thoroughly evaluating the process of transfusions and by implementing wireless electronic transfusion verification technology. During the 27 months following implementation of the CareFusion Transfusion Verification there have been zero cases of transfusing mismatched blood.

  3. Workplace safety and health improvements through a labor/management training and collaboration. (United States)

    Mahan, Bruce; Morawetz, John; Ruttenberg, Ruth; Workman, Rick


    Seven hundred thirty-nine workers at Merck's Stonewall plant in Elkton, Virginia, have a safer and healthier workplace because four of them were enthusiastic about health and safety training they received from the union's training center in Cincinnati, Ohio. What emerged was not only that all 739 plant employees received OSHA 10-hour General Industry training, but that it was delivered by "OSHA-authorized" members of the International Chemical Workers Union Council who worked at the plant. Merck created a new full-time position in its Learning and Development Department and filled it with one of the four workers who had received the initial training. Strong plant leadership promoted discussions both during the training, in evaluation, and in newly energized joint labor-management meetings following the training. These discussions identified safety and health issues needing attention. Then, in a new spirit of trust and collaboration, major improvements occurred.

  4. Workplace Safety and Health Improvements Through a Labor/Management Training and Collaboration (United States)

    Mahan, Bruce; Morawetz, John; Ruttenberg, Ruth; Workman, Rick


    Seven hundred thirty-nine workers at Merck's Stonewall plant in Elkton, Virginia, have a safer and healthier workplace because four of them were enthusiastic about health and safety training they received from the union's training center in Cincinnati, Ohio. What emerged was not only that all 739 plant employees received OSHA 10-hour General Industry training, but that it was delivered by “OSHA-authorized” members of the International Chemical Workers Union Council who worked at the plant. Merck created a new fulltime position in its Learning and Development Department and hired one of the four workers who had received the initial training. Strong plant leadership promoted discussions both during the training, in evaluation, and in newly energized joint labor-management meetings following the training. These discussions identified safety and health issues needing attention. Then, in a new spirit of trust and collaboration, major improvements occurred. PMID:24704812

  5. Use of a risk assessment method to improve the safety of negative pressure wound therapy. (United States)

    Lelong, Anne-Sophie; Martelli, Nicolas; Bonan, Brigitte; Prognon, Patrice; Pineau, Judith


    To conduct a risk analysis of the negative pressure wound therapy (NPWT) care process and to improve the safety of NPWT, a working group of nurses, hospital pharmacists, physicians and hospital managers performed a risk analysis for the process of NPWT care. The failure modes, effects and criticality analysis (FMECA) method was used for this analysis. Failure modes and their consequences were defined and classified as a function of their criticality to identify priority actions for improvement. By contrast to classical FMECA, the criticality index (CI) of each consequence was calculated by multiplying occurrence, severity and detection scores. We identified 13 failure modes, leading to 20 different consequences. The CI of consequences was initially 712, falling to 357 after corrective measures were implemented. The major improvements proposed included the establishment of 6-monthly training cycles for nurses, physicians and surgeons and the introduction of computerised prescription for NPWT. The FMECA method also made it possible to prioritise actions as a function of the criticality ranking of consequences and was easily understood and used by the working group. This study is, to our knowledge, the first to use the FMECA method to improve the safety of NPWT.

  6. Ward round documentation in a major trauma centre: can we improve patient safety? (United States)

    Green, Gemma; Aframian, Arash; Bernard, Jason


    Our objective was to improve documentation and patient safety in a major trauma centre. A retrospective audit was undertaken in March 2014. Ward round entries for each orthopaedic patients on three dates were assessed against standards and analysed. The audit was repeated in April 2014, and again in August 2014. Thorough documentation is paramount in a major trauma centre. It forms a useful record of the patients hospital stay, is a legal document and is highlighted in national guidelines. It provides a basis for good handover, ensuring continuation of care and maintaining patient safety. Resultant poor compliance with Royal College guidelines in the initial audit led to the production of a new electronic based note keeping system. A meeting was held with all staff prior to introduction. Our initial results gained 75 entries, and none showed full compliance. Mean compliance per entry was 59% (0-81%). The second attempt gained 90 entries, with 30 from the weekend. Mean compliance per entry 97%. Third attempt received 61 entries, with 27 from the weekend. Mean compliance was 96%, meaning that the improvement was being maintained. Recent distressing reports regarding patient highlighted the importance of patient. Our initial audit proved there were many areas lacking in our documentation and improvement was necessary. Prior to introducing electronic systems, the implemented change has produced improvement in documentation, and provides a useful handover tool for staff.

  7. Li-Ion Electrolytes with Improved Safety and Tolerance to High-Voltage Systems (United States)

    Smart, Marshall C.; Bugga, Ratnakumar V.; Prakash, Surya; Krause, Frederick C.


    Given that lithium-ion (Li-ion) technology is the most viable rechargeable energy storage device for near-term applications, effort has been devoted to improving the safety characteristics of this system. Therefore, extensive effort has been devoted to developing nonflammable electrolytes to reduce the flammability of the cells/battery. A number of promising electrolytes have been developed incorporating flame-retardant additives, and have been shown to have good performance in a number of systems. However, these electrolyte formulations did not perform well when utilizing carbonaceous anodes with the high-voltage materials. Thus, further development was required to improve the compatibility. A number of Li-ion battery electrolyte formulations containing a flame-retardant additive [i.e., triphenyl phosphate (TPP)] were developed and demonstrated in high-voltage systems. These electrolytes include: (1) formulations that incorporate varying concentrations of the flame-retardant additive (from 5 to 15%), (2) the use of mono-fluoroethylene carbonate (FEC) as a co-solvent, and (3) the use of LiBOB as an electrolyte additive intended to improve the compatibility with high-voltage systems. Thus, improved safety has been provided without loss of performance in the high-voltage, high-energy system.

  8. Airline Safety Improvement Through Experience with Near-Misses: A Cautionary Tale. (United States)

    Madsen, Peter; Dillon, Robin L; Tinsley, Catherine H


    In recent years, the U.S. commercial airline industry has achieved unprecedented levels of safety, with the statistical risk associated with U.S. commercial aviation falling to 0.003 fatalities per 100 million passengers. But decades of research on organizational learning show that success often breeds complacency and failure inspires improvement. With accidents as rare events, can the airline industry continue safety advancements? This question is complicated by the complex system in which the industry operates where chance combinations of multiple factors contribute to what are largely probabilistic (rather than deterministic) outcomes. Thus, some apparent successes are realized because of good fortune rather than good processes, and this research intends to bring attention to these events, the near-misses. The processes that create these near-misses could pose a threat if multiple contributing factors combine in adverse ways without the intervention of good fortune. Yet, near-misses (if recognized as such) can, theoretically, offer a mechanism for continuing safety improvements, above and beyond learning gleaned from observable failure. We test whether or not this learning is apparent in the airline industry. Using data from 1990 to 2007, fixed effects Poisson regressions show that airlines learn from accidents (their own and others), and from one category of near-misses-those where the possible dangers are salient. Unfortunately, airlines do not improve following near-miss incidents when the focal event has no clear warnings of significant danger. Therefore, while airlines need to and can learn from certain near-misses, we conclude with recommendations for improving airline learning from all near-misses. © 2015 Society for Risk Analysis.

  9. Republished paper: Improving safety culture on adult medical units through multidisciplinary teamwork and communication interventions: the TOPS Project. (United States)

    Blegen, M A; Sehgal, N L; Alldredge, B K; Gearhart, S; Auerbach, A A; Wachter, R M


    The goal of this project was to improve unit-based safety culture through implementation of a multidisciplinary (pharmacy, nursing, medicine) teamwork and communication intervention. The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture was used to determine the impact of the training with a before-after design. Surveys were returned from 454 healthcare staff before the training and 368 staff 1 year later. Five of eleven safety culture subscales showed significant improvement. Nurses perceived a stronger safety culture than physicians or pharmacists. While it is difficult to isolate the effects of the team training intervention from other events occurring during the year between training and postevaluation, overall the intervention seems to have improved the safety culture on these medical units.

  10. Impact of social prescribing on general practice workload and polypharmacy. (United States)

    Loftus, A M; McCauley, F; McCarron, M O


    Social prescribing has emerged as a useful tool for helping patients overcome some of the social and behavioural determinants of poor health. There has been little research on the impact of social prescribing on use of primary healthcare resources. This study sought to determine whether social prescribing activities influenced patient-general practitioner (GP) contacts and polypharmacy. Quality-improvement design with social prescribing activity interventions from an urban general practice in Northern Ireland. Patients over 65 years of age with a chronic condition who attended their GP frequently or had multiple medications were offered a social prescribing activity. Participants' contacts with GP and the new repeat prescriptions before and during the social prescribing activity were measured. The total number of repeat prescriptions per patient was compared at the time of referral and 6-12 months later. Indications for referral, primary diagnoses and reasons for declining participation in a social prescribing activity after referral were prospectively recorded. Sixty-eight patients agreed to participate but only 28 (41%) engaged in a prescribed social activity. There was no statistically significant difference in GP contacts (visits to GP, home visits or telephone calls) or number of new repeat prescriptions between referral and completion of 12 weeks of social prescribing activity. Similarly there was no statistically significant difference in the total number of repeat prescriptions between referral and 6-12 months after social prescribing activity in either intention to treat or per protocol analyses. Social prescribing participants had similar demographic factors. Mental health issues (anxiety and/or depression) were more common among participants than those who were referred but declined participation in a social prescribing activity (P = 0.022). While social prescribing may help patients' self-esteem and well-being, it may not decrease GP workload. Further

  11. The effect of Health, Safety and Environment Management System (HSE-MS on the improvement of safety performance indices in Urea and Ammonia Kermanshah Petrochemical Company

    Directory of Open Access Journals (Sweden)

    M. S. Poursoleiman


    Full Text Available Introduction: Work-related accidents may cause damage to people, environment and lead to waste of time and money. Health, Safety and Environment Management System has been developed in order to reduce accidents. This study aimed to investigate the effect of implementation of this system on reduction of the accidents and its consequences and also on the safety performance indices in Kermanshah Petrochemical Company. Material and Method: In this study, records of accidents were collected by OSHA incident report form 301 over 4 years. Following, the mean annual accidents and its consequences and safety performance indices were calculated and reported. Then, using statistical analysis, the impacts of two years implementation of this system on the accidents and its consequences and safety performance indices were evaluated. Result: The results showed that the implementation of HSE system was significantly correlated with Frequency Severity Indicator, Accident Severity Rate, lost days, minor accidents and total incidents (P-value 0.05. Conclusion: The implementation of Health, Safety and the Environment Management System caused a reduction in accidents and its consequences and most of the safety performance indices in the entire process cycle of Kermanshah Petrochemical Company. Overall, safety condition has been improved considerably.

  12. Positioning Continuing Education: Boundaries and Intersections between the Domains Continuing Education, Knowledge Translation, Patient Safety and Quality Improvement (United States)

    Kitto, Simon; Bell, Mary; Peller, Jennifer; Sargeant, Joan; Etchells, Edward; Reeves, Scott; Silver, Ivan


    Public and professional concern about health care quality, safety and efficiency is growing. Continuing education, knowledge translation, patient safety and quality improvement have made concerted efforts to address these issues. However, a coordinated and integrated effort across these domains is lacking. This article explores and discusses the…

  13. Positioning Continuing Education: Boundaries and Intersections between the Domains Continuing Education, Knowledge Translation, Patient Safety and Quality Improvement (United States)

    Kitto, Simon; Bell, Mary; Peller, Jennifer; Sargeant, Joan; Etchells, Edward; Reeves, Scott; Silver, Ivan


    Public and professional concern about health care quality, safety and efficiency is growing. Continuing education, knowledge translation, patient safety and quality improvement have made concerted efforts to address these issues. However, a coordinated and integrated effort across these domains is lacking. This article explores and discusses the…

  14. Obstetrician/gynecologist hospitalists: can we improve safety and outcomes for patients and hospitals and improve lifestyle for physicians? (United States)

    Olson, Rob; Garite, Thomas J; Fishman, Alan; Andress, Ianthe F


    Over the last 5 years, a new obstetric-gynecologic hospitalist model has emerged rapidly, the primary focus of which is the care and safety of the laboring patient. The need for this type of practitioner has been driven by a number of factors: various types of patient safety programs that require a champion and organizer; the realization that bad outcomes and malpractice lawsuits often result from the lack of immediate availability of a physician in the labor and delivery suite; the desire for many younger practicing physicians to seek a balance between their personal and professional lives; the appeal of shift work as opposed to running a busy private practice; the waning amount of training that new residency graduates receive in critical skills that are needed on labor and delivery; the void in critical care of the laboring patient that is created by the outpatient focus of many physicians in maternal-fetal medicine; the need for hospitals to have a group of physicians to implement protocols and policies on the unit, and the need for teaching in all hospitals, not just academic centers. By having a dedicated group of physicians whose practice is limited mostly to the care of the labor and delivery aspects of patient care, there is great potential to address many of these needs. There are currently 164 known obstetrician/gynecologist hospitalist programs across the United States, with 2 more coming on each month; the newly formed Society of Obstetrician/Gynecologist Hospitalists currently has >80 individual members. This article addresses the advantages, challenges, and variety of Hospitalist models and will suggest that what may be considered an emerging trend is actually a sustainable model for improved patient care and safety.


    Directory of Open Access Journals (Sweden)

    Primož Rožman


    Full Text Available Background. Even though blood transfusion is a relatively safe form of therapy, because of the eventual administrative errors in the transfusion chain between the blood donor and the recipient of blood, transfusion errors still occur. Therefore, it is imperative to ensure an utmost extent of safety and reliability of all transfusion related procedures. The safety of blood transfusion can be improved by preventive actions, i.e. implementation of the total quality management concept, haemovigilance and virtual transfusion laboratory. In the resulting system, the information web, robotics, computer sciences and communication technologies ensure safe and reliable identification of the patients, blood donors, corresponding test samples and blood products. Apart form this; the modern technologies enable the automation of laboratory testing, the integrity of laboratory results and enable an optimal use of blood.Conclusions. For an improved transfusion safety in Slovenia, adoption of corresponding prevention as well as haemovigilance is necessary. Identification errors can be prevented by implementation of the wristbands systems with the code bars for the tagging of the patient and his biological samples, whereas the administrative errors in the blood bank and transfusion laboratory can be prevented by implementation of information systems and automation.We assume that the virtual transfusion laboratory will become an integral part of the new Slovenian transfusion web and will speed up, unify and simplify today’s methods of ordering and administering blood products. To the attending physician, it will enable the choice of optimal transfusion therapy schedule and at the same time, it will enable the supervision of individual orders, deviations and indications, all of which is needed in order to analyse and improve the quality and the costs of the treatment. These services represent the first obligatory step for the modernisation of the transfusion

  16. Hybrid Aluminum and Natural Fiber Composite Structure for Crash Safety Improvement (United States)

    Helaili, S.; Chafra, M.; Chevalier, Y.

    There is a growing interest on pedestrian's protection in automotive safety standards. Pedestrians head impact is one of the most important tests. In this paper, a hybrid composite structure made from natural fiber and aluminum, which improve the head protection when impact is taken place, is presented. The structure is made from a honeycomb composite made from unidirectional and woven composites and a thin aluminum layer. A head impact model is developed. The number of hexagonal layers is fixed and the thickness of the aluminum layer of the honeycomb structure is varied. The specific absorption energy is then calculated.

  17. Improved safety fast reactor with “reservoir” for delayed neutrons generating (United States)

    Kulikov, G. G.; Apse, V. A.; Shmelev, A. N.; Kulikov, E. G.


    The paper considers the possibility to improve safety of fast reactors by using weak neutron absorber with large atomic weight as a material for external neutron reflector and for internal cavity in the reactor core (the neutron “reservoir”) where generation of some additional “delayed” neutron takes place. The effects produced by the external neutron reflector and the internal neutron “reservoir” on kinetic behavior of fast reactors are inter-compared. It is demonstrated that neutron kinetics of fast reactors with such external and internal zones becomes the quieter as compared with neutron kinetics of thermal reactors.

  18. Neuropsychological consequences of boxing and recommendations to improve safety: a National Academy of Neuropsychology education paper. (United States)

    Heilbronner, Robert L; Bush, Shane S; Ravdin, Lisa D; Barth, Jeffrey T; Iverson, Grant L; Ruff, Ronald M; Lovell, Mark R; Barr, William B; Echemendia, Ruben J; Broshek, Donna K


    Boxing has held appeal for many athletes and audiences for centuries, and injuries have been part of boxing since its inception. Although permanent and irreversible neurologic dysfunction does not occur in the majority of participants, an association has been reported between the number of bouts fought and the development of neurologic, psychiatric, or histopathological signs and symptoms of encephalopathy in boxers. The purpose of this paper is to (i) provide clinical neuropsychologists, other health-care professionals, and the general public with information about the potential neuropsychological consequences of boxing, and (ii) provide recommendations to improve safety standards for those who participate in the sport.


    Directory of Open Access Journals (Sweden)

    Irina MAKAROVA


    Full Text Available The paper presents an analysis of road traffic accidents at non-signalized pedestrian crosswalks. A field study was conducted to determine the parameters for traffic and pedestrian flow, and construct the simulation models enabling experimentation at different loadings on the street and road network. Variants for improving the pedestrian safety at non-signalized crosswalks have been proposed. Simulation modeling of the proposed managerial decisions is expected to diminish the likelihood of road accidents. The efficiency of proposed decisions has been estimated.

  20. Traffic safety as a factor of improving logistics in construction sector

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    Ognjenovic Slobodan


    Full Text Available Security is a complex problem. It includes the driver’s behavior, the features of the vehicle, those of the road and the driving conditions. Security can be approached from the aspect of the vehicle and pavement design, of driving habits, traffic regulation and application of laws. The good coordination of the driver, the vehicle and the road enables for better estimation of the traffic safety relations and interrelations giving the possibilities of improvement of the situation at present and in future. The driver has the main role in the determination of the success or failure of the road system. Over 90% of the accidents are due to improper behavior of people in traffic. Understanding of the human factors is the key factor in the optimal road design and traffic flow. Nevertheless, engineers need more understanding about driving behavior, as they are responsible for road design, for the traffic flow, and for the regulations intended to avoid errors wherever possible. The purpose of this paper is to inform about the current situation both in practice and in the researches of traffic safety, as well as to yield a broader review of the actual traffic safety situation on the roads in Republic of Macedonia.

  1. EPA Proposes Revisions to its Risk Management Program to Improve Chemical Process Safety and Further Protect Communities and First Responders (United States)

    WASHINGTON - The U.S. Environmental Protection Agency (EPA) is proposing to revise its Risk Management Program (RMP) regulations to improve chemical process safety, assist local emergency authorities in planning for and responding to accidents, and

  2. Optimising drug prescribing and dispensing in subjects at risk for drug errors due to renal impairment : improving drug safety in primary healthcare by low eGFR alerts

    NARCIS (Netherlands)

    Joosten, Hanneke; Drion, Iefke; Boogerd, Kees J.; van der Pijl, Emiel V.; Slingerland, Robbert J.; Slaets, Joris P. J.; Jansen, Tiele J.; Schwantje, Olof; Gans, Reinold O. B.; Bilo, Henk J. G.


    Objectives: To assess the risk of medication errors in subjects with renal impairment (defined as an estimated glomerular filtration rate (eGFR) Design: Clinical survey. Setting: The city of Zwolle, The Netherlands, in a primary care setting including 22 community pharmacists and 65 general practiti

  3. Evaluating the Effectiveness of Two Teaching Strategies to Improve Nursing Students' Knowledge, Skills, and Attitudes About Quality Improvement and Patient Safety. (United States)

    Maxwell, Karen L; Wright, Vivian H

    The purpose of this study was to evaluate two teaching strategies with regard to quality and safety education for nurses content on quality improvement and safety. Two groups (total of 64 students) participated in online learning or online learning in conjunction with a flipped classroom. A pretest/posttest control group design was used. The use of online modules in conjunction with the flipped classroom had a greater effect on increasing nursing students' knowledge of quality improvement than the use of online modules only. There was no statistically significant difference between the groups for safety.

  4. Therapeutic drug monitoring: how to improve drug dosage and patient safety in tuberculosis treatment

    Directory of Open Access Journals (Sweden)

    Giovanni Sotgiu


    Full Text Available In this article we describe the key role of tuberculosis (TB treatment, the challenges (mainly the emergence of drug resistance, and the opportunities represented by the correct approach to drug dosage, based on the existing control and elimination strategies. In this context, the role and contribution of therapeutic drug monitoring (TDM is discussed in detail. Treatment success in multidrug-resistant (MDR TB cases is low (62%, with 7% failing or relapsing and 9% dying and in extensively drug-resistant (XDR TB cases is even lower (40%, with 22% failing or relapsing and 15% dying. The treatment of drug-resistant TB is also more expensive (exceeding €50 000 for MDR-TB and €160 000 for XDR-TB and more toxic if compared to that prescribed for drug-susceptible TB. Appropriate dosing of first- and second-line anti-TB drugs can improve the patient's prognosis and lower treatment costs. TDM is based on the measurement of drug concentrations in blood samples collected at appropriate times and subsequent dose adjustment according to the target concentration. The ‘dried blood spot’ technique offers additional advantages, providing the rationale for discussions regarding a possible future network of selected, quality-controlled reference laboratories for the processing of dried blood spots of difficult-to-treat patients from reference TB clinics around the world.

  5. A Technological Innovation to Reduce Prescribing Errors Based on Implementation Intentions: The Acceptability and Feasibility of MyPrescribe. (United States)

    Keyworth, Chris; Hart, Jo; Thoong, Hong; Ferguson, Jane; Tully, Mary


    Although prescribing of medication in hospitals is rarely an error-free process, prescribers receive little feedback on their mistakes and ways to change future practices. Audit and feedback interventions may be an effective approach to modifying the clinical practice of health professionals, but these may pose logistical challenges when used in hospitals. Moreover, such interventions are often labor intensive. Consequently, there is a need to develop effective and innovative interventions to overcome these challenges and to improve the delivery of feedback on prescribing. Implementation intentions, which have been shown to be effective in changing behavior, link critical situations with an appropriate response; however, these have rarely been used in the context of improving prescribing practices. Semistructured qualitative interviews were conducted to evaluate the acceptability and feasibility of providing feedback on prescribing errors via MyPrescribe, a mobile-compatible website informed by implementation intentions. Data relating to 200 prescribing errors made by 52 junior doctors were collected by 11 hospital pharmacists. These errors were populated into MyPrescribe, where prescribers were able to construct their own personalized action plans. Qualitative interviews with a subsample of 15 junior doctors were used to explore issues regarding feasibility and acceptability of MyPrescribe and their experiences of using implementation intentions to construct prescribing action plans. Framework analysis was used to identify prominent themes, with findings mapped to the behavioral components of the COM-B model (capability, opportunity, motivation, and behavior) to inform the development of future interventions. MyPrescribe was perceived to be effective in providing opportunities for critical reflection on prescribing errors and to complement existing training (such as junior doctors' e-portfolio). The participants were able to provide examples of how they would use

  6. Teamwork, communication and safety climate: a systematic review of interventions to improve surgical culture. (United States)

    Sacks, Greg D; Shannon, Evan M; Dawes, Aaron J; Rollo, Johnathon C; Nguyen, David K; Russell, Marcia M; Ko, Clifford Y; Maggard-Gibbons, Melinda A


    To define the target domains of culture-improvement interventions, to assess the impact of these interventions on surgical culture and to determine whether culture improvements lead to better patient outcomes and improved healthcare efficiency. Healthcare systems are investing considerable resources in improving workplace culture. It remains unclear whether these interventions, when aimed at surgical care, are successful and whether they are associated with changes in patient outcomes. PubMed, Cochrane, Web of Science and Scopus databases were searched from January 1980 to January 2015. We included studies on interventions that aimed to improve surgical culture, defined as the interpersonal, social and organisational factors that affect the healthcare environment and patient care. The quality of studies was assessed using an adapted tool to focus the review on higher-quality studies. Due to study heterogeneity, findings were narratively reviewed. The 47 studies meeting inclusion criteria (4 randomised trials and 10 moderate-quality observational studies) reported on interventions that targeted three domains of culture: teamwork (n=28), communication (n=26) and safety climate (n=19); several targeted more than one domain. All moderate-quality studies showed improvements in at least one of these domains. Two studies also demonstrated improvements in patient outcomes, such as reduced postoperative complications and even reduced postoperative mortality (absolute risk reduction 1.7%). Two studies reported improvements in healthcare efficiency, including fewer operating room delays. These findings were supported by similar results from low-quality studies. The literature provides promising evidence for various strategies to improve surgical culture, although these approaches differ in terms of the interventions employed as well as the techniques used to measure culture. Nevertheless, culture improvement appears to be associated with other positive effects, including

  7. The contribution of on-road studies of road user behaviour to improving road safety. (United States)

    Lenné, Michael G


    For over 40 years transport safety researchers have been using methods of vehicle instrumentation to gain greater insights into the factors that contribute to road user crash risk and the associated crash factors. In the previous decade in particular the widespread availability of lower cost and more advanced methods of vehicle instrumentation and recording technologies are supporting the increasing number of on-road research studies worldwide. The design of these studies ranges from multi-method studies using instrumented test vehicles and defined driving routes, to field operational tests, through to much larger and more naturalistic studies. It is timely to assess the utility of these methods for studying the influences of driver characteristics and states, the design and operation of the road system, and the influences of in-vehicle technologies on behaviour and safety for various road user groups. This special issue considers the extent to which on-road studies using vehicle instrumentation have been used to advance knowledge across these areas of road safety research. The papers included in this issue illustrate how research using instrumented test vehicles continues to generate new knowledge, and how the larger scale United States and European naturalistic and field operational test studies are providing a wealth of data about road user behaviour in real traffic. This is balanced with a number of studies that present methodological developments in data collection and analysis methods that, while promising, need further validation. The use of on-road methods to accurately describe the behaviours occurring in everyday real-world conditions, to quantify risks for safety critical events, and an improved understanding of the factors that contribute to risk, clearly has huge potential to promote further road trauma reductions.

  8. Do daily ward interviews improve measurement of hospital quality and safety indicators? A prospective observational study. (United States)

    Sarkies, Mitchell N; Bowles, Kelly-Ann; Skinner, Elizabeth H; Haas, Romi; Mitchell, Deb; O'Brien, Lisa; May, Kerry; Ghaly, Marcelle; Ho, Melissa; Haines, Terry P


    The aim of this study was to determine if the addition of daily ward interview data improves the capture of hospital quality and safety indicators compared with incident reporting systems alone. An additional aim was to determine the potential characteristics influencing under-reporting of hospital quality and safety indicators in incident reporting systems. A prospective, observational study was performed at two tertiary metropolitan public hospitals. Research assistants from allied health backgrounds met daily with the nurse in charge of the ward and discussed the occurrence of any falls, pressure injuries and rapid response medical team calls. Data were collected from four general medical wards, four surgical wards, an orthopaedic, neurosciences, plastics, respiratory, renal, sub-acute and acute medical assessment unit. An estimated total of 303 falls, 221 pressure injuries and 884 rapid response medical team calls occurred between 15 wards across two hospitals, over a period of 6 months. Hospital incident reporting systems underestimated falls by 30.0%, pressure injuries by 59.3% and rapid response medical team calls by 17.0%. The use of ward interview data collection in addition to hospital incident reporting systems improved data capture of falls by 23.8% (n = 72), pressure injuries by 21.7% (n = 48) and rapid response medical team calls by 12.7% (n = 112). Falls events were significantly less likely to be reported if they occurred on a Monday (P = 0.04) and pressure injuries significantly more likely to be reported if they occurred on a Wednesday (P = 0.01). Hospital quality and safety indicators (falls, pressure injuries and rapid response medical team calls) were under-reported in incident reporting systems, with variability in under-reporting between wards and the day of event occurrence. The use of ward interview data collection in addition to hospital incident reporting systems improved reporting of hospital quality and safety

  9. The Role of Fear Appeals in Improving Driver Safety: A Review of the Effectiveness of Fear-Arousing (Threat) Appeals in Road Safety Advertising (United States)

    Lewis, I.; Watson, B.; Tay, R.; White, K. M.


    This paper reviews theoretical and empirical evidence relating to the effectiveness of fear (threat) appeals in improving driver safety. The results of the review highlight the mixed and inconsistent findings that have been reported in the literature. While fear arousal appears important for attracting attention, its contribution to behaviour…

  10. Improving medication safety in primary care. A review and consensus procedure by the LINNEAUS collaboration on patient safety in primary care

    NARCIS (Netherlands)

    Lainer, M.; Vogele, A.; Wensing, M.; Sonnichsen, A.


    BACKGROUND: Drug treatment is an important clinical process in primary care that is associated with risk of error and adverse events. OBJECTIVE: To review currently available research evidence on the topic and to develop a framework, which can help to guide improvement of medication safety. METHODS:

  11. Evaluation of the SEDline to improve the safety and efficiency of conscious sedation. (United States)

    Caputo, Thomas D; Ramsay, Michael A E; Rossmann, Jeffrey A; Beach, M Miles; Griffiths, Garth R; Meyrat, Benjamin; Barnes, James B; Kerns, David G; Crump, Brad; Bookatz, Barnett; Ezzo, Paul


    Brain function monitors have improved safety and efficiency in general anesthesia; however, they have not been adequately tested for guiding conscious sedation for periodontal surgical procedures. This study evaluated the patient state index (PSI) obtained from the SEDline monitor (Sedline Inc., San Diego, CA) to determine its capacity to improve the safety and efficiency of intravenous conscious sedation during outpatient periodontal surgery. Twenty-one patients at the periodontics clinic of Baylor College of Dentistry were admitted to the study in 2009 and sedated to a moderate level using midazolam and fentanyl during periodontal surgery. The PSI monitoring was blinded from the clinician, and the following data were collected: vital signs, Ramsay sedation scale (RSS), medications administered, adverse events, PSI, electroencephalography, and the patients' perspective through visual analogue scales. The data were correlated to evaluate the PSI's ability to assess the level of sedation. Results showed that the RSS and PSI did not correlate (r = -0.25) unless high values associated with electromyographical (EMG) activity were corrected (r = -0.47). Oxygen desaturation did not correlate with the PSI (r = -0.08). Satisfaction (r = -0.57) and amnesia (r = -0.55) both increased as the average PSI decreased. In conclusion, within the limits of this study, PSI appears to correlate with amnesia, allowing a practitioner to titrate medications to that effect. It did not provide advance warning of adverse events and had inherent inaccuracies due to EMG activity during oral surgery. The PSI has the potential to increase safety and efficiency in conscious sedation but requires further development to eliminate EMG activity from confounding the score.

  12. Clarification of the characteristics of needle-tip movement during vacuum venipuncture to improve safety

    Directory of Open Access Journals (Sweden)

    Fujii C


    Full Text Available Chieko FujiiFaculty of Nursing and Medical Care, Keio University, Kanagawa, JapanBackground: Complications resulting from venipuncture include vein and nerve damage, hematoma, and neuropathic pain. Although the basic procedures are understood, few analyses of actual data exist. It is important to improve the safety standards of this technique during venipuncture. This study aimed to obtain data on actual needle movement during vacuum venipuncture in order to develop appropriate educational procedures.Methods: Six experienced nurses were recruited to collect blood samples from 64 subjects. These procedures were recorded using a digital camera. Software was then used to track and analyze motion without the use of a marker in order to maintain the sterility of the needle. Movement along the X- and Y-axes during blood sampling was examined.Results: Approximately 2.5 cm of the needle was inserted into the body, of which 6 mm resulted from advancing or moving the needle following puncture. The mean calculated puncture angle was 15.2°. Given the hazards posed by attaching and removing the blood collection tube, as well as by manipulating the needle to fix its position, the needle became unstable whether it was fixed or not fixed.Conclusion: This study examined venipuncture procedures and showed that the method was influenced by increased needle movement. Focusing on skills for puncturing the skin, inserting the needle into the vein, and changing hands while being conscious of needle-tip stability may be essential for improving the safety of venipuncture.Keywords: blood collection, nerve damage, motion analysis, patient safety, puncture angle, clinical education

  13. Eye tracking as a debriefing mechanism in the simulated setting improves patient safety practices. (United States)

    Henneman, Elizabeth A; Cunningham, Helene; Fisher, Donald L; Plotkin, Karen; Nathanson, Brian H; Roche, Joan P; Marquard, Jenna L; Reilly, Cheryl A; Henneman, Philip L


    Human patient simulation has been widely adopted in healthcare education despite little research supporting its efficacy. The debriefing process is central to simulation education, yet alternative evaluation methods to support providing optimal feedback to students have not been well explored. Eye tracking technology is an innovative method for providing objective evaluative feedback to students after a simulation experience. The purpose of this study was to compare 3 forms of simulation-based student feedback (verbal debrief only, eye tracking only, and combined verbal debrief and eye tracking) to determine the most effective method for improving student knowledge and performance. An experimental study using a pretest-posttest design was used to compare the effectiveness of 3 types of feedback. The subjects were senior baccalaureate nursing students in their final semester enrolled at a large university in the northeast United States. Students were randomly assigned to 1 of the 3 intervention groups. All groups performed better in the posttest evaluation than in the pretest. Certain safety practices improved significantly in the eye tracking-only group. These criteria were those that required an auditory and visual comparison of 2 artifacts such as "Compares patient stated name with name on ID band." Eye tracking offers a unique opportunity to provide students with objective data about their behaviors during simulation experiences, particularly related to safety practices that involve the comparison of patient stated data to an artifact such as an ID band. Despite the limitations of current eye tracking technology, there is significant potential for the use of this technology as a method for the study and evaluation of patient safety practices.

  14. Safety threats and opportunities to improve interfacility care transitions: insights from patients and family members. (United States)

    Jeffs, Lianne; Kitto, Simon; Merkley, Jane; Lyons, Renee F; Bell, Chaim M


    To explore patients' and family members' perspectives on how safety threats are detected and managed across care transitions and strategies that improve care transitions from acute care hospitals to complex continuing care and rehabilitation health care organizations. Poorly executed care transitions can result in additional health care spending due to adverse outcomes and delays as patients wait to transfer from acute care to facilities providing different levels of care. Patients and their families play an integral role in ensuring they receive safe care, as they are the one constant in care transitions processes. However, patients' and family members' perspectives on how safety threats are detected and managed across care transitions from health care facility to health care facility remain poorly understood. This qualitative study used semistructured interviews with patients (15) and family members (seven) who were transferred from an acute care hospital to a complex continuing care/rehabilitation care facility. Data were analyzed using a directed content analytical approach. OUR RESULTS REVEALED THREE KEY OVERARCHING THEMES IN THE PERCEPTIONS: lacking information, getting "funneled through" too soon, and difficulty adjusting to the shift from total care to almost self-care. Several patients and families described their expectations and experiences associated with their interfacility care transitions as being uninformed about their transfer or that transfer happened too early. In addition, study participants identified the need for having a coordinated approach to care transitions that engages patients and family members. Study findings provide patients' and family members' perspectives on key safety threats and how to improve care transitions. Of particular importance is the need for patients and family members to play a more active role in their care transition planning and self-care management.

  15. NSAID prescribing precautions. (United States)

    Risser, Amanda; Donovan, Deirdre; Heintzman, John; Page, Tanya


    Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used, but have risks associated with their use, including significant upper gastrointestinal tract bleeding. Older persons, persons taking anticoagulants, and persons with a history of upper gastrointestinal tract bleeding associated with NSAIDs are at especially high risk. Although aspirin is cardioprotective, other NSAIDs can worsen congestive heart failure, can increase blood pressure, and are related to adverse cardiovascular events, such as myocardial infarction and ischemia. Cyclooxygenase-2 inhibitors have been associated with increased risk of myocardial infarction; however, the only cyclooxygenase-2 inhibitor still available in the United States, celecoxib, seems to be safer in this regard. Hepatic damage from NSAIDs is rare, but these medications should not be used in persons with cirrhotic liver diseases because bleeding problems and renal failure are more likely. Care should be used when prescribing NSAIDs in persons taking anticoagulants and in those with platelet dysfunction, as well as immediately before surgery. Potential central nervous system effects include aseptic meningitis, psychosis, and tinnitus. Asthma may be induced or exacerbated by NSAIDs. Although most NSAIDs are likely safe in pregnancy, they should be avoided in the last six to eight weeks of pregnancy to prevent prolonged gestation from inhibition of prostaglandin synthesis, premature closure of the ductus arteriosus, and maternal and fetal complications from antiplatelet activity. Ibuprofen, indomethacin, and naproxen are safe in breastfeeding women. Care should be taken to prevent accidental NSAID overdose in children by educating parents about correct dosing and storage in childproof containers.

  16. High Energy Density Additives for Hybrid Fuel Rockets to Improve Performance and Enhance Safety (United States)

    Jaffe, Richard L.


    We propose a conceptual study of prototype strained hydrocarbon molecules as high energy density additives for hybrid rocket fuels to boost the performance of these rockets without compromising safety and reliability. Use of these additives could extend the range of applications for which hybrid rockets become an attractive alternative to conventional solid or liquid fuel rockets. The objectives of the study were to confirm and quantify the high enthalpy of these strained molecules and to assess improvement in rocket performance that would be expected if these additives were blended with conventional fuels. We confirmed the chemical properties (including enthalpy) of these additives. However, the predicted improvement in rocket performance was too small to make this a useful strategy for boosting hybrid rocket performance.

  17. Using lean methodology to teach quality improvement to internal medicine residents at a safety net hospital. (United States)

    Weigel, Charlene; Suen, Winnie; Gupte, Gouri


    The overall objective of this initiative was to develop a quality improvement (QI) curriculum using Lean methodology for internal medicine residents at Boston Medical Center, a safety net academic hospital. A total of 90 residents and 8 School of Public Health students participated in a series of four, 60- to 90-minute interactive and hands-on QI sessions. Seventeen QI project plans were created and conducted over a 4-month period. The curriculum facilitated internal medicine residents' learning about QI and development of positive attitudes toward QI (assessed using pre- and post-attitude surveys) and exposed them to an interprofessional team structure that duplicates future working relationships. This QI curriculum can be an educational model of how health care trainees can work collaboratively to improve health care quality.

  18. Lithium-Ion Electrolytes with Improved Safety Tolerance to High Voltage Systems (United States)

    Smart, Marshall C. (Inventor); Bugga, Ratnakumar V. (Inventor); Prakash, Surya G. (Inventor); Krause, Frederick C. (Inventor)


    The invention discloses various embodiments of electrolytes for use in lithium-ion batteries, the electrolytes having improved safety and the ability to operate with high capacity anodes and high voltage cathodes. In one embodiment there is provided an electrolyte for use in a lithium-ion battery comprising an anode and a high voltage cathode. The electrolyte has a mixture of a cyclic carbonate of ethylene carbonate (EC) or mono-fluoroethylene carbonate (FEC) co-solvent, ethyl methyl carbonate (EMC), a flame retardant additive, a lithium salt, and an electrolyte additive that improves compatibility and performance of the lithium-ion battery with a high voltage cathode. The lithium-ion battery is charged to a voltage in a range of from about 2.0 V (Volts) to about 5.0 V (Volts).

  19. Patient safety in plastic surgery: identifying areas for quality improvement efforts. (United States)

    Hernandez-Boussard, Tina; McDonald, Kathryn M; Rhoads, Kim F; Curtin, Catherine M


    Improving quality of health care is a global priority. Before quality benchmarks are established, we first must understand rates of adverse events (AEs). This project assessed risk-adjusted rates of inpatient AEs for soft tissue reconstructive procedures.Patients receiving soft tissue reconstructive procedures from 2005 to 2010 were extracted from the Nationwide Inpatient Sample. Inpatient AEs were identified using patient safety indicators (PSIs), established measures developed by Agency for Healthcare Research and Quality.We identified 409,991 patients with soft tissue reconstruction and 16,635 (4.06%) had a PSI during their hospital stay. Patient safety indicators were associated with increased risk-adjusted mortality, longer length of stay, and decreased routine disposition (P plastic surgery patients had significantly lower risk-adjusted rate compared to other surgical inpatients for all events evaluated except for failure to rescue and postoperative hemorrhage or hematoma, which were not statistically different. Risk-adjusted rates of hematoma hemorrhage were significantly higher in patients receiving size-reduction surgery, and these rates were further accentuated when broken down by sex and payer. In general, plastic surgery patients had lower rates of in-hospital AEs than other surgical disciplines, but PSIs were not uncommon. With the establishment of national basal PSI rates in plastic surgery patients, benchmarks can be devised and target areas for quality improvement efforts identified. Further prospective studies should be designed to elucidate the drivers of AEs identified in this population.

  20. Safety and improvement of movement function after stroke with atomoxetine: A pilot randomized trial (United States)

    Ward, Andrea; Carrico, Cheryl; Powell, Elizabeth; Westgate, Philip M.; Nichols, Laurie; Fleischer, Anne; Sawaki, Lumy


    Background: Intensive, task-oriented motor training has been associated with neuroplastic reorganization and improved upper extremity movement function after stroke. However, to optimize such training for people with moderate-to-severe movement impairment, pharmacological modulation of neuroplasticity may be needed as an adjuvant intervention. Objective: Evaluate safety, as well as improvement in movement function, associated with motor training paired with a drug to upregulate neuroplasticity after stroke. Methods: In this double-blind, randomized, placebo-controlled study, 12 subjects with chronic stroke received either atomoxetine or placebo paired with motor training. Safety was assessed using vital signs. Upper extremity movement function was assessed using Fugl-Meyer Assessment, Wolf Motor Function Test, and Action Research Arm Test at baseline, post-intervention, and 1-month follow-up. Results: No significant between-groups differences were found in mean heart rate (95% CI, –12.4–22.6; p = 0.23), mean systolic blood pressure (95% CI, –1.7–29.6; p = 0.21), or mean diastolic blood pressure (95% CI, –10.4–13.3; p = 0.08). A statistically significant between-groups difference on Fugl-Meyer at post-intervention favored the atomoxetine group (95% CI, 1.6–12.7; p = 0.016). Conclusion: Atomoxetine combined with motor training appears safe and may optimize motor training outcomes after stroke. PMID:27858723

  1. Willingness to use mobile application for smartphone for improving road safety. (United States)

    Cardamone, Angelo Stephen; Eboli, Laura; Forciniti, Carmen; Mazzulla, Gabriella


    In the last few years mobile devices have reached a large amount of consumers in both developed and high-growth world economies. In 2013, 97% of the Italian population owns a mobile phone, and 62% owns a smartphone. Application software for mobile devices is largely proposed to consumers, and several mobile applications were oriented toward the improvement of road safety and road accident risk reduction. In this paper, we describe the results of a survey oriented to preventively investigate on the willingness to receive and/or to give information about road condition by means of mobile devices. Road users were informed about the characteristics of a mobile application, and then they were invited to complete a questionnaire. Experimental data were used for capturing road user attitudes toward the use of the smartphone to improve road safety, and to establish the preferences for the different features of the proposed mobile application. To this end, we choose to use the ordered probit model methodology. We demonstrate that the adopted methodology accounts for the differential impacts of the willingness to receive and/or to give information about road conditions on the overall willingness to receive and/or to give information through an application software for mobile devices.

  2. A cooperative transponder system for improved traffic safety, localizing road users in the 5 GHz band (United States)

    Schaffer, B.; Kalverkamp, G.; Chaabane, M.; Biebl, E. M.


    We present a multi-user cooperative mobile transponder system which enables cars to localize pedestrians, bicyclists and other road users in order to improve traffic safety. The system operates at a center frequency of 5.768 GHz, offering the ability to test precision localization technology at frequencies close to the newly designated automotive safety related bands around 5.9 GHz. By carrying out a roundtrip time of flight measurement, the sensor can determine the distance from the onboard localization unit of a car to a road user who is equipped with an active transponder, employing the idea of a secondary radar and pulse compression. The onboard unit sends out a pseudo noise coded interrogation pulse, which is answered by one or more transponders after a short waiting time. Each transponder uses a different waiting time in order to allow for time division multiple access. We present the system setup as well as range measurement results, achieving an accuracy up to centimeters for the distance measurement and a range in the order of hundred meters. We also discuss the effect of clock drift and offset on distance accuracy for different waiting times and show how the system can be improved to further increase precision in a multiuser environment.

  3. Assessing risk: the role of probabilistic risk assessment (PRA) in patient safety improvement. (United States)

    Wreathall, J; Nemeth, C


    Morbidity and mortality due to "medical errors" compel better understanding of health care as a system. Probabilistic risk assessment (PRA) has been used to assess the designs of high hazard, low risk systems such as commercial nuclear power plants and chemical manufacturing plants and is now being studied for its potential in the improvement of patient safety. PRA examines events that contribute to adverse outcomes through the use of event tree analysis and determines the likelihood of event occurrence through fault tree analysis. It complements tools already in use in patient safety such as failure modes and effects analyses (FMEAs) and root cause analyses (RCAs). PRA improves on RCA by taking account of the more complex causal interrelationships that are typical in health care. It also enables the analyst to examine potential solution effectiveness by direct graphical representations. However, PRA simplifies real world complexity by forcing binary conditions on events, and it lacks adequate probability data (although recent developments help to overcome these limitations). Its reliance on expert assessment calls for deep domain knowledge which has to come from research performed at the "sharp end" of acute care.

  4. Live attenuated S. Typhimurium vaccine with improved safety in immuno-compromised mice.

    Directory of Open Access Journals (Sweden)

    Balamurugan Periaswamy

    Full Text Available Live attenuated vaccines are of great value for preventing infectious diseases. They represent a delicate compromise between sufficient colonization-mediated adaptive immunity and minimizing the risk for infection by the vaccine strain itself. Immune defects can predispose to vaccine strain infections. It has remained unclear whether vaccine safety could be improved via mutations attenuating a vaccine in immune-deficient individuals without compromising the vaccine's performance in the normal host. We have addressed this hypothesis using a mouse model for Salmonella diarrhea and a live attenuated Salmonella Typhimurium strain (ssaV. Vaccination with this strain elicited protective immunity in wild type mice, but a fatal systemic infection in immune-deficient cybb(-/-nos2(-/- animals lacking NADPH oxidase and inducible NO synthase. In cybb(-/-nos2(-/- mice, we analyzed the attenuation of 35 ssaV strains carrying one additional mutation each. One strain, Z234 (ssaV SL1344_3093, was >1000-fold attenuated in cybb(-/-nos2(-/- mice and ≈100 fold attenuated in tnfr1(-/- animals. However, in wt mice, Z234 was as efficient as ssaV with respect to host colonization and the elicitation of a protective, O-antigen specific mucosal secretory IgA (sIgA response. These data suggest that it is possible to engineer live attenuated vaccines which are specifically attenuated in immuno-compromised hosts. This might help to improve vaccine safety.

  5. Editorial: Advances in healthcare provider and patient training to improve the quality and safety of patient care

    Directory of Open Access Journals (Sweden)

    Elizabeth M. Borycki


    Full Text Available This special issue of the Knowledge Management & E-Learning: An International Journal is dedicated to describing “Advances in Healthcare Provider and Patient Training to Improve the Quality and Safety of Patient Care.” Patient safety is an important and fundamental requirement of ensuring the quality of patient care. Training and education has been identified as a key to improving healthcare provider patient safety competencies especially when working with new technologies such as electronic health records and mobile health applications. Such technologies can be harnessed to improve patient safety; however, if not used properly they can negatively impact on patient safety. In this issue we focus on advances in training that can improve patient safety and the optimal use of new technologies in healthcare. For example, use of clinical simulations and online computer based training can be employed both to facilitate learning about new clinical discoveries as well as to integrate technology into day to day healthcare practices. In this issue we are publishing papers that describe advances in healthcare provider and patient training to improve patient safety as it relates to the use of educational technologies, health information technology and on-line health resources. In addition, in the special issue we describe new approaches to training and patient safety including, online communities, clinical simulations, on-the-job training, computer based training and health information systems that educate about and support safer patient care in real-time (i.e. when health professionals are providing care to patients. These educational and technological initiatives can be aimed at health professionals (i.e. students and those who are currently working in the field. The outcomes of this work are significant as they lead to safer care for patients and their family members. The issue has both theoretical and applied papers that describe advances in patient

  6. Strategies for Developing and Recognizing Faculty Working in Quality Improvement and Patient Safety. (United States)

    Coleman, David L; Wardrop, Richard M; Levinson, Wendy S; Zeidel, Mark L; Parsons, Polly E


    Academic clinical departments have the opportunity and responsibility to improve the quality and value of care and patient safety by supporting effective quality improvement activities. The pressure to provide high-value care while further developing academic programs has increased the complexity of decision making and change management in academic health systems. Overcoming these challenges will require faculty engagement and leadership; however, most academic departments do not have a sufficient number of individuals with expertise and experience in quality improvement and patient safety (QI/PS). Accordingly, the authors of this article advocate for a targeted and proactive approach to developing faculty working in QI/PS. They propose a strategy predicated on the identification of QI/PS as a strategic priority for academic departments, the creation of enabling resources in QI/PS, and the expansion of rigorous training programs in change management and in improvement and implementation sciences. Professional organizations, health systems, medical schools, and academic departments should recognize successful QI/PS work with awards and promotions. Individual faculty members should expand their collaborative networks, consider the generalizability and scholarly impact of their efforts when designing QI/PS initiatives, and benchmark the outcomes of their performance. Appointments and promotions committees should work proactively with department and QI/PS leaders to ensure that outstanding achievement in QI/PS is defined and recognized. As with the development of physician-investigators and clinician-educators, departments and health systems need a comprehensive approach to support and recognize the contributions of faculty working in QI/PS to meet the considerable needs and opportunities in health care.

  7. Errors associated with outpatient computerized prescribing systems (United States)

    Rothschild, Jeffrey M; Salzberg, Claudia; Keohane, Carol A; Zigmont, Katherine; Devita, Jim; Gandhi, Tejal K; Dalal, Anuj K; Bates, David W; Poon, Eric G


    Objective To report the frequency, types, and causes of errors associated with outpatient computer-generated prescriptions, and to develop a framework to classify these errors to determine which strategies have greatest potential for preventing them. Materials and methods This is a retrospective cohort study of 3850 computer-generated prescriptions received by a commercial outpatient pharmacy chain across three states over 4 weeks in 2008. A clinician panel reviewed the prescriptions using a previously described method to identify and classify medication errors. Primary outcomes were the incidence of medication errors; potential adverse drug events, defined as errors with potential for harm; and rate of prescribing errors by error type and by prescribing system. Results Of 3850 prescriptions, 452 (11.7%) contained 466 total errors, of which 163 (35.0%) were considered potential adverse drug events. Error rates varied by computerized prescribing system, from 5.1% to 37.5%. The most common error was omitted information (60.7% of all errors). Discussion About one in 10 computer-generated prescriptions included at least one error, of which a third had potential for harm. This is consistent with the literature on manual handwritten prescription error rates. The number, type, and severity of errors varied by computerized prescribing system, suggesting that some systems may be better at preventing errors than others. Conclusions Implementing a computerized prescribing system without comprehensive functionality and processes in place to ensure meaningful system use does not decrease medication errors. The authors offer targeted recommendations on improving computerized prescribing systems to prevent errors. PMID:21715428

  8. Appropriate prescribing for older people

    NARCIS (Netherlands)

    Drenth - van Maanen, A.C.


    Appropriate prescribing is the result of pharmacotherapeutic decision-making to maximise the net health benefit of treatment, given the resources available. Several risk factors for inappropriate prescribing in older people have been identified, such as polypharmacy, impaired renal function, and

  9. Patient safety culture in a large teaching hospital in Riyadh: baseline assessment, comparative analysis and opportunities for improvement. (United States)

    El-Jardali, Fadi; Sheikh, Farheen; Garcia, Nereo A; Jamal, Diana; Abdo, Ayman


    In light of the immense attention given to patient safety, this paper details the findings of a baseline assessment of the patient safety culture in a large hospital in Riyadh and compares results with regional and international studies that utilized the Hospital Survey on Patient Safety Culture. This study also aims to explore the association between patient safety culture predictors and outcomes, considering respondent characteristics and facility size. This cross sectional study adopted a customized version of the HSOPSC and targeted hospital staff fitting sampling criteria (physicians, nurses, clinical and non-clinical staff, pharmacy and laboratory staff, dietary and radiology staff, supervisors, and hospital managers). 3000 questionnaires were sent and 2572 were returned (response rate of 85.7%). Areas of strength were Organizational Learning and Continuous Improvement and Teamwork within units whereas areas requiring improvement were hospital non-punitive response to error, staffing, and Communication Openness. The comparative analysis noted several areas requiring improvement when results on survey composites were compared with results from Lebanon, and the United States. Regression analysis showed associations between higher patient safety aggregate score and greater age (46 years and above), longer work experience, having a Baccalaureate degree, and being a physician or other health professional. Patient safety practices are crucial toward improving overall performance and quality of services in healthcare organizations. Much can be done in the sampled organizations and in the context of KSA in general to improve areas of weakness and further enhance areas of strength.

  10. An exploration of the continuing professional development needs of nurse independent prescribers and nurse supplementary prescribers who prescribe medicines for patients with diabetes. (United States)

    Carey, Nicola; Courtenay, Molly


    Nurse Independent and Nurse Supplementary Prescribing has extended the role that nurses in the UK have in the management of care for patients with diabetes. Concerns surround nurses' pharmacological knowledge and provision of continuing professional development to meet the needs of nurse prescribers. To examine the continuing professional development needs of nurses who prescribe medicines to patients with diabetes. A questionnaire survey. The NMC database was used to randomly select and distribute questionnaires to 1992 registered Nurse Independent/Nurse Supplementary Prescribers. One thousand and four hundred questionnaires were returned. Medicines for patients with diabetes were prescribed by 439 respondents. This paper reports on the findings of these 439 nurses. The majority (63%) of nurses worked in general practice. Over 80% reported continuing professional development was available and that they had accessed it to support their prescribing role. Over 40% of nurses had continuing professional development needs in the areas of prescribing policy, pharmacology for diabetes and the management and treatment of diabetes related conditions. Senior nurses reported fewer continuing professional development needs. Access and provision of continuing professional development for nurse prescribers has improved since the initial implementation of nurse prescribing. However, nurse's pharmacological knowledge and the provision of continuing professional development continue to be an area of concern which warrant further investigation. Previous concerns have been identified about the provision of continuing professional development to meet the needs of nurse prescribers. Pharmacological knowledge is still the greatest continuing professional development requirement of nurses who prescribe for patients with diabetes. Education providers may wish to consider developing the content of continuing professional development programmes to meet these needs.

  11. Computerized Aid Improves Safety Decision Process for Survivors of Intimate Partner Violence (United States)

    Glass, Nancy; Eden, Karen B.; Bloom, Tina; Perrin, Nancy


    A computerized safety decision aid was developed and tested with Spanish or English-speaking abused women in shelters or domestic violence (DV) support groups (n = 90). The decision aid provides feedback about risk for lethal violence, options for safety, assistance with setting priorities for safety, and a safety plan personalized to the user.…

  12. Prescribing antibiotics in general practice:

    DEFF Research Database (Denmark)

    Sydenham, Rikke Vognbjerg; Pedersen, Line Bjørnskov; Plejdrup Hansen, Malene

    Objectives The majority of antibiotics are prescribed from general practice. The use of broad-spectrum antibiotics increases the risk of development of bacteria resistant to antibiotic treatment. In spite of guidelines aiming to minimize the use of broad-spectrum antibiotics we see an increase...... in the use of these agents. The overall aim of the project is to explore factors influencing the decision process and the prescribing behaviour of the GPs when prescribing antibiotics. We will study the impact of microbiological testing on the choice of antibiotic. Furthermore the project will explore how...... the GPs’ prescribing behaviour is influenced by selected factors. Method The study consists of a register-based study and a questionnaire study. The register-based study is based on data from the Register of Medicinal Product Statistics (prescribed antibiotics), Statistics Denmark (socio-demographic data...

  13. An evaluation of knowledge, attitude, and practice of adverse drug reaction reporting among prescribers at a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Chetna K Desai


    Full Text Available Objectives: Spontaneous reporting is an important tool in pharmacovigilance. However, its success depends on cooperative and motivated prescribers. Under-reporting of adverse drug reactions (ADRs by prescribers is a common problem. The present study was undertaken to evaluate the knowledge, attitude, and practices (KAP regarding ADR reporting among prescribers at the Civil Hospital, Ahmedabad, to get an insight into the causes of under-reporting of ADRs. Materials and Methods: A pretested KAP questionnaire comprising of 15 questions (knowledge 6, attitude 5, and practice 4 was administered to 436 prescribers. The questionnaires were assessed for their completeness (maximum score 20 and the type of responses regarding ADR reporting. Microsoft Excel worksheet (Microsoft Office 2007 and Chi-Square test were used for statistical analysis. Results: A total of 260 (61% prescribers completed the questionnaire (mean score of completion 18.04. The response rate of resident doctors (70.7% was better than consultants (34.5% (P < 0.001. ADR reporting was considered important by 97.3% of the respondents; primarily for improving patient safety (28.8% and identifying new ADRs (24.6%. A majority of the respondents opined that they would like to report serious ADRs (56%. However, only 15% of the prescribers had reported ADRs previously. The reasons cited for this were lack of information on where (70% and how (68% to report and the lack of access to reporting forms (49.2%. Preferred methods for reporting were e-mail (56% and personal communication (42%. Conclusion: The prescribers are aware of the ADRs and the importance of their reporting. However, under reporting and lack of knowledge about the reporting system are clearly evident. Creating awareness about ADR reporting and devising means to make it easy and convenient may aid in improving spontaneous reporting.

  14. Improvement of the safety of a clinical process using failure mode and effects analysis: Prevention of venous thromboembolic disease in critical patients. (United States)

    Viejo Moreno, R; Sánchez-Izquierdo Riera, J Á; Molano Álvarez, E; Barea Mendoza, J A; Temprano Vázquez, S; Díaz Castellano, L; Montejo González, J C


    To improve critical patient safety in the prevention of venous thromboembolic disease, using failure mode and effects analysis as safety tool. A contemporaneous cohort study covering the period January 2014-March 2015 was made in 4 phases: phase 1) prior to failure mode and effects analysis; phase 2) conduction of mode analysis and implementation of the detected improvements; phase 3) evaluation of outcomes, and phase 4) (post-checklist introduction impact. Patients admitted to the adult polyvalent ICU of a third-level hospital center. A total of 196 patients, older than 18 years, without thromboembolic disease upon admission to the ICU and with no prior anticoagulant treatment. A series of interventions were implemented following mode analysis: training, and introduction of a protocol and checklist to increase preventive measures in relation to thromboembolic disease. Indication and prescription of venous thrombosis prevention measures before and after introduction of the measures derived from the failure mode and effects analysis. A total of 59, 97 and 40 patients were included in phase 1, 3 and 4, respectively, with an analysis of the percentage of subjects who received thromboprophylaxis. The failure mode and effects analysis was used to detect potential errors associated to a lack of training and protocols referred to thromboembolic disease. An awareness-enhancing campaign was developed, with staff training and the adoption of a protocol for the prevention of venous thromboembolic disease. The prescription of preventive measures increased in the phase 3 group (91.7 vs. 71.2%, P=.001). In the post-checklist group, prophylaxis was prescribed in 97.5% of the patients, with an increase in the indication of dual prophylactic measures (4.7, 6.7 and 41%; P<.05). There were no differences in complications rate associated to the increase in prophylactic measures. The failure mode and effects analysis allowed us to identify improvements in the prevention of


    Directory of Open Access Journals (Sweden)

    V. N. Kuzmenko


    Full Text Available The paper presents results pertaining to investigations of traffic conditions and intensity of traffic and pedestrian flows, calculations on loading level of objects located in the Makayonka Street, Minsk. The objects constitute transport regional development which presupposes reconstruction of regional arterial street with due account of infrastructure improvement,   residential  construction and  construction  of  multi-purpose  complex  with   shopping,  entertainment,   wellness  and business centers. In addition to this it is planned to construct a two-level underground parking, a two-level interchange at intersection of the Filimonova Street and Nezavisimosty Avenue due to an increase of traffic load at adjacent neighboring street and road network. An analysis on the current traffic management and calculation for distribution of the existing and prospective traffic load levels after implementation of appropriate measures to improve quality as a whole and road safety as well has been carried out in the paper. Determination of loading levels for a street and road network has been carried out while taking into account an intensity of traffic flows in order to evaluate various options for road traffic organization. Variants for planning of road junctions, road traffic organization and traffic signalization (including coordinated passing of  transport facilities have been developed in the paper. All this will contribute to improvement of quality and road safety in the investigated street with due consideration of further development of the region and overbuilding of the existing housing system in the Makayonka Streets and increase of its transport importance in the Minsk street and road network.

  16. Improving Road Safety of Tank Truck in Indonesia by Speed Limiter Installation

    Directory of Open Access Journals (Sweden)

    Pranoto Hadi


    Full Text Available Indonesia has one of the highest number of fatalities caused by traffic accident. It is become main concern since last decades. Approximately of 10% fatalities is caused by tank truck accident, it recorded by PT. Pertamina Persero, Indonesia in 2015 that 17% and 20% tank truck accident is caused by over speed and fatigue, respectively. Therefore, over speed has become main factor the occurrence of tank truck accident. Main objective of this research is to install speed limiter on the tank truck in order to improve safety engineering system, decrease accident and to maintain engine performance. This research is conducted in Indonesia especially in Java-Bali route travel. Speed limiter is installed to the tank truck engine which completed by fuel cut-off solenoid to reduce the speed automatically when it exceeding the maximum speed that has been determined. From the result shows that top speed which performed by driver up to 133 km/h when tank truck uninstalled by speed limiter. Meanwhile, when speed limiter is installed to the tank truck, top speed locked at 70 km/h even though the driver want to speed up. It means that fuel cut-off system is very effective to lock the speed at 70 km/h and it shown the improvement up to 65%. The monitoring activities observed that the decreasing number of fatalities caused by tank truck accident become 7% as compared to last year of 17%. It can be found that the speed limiter coupled by speed recorder was very efficient to improve safety engineering system of the tank truck.

  17. [Analysis of patient complaints in Primary Care: An opportunity to improve clinical safety]. (United States)

    Añel-Rodríguez, R M; Cambero-Serrano, M I; Irurzun-Zuazabal, E


    To determine the prevalence and type of the clinical safety problems contained in the complaints made by patients and users in Primary Care. An observational, descriptive, cross-sectional study was conducted by analysing both the complaint forms and the responses given to them in the period of one year. At least 4.6% of all claims analysed in this study contained clinical safety problems. The family physician is the professional who received the majority of the complaints (53.6%), and the main reason was the problems related to diagnosis (43%), mainly the delay in diagnosis. Other variables analysed were the severity of adverse events experienced by patients (in 68% of cases the patient suffered some harm), the subsequent impact on patient care, which was affected in 39% of cases (7% of cases even requiring hospital admission), and the level of preventability of adverse events (96% avoidable) described in the claims. Finally the type of response issued to each complaint was analysed, being purely bureaucratic in 64% of all cases. Complaints are a valuable source of information about the deficiencies identified by patients and healthcare users. There is considerable scope for improvement in the analysis and management of claims in general, and those containing clinical safety issues in particular. To date, in our area, there is a lack of appropriate procedures for processing these claims. Likewise, we believe that other pathways or channels should be opened to enable communication by patients and healthcare users. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

  18. Nurse prescribing in primary care: a metasynthesis of the literature. (United States)

    Nuttall, Dilyse


    ; the need for knowledge; professional accountability and boundary setting; safety consciousness; barriers to effective prescribing; role preservation; power-shifts and inter-professional relationships; and culture of prescribing.

  19. [Formal criteria for good prescribing in the hospital]. (United States)

    Langebrake, Claudia; Melzer, Simone; Baehr, Michael


    The provision of drugs to hospitalised patients is a complex process with the involvement of different healthcare professionals. As pharmacotherapy is (1) one of the most common medical interventions, (2) a high-risk procedure, and (3) affects the majority of hospitalised patients, medication errors have sustainable impact on patient safety. Although medication errors can occur at different stages of drug use (prescribing, dispensing, administration), they are most likely within the prescribing process. According to the Reason's model of accident causation, these errors can be divided into active failures, error-provoking conditions, and latent conditions. Commonly, the complex interaction between lacking knowledge and/or experience, rule-based mistakes, skill-based slips and memory lapses, inadequate working environment (exessive work load, fatigue) as well as poor communication and safety culture is causative for prescribing errors. Therefore, good prescribing should include the following items: Adherence to formal criteria (e. g. avoidance of abbreviations), performance of medication reconciliation, implementation of an electronic prescribing system (computerised physician order entry, CPOE) - preferably combined with a clinical decision support system (CDSS), education and training as well as the establishment of a positive error management culture. The implementation of recommendations to reduce prescribing errors is described on the basis of established processes in hospitals.

  20. Prescribers and pharmaceutical representatives: why are we still meeting? (United States)

    Fischer, Melissa A; Keough, Mary Ellen; Baril, Joann L; Saccoccio, Laura; Mazor, Kathleen M; Ladd, Elissa; Von Worley, Ann; Gurwitz, Jerry H


    Research suggests that pharmaceutical marketing influences prescribing and may cause cognitive dissonance for prescribers. This work has primarily been with physicians and physician-trainees. Questions remain regarding why prescribers continue to meet with pharmaceutical representatives (PRs). To describe the reasons that prescribers from various health professions continue to interact with PRs despite growing evidence of the influence of these interactions. Multi-disciplinary focus groups with 61 participants held in practice settings and at society meetings. Most prescribers participating in our focus groups believe that overall PR interactions are beneficial to patient care and practice health. They either trust the information from PRs or feel that they are equipped to evaluate it independently. Despite acknowledgement of study findings to the contrary, prescribers state that they are able to effectively manage PR interactions such that their own prescribing is not adversely impacted. Prescribers describe few specific strategies or policies for these interactions, and report that policies are not consistently implemented with all members of a clinic or institution. Some prescribers perceive an inherent contradiction between academic centers and national societies receiving money from pharmaceutical companies, and then recommending restriction at the level of the individual prescriber. Prescribers with different training backgrounds present a few novel reasons for these meetings. Despite evidence that PR detailing influences prescribing, providers from several health professions continue to believe that PR interactions improve patient care, and that they can adequately evaluate and filter information presented to them by PRs. Focus group comments suggest that cultural change is necessary to break the norms that exist in many settings. Applying policies consistently, considering non-physician members of the healthcare team, working with trainees, restructuring

  1. Food safety regulatory systems in Europe and China:A study of how co-regulation can improve regulatory effectiveness

    Institute of Scientific and Technical Information of China (English)

    Kevin Chen; WANG Xin-xin; SONG Hai-ying


    Food safety has received a great deal of attention in both developed and developing countries in recent years. In China, the numerous food scandals and scares that have struck over the past decade have spurred signiifcant food safety regulatory reform, which has been increasingly oriented towards the public-private partnership model adopted by the Europe Union’s (EU) food safety regulatory system. This paper analyzes the development of both the EU’s and China’s food safety regu-latory systems, identiifes the current chalenges for China and additionaly considers the role of public-private partnership. The success of co-regulation in the food regulatory system would bring signiifcant beneifts and opportunities for China. Finaly, this paper recommends additional measures like training and grants to improve the private’s sector effectiveness in co-regulating China’s food safety issues.

  2. A strategic approach to quality improvement and patient safety education and resident integration in a general surgery residency. (United States)

    O'Heron, Colette T; Jarman, Benjamin T


    To outline a structured approach for general surgery resident integration into institutional quality improvement and patient safety education and development. A strategic plan to address Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review assessments for resident integration into Quality Improvement and Patient Safety initiatives is described. Gundersen Lutheran Medical Foundation is an independent academic medical center graduating three categorical residents per year within an integrated multi-specialty health system serving 19 counties over 3 states. The quality improvement and patient safety education program includes a formal lecture series, online didactic sessions, mandatory quality improvement or patient safety projects, institutional committee membership, an opportunity to serve as a designated American College of Surgeons National Surgical Quality Improvement Project and Quality in Training representative, mandatory morbidity and mortality conference attendance and clinical electives in rural surgery and international settings. Structured education regarding and participation in quality improvement and patient safety programs are able to be accomplished during general surgery residency. The long-term outcomes and benefits of these strategies are unknown at this time and will be difficult to measure with objective data. © 2013 Published by Association of Program Directors in Surgery on behalf of Association of Program Directors in Surgery.

  3. Combination of minimal processing and irradiation to improve the microbiological safety of lettuce ( Lactuca sativa, L.) (United States)

    Goularte, L.; Martins, C. G.; Morales-Aizpurúa, I. C.; Destro, M. T.; Franco, B. D. G. M.; Vizeu, D. M.; Hutzler, B. W.; Landgraf, M.


    The feasibility of gamma radiation in combination with minimal processing (MP) to reduce the number of Salmonella spp. and Escherichia coli O157:H7 in iceberg lettuce ( Lactuca sativa, L.) (shredded) was studied in order to increase the safety of the product. The reduction of the microbial population during the processing, the D10-values for Salmonella spp. and E. coli O157:H7 inoculated on shredded iceberg lettuce as well as the sensory evaluation of the irradiated product were evaluated. The immersion in chlorine (200 ppm) reduced coliform and aerobic mesophilic microorganisms by 0.9 and 2.7 log, respectively. D-values varied from 0.16 to 0.23 kGy for Salmonella spp. and from 0.11 to 0.12 kGy for E. coli O157:H7. Minimally processed iceberg lettuce exposed to 0.9 kGy does not show any change in sensory attributes. However, the texture of the vegetable was affected during the exposition to 1.1 kGy. The exposition of MP iceberg lettuce to 0.7 kGy reduced the population of Salmonella spp. by 4.0 log and E. coli by 6.8 log without impairing the sensory attributes. The combination of minimal process and gamma radiation to improve the safety of iceberg lettuce is feasible if good hygiene practices begins at farm stage.

  4. Combination of minimal processing and irradiation to improve the microbiological safety of lettuce (Lactuca sativa, L.)

    Energy Technology Data Exchange (ETDEWEB)

    Goularte, L.; Martins, C.G.; Morales-Aizpurua, I.C.; Destro, M.T.; Franco, B.D.G.M.; Vizeu, D.M.; Hutzler, B.W.; Landgraf, M. E-mail:


    The feasibility of gamma radiation in combination with minimal processing (MP) to reduce the number of Salmonella spp. and Escherichia coli O157:H7 in iceberg lettuce (Lactuca sativa, L.) (shredded) was studied in order to increase the safety of the product. The reduction of the microbial population during the processing, the D{sub 10}-values for Salmonella spp. and E. coli O157:H7 inoculated on shredded iceberg lettuce as well as the sensory evaluation of the irradiated product were evaluated. The immersion in chlorine (200 ppm) reduced coliform and aerobic mesophilic microorganisms by 0.9 and 2.7 log, respectively. D-values varied from 0.16 to 0.23 kGy for Salmonella spp. and from 0.11 to 0.12 kGy for E. coli O157:H7. Minimally processed iceberg lettuce exposed to 0.9 kGy does not show any change in sensory attributes. However, the texture of the vegetable was affected during the exposition to 1.1 kGy. The exposition of MP iceberg lettuce to 0.7 kGy reduced the population of Salmonella spp. by 4.0 log and E. coli by 6.8 log without impairing the sensory attributes. The combination of minimal process and gamma radiation to improve the safety of iceberg lettuce is feasible if good hygiene practices begins at farm stage.

  5. Eight principles for safer opioid prescribing and cautions with benzodiazepines. (United States)

    Webster, Lynn R; Reisfield, Gary M; Dasgupta, Nabarun


    The provision of long-term opioid analgesic therapy for chronic pain requires a careful risk/benefit analysis followed by clinical safety measures to identify and reduce misuse, abuse, and addiction and their associated morbidity and mortality. Multiple data sources show that benzodiazepines, prescribed for comorbid insomnia, anxiety, and mood disorders, heighten the risk of respiratory depression and other adverse outcomes when combined with opioid therapy. Evidence is presented for hazards associated with coadministration of opioids and benzodiazepines and the need for caution when initiating opioid therapy for chronic pain. Clinical recommendations follow, as drawn from 2 previously published literature reviews, one of which proffers 8 principles for safer opioid prescribing; the other review presents risks associated with benzodiazepines, suggests alternatives for co-prescribing benzodiazepines and opioids, and outlines recommendations regarding co-prescribing if alternative therapies are ineffective.

  6. The pharmacist as prescriber: a discourse analysis of newspaper media in Canada. (United States)

    Schindel, Theresa J; Given, Lisa M


    Legislation to expand the scope of practice for pharmacists to include authority to independently prescribe medications in Alberta, Canada was announced in 2006 and enacted in April 2007. To date, very little research has explored public views of pharmacist prescribing. This study analyzes newspaper media coverage of pharmacist prescribing 1 year before and 2 years after prescribing was implemented. News items related to pharmacist prescribing were retrieved from 2 national, Canadian newspapers and 5 local newspapers in Alberta over a 3-year period after the announcement of pharmacist prescribing. A purposive sample of 66 texts including news items, editorials, and letters were retrieved electronically from 2 databases, Newscan and Canadian Newsstand. This study uses social positioning theory as a lens for analyzing the discourse of pharmacist prescribing. The results demonstrate a binary positioning of the debate on pharmacist prescribing rights. Using social positioning theory as a lens for analysis, the results illustrate self- and other-positioning of pharmacists' expected roles as prescribers. Themes related to the discourse on pharmacist prescribing include qualifications, diagnosis, patient safety, physician support, and conflict of interest. Media representations of pharmacist prescribing point to polarized views that may serve to shape public, pharmacist, physician, and others' opinions of the issue. Multiple and contradictory views of pharmacist prescribing coexist. Pharmacists and pharmacy organizations are challenged to bring clarity and consistency about pharmacist prescribing to better serve the public interest in understanding options for health care services. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. Improving health IT through understanding the cultural production of safety in clinical settings. (United States)

    Novak, Laurie Lovett


    Health IT is said to have the potential to improve the safety and effectiveness of care. However, it is known that the implementation of health IT can introduce new risks into the environment of care as a result of design failures, implementation failures, and unintended consequences. The design and implementation of health IT systems reflect explicit or implicit assumptions about what constitutes safe practice. These assumptions may clash with those held by patients and clinicians who are the intended users and subjects of the technology. Current perspectives on risk are discussed and an anthropological approach to understanding the construction of safe practices in the clinical setting is explored using research in barcode medication administration.

  8. A new system to reduce formaldehyde levels improves safety conditions during gross veterinary anatomy learning. (United States)

    Nacher, Víctor; Llombart, Cristina; Carretero, Ana; Navarro, Marc; Ysern, Pere; Calero, Sebastián; Fígols, Enric; Ruberte, Jesús


    Dissection is a very useful method of learning veterinary anatomy. However, formaldehyde, which is widely used to preserve cadavers, is an irritant, and it has recently been classified as a carcinogen. In 1997, the Instituto Nacional de Seguridad e Higiene en el Trabajo [National Institute of Workplace Security and Hygiene] found that the levels of formaldehyde in our dissection room were above the threshold limit values. Unfortunately, no optimal substitute for formaldehyde is currently available. Therefore, we designed a new ventilation system that combines slow propulsion of fresh air from above the dissection table and rapid aspiration of polluted air from the perimeter. Formaldehyde measurements performed in 2004, after the introduction of this new system into our dissection laboratory, showed a dramatic reduction (about tenfold, or 0.03 ppm). A suitable propelling/aspirating air system successfully reduces the concentration of formaldehyde in the dissection room, significantly improving safety conditions for students, instructors, and technical staff during gross anatomy learning.

  9. Patient-centered transfer process for patients admitted through the ED boosts satisfaction, improves safety. (United States)


    To improve safety and patient flow, administrators at Hallmark Health System, based in Melrose, MA, implemented a new patient-centered transfer process for patients admitted through the ED at the health system's two hospitals. Under the new approach, inpatient nurses come down to the ED to take reports on new patients in a process that includes the ED care team as well as family members. The inpatient nurses then accompany the patients up to their designated floors. Since the new patient-transfer process was implemented in June 2012, patient satisfaction has increased by at least one point on patient satisfaction surveys. Administrators anticipate that medical errors or omissions related to the handoff process will show a drop of at least 50%, when data is tabulated.

  10. Interaction of lactic acid bacteria with metal ions: opportunities for improving food safety and quality. (United States)

    Mrvčić, Jasna; Stanzer, Damir; Solić, Ema; Stehlik-Tomas, Vesna


    Certain species of lactic acid bacteria (LAB), as well as other microorganisms, can bind metal ions to their cells surface or transport and store them inside the cell. Due to this fact, over the past few years interactions of metal ions with LAB have been intensively investigated in order to develop the usage of these bacteria in new biotechnology processes in addition to their health and probiotic aspects. Preliminary studies in model aqueous solutions yielded LAB with high absorption potential for toxic and essential metal ions, which can be used for improving food safety and quality. This paper provides an overview of results obtained by LAB application in toxic metal ions removing from drinking water, food and human body, as well as production of functional foods and nutraceutics. The biosorption abilities of LAB towards metal ions are emphasized. The binding mechanisms, as well as the parameters influencing the passive and active uptake are analyzed.

  11. Self-Regulative Nanogelator Solid Electrolyte: A New Option to Improve the Safety of Lithium Battery. (United States)

    Wu, Feng; Chen, Nan; Chen, Renjie; Zhu, Qizhen; Tan, Guoqiang; Li, Li


    The lack of suitable nonflammable electrolytes has delayed battery application in electric vehicles. A new approach to improve the safety performance for lithium battery is proposed here. This technology is based on a nanogelator-based solid electrolyte made of porous oxides and an ionic liquid. The electrolyte is fabricated using an in situ method and the porous oxides serve as a nonflammable "nanogelator" that spontaneously immobilizes the ionic liquid. The electrolyte exhibits a high liquid-like apparent ionic conductivity of 2.93 × 10(-3) S cm(-1) at room temperature. The results show that the nanogelator, which possess self-regulating ability, is able to immobilize imidazolium-, pyrrolidinium-, or piperidinium-based ionic liquids, simply by adjusting the ion transport channels. Our prototype batteries made of Ti-nanogeltor solid electrolyte outperform conventional lithium batteries made using ionic liquid and commercial organic liquid electrolytes.


    Directory of Open Access Journals (Sweden)

    I. A. Ivanova


    Full Text Available Problem statement. The problem of improvement of industrial safety of technol-ogical processes in mixers of asphalt-concrete plants is considered on the basis of analysis of organic impurities content in incomplete combustion products, and es-timation of efficiency of purification of asphalt-concrete plant emissions in the presence of “wet” flue gas purification system is given.Results and conclusions. It has been found that the efficiency of hydrocarbon fuel burning affects the amount of hydrophobic dust thrown into the atmosphere, and burning of heavy fuel oil is attended by significant incompleteness of fuel combustion, and this is connected with the processes of fuel dispersion and evapo-ration. The optimal measures for efficient combustion and cleaning of hydrophob-ic dust are described.

  13. Use of electron beam irradiation to improve the microbiological safety of Hippophae rhamnoides

    Energy Technology Data Exchange (ETDEWEB)

    Minea, R. [National Institute for Lasers, Plasma and Radiation Physics, Electron Accelerators Department, 409 Atomistilor St., Bucharest-Magurele 077125 (Romania); Nemtanu, M.R. [National Institute for Lasers, Plasma and Radiation Physics, Electron Accelerators Department, 409 Atomistilor St., Bucharest-Magurele 077125 (Romania)], E-mail:; Manea, S.; Mazilu, E. [S.C. Hofigal Export-Import S.A., 2A Intrarea Serelor St., 75669, Bucharest 4 (Romania)


    Sea buckthorn (Hippophae rhamnoides) is increasingly used in food supplements due to its dietary and medicinal compounds with a beneficial role in human diet and health. As many other medicinal plants, sea buckthorn can be contaminated with microorganisms which exerts an important impact on the overall quality of the products. Irradiation is an effective method for food preservation because it is able to destroy pathogenic microorganisms keeping the organoleptic and nutritional characteristics of the foods. The objective of the present study was to investigate the application of electron beam irradiation in order to improve the microbiological safety of sea buckthorn. The experimental results indicated that the electron beam treatment might be a good method to remove undesirable microorganisms from sea buckthorn without significant changes in its active principles.

  14. Use of electron beam irradiation to improve the microbiological safety of Hippophae rhamnoides (United States)

    Minea, R.; Nemţanu, M. R.; Manea, S.; Mazilu, E.


    Sea buckthorn ( Hippophae rhamnoides) is increasingly used in food supplements due to its dietary and medicinal compounds with a beneficial role in human diet and health. As many other medicinal plants, sea buckthorn can be contaminated with microorganisms which exerts an important impact on the overall quality of the products. Irradiation is an effective method for food preservation because it is able to destroy pathogenic microorganisms keeping the organoleptic and nutritional characteristics of the foods. The objective of the present study was to investigate the application of electron beam irradiation in order to improve the microbiological safety of sea buckthorn. The experimental results indicated that the electron beam treatment might be a good method to remove undesirable microorganisms from sea buckthorn without significant changes in its active principles.

  15. Proceedings of the NASA Conference on Materials for Improved Fire Safety (United States)


    The Manned Spacecraft Center was pleased to host the NASA Conference on Materials for Improved Fire Safety which was held on May 6 and 7, 1970. This document is a compilation of papers presented at the conference and represents the culmination of several years of effort by NASA and industry which was directed toward the common objective of minimizing the fire hazard in manned spacecraft and in some other related areas. One of the more serious problem areas in the Apollo program was the flammability of nonmetallic materials. The effective and timely solution of this problem area resulted from much of the effort reported herein and contributed greatly toward the successful achievement of landing men on the moon and returning them safely to earth.

  16. Discourse-based intervention for modifying supervisory communication as leverage for safety climate and performance improvement: a randomized field study. (United States)

    Zohar, Dov; Polachek, Tal


    The article presents a randomized field study designed to improve safety climate and resultant safety performance by modifying daily messages in supervisor-member communications. Supervisors in the experimental group received 2 individualized feedback sessions regarding the extent to which they integrated safety and productivity-related issues in daily verbal exchanges with their members; those in the control group received no feedback. Feedback data originated from 7-9 workers for each supervisor, reporting about received supervisory messages during the most recent verbal exchange. Questionnaire data collected 8 weeks before and after the 12-week intervention phase revealed significant changes for safety climate, safety behavior, subjective workload, teamwork, and (independently measured) safety audit scores for the experimental group. Data for the control group (except for safety behavior) remained unchanged. These results are explained by corresponding changes (or lack thereof in the control group) in perceived discourse messages during the 6-week period between the 1st and 2nd feedback sessions. Theoretical and practical implications for climate improvement and organizational discourse research are discussed.


    Directory of Open Access Journals (Sweden)



    Full Text Available Railroad passing underwater tunnel has been increasingly growing recently at home and abroad in a bid to reduce construction cost of railroad system as well as for aesthetic improvement. But design concept and technical maturity with regard to underwater tunnel in Korea still remain behind and moreover, local laws & standards and basic design guideline for design safety are yet to be available. In this study, design guideline and related regulation that incorporate domestic environment is developed by referring to advanced European or American standards or design guidelines. Based on such outcome, safety requirements in disaster prevention were identified and the study to secure the safety in terms of disaster prevention was conducted by incorporating the outcome into the design. With the safety requirements identified, the procedure was proposed to incorporate into tunnel design and besides, improved QFD incorporating safety factors was proposed instead of existing QFD implemented by common traditional approach. Disaster prevention safety requirements developed through such methodology were incorporated. The methodology to identify disaster prevention safety requirements and incorporate into the design is expected to make commitment to developing design guideline by providing fundamental information, when applying to underwater tunnel design.

  18. An Evaluation Scheme for Assessing the Effectiveness of Intersection Movement Assist (IMA) on Improving Traffic Safety. (United States)

    Wu, Kun-Feng; Ardiansyah, Nashir; Ye, Wei-Jyun


    Intersection Movement Assist (IMA) has been recognized as one of the prominent countermeasures to reduce angle crashes at intersections, which constitute 22 percent of total crashes in the US. Utilizing vehicle-based sensors, vehicle-to-vehicle (V2░V), and vehicle-to-infrastructure (V2I) communications, IMA offers extended vision to provide early warning for an imminent crash. However, most of IMA related research implements their methods and strategies only in simulations, test tracks, or driving simulator studies that have quite a few assumptions and limitations, and hence the effectiveness evaluations reported may not be transferable or comparable. This study seeks to develop a generalized evaluation scheme that can be used not only to assess the effectiveness of IMA on improving traffic safety at intersections, but also to facilitate comparisons across similar studies. The proposed evaluation scheme utilizes the concepts of traffic conflict in terms of Time-to-collision (TTC) as a crash surrogate. This approach avoids the issue of having insufficient crash frequency data for system evaluation. To measure the effectiveness of IMA on reducing traffic conflicts, a relative risk is calculated for comparing the risk of with/without using the IMA. As a proof-of-concept study, this study applied the proposed evaluation scheme and reported the effectiveness of IMA on improving traffic safety in a Field Operation Test (FOT). Seven test scenarios were conducted at four intersections, and a total of 40 participants were recruited to use the IMA for six months. It was estimated that IMA users have 26 percent fewer conflicts with TTC less than five seconds, and have 15 percent fewer conflicts with TTC less than four seconds. However, the results vary across different sites and different definitions of conflicts in terms of TTC. Overall, IMA is promising to effectively reduce angle crashes related to sight obstruction, and has potential to reduce not only crash frequency

  19. Pre-Clinical Study of a Novel Recombinant Botulinum Neurotoxin Derivative Engineered for Improved Safety. (United States)

    Vazquez-Cintron, Edwin; Tenezaca, Luis; Angeles, Christopher; Syngkon, Aurelia; Liublinska, Victoria; Ichtchenko, Konstantin; Band, Philip


    Cyto-012 is a recombinant derivative of Botulinum neurotoxin Type A (BoNT/A). It primarily differs from wild type (wt) BoNT/A1 in that it incorporates two amino acid substitutions in the catalytic domain of the light chain (LC) metalloprotease (E224 > A and Y366 > A), designed to provide a safer clinical profile. Cyto-012 is specifically internalized into rat cortical and hippocampal neurons, and cleaves Synaptosomal-Associated Protein 25 (SNAP-25), the substrate of wt BoNT/A, but exhibits slower cleavage kinetics and therefore requires a higher absolute dose to exhibit pharmacologic activity. The pharmacodynamics of Cyto-012 and wt BoNT/A have similar onset and duration of action using the Digital Abduction Assay (DAS). Intramuscular LD50 values for Cyto-012 and wt BoNT/A respectively, were 0.63 ug (95% CI = 0.61, 0.66) and 6.22 pg (95% CI = 5.42, 7.02). ED50 values for Cyto-012 and wt BoNT/A were respectively, 0.030 ug (95% CI = 0.026, 0.034) and 0.592 pg (95% CI = 0.488, 0.696). The safety margin (intramuscular LD50/ED50 ratio) for Cyto-012 was found to be improved 2-fold relative to wt BoNT/A (p < 0.001). The DAS response to Cyto-012 was diminished when a second injection was administered 32 days after the first. These data suggest that the safety margin of BoNT/A can be improved by modulating their activity towards SNAP-25.

  20. Evaluation of intestinal phosphate binding to improve the safety profile of oral sodium phosphate bowel cleansing.

    Directory of Open Access Journals (Sweden)

    Stef Robijn

    Full Text Available Prior to colonoscopy, bowel cleansing is performed for which frequently oral sodium phosphate (OSP is used. OSP results in significant hyperphosphatemia and cases of acute kidney injury (AKI referred to as acute phosphate nephropathy (APN; characterized by nephrocalcinosis are reported after OSP use, which led to a US-FDA warning. To improve the safety profile of OSP, it was evaluated whether the side-effects of OSP could be prevented with intestinal phosphate binders. Hereto a Wistar rat model of APN was developed. OSP administration (2 times 1.2 g phosphate by gavage with a 12h time interval induced bowel cleansing (severe diarrhea and significant hyperphosphatemia (21.79 ± 5.07 mg/dl 6h after the second OSP dose versus 8.44 ± 0.97 mg/dl at baseline. Concomitantly, serum PTH levels increased fivefold and FGF-23 levels showed a threefold increase, while serum calcium levels significantly decreased from 11.29 ± 0.53 mg/dl at baseline to 8.68 ± 0.79 mg/dl after OSP. OSP administration induced weaker NaPi-2a staining along the apical proximal tubular membrane. APN was induced: serum creatinine increased (1.5 times baseline and nephrocalcinosis developed (increased renal calcium and phosphate content and calcium phosphate deposits on Von Kossa stained kidney sections. Intestinal phosphate binding (lanthanum carbonate or aluminum hydroxide was not able to attenuate the OSP induced side-effects. In conclusion, a clinically relevant rat model of APN was developed. Animals showed increased serum phosphate levels similar to those reported in humans and developed APN. No evidence was found for an improved safety profile of OSP by using intestinal phosphate binders.

  1. Improving health and safety conditions in agriculture through professional training of Florida farm labor supervisors. (United States)

    Morera, Maria C; Monaghan, Paul F; Tovar-Aguilar, J Antonio; Galindo-Gonzalez, Sebastian; Roka, Fritz M; Asuaje, Cesar


    Because farm labor supervisors (FLSs) are responsible for ensuring safe work environments for thousands of workers, providing them with adequate knowledge is critical to preserving worker health. Yet a challenge to offering professional training to FLSs, many of whom are foreign-born and have received different levels of education in the US and abroad, is implementing a program that not only results in knowledge gains but meets the expectations of a diverse audience. By offering bilingual instruction on safety and compliance, the University of Florida Institute of Food and Agricultural Sciences (UF/IFAS) FLS Training program is helping to improve workplace conditions and professionalize the industry. A recent evaluation of the program combined participant observation and surveys to elicit knowledge and satisfaction levels from attendees of its fall 2012 trainings. Frequency distributions and dependent- and independent-means t-tests were used to measure and compare participant outcomes. The evaluation found that attendees rated the quality of their training experience as either high or very high and scored significantly better in posttraining knowledge tests than in pretraining knowledge tests across both languages. Nonetheless, attendees of the trainings delivered in English had significantly higher posttest scores than attendees of the trainings delivered in Spanish. As a result, the program has incorporated greater standardization of content delivery and staff development. Through assessment of its program components and educational outcomes, the program has documented its effectiveness and offers a replicable approach that can serve to improve the targeted outcomes of safety and health promotion in other states.

  2. Patient Safety and Quality Improvement in Otolaryngology Education: A Systematic Review. (United States)

    Gettelfinger, John D; Paulk, P Barrett; Schmalbach, Cecelia E


    Objective The breadth and depth of patient safety/quality improvement (PS/QI) research dedicated to otolaryngology-head and neck surgery (OHNS) education remains unknown. This systematic review aims to define this scope and to identify knowledge gaps as well as potential areas of future study to improved PS/QI education and training in OHNS. Data Sources A computerized Ovid/Medline database search was conducted (January 1, 1965, to May 15, 2015). Similar computerized searches were conducted using Cochrane Database, PubMed, and Google Scholar. Review Methods The study protocol was developed a priori using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles were classified by year, subspecialty, Institute of Medicine (IOM) Crossing the Chasm categories, and World Health Organization (WHO) subclass. Results Computerized searches yielded 8743 eligible articles, 267 (3.4%) of which met otolaryngology PS/QI inclusion criteria; 51 (19%) were dedicated to resident/fellow education and training. Simulation studies (39%) and performance/competency evaluation (23.5%) were the most common focus. Most projects involved general otolaryngology (47%), rhinology (18%), and otology (16%). Classification by the IOM included effective care (45%), safety/effective care (41%), and effective and efficient care (7.8%). Most research fell into the WHO category of "identifying solutions" (61%). Conclusion Nineteen percent of OHNS PS/QI articles are dedicated to education, the majority of which are simulation and focus on effective care. Knowledges gaps for future research include facial plastics PS/QI and the WHO category of "studies translating evidence into safer care."

  3. Implementation of unit-based interventions to improve teamwork and patient safety on a medical service. (United States)

    O'Leary, Kevin J; Creden, Amanda J; Slade, Maureen E; Landler, Matthew P; Kulkarni, Nita; Lee, Jungwha; Vozenilek, John A; Pfeifer, Pamela; Eller, Susan; Wayne, Diane B; Williams, Mark V


    In a prior study involving 2 medical units, Structured Interdisciplinary Rounds (SIDRs) improved teamwork and reduced adverse events (AEs). SIDR was implemented on 5 additional units, and a pre- versus postintervention comparison was performed. SIDR combined a structured format for communication with daily interprofessional meetings. Teamwork was assessed using the Safety Attitudes Questionnaire (score range = 0-100), and AEs were identified using queries of information systems confirmed by 2 physician researchers. Paired analyses for 82 professionals completing surveys both pre and post implementation revealed improved teamwork (mean 76.8 ± 14.3 vs 80.5 ± 11.6; P = .02), which was driven mainly by nurses (76.4 ± 14.1 vs 80.8 ± 10.4; P = .009). The AE rate was similar across study periods (3.90 vs 4.07 per 100 patient days; adjusted IRR = 1.08; P = .60). SIDR improved teamwork yet did not reduce AEs. Higher baseline teamwork scores and lower AE rates than the prior study may reflect a positive cultural shift that began prior to the current study. © The Author(s) 2014.

  4. Performance improvement of artificial neural networks designed for safety key parameters prediction in nuclear research reactors

    Energy Technology Data Exchange (ETDEWEB)

    Mazrou, Hakim [Division de Physique Radiologique, Centre de Recherche Nucleaire d' Alger (CRNA), 02 Boulevard Frantz, Fanon, B.P. 399, 16000 Alger (Algeria)], E-mail:


    The present work explores, through a comprehensive sensitivity study, a new methodology to find a suitable artificial neural network architecture which improves its performances capabilities in predicting two significant parameters in safety assessment i.e. the multiplication factor k{sub eff} and the fuel powers peaks P{sub max} of the benchmark 10 MW IAEA LEU core research reactor. The performances under consideration were the improvement of network predictions during the validation process and the speed up of computational time during the training phase. To reach this objective, we took benefit from Neural Network MATLAB Toolbox to carry out a widespread sensitivity study. Consequently, the speed up of several popular algorithms has been assessed during the training process. The comprehensive neural system was subsequently trained on different transfer functions, number of hidden neurons, levels of error and size of generalization corpus. Thus, using a personal computer with data created from preceding work, the final results obtained for the treated benchmark were improved in both network generalization phase and much more in computational time during the training process in comparison to the results obtained previously.

  5. A Performance Improvement of Power Supply Module for Safety-related Controller

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong-Kyun; Yun, Dong-Hwa; Hwang, Sung-Jae; Lee, Myeong-Kyun; Yoo, Kwan-Woo [PONUTech Co., Seoul (Korea, Republic of)


    In this paper, in relation to voltage shortage state when power supply module is a slave mode, the performance improvement by modifying a PFC(Power Factor Correction) circuit is presented. With the modification of the PFC circuit, the performance improvement in respect of the voltage shortage state when the power supply module is a slave mode is checked. As a result, POSAFE-Q PLC can ensure the stability with the redundant power supply module. The purpose of this paper is to improve the redundant performance of power supply module(NSPS-2Q). It is one of components in POSAFE-Q which is a PLC(Programmable Logic Controller) that has been developed for the evaluation of safety-related. Power supply module provides a stable power in order that POSAFE-Q can be operated normally. It is possible to be mounted two power supply modules in POSAFE-Q for a redundant(Master/Slave) function. So that even if a problem occurs in one power supply module, another power supply module will provide a power to POSAFE-Q stably.

  6. Work improvement and occupational safety and health management systems: common features and research needs. (United States)

    Kogi, Kazutaka


    There is a growing trend in re-orientating occupational health research towards risk management. Such a trend is accelerated by the increasing attention to occupational safety and health management systems. The trend, also seen in many Asian countries, is offering new opportunities for strengthening primary prevention. Useful examples are provided from recent work improvement projects dealing with technology transfer, small workplaces and rural areas. Common features of both these work improvement projects and accepted occupational risk management principles are reviewed based on recent experiences in Asian countries. Such features seem highly relevant in examining the occupational health research strategies. These experiences clearly show that locally adjusted procedures for risk assessment and control must be developed. There are new research needs concerning (a) the effective ways to encourage voluntary control at the workplace; (b) practical methods for local risk assessment; and (c) the types of participatory steps leading to continual improvements in the varying local context. Criteria of action-oriented research that can contribute to more effective risk control in different settings are discussed. Six relevant criteria may be mentioned: (a) adaptive risk management; (b) work/risk relationships; (c) action-oriented risk assessment; (d) use of collective expertise; (e) participation of local people; and (f) mutual learning. It appears crucial to stimulate research into the practical risk control procedures adjusted to the local situation.

  7. Non-medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care. (United States)

    Weeks, Greg; George, Johnson; Maclure, Katie; Stewart, Derek


    A range of health workforce strategies are needed to address health service demands in low-, middle- and high-income countries. Non-medical prescribing involves nurses, pharmacists, allied health professionals, and physician assistants substituting for doctors in a prescribing role, and this is one approach to improve access to medicines. To assess clinical, patient-reported, and resource use outcomes of non-medical prescribing for managing acute and chronic health conditions in primary and secondary care settings compared with medical prescribing (usual care). We searched databases including CENTRAL, MEDLINE, Embase, and five other databases on 19 July 2016. We also searched the grey literature and handsearched bibliographies of relevant papers and publications. Randomised controlled trials (RCTs), cluster-RCTs, controlled before-and-after (CBA) studies (with at least two intervention and two control sites) and interrupted time series analysis (with at least three observations before and after the intervention) comparing: 1. non-medical prescribing versus medical prescribing in acute care; 2. non-medical prescribing versus medical prescribing in chronic care; 3. non-medical prescribing versus medical prescribing in secondary care; 4 non-medical prescribing versus medical prescribing in primary care; 5. comparisons between different non-medical prescriber groups; and 6. non-medical healthcare providers with formal prescribing training versus those without formal prescribing training. We used standard methodological procedures expected by Cochrane. Two review authors independently reviewed studies for inclusion, extracted data, and assessed study quality with discrepancies resolved by discussion. Two review authors independently assessed risk of bias for the included studies according to EPOC criteria. We undertook meta-analyses using the fixed-effect model where studies were examining the same treatment effect and to account for small sample sizes. We compared

  8. Food Safety Instruction Improves Knowledge and Behavior Risk and Protection Factors for Foodborne Illnesses in Pregnant Populations. (United States)

    Kendall, Patricia; Scharff, Robert; Baker, Susan; LeJeune, Jeffrey; Sofos, John; Medeiros, Lydia


    Objective This study compared knowledge and food-handling behavior after pathogen-specific (experimental treatment) versus basic food safety instruction (active control) presented during nutrition education classes for low-income English- and Spanish-language pregnant women. Methods Subjects (n = 550) were randomly assigned to treatment groups in two different locations in the United States. Food safety instruction was part of an 8-lesson curriculum. Food safety knowledge and behavior were measured pre/post intervention. Descriptive data were analyzed by Chi-Square or ANOVA; changes after intervention were analyzed by regression analysis. Results Knowledge improved after intervention in the pathogen-specific treatment group compared to active control, especially among Spanish-language women. Behavior change after intervention for the pathogen-specific treatment group improved for thermometer usage, refrigeration and consumption of foods at high risk for safety; however, all other improvements in behavior were accounted for by intervention regardless of treatment group. As expected, higher pre-instruction behavioral competency limited potential gain in behavior post-instruction due to a ceiling effect. This effect was more dominant among English-language women. Improvements were also linked to formal education completed, a partner at home, and other children in the home. Conclusions for Practice This study demonstrated that pathogen-specific food safety instruction leads to enhance knowledge and food handling behaviors that may improve the public health of pregnant women and their unborn children, especially among Spanish-language women. More importantly, food safety instruction, even at the most basic level, benefited pregnant women's food safety knowledge and food-handling behavior after intervention.

  9. A methodology for improving road safety by novel infrastructural and invehicle technology combinations

    NARCIS (Netherlands)

    Wiethoff, M.; Brookhuis, K.A.; De Waard, D.; Marchau, V.A.W.J.; Walta, L.; Wenzel, G.; De Brucker, K.; Macharis, C.


    Introduction Still too many deaths and injuries are a result of road safety limitations within Europe. Road safety measures aimed to change the road environment to reduce the risks on driver errors and to reduce the seriousness of the effects of driver errors are expected to increase road safety. A

  10. Participatory approaches to improving safety and health under trade union initiative--experiences of POSITIVE training program in Asia. (United States)

    Kawakami, Tsuyoshi; Kogi, Kazutaka; Toyama, Naoki; Yoshikawa, Toru


    The participatory, action-oriented training program in occupational safety and health named POSITIVE (Participation-Oriented Safety Improvements by Trade Union InitiatiVE) was established in Pakistan and extended to other countries in Asia. The steps taken in the development of the POSITIVE program included collecting local good examples in safety and health, developing an action-checklist, testing a participatory training program, and conducting follow-up activities to examine local achievements. Training manuals were compiled to provide workers with the practical, easy-to-understand information on safety and health improvements and on the positive roles of trade unions. Trade union trainers trained in the methodology conducted serial POSITIVE training workshops in Pakistan and then in Bangladesh, Mongolia, Nepal, the Philippines and Thailand and recently in China. These workshops resulted in many low-cost improvements at the workplace level. These improvements were carried out in the technical areas of materials handling, workstations, machine safety, physical environment, and welfare facilities. The trade union networks have been vital in reaching an increasing number of grass-root workplaces and in expanding the program to other countries. This included the visits to Mongolia and Thailand of Pakistani trade union trainers to demonstrate the POSITIVE training. The participatory training tools used in the POSITIVE program such as the action checklist and group discussion methods were commonly applied in different local situations. Participatory approaches adopted in the POSITIVE program have proven useful for providing practical problem-solving measures based on the local trade union initiative.

  11. Objective 1: Extend Life, Improve Performance, and Maintain Safety of the Current Fleet Implementation Plan

    Energy Technology Data Exchange (ETDEWEB)

    Robert Youngblood


    Nuclear power has reliably and economically contributed almost 20% of electrical generation in the United States over the past two decades. It remains the single largest contributor (more than 70%) of non-greenhouse-gas-emitting electric power generation in the United States. By the year 2030, domestic demand for electrical energy is expected to grow to levels of 16 to 36% higher than 2007 levels. At the same time, most currently operating nuclear power plants will begin reaching the end of their 60 year operating licenses. Figure E 1 shows projected nuclear energy contribution to the domestic generating capacity. If current operating nuclear power plants do not operate beyond 60 years, the total fraction of generated electrical energy from nuclear power will begin to decline—even with the expected addition of new nuclear generating capacity. The oldest commercial plants in the United States reached their 40th anniversary in 2009. The U.S. Department of Energy Office of Nuclear Energy’s Research and Development (R&D) Roadmap has organized its activities in accordance with four objectives that ensure nuclear energy remains a compelling and viable energy option for the United States. The objectives are as follows: (1) develop technologies and other solutions that can improve the reliability, sustain the safety, and extend the life of the current reactors; (2) develop improvements in the affordability of new reactors to enable nuclear energy to help meet the Administration’s energy security and climate change goals; (3) develop sustainable nuclear fuel cycles; and (4) understand and minimize risks of nuclear proliferation and terrorism. The Light Water Reactor Sustainability (LWRS) Program is the primary programmatic activity that addresses Objective 1. This document describes how Objective 1 and the LWRS Program will be implemented. The existing U.S. nuclear fleet has a remarkable safety and performance record and today accounts for 70% of the low greenhouse

  12. Objective 1: Extend Life, Improve Performance, and Maintain Safety of the Current Fleet Implementation Plan

    Energy Technology Data Exchange (ETDEWEB)

    Robert Youngblood


    Nuclear power has reliably and economically contributed almost 20% of electrical generation in the United States over the past two decades. It remains the single largest contributor (more than 70%) of non-greenhouse-gas-emitting electric power generation in the United States. By the year 2030, domestic demand for electrical energy is expected to grow to levels of 16 to 36% higher than 2007 levels. At the same time, most currently operating nuclear power plants will begin reaching the end of their 60 year operating licenses. Figure E 1 shows projected nuclear energy contribution to the domestic generating capacity. If current operating nuclear power plants do not operate beyond 60 years, the total fraction of generated electrical energy from nuclear power will begin to decline—even with the expected addition of new nuclear generating capacity. The oldest commercial plants in the United States reached their 40th anniversary in 2009. The U.S. Department of Energy Office of Nuclear Energy’s Research and Development (R&D) Roadmap has organized its activities in accordance with four objectives that ensure nuclear energy remains a compelling and viable energy option for the United States. The objectives are as follows: (1) develop technologies and other solutions that can improve the reliability, sustain the safety, and extend the life of the current reactors; (2) develop improvements in the affordability of new reactors to enable nuclear energy to help meet the Administration’s energy security and climate change goals; (3) develop sustainable nuclear fuel cycles; and (4) understand and minimize risks of nuclear proliferation and terrorism. The Light Water Reactor Sustainability (LWRS) Program is the primary programmatic activity that addresses Objective 1. This document describes how Objective 1 and the LWRS Program will be implemented. The existing U.S. nuclear fleet has a remarkable safety and performance record and today accounts for 70% of the low greenhouse

  13. Refractive improvements and safety with topography-guided corneal crosslinking for keratoconus: 1-year results. (United States)

    Nordström, Maria; Schiller, Maria; Fredriksson, Anneli; Behndig, Anders


    To assess the refractive improvements and the corneal endothelial safety of an individualised topography-guided regimen for corneal crosslinking in progressive keratoconus. An open-label prospective randomised clinical trial was performed at the Department of Clinical Sciences, Ophthalmology, Umeå University Hospital, Umeå, Sweden. Thirty-seven patients (50 eyes) with progressive keratoconus planned for corneal crosslinking were included. The patients were randomised to topography-guided crosslinking (photorefractive intrastromal crosslinking (PiXL); n=25) or uniform 9 mm crosslinking (corneal collagen crosslinking (CXL); n=25). Visual acuity, refraction, keratometry (K1, K2 and Kmax) and corneal endothelial morphometry were assessed preoperatively and at 1, 3, 6 and 12 months postoperatively. The PiXL treatment involved an asymmetrical treatment zone centred on the area of maximum corneal steepness with treatment energies ranging from 7.2 to 15.0 J/cm(2); the CXL treatment was a uniform 9 mm 5.4 J/cm(2) pulsed crosslinking. The main outcome measures were changes in refractive errors and corneal endothelial cell density. The spherical refractive errors decreased (pkeratoconus with decreased spherical refractive errors and improved visual acuity, without damage to the corneal endothelium. NCT02514200, Results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  14. Starter culture development for improving safety and quality of Domiati cheese. (United States)

    Ayad, Eman H E


    Eleven lactococci strains (sp. lactis and cremoris) were collected according to specific or selected characteristics for development of defined strain starter (DSS) to improve safety and nutritional quality of traditional and low salt Domiati cheese. Thirteen DSS; nisin-producing system or/and folate-producing strains were prepared. The behaviour of the strains in DSS was studied in milk and in two series of Domiati cheese; the first one made with 5% NaCl and salt tolerant strains, the second made with 3% NaCl and the control cheeses were made without starters. The population dynamics of strains and sensory evaluation of cheese corroborated the results in milk. All strains can grow well together and appeared to produce pleasant flavours, normal (typical) body and texture Domiati cheese. There was no apparent difference in cheese composition between cheeses in each series; the levels were within margins for composition of Domiati cheese. The levels of nisin (IU g(-1)) ranged from 204 to 324 IU g(-1) in 3-months' cheeses. Folate concentration increased in cheeses made with DSS cultures than control and the level ranged from 5.5 to 11.1 microg 100 g(-1) in cheeses after 3 months. All results revealed that selected DSS can be used for improving Domiati cheese.

  15. Intensive care unit without walls: seeking patient safety by improving the efficiency of the system. (United States)

    Gordo, F; Abella, A


    The term "ICU without walls" refers to innovative management in Intensive Care, based on two key elements: (1) collaboration of all medical and nursing staff involved in patient care during hospitalization and (2) technological support for severity early detection protocols by identifying patients at risk of deterioration throughout the hospital, based on the assessment of vital signs and/or laboratory test values, with the clear aim of improving critical patient safety in the hospitalization process. At present, it can be affirmed that there is important work to be done in the detection of severity and early intervention in patients at risk of organ dysfunction. Such work must be adapted to the circumstances of each center and should include training in the detection of severity, multidisciplinary work in the complete patient clinical process, and the use of technological systems allowing intervention on the basis of monitored laboratory and physiological parameters, with effective and efficient use of the information generated. Not only must information be generated, but also efficient management of such information must also be achieved. It is necessary to improve our activity through innovation in management procedures that facilitate the work of the intensivist, in collaboration with other specialists, throughout the hospital environment. Innovation is furthermore required in the efficient management of the information generated in hospitals, through intelligent and directed usage of the new available technology.

  16. TJC: HCOs need to be on alert for HIT problems related to sociotechnical factors, take steps to improve safety culture, process, and leadership. (United States)


    Noting that too many errors related to health information technology (HIT) are resulting in adverse consequences, The Joint Commission (TJC) has issued a Sentinel Event Alert, urging health care providers to take steps to improve their safety culture, approach to process improvement, and leadership in this area. In this latest alert, the accrediting agency is taking particular aim at risks posed by sociotechnical factors--or the ways in which HIT is implemented and used. Experts say that many of these risks are, in fact, exemplified at a higher level in the emergency setting, where providers are under constant pressure to see more patients and move them though the system faster. In an analysis of 3,375 sentinel events that resulted in permanent patient harm or death between January 1, 2010, and June 20, 2013, The Joint Commission (TJC) found that 120 events included HIT-related contributing factors. Many of the problems cited by TJC relate to orders or medicines being prescribed for the wrong patients. These can result from toggling errors or pop-up screens where providers are asked to click on the appropriate patient or medicine, and they mistakenly click on the wrong selection. In the ED, experts recommend the creation of a multidisciplinary performance improvement group to continuously monitor the ED information system (EDIS), recognize problems, and work with the vendor to resolve them. Also important is a quick and easy way for providers to report HIT-related problems. Experts add that emergency providers need to be fully engaged in the process of selecting HIT that they will be using, and that health care organizations should arrange for usability assessments before purchasing HIT.

  17. Improving aviation safety with information visualization: Airflow hazard display for helicopter pilots (United States)

    Aragon, Cecilia Rodriguez

    Many aircraft accidents each year are caused by encounters with airflow hazards near the ground, such as vortices or other turbulence. While such hazards frequently pose problems to fixed-wing aircraft, they are especially dangerous to helicopters, whose pilots often have to operate into confined areas or under operationally stressful conditions. Pilots are often unaware of these invisible hazards while simultaneously attending to other aspects of aircraft operation close to the ground. Recent advances in aviation sensor technology offer the potential for aircraft-based sensors that can gather large amounts of airflow velocity data in real time. This development is likely to lead to the production of onboard detection systems that can convey detailed, specific information about imminent airflow hazards to pilots. A user interface is required that can present extensive amounts of data to the pilot in a useful manner in real time, yet not distract from the pilot's primary task of flying the aircraft. In this dissertation, we address the question of how best to present safety-critical visual information to a cognitively overloaded user in real time. We designed an airflow hazard visualization system according to user-centered design principles, implemented the system in a high fidelity, aerodynamically realistic rotorcraft flight simulator, and evaluated it via usability studies with experienced military and civilian helicopter pilots. We gathered both subjective data from the pilots' evaluations of the visualizations, and objective data from the pilots' performance during the landing simulations. Our study demonstrated that information visualization of airflow hazards, when presented to helicopter pilots in the simulator, dramatically improved their ability to land safely under turbulent conditions. Although we focused on one particular aviation application, the results may be relevant to user interfaces and information visualization in other safety

  18. Lidar and Dial application for detection and identification: a proposal to improve safety and security (United States)

    Gaudio, P.; Malizia, A.; Gelfusa, M.; Murari, A.; Parracino, S.; Poggi, L. A.; Lungaroni, M.; Ciparisse, J. F.; Di Giovanni, D.; Cenciarelli, O.; Carestia, M.; Peluso, E.; Gabbarini, V.; Talebzadeh, S.; Bellecci, C.


    Nowadays the intentional diffusion in air (both in open and confined environments) of chemical contaminants is a dramatic source of risk for the public health worldwide. The needs of a high-tech networks composed by software, diagnostics, decision support systems and cyber security tools are urging all the stakeholders (military, public, research & academic entities) to create innovative solutions to face this problem and improve both safety and security. The Quantum Electronics and Plasma Physics (QEP) Research Group of the University of Rome Tor Vergata is working since the 1960s on the development of laser-based technologies for the stand-off detection of contaminants in the air. Up to now, four demonstrators have been developed (two LIDAR-based and two DIAL-based) and have been used in experimental campaigns during all 2015. These systems and technologies can be used together to create an innovative solution to the problem of public safety and security: the creation of a network composed by detection systems: A low cost LIDAR based system has been tested in an urban area to detect pollutants coming from urban traffic, in this paper the authors show the results obtained in the city of Crotone (south of Italy). This system can be used as a first alarm and can be coupled with an identification system to investigate the nature of the threat. A laboratory dial based system has been used in order to create a database of absorption spectra of chemical substances that could be release in atmosphere, these spectra can be considered as the fingerprints of the substances that have to be identified. In order to create the database absorption measurements in cell, at different conditions, are in progress and the first results are presented in this paper.

  19. [Improving Agricultural Safety of Soils Contaminated with Polycyclic Aromatic Hydrocarbons by In Situ Bioremediation]. (United States)

    Jiao, Hai-huan; Pan, Jian-gang; Xu, Shena-jun; Bai, Zhi-hui; Wang, Dong; Huang, Zhan-bin


    In order to reduce the risk of enrichment of polycyclic aromatic hydrocarbons (PAHs) in crops, reduce the potential hazards of food-sourced PAHs to human and increase the agricultural safety of PAHs contaminated soils, the bio-augmented removal of polycyclic aromatic hydrocarbons (PAHs) was investigated through in situ remediation by introducing Rhodobacter sphaeroides (RS) into the agricultural soil contaminated by PAHs. The 50-times diluted RS was sprayed on leaf surface (in area B) or irrigated to roots (in area D). The treatment of spraying water of the equal amount was taken as the control (A) and the wheat field without any treatment as the blank (CK). Treatments were conducted since wheat seeding. Soil and wheat samples were collected in the mature period to analyze the changes of community structure of the soil microorganisms and the concentration of PAHs in soils and investigate the strengthening and restoration effects of RS on PAHs contaminated soils. Compared to the CK Area, the areas B and D revealed that the variation ratio of phospholipid fatty acids (PLFAs) that were the biomarker of soil microorganisms was 29.6%, and the ratio of total PAHs removed was increased 1.59 times and 1.68 times, respectively. The dry weight of wheat grain of 50 spikes was increased by 8.95% and 12.5%, respectively, and the enrichment factor of total PAHs was decreased by 58.9% and 62.2% respectively in the wheat grains. All the results suggested that RS reduced enrichment of PAHs in wheat grains and increased wheat yield, which had great exploitation and utilization potentiality in repairing and improving the agricultural safety of the soils contaminated with PHAs.

  20. Development of Pneumatic Aerodynamic Devices to Improve the Performance, Economics, and Safety of Heavy Vehicles

    Energy Technology Data Exchange (ETDEWEB)

    Robert J. Englar


    Under contract to the DOE Office of Heavy Vehicle Technologies, the Georgia Tech Research Institute (GTRI) is developing and evaluating pneumatic (blown) aerodynamic devices to improve the performance, economics, stability and safety of operation of Heavy Vehicles. The objective of this program is to apply the pneumatic aerodynamic aircraft technology previously developed and flight-tested by GTRI personnel to the design of an efficient blown tractor-trailer configuration. Recent experimental results obtained by GTRI using blowing have shown drag reductions of 35% on a streamlined automobile wind-tunnel model. Also measured were lift or down-load increases of 100-150% and the ability to control aerodynamic moments about all 3 axes without any moving control surfaces. Similar drag reductions yielded by blowing on bluff afterbody trailers in current US trucking fleet operations are anticipated to reduce yearly fuel consumption by more than 1.2 billion gallons, while even further reduction is possible using pneumatic lift to reduce tire rolling resistance. Conversely, increased drag and down force generated instantaneously by blowing can greatly increase braking characteristics and control in wet/icy weather due to effective ''weight'' increases on the tires. Safety is also enhanced by controlling side loads and moments caused on these Heavy Vehicles by winds, gusts and other vehicles passing. This may also help to eliminate the jack-knifing problem if caused by extreme wind side loads on the trailer. Lastly, reduction of the turbulent wake behind the trailer can reduce splash and spray patterns and rough air being experienced by following vehicles. To be presented by GTRI in this paper will be results developed during the early portion of this effort, including a preliminary systems study, CFD prediction of the blown flowfields, and design of the baseline conventional tractor-trailer model and the pneumatic wind-tunnel model.

  1. Structural equation model to investigate the dimensions influencing safety culture improvement in construction sector: A case in Indonesia (United States)

    Machfudiyanto, Rossy Armyn; Latief, Yusuf; Yogiswara, Yoko; Setiawan, R. Mahendra Fitra


    In facing the ASEAN Economic Community, the level of prevailing working accidents becomes one of the competitiveness factors among the companies. A construction industry is one of the industries prone to high level of accidents. Improving the safety record will not be completely effective unless the occupational safety and healthy culture is enhanced. The aim of this research was to develop a model and to conduct empirical investigation on the relationships among the dimensions of construction occupational safety culture. This research used the structural equation model as a means to examine the hypothesis of positive relationships between dimensions and objectives. The method used in this research was questionnaire survey which was distributed to the respondents from construction companies in a state-owned enterprise in Indonesia. Moreover, there were dimensions of occupational safety culture that was established, such as leadership, behavior, value, strategy, policy, process, employee, safety cost, and contract system. The results of this study indicated that all dimensions were significant and inter-related in forming the safety culture. The result of R2 yielded the safety performance was 54%, which means it was in low category and evaluation of policies on construction companies was required in addressing the issue of working accidents.

  2. Frontline experiences of a practice redesign to improve self-management of obesity in safety net clinics. (United States)

    AuYoung, Mona; Duru, O Kenrik; Ponce, Ninez A; Mangione, Carol M; Rodriguez, Hector P


    Teamlets of physicians and medical assistants may help improve obesity management in primary care settings. We aimed to understand the barriers and facilitators of implementing a teamlet approach to managing obesity in 3 safety net clinics. Key stakeholder interviews (n = 21) were conducted both during early implementation of practice change and 6 months later. Patient surveys (n = 393) examined obese patient activation and health status. Insufficient program resources and limited patient engagement due to external factors were implementation barriers despite fairly high patient activation. Staff members need time and resources to execute new responsibilities to support obesity management in safety net settings. Because of high turnover, multiple supporters may improve sustainability.

  3. Improving timeliness and efficiency in the referral process for safety net providers: application of the Lean Six Sigma methodology. (United States)

    Deckard, Gloria J; Borkowski, Nancy; Diaz, Deisell; Sanchez, Carlos; Boisette, Serge A


    Designated primary care clinics largely serve low-income and uninsured patients who present a disproportionate number of chronic illnesses and face great difficulty in obtaining the medical care they need, particularly the access to specialty physicians. With limited capacity for providing specialty care, these primary care clinics generally refer patients to safety net hospitals' specialty ambulatory care clinics. A large public safety net health system successfully improved the effectiveness and efficiency of the specialty clinic referral process through application of Lean Six Sigma, an advanced process-improvement methodology and set of tools driven by statistics and engineering concepts.

  4. A Hazard Analysis-based Approach to Improve the Landing Safety of a BWB Remotely Piloted Vehicle

    Institute of Scientific and Technical Information of China (English)

    LU Yi; ZHANG Shuguang; LI Xueqing


    The BUAA-BWB remotely piloted vehicle (RPV) designed by our research team encountered an unexpected landing safety problem in flight tests.It has obviously affected further research project for blended-wing-body (BWB) aircraft configuration characteristics.Searching for a safety improvement is an urgent requirement in the development work of the RPV.In view of the vehicle characteristics,a new systemic method called system-theoretic process analysis (STPA) has been tentatively applied to the hazardous factor analysis of the RPV flight test.An uncontrolled system behavior “path sagging phenomenon” is identified by implementing a three degrees of freedom simulation based on wind tunnel test data and establishing landing safety system dynamics archetype.To obtain higher safety design effectiveness and considering safety design precedence,a longitudinal “belly-flap” control surface is innovatively introduced and designed to eliminate hazards in landing.Finally,flight tests show that the unsafe factor has been correctly identified and the landing safety has been efficiently improved.

  5. Improving risk-adjusted measures of surgical site infection for the national healthcare safety network. (United States)

    Mu, Yi; Edwards, Jonathan R; Horan, Teresa C; Berrios-Torres, Sandra I; Fridkin, Scott K


    The National Healthcare Safety Network (NHSN) has provided simple risk adjustment of surgical site infection (SSI) rates to participating hospitals to facilitate quality improvement activities; improved risk models were developed and evaluated. Data reported to the NHSN for all operative procedures performed from January 1, 2006, through December 31, 2008, were analyzed. Only SSIs related to the primary incision site were included. A common set of patient- and hospital-specific variables were evaluated as potential SSI risk factors by univariate analysis. Some ific variables were available for inclusion. Stepwise logistic regression was used to develop the specific risk models by procedure category. Bootstrap resampling was used to validate the models, and the c-index was used to compare the predictive power of new procedure-specific risk models with that of the models with the NHSN risk index as the only variable (NHSN risk index model). From January 1, 2006, through December 31, 2008, 847 hospitals in 43 states reported a total of 849,659 procedures and 16,147 primary incisional SSIs (risk, 1.90%) among 39 operative procedure categories. Overall, the median c-index of the new procedure-specific risk was greater (0.67 [range, 0.59-0.85]) than the median c-index of the NHSN risk index models (0.60 [range, 0.51-0.77]); for 33 of 39 procedures, the new procedure-specific models yielded a higher c-index than did the NHSN risk index models. A set of new risk models developed using existing data elements collected through the NHSN improves predictive performance, compared with the traditional NHSN risk index stratification.

  6. Inappropriate prescribing in the elderly.

    LENUS (Irish Health Repository)

    Gallagher, P


    BACKGROUND AND OBJECTIVE: Drug therapy is necessary to treat acute illness, maintain current health and prevent further decline. However, optimizing drug therapy for older patients is challenging and sometimes, drug therapy can do more harm than good. Drug utilization review tools can highlight instances of potentially inappropriate prescribing to those involved in elderly pharmacotherapy, i.e. doctors, nurses and pharmacists. We aim to provide a review of the literature on potentially inappropriate prescribing in the elderly and also to review the explicit criteria that have been designed to detect potentially inappropriate prescribing in the elderly. METHODS: We performed an electronic search of the PUBMED database for articles published between 1991 and 2006 and a manual search through major journals for articles referenced in those located through PUBMED. Search terms were elderly, inappropriate prescribing, prescriptions, prevalence, Beers criteria, health outcomes and Europe. RESULTS AND DISCUSSION: Prescription of potentially inappropriate medications to older people is highly prevalent in the United States and Europe, ranging from 12% in community-dwelling elderly to 40% in nursing home residents. Inappropriate prescribing is associated with adverse drug events. Limited data exists on health outcomes from use of inappropriate medications. There are no prospective randomized controlled studies that test the tangible clinical benefit to patients of using drug utilization review tools. Existing drug utilization review tools have been designed on the basis of North American and Canadian drug formularies and may not be appropriate for use in European countries because of the differences in national drug formularies and prescribing attitudes. CONCLUSION: Given the high prevalence of inappropriate prescribing despite the widespread use of drug-utilization review tools, prospective randomized controlled trials are necessary to identify useful interventions. Drug

  7. Importance of awareness in improving performance of emergency medical services (EMS) systems in enhancing traffic safety: A lesson from India. (United States)

    Vasudevan, Vinod; Singh, Preeti; Basu, Samyajit


    India has been slow in implementing a central emergency medical services (EMS) system across the country. "108 services" is one of the most popular services that is functional under the public-private partnership model. Limited available literature shows that despite access to services, many traffic crash victims are transported using private vehicles. The objective of this study is to understand the effectiveness of 108 services from a traffic safety perspective. A questionnaire survey is conducted to understand the awareness of EMS and their function. Using traffic-related fatalities as the dependent variable, a fixed effect panel data model is developed to analyze the effectiveness of the 108 services in improving the traffic safety. The results from the survey show that, in general, people are not aware of the 108 services. A majority of the population prefers taking victims to the hospital using their personal vehicles or any other vehicles available compared to calling an ambulance. Results from panel data analysis show that despite having an efficient system, these services failed to make significant improvement in the safety of road users in the states in which their services were subscribed. The lack of awareness of an important safety service is alarming. This could be a major reason for lower utilization of 108 services for transporting victims of traffic crashes. This article shows the importance of having efficient awareness campaigns to improve the efficiency of any similar programs that are aimed to enhance the safety of a region.

  8. 'Doing the right thing': factors influencing GP prescribing of antidepressants and prescribed doses. (United States)

    Johnson, Chris F; Williams, Brian; MacGillivray, Stephen A; Dougall, Nadine J; Maxwell, Margaret


    prescribing (e.g. fear of depression recurrence), few perceived continuation problems (e.g. lack of safety concerns) and lack of proactive medication review (e.g. patients only present in crisis), all combine to further drive antidepressant prescribing growth over time. GPs strive to 'do the right thing' to help people. Antidepressants are only a single facet of depression treatment. However, increased awareness of drug limitations and regular proactive reviews may help optimise care.

  9. The roles of emotional intelligence, interpersonal skill, and transformational leadership on improving construction safety performance

    Directory of Open Access Journals (Sweden)

    Riza Yosia Sunindijo


    Full Text Available Due to the characteristics of the constructionindustry, human skills are essential for working with and through others inmanaging safety. Research has shown that emotional intelligence, interpersonalskill, and transformational leadership are human skill components that generatesuperior performance in today’s workplace. The aim of this research is toinvestigate the influence of project management personnel’s human skills on theimplementation of safety management tasks and development of safety climate inconstruction projects. The structural equation modelling (SEM method wasapplied to analyse the quantitative data collected and establishinterrelationship among the research variables. The results indicate thatemotional intelligence is a key factor for developing interpersonal skill andtransformational leadership, and for implementing safety management tasks whichleads to the development of safety climate. This research also found thatinterpersonal skill is needed for becoming transformational leaders whocontribute to the development of safety climate.

  10. Evaluation of prescribing indicators in prescriptions of private practitioners in Kolkata, India

    Directory of Open Access Journals (Sweden)

    Pragnadyuti Mandal


    Conclusion: Poly-pharmacy, lack of generic prescribing, low rate of prescriptions from EDL is the present prescribing scenario of private set-up based practitioners of Kolkata. Regulation and intervention is required to improve the irrational prescribing practices. [Int J Basic Clin Pharmacol 2015; 4(5.000: 919-923

  11. Improving the regulation of safety at DOE nuclear facilities. Final report: Appendices

    Energy Technology Data Exchange (ETDEWEB)



    The report strongly recommends that, with the end of the Cold War, safety and health at DOE facilities should be regulated by outside agencies rather than by any regulatory scheme, DOE must maintain a strong internal safety management system; essentially all aspects of safety at DOE`s nuclear facilities should be externally regulated; and existing agencies rather than a new one should be responsible for external regulation.

  12. Improving the regulation of safety at DOE nuclear facilities. Final report

    Energy Technology Data Exchange (ETDEWEB)



    The report strongly recommends that, with the end of the Cold War, safety and health at DOE facilities should be regulated by outside agencies rather than by DOE itself. The three major recommendations are: under any regulatory scheme, DOE must maintain a strong internal safety management system; essentially all aspects of safety at DOE`s nuclear facilities should be externally regulated; and existing agencies rather than a new one should be responsible for external regulation.

  13. How to prescribe physical exercise in rheumatology

    Directory of Open Access Journals (Sweden)

    S. Maddali Bongi


    Full Text Available Physical exercise, aiming to improve range of movement, muscle strength and physical well being, lately substituted the immobilization previously prescribed in rheumatic diseases. International guidelines, recommendations of Scientific Societies, and structured reviews regard physical exercise as of pivotal importance in treating rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, fibromyalgia syndrome, osteoporosis, and to be considered in connective tissue diseases. Therapeutic exercise should: aim to improve firstly local symptoms and then general health; respect the pain threshold; be a part of a treatment including pharmacological therapies and other rehabilitation techniques, be administered by skilled physiotherapist under the guide of a rheumatologist, be different according to different diseases, disease phases and patient expectations.

  14. Improving safety-restraint use by children in shopping carts: evaluation of a store-based safety intervention. (United States)

    Smith, Gary A


    Approximately 20,700 children who are effectiveness of an in-store intervention to increase the use of restraints in shopping carts by children who are cash coupon incentive. The study used a preintervention and postintervention design with an untreated "control" group. Three stores served as intervention stores, and 4 stores served as nonintervention stores. Trained study personnel conducted the observations unobtrusively in all 7 stores simultaneously, recording the status of children's restraint use in the shopping cart as caregivers approached store checkout areas. The main outcome measure of the study was the change in the proportion of children who were rate increased to 49% in stores with this modest intervention. However, half of the young children in shopping carts remained unrestrained or restrained incorrectly. Higher rates of correct restraint use may occur with a more comprehensive and sustained shopping cart safety intervention. Shopping cart designs that seat children close to the floor and that do not rely on caregiver behavior change and vigilance for injury protection also should be implemented and evaluated as a passive strategy to prevent shopping cart-related injuries to young children.

  15. Electrical safety guidelines

    Energy Technology Data Exchange (ETDEWEB)


    The Electrical Safety Guidelines prescribes the DOE safety standards for DOE field offices or facilities involved in the use of electrical energy. It has been prepared to provide a uniform set of electrical safety standards and guidance for DOE installations in order to affect a reduction or elimination of risks associated with the use of electrical energy. The objectives of these guidelines are to enhance electrical safety awareness and mitigate electrical hazards to employees, the public, and the environment.

  16. How will we know patients are safer? An organization-wide approach to measuring and improving safety. (United States)

    Pronovost, Peter; Holzmueller, Christine G; Needham, Dale M; Sexton, J Bryan; Miller, Marlene; Berenholtz, Sean; Wu, Albert W; Perl, Trish M; Davis, Richard; Baker, David; Winner, Laura; Morlock, Laura


    Our institution, like many, is struggling to develop measures that answer the question, How do we know we are safer? Our objectives are to present a framework to evaluate performance in patient safety and describe how we applied this model in intensive care units. We focus on measures of safety rather than broader measures of quality. The measures will allow health care organizations to evaluate whether they are safer now than in the past by answering the following questions: How often do we harm patients? How often do patients receive the appropriate interventions? How do we know we learned from defects? How well have we created a culture of safety? The first two measures are rate based, whereas the latter two are qualitative. To improve care within institutions, caregivers must be engaged, must participate in the selection and development of measures, and must receive feedback regarding their performance. The following attributes should be considered when evaluating potential safety measures: Measures must be important to the organization, must be valid (represent what they intend to measure), must be reliable (produce similar results when used repeatedly), must be feasible (affordable to collect data), must be usable for the people expected to employ the data to improve safety, and must have universal applicability within the entire institution. Health care institutions. Health care currently lacks a robust safety score card. We developed four aggregate measures of patient safety and present how we applied them to intensive care units in an academic medical center. The same measures are being applied to nearly 200 intensive care units as part of ongoing collaborative projects. The measures include how often do we harm patients, how often do we do what we should (i.e., use evidence-based medicine), how do we know we learned from mistakes, and how well do we improve culture. Measures collected by different departments can then be aggregated to provide a hospital

  17. [Observational Team work Assessment for Surgery as Quality and Safety improvement tool]. (United States)

    Amato, S; Basilico, O; Bevilacqua, L; Burato, E; Levati, A; Molinelli, V; Picchetti, C; Suardi, R; Trucco, P; Lucchina, C


    As in high reliability systems , also in surgery the causes of adverse events are primarily correlated to deficiencies in Non Technical Skills (individual and social skills), that contribute with Technical Skills to a safe surgical procedure. Non Technical Skills are cognitive behavioural and interpersonal abilities, that are not specific to the expertise of one profession, but very important to guarantee the patient safety and to reduce risk of errors and adverse events. The Observational Teamwork Assessment for Surgery (OTAS) is an useful tool to assess teamwork of the whole surgical team (surgeons, anaesthetists, nurses) in real time and through the surgical procedure (pre-intra-postoperative phases). OTAS consists of the two following parts: a) teamwork-related task checklist to fill by a surgeon, b) teamwork-related behaviours rated by a psychologist/human factors expert. Back translation in Italian language of the eight task checklists and of the rating scales of the five behavioural areas was performed by two Italian surgeons with certified English language knowledge. The OTAS model in Italian language was applied in four surgical procedures : the test-retest reliability was found to be acceptable with K- Pearson index. The internal consistency of behavioural scales appeared sound using Cronbach ?. OTAS is an useful tool to assess the risk factors correlated to patient and team and to detect the vulnerability areas where changes to reduce errors and improve surgical outcomes might be introduced.

  18. An Intelligent System Proposal for Improving the Safety and Accessibility of Public Transit by Highway. (United States)

    García, Carmelo R; Quesada-Arencibia, Alexis; Cristóbal, Teresa; Padrón, Gabino; Pérez, Ricardo; Alayón, Francisco


    The development of public transit systems that are accessible and safe for everyone, including people with special needs, is an objective that is justified from the civic and economic points of view. Unfortunately, public transit services are conceived for people who do not have reduced physical or cognitive abilities. In this paper, we present an intelligent public transit system by highway with the goal of facilitating access and improving the safety of public transit for persons with special needs. The system is deployed using components that are commonly available in transport infrastructure, e.g., sensors, mobile communications systems, and positioning systems. In addition, the system can operate in non-urban transport contexts, e.g., isolated rural areas, where the availability of basic infrastructure, such as electricity and communications infrastructures, is not always guaranteed. To construct the system, the principles and techniques of Ubiquitous Computing and Ambient Intelligence have been employed. To illustrate the utility of the system, two cases of services rendered by the system are described: the first case involves a surveillance system to guarantee accessibility at bus stops; the second case involves a route assistant for blind people.

  19. An Intelligent System Proposal for Improving the Safety and Accessibility of Public Transit by Highway

    Directory of Open Access Journals (Sweden)

    Carmelo R. García


    Full Text Available The development of public transit systems that are accessible and safe for everyone, including people with special needs, is an objective that is justified from the civic and economic points of view. Unfortunately, public transit services are conceived for people who do not have reduced physical or cognitive abilities. In this paper, we present an intelligent public transit system by highway with the goal of facilitating access and improving the safety of public transit for persons with special needs. The system is deployed using components that are commonly available in transport infrastructure, e.g., sensors, mobile communications systems, and positioning systems. In addition, the system can operate in non-urban transport contexts, e.g., isolated rural areas, where the availability of basic infrastructure, such as electricity and communications infrastructures, is not always guaranteed. To construct the system, the principles and techniques of Ubiquitous Computing and Ambient Intelligence have been employed. To illustrate the utility of the system, two cases of services rendered by the system are described: the first case involves a surveillance system to guarantee accessibility at bus stops; the second case involves a route assistant for blind people.

  20. Improving infant sleep safety through a comprehensive hospital-based program. (United States)

    Goodstein, Michael H; Bell, Theodore; Krugman, Scott D


    We evaluated a comprehensive hospital-based infant safe sleep education program on parental education and safe sleep behaviors in the home using a cross-sectional survey of new parents at hospital discharge (HD) and 4-month follow-up (F/U). Knowledge and practices of infant safe sleep were compared to the National Infant Sleep Position Study benchmark. There were 1092 HD and 490 F/U surveys. Supine sleep knowledge was 99.8% at HD; 94.8% of families planned to always use this position. At F/U, 97.3% retained supine knowledge, and 84.9% maintained this position exclusively (P < .01). Knowledge of crib as safest surface was 99.8% at HD and 99.5% F/U. Use in the parents' room fell to 91.9% (HD) and 68.2% (F/U). Compared to the National Infant Sleep Position Study, the F/U group was more likely to use supine positioning and a bassinette or crib. Reinforcing the infant sleep safety message through intensive hospital-based education improves parental compliance with sudden infant death syndrome risk reduction guidelines.

  1. Improving Nuclear Safety of Fast Reactors by Slowing Down Fission Chain Reaction

    Directory of Open Access Journals (Sweden)

    G. G. Kulikov


    Full Text Available Light materials with small atomic mass (light or heavy water, graphite, and so on are usually used as a neutron reflector and moderator. The present paper proposes using a new, heavy element as neutron moderator and reflector, namely, “radiogenic lead” with dominant content of isotope 208Pb. Radiogenic lead is a stable natural lead. This isotope is characterized by extremely low micro cross-section of radiative neutron capture (~0.23 mb for thermal neutrons, which is smaller than graphite and deuterium cross-sections. The reflector-converter for a fast reactor core is the structure capable of transforming some part of prompt neutrons leaked from the core into the reflected neutrons with properties similar to those of delayed neutrons, that is, sufficiently large contribution to reactivity at the level of effective fraction of delayed neutrons and relatively long lifetime, comparable with lifetimes of radionuclides-emitters of delayed neutrons. It is evaluated that the use of radiogenic lead makes it possible to slow down the chain fission reaction on prompt neutrons in the fast reactor. This can improve the fast reactor safety and reduce some requirements to the technologies used to fabricate fuel for the fast reactor.

  2. Individualized conditioning regimes in cord blood transplantation: Towards improved and predictable safety and efficacy. (United States)

    Admiraal, R; Boelens, J J


    The conditioning regimen used in cord blood transplantation (CBT) may significantly impact the outcomes. Variable pharmacokinetics (PK) of drugs used may further influence outcome. Individualized dosing takes inter-patient differences in PK into account, tailoring drug dose for each individual patient in order to reach optimal exposure. Dose individualization may result in a better predictable regimen in terms of safety and efficacy, including timely T cell reconstitution, which may result in improved survival chances. Conditioning regimens used in CBT varies significantly between and within centres. For busulfan, individualized dosing with therapeutic drug monitoring has resulted in better outcomes. Anti-thymocyte globulin (ATG), used to prevent rejection and GvHD, significantly hampers early T-cell reconstitution (IR). Timely IR is crucial in preventing viral reactivations and relapse. By individudalizing ATG, IR is better predicted and may prevent morbidity and mortality. Individualization of agents used in the conditioning regimen in CBT has proven its added value. Further fine-tuning, including new drugs and/or comprehensive models for all drugs, may result in better predictable conditioning regimens. A predictable conditioning regimen is also of interest/importance when studying adjuvant therapies, including immunotherapies (e.g. cellular vaccines or engineered T-cell) in a harmonized clinical trial design setting.

  3. Improving safety of salami by application of bacteriocins produced by an autochthonous Lactobacillus curvatus isolate. (United States)

    de Souza Barbosa, Matheus; Todorov, Svetoslav Dimitrov; Ivanova, Iskra; Chobert, Jean-Marc; Haertlé, Thomas; de Melo Franco, Bernadette Dora Gombossy


    The aims of this study were to isolate LAB with anti-Listeria activity from salami samples, characterize the bacteriocin/s produced by selected isolates, semi-purify them and evaluate their effectiveness for the control of Listeria monocytogenes during manufacturing of salami in a pilot scale. Two isolates (differentiated by RAPD-PCR) presented activity against 22 out of 23 L. monocytogenes strains for bacteriocin MBSa2, while the bacteriocin MBSa3 inhibited all 23 strains in addition to several other Gram-positive bacteria for both antimicrobials and were identified as Lactobacillus curvatus based on 16S rRNA sequencing. A three-step purification procedure indicated that both strains produced the same two active peptides (4457.9 Da and 4360.1 Da), homlogous to sakacins P and X, respectively. Addition of the semi-purified bacteriocins produced by Lb. curvatus MBSa2 to the batter for production of salami, experimentally contaminated with L. monocytogenes (10(4)-10(5) CFU/g), caused 2 log and 1.5 log reductions in the counts of the pathogen in the product after 10 and 20 days respectively, highlighting the interest for application of these bacteriocins to improve safety of salami during its manufacture.

  4. Novel Approaches to Improve the Intrinsic Microbiological Safety of Powdered Infant Milk Formula

    Directory of Open Access Journals (Sweden)

    Robert M. Kent


    Full Text Available Human milk is recognised as the best form of nutrition for infants. However; in instances where breast-feeding is not possible, unsuitable or inadequate, infant milk formulae are used as breast milk substitutes. These formulae are designed to provide infants with optimum nutrition for normal growth and development and are available in either powdered or liquid forms. Powdered infant formula is widely used for convenience and economic reasons. However; current manufacturing processes are not capable of producing a sterile powdered infant formula. Due to their immature immune systems and permeable gastro-intestinal tracts, infants can be more susceptible to infection via foodborne pathogenic bacteria than other age-groups. Consumption of powdered infant formula contaminated by pathogenic microbes can be a cause of serious illness. In this review paper, we discuss the current manufacturing practices present in the infant