WorldWideScience

Sample records for patient safety issues

  1. Ethical issues in patient safety: Implications for nursing management.

    Kangasniemi, Mari; Vaismoradi, Mojtaba; Jasper, Melanie; Turunen, Hannele

    2013-12-01

    The purpose of this article is to discuss the ethical issues impacting the phenomenon of patient safety and to present implications for nursing management. Previous knowledge of this perspective is fragmented. In this discussion, the main drivers are identified and formulated in 'the ethical imperative' of patient safety. Underlying values and principles are considered, with the aim of increasing their visibility for nurse managers' decision-making. The contradictory nature of individual and utilitarian safety is identified as a challenge in nurse management practice, together with the context of shared responsibility and identification of future challenges. As a conclusion, nurse managers play a strategic role in patient safety. Their role is to incorporate ethical values of patient safety into decision-making at all levels in an organization, and also to encourage clinical nurses to consider values in the provision of care to patients. Patient safety that is sensitive to ethics provides sustainable practice where the humanity and dignity of all stakeholders are respected.

  2. Effects of the Smartphone Application "Safe Patients" on Knowledge of Patient Safety Issues Among Surgical Patients.

    Cho, Sumi; Lee, Eunjoo

    2017-12-01

    Recently, the patient's role in preventing adverse events has been emphasized. Patients who are more knowledgeable about safety issues are more likely to engage in safety initiatives. Therefore, nurses need to develop techniques and tools that increase patients' knowledge in preventing adverse events. For this reason, an educational smartphone application for patient safety called "Safe Patients" was developed through an iterative process involving a literature review, expert consultations, and pilot testing of the application. To determine the effect of "Safe Patients," it was implemented for patients in surgical units in a tertiary hospital in South Korea. The change in patients' knowledge about patient safety was measured using seven true/false questions developed in this study. A one-group pretest and posttest design was used, and a total of 123 of 190 possible participants were tested. The percentage of correct answers significantly increased from 64.5% to 75.8% (P effectively improve patients' knowledge of safety issues. This will ultimately empower patients to engage in safe practices and prevent adverse events related to surgery.

  3. Nuclear safety - Topical issues

    1995-01-01

    The following topical issues related to nuclear safety are discussed: steam generators; maintenance strategies; control rod drive nozzle cracks; core shrouds cracks; sump strainer blockage; fire protection; computer software important for safety; safety during shutdown; operational safety experience; external hazards and other site related issues. 5 figs, 5 tabs

  4. Aviation Safety Issues Database

    Morello, Samuel A.; Ricks, Wendell R.

    2009-01-01

    The aviation safety issues database was instrumental in the refinement and substantiation of the National Aviation Safety Strategic Plan (NASSP). The issues database is a comprehensive set of issues from an extremely broad base of aviation functions, personnel, and vehicle categories, both nationally and internationally. Several aviation safety stakeholders such as the Commercial Aviation Safety Team (CAST) have already used the database. This broader interest was the genesis to making the database publically accessible and writing this report.

  5. Patient safety issues in office-based surgery and anaesthesia in Switzerland: a qualitative study.

    McLennan, Stuart; Schwappach, David; Harder, Yves; Staender, Sven; Elger, Bernice

    2017-08-01

    To identify the spectrum of patient safety issues in office-based surgery and anaesthesia in Switzerland. Purposive sample of 23 experts in surgery and anaesthesia and quality and regulation in Switzerland. Data were collected via individual qualitative interviews using a researcher-developed semi-structured interview guide between March 2016 and September 2016. Interviews were transcribed and analysed using conventional content analysis. Issues were categorised under the headings "structure", "process", and "outcome". Experts identified two key overarching patient safety and regulatory issues in relation to office-based surgery and anaesthesia in Switzerland. First, experts repeatedly raised the current lack of data and transparency of the setting. It is unknown how many surgeons are operating in offices, how many and what types of operations are being done, and what the outcomes are. Secondly, experts also noted the limited oversight and regulation of the setting. While some standards exists, most experts felt that more minimal safety standards are needed regarding the requirements that must be met to do office-based surgery and what can and cannot be done in the office-based setting are needed, but they advocated a self-regulatory approach. There is a lack of empirical data regarding the quantity and quality office-based surgery and anaesthesia in Switzerland. Further research is needed to address these research gaps and inform health policy in relation to patient safety in office-based surgery and anaesthesia in Switzerland. Copyright © 2017. Published by Elsevier GmbH.

  6. Hydrogen peroxide safety issues

    Conner, W.V.

    1993-01-01

    A literature survey was conducted to review the safety issues involved in handling hydrogen peroxide solutions. Most of the information found in the literature is not directly applicable to conditions at the Rocky Flats Plant, but one report describes experimental work conducted previously at Rocky Flats to determine decomposition reaction-rate constants for hydrogen peroxide solutions. Data from this report were used to calculate decomposition half-life times for hydrogen peroxide in solutions containing several decomposition catalysts. The information developed from this survey indicates that hydrogen peroxide will undergo both homogeneous and heterogeneous decomposition. The rate of decomposition is affected by temperature and the presence of catalytic agents. Decomposition of hydrogen peroxide is catalyzed by alkalies, strong acids, platinum group and transition metals, and dissolved salts of transition metals. Depending upon conditions, the consequence of a hydrogen peroxide decomposition can range from slow evolution of oxygen gas to a vapor, phase detonation of hydrogen peroxide vapors

  7. Nuclear reactors safety issues

    Barre, Francois; Seiler, Nathalie

    2008-01-01

    Full text of publication follows: Since the seventies, economic incentives have led the utilities to drive a permanent evolution of the light water reactor (LWR). The evolution deals with the reactor designs as well as the way to operate them in a more flexible manner. It is for instance related to the fuel technologies and management. On the one hand, the technologies are in continuous evolution, such as the fuel pellets (MOX, Gd fuel, or Cr doped fuels..) as well as advanced cladding materials (M5 TM , MDA or ZIRLO). On the other hand, the fuel management is also subject to continuous evolution in particular in terms of increasing the level of burn-up, the reactor (core) power, the enrichment, as well as the duration of reactor cycles. For instance, in a few years in France, the burn-up has raised beyond the value of 39 GWj/t, initially authorized up to 52 GWj/t for the UO 2 fuel. In the near future, utilities foreseen to reach fuel burn-up of 60 GWj/t for MOX fuel and 70 GWj/t for UO 2 fuel. Furthermore, the future reactor of fourth generation will use new fuels of advanced conception. Furthermore with the objective of improving the safety margins, methods and calculation tools used by the utilities in the elaboration of their safety demonstrations submitted to the Safety Authority, are in movement. The margin evaluation methodologies often consist of a calculation chain of best-estimate multi-field simulations (e.g. various codes being coupled to simulate in a realistic way the evolution of the thermohydraulic, neutronic and mechanic state of the reactor). The statistical methods are more and more sophisticated and the computer codes are integrating ever-complex physical models (e.g. three-dimensional at fine scale). Following this evolution, the Institute of Radioprotection and Nuclear Safety (IRSN), whose one of the roles is to examine the safety records and to rend a technical expertise, considers the necessity of reevaluating the safety issues for advanced

  8. Prioritization of generic safety issues

    Emrit, R.; Minners, W.; VanderMolen, H.

    1983-12-01

    This report presents the priority rankings for generic safety issues related to nuclear power plants. The purpose of these rankings is to assist in the timely and efficient allocation of NRC resources for the resolution of those safety issues that have a significant potential for reducing risk. The report focuses on the prioritization of generic safety issues. Issues primarily concerned with the licensing process or environmental protection and not directly related to safety have been excluded from prioritization. The prioritized issues include: TMI Action Plan items under development; previously proposed issues covered by Task Action Plans, except issues designated at Unresolved Safety Issues (USIs) which had already been assigned high priority; and newly-proposed issues. Future supplements to this report will include the prioritization of additional issues. The safety priority rankings are HIGH, MEDIUM, LOW, and DROP and have been assigned on the basis of risk significance estimates, the ratio of risk to costs and other impacts estimated to result if resolutions of the safety issues were implemented, and the consideration of uncertainties and other quantitative or qualitative factors. To the extent practical, estimates are quantitative

  9. RBMK safety issues

    Weber, J.P.; Reichenbach, D.; Tscherkashow, J.M.

    1995-01-01

    On the basis of information and documents from the RBMK operation countries, the Western consortium mainly examined the two most modern plants, Ignalin-2 and Smolensk-3. The identification of numerous shortcomings, some of which had already been recongized by the participating Eastern organizations, resulted in some 300 specific recommendations to reactor designers, operators and licensing authorities. These recommendations are to be acted upon at once; only a small number did not meet with the approval of the Eastern partners. The safety review provided the Western consotrium with a profound insight into the design and safety of third-generation RBMK reactors; the Eastern partners were able to accumulate experience in working with Western safety philosophy. (orig.) [de

  10. Fixing broken bones and broken homes: domestic violence as a patient safety issue.

    Cohn, Felicia; Rudman, William J

    2004-11-01

    Domestic violence (DV) is a significant problem in terms of both patient harm and cost. To better address this problem, the diagnosis and treatment of DV are considered within the emerging model of patient safety and medical error reduction. The case of a female patient who presents in the clinical setting following an incident of DV shows how medical errors can be analyzed as they are in medical cases not involving DV, such as when a person with abdominal pain is sent away from the emergency department with instructions to take an acid reducer and later suffers a burst appendix. A number of factors inhibit the correct diagnosis and treatment of DV victims seeking additional treatment. Physicians often fail to screen for DV, misidentify symptoms, or deny the possibility of underlying DV, and patients often hide the symptoms and refuse to admit the problem. However, human factor errors related to knowledge, cultural norms, and individual biases; organizational factors, including lack of training and reimbursement; and technology factors related to information accessibility appear to play significant roles. Failure to diagnose or adequately address DV can be interpreted as medical errors. Addressing DV requires a systemic response, which might begin with integrating education and training about DV into the clinical setting, ensuring the use of existing screening tools, and providing adequate and appropriate reimbursement levels.

  11. Hospital safety climate surveys: measurement issues.

    Jackson, Jeanette; Sarac, Cakil; Flin, Rhona

    2010-12-01

    Organizational safety culture relates to behavioural norms in the workplace and is usually assessed by safety climate surveys. These can be a diagnostic indicator on the state of safety in a hospital. This review examines recent studies using staff surveys of hospital safety climate, focussing on measurement issues. Four questionnaires (hospital survey on patient safety culture, safety attitudes questionnaire, patient safety climate in healthcare organizations, hospital safety climate scale), with acceptable psychometric properties, are now applied across countries and clinical settings. Comparisons for benchmarking must be made with caution in case of questionnaire modifications. Increasing attention is being paid to the unit and hospital level wherein distinct cultures may be located, as well as to associated measurement and study design issues. Predictive validity of safety climate is tested against safety behaviours/outcomes, with some relationships reported, although effects may be specific to professional groups/units. Few studies test the role of intervening variables that could influence the effect of climate on outcomes. Hospital climate studies are becoming a key component of healthcare safety management systems. Large datasets have established more reliable instruments that allow a more focussed investigation of the role of culture in the improvement and maintenance of staff's safety perceptions within units, as well as within hospitals.

  12. Practicing industrial safety - issues involved

    Gunasekaran, P.

    2016-01-01

    Industrial safety is all about measures or techniques implemented to reduce the risk of injury, loss to persons, property or the environment in any industrial facility. The issue of industrial safety evolved concurrently with industrial development as a shift from compensation to prevention as well. Today, industrial safety is widely regarded as one of the most important factors that any business, large or small, must consider in its operations, as prevention of loss is also a part of profit. Factories Act of Central government and Rules made under it by the state deals with the provisions on industrial safety legislation. There are many other acts related to safety of personnel, property and environment. Occupational health and safety is also of primary concern. The aim is to regulate health and safety conditions for all employers. It includes safety standards and health standards. These acts encourage employers and employees to reduce workplace hazards and to implement new or improve existing safety and health standards; and develop innovative ways to achieve them. Maintain a reporting and record keeping system to monitor job-related injuries and illnesses; establish training programs to increase the number and competence of occupational safety and health personnel

  13. Key issues for passive safety

    Hayns, M.R.

    1996-01-01

    The paper represents a summary of the introductory presentation made at this Advisory Group Meeting on the Technical Feasibility and Reliability of Passive Safety Systems. It was intended as an overview of our views on what are the key issues and what are the technical problems which might dominate any future developments of passive safety systems. It is, therefore, not a ''review paper'' as such and only record the highlights. (author)

  14. Key issues for passive safety

    Hayns, M R [AEA Technology, Harwell, Didcot (United Kingdom). European Institutions; Hicken, E F [Forschungszentrum Juelich GmbH (Germany)

    1996-12-01

    The paper represents a summary of the introductory presentation made at this Advisory Group Meeting on the Technical Feasibility and Reliability of Passive Safety Systems. It was intended as an overview of our views on what are the key issues and what are the technical problems which might dominate any future developments of passive safety systems. It is, therefore, not a ``review paper`` as such and only record the highlights. (author).

  15. Patient safety: Safety culture and patient safety ethics

    Madsen, Marlene Dyrløv

    2006-01-01

    ,demonstrating significant, consistent and sometimes large differences in terms of safety culture factors across the units participating in the survey. Paper 5 is the results of a study of the relation between safety culture, occupational health andpatient safety using a safety culture questionnaire survey......Patient safety - the prevention of medical error and adverse events - and the initiative of developing safety cultures to assure patients from harm have become one of the central concerns in quality improvement in healthcare both nationally andinternationally. This subject raises numerous...... challenging issues of systemic, organisational, cultural and ethical relevance, which this dissertation seeks to address through the application of different disciplinary approaches. The main focus of researchis safety culture; through empirical and theoretical studies to comprehend the phenomenon, address...

  16. Assessment of basic safety issues

    Queniart, D.

    1996-01-01

    Work on the French-German common safety approach for future nuclear power plants continued in 1994 to allow for more detailed discussion of some major issues, taking into account the options provided by the industry for the EPR (European Pressurized water Reactor) project, as described in the document entitled 'Conceptual Safety Features Review File'. Seven meetings of a GPR/RSK advisory experts subgroup, six GPR/RSK plenary sessions and six meetings of the safety authorities (DFD) dealt with the following topics: design of the systems and use of probabilistic approaches, application of a 'break preclusion' approach to the main primary pipings, protection against external hazards (aircraft crashes, explosions, earthquakes), provisions with respect to accidents involving core melt and to containment design, radiological consequences of reference accidents and accidents involving core melt at low pressure. The important aspects of the joint policy are recalled in the presentation. The whole set of GPR/RSK recommendations were agreed by the French and German safety authorities during the DFD meetings of 1994 and early 1995. The utilities decided to begin the basic design phase in February, 1995. Work is now continuing to develop the common French-German approach for future nuclear power plants, in the same way as before. In 1995, this mainly covers the design of the containment and of the systems, but also new issues such as the protection against secondary side overpressurization, radiological protection of workers and radioactive wastes. (J.S.). 3 figs., 1 tab

  17. Safety issues on advanced fuel

    Gross, H.; Krebs, W.D.

    1998-01-01

    In the recent years a general discussion has started whether unsolved safety issues are related to advanced fuel. Advanced fuel is in this context a summary of features like high burnup, improved clad materials, low leakage loading pattern with high peaking factors etc. The design basis accidents RIA and Loca are of special interest for this discussion. From the Siemens point of view RIA is not a safety issue. There are sufficient margins between the enthalpy rise calculated by modern 3D methods and the fuel failures which occurred in RIA simulation tests when the effect of pulse width is taken into account. The evaluation of possible uncertainties for the established Loca criteria (17% equivalent corrosion, 1200 C clad temperature) for high burnup makes sense. But fuel with high burnup has significantly lower peaking factors than fuel with lower burnup. This gives sufficient margin counterbalancing possible uncertainties. In contrast to the above incomplete control rod insertion at higher burnup is potentially a real safety issue. Although Siemens fuel was not affected by the reported incidents they addressed the problem and checked that they have sufficient design margin for their fuel. (orig.) [de

  18. Identification errors in the blood transfusion laboratory: a still relevant issue for patient safety.

    Lippi, Giuseppe; Plebani, Mario

    2011-04-01

    Remarkable technological advances and increased awareness have both contributed to decrease substantially the uncertainty of the analytical phase, so that the manually intensive preanalytical activities currently represent the leading sources of errors in laboratory and transfusion medicine. Among preanalytical errors, misidentification and mistransfusion are still regarded as a considerable problem, posing serious risks for patient health and carrying huge expenses for the healthcare system. As such, a reliable policy of risk management should be readily implemented, developing through a multifaceted approach to prevent or limit the adverse outcomes related to transfusion reactions from blood incompatibility. This strategy encompasses root cause analysis, compliance with accreditation requirements, strict adherence to standard operating procedures, guidelines and recommendations for specimen collection, use of positive identification devices, rejection of potentially misidentified specimens, informatics data entry, query host communication, automated systems for patient identification and sample labeling and an adequate and safe environment. Copyright © 2011 Elsevier Ltd. All rights reserved.

  19. Organizational culture, team climate, and quality management in an important patient safety issue: nosocomial pressure ulcers.

    Bosch, Marije; Halfens, Ruud J G; van der Weijden, Trudy; Wensing, Michel; Akkermans, Reinier; Grol, Richard

    2011-03-01

    Increasingly, policy reform in health care is discussed in terms of changing organizational culture, creating practice teams, and organizational quality management. Yet, the evidence for these suggested determinants of high-quality care is inconsistent. To determine if the type of organizational culture (Competing Values Framework), team climate (Team Climate Inventory), and preventive pressure ulcer quality management at ward level were related to the prevalence of pressure ulcers. Also, we wanted to determine if the type of organizational culture, team climate, or the institutional quality management related to preventive quality management at the ward level. In this cross-sectional observational study multivariate (logistic) regression analyses were performed, adjusting for potential confounders and institution-level clustering. Data from 1274 patients and 460 health care professionals in 37 general hospital wards and 67 nursing home wards in the Netherlands were analyzed. The main outcome measures were nosocomial pressure ulcers in patients at risk for pressure ulcers (Braden score ≤ 18) and preventive quality management at ward level. No associations were found between organizational culture, team climate, or preventive quality management at the ward level and the prevalence of nosocomial pressure ulcers. Institutional quality management was positively correlated with preventive quality management at ward level (adj. β 0.32; p organizational culture, team climate, or preventive quality management at the ward level. These results would therefore not subscribe the widely suggested importance of these factors in improving health care. However, different designs and research methods (that go beyond the cross-sectional design) may be more informative in studying relations between such complex factors and outcomes in a more meaningful way. Copyright ©2010 Sigma Theta Tau International.

  20. ISSUES OF FETUS DRUG SAFETY

    A.V. Ostrovskaya

    2010-01-01

    Full Text Available The article is focused on the issue of fetus drug safety. Development of a child’s health depends both on hereditary information and environment factors. The reason for deviation from the process of normal prenatal development could be any xenobiotics, physical factors and some medications having a pathogenic effect during pregnancy on the embryo and fetus. Due to that, the physician’s preventive work based on the knowledge of embryogenesis processes and critical development periods. Key words: teratogenic action, medications, prenatal development, congenital malformation, newborns, children.(Pediatric Pharmacology. – 2010; 7(1:25-28

  1. Safety culture issues and perspectives

    Dahlgren Persson, K.

    1999-01-01

    indicators, the symptoms and significance of shortcomings and degradation in the safety management processes and safety culture and hence failed to take effective corrective actions at an early stage. Key performance issues such as critical oversight, self assessment processes and effective corrective action programmes were not fully appreciated by senior management even after performance deficiencies were identified by the regulator and other external agencies. The seeming inability of the regulator to influence this senior management level, especially at the early stages of safety performance degradation was a major contributing factor in the continuation of the performance decline to the point that regulatory intervention became a necessity. Recovery processes commonly used a new utility senior management team to kick-start the change process and corresponding regulatory resource increases focused on monitoring the recovery. A comprehensive recovery plan and an interactive relationship with the regulator were deemed essential for a successful recovery. A review of the developing safety culture was a factor considered necessary to ensure sustainability. Public involvement in the regulatory monitoring process helped restore their confidence in the regulator, utility and plant management. The group recommended IAEA continue work to develop guidance for senior corporate management and regulators in this area (author) (ml)

  2. Patient safety

    Page 1 .... BMJ 2012;344:e832. Table 2. Unsafe medical care. Structural factors. Organisational determinants. Structural accountability (accreditation and regulation). Safety culture. Training, education and human resources. Stress and fatigue .... for routine take-off and landing, yet doctors feel that it is demeaning to do so?

  3. Safety issues on advanced fuel

    Gross, H.; Krebs, W.D. [Siemens AG, Bereich Energieerzeugug (KWU), Erlangen (Germany). Geschaeftsgebiet Nukleare Energieerzeugung

    1998-05-01

    In the recent years a general discussion has started whether unsolved safety issues are related to advanced fuel. Advanced fuel is in this context a summary of features like high burnup, improved clad materials, low leakage loading pattern with high peaking factors etc. The design basis accidents RIA and Loca are of special interest for this discussion. From the Siemens point of view RIA is not a safety issue. There are sufficient margins between the enthalpy rise calculated by modern 3D methods and the fuel failures which occurred in RIA simulation tests when the effect of pulse width is taken into account. The evaluation of possible uncertainties for the established Loca criteria (17% equivalent corrosion, 1200 C clad temperature) for high burnup makes sense. But fuel with high burnup has significantly lower peaking factors than fuel with lower burnup. This gives sufficient margin counterbalancing possible uncertainties. In contrast to the above incomplete control rod insertion at higher burnup is potentially a real safety issue. Although Siemens fuel was not affected by the reported incidents they addressed the problem and checked that they have sufficient design margin for their fuel. (orig.) [Deutsch] In den letzten Jahren hat eine allgemeine Diskussion begonnen, ob mit fortgeschrittenen Brennelementen (BE) ungeklaerte Sicherheitsprobleme verbunden sind. Dabei ist `Fortgeschrittene Brennelemente` ein Sammelbegriff fuer hohe Abbraende, verbesserte Huellrohrmaterialien, Low-leakage-Einsatzplanungen mit hohen Heissstellenfaktoren usw. Die Auslegungsstoerfaelle RIA und Loca sind in dieser Diskussion von besonderer Bedeutung. Aus der Sicht von Siemens ist der RIA kein Sicherheitsproblem. Zwischen den mit modernen 3D-Methoden berechneten Enthalpieerhoehungen und den in RIA-Experimenten aufgetretenen Brennstabdefekten bestehen ausreichende Abstaende, wenn der Einfluss der Pulsbreite beruecksichtigt wird. Die Untersuchung eventueller Unsicherheiten bei hohen

  4. Transient analysis for resolving safety issues

    Chao, J.; Layman, W.

    1987-01-01

    The Nuclear Safety Analysis Center (NSAC) has a Generic Safety Analysis Program to help resolve high priority generic safety issues. This paper describes several high priority safety issues considered at NSAC and how they were resolved by transient analysis using thermal hydraulics and neutronics codes. These issues are pressurized thermal shock (PTS), anticipated transients without scram (ATWS), steam generator tube rupture (SGTR), and reactivity transients in light of the Chernobyl accident

  5. Research of beryllium safety issues

    Longhurst, G.R.; Anderl, R.A.; Dolan, T.J.; Hankins, M.R.; Pawelko, R.J.

    1993-01-01

    Beryllium has been identified as a leading contender for the plasma-facing material in ITER. Its use has some obvious advantages, but there are also a number of safety concerns associated with it. The Idaho National Engineering Laboratory (INEL) has undertaken a number of studies to help resolve some of these issues. One issue is the response of beryllium to neutron irradiation. We have tested samples irradiated in the Advanced Test Reactor (ATR) and are currently preparing to make measurements of the change in mechanical properties of beryllium samples irradiated at elevated temperatures in the Fast Flux Test Facility (FFTF) and the Experimental Breeder Reactor II (EBR-II) at the INEL. Mechanical tests will be conducted at the irradiation temperatures of 375-550 C. Other experiments address permeation and retention of implanted tritium in plasma-sprayed beryllium. In one test the porosity of the material allowed 0.12% of implanted ions and 0.17% of atoms from background gas pressure to pass through the foil with essentially no delay. For comparison, similar tests on fully dense hot-rolled, vacuum melted or sintered powder foils of high purity beryllium showed only 0.001% of implanting ions to pass through the foil, and then only after a delay of several hours. None of the molecular gas appeared to permeate these latter targets. An implication is that plasma-sprayed beryllium may substantially enhance recycling of tritium to the plasma provided it is affixed to a relatively impermeable substrate. (orig.)

  6. Patient Safety and Healthcare Quality

    Aikaterini Toska; Panagiotis Kyloudis; Maria Rekleiti; Maria Saridi

    2012-01-01

    Introduction: Due to a variety of circumstances and world-wide research findings, patient safety andquality care during hospitalization have emerged as major issues. Patient safety deficits may burdenhealth systems as well as allocated resources. The international community has examined severalproposals covering general and systemic aspects in order to improve patient safety; several long-termprograms and strategies have also been implemented promoting the participation of health-relatedagent...

  7. Safety issues and updates under MR environments

    Kim, Soo Jung; Kim, Kyung Ah, E-mail: bellenina@daum.net

    2017-04-15

    Highlights: • Unexpected biological effects can occur within stronger magnetic fields. • MR safety for MR conditional items is not guaranteed beyond the tested conditions. • Updated knowledge about MR-related safety is important for a safe MR environment. - Abstract: Magnetic resonance (MR) imaging is a useful imaging tool with superior soft tissue contrast for diagnostic evaluation. The MR environments poses unique risks to patients and employees differently from ionizing radiation exposure originated from computed tomography and plain x-ray films. The technology associated with MR system has evolved continuously since its introduction in the late 1970s. MR systems have advanced with static magnetic fields, faster and stronger gradient magnetic fields and more powerful radiofrequency transmission coils. Higher field strengths of MR offers greater signal to noise capability and better spatial resolution, resulting in better visualization of anatomic detail, with a reduction in scan time. With the rapid evolution of technology associated with MR, we encounter new MR-related circumstances and unexpected dangerous conditions. A comprehensive update of our knowledge about MR safety is necessary to prevent MR-related accidents and to ensure safety for patients and staff associated with MR. This review presents an overview about MR-related safety issues and updates.

  8. Maintenance as a safety issue.

    White, Jim

    2008-11-01

    Because safety is related to electrical power systems maintenance, it seems reasonable to assume there could be legal issues if maintenance is not performed. OSHA has not yet taken the stand that not performing maintenance as required by the manufacturer, NFPA 70B, or ANSI/NETA MTS-07 constitutes a willful violation. OSHA defines a willful citation as one where: "the employer knowingly commits with plain indifference to the law. The employer either knows that what he or she is doing constitutes a violation, or is aware that a hazardous condition existed and made no reasonable effort to eliminate it". However, NFPA 70E 2009 requires this maintenance, and OSHA has stated on its Web site that NFPA 70E is "a guide for meeting the requirements of the OSHA electrical regulations". In addition, federal courts have found that NFPA 70E is "standard industry practice." Once a company receives and accepts a willful citation, especially if received as the result of an accident investigation, its worker's compensation protection no longer shields it. One definition given by a trial attorney for a willful citation was that it is equal to negligent behavior. Be smart: Maintain that equipment and save yourself major problems, including unscheduled shutdowns and possible litigation.

  9. Development of nuclear safety issues program

    Cho, J. C.; Yoo, S. O.; Yoon, Y. K.; Kim, H. J.; Jeong, M. J.; Noh, K. W.; Kang, D. K

    2006-12-15

    The nuclear safety issues are defined as the cases which affect the design and operation safety of nuclear power plants and also require the resolution action. The nuclear safety issues program (NSIP) which deals with the overall procedural requirements for the nuclear safety issues management process is developed, in accordance with the request of the scientific resolution researches and the establishment/application of the nuclear safety issues management system for the nuclear power plants under design, construction or operation. The NSIP consists of the following 4 steps; - Step 1 : Collection of candidates for nuclear safety issues - Step 2 : Identification of nuclear safety issues - Step 3 : Categorization and resolution of nuclear safety issues - Step 4 : Implementation, verification and closure The NSIP will be applied to the management directives of KINS related to the nuclear safety issues. Through the identification of the nuclear safety issues which may be related to the potential for accident/incidents at operating nuclear power plants either directly or indirectly, followed by performance of regulatory researches to resolve the safety issues, it will be possible to prevent occurrence of accidents/incidents as well as to cope with unexpected accidents/incidents by analyzing the root causes timely and scientifically and by establishing the proper flow-up or remedied regulatory actions. Moreover, the identification and resolution of the safety issues related to the new nuclear power plants completed at the design stage are also expected to make the new reactor licensing reviews effective and efficient as well as to make the possibility of accidents/incidents occurrence minimize. Therefore, the NSIP developed in this study is expected to contribute for the enhancement of the safety of nuclear power plants.

  10. Development of nuclear safety issues program

    Cho, J. C.; Yoo, S. O.; Yoon, Y. K.; Kim, H. J.; Jeong, M. J.; Noh, K. W.; Kang, D. K.

    2006-12-01

    The nuclear safety issues are defined as the cases which affect the design and operation safety of nuclear power plants and also require the resolution action. The nuclear safety issues program (NSIP) which deals with the overall procedural requirements for the nuclear safety issues management process is developed, in accordance with the request of the scientific resolution researches and the establishment/application of the nuclear safety issues management system for the nuclear power plants under design, construction or operation. The NSIP consists of the following 4 steps; - Step 1 : Collection of candidates for nuclear safety issues - Step 2 : Identification of nuclear safety issues - Step 3 : Categorization and resolution of nuclear safety issues - Step 4 : Implementation, verification and closure The NSIP will be applied to the management directives of KINS related to the nuclear safety issues. Through the identification of the nuclear safety issues which may be related to the potential for accident/incidents at operating nuclear power plants either directly or indirectly, followed by performance of regulatory researches to resolve the safety issues, it will be possible to prevent occurrence of accidents/incidents as well as to cope with unexpected accidents/incidents by analyzing the root causes timely and scientifically and by establishing the proper flow-up or remedied regulatory actions. Moreover, the identification and resolution of the safety issues related to the new nuclear power plants completed at the design stage are also expected to make the new reactor licensing reviews effective and efficient as well as to make the possibility of accidents/incidents occurrence minimize. Therefore, the NSIP developed in this study is expected to contribute for the enhancement of the safety of nuclear power plants

  11. A prioritization of generic safety issues

    Emrit, R.; Riggs, R.; Milstead, W.; Pittman, J.

    1991-07-01

    This report presents the priority rankings for generic safety issues and related to nuclear power plants. The purpose of these rankings is to assist in the timely and efficient allocation of NRC resources for the resolution of those safety issues that have a significant potential for reducing risk. The report focuses on the prioritization of generic safety issues. Issues primarily concerned with the licensing process or environmental protection and not directly related to safety have been excluded from prioritization. The prioritized issues include: TMI Action Plan items under development; previously proposed issues covered by Task Action Plans, except issues designated as Un-resolved Safety Issues (USIs) which had already been assigned high priority; and newly-proposed issues. Future supplements to this report will include the prioritization of additional issues. The safety priority rankings are High, Medium, Low, and Drop and have been assigned on the basis of risk significance estimates, the ratio of risk to costs and other impacts estimated to result if resolutions of the safety issues were implemented, and the consideration of uncertainties and other quantitative or qualitative factors. To the extent practical, estimates are quantitative. 1310 refs

  12. Evaluation on safety issues of SMART

    Kim, W. S.; Seol, K. W.; Yoon, Y. K.; Lee, J. H.

    2001-01-01

    Safety issues on the SMART were evaluated in the light of the compliance with the Ministerial Ordinance of Technical Requirements applying to Nuclear Installations, which was recently revised. Evaluation concludes that regulatory requirements associated with following items have to be developed as the licensing criteria for the SMART: (1) proving the safety of design or materials different form existing reactors; (2) coping with beyond design basis accidents; (3) rulemaking on the safety of reactor safeguard vessel ; (4) ensuring integrity of steam generator tubes; and (5) classifying equipment based on their safety significance. Appropriate actions including implementation of new requirements under development should be taken for safety issues such as diversity of reactivity control and in-service inspection of steam generator tubes that are not complied with the current Technical Requirements. Safety level of the SMART design will be evaluated further by the more detailed assessment according to the Technical Requirements, and additional safety issues will be identified and resolved, if it necessary

  13. National Patient Safety Foundation

    ... News Member Testimonials Lifetime Members Stand Up for Patient Safety Welcome Stand Up Members Stand Up e-News ... PLS Webcast Archives Stand Up Templates and Logos Patient Safety Coalition Coalition Overview Coalition Member Roster Members-Only ...

  14. Safety and licensing issues for Indian PHWRs

    Srinivasan, G.R.; Das, M.

    1997-01-01

    India has achieved competency in design, construction, commissioning and operation of Pressurized Heavy Water Reactor based Nuclear Power Plants and has completed more than 120 reactor operating years with an extremely satisfactory safety record. In this paper, the safety management in NPCIL and operational safety aspects are discussed, licensing and regulatory approach is described and some of the main safety issues for Indian PHWRs are brought out. (author)

  15. Status of safety issues at licensed power plants: TMI action plan requirements, unresolved safety issues, generic safety issues

    1991-12-01

    As part of ongoing US Nuclear Regulatory Commission (NRC) efforts to ensure the quality and accountability of safety issue information, a program was established whereby an annual NUREG report would be published on the status of licensee implementation and NRC verification of safety issues in major NRC requirements areas. This information was compiled and reported in three NUREG volumes. Volume 1, published in March 1991, addressed the status of of Three Mile Island (TMI) Action Plan Requirements. Volume 2, published in May 1991, addressed the status of unresolved safety issues (USIs). Volume 3, published in June 1991, addressed the implementation and verification status of generic safety issues (GSIs). This annual NUREG report combines these volumes into a single report and provides updated information as of September 30, 1991. The data contained in these NUREG reports are a product of the NRC's Safety Issues Management System (SIMS) database, which is maintained by the Project Management Staff in the Office of Nuclear Reactor Regulation and by NRC regional personnel. This report is to provide a comprehensive description of the implementation and verification status of TMI Action Plan Requirements, safety issues designated as USIs, and GSIs that have been resolved and involve implementation of an action or actions by licensees. This report makes the information available to other interested parties, including the public. An additional purpose of this NUREG report is to serve as a follow-on to NUREG-0933, ''A Prioritization of Generic Safety Issues,'' which tracks safety issues up until requirements are approved for imposition at licensed plants or until the NRC issues a request for action by licensees

  16. When should a multicampus hospital be considered a single entity for public reporting on patient safety issues?

    Naessens, James M; Culbertson, Richard A; Lefante, John J; Campbell, Claudia R

    2007-01-01

    Attempts to provide information to consumers about patient safety on specific hospitals have conflicted with organization self-perceptions and led to confusion among the general public. This article presents organizational theory framework and criteria to classify organizations as single versus multiple reporting entities. Operational definitions are presented. A case study comparing institutions both within and across state boundaries in the Mayo Clinic Health System is used to demonstrate their utility. The study includes analysis of an employee survey on employee satisfaction and patient safety climate in 2004 among nurses and physicians at the 2 Mayo Clinic hospitals in Rochester, Minn. The criteria for a single organization are more strongly supported for the Mayo Clinic hospitals located in the same city than for hospitals in the same system but separated geographically. Although there is debate about the measurement of organizational culture, employee surveys provide some evidence of a commonality across hospitals in the same city. The case study comparing institutions both within and across state boundaries in the Mayo Clinic Health System demonstrate the utility of the proposed criteria.

  17. Commercial truck parking and other safety issues.

    2015-10-01

    Commercial truck parking is a safety issue, since trucks are involved in approximately 10% of all fatal accidents on interstates and : parkways in Kentucky. Drivers experience schedule demands and long hours on the road, yet they cannot easily determ...

  18. Patient Safety Culture

    Kristensen, Solvejg

    of health care professional’s behaviour, habits, norms, values, and basic assumptions related to patient care; it is the way things are done. The patient safety culture guides the motivation, commitment to and know-how of the safety management, and how all members of a work place interact. This thesis......Patient safety is highly prioritised in the Danish health care system, never the less, patients are still exposed to risk and harmed every day. Implementation of a patient safety culture has been suggested an effective mean to protect patients against adverse events. Working strategically...

  19. Road safety issues for bus transport management.

    Cafiso, Salvatore; Di Graziano, Alessandro; Pappalardo, Giuseppina

    2013-11-01

    Because of the low percentage of crashes involving buses and the assumption that public transport improves road safety by reducing vehicular traffic, public interest in bus safety is not as great as that in the safety of other types of vehicles. It is possible that less attention is paid to the significance of crashes involving buses because the safety level of bus systems is considered to be adequate. The purpose of this study was to evaluate the knowledge and perceptions of bus managers with respect to safety issues and the potential effectiveness of various technologies in achieving higher safety standards. Bus managers were asked to give their opinions on safety issues related to drivers (training, skills, performance evaluation and behaviour), vehicles (maintenance and advanced devices) and roads (road and traffic safety issues) in response to a research survey. Kendall's algorithm was used to evaluate the level of concordance. The results showed that the majority of the proposed items were considered to have great potential for improving bus safety. The data indicated that in the experience of the participants, passenger unloading and pedestrians crossing near bus stops are the most dangerous actions with respect to vulnerable users. The final results of the investigation showed that start inhibition, automatic door opening, and the materials and internal architecture of buses were considered the items most strongly related to bus passenger safety. Brake assistance and vehicle monitoring systems were also considered to be very effective. With the exception of driver assistance systems for passenger and pedestrian safety, the perceptions of the importance of other driver assistance systems for vehicle monitoring and bus safety were not unanimous among the bus company managers who participated in this survey. The study results showed that the introduction of new technologies is perceived as an important factor in improving bus safety, but a better understanding

  20. The safety issues of medical robotics

    Fei Baowei; Ng, W.S.; Chauhan, Sunita; Kwoh, Chee Keong

    2001-08-01

    In this paper, we put forward a systematic method to analyze, control and evaluate the safety issues of medical robotics. We created a safety model that consists of three axes to analyze safety factors. Software and hardware are the two material axes. The third axis is the policy that controls all phases of design, production, testing and application of the robot system. The policy was defined as hazard identification and safety insurance control (HISIC) that includes seven principles: definitions and requirements, hazard identification, safety insurance control, safety critical limits, monitoring and control, verification and validation, system log and documentation. HISIC was implemented in the development of a robot for urological applications that was known as URObot. The URObot is a universal robot with different modules adaptable for 3D ultrasound image-guided interstitial laser coagulation, radiation seed implantation, laser resection, and electrical resection of the prostate. Safety was always the key issue in the building of the robot. The HISIC strategies were adopted for safety enhancement in mechanical, electrical and software design. The initial test on URObot showed that HISIC had the potential ability to improve the safety of the system. Further safety experiments are being conducted in our laboratory.

  1. The safety issues of medical robotics

    Fei Baowei; Ng, W.S.; Chauhan, Sunita; Kwoh, Chee Keong

    2001-01-01

    In this paper, we put forward a systematic method to analyze, control and evaluate the safety issues of medical robotics. We created a safety model that consists of three axes to analyze safety factors. Software and hardware are the two material axes. The third axis is the policy that controls all phases of design, production, testing and application of the robot system. The policy was defined as hazard identification and safety insurance control (HISIC) that includes seven principles: definitions and requirements, hazard identification, safety insurance control, safety critical limits, monitoring and control, verification and validation, system log and documentation. HISIC was implemented in the development of a robot for urological applications that was known as URObot. The URObot is a universal robot with different modules adaptable for 3D ultrasound image-guided interstitial laser coagulation, radiation seed implantation, laser resection, and electrical resection of the prostate. Safety was always the key issue in the building of the robot. The HISIC strategies were adopted for safety enhancement in mechanical, electrical and software design. The initial test on URObot showed that HISIC had the potential ability to improve the safety of the system. Further safety experiments are being conducted in our laboratory

  2. Editorial safety science special issue road safety management.

    Wegman, F.C.M. & Hagezieker, M.P.

    2014-01-01

    The articles presented in this Special Issue on Road Safety Management represent an illustration of the growing interest in policy-related research in the area of road safety. The complex nature of this type of research combined with the observation that scientific journals pay limited attention to

  3. Safety issues at the defense production reactors

    1987-01-01

    The United States produces plutonium and tritium for use in nuclear weapons at the defense production reactors - the N Reactor in Washington and the Savannah River reactors in South Carolina. This report reaches general conclusions about the management of those reactors and highlights a number of safety and technical issues that should be resolved. The report provides an assessment of the safety management, safety review, and safety methodology employed by the Department of Energy and the private contractors who operate the reactors for the federal government. This report examines the safety objective established by the Department of Energy for the production reactors and the process the Department of its contractors use to implement the objective; focuses on a variety of uncertainties concerning the production reactors, particularly those related to potential vulnerabilities to severe accidents; and identifies ways in which the DOE approach to management of the safety of the production reactors can be improved

  4. Safety Issues Concerning the Medical Use of Cannabis and Cannabinoids

    Mark A Ware

    2005-01-01

    Full Text Available Safety issues are a major barrier to the use of cannabis and cannabinoid medications for clinical purposes. Information on the safety of herbal cannabis may be derived from studies of recreational cannabis use, but cannabis exposure and effects may differ widely between medical and recreational cannabis users. Standardized, quality-controlled cannabinoid products are available in Canada, and safety profiles of approved medications are available through the Canadian formulary. In the present article, the evidence behind major safety issues related to cannabis use is summarized, with the aim of promoting informed dialogue between physicians and patients in whom cannabinoid therapy is being considered. Caution is advised in interpreting these data, because clinical experience with cannabinoid use is in the early stages. There is a need for long-term safety monitoring of patients using cannabinoids for a wide variety of conditions, to further guide therapeutic decisions and public policy.

  5. Unresolved safety issues summary: aqua book

    1982-06-01

    The unresolved safety issues summary is designed to provide the management of the Nuclear Regulatory Commission with a quarterly overview of the progress and plans for completion of generic tasks addressing unresolved safety issues reported to Congress pursuant to Section 210 of the Energy Reorganization Act of 1974 as amended. This summary utilizes data collected from the Office of Nuclear Reactor Regulation, Office of Nuclear Regulatory Research, and the National Laboratories and is prepared by the Office of Resource Management. The schedules in this book include a milestone at the end of each action plan which represents the initiation of the implementation process both with respect to incorporation of the technical resolution in the NRC official guidance or requirements and also the application of changes to individual operating plants. The progress and status for implementation of unresolved safety issues for which a technical resolution has been completed are reported specifically in a separate table provided in this summary

  6. Status of safety issues at licensed power plants: TMI Action Plan requirements, unresolved safety issues, generic safety issues, other multiplant action issues

    1992-12-01

    This report is to provide a comprehensive description of the implementation and verification status of Three Mile Island (TMI) Action Plan requirements, safety issues designated as Unresolved Safety Issues (USIs), Generic Safety Issues(GSIs), and other Multiplant Actions (MPAs) that have been resolved and involve implementation of an action or actions by licensees. This report makes the information available to other interested parties, including the public. An additional purpose of this NUREG report is to serve as a follow-on to NUREG-0933, ''A Prioritization of Generic Safety Issues,'' which tracks safety issues up until requirements are approved for imposition at licensed plants or until the NRC issues a request for action by licensees

  7. Current safety issues of CANDU licensing

    Lee, Y.; Natalizio, A.

    1994-01-01

    As requested by Korea Institute of Nuclear Safety(KINS), the status of five generic licensing issues has been examined and their potential impact on a new plant that would be constructed in Canada has been evaluated. The results and conclusions of this evaluation are summarized as follows: steam explosion in calandria, hydrogen explosion in containment, use of PSA in reactor licensing, human factors, safety critical software

  8. Medical and Dental Patient Issues

    ... A RadiationAnswers.org Ask the Experts Medical and Dental Patient Issues What's My Risk? The risks of ... developed by our topic editors for this category: Dental-Patient Issues Medical CT Reference Books and Articles ...

  9. Safety issues with bisphosphonate therapy for osteoporosis

    Suresh, Ernest; Pazianas, Michael; Abrahamsen, Bo

    2014-01-01

    Randomized controlled trials have demonstrated the efficacy of bisphosphonates (BP) in improving BMD and reducing fracture risk. Various safety issues that were not noted in clinical trials have, however, now emerged with post-marketing surveillance and increasing clinical experience. The risk...

  10. Characterization report for the ferrocyanide safety issue

    Pulsipher, B.A.; Burger, L.L.; Liebetrau, A.M.; Scheele, R.D.

    1997-06-01

    Recently PNNL was tasked by DOE to develop and demonstrate a risk-based strategic approach to characterizing Hanford's Nuclear Waste Tanks. This strategic approach was documented in a report entitled ''A Risk-Based Focused Decision-Management Approach for Justifying Characterization of Hanford Tank Waste''. In support of the general approach, a specific strategy for addressing each of the several safety issues associated with the tanks was developed. This report documents the approach for the Ferrocyanide Safety Issue. The purpose of this report is to describe a structured logic diagram (SLD) for determining the risk associated with the ferrocyanide tank safety issue and provide the supporting information for the SLD. The SLD addresses the resolution of risks resulting from the presence of ferrocyanide layers within the Hanford tanks. The informational requirements for determining risk from any reaction stemming from ferrocyanide are outlined in the SLD. This report will describe the potential paths to a successful resolution of the ferrocyanide safety issue. Complete development of the intervention pathway is outside the scope of this current activity. General descriptions of the approach, key components of the SLD, and conclusions are provided in the body of this report. The complete SLD, descriptions of each box shown in the SLD, a discussion on how to fill data needs, and a list of contributors is provided in the appendices

  11. Antipsychotic interventions in prodromal psychosis: safety issues.

    Liu, Chen-Chung; Demjaha, Arsime

    2013-03-01

    In recent years, psychopharmacological intervention in prodromal psychosis, also known as the ultra-high risk (UHR) mental state for psychosis, has attracted much attention. Whilst it has been shown that antipsychotic use in UHR individuals may be effective in potentially delaying or even averting progression to frank psychosis, their use in subjects that do not necessarily convert to psychosis has raised considerable ethical concerns because of their adverse effects. Recent treatment guidelines for patients at UHR for psychosis recommend the use of antipsychotics only in exceptional conditions and with great precautions. To date only a few studies have investigated the use of antipsychotic medications in UHR patients and the potential benefits and risks related to their use in prodromal psychosis remain unclear. We review here all published studies that included UHR patients treated with antipsychotics, regardless of study design. These studies were all of second-generation antipsychotics, given that first-generation antipsychotics cannot be recommended because of their adverse drug reactions. We specifically examine the available descriptions of adverse reactions of the individual antipsychotic medication in each study and discuss the potential effects of various demographic and clinical factors that may impact on safety issues of pharmacological interventions in UHR patients. Clinical trials to date investigating potential benefits of antipsychotic treatments in preventing transition to psychosis were of relatively short duration and have involved a small number of patients. Whilst it appears that pharmacological intervention at this stage may be effective in both reducing the psychopathology and decreasing transition rates, and is potentially safe, in the absence of sufficient evidence-based knowledge to guide treatment, definitive clinical recommendations and guidelines cannot be derived. Certain adverse events take time to develop, such as metabolic syndrome

  12. Safety issues of nuclear production of hydrogen

    Piera, Mireia; Martinez-Val, Jose M.; Jose Montes, Ma

    2006-01-01

    Hydrogen is not an uncommon issue in Nuclear Safety analysis, particularly in relation to severe accidents. On the other hand, hydrogen is a household name in the chemical industry, particularly in oil refineries, and is also a well known chemical element currently produced by steam reforming of natural gas, and other methods (such as coal gasification). In the not-too-distant future, hydrogen will have to be produced (by chemical reduction of water) using renewable and nuclear energy sources. In particular, nuclear fission seems to offer the cheapest way to provide the primary energy in the medium-term. Safety principles are fundamental guidelines in the design, construction and operation both of hydrogen facilities and nuclear power plants. When these two technologies are integrated, a complete safety analysis must consider not only the safety practices of each industry, but any interaction that could be established between them. In particular, any accident involving a sudden energy release from one of the facilities can affect the other. Release of dangerous substances (chemicals, radiotoxic effluents) can also pose safety problems. Although nuclear-produced hydrogen facilities will need specific approaches and detailed analysis on their safety features, a preliminary approach is presented in this paper. No significant roadblocks are identified that could hamper the deployment of this new industry, but some of the hydrogen production methods will involve very demanding safety standards

  13. Patient Safety and Healthcare Quality

    Aikaterini Toska

    2012-01-01

    Full Text Available Introduction: Due to a variety of circumstances and world-wide research findings, patient safety andquality care during hospitalization have emerged as major issues. Patient safety deficits may burdenhealth systems as well as allocated resources. The international community has examined severalproposals covering general and systemic aspects in order to improve patient safety; several long-termprograms and strategies have also been implemented promoting the participation of health-relatedagents, and also government agencies and non-governmental organizations.Aim: Those factors that have negative correlations with patient safety and quality healthcare weredetermined; WHO and EU programs as well as the Greek health policy were also reviewed.Method: Local and international literature was reviewed, including EU and WHO official publications,by using the appropriate keywords.Conclusions: International cooperation on patient safety is necessary in order to improvehospitalization and healthcare quality standards. Such incentives depend heavily on establishing worldwideviable and effective health programs and planning. These improvements also require further stepson safe work procedures, environment safety, hazard management, infection control, safe use ofequipment and medication, and sufficient healthcare staff.

  14. Laboratory test requesting appropriateness and patient safety

    Blasco, Álvaro; Carratalá, Arturo; Lopez-Garrígos, Maite; Rodriguez-Borja, Enrique

    2016-01-01

    Patient Safety emphasizes the reporting, analysis and prevention of medical errors that very often leads to adverse healthcare situations.1 in 10 patients are impacted by medical errors.The WHO calls the patient safety issue an endemic concern. A number of well-known experts of all areas in the medical field have collectedvery valuable information for a better patient treatment and higher safety culture in all medical disciplines.

  15. Delay in diagnosis of cancer as a patient safety issue - a root cause analysis based on a representative case report

    Mansour Paul

    2011-07-01

    Full Text Available Abstract Background It is well known in the literature that imaging has almost no value for diagnosis of superficial bladder cancer. However, wide gap exists between knowledge on diagnosis of bladder cancer and actual clinical practice. Case presentation Delay in diagnosis of bladder cancer in a male person with tetraplegia occurred because of reliance on negative flexible cystoscopy and single biopsy, negative ultrasound examination of urinary bladder, and computerised tomography of pelvis. Difficulties in scheduling cystoscopy also contributed to a delay of nearly ten months between the onset of haematuria and establishing a histological diagnosis of vesical malignancy in this patient. The time interval between transurethral resection and cystectomy was 42 days. This delay was mainly due to scheduling of surgery. Conclusion We learn from this case that doctors should be aware of the limitations of negative flexible cystoscopy and single biopsy, cytology of urine, ultrasound examination of urinary bladder, and computed tomography of pelvis for diagnosis of bladder cancer in spinal cord injury patients. Random bladder biopsies must be considered under general anaesthesia when there is high suspicion of bladder cancer. Spinal cord injury patients with lesions above T-6 may develop autonomic dysreflexia; therefore, one should be extremely well prepared to prevent or manage autonomic dysreflexia when performing cystoscopy and bladder biopsy. Spinal cord injury patients, who pass blood in urine, should be accorded top priority in scheduling of investigations and surgical procedures.

  16. Unresolved safety issues summary: aqua book

    1983-06-01

    The unresolved safety issues summary is designed to provide the management of the nuclear regulatory commission with a quarterly overview of the progress and plans for completion of generic tasks addressing unresolved safety issues reported to congress pursuant to section 210 of the Energy Reorganization Act of 1974 as amended. The schedules in this book include a milestone at the end of each action plan which represents the initiation of the implementation process both with respect to incorporation of the technical resolution in the NRC official guidance or requirements and also the application of changes to individual operating plants. The schedule for implementation will not normally be included in the task action plan(s) for the resolution of a USI since the nature and extent of the activities necessary to accomplish the implementation cannot normally be reasonably determined prior to the determination of a technical resolution. The progress and status for implementation of unresolved safety issues for which a technical resolution has been completed are reported specifically in a separate table provided in this summary

  17. Status of safety issues at licensed power plants: TMI Action Plan requirements; unresolved safety issues; generic safety issues; other multiplant action issues

    1993-12-01

    As part of ongoing US Nuclear Regulatory Commission (NRC) efforts to ensure the quality and accountability of safety issue information, the NRC established a program for publishing an annual report on the status of licensee implementation and NRC verification of safety issues in major NRC requirements areas. This information was initially compiled and reported in three NUREG-series volumes. Volume 1, published in March 1991, addressed the status of Three Mile Island (TMI) Action Plan Requirements. Volume 2, published in May 1991, addressed the status of unresolved safety issues (USIs). Volume 3, published in June 1991, addressed the implementation and verification status of generic safety issues (GSIs). The first annual supplement, which combined these volumes into a single report and presented updated information as of September 30, 1991, was published in December 1991. The second annual supplement, which provided updated information as of September 30, 1992, was published in December 1992. Supplement 2 also provided the status of licensee implementation and NRC verification of other multiplant action (MPA) issues not related to TMI Action Plan requirements, USIs, or GSIs. This third annual NUREG report, Supplement 3, presents updated information as of September 30, 1993. This report gives a comprehensive description of the implementation and verification status of TMI Action Plan requirements, safety issues designated as USIs, GSIs, and other MPAs that have been resolved and involve implementation of an action or actions by licensees. This report makes the information available to other interested parties, including the public. Additionally, this report serves as a follow-on to NUREG-0933, ''A Prioritization of Generic Safety Issues,'' which tracks safety issues until requirements are approved for imposition at licensed plants or until the NRC issues a request for action by licensees

  18. Status of safety issues at licensed power plants: TMI Action Plan requirements, unresolved safety issues, generic safety issues, other multiplant action issues. Supplement 4

    1994-12-01

    As part of ongoing US Nuclear Regulatory Commission (NRC) efforts to ensure the quality and accountability of safety issue information, the NRC established a program for publishing an annual report on the status of licensee implementation and NRC verification of safety issues in major NRC requirements areas. This information was initially compiled and reported in three NUREG-series volumes. Volume 1, published in March 1991, addressed the status of Three Mile Island (TMI) Action Plan Requirements. Volume 2, published in May 1991, addressed the status of unresolved safety issues (USIs). Volume 3, published in June 1991, addressed the implementation and verification status of generic safety issues (GSIs). The first annual supplement, which combined these volumes into a single report and presented updated information as of September 30, 1991, was published in December 1991. The second annual supplement, which provided updated information as of September 30, 1992, was published in December 1992. Supplement 2 also provided the status of licensee implementation and NRC verification of other multiplant action (MPA) issues not related to TMI Action Plan requirements, USIs, or GSIs. Supplement 3 gives status as of September 30, 1993. This annual report, Supplement 4, presents updated information as of September 30, 1994. This report gives a comprehensive description of the implementation and verification status of TMI Action Plan requirements, safety issues designated as USIs, GSIs, and other MPAs that have been resolved and involve implementation of an action or actions by licensees. This report makes the information available to other interested parties, including the public. Additionally, this report serves as a follow-on to NUREG-0933, ''A Prioritization of Generic Safety Issues,'' which tracks safety issues until requirements are approved for imposition at licensed plants or until the NRC issues a request for action by licensees

  19. Safety issues at the defense production reactors

    1987-01-01

    The United States produces plutonium and tritium for use in nuclear weapons at the defense production reactors endash the N Reactor in Washington and the Savannah River reactors in South Carolina. This report reaches general conclusions about the management of those reactors and highlights a number of safety and technical issues that should be resolved. The report provides an assessment of the safety management, safety review, and safety methodology employed by the Department of Energy and the private contractors who operate the reactors for the federal government. The report is necessarily based on a limited review of the defense production reactors. It does not address whether any of the reactors are ''safe,'' because such an analysis would involve a determination of acceptable risk endash a matter of obvious importance, but one that was beyond the purview of the committee. It also does not address whether the safety of the production reactors is comparable to that of commercial nuclear power stations, because even this narrower question extended beyond the charge to the committee and would have involved detailed analyses that the committee could not undertake

  20. Safety issues for superconducting fusion magnets

    Hsieh, S.Y.; Reich, M.; Powell, J.R.

    1978-01-01

    Safety issues for future superconducting fusion magnet systems are examined. It is found that safety and failure experience with existing superconducting magnets is not very applicable to predictions as to the safety and reliability of fusion magnets. Such predictions will have to depend on analysis and judgement for many years to come, rather than on accumulated experience. A number of generic potential structural, thermal-hydraulic, and electrical safety problems are identified and analyzed. Prevention of quenches and non-uniform temperature distributions, if quenches should occur, is of great importance, since such events can trigger processes which lead to magnet damage or failure. Engineered safety features will be necessary for fusion magnets. Two of these, an energy dispersion system and external coil containment, appear capable of reducing the probability of coil disruption to very low levels. However, they do not prevent loss of function accidents which are of economic concern. Elaborate detector, temperature equalization, and energy removal systems will be required to minimize the chances of loss of function accidents

  1. IMPROVING PATIENT SAFETY:

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

    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......, 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...

  2. Emerging issues in occupational safety and health.

    Schulte, Paul A

    2006-01-01

    In developed countries, changes in the nature of work and the workforce may necessitate recalibrating the vision of occupational safety and health (OSH) researchers, practitioners, and policymakers to increase the focus on the most important issues. New methods of organizing the workplace, extensive labor contracting, expansion of service and knowledge sectors, increase in small business, aging and immigrant workers, and the continued existence of traditional hazards in high-risk sectors such as construction, mining, agriculture, health care, and transportation support the need to address: 1) broader consideration of the role and impact of work, 2) relationship between work and psychological dysfunction, 3) increased surveillance basis for research and intervention, 4) overcoming barriers to the conduct and use of epidemiologic research, 5) information and knowledge transfer and application, 6) economic issues in prevention, and 7) the global interconnectedness of OSH. These issues are offered to spur thinking as new national research agendas for OSH are considered for developed countries.

  3. Analysis of high burnup fuel safety issues

    Lee, Chan Bock; Kim, D. H.; Bang, J. G.; Kim, Y. M.; Yang, Y. S.; Jung, Y. H.; Jeong, Y. H.; Nam, C.; Baik, J. H.; Song, K. W.; Kim, K. S

    2000-12-01

    Safety issues in steady state and transient behavior of high burnup LWR fuel above 50 - 60 MWD/kgU were analyzed. Effects of burnup extension upon fuel performance parameters was reviewed, and validity of both the fuel safety criteria and the performance analysis models which were based upon the lower burnup fuel test results was analyzed. It was found that further tests would be necessary in such areas as fuel failure and dispersion for RIA, and high temperature cladding corrosion and mechanical deformation for LOCA. Since domestic fuels have been irradiated in PWR up to burnup higher than 55 MWD/kgU-rod. avg., it can be said that Korea is in the same situation as the other countries in the high burnup fuel safety issues. Therefore, necessary research areas to be performed in Korea were derived. Considering that post-irradiation examination(PIE) for the domestic fuel of burnup higher than 30 MWD/kgU has not been done so far at all, it is primarily necessary to perform PIE for high burnup fuel, and then simulation tests for RIA and LOCA could be performed by using high burnup fuel specimens. For the areas which can not be performed in Korea, international cooperation will be helpful to obtain the test results. With those data base, safety of high burnup domestic fuels will be confirmed, current fuel safety criteria will be re-evaluated, and finally transient high burnup fuel behavior analysis technology will be developed through the fuel performance analysis code development

  4. Analysis of high burnup fuel safety issues

    Lee, Chan Bock; Kim, D. H.; Bang, J. G.; Kim, Y. M.; Yang, Y. S.; Jung, Y. H.; Jeong, Y. H.; Nam, C.; Baik, J. H.; Song, K. W.; Kim, K. S

    2000-12-01

    Safety issues in steady state and transient behavior of high burnup LWR fuel above 50 - 60 MWD/kgU were analyzed. Effects of burnup extension upon fuel performance parameters was reviewed, and validity of both the fuel safety criteria and the performance analysis models which were based upon the lower burnup fuel test results was analyzed. It was found that further tests would be necessary in such areas as fuel failure and dispersion for RIA, and high temperature cladding corrosion and mechanical deformation for LOCA. Since domestic fuels have been irradiated in PWR up to burnup higher than 55 MWD/kgU-rod. avg., it can be said that Korea is in the same situation as the other countries in the high burnup fuel safety issues. Therefore, necessary research areas to be performed in Korea were derived. Considering that post-irradiation examination(PIE) for the domestic fuel of burnup higher than 30 MWD/kgU has not been done so far at all, it is primarily necessary to perform PIE for high burnup fuel, and then simulation tests for RIA and LOCA could be performed by using high burnup fuel specimens. For the areas which can not be performed in Korea, international cooperation will be helpful to obtain the test results. With those data base, safety of high burnup domestic fuels will be confirmed, current fuel safety criteria will be re-evaluated, and finally transient high burnup fuel behavior analysis technology will be developed through the fuel performance analysis code development.

  5. Contrast media. Safety issues and ESUR guidelines

    Thomsen, H.S. (ed.) [Copenhagen Univ. Hospital, Herlev (Denmark). Dept. of Diagnostic Radiology 54E2

    2006-07-01

    In 1994 the European Society of Urogenital Radiology (ESUR) set up a committee to consider the safety of the contrast media used in radiology departments. Since then, the committee has questioned members, reviewed the literature, proposed guidelines, and discussed these proposals with participants at the annual symposia on urogenital radiology. This book represents the end result of this hard work. It contains all of the agreed guidelines, updated when necessary, and thereby comprehensively covers the many different safety issues relating to the diverse contrast media: barium contrast media, iodinated contrast media, MR contrast media (both gadolinium-based extracellular and organ-specific) and ultrasound contrast media. The prevention and treatment of both acute and delayed non-renal adverse reactions as well as the renal adverse reactions are covered in detail. The inclusion of all the ESUR guidelines within one book will offer an invaluable, unique and unparalleled resource. (orig.)

  6. Contrast media. Safety issues and ESUR guidelines

    Thomsen, H.S.

    2006-01-01

    In 1994 the European Society of Urogenital Radiology (ESUR) set up a committee to consider the safety of the contrast media used in radiology departments. Since then, the committee has questioned members, reviewed the literature, proposed guidelines, and discussed these proposals with participants at the annual symposia on urogenital radiology. This book represents the end result of this hard work. It contains all of the agreed guidelines, updated when necessary, and thereby comprehensively covers the many different safety issues relating to the diverse contrast media: barium contrast media, iodinated contrast media, MR contrast media (both gadolinium-based extracellular and organ-specific) and ultrasound contrast media. The prevention and treatment of both acute and delayed non-renal adverse reactions as well as the renal adverse reactions are covered in detail. The inclusion of all the ESUR guidelines within one book will offer an invaluable, unique and unparalleled resource. (orig.)

  7. Dust Combustion Safety Issues for Fusion Applications

    L. C. Cadwallader

    2003-05-01

    This report summarizes the results of a safety research task to identify the safety issues and phenomenology of metallic dust fires and explosions that are postulated for fusion experiments. There are a variety of metal dusts that are created by plasma erosion and disruptions within the plasma chamber, as well as normal industrial dusts generated in the more conventional equipment in the balance of plant. For fusion, in-vessel dusts are generally mixtures of several elements; that is, the constituent elements in alloys and the variety of elements used for in-vessel materials. For example, in-vessel dust could be composed of beryllium from a first wall coating, tungsten from a divertor plate, copper from a plasma heating antenna or diagnostic, and perhaps some iron and chromium from the steel vessel wall or titanium and vanadium from the vessel wall. Each of these elements has its own unique combustion characteristics, and mixtures of elements must be evaluated for the mixture’s combustion properties. Issues of particle size, dust temperature, and presence of other combustible materials (i.e., deuterium and tritium) also affect combustion in air. Combustion in other gases has also been investigated to determine if there are safety concerns with “inert” atmospheres, such as nitrogen. Several coolants have also been reviewed to determine if coolant breach into the plasma chamber would enhance the combustion threat; for example, in-vessel steam from a water coolant breach will react with metal dust. The results of this review are presented here.

  8. Hydrogen Safety Issues Compared to Safety Issues with Methane and Propane

    Green, Michael A.

    2005-01-01

    The hydrogen economy is not possible if the safety standards currently applied to liquid hydrogen and hydrogen gas by many laboratories are applied to devices that use either liquid or gaseous hydrogen. Methane and propane are commonly used by ordinary people without the special training. This report asks, 'How is hydrogen different from flammable gasses that are commonly being used all over the world?' This report compares the properties of hydrogen, methane and propane and how these properties may relate to safety when they are used in both the liquid and gaseous state. Through such an analysis, sensible safety standards for the large-scale (or even small-scale) use of liquid and gaseous hydrogen systems can be developed. This paper is meant to promote discussion of issues related to hydrogen safety so that engineers designing equipment can factor sensible safety standards into their designs

  9. Hydrogen Safety Issues Compared to Safety Issues with Methane andPropane

    Green, Michael A.

    2005-08-20

    The hydrogen economy is not possible if the safety standards currently applied to liquid hydrogen and hydrogen gas by many laboratories are applied to devices that use either liquid or gaseous hydrogen. Methane and propane are commonly used by ordinary people without the special training. This report asks, 'How is hydrogen different from flammable gasses that are commonly being used all over the world?' This report compares the properties of hydrogen, methane and propane and how these properties may relate to safety when they are used in both the liquid and gaseous state. Through such an analysis, sensible safety standards for the large-scale (or even small-scale) use of liquid and gaseous hydrogen systems can be developed. This paper is meant to promote discussion of issues related to hydrogen safety so that engineers designing equipment can factor sensible safety standards into their designs.

  10. Questionnaire responses concerning safety issues in MR examination

    Yamaguchi-Sekino, Sachiko; Nakai, Toshiharu; Muranaka, Hiroyuki

    2011-01-01

    Recently, the rising numbers of medical implants and scanners with higher static magnetic field have increased safety concerns for magnetic resonance (MR) examination. To determine future safety focus, we distributed anonymous questionnaires to 3250 members of the Japanese Society for Magnetic Resonance in Medicine (JSMRM) and received 978 responses. Safety issues on the questionnaire concentrated on the handling of patients with implants (Q7-18, appendix), acoustic trauma due to scanning (Q19-21, appendix), and MR compatibility within the scanner room (Q22-25, appendix). Ninety-three percent of respondents indicated they had encountered cases with implants or medical materials of unknown MR compatibility; 21.7% reported heating problems and 15.0%, nerve stimulation problems, in patients with implants during MR examination. Although 88.7% of respondents recognized the term ''MR compatibility'', 68.2% indicated limited detailed understanding of the term. Eleven percent had had cases with suspected acoustic injury from MR scanner noise. Scanner noise levels were not clarified in any way in 37.4% cases, but 69.5% applied ear protection to patients. Labeling of ''MR compatibility'' of equipment brought into the MR scanner room was reported by 71.9%. More than 50% experienced MR compatibility issues related to equipment brought into the MR scanner room. With regard to safety issues on metallic objects which are implanted in MR workers, 88.1% indicated they would continue current operations even the implant is inside the body. Respondents identified lectures and seminars by professional societies, safety training by manufacturers, and information from the Internet and literature as the 3 main sources for up-dating safety information for MR examination. (author)

  11. Patient safety and nutrition: is there a connection? | Nieuwoudt ...

    Nutrition care is not always recognised as a patient safety issue. This article explores the origins of the patient safety initiative and seeks to identify possible connections between nutrition care and patient safety. Examples of tools that can be used to improve the safety of nutrition care are provided. This is also a call to action ...

  12. Health safety issues of synthetic food colorants.

    Amchova, Petra; Kotolova, Hana; Ruda-Kucerova, Jana

    2015-12-01

    Increasing attention has been recently paid to the toxicity of additives used in food. The European Parliament and the Council published the REGULATION (EC) No. 1333/2008 on food additives establishing that the toxicity of food additives evaluated before 20th January 2009 must be re-evaluated by European Food Safety Authority (EFSA). The aim of this review is to survey current knowledge specifically on the toxicity issues of synthetic food colorants using official reports published by the EFSA and other available studies published since the respective report. Synthetic colorants described are Tartrazine, Quinoline Yellow, Sunset Yellow, Azorubine, Ponceau 4R, Erythrosine, Allura Red, Patent Blue, Indigo Carmine, Brilliant Blue FCF, Green S, Brilliant Black and Brown HT. Moreover, a summary of evidence on possible detrimental effects of colorant mixes on children's behaviour is provided and future research directions are outlined. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Food safety measurement issues. Way forward

    Venkatesh Iyengar

    2013-01-01

    Ensuring food safety (FS) is a persistent concern frequently faced by many countries. Safeguarding the quality of food that is fit for human consumption is the primary responsibility of the governmental regulatory agencies. For most part, agro-industries and food processors assume voluntary leadership for producing safe food. However, in the event of FS breach, the regulatory responsibility kicks into identify and rectify the situation. Notwithstanding whether it is the regulator or the industry that institutes the remedial action (e.g. improved hygiene and refined agricultural and manufacturing practices), the role of laboratory measurements is central in safeguarding the integrity of a functioning FS system. There are many analytical tools available to implement this task, such as validated analytical methods, natural matrix reference materials, field tested monitoring systems (proactive assessment) and effective surveillance systems (constant vigilance to prevent repeat safety violations). Way forward: existing FS tools are insufficient and should be strengthened with innovative approaches. Examples are: assembling swift intervention logistics to face FS breaches; rapid response systems including communication; robust metrology based measurement systems located at strategic locations in the country; and inter-disciplinary human resource to match the need for capacity development. These issues are discussed. (author)

  14. Key issues on safety design basis selection and safety assessment

    An, S.; Togo, Y.

    1976-01-01

    In current fast reactor design in Japan, four design accident conditions and four design seismic conditions are adopted as the design base classifications. These are classified by the considerations on both likelihood of occurrence and the severeness of the consequences. There are several major problem areas in safety design consideration such as core accident problems which include fuel sodium interaction, fuel failure propagation and residual decay heat removal, and decay heat removal systems problems which is more or less the problem of selection of appropriate system and of assurance of high reliability of the system. In view of licensing, two kinds of accidents are postulated in evaluating the adequacy of a reactor site. The one is the ''major accident'' which is the accident to give most severe radiation hazard to the public from technical point of view. The other is the ''hypothetical accident'', induced public accident of which is severer than that of major accident. While the concept of the former is rather unique to Japanese licensing, the latter is almost equivalent to design base hypothetical accident of the US practice. In this paper, design bases selections, key safety issues and some of the licensing considerations in Japan are described

  15. Strategy for resolution of the flammable gas safety issue

    Johnson, G.D.

    1997-05-23

    This document provides a strategy for resolution of the Flammable Gas Safety Issue. It defines the key elements required for the following: Closing the Flammable Gas Unreviewed Safety Question (USQ); Providing the administrative basis for resolving the safety issue; Defining the data needed to support these activities; and Providing the technical and administrative path for removing tanks from the Watch List.

  16. Strategy for resolution of the flammable gas safety issue

    Johnson, G.D.

    1997-01-01

    This document provides a strategy for resolution of the Flammable Gas Safety Issue. It defines the key elements required for the following: Closing the Flammable Gas Unreviewed Safety Question (USQ); Providing the administrative basis for resolving the safety issue; Defining the data needed to support these activities; and Providing the technical and administrative path for removing tanks from the Watch List

  17. 76 FR 67461 - Cosmetic Microbiological Safety Issues; Public Meeting

    2011-11-01

    ...] Cosmetic Microbiological Safety Issues; Public Meeting AGENCY: Food and Drug Administration, HHS. ACTION... Administration (FDA) is announcing a public meeting entitled ``Cosmetic Microbiological Safety Issues.'' The... cosmetic microbiological safety and to suggest areas for the possible development of FDA guidance documents...

  18. Can we Improve Patient Safety?

    Martin Thomas Corbally

    2014-09-01

    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.

  19. Categorization of reactor safety issues from a risk perspective

    1985-03-01

    This report presents the results of an effort to identify and rank reactor safety and risk issues identified from past Probabilistic Risk Assessments (PRAs) and other safety analyses. Because of the varied scope of these analyses, the list of issues may be incomplete. Nevertheless, those studies comprised ordered analyses to whatever their respective depths; hence, they warranted scrutiny for whatever insights they could reveal with respect to issue importance. The top-ranked issues in terms of their contribution to the uncertainty in risk are described in some detail. All of these risk issues are compared to the generic safety issues for completeness and omissions

  20. Patient safety: lessons learned

    Bagian, James P.

    2006-01-01

    The traditional approach to patient safety in health care has ranged from reticence to outward denial of serious flaws. This undermines the otherwise remarkable advances in technology and information that have characterized the specialty of medical practice. In addition, lessons learned in industries outside health care, such as in aviation, provide opportunities for improvements that successfully reduce mishaps and errors while maintaining a standard of excellence. This is precisely the call in medicine prompted by the 1999 Institute of Medicine report ''To Err Is Human: Building a Safer Health System.'' However, to effect these changes, key components of a successful safety system must include: (1) communication, (2) a shift from a posture of reliance on human infallibility (hence ''shame and blame'') to checklists that recognize the contribution of the system and account for human limitations, and (3) a cultivation of non-punitive open and/or de-identified/anonymous reporting of safety concerns, including close calls, in addition to adverse events. (orig.)

  1. International conference on topical issues in nuclear safety. Contributed papers

    NONE

    2001-07-01

    The objective of the Conference was to foster the exchange of information on topical issues in nuclear safety, with the aim of consolidating an international consensus on the present status of these issues, priorities for future work, and needs for strengthening international cooperation, including the IAEA recommendations for future activities. This book contains concise contributed papers submitted on issues falling within the thematic scope of the Conference: risk informed decision making, influence of external factors on safety, safety of fuel cycle facilities, safety of research reactors, and safety performance indicators.

  2. International conference on topical issues in nuclear safety. Contributed papers

    2001-01-01

    The objective of the Conference was to foster the exchange of information on topical issues in nuclear safety, with the aim of consolidating an international consensus on the present status of these issues, priorities for future work, and needs for strengthening international cooperation, including the IAEA recommendations for future activities. This book contains concise contributed papers submitted on issues falling within the thematic scope of the Conference: risk informed decision making, influence of external factors on safety, safety of fuel cycle facilities, safety of research reactors, and safety performance indicators

  3. Can we improve patient safety?

    Corbally, Martin Thomas

    2014-01-01

    Despite greater awareness of patient safety issues especially in the operating room and the widespread implementation of surgical time out World Health Organization (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. If we wish to improve patient safety during surgery and avoid wrong site errors then we must include parents in the Surgical Pause/Time Out. A recent pilot study has shown that neither staff nor parents found it added to their stress, but, moreover, 100% of parents considered that it should be a mandatory component of the Surgical Pause nor does it add to the stress of surgery. Surgeons should be required to confirm that the planned procedure is in keeping with the operative findings especially in extirpative surgery and this "step back" should be incorporated into the standard Surgical Pause. It is clear that we must improve patient safety further and these simple measures should add to that potential.

  4. Nuclear power and related safety issues

    Valdezco, Eulinia M.

    2009-01-01

    There are a cluster of trends that reinforce the importance of nuclear power on the world scene. Energy is the essential underpinning for economic and societal progress and, as the developing world advances, the demand for energy is growing significantly. At the same time, the carbon-intensive sources of energy on which the world has traditionally relied - in particular, coal, oil, and natural gas - pose grave threats because the growing concentrations of carbon dioxide in the atmosphere will bring about climate and ocean acidification. At the same time, rising and volatile fossil fuel prices, coupled with concerns about the security of supplies of oil and gas, enhance interest in sources of energy that do not pose the same costs and risks. As an important part of the world's response to these threats, many countries are embarking on either new or expanded nuclear power programs, more commonly referred to as a nuclear renaissance. The construction of nuclear power plants is under consideration in over thirty countries that do not currently use nuclear power. For new entrants that may have experience in constructing and operating large-scale industrial and infrastructure projects, they may not be fully familiar with the unique requirements of nuclear power and may not be fully recognize the major commitments and understandings that they must assume. Additionally, an understanding of the full range of obligations may have diminished in those countries with only one or a few reactors and where nuclear construction has not been undertaken for a long time. It is therefore in the interest of all to ensure that every country with a nuclear power program has the resources, expertise, authority and capacity to assure safety in a complete and effective manner and is committed to doing so. This presentation will outline some of the more important national infrastructure considerations including nuclear safety issues for launching a nuclear power program. An update on the

  5. Laboratory safety and the WHO World Alliance for Patient Safety.

    McCay, Layla; Lemer, Claire; Wu, Albert W

    2009-06-01

    Laboratory medicine has been a pioneer in the field of patient safety; indeed, the College of American Pathology first called attention to the issue in 1946. Delivering reliable laboratory results has long been considered a priority, as the data produced in laboratory medicine have the potential to critically influence individual patients' diagnosis and management. Until recently, most attention on laboratory safety has focused on the analytic stage of laboratory medicine. Addressing this stage has led to significant and impressive improvements in the areas over which laboratories have direct control. However, recent data demonstrate that pre- and post-analytical phases are at least as vulnerable to errors; to further improve patient safety in laboratory medicine, attention must now be focused on the pre- and post-analytic phases, and the concept of patient safety as a multi-disciplinary, multi-stage and multi-system concept better understood. The World Alliance for Patient Safety (WAPS) supports improvement of patient safety globally and provides a potential framework for considering the total testing process.

  6. High-heat tank safety issue resolution program plan

    Wang, O.S.

    1993-12-01

    The purpose of this program plan is to provide a guide for selecting corrective actions that will mitigate and/or remediate the high-heat waste tank safety issue for single-shell tank (SST) 241-C-106. This program plan also outlines the logic for selecting approaches and tasks to mitigate and resolve the high-heat safety issue. The identified safety issue for high-heat tank 241-C-106 involves the potential release of nuclear waste to the environment as the result of heat-induced structural damage to the tank's concrete, if forced cooling is interrupted for extended periods. Currently, forced ventilation with added water to promote thermal conductivity and evaporation cooling is used to cool the waste. At this time, the only viable solution identified to resolve this safety issue is the removal of heat generating waste in the tank. This solution is being aggressively pursued as the permanent solution to this safety issue and also to support the present waste retrieval plan. Tank 241-C-106 has been selected as the first SST for retrieval. The program plan has three parts. The first part establishes program objectives and defines safety issues, drivers, and resolution criteria and strategy. The second part evaluates the high-heat safety issue and its mitigation and remediation methods and alternatives according to resolution logic. The third part identifies major tasks and alternatives for mitigation and resolution of the safety issue. Selected tasks and best-estimate schedules are also summarized in the program plan

  7. Unresolved safety issues: where do we go from here

    Aycock, M.B.

    1980-01-01

    Section 210 of the Energy reorganization Act of 1974, as amended requires the NRC to develop a program for resolving Unresolved Safety Issues related to nuclear power plants. Seventeen Unresolved Safety Issues were identified by the NRC in 1978 and by early 1979 the NRC Unresolved Safety Issues Program was quickly becoming a well defined and manageable effort. Although, the Three Mile Island accident caused the momentum developed in early 1979 to be lost, efforts on ongoing generic tasks were continued by a special NRC Task Force established in June 1979. The momentum that was lost must be regained, however, if the Congressional mandate in Section 210 is to be met. With increased industry involvement and the marriage of the Unresolved Safety Issues Program with the improved and broader safety program development, audit and evaluation activities of the new NRR Division of Safety Technology, this should be possible

  8. Status of safety issues at licensed power plants

    1991-06-01

    As part of ongoing US Nuclear Regulatory Commission (NRC) efforts to ensure the quality and accountability of safety issue information, a program has been established whereby an annual NUREG report will be published on the status of licensee implementation and NRC verification of safety issues in major NRC requirement areas. This report, the third volume of a three-volume series, addresses the status of generic safety issues (GSIs) at licensed plants. Volume 1 addressed the status of Three Mile Island Action Plan requirements and was published in March 1991. Volume 2 addressed the status of implementation and verification of unresolved safety issues and was published in May 1991. The annual NUREG report will combine these three areas in a single volume to be published in late 1991. The data contained in these NUREG reports are a product of the NRC's Safety Issues Management System (SIMS) database, which is maintained by the Project Management Staff in the Office of Nuclear Reactor Regulation and by NRC regional personnel. The purpose of this report is to provide a comprehensive description of the status of implementation and verification of the 34 GSIs and sub-issues that have been resolved by the NRC and involve implementation of an action or actions by licensees. This NUREG report also serves as a follow-on to NUREG-0933, ''A Prioritization of Generic Safety Issues,'' which tracks safety issues up until a request for action by licensees is issued by NRC. 3 figs., 6 tabs

  9. Ethical and Safety Issues of Stem Cell-Based Therapy.

    Volarevic, Vladislav; Markovic, Bojana Simovic; Gazdic, Marina; Volarevic, Ana; Jovicic, Nemanja; Arsenijevic, Nebojsa; Armstrong, Lyle; Djonov, Valentin; Lako, Majlinda; Stojkovic, Miodrag

    2018-01-01

    Results obtained from completed and on-going clinical studies indicate huge therapeutic potential of stem cell-based therapy in the treatment of degenerative, autoimmune and genetic disorders. However, clinical application of stem cells raises numerous ethical and safety concerns. In this review, we provide an overview of the most important ethical issues in stem cell therapy, as a contribution to the controversial debate about their clinical usage in regenerative and transplantation medicine. We describe ethical challenges regarding human embryonic stem cell (hESC) research, emphasizing that ethical dilemma involving the destruction of a human embryo is a major factor that may have limited the development of hESC-based clinical therapies. With previous derivation of induced pluripotent stem cells (iPSCs) this problem has been overcome, however current perspectives regarding clinical translation of iPSCs still remain. Unlimited differentiation potential of iPSCs which can be used in human reproductive cloning, as a risk for generation of genetically engineered human embryos and human-animal chimeras, is major ethical issue, while undesired differentiation and malignant transformation are major safety issues. Although clinical application of mesenchymal stem cells (MSCs) has shown beneficial effects in the therapy of autoimmune and chronic inflammatory diseases, the ability to promote tumor growth and metastasis and overestimated therapeutic potential of MSCs still provide concerns for the field of regenerative medicine. This review offers stem cell scientists, clinicians and patient's useful information and could be used as a starting point for more in-depth analysis of ethical and safety issues related to clinical application of stem cells.

  10. Patient safety culture among nurses.

    Ammouri, A A; Tailakh, A K; Muliira, J K; Geethakrishnan, R; Al Kindi, S N

    2015-03-01

    Patient safety is considered to be crucial to healthcare quality and is one of the major parameters monitored by all healthcare organizations around the world. Nurses play a vital role in maintaining and promoting patient safety due to the nature of their work. The purpose of this study was to investigate nurses' perceptions about patient safety culture and to identify the factors that need to be emphasized in order to develop and maintain the culture of safety among nurses in Oman. A descriptive and cross-sectional design was used. Patient safety culture was assessed by using the Hospital Survey on Patient Safety Culture among 414 registered nurses working in four major governmental hospitals in Oman. Descriptive statistics and general linear regression were employed to assess the association between patient safety culture and demographic variables. Nurses who perceived more supervisor or manager expectations, feedback and communications about errors, teamwork across hospital units, and hospital handoffs and transitions had more overall perception of patient safety. Nurses who perceived more teamwork within units and more feedback and communications about errors had more frequency of events reported. Furthermore, nurses who had more years of experience and were working in teaching hospitals had more perception of patient safety culture. Learning and continuous improvement, hospital management support, supervisor/manager expectations, feedback and communications about error, teamwork, hospital handoffs and transitions were found to be major patient safety culture predictors. Investing in practices and systems that focus on improving these aspects is likely to enhance the culture of patient safety in Omani hospitals and others like them. Strategies to nurture patient safety culture in Omani hospitals should focus upon building leadership capacity that support open communication, blame free, team work and continuous organizational learning. © 2014 International

  11. Hospital disinfection: efficacy and safety issues.

    Dettenkofer, Markus; Block, Colin

    2005-08-01

    To review recent publications relevant to hospital disinfection (and cleaning) including the reprocessing of medical instruments. The key question as to whether the use of disinfectants on environmental surfaces rather than cleaning with detergents only reduces nosocomial infection rates still awaits conclusive studies. New disinfectants, mainly peroxygen compounds, show good sporicidal properties and will probably replace more problematical substances such as chlorine-releasing agents. The safe reprocessing of medical devices requires a well-coordinated approach, starting with proper cleaning. New methods and substances show promising activity for preventing the transmission of prions. Different aspects of virus inactivation have been studied, and the transmissibility, e.g. of norovirus, shows the need for sound data on how different disinfectant classes perform. Biofilms or other forms of surface-adherent organisms pose an extraordinary challenge to decontamination. Although resistance to biocides is generally not judged to be as critical as antibiotic resistance, scientific data support the need for proper use, i.e. the avoidance of widespread application, especially in low concentrations and in consumer products. Chemical disinfection of heat-sensitive instruments and targeted disinfection of environmental surfaces are established components of hospital infection control. To avoid danger to staff, patients and the environment, prudent use as well as established safety precautions are required. New technologies and products should be evaluated with sound methods. As emerging resistant pathogens will challenge healthcare facilities in the future even more than at present, there is a need for well-designed studies addressing the role of disinfection in hospital infection control.

  12. Safety issues of tooth whitening using peroxide-based materials.

    Li, Y; Greenwall, L

    2013-07-01

    In-office tooth whitening using hydrogen peroxide (H₂O₂) has been practised in dentistry without significant safety concerns for more than a century. While few disputes exist regarding the efficacy of peroxide-based at-home whitening since its first introduction in 1989, its safety has been the cause of controversy and concern. This article reviews and discusses safety issues of tooth whitening using peroxide-based materials, including biological properties and toxicology of H₂O₂, use of chlorine dioxide, safety studies on tooth whitening, and clinical considerations of its use. Data accumulated during the last two decades demonstrate that, when used properly, peroxide-based tooth whitening is safe and effective. The most commonly seen side effects are tooth sensitivity and gingival irritation, which are usually mild to moderate and transient. So far there is no evidence of significant health risks associated with tooth whitening; however, potential adverse effects can occur with inappropriate application, abuse, or the use of inappropriate whitening products. With the knowledge on peroxide-based whitening materials and the recognition of potential adverse effects associated with the procedure, dental professionals are able to formulate an effective and safe tooth whitening regimen for individual patients to achieve maximal benefits while minimising potential risks.

  13. Food control concept: Food safety/ingestion issues

    Armstrong, B.

    1995-01-01

    This talk outlines the issues in food safety/ingestion in the case of radiation accidents at nuclear power plants and how emergency preparedness plans can/should be tailored. The major topics are as follows: In Washington: food safety/ingestion issues exist at transition between response and regulatory worlds; agricultural concerns; customer concerns; Three Mile Island: detailed maps; development of response procedures; development of tools; legal issues

  14. Patient Safety Threat - Syringe Reuse

    ... Safety Stakeholder Meeting December 2009 The One & Only Campaign Patient Notification Toolkit Developing Documents for a Patient Notification Planning Media and Communication Strategies Writing for the Media Spokesperson Preparation Planning the ...

  15. Status of safety issues at licensed power plants

    1991-05-01

    As part of ongoing US Nuclear Regulatory Commission (NRC) efforts to ensure the quality and accountability of safety issue information, a program has been established whereby an annual NUREG report will be published on the status of licensee implementation and NRC verification of safety issues in major NRC requirement areas. This report, the second volume of a three-volume series, addresses the status of unresolved safety issues (USIs) at licensed plants. The data contained in these NUREG reports are a product of the NRC's Safety Issues Management System (SIMS) database, which is maintained by the Project Management Staff in the Office of Nuclear Reactor Regulation and by NRC regional personnel. The purpose of this report is to provide a comprehensive description of the status of implementation and verification of the 27 safety issues designated as USIs and to make this information available to other interested parties, including the public. A corollary purpose of this NUREG report is to serve as a follow-on to NUREG-0933, ''A Prioritization of Generic Safety Issues,'' which tracks safety issues up until requirements are approved for imposition at licensed plants. 3 figs., 4 tabs

  16. Developing patient safety in dentistry.

    Pemberton, M N

    2014-10-01

    Patient safety has always been important and is a source of public concern. Recent high profile scandals and subsequent reports, such as the Francis report into the failings at Mid Staffordshire, have raised those concerns even higher. Mortality and significant morbidity associated with the practice of medicine has led to many strategies to help improve patient safety, however, with its lack of associated mortality and lower associated morbidity, dentistry has been slower at systematically considering how patient safety can be improved. Recently, several organisations, researchers and clinicians have discussed the need for a patient safety culture in dentistry. Strategies are available to help improve patient safety in healthcare and deserve further consideration in dentistry.

  17. Nuclear power plant safety related pump issues

    Colaccino, J.

    1996-12-01

    This paper summarizes of a number of pump issues raised since the Third NRC/ASME Symposium on Valve and Pump Testing in 1994. General issues discussed include revision of NRC Inspection Procedure 73756, issuance of NRC Information Notice 95-08 on ultrasonic flow meter uncertainties, relief requests for tests that are determined by the licensee to be impractical, and items in the ASME OM-1995 Code, Subsection ISTB, for pumps. The paper also discusses current pump vibration issues encountered in relief requests and plant inspections - which include smooth running pumps, absolute vibration limits, and vertical centrifugal pump vibration measurement requirements. Two pump scope issues involving boiling water reactor waterlog and reactor core isolation cooling pumps are also discussed. Where appropriate, NRC guidance is discussed.

  18. Nuclear power plant safety related pump issues

    Colaccino, J.

    1996-01-01

    This paper summarizes of a number of pump issues raised since the Third NRC/ASME Symposium on Valve and Pump Testing in 1994. General issues discussed include revision of NRC Inspection Procedure 73756, issuance of NRC Information Notice 95-08 on ultrasonic flow meter uncertainties, relief requests for tests that are determined by the licensee to be impractical, and items in the ASME OM-1995 Code, Subsection ISTB, for pumps. The paper also discusses current pump vibration issues encountered in relief requests and plant inspections - which include smooth running pumps, absolute vibration limits, and vertical centrifugal pump vibration measurement requirements. Two pump scope issues involving boiling water reactor waterlog and reactor core isolation cooling pumps are also discussed. Where appropriate, NRC guidance is discussed

  19. Chemical Hazards and Safety Issues in Fusion Safety Design

    Cadwallader, L.C.

    2003-01-01

    Radiological inventory releases have dominated accident consequences for fusion; these consequences are important to analyze and are generally the most severe result of a fusion facility accident event. However, the advent of, or plan for, large-scale usage of some toxic materials poses the additional hazard of chemical exposure from an accident event. Examples of toxic chemicals are beryllium for magnetic fusion and fluorine for laser fusion. Therefore, chemical exposure consequences must also be addressed in fusion safety assessment. This paper provides guidance for fusion safety analysis. US Department of Energy (DOE) chemical safety assessment practices for workers and the public are reviewed. The US Environmental Protection Agency (EPA) has published some guidance on public exposure to releases of mixtures of chemicals, this guidance has been used to create an initial guideline for treating mixed radiological and toxicological releases in fusion; for example, tritiated hazardous dust from a tokamak vacuum vessel. There is no convenient means to judge the hazard severity of exposure to mixed materials. The chemical fate of mixed material constituents must be reviewed to determine if there is a separate or combined radiological and toxicological carcinogenesis, or if other health threats exist with radiological carcinogenesis. Recommendations are made for fusion facility chemical safety evaluation and safety guidance for protecting the public from chemical releases, since such levels are not specifically identified in the DOE fusion safety standard

  20. Light Water Reactor Generic Safety Issues Database (LWRGSIDB). User's manual

    1999-01-01

    The IAEA Conference on 'The Safety of Nuclear Power: Strategy for the Future' in 1991 was a milestone in nuclear safety. The objective of this conference was to review nuclear power safety issues for which achieving international consensus would be desirable, to address concerns on nuclear safety and to formulate recommendations for future actions by national and international authorities to advance nuclear safety to the highest level. Two of the important items addressed by this conference were ensuring and enhancing safety of operating plants and treatment of nuclear power plants built to earlier safety standards. Some of the publications related to these two items that have been issued subsequent to this conference are: A Common Basis for Judging the Safety of Nuclear Power Plants Built to Earlier Standards, INSAG-8 (1995), the IAEA Safety Guide 50-SG-O12, Periodic Safety Review of Operational Nuclear Power Plants (1994) and IAEA Safety Reports Series No. 12, Evaluation of the Safety of Operating Nuclear Power Plants Built to Earlier Standards: A Common Basis for Judgement (1998). Some of the findings of the 1991 conference have not yet been fully addressed. An IAEA Symposium on Reviewing the Safety of Existing Nuclear Power Plants in 1996 showed that there is an urgent need for operating organizations and national authorities to review those operating nuclear power plants which do not reach the high safety levels of the vast majority of plants and to undertake improvements with assistance from the international community if required. Safety reviews of operating nuclear power plants take on added importance in the context of the Convention on Nuclear Safety and its implementation. In order to perform safety reviews and to reassess the safety of operating nuclear power plants in a uniform manner, it is imperative to have an internationally accepted reference. Existing guidance needs to be complemented by a list of safety issues which have been encountered and

  1. [Operating Room Nurses' Experiences of Securing for Patient Safety].

    Park, Kwang Ok; Kim, Jong Kyung; Kim, Myoung Sook

    2015-10-01

    This study was done to evaluate the experience of securing patient safety in hospital operating rooms. Experiential data were collected from 15 operating room nurses through in-depth interviews. The main question was "Could you describe your experience with patient safety in the operating room?". Qualitative data from the field and transcribed notes were analyzed using Strauss and Corbin's grounded theory methodology. The core category of experience with patient safety in the operating room was 'trying to maintain principles of patient safety during high-risk surgical procedures'. The participants used two interactional strategies: 'attempt continuous improvement', 'immersion in operation with sharing issues of patient safety'. The results indicate that the important factors for ensuring the safety of patients in the operating room are manpower, education, and a system for patient safety. Successful and safe surgery requires communication, teamwork and recognition of the importance of patient safety by the surgical team.

  2. Relevant safety issues in designing the HTR-10 reactor

    Sun Yuliang; Xu Yuanghui

    2001-01-01

    The HTR-10 is a 10 MWth pebble bed high temperature gas cooled reactor being constructed as a research facility at the Institute of Nuclear Energy Technology. This paper discusses design issues of the HTR-10 which are related to safety. It addresses the safety criteria used in the development and assessment of the design, the safety important systems, and the safety classification of components. It also summarises the results of safety analysis, including the approach used for the radioactive source term, as well as the approach to containment design. (author)

  3. Unresolved safety issues summary. Aqua Book. Volume 6, No. 3

    Butts, J.

    1984-01-01

    The unresolved safety issues summary is designed to provide the management of the Nuclear Regulatory Commission with a quarterly overview of the progress and plans for completion of generic tasks addressing unresolved safety issues reported to Congress pursuant to Section 210 of the Energy Reorganization Act of 1974 as amended. This summary utilizes data collected from the Office of Nuclear Reactor Regulation, Office of Nuclear Regulatory Research, and the national laboratories and is prepared by the Office of Nuclear Reactor Regulation

  4. Safety Issues with Hydrogen as a Vehicle Fuel

    L. C. Cadwallader; J. S. Herring

    1999-09-01

    This report is an initial effort to identify and evaluate safety issues associated with the use of hydrogen as a vehicle fuel in automobiles. Several forms of hydrogen have been considered: gas, liquid, slush, and hydrides. The safety issues have been discussed, beginning with properties of hydrogen and the phenomenology of hydrogen combustion. Safety-related operating experiences with hydrogen vehicles have been summarized to identify concerns that must be addressed in future design activities and to support probabilistic risk assessment. Also, applicable codes, standards, and regulations pertaining to hydrogen usage and refueling have been identified and are briefly discussed. This report serves as a safety foundation for any future hydrogen safety work, such as a safety analysis or a probabilistic risk assessment.

  5. Safety Issues with Hydrogen as a Vehicle Fuel

    Cadwallader, Lee Charles; Herring, James Stephen

    1999-10-01

    This report is an initial effort to identify and evaluate safety issues associated with the use of hydrogen as a vehicle fuel in automobiles. Several forms of hydrogen have been considered: gas, liquid, slush, and hydrides. The safety issues have been discussed, beginning with properties of hydrogen and the phenomenology of hydrogen combustion. Safety-related operating experiences with hydrogen vehicles have been summarized to identify concerns that must be addressed in future design activities and to support probabilistic risk assessment. Also, applicable codes, standards, and regulations pertaining to hydrogen usage and refueling have been identified and are briefly discussed. This report serves as a safety foundation for any future hydrogen safety work, such as a safety analysis or a probabilistic risk assessment.

  6. Health, safety and environmental issues in thin film manufacturing

    Alsema, E.A.; Baumann, A.E.; Hill, R.; Patterson, M.H.

    1997-01-01

    An investigation is made of Health, Safety and Environmental (HSE) aspects for the manufacturing, use and decommissioning of CdTe, CIS and a-Si modules. Issues regarding energy requirements, resource availability, emissions of toxic materials, occupational health and safety and module waste

  7. Analysis of safety issues in household meat consumption in Odeda ...

    The study analyzed the safety problems with household meat consumption in Odeda Local Government Area, Ogun state, Nigeria. The objectives were to describe the socioeconomic characteristics of the respondents; assess the level of awareness of safety issues in households' meat consumption; and evaluate the ...

  8. Special Issue. 5th Meeting on Technology and Safety

    Kusakabe, Masashi; Kumagaya, Tadafusa; Minohara, Shinichi

    2010-01-01

    The documents in this Special Issue are the representative reports of achievements presented in the National Institute of Radiological Sciences (NIRS) 5th Meeting on Technology and Safety held on March 17, 2010. Personnel and investigators of NIRS and related companies gave their achievements by 19 oral and 31 poster presentations in fields of [IAR] irradiation (2 topics), accelerator/radiometry (9 topics), [EA] experimental animals (25 topics), [SM] safety management of facilities (5 topics), computer network system (4 topics), experimental instrument (1 topic), molecular imaging (2 topics) and others (2 topics). The Issue contains, as well as introductory and ending remarks, following 12 topics: [IAR] Working report of patient positioning system for radiotherapy with use of X-ray flat panel detector; Status of maintenance and management of facilities and equipments in Research center for Radiation Emergency Medicine; [EA] Past, present and future of mouse breeding in NIRS; Breeding of marmoset in NIRS/How can we have a bouncing marmoset baby?; Establishment of a genotyping method of transformed genes in transgenic mouse/genome walking method; Genetic monitoring system of mice by micro-satellite marker and its application in NIRS; Verification of sorting precision of FACSAria (Becton Dickinson and Co.), a highly sensitive, rapid sorting apparatus of cells/for precise sorting; Proposal of a task-solution workflow to determine the animal features for molecular imaging studies; [SM] Toward the introduction of Occupational Safety and Health Management System in NIRS; Use of unsealed radioisotopes less than the lower limit outside the legal control area; Arrangement of managing and supporting system for clinical studies; and Rearrangement of working system of personnel affairs. (T.T.)

  9. The Norwegian Plan of Action for nuclear safety issues

    1997-07-01

    The Plan of Action underlies Norwegian activities in the field of international co-operation to enhance nuclear safety and prevent radioactive contamination from activities in Eastern Europe and the former Soviet Union. Geographically the highest priority has been given to support for safety measures in north-west Russia. This information brochure outlines the main content of the Plan of Action for nuclear safety issues and lists a number of associated measures and projects

  10. The Norwegian Plan of Action for nuclear safety issues

    NONE

    1997-07-01

    The Plan of Action underlies Norwegian activities in the field of international co-operation to enhance nuclear safety and prevent radioactive contamination from activities in Eastern Europe and the former Soviet Union. Geographically the highest priority has been given to support for safety measures in north-west Russia. This information brochure outlines the main content of the Plan of Action for nuclear safety issues and lists a number of associated measures and projects.

  11. Safety Culture and Issue in the Malaysian Manufacturing Sector

    Ali Danish; Yusof Yusri; Adam Anbia

    2017-01-01

    . This paper highlights the Safety culture and issue in the Malaysian Manufacturing Sector and emphasis the high occupational accidents due to lack of safety culture and non-compliance of the requirements of Occupational Safety and Health Act 1994. The aim of this study is to review the occupational accidents occurrence in the Malaysia workplace since 2012-2016. Malaysia aimed to reduce the occupational accidents, the results show by DOSH increase that Occupational Noise Induced Hearing Loss ...

  12. Gender issues on occupational safety and health.

    Sorrentino, Eugenio; Vona, Rosa; Monterosso, Davide; Giammarioli, Anna Maria

    2016-01-01

    The increasing proportion of women in the workforce raises a range of gender-related questions about the different effects of work-related risks on men and women. Few studies have characterized gender differences across occupations and industries, although at this time, the gender sensitive approach is starting to acquire relevance in the field of human preventive medicine. The European Agency for Safety and Health at Work has encouraged a policy of gender equality in all European member states. Italy has adopted European provisions with new specific legislation that integrates the previous laws and introduces the gender differences into the workplace. Despite the fact that gender equal legislation opportunities have been enacted in Italy, their application is delayed by some difficulties. This review examines some of these critical aspects.

  13. Systems Thinking and Patient Safety

    Schyve, Paul M

    2005-01-01

    Patient safety is a prominent theme in health care delivery today. This should come as no surprise, given that "first, do no harm" has been the ethical watchword throughout the history of medicine, nursing, and pharmacy...

  14. Draft pilot report - Approaches to the resolution of safety issues

    2006-01-01

    The purpose of this report is to present in a concise form how some safety matters associated with currently operating light water reactors have been addressed. The issues discussed in this report are common to member countries with currently operating LWRs (PWR, BWR, VVER) and, as such, have wide interest in the nuclear safety community. Accordingly, this report can serve as a reference for researchers, regulations and others (e.g., industry) interested in understanding the approach and status of issues. This report should also be useful for knowledge transfer by documenting what has been done or is planned regarding selected safety matters and as a source for identifying reference material containing additional detail. The issues addressed in this report should not be viewed as questioning the safety of operating reactors, which have reached very high operational safety record, but rather as areas where uncertainty in knowledge exists, where safety assessment has been based on conservative assumptions, and where regulatory decisions need, or will need to be confirmed. Thus, the development of sound technical bases through continuing research will improve the current knowledge and allow for more realistic safety assessment. The safety issues discussed in this initial version of the report are: - design basis accident spectrum; - severe accident issues; - reactor pressure vessel integrity; - hydrogen control; - containment integrity; - accident management; - station blackout; - high burnup fuel; - power up-rates; - ECCS strainer clogging; - boron dilution. For each issue, the scope of the issue is defined, its status discussed and planned work or research described, including schedule. This pilot version of the report is limited to input from nine countries (Belgium, Czech Republic, Finland, France, Germany, Japan, Korea, Sweden and the U.S.). An overview of this information for each issue by country is provided in the table. This document does not contain a

  15. Status of safety issues at licensed power plants

    1991-03-01

    As part of ongoing US Nuclear Regulatory Commission (NRC) efforts to ensure the quality and accountability of safety issue information, a program has been established whereby an annual NUREG series report will be published on the status of licensee implementation and NRC verification of safety issues in major NRC requirement areas. The data contained in this report are a product of the NRC's Safety Issues Management System database, which is maintained by the Project Management Staff in the Office of Nuclear Reactor Regulation and by personnel in the NRC regions. This report has been prepared in order to provide a comprehensive description of the implementation and verification status of all the TMI Action Plan requirements at licensed reactors, and to make this information available to other interested parties, including the public. A corollary purpose of this report is for it to serve as a follow-on to NUREG-0933, ''A Prioritization of Safety Issues,'' which tracks safety issues up until requirements are approved for imposition at licensed facilities

  16. Mobility and safety issues in drivers with dementia.

    Carr, David B; O'Neill, Desmond

    2015-10-01

    Although automobiles remain the mobility method of choice for older adults, late-life cognitive impairment and progressive dementia will eventually impair the ability to meet transport needs of many. There is, however, no commonly utilized method of assessing dementia severity in relation to driving, no consensus on the specific types of assessments that should be applied to older drivers with cognitive impairment, and no gold standard for determining driving fitness or approaching loss of mobility and subsequent counseling. Yet, clinicians are often called upon by patients, their families, health professionals, and driver licensing authorities to assess their patients' fitness-to-drive and to make recommendations about driving privileges. We summarize the literature on dementia and driving, discuss evidenced-based assessments of fitness-to-drive, and outline the important ethical and legal concerns. We address the role of physician assessment, referral to neuropsychology, functional screens, dementia severity tools, driving evaluation clinics, and driver licensing authority referrals that may assist clinicians with an evaluation. Finally, we discuss mobility counseling (e.g. exploration of transportation alternatives) since health professionals need to address this important issue for older adults who lose the ability to drive. The application of a comprehensive, interdisciplinary approach to the older driver with cognitive impairment will have the best opportunity to enhance our patients' social connectedness and quality of life, while meeting their psychological and medical needs and maintaining personal and public safety.

  17. Breakout Session A: Safety Issues. Report from breakout session and discussion on safety issues

    Petit, Marc

    2013-01-01

    The first issue discussed during the breakout session on safety aspects of accident-tolerant fuels was the objective that must be assigned to the development of such concepts. The first goal should be to avoid, or at least limit, the release of radioactive materials into the environment in case of an accident. This implies that severe accidents (core melt) situations must be avoided. To reach this goal, the core geometry must remain coolable, even for accident scenarios worse than what current fuel designs are able to sustain. There was a consensus that the station blackout (SBO) is a good reference transient to evaluate the potential benefits from new, more robust, fuel designs. With respect to the present situation, the merits of new designs can be analysed with respect to three figures: - the 'grace period', i.e. the additional amount of time before the onset of core melt, during which more recovery actions can be made; - the amount of combustible gases produced; - the amount of radioactive materials released. It is important to note that those three values are not independent from one another. They may be understood as three different ways to measure the improvements arising from accident tolerant fuels. The notion of 'grace period' was discussed and it was suggested that it should be compared to the amount of time needed to switch from normal operation to accident management type of procedures. The participants agreed that the 'grace period' should be counted in hours (or even days but the realism of this last goal was questioned). In other words, there was a consensus that a 'grace period' of some minutes is pointless and definitely not worth the effort of developing and characterising the behaviour of new concepts. Although the purpose of accident-tolerant fuel development is to improve the core robustness in design basis accidents (DBA) and situations somewhat beyond like SBO, it was recognised that new concepts must

  18. Effect of generic issues program on improving safety

    Fard, M. R.; Kauffman, J. V.

    2010-01-01

    The U.S. Nuclear Regulatory Commission (NRC) identifies (by its assessment of plant operation) certain issues involving public health and safety, the common defense and security, or the environment that could affect multiple entities under NRC jurisdiction. The Generic Issues Program (GIP) addresses the resolution of these Generic Issues (GIs). The resolution of these issues may involve new or revised rules, new or revised guidance, or revised interpretation of rules or guidance that affect nuclear power plant licensees, nuclear material certificate holders, or holders of other regulatory approvals. U.S. NRC provides information related to the past and ongoing GIP activities to the general public by the use of three main resources, namely NUREG-0933, 'Resolution of Generic Safety Issues, ' Generic Issues Management Control System (GIMCS), and GIP public web page. GIP information resources provide information such as historical information on resolved GIs, current status of the open GIs, policy documents, program procedures, GIP annual and quarterly reports and the process to contact GIP and propose a GI This paper provides an overview of the GIP and several examples of safety improvements resulting from the resolution of GIs. In addition, the paper provides a brief discussion of a few recent GIs to illustrate how the program functions to improve safety. (authors)

  19. An Organizational Learning Framework for Patient Safety.

    Edwards, Marc T

    Despite concerted effort to improve quality and safety, high reliability remains a distant goal. Although this likely reflects the challenge of organizational change, persistent controversy over basic issues suggests that weaknesses in conceptual models may contribute. The essence of operational improvement is organizational learning. This article presents a framework for identifying leverage points for improvement based on organizational learning theory and applies it to an analysis of current practice and controversy. Organizations learn from others, from defects, from measurement, and from mindfulness. These learning modes correspond with contemporary themes of collaboration, no blame for human error, accountability for performance, and managing the unexpected. The collaborative model has dominated improvement efforts. Greater attention to the underdeveloped modes of organizational learning may foster more rapid progress in patient safety by increasing organizational capabilities, strengthening a culture of safety, and fixing more of the process problems that contribute to patient harm.

  20. Safety of research reactors. Topical issues paper no. 4

    Alcala-Ruiz, F.; Ferraz-Bastos, J.L.; Kim, S.C.; Voth, M.; Boeck, H.; Dimeglio, F.; Litai, D.

    2001-01-01

    Assessment of Research Reactors (INSARR) missions. The prime objective of these missions has been to conduct a comprehensive operational safety review of the research reactor facility and to verify compliance with the IAEA Safety Standards. The methods used during an INSARR mission have been collected and analysed. Some of the important issues identified are the following: general ageing of the facility; uncertain status of many research reactors (in extended shutdown); indefinite deferral of return to operation or decommissioning; inadequate regulatory supervision; insufficient systematic (periodic) reassessment of safety; lack of quality assurance (QA) programmes; lack of an international safety convention or arrangement; lack of financial support for safety measures (e.g. safety reassessment, safety upgrading, decommissioning) and utilization; lack of clear utilization programmes; inadequate emergency preparedness; inadequate safety documentation (e.g. safety analysis report, operating rules and procedures, emergency plan); inadequate funding of shutdown reactors; weak safety culture; loss of expertise and corporate memory; loss of information concerning radioactive materials contained in retired experimental devices stored in the facility indefinitely; obsolescence of equipment and lack of spare parts; inadequate training and qualifications of regulators and operators; safety implications of new fuel types. These issues have been addressed by the IAEA Secretariat and the chairman of the International Nuclear Safety Advisory Group (INSAG). INSAG has identified three major safety issues that are: the increasing age of research reactors, the number of research reactors that are not operating anymore but have not been decommissioned, and the number of research reactors in countries that do not have appropriate regulatory authorities. This issue paper discusses the concerns generated by an analysis of the results of INSARR missions and those expressed by INSAG. The

  1. Improving Patient Safety: Improving Communication.

    Bittner-Fagan, Heather; Davis, Joshua; Savoy, Margot

    2017-12-01

    Communication among physicians, staff, and patients is a critical element in patient safety. Effective communication skills can be taught and improved through training and awareness. The practice of family medicine allows for long-term relationships with patients, which affords opportunities for ongoing, high-quality communication. There are many barriers to effective communication, including patient factors, clinician factors, and system factors, but tools and strategies exist to address these barriers, improve communication, and engage patients in their care. Use of universal precautions for health literacy, appropriate medical interpreters, and shared decision-making are evidence-based tools that improve communication and increase patient safety. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  2. Collegiate Aviation Research and Education Solutions to Critical Safety Issues

    Bowen, Brent (Editor)

    2002-01-01

    This Conference Proceedings is a collection of 6 abstracts and 3 papers presented April 19-20, 2001 in Denver, CO. The conference focus was "Best Practices and Benchmarking in Collegiate and Industry Programs". Topics covered include: satellite-based aviation navigation; weather safety training; human-behavior and aircraft maintenance issues; disaster preparedness; the collegiate aviation emergency response checklist; aviation safety research; and regulatory status of maintenance resource management.

  3. Assemblages of Patient Safety

    Balatsas Lekkas, Angelos

    2016-01-01

    This thesis identifies how design processes emerge during the use of devices in healthcare, by attending to assemblages where contingencies of risk and harm co-exist with the contribution of healthcare professionals to the safe care of patients. With support from the field of Science and Technology...... practices of interdisciplinary care....

  4. Unresolved safety issues summary. Volume 3, Number 3. Aqua book

    1981-01-01

    The 'Unresolved Safety Issues' summary is designed to provide the management of the Nuclear Regulatory Commission with a quarterly overview of the progress and plans for completion of generic tasks addressing Unresolved Safety Issues reported to Congress pursuant to section 210 of The Energy Reorganization Act of 1974 as amended. This summary utilizes data collected from the Office of Nuclear Reactor Regulation, Office of Nuclear Regulatory Research, and the National Laboratories and is prepared by the office of Management and Program Analysis. The definition of what constitutes completion of an unresolved safety issue (USI) has recently been expanded to include the implementation of the technical resolution. This is in acknowledgement of the fact that real safety benefits occur only after the implementation has taken place. The schedules in this book include a milestone at the end of each action plan which represents the initiation of the implementation process both with respect to incorporation of the technical resolution in the NRC official guidance or requirements and also the application of changes to individual operating plants. The schedule for implementation will not normally be included in the task action plan(s) for the resolution of a USI since the nature and extent of the activities necessary to accomplish the implementation cannot normally be reasonably determined prior to the determination of a technical resolution. The progress and status for implementation of unresolved safety issues for which a technical resolution has been completed are reported specifically in a separate table provided in this summary

  5. Advanced nuclear reactor safety issues and research needs

    2002-01-01

    On 18-20 February 2002, the OECD Nuclear Energy Agency (NEA) organised, with the co-sponsorship of the International Atomic Energy Agency (IAEA) and in collaboration with the European Commission (EC), a Workshop on Advanced Nuclear Reactor Safety Issues and Research Needs. Currently, advanced nuclear reactor projects range from the development of evolutionary and advanced light water reactor (LWR) designs to initial work to develop even further advanced designs which go beyond LWR technology (e.g. high-temperature gas-cooled reactors and liquid metal-cooled reactors). These advanced designs include a greater use of advanced technology and safety features than those employed in currently operating plants or approved designs. The objectives of the workshop were to: - facilitate early identification and resolution of safety issues by developing a consensus among participating countries on the identification of safety issues, the scope of research needed to address these issues and a potential approach to their resolution; - promote the preservation of knowledge and expertise on advanced reactor technology; - provide input to the Generation IV International Forum Technology Road-map. In addition, the workshop tried to link advancement of knowledge and understanding of advanced designs to the regulatory process, with emphasis on building public confidence. It also helped to document current views on advanced reactor safety and technology, thereby contributing to preserving knowledge and expertise before it is lost. (author)

  6. Patient safety: break the silence.

    Johnson, Hope L; Kimsey, Diane

    2012-05-01

    A culture of patient safety requires commitment and full participation from all staff members. In 2008, results of a culture of patient safety survey conducted in the perioperative division of the Lehigh Valley Health Network in Pennsylvania revealed a lack of patient-centered focus, teamwork, and positive communication. As a result, perioperative leaders assembled a multidisciplinary team that designed a safety training program focusing on Crew Resource Management, TeamSTEPPS, and communication techniques. The team used video vignettes and an audience response system to engage learners and promote participation. Topics included using preprocedural briefings and postprocedural debriefings, conflict resolution, and assertiveness techniques. Postcourse evaluations showed that the majority of respondents believed they were better able to question the decisions or actions of someone with more authority. The facility has experienced a marked decrease in the number of incidents requiring a root cause analysis since the program was conducted. Copyright © 2012 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  7. Patient safety is not elective: a debate at the NPSF Patient Safety Congress.

    McTiernan, Patricia; Wachter, Robert M; Meyer, Gregg S; Gandhi, Tejal K

    2015-02-01

    The opening keynote session of the 16th Annual National Patient Safety Foundation Patient Safety Congress, held 14-16 May 2014, featured a debate addressing the merits and challenges of accountability with respect to key issues in patient safety. The specific resolution debated was: Certain safety practices should be inviolable, and transgressions should result in penalties, potentially including fines, suspensions, and firing. The themes discussed in the debate are issues that healthcare professionals and leaders commonly struggle with in their day-to-day work. How do we draw a line between systems problems and personal failings? When should clinicians and staff be penalised for failing to follow a known safety protocol? The majority of those who listened to the live debate agreed that it is time to begin holding health professionals accountable when they wilfully or repeatedly violate policies or protocols put in place by their institutions to protect the safety of patients. This article summarises the debate as well as the questions and discussion generated by each side. A video of the original debate can be found at http://bit.ly/Npsf_debate. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  8. Keeping nurse researchers safe: workplace health and safety issues.

    Barr, Jennieffer; Welch, Anthony

    2012-07-01

    This article is a report of a qualitative study of workplace health and safety issues in nursing research. Researcher health and safety have become increasing concerns as there is an increased amount of research undertaken in the community and yet there is a lack of appropriate guidelines on how to keep researchers safe when undertaking fieldwork. This study employed a descriptive qualitative approach, using different sources of data to find any references to researcher health and safety issues. A simple descriptive approach to inquiry was used for this study. Three approaches to data collection were used: interviews with 15 researchers, audits of 18 ethics applications, and exploration of the literature between 1992 and 2010 for examples of researcher safety issues. Data analysis from the three approaches identified participant comments, narrative descriptions or statements focused on researcher health and safety. Nurse researchers' health and safety may be at risk when conducting research in the community. Particular concern involves conducting sensitive research where researchers are physically at risk of being harmed, or being exposed to the development of somatic symptoms. Nurse researchers may perceive the level of risk of harm as lower than the actual or potential harm present in research. Nurse researchers do not consistently implement risk assessment before and during research. Researcher health and safety should be carefully considered at all stages of the research process. Research focusing on sensitive data and vulnerable populations need to consider risk minimization through strategies such as appropriate researcher preparation, safety during data collection, and debriefing if required. © 2012 Blackwell Publishing Ltd.

  9. Safety performance indicators. Topical issues paper no. 5

    Dahlgren, K.; Lederman, L.; Szikszai, T.; Palomo, J.

    2001-01-01

    performance, they are just one of a larger set of tools including probabilistic safety assessment (PSA), regulatory inspection, quality assurance, external reviews and self-assessment needed to assess operational safety performance. The integration of information compiled from such evaluation tools yields the best results. Two areas of increasingly common interest are 'risk based' indicators, and 'safety culture' indicators. The key to managing the nuclear business today is to establish a high quality safety management system as well as developing a strong safety culture within the entire organization. 'The safety management system comprises those arrangements made by the organization for the management of safety in order to promote a strong safety culture and achieve good safety performance'. This definition, presented in INSAG-13, illustrates the close connection between 'safety management systems' and 'safety culture' and that they are in fact inseparable. To manage safety effectively you need a systematic approach and at the same time be aware of the effects of the approach on individual and collective human behaviour. This issue covers the following: development of safety performance indicators, indicator selection and use, recommended indicators, indicators collected from nuclear power plant initiatives, management of safety and safety culture, need and feasibility of an international system, plant management needs, regulatory use of safety performance indicators, public communication, and recommendations for priorities in future work

  10. Emotional influences in patient safety.

    Croskerry, Pat; Abbass, Allan; Wu, Albert W

    2010-12-01

    The way that health care providers feel, both within themselves and toward their patients, may influence their clinical performance and impact patient safety, yet this aspect of provider behavior has received relatively little attention. How providers feel, their emotional or affective state, may exert a significant, unintended influence on their patients, and may compromise safety. We examined a broad literature across multiple disciplines to review the interrelationships between emotion, decision making, and behavior, and to assess their potential impact on patient safety. There is abundant evidence that the emotional state of the health care provider may be influenced by factors including characteristics of the patient, ambient conditions in the health care setting, diurnal, circadian, infradian, and seasonal variables, as well as endogenous disorders of the individual provider. These influences may lead to affective biases in decision making, resulting in errors and adverse events. Clinical reasoning and judgment may be particularly susceptible to emotional influence, especially those processes that rely on intuitive judgments. There are many ways that the emotional state of the health care provider can influence patient care. To reduce emotional errors, the level of awareness of these factors should be raised. Emotional skills training should be incorporated into the education of health care professionals. Specifically, clinical teaching should promote more openness and discussion about the provider's feelings toward patients. Strategies should be developed to help providers identify and de-bias themselves against emotional influences that may impact care, particularly in the emotionally evocative patient. Psychiatric conditions within the provider, which may compromise patient safety, need to be promptly detected, diagnosed, and managed.

  11. Japan's regulatory and safety issues regarding nuclear materials transport

    Saito, T.; Yamanaka, T.

    2004-01-01

    This paper focuses on the regulatory and safety issues on nuclear materials transport which the Government of Japan (GOJ) faces and needs to well handle. Background information about the status of nuclear power plants (NPP) and nuclear fuel cycle (NFC) facilities in Japan will promote a better understanding of what this paper addresses

  12. Characterization strategy report for the organic safety issues

    Goheen, S.C.; Campbell, J.A.; Fryxell, G.E.

    1997-08-01

    This report describes a logical approach to resolving potential safety issues resulting from the presence of organic components in hanford tank wastes. The approach uses a structured logic diagram (SLD) to provide a pathway for quantifying organic safety issue risk. The scope of the report is limited to selected organics (i.e., solvents and complexants) that were added to the tanks and their degradation products. The greatest concern is the potential exothermic reactions that can occur between these components and oxidants, such as sodium nitrate, that are present in the waste tanks. The organic safety issue is described in a conceptual model that depicts key modes of failure-event reaction processes in tank systems and phase domains (domains are regions of the tank that have similar contents) that are depicted with the SLD. Applying this approach to quantify risk requires knowing the composition and distribution of the organic and inorganic components to determine (1) how much energy the waste would release in the various domains, (2) the toxicity of the region associated with a disruptive event, and (3) the probability of an initiating reaction. Five different characterization options are described, each providing a different level of quality in calculating the risks involved with organic safety issues. Recommendations include processing existing data through the SLD to estimate risk, developing models needed to link more complex characterization information for the purpose of estimating risk, and examining correlations between the characterization approaches for optimizing information quality while minimizing cost in estimating risk

  13. Campus Safety and Student Privacy Issues in Higher Education

    Burnett, Kristen Slater

    2010-01-01

    The purpose of this study is to delve into, and further understand, the perceptions of higher education administrators when they experience having to simultaneously balance the issues of campus safety and student privacy. The research surveyed approximately 900 (with 147 returns) administrators who self-identified as having a role in incidents of…

  14. Ecological Issues Related to Children's Health and Safety

    Aldridge, Jerry; Kohler, Maxie

    2009-01-01

    Issues concerning the health and safety of children and youth occur at multiple levels. Bronfenbrenner (1995) proposed an ecological systems approach in which multiple systems interact to enhance or diminish children's development. The same systems are at work in health promotion. The authors present and review articles that reflect the multiple…

  15. Occupational safety and health issues associated with green building

    Terwoert, J.; Ustailieva, E.

    2013-01-01

    This e-fact provides information on the work-related risk factors and the occupational safety and health (OSH) issues associated the planning and construction of green buildings, their maintenance, renovation (retrofitting), demolition, on-site waste collection. Some of these OSH risks are new

  16. Environmental safety issues for semiconductors (research on scarce materials recycling)

    Izumi, Shigekazu

    2004-01-01

    In the 21st century, in the fabrication of various industrial parts, particularly, current and future electronics devices in the semiconductor industry, environmental safety issues should be carefully considered. We coined a new term, environmental safety issues for semiconductors, considering our semiconductor research and technology which include environmental and ecological factors. The main object of this analysis is to address the present situation of environmental safety problems in the semiconductor industry; some of which are: (1) the generation and use of hazardous toxic gases in the crystal growth procedure such as molecular beam epitaxy (MBE) and metalorganic chemical vapor deposition (MOCVD), (2) the generation of industrial toxic wastes in the semiconductor process and (3) scarce materials recycling from wastes in the MBE and MOCVD growth procedure

  17. Radiation Protection, Safety and Security Issues in Ghana

    Boadu, M. B.; Emi-Reynolds, G.; Amoako, J. K.; Hasford, F.; Akrobortu, E.

    2015-01-01

    The Radiation Protection Board was established in 1993 by PNDC Law 308 as the National Competent Authority for the regulation of radiation sources and radioactive materials in Ghana. The mandate and responsibilities of RPB are prescribed in the legislative instrument, LI 1559 issued in 1993. The operational functions of the Board are carried out by the Radiation Protection Institute, which was established to provide technical support for the enforcement of the legislative instrument. The regulatory activities include among others: – Issuance permits for the import/export of any radiation producing device and radioactive materials into/out of the country. It therefore certifies the radioactivity levels in food and the environmental samples. – Authorization and Inspection of practices using radiation sources and radioactive materials in Ghana. – Undertakes safety assessment services and enforcement actions on practices using radiation sources and radioactive materials in line with regulations. – Provides guidance and technical support in fulfilling regulatory requirement to users of radiation producing devices and radioactive materials nationwide by monitoring of monthly radiation absorbed doses for personnel working at radiation facilities. – Provides support to the management of practices in respect of nuclear and radioactive waste programme. – Calibrates radiation emitting equipment and nuclear instrumentation to ensure the safety of patients, workers and the general public. – Establish guidelines for the mounting (non-ionizing) communication masts. – Environmental monitoring (non-ionizing) programmes for communication masts. With the establishment of the national competent authority, facilities using radioactive sources and radiation emitting devices have been brought under regulatory control. Effective regulatory control of radiation emitting devices are achieved through established legal framework, independent Regulatory Authority supported by

  18. 76 FR 71345 - Patient Safety Organizations: Voluntary Relinquishment From Child Health Patient Safety...

    2011-11-17

    ... Organizations: Voluntary Relinquishment From Child Health Patient Safety Organization, Inc. AGENCY: Agency for... notification of voluntary relinquishment from Child Health Patient Safety Organization, Inc. of its status as a Patient Safety Organization (PSO). The Patient Safety and Quality Improvement Act of 2005 (Patient Safety...

  19. 76 FR 79192 - Patient Safety Organizations: Voluntary Relinquishment From HSMS Patient Safety Organization

    2011-12-21

    ... Organizations: Voluntary Relinquishment From HSMS Patient Safety Organization AGENCY: Agency for Healthcare... voluntary relinquishment from the HSMS Patient Safety Organization of its status as a Patient Safety Organization (PSO). The Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act), Public Law 109...

  20. Challenging patient safety culture: survey results

    Hellings, Johan; Schrooten, Ward; Klazinga, Niek; Vleugels, Arthur

    2007-01-01

    PURPOSE: The purpose of this paper is to measure patient safety culture in five Belgian general hospitals. Safety culture plays an important role in the approach towards greater patient safety in hospitals. DESIGN/METHODOLOGY/APPROACH: The Patient Safety Culture Hospital questionnaire was

  1. Patient Safety, Present and Future

    Amalberti, R.

    2016-01-01

    Health care tends to oversimplify patient safety concepts. We tend to think about patient safety as a linear dimension that is only associated with the progressive reduction in the number of errors and accidents, with the simple notion that fewer are always better. We consider figures in isolation from the underlying context and prerequisites that drive safety models and the reality of the clinical fields. There is no one ultimate reference model of safety, but many models that can be adapted to fit the various clinical fields requirements and constraints. It is therefore not necessarily a bad result to observe a lower safety figure in a medical domain compared to the figures obtained in nonmedical ultra-safe models. The poor figures may represent the best local safety optimization while coping with the special health care requirements such as a high frequency of unplanned and nonstandard challenges. The paper distinguishes three classes of safety models that fit different field demands: the resilient and adaptive model, the high reliability (HRO) model, and the ultra-safe model. The lecture benchmarks the traits of each model while highlighting the specific dimensions for optimization. The conclusion is that firstly, that since the task requirements dictate the relevance and choice of the model and not the other way around, it is counterproductive to impose a model that is inadequate for the task requirements. Either you move the requirements and change the model, or you keep the constraints, and try to locally optimize the model to the clinical and organizational needs. (author)

  2. Safety issues relating to the design of fusion power facilities

    Stasko, R.R.; Wong, K.Y.; Russell, S.B.

    1986-06-01

    In order to make fusion power a viable future source of energy, it will be necessary to ensure that the cost of power for fusion electric generation is competitive with advanced fission concepts. In addition, fusion power will have to live up to its original promise of being a more radiologically benign technology than fission, and be able to demonstrate excellent operational safety performance. These two requirements are interrelated, since the selection of an appropriate safety philosophy early in the design phase could greatly reduce or eliminate the capital costs of elaborate safety related and protective sytems. This paper will briefly overview a few of the key safety issues presently recognized as critical to the ultimate achievement of licensable, environmentally safe and socially acceptable fusion power facilities. 12 refs

  3. Occupational health and safety issues among nurses in the Philippines.

    de Castro, A B; Cabrera, Suzanne L; Gee, Gilbert C; Fujishiro, Kaori; Tagalog, Eularito A

    2009-04-01

    Nursing is a hazardous occupation in the United States, but little is known about workplace health and safety issues facing the nursing work force in the Philippines. In this article, work-related problems among a sample of nurses in the Philippines are described. Cross-sectional data were collected through a self-administered survey during the Philippine Nurses Association 2007 convention. Measures included four categories: work-related demographics, occupational injury/illness, reporting behavior, and safety concerns. Approximately 40% of nurses had experienced at least one injury or illness in the past year, and 80% had experienced back pain. Most who had an injury did not report it. The top ranking concerns were stress and overwork. Filipino nurses encounter considerable health and safety concerns that are similar to those encountered by nurses in other countries. Future research should examine the work organization factors that contribute to these concerns and strengthen policies to promote health and safety.

  4. Occupational Health and Safety Issues Among Nurses in the Philippines

    de Castro, A. B.; Cabrera, Suzanne L.; Gee, Gilbert C.; Fujishiro, Kaori; Tagalog, Eularito A.

    2009-01-01

    Nursing is a hazardous occupation in the United States, but little is known about workplace health and safety issues facing the nursing work force in the Philippines. In this article, work-related problems among a sample of nurses in the Philippines are described. Cross-sectional data were collected through a self-administered survey during the Philippine Nurses Association 2007 convention. Measures included four categories: work-related demographics, occupational injury/illness, reporting behavior, and safety concerns. Approximately 40% of nurses had experienced at least one injury or illness in the past year, and 80% had experienced back pain. Most who had an injury did not report it. The top ranking concerns were stress and overwork. Filipino nurses encounter considerable health and safety concerns that are similar to those encountered by nurses in other countries. Future research should examine the work organization factors that contribute to these concerns and strengthen policies to promote health and safety. PMID:19438081

  5. Study on operational safety issues in the Japanese disposal concept

    Suzuki, Satoru; Kitagawa, Yoshito; Hyodo, Hideaki; Kubota, Shigeru; Iijima, Masayoshi; Tamura, Akio; Ishiguro, Katsuhiko; Fujihara, Hiroshi

    2014-01-01

    In Japan, vitrified high-level radioactive waste (HLW) and certain types of low-level radioactive waste that results from the reprocessing of spent fuel and classified as TRU waste will be disposed of in deep geological formations. NUMO aims to ensure the safety of local residents and workers during the operational phase and after repository closure and will therefore establish a safety case for the geological disposal programme at the end of each stage of the stepwise siting process. Although the Japanese programme is still in the stage before initiation of the siting process, updating the generic (non-site-specific) safety case is required for building confidence among stakeholders. This study focuses on operational safety issues for the Japanese HLW disposal concept. (authors)

  6. Patient participation in patient safety still missing: Patient safety experts' views.

    Sahlström, Merja; Partanen, Pirjo; Rathert, Cheryl; Turunen, Hannele

    2016-10-01

    The aim of this study was to elicit patient safety experts' views of patient participation in promoting patient safety. Data were collected between September and December in 2014 via an electronic semi-structured questionnaire and interviews with Finnish patient safety experts (n = 21), then analysed using inductive content analysis. Patient safety experts regarded patients as having a crucial role in promoting patient safety. They generally deemed the level of patient safety as 'acceptable' in their organizations, but reported that patient participation in their own safety varied, and did not always meet national standards. Management of patient safety incidents differed between organizations. Experts also suggested that patient safety training should be increased in both basic and continuing education programmes for healthcare professionals. Patient participation in patient safety is still lacking in clinical practice and systematic actions are needed to create a safety culture in which patients are seen as equal partners in the promotion of high-quality and safe care. © 2016 John Wiley & Sons Australia, Ltd.

  7. Critical safety issues in the design of fusion machines

    Kramer, W.

    1991-01-01

    In the course of developing fusion machines both general safety considerations and safety assessments for the various components and systems of actual machines increase in number and become more and more coherent. This is particularly true for the NET/ITER projects where safety analysis plays an increasing role for the design of the machine. Since in a D/T tokamak the radiological hazards will be dominant basic radiological safety objectives are discussed. Critical safety issues as identified in particular by the NET/ITER community are reviewed. Subsequently, issues of major concern are considered both for normal operation and for conceivable accidents. The following accidents are considered to be crucial: Loss of cooling in plasma facing components, loss of vacuum, tritium system failure, and magnet system failure. To mitigate accident consequences a confinement concept based on passive features and multiple barriers including detritiation and filtering has to be applied. The reactor building as final barrier needs special attention to cope with both internal and external hazards. (orig.)

  8. Current safety issues related to research reactor operation

    Alcala-Ruiz, F.

    2000-01-01

    The Agency has included activities on research reactor safety in its Programme and Budget (P and B) since its inception in 1957. Since then, these activities have traditionally been oriented to fulfil the Agency's functions and obligations. At the end of the decade of the eighties, the Agency's Research Reactor Safety Programme (RRSP) consisted of a limited number of tasks related to the preparation of safety related publications and the conduct of safety missions to research reactor facilities. It was at the beginning of the nineties when the RRSP was upgraded and expanded as a subprogramme of the Agency's P and B. This subprogramme continued including activities related to the above subjects and started addressing an increasing number of issues related to the current situation of research reactors (in operation and shut down) around the world such as reactor ageing, modifications and decommissioning. The present paper discusses some of the above issues as recognised by various external review or advisory groups (e.g., Peer Review Groups under the Agency's Performance Programme Appraisal System (PPAS) or the standing International Nuclear Safety Advisory Group (INSAG)) and the impact of their recommendations on the preparation and implementation of the part of the Agency's P and B relating to the above subject. (author)

  9. Patient Safety and Organizational Learning

    Zinck Pedersen, Kirstine

    pragmatism, situated learning theory and science and technology studies, the paper contrasts the notion of ‘systemic’ learning expressed by the safety policy program with notions of learning as a socio-materially situated practice. Based on fieldwork conducted in 2010 in a Danish university hospital, I...... propose that learning, and more specifically learning from critical incidents, should be understood as a practical and experience-based activity as well as an equally individual and social achievement, which is always formed in relation to the specificities of the concrete situation. Parting from......The key trope of patient safety policy is learning. With the motto of going from ‘a culture of blame to a learning culture’, the safety program introduces a ‘systemic perspective’ to facilitate openness and willingness to talk about failures, hereby making failures into a system property. Within...

  10. Nuclear power systems: Their safety. Current issue review

    Myers, L.C.

    1994-04-01

    Human beings utilize energy in many forms and from a variety of sources. A number of countries have chosen nuclear-electric generation as a component of their energy system. At the end of 1992, there were 419 power reactors operating in 29 countries, accounting for more than 15% of the world's production of electricity. In 1992, 13 countries derived at least 25% of their electricity from nuclear units, with Lithuania leading at just over 78%, followed closely by France at 72%. In the same year, Canada produced about 16% of its electricity from nuclear units. Some 53 power reactors are under construction in 14 countries outside the former USSR. Within the ex-USSR countries, six new reactors are currently under construction. No human endeavour carries the guarantee of perfect safety and the question of whether of not nuclear-electric generation represents an 'acceptable' risk to society has long been vigorously debated. Until the events of late April 1986 in the then Soviet Union, nuclear safety had indeed been an issue for discussion, for some concern, but not for alarm. The accident at the Chernobyl reactor irrevocably changed all that. This disaster brought the matter of nuclear safety into the public mind in a dramatic fashion. Subsequent opening of the ex-Soviet nuclear power program to outside scrutiny has done little to calm people's concerns about the safety of nuclear power in that part of the world. This paper discusses the issue of safety in complex energy systems and provides brief accounts of some of the most serious reactor accidents that have occurred to date, as well as more recent, less dramatic events touching on the safety issue. (author). 7 refs

  11. An approach to maintenance optimization where safety issues are important

    Vatn, Jorn, E-mail: jorn.vatn@ntnu.n [NTNU, Production and Quality Engineering, 7491 Trondheim (Norway); Aven, Terje [University of Stavanger (Norway)

    2010-01-15

    The starting point for this paper is a traditional approach to maintenance optimization where an object function is used for optimizing maintenance intervals. The object function reflects maintenance cost, cost of loss of production/services, as well as safety costs, and is based on a classical cost-benefit analysis approach where a value of prevented fatality (VPF) is used to weight the importance of safety. However, the rationale for such an approach could be questioned. What is the meaning of such a VPF figure, and is it sufficient to reflect the importance of safety by calculating the expected fatality loss VPF and potential loss of lives (PLL) as being done in the cost-benefit analyses? Should the VPF be the same number for all type of accidents, or should it be increased in case of multiple fatality accidents to reflect gross accident aversion? In this paper, these issues are discussed. We conclude that we have to see beyond the expected values in situations with high safety impacts. A framework is presented which opens up for a broader decision basis, covering considerations on the potential for gross accidents, the type of uncertainties and lack of knowledge of important risk influencing factors. Decisions with a high safety impact are moved from the maintenance department to the 'Safety Board' for a broader discussion. In this way, we avoid that the object function is used in a mechanical way to optimize the maintenance and important safety-related decisions are made implicit and outside the normal arena for safety decisions, e.g. outside the traditional 'Safety Board'. A case study from the Norwegian railways is used to illustrate the discussions.

  12. An approach to maintenance optimization where safety issues are important

    Vatn, Jorn; Aven, Terje

    2010-01-01

    The starting point for this paper is a traditional approach to maintenance optimization where an object function is used for optimizing maintenance intervals. The object function reflects maintenance cost, cost of loss of production/services, as well as safety costs, and is based on a classical cost-benefit analysis approach where a value of prevented fatality (VPF) is used to weight the importance of safety. However, the rationale for such an approach could be questioned. What is the meaning of such a VPF figure, and is it sufficient to reflect the importance of safety by calculating the expected fatality loss VPF and potential loss of lives (PLL) as being done in the cost-benefit analyses? Should the VPF be the same number for all type of accidents, or should it be increased in case of multiple fatality accidents to reflect gross accident aversion? In this paper, these issues are discussed. We conclude that we have to see beyond the expected values in situations with high safety impacts. A framework is presented which opens up for a broader decision basis, covering considerations on the potential for gross accidents, the type of uncertainties and lack of knowledge of important risk influencing factors. Decisions with a high safety impact are moved from the maintenance department to the 'Safety Board' for a broader discussion. In this way, we avoid that the object function is used in a mechanical way to optimize the maintenance and important safety-related decisions are made implicit and outside the normal arena for safety decisions, e.g. outside the traditional 'Safety Board'. A case study from the Norwegian railways is used to illustrate the discussions.

  13. Patient Safety Movement: History and Future Directions.

    Lark, Meghan E; Kirkpatrick, Kay; Chung, Kevin C

    2018-02-01

    Despite progress within the past 15 years, improving patient safety in health care remains an important public health issue. The history of safety policies, research, and development has revealed that this issue is more complex than initially perceived and is pertinent to all health care settings. Solutions, therefore, must be approached at the systems level and supplemented with a change in safety culture, especially in higher risk fields such as surgery. To do so, health care agents at all levels have started to prioritize the improvement of nontechnical skills such as teamwork, communication, and accountability, as reflected by the development of various checklists and safety campaigns. This progress may be sustained by adopting teamwork training programs that have proven successful in other high-risk industries, such as crew resource management in aviation. These techniques can be readily implemented among surgical teams; however, successful application depends heavily on the strong leadership and vigilance of individual surgeons. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  14. Team of experts concludes review of safety issues at Temelin

    2001-01-01

    Full text: At the request of the Czech Government, the International Atomic Energy Agency (IAEA) assembled a team of national experts from Bulgaria, France, Germany, Spain, and the United Kingdom, with an observer from Austria, to review safety issues at the Temelin power plant that were identified in 1996 as relevant to reactors of the generic Temelin design (WWER-1000/320 type). Following a detailed on-site review from 18 to 23 November 2001, the experts concluded that most identified issues had been addressed and resolved. Work is continuing on the few remaining issues. These issues, however, are not judged by them to be significant and would not from the experts' standpoint preclude the safe operation of the Temelin nuclear power plant. The final report of the team of experts will be available to the Czech Government in one month's time. (author)

  15. Editorial: emerging issues in sociotechnical systems thinking and workplace safety.

    Noy, Y Ian; Hettinger, Lawrence J; Dainoff, Marvin J; Carayon, Pascale; Leveson, Nancy G; Robertson, Michelle M; Courtney, Theodore K

    2015-01-01

    The burden of on-the-job accidents and fatalities and the harm of associated human suffering continue to present an important challenge for safety researchers and practitioners. While significant improvements have been achieved in recent decades, the workplace accident rate remains unacceptably high. This has spurred interest in the development of novel research approaches, with particular interest in the systemic influences of social/organisational and technological factors. In response, the Hopkinton Conference on Sociotechnical Systems and Safety was organised to assess the current state of knowledge in the area and to identify research priorities. Over the course of several months prior to the conference, leading international experts drafted collaborative, state-of-the-art reviews covering various aspects of sociotechnical systems and safety. These papers, presented in this special issue, cover topics ranging from the identification of key concepts and definitions to sociotechnical characteristics of safe and unsafe organisations. This paper provides an overview of the conference and introduces key themes and topics. Sociotechnical approaches to workplace safety are intended to draw practitioners' attention to the critical influence that systemic social/organisational and technological factors exert on safety-relevant outcomes. This paper introduces major themes addressed in the Hopkinton Conference within the context of current workplace safety research and practice challenges.

  16. Workshop on radioisotope safety issues in medical and academic institutions

    1995-03-01

    The purpose of this workshop was to present current trends and recent initiatives of AECB staff members on issues relating to the regulation of radiation safety at hospitals and universities, and to invite the views of licencees on these matters. This report provides a record of presentations and discussions at this workshop. Presentation overheads are included as well as the results of workshop evaluations and a list of participants

  17. Workshop on radioisotope safety issues in medical and academic institutions

    NONE

    1995-03-01

    The purpose of this workshop was to present current trends and recent initiatives of AECB staff members on issues relating to the regulation of radiation safety at hospitals and universities, and to invite the views of licencees on these matters. This report provides a record of presentations and discussions at this workshop. Presentation overheads are included as well as the results of workshop evaluations and a list of participants.

  18. Assessment of Contributions to Patient Safety Knowledge by the Agency for Healthcare Research and Quality-Funded Patient Safety Projects

    Sorbero, Melony E S; Ricci, Karen A; Lovejoy, Susan; Haviland, Amelia M; Smith, Linda; Bradley, Lily A; Hiatt, Liisa; Farley, Donna O

    2009-01-01

    Objective To characterize the activities of projects funded in Agency for Healthcare Research and Quality (AHRQ)' patient safety portfolio and assess their aggregate potential to contribute to knowledge development. Data Sources Information abstracted from proposals for projects funded in AHRQ' patient safety portfolio, information on safety practices from the AHRQ Evidence Report on Patient Safety Practices, and products produced by the projects. Study Design This represented one part of the process evaluation conducted as part of a longitudinal evaluation based on the Context–Input–Process–Product model. Principal Findings The 234 projects funded through AHRQ' patient safety portfolio examined a wide variety of patient safety issues and extended their work beyond the hospital setting to less studied parts of the health care system. Many of the projects implemented and tested practices for which the patient safety evidence report identified a need for additional evidence. The funded projects also generated a substantial body of new patient safety knowledge through a growing number of journal articles and other products. Conclusions The projects funded in AHRQ' patient safety portfolio have the potential to make substantial contributions to the knowledge base on patient safety. The full value of this new knowledge remains to be confirmed through the synthesis of results. PMID:21456108

  19. Contrast media. Safety issues and ESUR guidelines. 2. rev. ed.

    Thomsen, Henrik S. [Copenhagen University Hospital, Herlev (Denmark). Dept. of Diagnostic Radiology; Copenhagen Univ., Herlev (Denmark). Dept. of Diagnostic Sciences; Webb, Judith A.W. (eds.) [St. Bartholomew' s Hospital London Univ. (United Kingdom). Dept. of Radiology

    2009-07-01

    In 1994 the European Society of Urogenital Radiology (ESUR) set up a committee to consider the safety of contrast media used for diagnostic imaging. Subsequently the committee questioned members, reviewed the literature, proposed guidelines and discussed these proposals with participants at the annual symposia of the society. The end result of this work was the successful first edition of this book, published in 2006. This second edition not only updates the previous edition, but also contains some completely new chapters, for example on gadolinium-based contrast agents, meta-analyses in contrast media research and various regulatory issues. Comprehensive consideration is given to the many different safety issues relating to iodinated, MR, ultrasound and barium contrast media. The text includes chapters on both acute and delayed non-renal adverse reactions and on renal adverse reactions. All those questions frequently raised in radiological practice are addressed, and the well-known ESUR guidelines on contrast media are included. This book, presented in a handy, easy to use format, provides an invaluable, unique and unparalleled source of information on the safety issues relating to contrast media. (orig.)

  20. Contribution of safety issues to public perceptions of energy systems

    Otway, H.J.; Thomas, K.

    1978-01-01

    Public opposition is an important consideration for those responsible for energy planning; however, the formulation of socially viable policies requires an understanding of the reasons for this opposition. An attitude model was applied to identify the underlying determinants of public perceptions of five energy systems: nuclear, coal, oil, solar and hydro. Empirical results (heterogeneous sample of the general public, N = 224) are reported in which these energy systems were found to be perceived in terms of four basic dimensions: psychological aspects; economic benefits; socio-political implications; environmental and physical safety issues. For the total sample, safety issues made an appreciable contribution to attitudes toward all of the systems except nuclear energy, where it was not significant. A differential analysis of two sub-samples, those respondents PRO and CON nuclear energy, showed that benefits and safety issues were important determinants of PRO attitudes while CON attitudes were primarily due to psychological aspects and concerns about personal and political power. The role of technical information in the formation of public attitudes toward technological policies is discussed

  1. Contrast media. Safety issues and ESUR guidelines. 2. rev. ed.

    Thomsen, Henrik S.; Copenhagen Univ., Herlev; Webb, Judith A.W.

    2009-01-01

    In 1994 the European Society of Urogenital Radiology (ESUR) set up a committee to consider the safety of contrast media used for diagnostic imaging. Subsequently the committee questioned members, reviewed the literature, proposed guidelines and discussed these proposals with participants at the annual symposia of the society. The end result of this work was the successful first edition of this book, published in 2006. This second edition not only updates the previous edition, but also contains some completely new chapters, for example on gadolinium-based contrast agents, meta-analyses in contrast media research and various regulatory issues. Comprehensive consideration is given to the many different safety issues relating to iodinated, MR, ultrasound and barium contrast media. The text includes chapters on both acute and delayed non-renal adverse reactions and on renal adverse reactions. All those questions frequently raised in radiological practice are addressed, and the well-known ESUR guidelines on contrast media are included. This book, presented in a handy, easy to use format, provides an invaluable, unique and unparalleled source of information on the safety issues relating to contrast media. (orig.)

  2. Safety for all: bringing together patient and employee safety.

    Stevenson, R Lynn; Moss, Lesley; Newlands, Tracey; Archer, Jana

    2013-01-01

    The safety of patients and of employees in healthcare have historically been separately managed and regulated. Despite efforts to reduce injury rates for employees and adverse events for patients, healthcare organizations continue to see less-than-optimal outcomes in both domains. This article challenges readers to consider how the traditional siloed approach to patient and employee safety can lead to duplication of effort, confusion, missed opportunities and unintended consequences. The authors propose that only through integrating patient and employee safety activities and challenging the paradigms that juxtapose the two will healthcare organizations experience sustained and improved safety practice and outcomes. Copyright © 2013 Longwoods Publishing.

  3. Implementing Patient Safety Initiatives in Rural Hospitals

    Klingner, Jill; Moscovice, Ira; Tupper, Judith; Coburn, Andrew; Wakefield, Mary

    2009-01-01

    Implementation of patient safety initiatives can be costly in time and energy. Because of small volumes and limited resources, rural hospitals often are not included in nationally driven patient safety initiatives. This article describes the Tennessee Rural Hospital Patient Safety Demonstration project, whose goal was to strengthen capacity for…

  4. Patient safety culture in primary care

    Verbakel, N.J.

    2015-01-01

    Background A constructive patient safety culture is a main prerequisite for patient safety and improvement initiatives. Until now, patient safety culture (PSC) research was mainly focused on hospital care, however, it is of equal importance in primary care. Measuring PSC informs practices on their

  5. Acute care patients discuss the patient role in patient safety.

    Rathert, Cheryl; Huddleston, Nicole; Pak, Youngju

    2011-01-01

    Patient safety has been a highly researched topic in health care since the year 2000. One strategy for improving patient safety has been to encourage patients to take an active role in their safety during their health care experiences. However, little research has shed light on how patients view their roles. This study attempted to address this deficit by inductively exploring the results of a qualitative study in which patients reported their ideas about what they believe their roles should be. Patients with an overnight stay in the previous 90 days at one of three hospitals were surveyed using a mailing methodology. Of 1,040 respondents, 491 provided an open-ended response regarding what they believe the patient role should be. Qualitative analysis found several prominent themes. The largest proportion of responses (23%) suggested that patients should follow instructions given by care providers. Other prominent themes were that patients should ask questions and become informed about their conditions and treatments, and many implied that they should expect competent care. Our results suggest that patients believe they should be able to trust that they are being provided competent care, as opposed to assuming a leadership role in their safety. Our results suggest that engaging patients in safety efforts may be complex, requiring a variety of strategies. Managers must provide environments conducive to staff and patient interactions to support patients in this effort. Different types of patients may require different engagement strategies.

  6. Draft report on compilation of generic safety issues for light water reactor nuclear power plants

    NONE

    1997-07-01

    A generally accepted approach to characterizing the safety concerns in nuclear power plants is to express them as safety issues which need to be resolved. When such safety issues are applicable to a generation of plants of a particular design or to a family of plants of similar design, they are termed generic safety issues. Examples of generic safety issues are those related to reactor vessel embrittlement, control rod insertion reliability or strainer clogging. The safety issues compiled in this document are based on broad international experience. This compilation is one element in the framework of IAEA activities to assist Member States in reassessing the safety of operating nuclear power plants. Refs.

  7. Draft report on compilation of generic safety issues for light water reactor nuclear power plants

    1997-07-01

    A generally accepted approach to characterizing the safety concerns in nuclear power plants is to express them as safety issues which need to be resolved. When such safety issues are applicable to a generation of plants of a particular design or to a family of plants of similar design, they are termed generic safety issues. Examples of generic safety issues are those related to reactor vessel embrittlement, control rod insertion reliability or strainer clogging. The safety issues compiled in this document are based on broad international experience. This compilation is one element in the framework of IAEA activities to assist Member States in reassessing the safety of operating nuclear power plants. Refs

  8. Advancing Measurement of Patient Safety Culture

    Ginsburg, Liane; Gilin, Debra; Tregunno, Deborah; Norton, Peter G; Flemons, Ward; Fleming, Mark

    2009-01-01

    Objective To examine the psychometric and unit of analysis/strength of culture issues in patient safety culture (PSC) measurement. Data Source Two cross-sectional surveys of health care staff in 10 Canadian health care organizations totaling 11,586 respondents. Study Design A cross-validation study of a measure of PSC using survey data gathered using the Modified Stanford PSC survey (MSI-2005 and MSI-2006); a within-group agreement analysis of MSI-2006 data. Extraction Methods Exploratory factor analyses (EFA) of the MSI-05 survey data and confirmatory factor analysis (CFA) of the MSI-06 survey data; Rwg coefficients of homogeneity were calculated for 37 units and six organizations in the MSI-06 data set to examine within-group agreement. Principal Findings The CFA did not yield acceptable levels of fit. EFA and reliability analysis of MSI-06 data suggest two reliable dimensions of PSC: Organization leadership for safety (α=0.88) and Unit leadership for safety (α=0.81). Within-group agreement analysis shows stronger within-unit agreement than within-organization agreement on assessed PSC dimensions. Conclusions The field of PSC measurement has not been able to meet strict requirements for sound measurement using conventional approaches of CFA. Additional work is needed to identify and soundly measure key dimensions of PSC. The field would also benefit from further attention to strength of culture/unit of analysis issues. PMID:18823446

  9. Resolution of the Hanford site ferrocyanide safety issue

    Cash, R.J.; Lilga, M.A.; Babad, H.

    1997-01-01

    The Ferrocyanide Safety Issue at the Hanford Site was officially resolved in December 1996. This paper summarizes the key activities that led to final resolution of this safety hazard, a process that began in 1990 after it and other safety concerns were identified for the underground high-level waste storage tanks at the Hanford Site. At the time little was known about ferrocyanide-nitrate/nitrite reactions and their potential to cause offsite releases of radioactivity. The ferrocyanide hazard was a perceived problem, but it took six years of intense studies and analyses of tank samples to prove that the problem no longer exists. The issue revolved around the fact that ferrocyanide and nitrate mixtures can be made to explode violently if concentrated, dry, and heated to temperatures of at least 250 degrees C. The studies conducted over the last six years have shown that the combined effects of temperature, radiation, and pH during 40 or more years of storage have destroyed almost all of the ferrocyanide originally added to tanks. This was shown in laboratory experiments using simulant wastes and confirmed by actual samples taken from the ferrocyanide tanks. The tank waste sludges are now too dilute to support a sustained exothermic reaction, even if dried out and heated to high temperatures. 2 tabs., 18 refs

  10. 76 FR 58812 - Patient Safety Organizations: Delisting for Cause of Patient Safety Organization One, Inc.

    2011-09-22

    ... Organizations: Delisting for Cause of Patient Safety Organization One, Inc. AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS. ACTION: Notice of Delisting. SUMMARY: Patient Safety Organization One, Inc.: AHRQ has delisted Patient Safety Organization One, Inc. as a Patient Safety Organization (PSO...

  11. 77 FR 11120 - Patient Safety Organizations: Voluntary Relinquishment From UAB Health System Patient Safety...

    2012-02-24

    ... Organizations: Voluntary Relinquishment From UAB Health System Patient Safety Organization AGENCY: Agency for... notification of voluntary relinquishment from the UAB Health System Patient Safety Organization of its status as a Patient Safety Organization (PSO). The Patient Safety and Quality Improvement Act of 2005...

  12. 76 FR 60495 - Patient Safety Organizations: Voluntary Relinquishment From the Patient Safety Group

    2011-09-29

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From the Patient Safety Group AGENCY: Agency for Healthcare Research and... voluntary relinquishment from The Patient Safety Group of its status as a Patient Safety Organization (PSO...

  13. Technical Issues and Proposes on the Legislation of Probabilistic Safety Assessment in Periodic Safety Review

    Hwang, Seok-Won; Jeon, Ho-Jun; Na, Jang-Hwan

    2015-01-01

    Korean Nuclear Power Plants have performed a comprehensive safety assessment reflecting design and procedure changes and using the latest technology every 10 years. In Korea, safety factors of PSR are revised to 14 by revision of IAEA Safety Guidelines in 2003. In the revised safety guidelines, safety analysis field was subdivided into deterministic safety analysis, PSA (Probabilistic safety analysis), and hazard analysis. The purpose to examine PSA as a safety factor on PSR is to make sure that PSA results and assumptions reflect the latest state of NPPs, validate the level of computer codes and analytical models, and evaluate the adequacy of PSA instructions. In addition, its purpose is to derive the plant design change, operating experience of other plants and safety enhancement items as well. In Korea, PSA is introduced as a new factor. Thus, the overall guideline development and long-term implementation strategy are needed. Today in Korea, full-power PSA model revision and low-power and shutdown (LPSD) PSA model development is being performed as a part of the post Fukushima action items for operating plants. The scope of the full-power PSA is internal/external level 1, 2 PSA. But in case of fire PSA, the scope is level 1 PSA using new method, NUREG/CR-6850. In case of LPSD PSA, level 1 PSA for all operating plants, and level 2 PSA for 2 demonstration plants are under development. The result of the LPSD PSA will be used as major input data for plant specific SAMG (Severe Accident Management Guideline). The scope of PSA currently being developed in Korea cannot fulfill 'All Mode, All Scope' requirements recommended in the IAEA Safety Guidelines. Besides the legislation of PSA, step-by-step development strategy for non-performed scopes such as level 3 PSA and new fire PSA is one of the urgent issues in Korea. This paper suggests technical issues and development strategies for each PSA technical elements.

  14. ISSUES AND RECENT TRENDS IN VEHICLE SAFETY COMMUNICATION SYSTEMS

    Sadayuki TSUGAWA

    2005-01-01

    Full Text Available This paper surveys the research on the applications of inter-vehicle communications, the issues of the deployment and technology, and the current status of inter-vehicle communications projects in Europe, the United States and Japan. The inter-vehicle communications, defined here as communications between on-board ITS computers, improve road traffic safety and efficiency by expanding the horizon of the drivers and on-board sensors. One of the earliest studies on inter-vehicle communications began in Japan in the early 1980s. The inter-vehicle communications play an essential role in automated platooning and cooperative driving systems developed since the 1990's by enabling vehicles to obtain data that would be difficult or impossible to measure with on-board sensors. During these years, interest in applications for inter-vehicle communications increased in the EU, the US and Japan, resulting in many national vehicle safety communications projects such as CarTALK2000 in the EU and VSCC in the US. The technological issues include protocol and communications media. Experiments employ various kinds of protocols and typically use infrared, microwave or millimeter wave media. The situation is ready for standardization. The deployment strategy is another issue. To be feasible, deployment should begin with multiple rather than single services that would work even at a low penetration rate of the communication equipment. In addition, non-technological, legal and institutional issues remained unsolved. Although inter-vehicle communications involve many issues, such applications should be promoted because they will lead to safer and more efficient automobile traffic.

  15. Resolving the Ferrocyanide Safety Issue at the Hanford Site

    Meacham, J.E.; Cash, R.J.; Babad, H.

    1994-02-01

    Considerable data have been obtained on the chemical and physical properties of ferrocyanide waste stored in Hanford Site single-shell tanks (SSTs). Theoretical analyses and ferrocyanide waste simulant studies have led to the development of fuel, moisture, and temperature criteria that define continued safe storage. Developing the criteria provides the technical basis for closing the Ferrocyanide Unreviewed Safety Question (USQ). Using the safety criteria, the ferrocyanide tanks have been ranked into one of three safety categories: Safe, Conditionally Safe, and Unsafe. All the ferrocyanide tanks are currently ranked in either the Safe or Conditionally Safe categories. Analyses of core samples taken from three ferrocyanide tanks have shown cyanide concentrations about a factor of ten lower than predicted by the original flowsheets. Hydrolytic and radiolytic destruction (aging) of the ferrocyanide matrix has occurred during the 35 plus years the waste has been stored at the Hanford Site. Because of waste aging, it is possible that all of the ferrocyanide tanks may now contain less than the 8 wt % sodium nickel ferrocyanide specified in the fuel criterion for the Safe category. Ferrocyanide tanks that remain in the Conditionally Safe category may require monitoring and surveillance to verify that the waste remains in an unreactive state. Further characterization of the tanks by core sampling and analyses should lead to resolution of the Ferrocyanide Safety Issue by September 1997

  16. Overview of safety and environmental issues for inertial fusion energy

    Piet, S.J.; Brereton, S.J.; Tanaka, S.

    1996-01-01

    This paper summarizes safety and environmental issues of Inertial Fusion Energy (IFE): inventories, effluents, maintenance, accident safety, waste management, and recycling. The fusion confinement approach among inertial and magnetic options affects how the fusion reaction is maintained and which materials surround the reaction chamber. The target fill technology has a major impact on the target factory tritium inventory. IFE fusion reaction chambers usually employ some means to protect the first structural wall from fusion pulses. This protective fluid or granular bed also moderates and absorbs most neutrons before they reach the first structural wall. Although the protective fluid activates, most candidate fluids have low activation hazard. Hands-on maintenance seems practical for the driver, target factory, and secondary coolant systems; remote maintenance is likely required for the reaction chamber, primary coolant, and vacuum exhaust cleanup systems. The driver and fuel target facility are well separated from the main reaction chamber

  17. Current issues and perspectives in food safety and risk assessment.

    Eisenbrand, G

    2015-12-01

    In this review, current issues and opportunities in food safety assessment are discussed. Food safety is considered an essential element inherent in global food security. Hazard characterization is pivotal within the continuum of risk assessment, but it may be conceived only within a very limited frame as a true alternative to risk assessment. Elucidation of the mode of action underlying a given hazard is vital to create a plausible basis for human toxicology evaluation. Risk assessment, to convey meaningful risk communication, must be based on appropriate and reliable consideration of both exposure and mode of action. New perspectives, provided by monitoring human exogenous and endogenous exposure biomarkers, are considered of great promise to support classical risk extrapolation from animal toxicology. © The Author(s) 2015.

  18. Evaluation of the patient safety Leadership Walkabout programme of a hospital in Singapore.

    Lim, Raymond Boon Tar; Ng, Benjamin Boon Lui; Ng, Kok Mun

    2014-02-01

    The Patient Safety Leadership Walkabout (PSLWA) programme is a commonly employed tool in the West, in which senior leaders visit sites within the hospital that are involved in patient care to talk to healthcare staff about patient safety issues. As there is a lack of perspective regarding PSLWA in Asia, we carried out an evaluation of its effectiveness in improving the patient safety culture in Tan Tock Seng Hospital, Singapore. A mixed methods analysis approach was used to review and evaluate all documents, protocols, meeting minutes, post-walkabout surveys, action plans and verbal feedback pertaining to the walkabouts conducted from January 2005 to October 2012. A total of 321 patient safety issues were identified during the study period. Of these, 308 (96.0%) issues were resolved as of November 2012. Among the various categories of issues raised, issues related to work environment were the most common (45.2%). Of all the issues raised during the walkabouts, 72.9% were not identified through other conventional methods of error detection. With respect to the hospital's patient safety culture, 94.8% of the participants reported an increased awareness in patient safety and 90.2% expressed comfort in openly and honestly discussing patient safety issues. PSLWA serves as a good tool to uncover latent errors before actual harm reaches the patient. If properly implemented, it is an effective method for engaging leadership, identifying patient safety issues, and supporting a culture of patient safety in the hospital setting.

  19. Does Employee Safety Matter for Patients Too? Employee Safety Climate and Patient Safety Culture in Health Care.

    Mohr, David C; Eaton, Jennifer Lipkowitz; McPhaul, Kathleen M; Hodgson, Michael J

    2015-04-22

    We examined relationships between employee safety climate and patient safety culture. Because employee safety may be a precondition for the development of patient safety, we hypothesized that employee safety culture would be strongly and positively related to patient safety culture. An employee safety climate survey was administered in 2010 and assessed employees' views and experiences of safety for employees. The patient safety survey administered in 2011 assessed the safety culture for patients. We performed Pearson correlations and multiple regression analysis to examine the relationships between a composite measure of employee safety with subdimensions of patient safety culture. The regression models controlled for size, geographic characteristics, and teaching affiliation. Analyses were conducted at the group level using data from 132 medical centers. Higher employee safety climate composite scores were positively associated with all 9 patient safety culture measures examined. Standardized multivariate regression coefficients ranged from 0.44 to 0.64. Medical facilities where staff have more positive perceptions of health care workplace safety climate tended to have more positive assessments of patient safety culture. This suggests that patient safety culture and employee safety climate could be mutually reinforcing, such that investments and improvements in one domain positively impacts the other. Further research is needed to better understand the nexus between health care employee and patient safety to generalize and act upon findings.

  20. IAEA activities on communication of nuclear safety issues

    Wieland, P.

    2001-01-01

    The regulatory authorities in several countries have taken the initiative to overcome the renowned difficulties of communicating nuclear safety issues. They communicate with segments of the public specially in case of nuclear/radiological accidents, waste disposal, transport of radioactive material or food irradiation. This reflects the full recognition of the importance of the topic. However it is also recognized that there is hitherto a need of international assistance in order to develop a regulatory communication strategy that could be harmonized and at the same time customized to the different needs. Communications on nuclear, radiation, transport and radioactive waste safety are needed to: disseminate information on safety to the public in both routine and emergency situations ; be attentive to public concerns, and address them; maintain social trust and confidence by keeping society informed on the established safety standards and how they are enforced; facilitate the decision-making process on nuclear matters by promptly presenting factual information in a clear manner; integrate and maintain an information network at both the national and international levels; improve co-operation with other countries and international organizations; encourage the dissemination of factual information on nuclear issues in schools. A major factor in addressing all of these questions is understanding the audience(s). A two way communication process is needed to establish what particular audiences want to know and in what form they prefer to receive information. This will differ depending on the audience and circumstances. For example, the information on a routine day-to-day basis will be different from what might be needed at the time of an accident. Communication with the news media is a matter of particular importance, as they are both an audience in themselves and a channel for communicating with wider audiences. (author)

  1. Laboratory errors and patient safety.

    Miligy, Dawlat A

    2015-01-01

    Laboratory data are extensively used in medical practice; consequently, laboratory errors have a tremendous impact on patient safety. Therefore, programs designed to identify and reduce laboratory errors, as well as, setting specific strategies are required to minimize these errors and improve patient safety. The purpose of this paper is to identify part of the commonly encountered laboratory errors throughout our practice in laboratory work, their hazards on patient health care and some measures and recommendations to minimize or to eliminate these errors. Recording the encountered laboratory errors during May 2008 and their statistical evaluation (using simple percent distribution) have been done in the department of laboratory of one of the private hospitals in Egypt. Errors have been classified according to the laboratory phases and according to their implication on patient health. Data obtained out of 1,600 testing procedure revealed that the total number of encountered errors is 14 tests (0.87 percent of total testing procedures). Most of the encountered errors lay in the pre- and post-analytic phases of testing cycle (representing 35.7 and 50 percent, respectively, of total errors). While the number of test errors encountered in the analytic phase represented only 14.3 percent of total errors. About 85.7 percent of total errors were of non-significant implication on patients health being detected before test reports have been submitted to the patients. On the other hand, the number of test errors that have been already submitted to patients and reach the physician represented 14.3 percent of total errors. Only 7.1 percent of the errors could have an impact on patient diagnosis. The findings of this study were concomitant with those published from the USA and other countries. This proves that laboratory problems are universal and need general standardization and bench marking measures. Original being the first data published from Arabic countries that

  2. Application of coupled codes for safety analysis and licensing issues

    Langenbuch, S.; Velkov, K.

    2006-01-01

    An overview is given on the development and the advantages of coupled codes which integrate 3D neutron kinetics into thermal-hydraulic system codes. The work performed within GRS by coupling the thermal-hydraulic system code ATHLET and the 3D neutronics code QUABOX/CUBBOX is described as an example. The application of the coupled codes as best-estimate simulation tools for safety analysis is discussed. Some examples from German licensing practices are given which demonstrate how the improved analytical methods of coupled codes have contributed to solve licensing issues related to optimized and more economical use of fuel. (authors)

  3. Safety issues of dry fuel storage at RSWF

    Clarksean, R.L.; Zahn, T.P.

    1995-01-01

    Safety issues associated with the dry storage of EBR-II spent fuel are presented and discussed. The containers for the fuel have been designed to prevent a leak of fission gases to the environment. The storage system has four barriers for the fission gases. These barriers are the fuel cladding, an inner container, an outer container, and the liner at the RSWF. Analysis has shown that the probability of a leak to the environment is much less than 10 -6 per year, indicating that such an event is not considered credible. A drop accident, excessive thermal loads, criticality, and possible failure modes of the containers are also addressed

  4. Modeling issues associated with production reactor safety assessment

    Stack, D.W.; Thomas, W.R.

    1990-01-01

    This paper describes several Probabilistic Safety Assessment (PSA) modeling issues that are related to the unique design and operation of the production reactors. The identification of initiating events and determination of a set of success criteria for the production reactors is of concern because of their unique design. The modeling of accident recovery must take into account the unique operation of these reactors. Finally, a more thorough search and evaluation of common-cause events is required to account for combinations of unique design features and operation that might otherwise not be included in the PSA. It is expected that most of these modeling issues also would be encountered when modeling some of the other more unique reactor and nonreactor facilities that are part of the DOE nuclear materials production complex. 9 refs., 2 figs

  5. HTGR Dust Safety Issues and Needs for Research and Development

    Paul W. Humrickhouse

    2011-06-01

    This report presents a summary of high temperature gas-cooled reactor dust safety issues. It draws upon a literature review and the proceedings of the Very High Temperature Reactor Dust Assessment Meeting held in Rockville, MD in March 2011 to identify and prioritize the phenomena and issues that characterize the effect of carbonaceous dust on high temperature reactor safety. It reflects the work and input of approximately 40 participants from the U.S. Department of Energy and its National Labs, the U.S. Nuclear Regulatory Commission, industry, academia, and international nuclear research organizations on the topics of dust generation and characterization, transport, fission product interactions, and chemical reactions. The meeting was organized by the Idaho National Laboratory under the auspices of the Next Generation Nuclear Plant Project, with support from the U.S. Nuclear Regulatory Commission. Information gleaned from the report and related meetings will be used to enhance the fuel, graphite, and methods technical program plans that guide research and development under the Next Generation Nuclear Plant Project. Based on meeting discussions and presentations, major research and development needs include: generating adsorption isotherms for fission products that display an affinity for dust, investigating the formation and properties of carbonaceous crust on the inside of high temperature reactor coolant pipes, and confirming the predominant source of dust as abrasion between fuel spheres and the fuel handling system.

  6. Eminent radiological safety issues confronting the State of Hawaii

    Hashimoto, H.H.

    1984-01-01

    The State of Hawaii currently has over one hundred radioactive material use licenses. Nuclear Regulatory Commission licenses are primarily held by hospitals, industrial radiographers, and academic institutions. Complementing this, the State Department of Health regulates x-ray machines, radium, and has an emergency response role for accidents involving radioactive materials. The existing radiation protection program was created by piecemeal legislation. As a result, regulatory surveillance and actual control vary widely among the agencies. The State Legislature, in 1980, decided that action must be taken to set a clear state policy towards the use and disposal of nuclear materials. It was therefore recommended that the State of Hawaii Radiation Safety Advisory Committee be convened to assist the state in the evaluation of the issues. This report contains issue papers on radiation related topics addressed by the Radiation Safety Advisory Committe. Topics discussed include transportation, environmental monitoring, emergency response, and waste disposal. A survey of various radioactive sources identified medical applications as a category requiring stricter control. Selected chapters of the Hawaii Revised Statutes are also examined

  7. Innovative Patient Safety Curriculum Using iPAD Game (PASSED) Improved Patient Safety Concepts in Undergraduate Medical Students.

    Kow, A W C; Ang, B L S; Chong, C S; Tan, W B; Menon, K R

    2016-11-01

    While healthcare outcomes have improved significantly, the complex management of diseases in the hospitals has also escalated the risks in patient safety. Therefore, in the process of training medical students to be proficient in medical knowledge and skills, the importance of patient safety cannot be neglected. A new innovation using mobile apps gaming system (PAtient Safety in Surgical EDucation-PASSED) to teach medical students on patient safety was created. Students were taught concepts of patient safety followed by a gaming session using iPad games created by us. This study aims to evaluate the outcome of patient safety perception using the PASSED games created. An interactive iPad game focusing on patient safety issues was created by the undergraduate education team in the Department of Surgery, Yong Loo Lin School of Medicine at the National University of Singapore. The game employed the unique touched-screen feature with clinical scenarios extracted from the hospital sentinel events. Some of the questions were time sensitive, with extra bonus marks awarded if the student provided the correct answer within 10 s. Students could reattempt the questions if the initial answer was wrong. However, this entailed demerit points. Third-year medical students posted to the Department of Surgery experienced this gaming system in a cohort of 55-60 students. Baseline understanding of the students on patient safety was evaluated using Attitudes to Patient Safety Questionnaire III (APSQ-III) prior to the game. A 20 min talk on concept of patient safety using the WHO Patient Safety Guidelines was conducted. Following this, students downloaded the apps from ITune store and played with the game for 20-30 min. The session ended with the students completing the postintervention questionnaire. A total of 221 3rd year medical students responded to the survey during the PASSED session. Majority of the students felt that the PASSED game had trained them to understand the

  8. Contrast media. Safety issues and ESUR guidelines. 3. ed.

    Thomsen, Henrik S.; Webb, Judith A.W.

    2014-01-01

    Fully updates the previous edition and includes new chapters on various complex topics. Represents a unique and unparalleled source of information on the many safety issues relating to different contrast media. Includes chapters on acute and delayed non-renal adverse reactions and on renal adverse reactions. Presented in a handy, easy-to-use format. In 1994 the European Society of Urogenital Radiology (ESUR) set up a committee to consider the safety of contrast media used for diagnostic imaging. Subsequently the committee questioned ESUR members, reviewed the literature, proposed guidelines, and discussed these proposals with participants at the annual symposia of the society. The end result of this work was the successful first edition of this book, published in 2006, which was followed by an equally successful second edition in 2009. This third edition not only fully updates the previous edition, but also includes new chapters on complex topics such as use of contrast media in children and practical aspects of off-label contrast media use. The authorship includes members, past members, and non-members of the Contrast Media Safety Committee.

  9. Safety Culture and Issue in the Malaysian Manufacturing Sector

    Ali Danish

    2017-01-01

    Full Text Available . This paper highlights the Safety culture and issue in the Malaysian Manufacturing Sector and emphasis the high occupational accidents due to lack of safety culture and non-compliance of the requirements of Occupational Safety and Health Act 1994. The aim of this study is to review the occupational accidents occurrence in the Malaysia workplace since 2012-2016. Malaysia aimed to reduce the occupational accidents, the results show by DOSH increase that Occupational Noise Induced Hearing Loss 83.7%, occupational musculoskeletal diseases, 4.4% and occupational lung diseases 2.3%. But the as per the record from DOSH that in last 5-Years, the increment in the fatal accidents by Average 26%, Permanent Disability by Average 71% and Non-Permanent Disability by 64 % are investigated only in Manufacturing Industries. The government must show their high interest on such a vulnerable employees to accomplish the above aim. This step will be helpful for planning to reduce the accidents in workplaces and it will also detect the prevention for the future accidents.

  10. Safety and Regulatory Issues of the Thorium Fuel Cycle

    Ade, Brian [ORNL; Worrall, Andrew [ORNL; Powers, Jeffrey [ORNL; Bowman, Steve [ORNL; Flanagan, George [ORNL; Gehin, Jess [ORNL

    2014-02-01

    Thorium has been widely considered an alternative to uranium fuel because of its relatively large natural abundance and its ability to breed fissile fuel (233U) from natural thorium (232Th). Possible scenarios for using thorium in the nuclear fuel cycle include use in different nuclear reactor types (light water, high temperature gas cooled, fast spectrum sodium, molten salt, etc.), advanced accelerator-driven systems, or even fission-fusion hybrid systems. The most likely near-term application of thorium in the United States is in currently operating light water reactors (LWRs). This use is primarily based on concepts that mix thorium with uranium (UO2 + ThO2), add fertile thorium (ThO2) fuel pins to LWR fuel assemblies, or use mixed plutonium and thorium (PuO2 + ThO2) fuel assemblies. The addition of thorium to currently operating LWRs would result in a number of different phenomenological impacts on the nuclear fuel. Thorium and its irradiation products have nuclear characteristics that are different from those of uranium. In addition, ThO2, alone or mixed with UO2 fuel, leads to different chemical and physical properties of the fuel. These aspects are key to reactor safety-related issues. The primary objectives of this report are to summarize historical, current, and proposed uses of thorium in nuclear reactors; provide some important properties of thorium fuel; perform qualitative and quantitative evaluations of both in-reactor and out-of-reactor safety issues and requirements specific to a thorium-based fuel cycle for current LWR reactor designs; and identify key knowledge gaps and technical issues that need to be addressed for the licensing of thorium LWR fuel in the United States.

  11. Safety of fuel cycle facilities. Topical issues paper no. 3

    Ranguelova, V.; Niehaus, F.; Delattre, D.

    2001-01-01

    that the relative hazards vary from facility to facility depending upon the processes employed. However, all installations should be designed and operated so as to keep all sources of radiation exposure under strict technical and administrative control. The design management should ensure that the structures, systems and components important to safety have the appropriate characteristics, specifications and material composition to perform the required safety functions. Emphasis should be placed on the use of proven engineered safety features in the implementation of the defence in depth concept in the facility design and operation. The development of nuclear safety standards is one of the tasks given by the Statute of the IAEA. Over a number of years, the IAEA has developed a comprehensive set of publications which address, in a structured manner, the safety of nuclear installations. The Safety Fundamentals publication entitled 'The Safety of Nuclear Installations' presents an international consensus on the basic concepts underlying the principles for the regulation, design and operation of nuclear installations, including fuel cycle facilities. Detailed requirements and guides for activities relating to siting, design, construction, operation, decommissioning and regulation of nuclear installations are addressed by lower hierarchy safety standards, which cover nuclear power plants (NPPs) and research reactors. Although some of the IAEA NPP standards can be adapted and applied to fuel cycle facilities and some standards on criticality safety are published by the International Organization for Standardization (ISO), in general there is a lack of international safety standards to cover the safety of such facilities. With a view to establishing a plan for the development of safety standards for fuel cycle facilities, the IAEA began to compile information on the status of national regulations and safety issues concerning such facilities. It also held a Technical Committee

  12. Safety in GPR prospecting: a rarely-considered issue

    Persico, Raffaele; Pajewski, Lara; Trela, Christiane; Carrick Utsi, Erica

    2016-04-01

    Safety issues (of people first of all, but also of the equipment and environment) are rarely considered in Ground-Penetrating Radar (GPR) prospecting and, more in general, in near-surface geophysical prospecting. As is right and fully understandable, the scientific community devotes greatest attention first of all to the theoretical and practical aspects of GPR technique, affecting the quality of attainable results, secondly to the efforts and costs needed to achieve them [1-2]. However, the (luckily) growing GPR market and range of applications make it worth giving serious consideration to safety issues, too. The existing manuals dealing with safety in geophysics are mainly concerned with applications requiring "deep" geophysical prospecting, for example the search for oilfields and other hydrocarbon resources [3]. Near-surface geophysics involves less dangers than deep geophysics, of course. Nevertheless, several accidents have already happened during GPR experimental campaigns. We have personally had critical experiences and collected reliable testimonies concerning occurred problems as mountain sicks, fractures of legs, stomach problems, allergic reactions, encounters with potentially-dangerous animals, and more. We have also noticed that much more attention is usually paid to safety issues during indoor experimental activities (in laboratory), rather than during outdoor fieldworks. For example, the Italian National research Council is conventioned with safety experts who hold periodical seminaries about safety aspects. Having taken part to some of them, to our experience we have never heard a "lecture" devoted to outdoor prospecting. Nowadays, any aspects associated to the use of the technologies should be considered. The increasing sensibility and sense of responsibility towards environmental matters impose GPR end-users to be careful not to damage the environment and also the cultural heritage. Near-surface prospecting should not compromise the flora and

  13. Patient handover in orthopaedics, improving safety using Information Technology.

    Pearkes, Tim

    2015-01-01

    Good inpatient handover ensures patient safety and continuity of care. An adjunct to this is the patient list which is routinely managed by junior doctors. These lists are routinely created and managed within Microsoft Excel or Word. Following the merger of two orthopaedic departments into a single service in a new hospital, it was felt that a number of safety issues within the handover process needed to be addressed. This quality improvement project addressed these issues through the creation and implementation of a new patient database which spanned the department, allowing trouble free, safe, and comprehensive handover. Feedback demonstrated an improved user experience, greater reliability, continuity within the lists and a subsequent improvement in patient safety.

  14. Priming patient safety: A middle-range theory of safety goal priming via safety culture communication.

    Groves, Patricia S; Bunch, Jacinda L

    2018-05-18

    The aim of this paper is discussion of a new middle-range theory of patient safety goal priming via safety culture communication. Bedside nurses are key to safe care, but there is little theory about how organizations can influence nursing behavior through safety culture to improve patient safety outcomes. We theorize patient safety goal priming via safety culture communication may support organizations in this endeavor. According to this theory, hospital safety culture communication activates a previously held patient safety goal and increases the perceived value of actions nurses can take to achieve that goal. Nurses subsequently prioritize and are motivated to perform tasks and risk assessment related to achieving patient safety. These efforts continue until nurses mitigate or ameliorate identified risks and hazards during the patient care encounter. Critically, this process requires nurses to have a previously held safety goal associated with a repertoire of appropriate actions. This theory suggests undergraduate educators should foster an outcomes focus emphasizing the connections between nursing interventions and safety outcomes, hospitals should strategically structure patient safety primes into communicative activities, and organizations should support professional development including new skills and the latest evidence supporting nursing practice for patient safety. © 2018 John Wiley & Sons Ltd.

  15. Status report on resolution of Waste Tank Safety Issues at the Hanford Site. Revision 1

    Dukelow, G.T.; Hanson, G.A.

    1995-05-01

    The purpose of this report is to provide and update the status of activities supporting the resolution of waste tank safety issues and system deficiencies at the Hanford Site. This report provides: (1) background information on safety issues and system deficiencies; (2) a description of the Tank Waste Remediation System and the process for managing safety issues and system deficiencies; (3) changes in safety issue description, prioritization, and schedules; and (4) a summary of the status, plans, order of magnitude, cost, and schedule for resolving safety issues and system deficiencies

  16. Educating future leaders in patient safety

    Leotsakos, Agnès; Ardolino, Antonella; Cheung, Ronny; Zheng, Hao; Barraclough, Bruce; Walton, Merrilyn

    2014-01-01

    Education of health care professionals has given little attention to patient safety, resulting in limited understanding of the nature of risk in health care and the importance of strengthening systems. The World Health Organization developed the Patient Safety Curriculum Guide: Multiprofessional Edition to accelerate the incorporation of patient safety teaching into higher educational curricula. The World Health Organization Curriculum Guide uses a health system-focused, team-dependent approach, which impacts all health care professionals and students learning in an integrated way about how to operate within a culture of safety. The guide is pertinent in the context of global educational reforms and growing recognition of the need to introduce patient safety into health care professionals’ curricula. The guide helps to advance patient safety education worldwide in five ways. First, it addresses the variety of opportunities and contexts in which health care educators teach, and provides practical recommendations to learning. Second, it recommends shared learning by students of different professions, thus enhancing student capacity to work together effectively in multidisciplinary teams. Third, it provides guidance on a range of teaching methods and pedagogical activities to ensure that students understand that patient safety is a practical science teaching them to act in evidence-based ways to reduce patient risk. Fourth, it encourages supportive teaching and learning, emphasizing the need to establishing teaching environments in which students feel comfortable to learn and practice patient safety. Finally, it helps educators incorporate patient safety topics across all areas of clinical practice. PMID:25285012

  17. Researchers' Roles in Patient Safety Improvement.

    Pietikäinen, Elina; Reiman, Teemu; Heikkilä, Jouko; Macchi, Luigi

    2016-03-01

    In this article, we explore how researchers can contribute to patient safety improvement. We aim to expand the instrumental role researchers have often occupied in relation to patient safety improvement. We reflect on our own improvement model and experiences as patient safety researchers in an ongoing Finnish multi-actor innovation project through self-reflective narration. Our own patient safety improvement model can be described as systemic. Based on the purpose of the innovation project, our improvement model, and the improvement models of the other actors in the project, we have carried out a wide range of activities. Our activities can be summarized in 8 overlapping patient safety improvement roles: modeler, influencer, supplier, producer, ideator, reflector, facilitator, and negotiator. When working side by side with "practice," researchers are offered and engage in several different activities. The way researchers contribute to patient safety improvement and balance between different roles depends on the purpose of the study, as well as on the underlying patient safety improvement models. Different patient safety research paradigms seem to emphasize different improvement roles, and thus, they also face different challenges. Open reflection on the underlying improvement models and roles can help researchers with different backgrounds-as well as other actors involved in patient safety improvement-in structuring their work and collaborating productively.

  18. Burns From Hot Wheat Bags: A Public Safety Issue

    Collins, Anna; Amprayil, Mathew; Solanki, Nicholas S.; Greenwood, John Edward

    2011-01-01

    Introduction: Wheat bags are therapeutic devices that are heated in microwaves and commonly used to provide relief from muscle and joint pain. The Royal Adelaide Hospital Burns Unit has observed a number of patients with significant burn injuries resulting from their use. Despite their dangers, the products come with limited safety information. Methods: Data were collected from the Burns Unit database for all patients admitted with burns due to hot wheat bags from 2004 to 2009. This was analyzed to determine the severity of the burn injury and identify any predisposing factors. An experimental study was performed to measure the temperature of wheat bags when heated to determine their potential for causing thermal injury. Results: 11 patients were admitted with burns due to hot wheat bags. The median age was 52 years and the mean total body surface area was 1.1%. All burns were either deep dermal (45.5%) or full thickness (54.5%). Ten patients required operative management. Predisposing factors (eg, neuropathy) to thermal injury were identified in 7 patients. The experimental study showed that hot wheat bags reached temperatures of 57.3°C (135.1°F) when heated according to instructions, 63.3°C (145.9°F) in a 1000 W microwave and 69.6°C (157.3°F) on reheating. Conclusions: Hot wheat bags cause serious burn injury. When heated improperly, they can reach temperatures high enough to cause epidermal necrosis in a short period of time. Patients with impaired temperature sensation are particularly at risk. There should be greater public awareness of the dangers of wheat bag use and more specific safety warnings on the products. PMID:21915357

  19. A region addresses patient safety.

    Feinstein, Karen Wolk; Grunden, Naida; Harrison, Edward I

    2002-06-01

    The Pittsburgh Regional Healthcare Initiative (PRHI) is a coalition of 35 hospitals, 4 major insurers, more than 30 major and small-business health care purchasers, dozens of corporate and civic leaders, organized labor, and partnerships with state and federal government all working together to deliver perfect patient care throughout Southwestern Pennsylvania. PRHI believes that in pursuing perfection, many of the challenges facing today's health care delivery system (eg, waste and error in the delivery of care, rising costs, frustration and shortage among clinicians and workers, financial distress, overcapacity, and lack of access to care) will be addressed. PRHI has identified patient safety (nosocomial infections and medication errors) and 5 clinical areas (obstetrics, orthopedic surgery, cardiac surgery, depression, and diabetes) as ideal starting points. In each of these areas of work, PRHI partners have assembled multifacility/multidisciplinary groups charged with defining perfection, establishing region-wide reporting systems, and devising and implementing recommended improvement strategies and interventions. Many design and conceptual elements of the PRHI strategy are adapted from the Toyota Production System and its Pittsburgh derivative, the Alcoa Business System. PRHI is in the proof-of-concept phase of development.

  20. Patient safety culture in Norwegian nursing homes.

    Bondevik, Gunnar Tschudi; Hofoss, Dag; Husebø, Bettina Sandgathe; Deilkås, Ellen Catharina Tveter

    2017-06-20

    Patient safety culture concerns leader and staff interaction, attitudes, routines, awareness and practices that impinge on the risk of patient-adverse events. Due to their complex multiple diseases, nursing home patients are at particularly high risk of adverse events. Studies have found an association between patient safety culture and the risk of adverse events. This study aimed to investigate safety attitudes among healthcare providers in Norwegian nursing homes, using the Safety Attitudes Questionnaire - Ambulatory Version (SAQ-AV). We studied whether variations in safety attitudes were related to professional background, age, work experience and mother tongue. In February 2016, 463 healthcare providers working in five nursing homes in Tønsberg, Norway, were invited to answer the SAQ-AV, translated and adapted to the Norwegian nursing home setting. Previous validation of the Norwegian SAQ-AV for nursing homes identified five patient safety factors: teamwork climate, safety climate, job satisfaction, working conditions and stress recognition. SPSS v.22 was used for statistical analysis, which included estimations of mean values, standard deviations and multiple linear regressions. P-values safety factors teamwork climate, safety climate, job satisfaction and working conditions. Not being a Norwegian native speaker was associated with a significantly higher mean score for job satisfaction and a significantly lower mean score for stress recognition. Neither professional background nor work experience were significantly associated with mean scores for any patient safety factor. Patient safety factor scores in nursing homes were poorer than previously found in Norwegian general practices, but similar to findings in out-of-hours primary care clinics. Patient safety culture assessment may help nursing home leaders to initiate targeted quality improvement interventions. Further research should investigate associations between patient safety culture and the occurrence

  1. Improving Patient Safety in Hospitals through Usage of Cloud Supported Video Surveillance

    Predrag Dašić

    2017-03-01

    CONCLUSION: Patient safety is a growing issue which can be improved with the usage of high-end centralised surveillance systems allowing the staff to focus more on treating health issues rather that keeping a watchful eye on potential incidents.

  2. Characterization strategy for the flammable gas safety issue

    Stewart, C.W.; Brewster, M.E.; Roberts, J.S.

    1997-06-01

    The characterization strategy for resolving the flammable gas safety issue for Hanford waste tanks is based on a structured logic diagram (SLD) that displays the outcomes necessary to reach the desired goal of making flammable gas risk acceptable. The diagram provides a structured path that can identify all information inputs, data as well as models, needed to achieve the goal. Tracing the path from need to outcome provides an immediate and clear justification and defense of a specific need. The diagram itself is a open-quote picture of a risk calculation close-quote and forms the basis for a quantitative model of risk. The SLID, with the risk calculation, identifies options for characterization, mitigation, and controls that have the maximum effect in reducing risk. It provides quantitative input to risk-based decision making so that options are chosen for maximum impact at least cost

  3. The role of aging in resolving the ferrocyanide safety issue

    Babad, H.; Meacham, J.E.; Simpson, B.C.; Cash, R.J.

    1993-08-01

    A chemical process called aging, in which stored ferrocyanide waste could be dissolved and dispersed among waste tanks, or destroyed by radiolysis and hydrolysis, has been proposed at the Hanford Site. This paper summarizes the results of applied research, characterization, and modeling activities on Hanford Site ferrocyanide waste material that support the existence of a chemical aging mechanism. Test results from waste simulants and actual waste tank materials are presented and compared with theoretical estimates. Chemical and energetic behavior of the materials are the key indicators of destruction or dispersion. Screening experiments on vendor-prepared sodium nickel ferrocyanide and the initial results from core sampling support the concept that aging of ferrocyanide is taking place in the waste tanks at the Hanford Site. This report defines the concept of waste aging and explains the role that aging could play in resolving the Hanford Site ferrocyanide safety issue

  4. Compiler issues associated with safety-related software

    Feinauer, L.R.

    1991-01-01

    A critical issue in the quality assurance of safety-related software is the ability of the software to produce identical results, independent of the host machine, operating system, or compiler version under which the software is installed. A study is performed using the VIPRE-0l, FREY-01, and RETRAN-02 safety-related codes. Results from an IBM 3083 computer are compared with results from a CYBER 860 computer. All three of the computer programs examined are written in FORTRAN; the VIPRE code uses the FORTRAN 66 compiler, whereas the FREY and RETRAN codes use the FORTRAN 77 compiler. Various compiler options are studied to determine their effect on the output between machines. Since the Control Data Corporation and IBM machines inherently represent numerical data differently, methods of producing equivalent accuracy of data representation were an important focus of the study. This paper identifies particular problems in the automatic double-precision option (AUTODBL) of the IBM FORTRAN 1.4.x series of compilers. The IBM FORTRAN version 2 compilers provide much more stable, reliable compilation for engineering software. Careful selection of compilers and compiler options can help guarantee identical results between different machines. To ensure reproducibility of results, the same compiler and compiler options should be used to install the program as were used in the development and testing of the program

  5. Research on patient safety: falls and medications.

    Boddice, Sandra Dawn; Kogan, Polina

    2009-10-01

    Below you will find summaries of published research describing investigations into patient safety issues related to falls and medications. The first summary provides details on the incidence of falls associated with the use of walkers and canes. This is followed by a summary of a fall-prevention intervention study that evaluated the effectiveness of widespread dissemination of evidence-based strategies in a community in Connecticut. The third write up provides information on three classes of medications that are associated with a significant number of emergency room visits. The last summary describes a pharmacist-managed medication reconciliation intervention pilot program. For additional details about the study findings and interventions, we encourage readers to review the original articles.

  6. Managing risk in healthcare: understanding your safety culture using the Manchester Patient Safety Framework (MaPSaF).

    Parker, Dianne

    2009-03-01

    To provide sufficient information about the Manchester Patient Safety Framework (MaPSaF) to allow healthcare professionals to assess its potential usefulness. The assessment of safety culture is an important aspect of risk management, and one in which there is increasing interest among healthcare organizations. Manchester Patient Safety Framework offers a theory-based framework for assessing safety culture, designed specifically for use in the NHS. The framework covers multiple dimensions of safety culture, and five levels of safety culture development. This allows the generation of a profile of an organization's safety culture in terms of areas of relative strength and challenge, which can be used to identify focus issues for change and improvement. Manchester Patient Safety Framework provides a useful method for engaging healthcare professionals in assessing and improving the safety culture in their organization, as part of a programme of risk management.

  7. Implementing Protocols to Improve Patient Safety in the Medical Imaging Department.

    Carrizales, Gwen; Clark, Kevin R

    2015-01-01

    Patient safety is a focal point in healthcare because of recent changes issued by CMS. Hospital reimbursement rates have fallen, and these reimbursement rates are governed by CMS mandates regarding patient safety procedures. Reimbursement changes are reflected in the National Patient Safety Goals (NPSGs) administered annually by The Joint Commission. Medical imaging departments have multiple areas of patient safety concerns including effective handoff communication, proper patient identification, and safe medication/contrast administration. This literature review examines those areas of patient safety within the medical imaging department and reveals the need for continued protocol and policy changes to keep patients safe.

  8. The issue of safety in the transports of radioactive materials

    Pallier, Lucien

    1961-01-01

    This report addresses and discusses the various hazards associated with transports of radioactive materials, their prevention, intervention measures, and precautions to be taken by rescuers, notably how these issues are addressed in regulations. For each of these issues, this report proposes guidelines, good practices, or procedures to handle the situation. The author first addresses hazards related to a transport of radioactive products: multiplicity of hazards, different hazards due to radioactivity, hazards due to transport modes, scale of dangerous doses. The second part addresses precautionary measures: for road transports, for air transports, for maritime transports, control procedures. The third part addresses the intervention in case of accident: case of a road accident with an unhurt or not vehicle crew, role of the first official rescuers, other kinds of accidents. The fourth part briefly addresses the case of transport of fissile materials. The fifth part discusses the implications of safety measures. Appendices indicate standards, and give guidelines for the construction of a storage building for radioactive products, for the control and storage of parcels containing radioactive products, and for the establishment of instructions for the first aid personnel

  9. Strategy for resolution of the Flammable Gas Safety Issue

    Johnson, G.D.

    1995-01-01

    The purpose of this document is to provide the general strategy for resolution of the flammable gas safety issue; it is not a detailed description of program activities. budgets and schedules. Details of the program activities have been issued (Johnson and Sherwood, 1994) and the information pertaining to budgets is provided in the FY 1995-1997 Multi-Year Work Plan for Tank Waste Remediation System (TWRS) (Program Element 1.1.1.2.02.). The key element in this strategy is to provide an understanding of the behavior of each of the Flammable Gas Watch List tanks. While a review of historical information does provide some insight, it is necessary to gather current information about the gases, behavior and nature of the waste,. and about the control systems that maintain and monitor the waste. Analysis of this information will enable TWRS to determine the best approach to place any tank in a safe condition, if it is found to be in an unsafe state

  10. EDF view on next generation reactor safety and operability issues

    Serviere, G.

    2002-01-01

    In the foreseeable future, EDF will have to compete in an economically de-regulated market. Nuclear currently accounts for more than 80% of the electricity generated by the company, and generation costs are quite competitive compared to that of other competing energies. It is so likely that nuclear units will remain the backbone of EDF generating fleet in the years to come. However, to remain a viable option for electricity generation in the longer term, nuclear will have to maintain both its cost-effectiveness and a very high safety level. This could seem quite straightforward considering the current situation where safety records are at an all time high and Operating and Maintenance costs are under tight control. In fact, it could be a real challenge. Competing fossil technologies progress and there is a concurrent trend to try and improve the performance of future nuclear units. However, in most cases, proposed designs depart from the well-known Light Water Reactor (LWR) technology. They are either new concepts or designs already tested in the past and modified to address some of their perceived drawbacks. Contrary to the prevailing situation where short-term alternatives like the EPR, the ABWR or the AP600 largely build upon experience gathered on operating units, most designs contemplated for implementation beyond 2020 or 2030 cannot be considered proven. Considering the above mentioned uncertainties, EDF have confirmed their preference for proven designs with higher outputs, such as the EPR. However, it would appear unreasonable to consider that new designs are doomed to fail: they could well turn out to be adequate for specific niches in a de-regulated market and provide reasonable alternatives for the utility. Nevertheless, for such an alternative to be considered, additional evidence is needed that utility preferences are reflected in the design, and that all potential technical issues have been identified, adequately addressed and resolved. Currently, EDF

  11. Editorial: Advances in healthcare provider and patient training to improve the quality and safety of patient care

    Elizabeth M. Borycki

    2015-01-01

    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 ...

  12. 76 FR 71345 - Patient Safety Organizations: Voluntary Relinquishment From Emergency Medicine Patient Safety...

    2011-11-17

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From Emergency Medicine Patient Safety Foundation AGENCY: Agency for... notification of voluntary relinquishment from Emergency Medicine Patient Safety Foundation of its status as a...

  13. 78 FR 40146 - Patient Safety Organizations: Voluntary Relinquishment From Northern Metropolitan Patient Safety...

    2013-07-03

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From Northern Metropolitan Patient Safety Institute AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS. ACTION: Notice of Delisting. SUMMARY: The Patient Safety and...

  14. 78 FR 59036 - Patient Safety Organizations: Voluntary Relinquishment From Cogent Patient Safety Organization, Inc.

    2013-09-25

    ... Organizations: Voluntary Relinquishment From Cogent Patient Safety Organization, Inc. AGENCY: Agency for... for the formation of Patient Safety Organizations (PSOs), which collect, aggregate, and analyze... Cogent Patient Safety Organization, Inc. of its status as a PSO, and has delisted the PSO accordingly...

  15. 76 FR 9350 - Patient Safety Organizations: Voluntary Delisting From Rocky Mountain Patient Safety Organization

    2011-02-17

    ... Organizations: Voluntary Delisting From Rocky Mountain Patient Safety Organization AGENCY: Agency for Healthcare... Organization: AHRQ has accepted a notification of voluntary relinquishment from Rocky Mountain Patient Safety Organization, a component entity of Colorado Hospital Association, of its status as a Patient Safety...

  16. 76 FR 7853 - Patient Safety Organizations: Voluntary Delisting From Oregon Patient Safety Commission

    2011-02-11

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary Delisting From Oregon Patient Safety Commission AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS. ACTION: Notice of delisting. SUMMARY: Oregon Patient Safety Commission: AHRQ...

  17. 76 FR 9351 - Patient Safety Organizations: Voluntary Delisting From West Virginia Center for Patient Safety

    2011-02-17

    ... Patient Safety, a component entity of West Virginia Hospital Association, West Virginia Medical Institute (WVMI), and West Virginia State Medical. Association (WVSMA), of its status as a Patient Safety... Patient Safety, a component entity of West Virginia Hospital Association, West Virginia Medical Institute...

  18. Identifying organizational cultures that promote patient safety.

    Singer, Sara J; Falwell, Alyson; Gaba, David M; Meterko, Mark; Rosen, Amy; Hartmann, Christine W; Baker, Laurence

    2009-01-01

    Safety climate refers to shared perceptions of what an organization is like with regard to safety, whereas safety culture refers to employees' fundamental ideology and orientation and explains why safety is pursued in the manner exhibited within a particular organization. Although research has sought to identify opportunities for improving safety outcomes by studying patterns of variation in safety climate, few empirical studies have examined the impact of organizational characteristics such as culture on hospital safety climate. This study explored how aspects of general organizational culture relate to hospital patient safety climate. In a stratified sample of 92 U.S. hospitals, we sampled 100% of senior managers and physicians and 10% of other hospital workers. The Patient Safety Climate in Healthcare Organizations and the Zammuto and Krakower organizational culture surveys measured safety climate and group, entrepreneurial, hierarchical, and production orientation of hospitals' culture, respectively. We administered safety climate surveys to 18,361 personnel and organizational culture surveys to a 5,894 random subsample between March 2004 and May 2005. Secondary data came from the 2004 American Hospital Association Annual Hospital Survey and Dun & Bradstreet. Hierarchical linear regressions assessed relationships between organizational culture and safety climate measures. Aspects of general organizational culture were strongly related to safety climate. A higher level of group culture correlated with a higher level of safety climate, but more hierarchical culture was associated with lower safety climate. Aspects of organizational culture accounted for more than threefold improvement in measures of model fit compared with models with controls alone. A mix of culture types, emphasizing group culture, seemed optimal for safety climate. Safety climate and organizational culture are positively related. Results support strategies that promote group orientation and

  19. Collegiate Aviation Research and Education Solutions to Critical Safety Issues. UNO Aviation Monograph Series. UNOAI Report.

    Bowen, Brent, Ed.

    This document contains four papers concerning collegiate aviation research and education solutions to critical safety issues. "Panel Proposal Titled Collegiate Aviation Research and Education Solutions to Critical Safety Issues for the Tim Forte Collegiate Aviation Safety Symposium" (Brent Bowen) presents proposals for panels on the…

  20. Patients' and healthcare workers' perceptions of a patient safety advisory.

    Schwappach, David L B; Frank, Olga; Koppenberg, Joachim; Müller, Beat; Wasserfallen, Jean-Blaise

    2011-12-01

    To assess patients' and healthcare workers' (hcw) attitudes and experiences with a patient safety advisory, to investigate predictors for patients' safety-related behaviors and determinants for staff support for the advisory. Cross-sectional surveys of patients (n= 1053) and hcw (n= 275). Three Swiss hospitals. Patients who received the safety advisory and hcw caring for these patients. Patient safety advisory disseminated to patients at the study hospitals. Attitudes towards and experiences with the advisory. Hcw support for the intervention and patients' intentions to apply the recommendations were modelled using regression analyses. Patients (95%) and hcw (78%) agreed that hospitals should educate patients how to prevent errors. Hcw and patients' evaluations of the safety advisory were positive and followed a similar pattern. Patients' intentions to engage in safety were significantly predicted by behavioral control, subjective norms, attitudes, safety behaviors during hospitalization and experiences with taking action. Hcw support for the campaign was predicted by rating of the advisory (Odds ratio (OR) 3.4, confidence interval (CI) 1.8-6.1, Ppatients (OR 1.9, CI 1.1-3.3, P= 0.034) and experience of unpleasant situations (OR 0.6, CI 0.4-1.0, P= 0.035). The safety advisory was well accepted by patients and hcw. To be successful, the advisory should be accompanied by measures that target norms and barriers in patients, and support staff in dealing with difficult situations.

  1. Characterization strategy report for the criticality safety issue

    Doherty, A.L.; Doctor, P.G.; Felmy, A.R.; Prichard, A.W.; Serne, R.J.

    1997-06-01

    High-level radioactive waste from nuclear fuels processing is stored in underground waste storage tanks located in the tank farms on the Hanford Site. Waste in tank storage contains low concentrations of fissile isotopes, primarily U-235 and Pu-239. The composition and the distribution of the waste components within the storage environment is highly complex and not subject to easy investigation. An important safety concern is the preclusion of a self-sustaining neutron chain reaction, also known as a nuclear criticality. A thorough technical evaluation of processes, phenomena, and conditions is required to make sure that subcriticality will be ensured for both current and future tank operations. Subcriticality limits must be based on considerations of tank processes and take into account all chemical and geometrical phenomena that are occurring in the tanks. The important chemical and physical phenomena are those capable of influencing the mixing of fissile material and neutron absorbers such that the degree of subcriticality could be adversely impacted. This report describes a logical approach to resolving the criticality safety issues in the Hanford waste tanks. The approach uses a structured logic diagram (SLD) to identify the characterization needed to quantify risk. The scope of this section of the report is limited to those branches of logic needed to quantify the risk associated with a criticality event occurring. The process is linked to a conceptual model that depicts key modes of failure which are linked to the SLD. Data that are needed include adequate knowledge of the chemical and geometric form of the materials of interest. This information is used to determine how much energy the waste would release in the various domains of the tank, the toxicity of the region associated with a criticality event, and the probability of the initiating criticality event

  2. Evolution of approaches to viral safety issues for biological products.

    Lubiniecki, Anthony S

    2011-01-01

    CONFERENCE PROCEEDING Proceedings of the PDA/FDA Adventitious Viruses in Biologics: Detection and Mitigation Strategies Workshop in Bethesda, MD, USA; December 1-3, 2010 Guest Editors: Arifa Khan (Bethesda, MD), Patricia Hughes (Bethesda, MD) and Michael Wiebe (San Francisco, CA) Approaches to viral safety issues for biological products have evolved during the past 50+ years. The first cell culture products (viral vaccines) relied largely on the use of in vitro and in vivo virus screening assays that were based upon infectivity of adventitious viral agents. The use of Cohn fractionation and pasteurization by manufacturers of plasma derivatives introduced the concepts that purification and treatment with physical and chemical agents could greatly reduce the risk of viral contamination of human albumin and immunoglobulin products. But the limitations of such approaches became clear for thermolabile products that were removed early in fractionation such as antihemophilic factors, which transmitted hepatitis viruses and HIV-1 to some product recipients. These successes and limitations were taken into account by the early developers of recombinant DNA (rDNA)-derived cell culture products and by regulatory agencies, leading to the utilization of cloning technology to reduce/eliminate contamination due to human viruses and purification technologies to physically remove and inactivate adventitious and endogenous viruses, along with cell banking and cell bank characterization for adventitious and endogenous viruses, viral screening of biological raw materials, and testing of cell culture harvests, to ensure virus safety. Later development and incorporation of nanofiltration technology in the manufacturing process provided additional assurance of viral clearance for safety of biotechnology products. These measures have proven very effective at preventing iatrogenic infection of recipients of biotechnology products; however, viral contamination of production cell cultures has

  3. NS [Nuclear Safety] update. Current safety and security activities and developments taking place in the Department of Nuclear Safety and Security, Issue no. 10, March 2009

    2009-03-01

    The current issue contains information about the following meetings: Application of the Code of Conduct on the Safety of Research Reactors (the 'Code'). Environmental Modelling for Radiation Safety (EMRAS II); Convention on the Safety of Spent Fuel Management and on the Safety of Radioactive Waste Management (the Joint Convention). The document also gives an overview on International Nuclear Security Advisory Service (INSServ)

  4. NS [Nuclear Safety] update. Current safety and security activities and developments taking place in the Department of Nuclear Safety and Security, Issue no. 11, June 2009

    2009-06-01

    The current issue presents information about the following topics: Nuclear Safety Review for the Year 2008; Feedback from IRS Topical Studies and Events Applied to Safety Standards; Education and Training Programmes at the IAEA Department of Nuclear Safety and Security; Peer Review of Operational Safety Performance (PROSPER)

  5. Passionate scholarship or academic safety: an ethical issue.

    Merryfeather, Lyn

    2015-03-01

    Are we passionate scholars or is academic safety something to which we aspire? Do we teach our students one thing and practice another? Are some forms of scholarship more acclaimed than others, some methodologies more acceptable? What are the ethical implications in these various questions? In this article, I outline my experiences, both as a student researcher and as an educator, that have brought me to ask these things. Holism is an ideal that many nursing students are taught and encouraged to bring to their practice, and yet holism does not seem, in many instances, to be supported in academia or in bedside practice. I suggest the possible causes for these difficulties and propose solutions. I suggest that the bedrock of ethical practice, both in the academy and with patients, is to bring all of who we are, the alchemic mystery of holism, to everything we do. © The Author(s) 2014.

  6. Patients for patient safety in China: a cross sectional study.

    Zhang, Qiongwen; Li, Yulin; Li, Jing; Mao, Xuanyue; Zhang, Lijuan; Ying, Qinghua; Wei, Xin; Shang, Lili; Zhang, Mingming

    2012-02-01

    To investigate the baseline status of patients' awareness, knowledge, and attitudes to patient safety in China, and to determine the factors that influence patients' involvement in patient safety. We conducted a cross sectional survey using questionnaires adapted from recent studies on patient safety from outside China. The items included medical errors, infection, medication safety, and other aspects of patient safety. The questionnaire included 17 items and 5 domains. The survey was conducted between Jan. 2009 and Dec. 2010 involving 1000 patients from ten grade-A hospitals in seven provinces or cities in China. Most patients from the surgery departments completed the questionnaires voluntarily and anonymously. Five reviewers independently input the data into Microsoft Excel 2003, and the data were double-checked. Data were analyzed using SPSS 15.0 software for differences in the perceptions and attitudes of patients toward patient safety among different genders, ages, and regions. We distributed 1000 questionnaires and collected 959 completed questionnaires (response rate: 96%). Among the respondents, 58% of patients did not know what medical error is. Sixty-five percent of patients wanted disclosure of all medical errors. After errors occurred, 58% of patients wanted explanations of all possible harms that had resulted. Among 187 patients who had experienced medical errors, 83% of patients had sought appropriate legal action. About 52% of patients understood hospital infection, but 28% patients did not know that infections could occur in hospital. Seventy-eight percent of patients thought that medical staff should wash their hands before examining patients. More than half of the patients (68%) were willing to remind the staff of hygiene if they saw unsanitary conditions in a health clinic. Only 14% of patients knew the side effects of medications that they took. The majority of patients surveyed expressed willingness to contribute to patient safety, but their

  7. Guidelines for nuclear power plant safety issue prioritization information development. Supplement 2

    Andrews, W.B.; Gallucci, R.H.V.; Konzek, G.J.; Heaberlin, S.W.; Fecht, B.A.; Allen, C.H.; Allen, R.D.; Bickford, W.E.; Carbaugh, E.H.; Lewis, J.R.

    1983-12-01

    This is the third in a series of reports to document the use of a methodology developed by the Pacific Northwest Laboratory to calculate, for prioritization purposes, the risk, dose and cost impacts of implementing resolutions to reactor safety issues (NUREG/CR-2800, Andrews et al. 1983). This report contains results of issue-specific analyses for 31 issues. Each issue was considered within the constraints of available information as of summer 1983, and two staff-weeks of labor. The results are referenced, as one consideration in setting priorities for reactor safety issues, in NUREG-0933, A Prioritization of Generic Safety Issues

  8. Designing a Safety Reporting Smartphone Application to Improve Patient Safety After Total Hip Arthroplasty.

    Krumsvik, Ole Andreas; Babic, Ankica

    2017-01-01

    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.

  9. Long-term safety issues associated with mixer pump operation

    Kubic, W.L. Jr.

    1994-01-01

    In this report, we examine several long-term issues: the effect of pump operation on future gas release events (GREs), uncontrolled chemical reactions, chronic toxic gas releases, foaming, and erosion and corrosion. Heat load in excess of the design limit, uncontrolled chemical reactions, chronic toxic gas releases, foaming, and erosion and corrosion have been shown not to be safety concerns. The effect of pump operation on future GREs could not be quantified. The problem with evaluating the long-term effects of pump operation on GREs is a lack of knowledge and uncertainty. In particular, the phenomena governing gas retention, particle size distribution, and settling are not well understood, nor are the interactions among these factors understood. There is a possibility that changes in these factors could increase the size of future GREs. Bounding estimates of the potential increase in size of GREs are not possible because of a lack of engineering data. Proper management of the hazards can reduce, but not eliminate, the possibility of undesirable changes. Maintaining temperature within the historical limits can reduce the possibility of undesirable changes. A monitoring program to detect changes in the gas composition and crust thickness will help detect slowly occurring changes. Because pump operation has be shown to eliminate GREs, continued pump operation can eliminate the hazards associated with future GREs

  10. Technical resolution of Generic Safety Issue A-29

    1989-09-01

    This report summarizes key technical findings related to Generic Safety Issue A-29, ''Nuclear Power Plant Design for Reduction of Vulnerability to Industrial Sabotage.'' The findings in this report deal with (1) a historical review of reported sabotage-related events at nuclear facilities, (2) NRC physical security requirements, (3) industry measures to prevent/mitigate sabotage, (4) design and procedural approaches that could be used to deter sabotage, (5) current NRC and industry initiatives aimed at personnel screening and selection, and (6) design considerations applicable to Advanced Light Water Reactors (ALWRs). The results reveal that insider sabotage at operating nuclear plants has not been a significant problem in the United States to date and that there are no singular design modifications or procedures that by themselves would completely eliminate or mitigate the threat of insider sabotage. Rather, it will take a combination of systematic and focused improvements in the three areas of reliable personnel, effective design features, and plant procedures developed to provide a strategy to deal with prevention of insider sabotage and to be able to mitigate adverse actions. 24 refs., 2 figs., 5 tabs

  11. [Patient safety culture in Family practice residents of Galicia].

    Portela Romero, Manuel; Bugarín González, Rosendo; Rodríguez Calvo, María Sol

    To determine the views held by Family practice (FP) residents on the different dimensions of patient safety, in order to identify potential areas for improvement. A cross-sectional study. Seven FP of Galicia teaching units. 182 FP residents who completed the Medical Office Survey on Patient Safety Culture questionnaire. The Medical Office Survey on Patient Safety Culture questionnaire was chosen because it is translated, validated, and adapted to the Spanish model of Primary Care. The results were grouped into 12 composites assessed by the mentioned questionnaire. The study variables were the socio-demographic dimensions of the questionnaire, as well as occupational/professional variables: age, gender, year of residence, and teaching unit of FP of Galicia. The "Organisational learning" and "Teamwork" items were considered strong areas. However, the "Patient safety and quality issues", "Information exchange with other settings", and "Work pressure and pace" items were considered areas with significant potential for improvement. First-year residents obtained the best results and the fourth-year ones the worst. The results may indicate the need to include basic knowledge on patient safety in the teaching process of FP residents in order to increase and consolidate the fragile patient safety culture described in this study. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  12. Culture matters: indigenizing patient safety in Bhutan.

    Pelzang, Rinchen; Johnstone, Megan-Jane; Hutchinson, Alison M

    2017-09-01

    Studies show that if quality of healthcare in a country is to be achieved, due consideration must be given to the importance of the core cultural values as a critical factor in improving patient safety outcomes. The influence of Bhutan's traditional (core) cultural values on the attitudes and behaviours of healthcare professionals regarding patient care are not known. This study aimed to explore the possible influence of Bhutan's traditional cultural values on staff attitudes towards patient safety and quality care. Undertaken as a qualitative exploratory descriptive inquiry, a purposeful sample of 94 healthcare professionals and managers were recruited from three levels of hospitals, a training institute and the Ministry of Health. Interviews were transcribed verbatim and analysed using thematic analysis strategies. The findings of the study suggest that Bhutanese traditional cultural values have both productive and counterproductive influences on staff attitudes towards healthcare delivery and the processes that need to be in place to ensure patient safety. Productive influences encompassed: karmic incentives to avoid preventable harm and promote safe patient care; and the prospective adoption of the 'four harmonious friends' as a culturally meaningful frame for improving understanding of the role and importance of teamwork in enhancing patient safety. Counterproductive influences included: the adoption of hierarchical and authoritative styles of management; unilateral decision-making; the legitimization of karmic beliefs; differential treatment of patients; and preferences for traditional healing practices and rituals. Although problematic in some areas, Bhutan's traditional cultural values could be used positively to inform and frame an effective model for improving patient safety in Bhutan's hospitals. Such a model must entail the institution of an 'indigenized' patient safety program, with patient safety research and reporting systems framed around local

  13. Issues of Safety and Security: New Challenging to Malaysia Tourism Industry

    Mohd Ayob Norizawati; Masron Tarmiji

    2014-01-01

    The safety and security issues nowadays become one of the forces causing changes in tourism industry in era of millennium. The main concern of this issues more focus on crime rates, terrorism, food safety, health issues and natural disaster. This topic gained the popularity in tourism research after 9/11 tragedy and since then the academicians and practitioners started seeking the best solution in ways to mitigate these negative impacts. For Malaysia, the image as safety and secure destinatio...

  14. An interagency space nuclear propulsion safety policy for SEI - Issues and discussion

    Marshall, A. C.; Sawyer, J. C., Jr.

    1991-01-01

    An interagency Nuclear Safety Policy Working Group (NSPWG) was chartered to recommend nuclear safety policy, requirements, and guidelines for the Space Exploration Initiative nuclear propulsion program to facilitate the implementation of mission planning and conceptual design studies. The NSPWG developed a top level policy to provide the guiding principles for the development and implementation of the nuclear propulsion safety program and the development of Safety Functional Requirements. In addition, the NSPWG reviewed safety issues for nuclear propulsion and recommended top level safety requirements and guidelines to address these issues. Safety topics include reactor start-up, inadvertent criticality, radiological release and exposure, disposal, entry, safeguards, risk/reliability, operational safety, ground testing, and other considerations. In this paper the emphasis is placed on the safety policy and the issues and considerations that are addressed by the NSPWG recommendations.

  15. Issues affecting advanced passive light-water reactor safety analysis

    Beelman, R.J.; Fletcher, C.D.; Modro, S.M.

    1992-01-01

    Next generation commercial reactor designs emphasize enhanced safety through improved safety system reliability and performance by means of system simplification and reliance on immutable natural forces for system operation. Simulating the performance of these safety systems will be central to analytical safety evaluation of advanced passive reactor designs. Yet the characteristically small driving forces of these safety systems pose challenging computational problems to current thermal-hydraulic systems analysis codes. Additionally, the safety systems generally interact closely with one another, requiring accurate, integrated simulation of the nuclear steam supply system, engineered safeguards and containment. Furthermore, numerical safety analysis of these advanced passive reactor designs wig necessitate simulation of long-duration, slowly-developing transients compared with current reactor designs. The composite effects of small computational inaccuracies on induced system interactions and perturbations over long periods may well lead to predicted results which are significantly different than would otherwise be expected or might actually occur. Comparisons between the engineered safety features of competing US advanced light water reactor designs and analogous present day reactor designs are examined relative to the adequacy of existing thermal-hydraulic safety codes in predicting the mechanisms of passive safety. Areas where existing codes might require modification, extension or assessment relative to passive safety designs are identified. Conclusions concerning the applicability of these codes to advanced passive light water reactor safety analysis are presented

  16. A prioritization of generic safety issues. Supplement 21, Revision insertion instructions

    None, None

    1996-12-31

    The report presents the safety priority ranking for generic safety issues related to nuclear power plants. The purpose of these rankings is to assist in the timely and efficient allocation of NRC resources for the resolution of those safety issues that have a significant potential for reducing risk. The safety priority rankings are HIGH, MEDIUM, LOW, and DROP, and have been assigned on the basis of risk significance estimates, the ratio of risk to costs and other impacts estimated to result if resolution of the safety issues were implemented, and the consideration of uncertainties and other quantitative or qualitative factors. To the extent practical, estimates are quantitative.

  17. A prioritization of generic safety issues. Supplement 21, Revision insertion instructions

    1996-01-01

    The report presents the safety priority ranking for generic safety issues related to nuclear power plants. The purpose of these rankings is to assist in the timely and efficient allocation of NRC resources for the resolution of those safety issues that have a significant potential for reducing risk. The safety priority rankings are HIGH, MEDIUM, LOW, and DROP, and have been assigned on the basis of risk significance estimates, the ratio of risk to costs and other impacts estimated to result if resolution of the safety issues were implemented, and the consideration of uncertainties and other quantitative or qualitative factors. To the extent practical, estimates are quantitative.

  18. Patient safety culture assessment in oman.

    Al-Mandhari, Ahmed; Al-Zakwani, Ibrahim; Al-Kindi, Moosa; Tawilah, Jihane; Dorvlo, Atsu S S; Al-Adawi, Samir

    2014-07-01

    To illustrate the patient safety culture in Oman as gleaned via 12 indices of patient safety culture derived from the Hospital Survey on Patient Safety Culture (HSPSC) and to compare the average positive response rates in patient safety culture between Oman and the USA, Taiwan, and Lebanon. This was a cross-sectional research study employed to gauge the performance of HSPSC safety indices among health workers representing five secondary and tertiary care hospitals in the northern region of Oman. The participants (n=398) represented different professional designations of hospital staff. Analyses were performed using univariate statistics. The overall average positive response rate for the 12 patient safety culture dimensions of the HSPSC survey in Oman was 58%. The indices from HSPSC that were endorsed the highest included 'organizational learning and continuous improvement' while conversely, 'non-punitive response to errors' was ranked the least. There were no significant differences in average positive response rates between Oman and the United States (58% vs. 61%; p=0.666), Taiwan (58% vs. 64%; p=0.386), and Lebanon (58% vs. 61%; p=0.666). This study provides the first empirical study on patient safety culture in Oman which is similar to those rates reported elsewhere. It highlights the specific strengths and weaknesses which may stem from the specific milieu prevailing in Oman.

  19. Patient Safety Culture Assessment in Oman

    Al-Mandhari, Ahmed; Al-Zakwani, Ibrahim; Al-Kindi, Moosa; Tawilah, Jihane; Dorvlo, Atsu S.S.; Al-Adawi, Samir

    2014-01-01

    Objective To illustrate the patient safety culture in Oman as gleaned via 12 indices of patient safety culture derived from the Hospital Survey on Patient Safety Culture (HSPSC) and to compare the average positive response rates in patient safety culture between Oman and the USA, Taiwan, and Lebanon. Methods This was a cross-sectional research study employed to gauge the performance of HSPSC safety indices among health workers representing five secondary and tertiary care hospitals in the northern region of Oman. The participants (n=398) represented different professional designations of hospital staff. Analyses were performed using univariate statistics. Results The overall average positive response rate for the 12 patient safety culture dimensions of the HSPSC survey in Oman was 58%. The indices from HSPSC that were endorsed the highest included ‘organizational learning and continuous improvement’ while conversely, ‘non-punitive response to errors’ was ranked the least. There were no significant differences in average positive response rates between Oman and the United States (58% vs. 61%; p=0.666), Taiwan (58% vs. 64%; p=0.386), and Lebanon (58% vs. 61%; p=0.666). Conclusion This study provides the first empirical study on patient safety culture in Oman which is similar to those rates reported elsewhere. It highlights the specific strengths and weaknesses which may stem from the specific milieu prevailing in Oman. PMID:25170407

  20. 77 FR 25179 - Patient Safety Organizations: Voluntary Relinquishment From Surgical Safety Institute

    2012-04-27

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety... voluntary relinquishment from the Surgical Safety Institute of its status as a Patient Safety Organization (PSO). The Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act) authorizes the...

  1. Radiological protection, safety and security issues in the industrial and medical applications of radiation sources

    Vaz, Pedro

    2015-01-01

    The use of radiation sources, namely radioactive sealed or unsealed sources and particle accelerators and beams is ubiquitous in the industrial and medical applications of ionizing radiation. Besides radiological protection of the workers, members of the public and patients in routine situations, the use of radiation sources involves several aspects associated to the mitigation of radiological or nuclear accidents and associated emergency situations. On the other hand, during the last decade security issues became burning issues due to the potential malevolent uses of radioactive sources for the perpetration of terrorist acts using RDD (Radiological Dispersal Devices), RED (Radiation Exposure Devices) or IND (Improvised Nuclear Devices). A stringent set of international legally and non-legally binding instruments, regulations, conventions and treaties regulate nowadays the use of radioactive sources. In this paper, a review of the radiological protection issues associated to the use of radiation sources in the industrial and medical applications of ionizing radiation is performed. The associated radiation safety issues and the prevention and mitigation of incidents and accidents are discussed. A comprehensive discussion of the security issues associated to the global use of radiation sources for the aforementioned applications and the inherent radiation detection requirements will be presented. Scientific, technical, legal, ethical, socio-economic issues are put forward and discussed. - Highlights: • The hazards associated to the use of radioactive sources must be taken into account. • Security issues are of paramount importance in the use of radioactive sources. • Radiation sources can be used to perpetrate terrorist acts (RDDs, INDs, REDs). • DSRS and orphan sources trigger radiological protection, safety and security concerns. • Regulatory control, from cradle to grave, of radioactive sources is mandatory.

  2. Survey of factors associated with nurses' perception of patient safety.

    Park, Sun A; Lee, Sui Jin; Choi, Go Un

    2011-01-01

    To describe the nurses' perception of hospital organization related to cultural issues on the safety of the patient and reporting medical errors. In addition, to identify factors associated with the safety of the patient and the nurse. A survey conducted during December 2008-Jannuary 2009, with 126 nurses using the Korean version of the AHRQ patient safety survey, a self-report 5-point Likert scale. Stata 10.0 was used for descriptive analysis, ANOVA (Analysis of variance) and logistic regression. National Cancer Center in Korea. The means for a working environment related to patient safety was 3.4 (±0.62). The associated factors of duration were at a present hospital, a special area, and direct contact with patients. Among organizational culture factors related to patient safety, the means were 3.81(±0.54) for the boss/manager's perception of patient safety and 3.37(±0.49) for the cooperation/collaboration between units. The frequent number of errors reported by nurses were 1~2(22.2%) times over the past 12 months. For incidence reporting, the items that the 'nurses perceived for communication among clinicians as fair' had a means of 3.23(±0.40) and the 'overall evaluation of patient safety was a good' 3.34(±0.73). The nurses' perception of cooperation and collaboration between units were associated with the direct contact between the patient and the nurse. The frequency of incidence reporting was associated with the duration of working hours at the present hospital and also their work experience. The nurses' perception of hospital environment, organizational culture, and incidence reporting was above average and mostly associated with organizational culture.

  3. Patient Education May Improve Perioperative Safety.

    de Haan, L.S.; Calsbeek, H; Wolff, André

    2016-01-01

    Importance: There is a growing interest in enabling ways for patients to participate in their own care to improve perioperative safety, but little is known about the effectiveness of interventions enhancing an active patient role. Objective: To evaluate the effect of patient participation on

  4. Safety issues in cultural heritage management and critical infrastructures management

    Soldovieri, Francesco; Masini, Nicola; Alvarez de Buergo, Monica; Dumoulin, Jean

    2013-12-01

    This special issue is the fourth of its kind in Journal of Geophysics and Engineering , containing studies and applications of geophysical methodologies and sensing technologies for the knowledge, conservation and security of products of human activity ranging from civil infrastructures to built and cultural heritage. The first discussed the application of novel instrumentation, surface and airborne remote sensing techniques, as well as data processing oriented to both detection and characterization of archaeological buried remains and conservation of cultural heritage (Eppelbaum et al 2010). The second stressed the importance of an integrated and multiscale approach for the study and conservation of architectural, archaeological and artistic heritage, from SAR to GPR to imaging based diagnostic techniques (Masini and Soldovieri 2011). The third enlarged the field of analysis to civil engineering structures and infrastructures, providing an overview of the effectiveness and the limitations of single diagnostic techniques, which can be overcome through the integration of different methods and technologies and/or the use of robust and novel data processing techniques (Masini et al 2012). As a whole, the special issue put in evidence the factors that affect the choice of diagnostic strategy, such as the material, the spatial characteristics of the objects or sites, the value of the objects to be investigated (cultural or not), the aim of the investigation (knowledge, conservation, restoration) and the issues to be addressed (monitoring, decay assessment). In order to complete the overview of the application fields of sensing technologies this issue has been dedicated to monitoring of cultural heritage and critical infrastructures to address safety and security issues. Particular attention has been paid to the data processing methods of different sensing techniques, from infrared thermography through GPR to SAR. Cascini et al (2013) present the effectiveness of a

  5. Identification of unresolved safety issues relating to nuclear power plants. Report to Congress

    1979-01-01

    The report describes the review undertaken over the last year that resulted in identifying 17 issues as Unresolved Safety Issues. In addition, the report provides specific discussions of why certain issues were not included. The report also provides a brief background discussion describing Section 210 of the Energy Reorganization Act and the NRC program for the resolution of generic issues described in NUREG-0410

  6. Radiological protection, safety and security issues in the industrial and medical applications of radiation sources

    Vaz, Pedro

    2015-11-01

    The use of radiation sources, namely radioactive sealed or unsealed sources and particle accelerators and beams is ubiquitous in the industrial and medical applications of ionizing radiation. Besides radiological protection of the workers, members of the public and patients in routine situations, the use of radiation sources involves several aspects associated to the mitigation of radiological or nuclear accidents and associated emergency situations. On the other hand, during the last decade security issues became burning issues due to the potential malevolent uses of radioactive sources for the perpetration of terrorist acts using RDD (Radiological Dispersal Devices), RED (Radiation Exposure Devices) or IND (Improvised Nuclear Devices). A stringent set of international legally and non-legally binding instruments, regulations, conventions and treaties regulate nowadays the use of radioactive sources. In this paper, a review of the radiological protection issues associated to the use of radiation sources in the industrial and medical applications of ionizing radiation is performed. The associated radiation safety issues and the prevention and mitigation of incidents and accidents are discussed. A comprehensive discussion of the security issues associated to the global use of radiation sources for the aforementioned applications and the inherent radiation detection requirements will be presented. Scientific, technical, legal, ethical, socio-economic issues are put forward and discussed.

  7. A patient safety objective structured clinical examination.

    Singh, Ranjit; Singh, Ashok; Fish, Reva; McLean, Don; Anderson, Diana R; Singh, Gurdev

    2009-06-01

    There are international calls for improving education for health care workers around certain core competencies, of which patient safety and quality are integral and transcendent parts. Although relevant teaching programs have been developed, little is known about how best to assess their effectiveness. The objective of this work was to develop and implement an objective structured clinical examination (OSCE) to evaluate the impact of a patient safety curriculum. The curriculum was implemented in a family medicine residency program with 47 trainees. Two years after commencing the curriculum, a patient safety OSCE was developed and administered at this program and, for comparison purposes, to incoming residents at the same program and to residents at a neighboring residency program. All 47 residents exposed to the training, all 16 incoming residents, and 10 of 12 residents at the neighboring program participated in the OSCE. In a standardized patient case, error detection and error disclosure skills were better among trained residents. In a chart-based case, trained residents showed better performance in identifying deficiencies in care and described more appropriate means of addressing them. Third year residents exposed to a "Systems Approach" course performed better at system analysis and identifying system-based solutions after the course than before. Results suggest increased systems thinking and inculcation of a culture of safety among residents exposed to a patient safety curriculum. The main weaknesses of the study are its small size and suboptimal design. Much further investigation is needed into the effectiveness of patient safety curricula.

  8. Patient safety in otolaryngology: a descriptive review.

    Danino, Julian; Muzaffar, Jameel; Metcalfe, Chris; Coulson, Chris

    2017-03-01

    Human evaluation and judgement may include errors that can have disastrous results. Within medicine and healthcare there has been slow progress towards major changes in safety. Healthcare lags behind other specialised industries, such as aviation and nuclear power, where there have been significant improvements in overall safety, especially in reducing risk of errors. Following several high profile cases in the USA during the 1990s, a report titled "To Err Is Human: Building a Safer Health System" was published. The report extrapolated that in the USA approximately 50,000 to 100,000 patients may die each year as a result of medical errors. Traditionally otolaryngology has always been regarded as a "safe specialty". A study in the USA in 2004 inferred that there may be 2600 cases of major morbidity and 165 deaths within the specialty. MEDLINE via PubMed interface was searched for English language articles published between 2000 and 2012. Each combined two or three of the keywords noted earlier. Limitations are related to several generic topics within patient safety in otolaryngology. Other areas covered have been current relevant topics due to recent interest or new advances in technology. There has been a heightened awareness within the healthcare community of patient safety; it has become a major priority. Focus has shifted from apportioning blame to prevention of the errors and implementation of patient safety mechanisms in healthcare delivery. Type of Errors can be divided into errors due to action and errors due to knowledge or planning. In healthcare there are several factors that may influence adverse events and patient safety. Although technology may improve patient safety, it also introduces new sources of error. The ability to work with people allows for the increase in safety netting. Team working has been shown to have a beneficial effect on patient safety. Any field of work involving human decision-making will always have a risk of error. Within

  9. Evaluation of patient safety culture among Malaysian retail pharmacists: results of a self-reported survey.

    Sivanandy, Palanisamy; Maharajan, Mari Kannan; Rajiah, Kingston; Wei, Tan Tyng; Loon, Tan Wee; Yee, Lim Chong

    2016-01-01

    Patient safety is a major public health issue, and the knowledge, skills, and experience of health professionals are very much essential for improving patient safety. Patient safety and medication error are very much associated. Pharmacists play a significant role in patient safety. The function of pharmacists in the medication use process is very different from medical and nursing colleagues. Medication dispensing accuracy is a vital element to ensure the safety and quality of medication use. To evaluate the attitude and perception of the pharmacist toward patient safety in retail pharmacies setup in Malaysia. A Pharmacy Survey on Patient Safety Culture questionnaire was used to assess patient safety culture, developed by the Agency for Healthcare Research and Quality, and the convenience sampling method was adopted. The overall positive response rate ranged from 31.20% to 87.43%, and the average positive response rate was found to be 67%. Among all the eleven domains pertaining to patient safety culture, the scores of "staff training and skills" were less. Communication openness, and patient counseling are common, but not practiced regularly in the Malaysian retail pharmacy setup compared with those in USA. The overall perception of patient safety of an acceptable level in the current retail pharmacy setup. The study revealed that staff training, skills, communication in patient counseling, and communication across shifts and about mistakes are less in current retail pharmacy setup. The overall perception of patient safety should be improved by educating the pharmacists about the significance and essential of patient safety.

  10. Simulation research to enhance patient safety and outcomes: recommendations of the Simnovate Patient Safety Domain Group

    Pucher, PH; Tamblyn, R; Boorman, D; Dixon-Woods, Mary Margaret; Donaldson, L; Draycott, T; Forster, A; Nadkarni, V; Power, C; Sevdalis, N; Aggarwal, R

    2017-01-01

    The use of simulation-based training has established itself in healthcare but its implementation has been varied and mostly limited to technical and non-technical skills training. This article discusses the possibilities of the use of simulation as part of an overarching approach to improving patient safety, and represents the views of the Simnovate Patient Safety Domain Group, an international multidisciplinary expert group dedicated to the improvement of patient safety. The application and ...

  11. Patient safety trilogy: perspectives from clinical engineering.

    Gieras, Izabella; Sherman, Paul; Minsent, Dennis

    2013-01-01

    This article examines the role a clinical engineering or healthcare technology management (HTM) department can play in promoting patient safety from three different perspectives: a community hospital, a national government health system, and an academic medical center. After a general overview, Izabella Gieras from Huntington Hospital in Pasadena, CA, leads off by examining the growing role of human factors in healthcare technology, and describing how her facility uses clinical simulations in medical equipment evaluations. A section by Paul Sherman follows, examining patient safety initiatives from the perspective of the Veterans Health Administration with a focus on hazard alerts and recalls. Dennis Minsent from Oregon Health & Science University writes about patient safety from an academic healthcare perspective, and details how clinical engineers can engage in multidisciplinary safety opportunities.

  12. Fundamentals of a patient safety program

    Frush, Karen S.

    2008-01-01

    Thousands of people are injured or die from medical errors and adverse events each year, despite being cared for by hard-working, intelligent and well-intended health care professionals, working in the highly complex and high-risk environment of the American health care system. Patient safety leaders have described a need for health care organizations to make error prevention a major strategic objective while at the same time recognizing the importance of transforming the traditional health care culture. In response, comprehensive patient safety programs have been developed with the aim of reducing medical errors and adverse events and acting as a catalyst in the development of a culture of safety. Components of these programs are described, with an emphasis on strategies to improve pediatric patient safety. Physicians, as leaders of the health care team, have a unique opportunity to foster the culture and commitment required to address the underlying systems causes of medical error and harm. (orig.)

  13. Adult Learning in Health and Safety: Some Issues and Approaches.

    O Fathaigh, Mairtin

    This document, which was developed for presentation at a seminar on adult learning and safety, examines approaches to occupational safety and health (OSH) learning/training in the workplace. Section 1 examines selected factors affecting adults' learning in workplace OSH programs. The principal dimensions along which individual adult learners will…

  14. Guidelines for nuclear-power-plant safety-issue-prioritization information development

    Andrews, W.B.; Gallucci, R.H.V.; Heaberlin, S.W.; Bickford, W.E.; Konzek, G.J.; Strenge, D.L.; Smith, R.I.; Weakley, S.A.

    1983-02-01

    Pacific Northwest Laboratory has developed a methodology, with examples, to calculate - to an approximation serviceable for prioritization purposes - the risk, dose and cost impacts of implementing resolutions to reactor safety issues. This report is an applications guide to issue-specific calculations. A description of the approach, mathematical models, worksheets and step-by-step examples are provided. Analysis using this method is intended to provide comparable results for many issues at a cost of two staff-weeks per issue. Results will be used by the NRC to support decisions related to issue priorities in allocation of resources to complete safety issue resolutions

  15. Guidelines for nuclear power plant safety issue prioritization information development. Supplement 5

    Daling, P.M.; Lavender, J.C.

    1996-07-01

    This is the sixth in a series of reports to document the development and use of a methodology developed by the Pacific Northwest Laboratory (PNL) to calculate, for prioritization purposes, the risk, dose, and cost impacts of implementing potential resolutions to reactor safety issues (see NUREG/CR-2800, Andrews, et al., 1983). This report contains the results of issue-specific analyses for 34 generic issues. Each issue was considered within the constraints of available information at the time the issues were examined and approximately 2 staff-weeks of labor. The results are referenced as one consideration in NUREG-0933, A Prioritization of Generic Safety Issues (Emrit, et al., 1983)

  16. Guidelines for nuclear power plant safety issue prioritization information development. Supplement 5

    Daling, P.M.; Lavender, J.C. [Pacific Northwest National Lab., Richland, WA (United States)

    1996-07-01

    This is the sixth in a series of reports to document the development and use of a methodology developed by the Pacific Northwest Laboratory (PNL) to calculate, for prioritization purposes, the risk, dose, and cost impacts of implementing potential resolutions to reactor safety issues (see NUREG/CR-2800, Andrews, et al., 1983). This report contains the results of issue-specific analyses for 34 generic issues. Each issue was considered within the constraints of available information at the time the issues were examined and approximately 2 staff-weeks of labor. The results are referenced as one consideration in NUREG-0933, A Prioritization of Generic Safety Issues (Emrit, et al., 1983).

  17. NS [Nuclear Safety] update. Current safety and security activities and developments taking place in the Department of Nuclear Safety and Security, Issue no. 12, September 2009

    2009-09-01

    The current issue presents information about the following topics: Nuclear Security Report 2009; G8 Nuclear Safety and Security Group (NSSG); Uranium Production Site Appraisal Team (UPSAT); New Entrant Nuclear Power Programmes Safety Guide on the Establishment of the Safety Infrastructure (DS424)

  18. Improving patient safety: lessons from rock climbing.

    Robertson, Nic

    2012-02-01

    How to improve patient safety remains an intractable problem, despite large investment and some successes. Academics have argued that the root of the problem is a lack of a comprehensive 'safety culture' in hospitals. Other safety-critical industries such as commercial aviation invest heavily in staff training to develop such a culture, but comparable programmes are almost entirely absent from the health care sector. In rock climbing and many other dangerous activities, the 'buddy system' is used to ensure that safety systems are adhered to despite adverse circumstances. This system involves two or more people using simple checks and clear communication to prevent problems causing harm. Using this system as an example could provide a simple, original and entertaining way of introducing medical students to the idea that human factors are central to ensuring patient safety. Teaching the buddy system may improve understanding and acceptance of other patient safety initiatives, and could also be used by junior doctors as a tool to improve the safety of their practice. © Blackwell Publishing Ltd 2012.

  19. Editorial: Advances in healthcare provider and patient training to improve the quality and safety of patient care

    Elizabeth M. Borycki

    2015-09-01

    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

  20. Program plan for evaluation of the Ferrocyanide Waste Tank safety issue at the Hanford Site

    Borsheim, G.L.; Meacham, J.E.; Cash, R.J.; Dukelow, G.T.

    1994-03-01

    This document describes the background, priorities, strategy and logic, and task descriptions for the Ferrocyanide Waste Tank Safety Program. The Ferrocyanide Safety Program was established in 1990 to provide resolution of a major safety issue identified for 24 high-level radioactive waste tanks at the Hanford Site

  1. Safety issue resolution strategy plan for inactive miscellaneous underground storage tanks

    Wang, O.S.; Powers, T.B.

    1994-09-01

    The purpose of this strategy plan is to identify, confirm, and resolve safely issues associated with inactive miscellaneous underground storage tanks (MUSTs) using a risk-based priority approach. Assumptions and processes to assess potential risks and operational concerns are documented in this report. Safety issue priorities are ranked based on a number of considerations including risk ranking and cost effectiveness. This plan specifies work scope and recommends schedules for activities related to resolving safety issues, such as collecting historical data, searching for authorization documents, performing Unreviewed Safety Question (USQ) screening and evaluation, identifying safety issues, imposing operational controls and monitoring, characterizing waste contents, mitigating and resolving safety issues, and fulfilling other remediation requirements consistent with the overall Tank Waste Remediation System strategy. Recommendations for characterization and remediation are also recommended according to the order of importance and practical programmatic consideration

  2. Environmental and safety issues of the fusion fuel cycle

    Crocker, J.G.

    1980-01-01

    This paper discusses the environmental and safety concerns inherent in the development of fusion energy, and the current Department of Energy programs seeking to: (1) develop safe and reliable techniques for tritium control; (2) reduce the quantity of activation products produced; and (3) provide designs to limit the potential for accidents that could result in release of radioactive materials. Because of the inherent safety features of fusion and the early start that has been made in safety problem recognition and solution, fusion should be among the lower risk technologies for generation of commercial power

  3. Key issues of the common French-German safety approach for future PWRs

    Frisch, W.; Rohde, J.; Gros, G.; Queniart, D.

    1996-01-01

    The general common safety approach issued in May 1993 contains safety objectives, general principles and already some technical principles. Based on general safety approach, detailed recommendations have been developed in 1994 on key issues such as: system design and use of PSA; integrity of the primary circuit; external hazards; severe accidents and containment design; radiological consequences of reference accidents and low pressure core melt accidents. A selection of the detailed recommendations is presented in the full paper. (author)

  4. Safety culture issues raised in the SAR of the INPP

    Elam, B

    1997-09-01

    The following aspects of safety culture promotion at Ignalina NPP are discussed: performance objectives and expectations; current applicable Lithuanian standards; current plant practice; validation of plant function; assessment of plant function and non-compliances.

  5. Promoting personal safety of building service workers: issues and challenges.

    Chen, Shelley I; Skillen, D Lynn

    2006-06-01

    This exploratory, descriptive study conducted at a large western Canadian university solicited perceptions of personal safety among building service workers who perform night shift work alone. Ten semi-structured interviews were conducted at approximately 10:00 p.m. or 7:00 a.m with a convenience sample of night building service workers in private or semi-private locations on the university campus. Transcribed interview data were subjected to inductive content analysis using descriptive, interpretive, and pattern coding (Miles & Huberman, 1994). Results suggest that building service night shift workers are exposed to personal safety hazards in their physical and psychosocial work environments. In addition, culturally and linguistically appropriate delivery of safety training and education about policies and procedures is required for culturally diverse building service workers. Promotion of personal safety in this heterogeneous worker population requires due diligence, assessment, and advocacy.

  6. Safety culture issues raised in the SAR of the INPP

    Elam, B.

    1997-01-01

    The following aspects of safety culture promotion at Ignalina NPP are discussed: performance objectives and expectations; current applicable Lithuanian standards; current plant practice; validation of plant function; assessment of plant function and non-compliances

  7. Safety Committees for Argentinean Research Reactor - Regulatory Issues

    Perrin, Carlos D.

    2009-01-01

    In the field of radiological and nuclear safety, the Nuclear Regulatory Authority (ARN) of Argentina controls three research reactors and three critical assemblies, by means of evaluations, audits and inspections, in order to ensure the fulfillment of the requirements established in the Licenses, in the Regulatory Standards and in the Mandatory Documentation in general. From the Nuclear Regulatory Authority's point of view, within the general process of research reactors safety management, the Operational Organization self verification of radiological and nuclear safety plays an outstanding role. In this aspect the ARN has established specific requirements in the Regulatory Standards, in the Operation Licenses and in the Operational Limits and Conditions. These requirements include the figure of different safety committees, which act as reviewers or advisers in diverse situations. This paper describes the main characteristics of the committees, their function, scope and the regulatory documents where the requirements are included. (author)

  8. Socio-technical issues and challenges in implementing safe patient handovers: insights from ethnographic case studies.

    Balka, Ellen; Tolar, Marianne; Coates, Shannon; Whitehouse, Sandra

    2013-12-01

    Ineffective handovers in patient care, including those where information loss occurs between care providers, have been identified as a risk to patient safety. Computerization of health information is often offered as a solution to improve the quality of care handovers and decrease adverse events related to patient safety. The purpose of this paper is to broaden our understanding of clinical handover as a patient safety issue, and to identify socio-technical issues which may come to bear on the success of computer based handover tools. Three in depth ethnographic case studies were undertaken. Field notes were transcribed and analyzed with the aid of qualitative data analysis software. Within case analysis was performed on each case, and subsequently, cross case analyses were performed. We identified five types of socio-technical issues which must be addressed if electronic handover tools are to succeed. The inter-dependencies of these issues are addressed in relation to arenas in which health care work takes place. We suggest that the contextual nature of information, ethical and medico-legal issues arising in relation to information handover, and issues related to data standards and system interoperability must be addressed if computerized health information systems are to achieve improvements in patient safety related to handovers in care. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  9. A brief overview of Ignalina NPP safety issues

    Almenas, K.; Ushpuras, E.

    1998-01-01

    A description of the safety of Ignalina NPP in a very popular form is presented. Answers to the most frequently recurring questions concerning the Ignalina NPP are provided based on recently completed international studies. Questions are like these: can a similar accident to the one that occurred in Chernobyl take place at Ignalina NPP, does the Ignalina NPP have a containment, what are the probabilities and potential consequences of accidents, etc. The brochure contains a short description of Ignalina NPP safety improvement programs

  10. Patient safety climate and worker safety behaviours in acute hospitals in Scotland.

    Agnew, Cakil; Flin, Rhona; Mearns, Kathryn

    2013-06-01

    To obtain a measure of hospital safety climate from a sample of National Health Service (NHS) acute hospitals in Scotland and to test whether these scores were associated with worker safety behaviors, and patient and worker injuries. Data were from 1,866 NHS clinical staff in six Scottish acute hospitals. A Scottish Hospital Safety Questionnaire measured hospital safety climate (Hospital Survey on Patient Safety Culture), worker safety behaviors, and worker and patient injuries. The associations between the hospital safety climate scores and the outcome measures (safety behaviors, worker and patient injury rates) were examined. Hospital safety climate scores were significantly correlated with clinical workers' safety behavior and patient and worker injury measures, although the effect sizes were smaller for the latter. Regression analyses revealed that perceptions of staffing levels and managerial commitment were significant predictors for all the safety outcome measures. Both patient-specific and more generic safety climate items were found to have significant impacts on safety outcome measures. This study demonstrated the influences of different aspects of hospital safety climate on both patient and worker safety outcomes. Moreover, it has been shown that in a hospital setting, a safety climate supporting safer patient care would also help to ensure worker safety. The Scottish Hospital Safety Questionnaire has proved to be a usable method of measuring both hospital safety climate as well as patient and worker safety outcomes. Copyright © 2013 National Safety Council and Elsevier Ltd. Published by Elsevier Ltd. All rights reserved.

  11. Safety issues of botanicals and botanical preparations in functional foods

    Kroes, R.; Walker, R.

    2004-01-01

    Although botanicals have played a role in the marketing of health products for ages, there is an increased interest today due to their perceived health benefits. Not only do consumers increasingly take charge of their health, but the scientific information and understanding of the beneficial health effects of bioactive substances in food, functional foods and food supplements have improved. Increasing use of these products has also led to concerns about their actual safety. Recorded cases of intoxications have triggered such concerns. The safety assessment of these substances is complicated by, amongst others, the variability of composition. Furthermore, consumption of such functional products is expected to produce physiological effects, which may lead to low margins of safety as the margin between exposure of such products and the safe level of intake are likely to be small. The safety assessment of botanicals and botanical preparations in food and food supplement should at least involve: - the characterisation and quality of the material, its quality control; - the intended use and consequent exposure; - history of use and exposure; - product comparison(s); - toxicological information gathering; - Risk characterisation/safety assessment; As a guidance tool, a decision tree approach is proposed to assist in determining the extent of data requirements based on the nature of the such product. This guidance tool in safety assessment was developed by an expert group of the International Life Sciences Institute (ILSI), European Branch, and is currently in press. In this paper a summarised version of this tool is presented

  12. Medical error disclosure and patient safety: legal aspects

    Olivier Guillod

    2013-12-01

    Full Text Available Reducing the number of preventable adverse events has become a public health issue. The paper discusses in which ways the law can contribute to that goal, especially by encouraging a culture of safety among healthcare professionals. It assesses the need or the usefulness to pass so-called disclosure laws and apology laws, to adopt mandatory but strictly confidential Critical Incidents Reporting Systems in hospitals, to change the fault-based system of medical liability or to amend the rules on criminal liability. The paper eventually calls for adding the law to the present agenda of patient safety.

  13. HRET patient safety leadership fellowship: the role of "community" in patient safety.

    Leonhardt, Kathryn Kraft

    2010-01-01

    Community engagement is widely endorsed but poorly defined as a strategy to improve patient safety. With strong evidence that engaging patients can positively influence health outcomes, it is presumed that community engagement could improve patient safety. Leaning on the models from other disciplines such as public health, the adequate knowledge and application of the principles of community engagement are critical for this approach to be effective. This article provides a description of the theories supporting patient partnership and community engagement, reviews critical elements of successful community-based programs, and identifies the potential for empowering communities to improve patient safety.

  14. En Route Patient Safety: A Mixed-Methods Study

    2014-03-01

    Army, Navy, volunteers, and civilians who meet the planes lack proper safety training First-names-only rule • MCD often refuses to give report...record; EMED = emergency medical; GPMRC = Global Patient Movement Requirements Center; MCD = medical crew director; MDG = Medical Group; OI...crews voiced concerns that “the biggest issue as far as taking report from the MCD is it’s always second hand.” However, several nurses who filled

  15. Guidelines for nuclear-power-plant safety-issue prioritization information development

    Andrews, W.B.; Gallucci, R.H.V.; Konzek, G.J.

    1983-05-01

    This is the second in a series of reports to document the use of a methodology developed by the Pacific Northwest Laboratory to calculate, for prioritization purposes, the risk, dose and cost impacts of implementing resolutions to reactor safety issues. This report contains results of issue-specific analyses for 15 issues. Each issue was considered within the contraints of available information as of September 1982 and two staff-weeks of labor. The results will be referenced, as one consideration in setting priorities for reactor safety issues, in an NRC prioritization report to be published at a future date

  16. The accession to the European Union. The nuclear safety issue

    Mayer, S.; Tomic, B.; Goldemund, M.; Van der Mheen, W.; Johanson, G.

    2000-01-01

    Since mid 1999, a project based on an initiative by the European Commission has been conducted with the primary objective to develop a comprehensive, consistent, and wellbalanced methodology for the evaluation of the status of nuclear safety in countries with operating nuclear power plants, and to perform a preliminary assessment for Bulgaria, Czech Republic, Hungary, Lithuania, Romania, Slovak Republic, and Slovenia. In addition to the safety status of nuclear power plants, emphasis is placed on nuclear regulation, both on organisational and legislative aspects, and on the practice of performing safety assessment. A brief overview will also be given on the nuclear safety situation in the Newly Independent States (NIS). During the course of the project, a Performance Evaluation Guide was developed with the objective to establish a sound methodology for evaluating safety of nuclear reactors in different countries in a consistent manner. The project is performed by a Consortium led by ENCONET Consulting (Austria), with participation of NNC (United Kingdom), NRG (Netherlands), and ES-konsult (Sweden). (author)

  17. From Safe Systems to Patient Safety

    Aarts, J.; Nøhr, C.

    2010-01-01

    for the third conference with the theme: The ability to design, implement and evaluate safe, useable and effective systems within complex health care organizations. The theme for this conference was "Designing and Implementing Health IT: from safe systems to patient safety". The contributions have reflected...... and implementation of safe systems and thus contribute to the agenda of patient safety? The contributions demonstrate how the health informatics community has contributed to the performance of significant research and to translating research findings to develop health care delivery and improve patient safety......This volume presents the papers from the fourth International Conference on Information Technology in Health Care: Socio-technical Approaches held in Aalborg, Denmark in June 2010. In 2001 the first conference was held in Rotterdam, The Netherlands with the theme: Sociotechnical' approaches...

  18. Improving patient safety in radiation oncology

    Hendee, William R.; Herman, Michael G.

    2011-01-01

    Beginning in the 1990s, and emphasized in 2000 with the release of an Institute of Medicine report, healthcare providers and institutions have dedicated time and resources to reducing errors that impact the safety and well-being of patients. But in January 2010 the first of a series of articles appeared in the New York Times that described errors in radiation oncology that grievously impacted patients. In response, the American Association of Physicists in Medicine and the American Society of Radiation Oncology sponsored a working meeting entitled ''Safety in Radiation Therapy: A Call to Action''. The meeting attracted 400 attendees, including medical physicists, radiation oncologists, medical dosimetrists, radiation therapists, hospital administrators, regulators, and representatives of equipment manufacturers. The meeting was cohosted by 14 organizations in the United States and Canada. The meeting yielded 20 recommendations that provide a pathway to reducing errors and improving patient safety in radiation therapy facilities everywhere.

  19. Patient safety initiatives in Central and Eastern Europe: A mixed methods approach by the LINNEAUS collaboration on patient safety in primary care

    Godycki-Cwirko, Maciek; Esmail, Aneez; Dovey, Susan; Wensing, Michel; Parker, Dianne; Kowalczyk, Anna; Błaszczyk, Honorata; Kosiek, Katarzyna

    2015-01-01

    ABSTRACT Background: Despite patient safety being recognized as an important healthcare issue in the European Union, there has been variable implementation of patient safety initiatives in Central and Eastern Europe (CEE). Objective: To assess the status of patient safety initiatives in countries in CEE; to describe a process of engagement in Poland, which can serve as a template for the implementation of patient safety initiatives in primary care. Methods: A mixed methods design was used. We conducted a review of literature focusing on publications from CEE, an inventory of patient safety initiatives in CEE countries, interviews with key informants, international survey, review of national reporting systems, and pilot demonstrator project in Poland with implementation of patient safety toolkits assessment. Results: There was no published patient safety research from Albania, Belarus, Greece, Latvia, Lithuania, Romania, or Russia. Nine papers were found from Bulgaria, Croatia, the Czech Republic, Poland, Serbia, and Slovenia. In most of the CEE countries, patient safety had been addressed at the policy level although the focus was mainly in hospital care. There was a dearth of activity in primary care. The use of patient improvement strategies was low. Conclusion: International cooperation as exemplified in the demonstrator project can help in the development and implementation of patient safety initiatives in primary care in changing the emphasis away from a blame culture to one where greater emphasis is placed on improvement and learning. PMID:26339839

  20. High-heat tank safety issue resolution program plan. Revision 2

    Wang, O.S.

    1994-12-01

    The purpose of this program plan is to provide a guide for selecting corrective actions that will mitigate and/or remediate the high-heat waste tank safety issue for single-shell tank 241-C-106. The heat source of approximately 110,000 Btu/hr is the radioactive decay of the stored waste material (primarily 90 Sr) inadvertently transferred into the tank in the later 1960s. Currently, forced ventilation, with added water to promote thermal conductivity and evaporation cooling, is used for heat removal. The method is very effective and economical. At this time, the only viable solution identified to permanently resolve this safety issue is the removal of heat-generating waste in the tank. This solution is being aggressively pursued as the only remediation method to this safety issue, and tank 241-C-106 has been selected as the first single-shell tank for retrieval. The current cooling method and other alternatives are addressed in this program as means to mitigate this safety issue before retrieval. This program plan has three parts. The first part establishes program objectives and defines safety issue, drivers, and resolution criteria and strategy. The second part evaluates the high-heat safety issue and its mitigation and remediation methods and other alternatives according to resolution logic. The third part identifies major tasks and alternatives for mitigation and resolution of the safety issue. A table of best-estimate schedules for the key tasks is also included in this program plan

  1. PATIENT SAFETY IN SURGERY: THE QUALITY OF IMPLEMENTATION OF PATIENT SAFETY CHECKLISTS IN A REGIONAL HOSPITAL

    V. Karyadinata

    2012-09-01

    Full Text Available Introduction. Patient safety and the avoidance of inhospital adverse events is a key focus of clinical practice and medical audit. A large of proportion of medical errors affect surgical patients in the peri-operative setting. Safety checklists have been adopted by the medical profession from the aviation industry as a cheap and reliable method of avoiding errors which arise from complex or stressful situations. Current evidence suggests that the use of periooperative checklists has led to a decrease in surgical morbidity and hospital costs. Aim. To assess the quality of implementation of a modified patient safety checklist in a UK district general hospital. Methods. An observational tool was designed to assess in real time the peri-operative performance of the surgical safety checklist in patients undergoing general surgical, urological or orthopaedic procedures. Initiation of the checklist, duration of performance and staff participation were audited in real time. Results. 338 cases were monitored. Nurses were most active in initiating the safety checklist. The checklist was performed successfully in less than a minute in most cases. 11-24% of staff (according to professional group present in the operating room did not participate in the checklist. Critical safety checks (patient identity and procedure name were performed in all cases across all specialties. Variations were noted in checking other categories, such as deep vein thrombosis (DVT prophylaxis or patient warming. Conclusions. There is still a potential for improving the practice and culture of surgical patient safety activities. Staff training and designation of patient safety leadership roles is needed in increasing compliance and implementation of patient safety mechanism, such as peri-operative checklists. There is significant data to advocate the need to implement patient safety surgical checklists internationally

  2. Process management - critical safety issues with focus on risk management

    Sanne, Johan M.

    2005-12-01

    Organizational changes focused on process orientation are taking place among Swedish nuclear power plants, aiming at improving the operation. The Swedish Nuclear Power Inspectorate has identified a need for increased knowledge within the area for its regulatory activities. In order to analyze what process orientation imply for nuclear power plant safety a number of questions must be asked: 1. How is safety in nuclear power production created currently? What significance does the functional organization play? 2. How can organizational forms be analysed? What consequences does quality management have for work and for the enterprise? 3. Why should nuclear power plants be process oriented? Who are the customers and what are their customer values? Which customers are expected to contribute from process orientation? 4. What can one learn from process orientation in other safety critical systems? What is the effect on those features that currently create safety? 5. Could customer values increase for one customer without decreasing for other customers? What is the relationship between economic and safety interests from an increased process orientation? The deregulation of the electricity market have caused an interest in increased economic efficiency, which is the motivation for the interest in process orientation. among other means. It is the nuclear power plants' owners and the distributors (often the same corporations) that have the strongest interest in process orientation. If the functional organization and associated practices are decomposed, the prerequisites of the risk management regime changes, perhaps deteriorating its functionality. When nuclear power operators consider the introduction of process orientation, the Nuclear Power Inspectorate should require that 1. The operators perform a risk analysis beforehand concerning the potential consequences that process orientation might convey: the analysis should contain a model specifying how safety is currently

  3. Topical issues in nuclear, radiation and radioactive waste safety. Contributed papers

    NONE

    1998-08-01

    The IAEA International Conference on Topical Issues in Nuclear, Radiation and Radioactive Waste Safety was held in Vienna, Austria, 30 August - 4 September 1998 with the objective to foster the exchange of information on topical issues in nuclear, radiation and radioactive waste safety, with the aim of consolidating an international consensus on: the present status of these issues; priorities for future work; and needs for strengthening international co-operation, including recommendations for the IAEA`s future activities. The document includes 43 papers presented at the Conference dealing with the following topical issues: Safety Management; Backfitting, Upgrading and Modernization of NPPs; Regulatory Strategies; Occupational Radiation Protection: Trends and Developments; Situations of Chronic Exposure to Residual Radioactive Materials: Decommissioning and Rehabilitation and Reclamation of Land; Radiation Safety in the Far Future: The Issue of Long Term Waste Disposal. A separate abstract and indexing were provided for each paper. Refs, figs, tabs

  4. Topical issues in nuclear, radiation and radioactive waste safety. Contributed papers

    1998-08-01

    The IAEA International Conference on Topical Issues in Nuclear, Radiation and Radioactive Waste Safety was held in Vienna, Austria, 30 August - 4 September 1998 with the objective to foster the exchange of information on topical issues in nuclear, radiation and radioactive waste safety, with the aim of consolidating an international consensus on: the present status of these issues; priorities for future work; and needs for strengthening international co-operation, including recommendations for the IAEA's future activities. The document includes 43 papers presented at the Conference dealing with the following topical issues: Safety Management; Backfitting, Upgrading and Modernization of NPPs; Regulatory Strategies; Occupational Radiation Protection: Trends and Developments; Situations of Chronic Exposure to Residual Radioactive Materials: Decommissioning and Rehabilitation and Reclamation of Land; Radiation Safety in the Far Future: The Issue of Long Term Waste Disposal. A separate abstract and indexing were provided for each paper

  5. European community light water reactor safety research projects. Experimental issue

    1975-01-01

    Research programs on light water reactor safety currently carried out in the European Community are presented. They cover: accident conditions (LOCA, ECCS, core meltdown, external influences, etc...), fault and accident prevention and means of mitigation, normal operation conditions, on and off site implications and equipment under severe accident conditions, and miscellaneous subjects

  6. Nuclear versus fossil weighing up the safety issues

    Gittus, Dzh.

    1992-01-01

    The problems of nuclear power plant safety are discussed as compared with those for the plants based on fossil fuel utilization. The conclusion is made that merits of nuclear power are much greater than its disadvantages as far as the environmental impacts are concerned

  7. Methodological issues and pitfalls of short safety culture questionnaires

    Jagtman, H.M.; Koornneef, F.; Akselsson, R.; Stewart, S.

    2013-01-01

    Safety culture surveys have been fielded in many different sectors of industrial activities. Many of these surveys consist of a long list of questions which is time consuming for the respondents. As part of the FP6 HILAS project a shorter survey has been developed, which aimed at getting a high

  8. Gender issues in safety and health at work : a review

    Houtman, I.L.D.; Kauppinen, K.; Kumpulainen, R.; Goudswaard, A.

    2003-01-01

    This report explores the gender differences in occupational safety and health. There is strong segregation of women and men into different jobs and tasks at work. Both men and women face significant risks. In general, men suffer more accidents and injuries at work than women do, whereas women report

  9. Key practical issues in strengthening safety culture. INSAG-15. A report by the International Safety Advisory Group [Russian Edition

    2015-01-01

    This report describes the essential practical issues to be considered by organizations aiming to strengthen safety culture. It is intended for senior executives, managers and first line supervisors in operating organizations. Although safety culture cannot be directly regulated, it is important that members of regulatory bodies understand how their actions affect the development of attempts to strengthen safety culture and are sympathetic to the need to improve the less formal human related aspects of safety. The report is therefore of relevance to regulators, although not intended primarily for them. The International Nuclear Safety Advisory Group (INSAG) introduced the concept of safety culture in its INSAG-4 report in 1991. Since then, many papers have been written on safety culture, as it relates to organizations and individuals, its improvement and its underpinning prerequisites. Variations in national cultures mean that what constitutes a good approach to enhancing safety culture in one country may not be the best approach in another. However, INSAG seeks to provide pragmatic and practical advice of wide applicability in the principles and issues presented in this report. Nuclear and radiological safety are the prime concerns of this report, but the topics discussed are so general that successful application of the principles should lead to improvements in other important areas, such as industrial safety, environmental performance and, in some respects, wider business performance. This is because many of the attitudes and practices necessary to achieve good performance in nuclear safety, including visible commitment by management, openness, care and thoroughness in completing tasks, good communication and clarity in recognizing major issues and dealing with them as a priority, have wide applicability

  10. Key practical issues in strengthening safety culture. INSAG-15. A report by the International Safety Advisory Group

    2002-01-01

    This report describes the essential practical issues to be considered by organizations aiming to strengthen safety culture. It is intended for senior executives, managers and first line supervisors in operating organizations. Although safety culture cannot be directly regulated, it is important that members of regulatory bodies understand how their actions affect the development of attempts to strengthen safety culture and are sympathetic to the need to improve the less formal human related aspects of safety. The report is therefore of relevance to regulators, although not intended primarily for them. The International Nuclear Safety Advisory Group (INSAG) introduced the concept of safety culture in its INSAG-4 report in 1991. Since then, many papers have been written on safety culture, as it relates to organizations and individuals, its improvement and its underpinning prerequisites. Variations in national cultures mean that what constitutes a good approach to enhancing safety culture in one country may not be the best approach in another. However, INSAG seeks to provide pragmatic and practical advice of wide applicability in the principles and issues presented in this report. Nuclear and radiological safety are the prime concerns of this report, but the topics discussed are so general that successful application of the principles should lead to improvements in other important areas, such as industrial safety, environmental performance and, in some respects, wider business performance. This is because many of the attitudes and practices necessary to achieve good performance in nuclear safety, including visible commitment by management, openness, care and thoroughness in completing tasks, good communication and clarity in recognizing major issues and dealing with them as a priority, have wide applicability

  11. Patients' safety in the era of EMR/EHR automation

    Bakheet Aldosari

    2017-01-01

    Full Text Available Accurate maintenance of the medical records of patients has become a worldwide problem with the rapid rise in the count of patients. Furthermore, providing them adequate health care keeping their safety in view is turning into a great challenge for physicians. As such, electronic health records (EHRs were developed to solve these issues by aiding physicians in imparting quality health care to patients as well as maintaining their safety. Nonetheless, rather than increasing their efficiency, EHRs have become a burden for the physicians as they ultimately increase their error rate and reduce output rate affecting patient safety. As health-IT is advancing progressively, new features are added to the existing EHRs with the aim to support physicians in providing better healthcare. Till date, some of the most advanced features include clinical support decision system (CDSS, computerized physician order entry (CPOE system, health information exchange (HIE, mobile documentation application, and a system of safety alerts on a dashboard. Proper training to the physicians on judiciously usage of these EHR functions is required to extract maximum benefit. Else, these can introduce a considerable number of medical errors, which can result in fatal outcomes for the patients.

  12. A framework for elaborating a geological disposal safety case: Main issues to be addressed

    Besnus, F.; Gay, D.

    2002-01-01

    International guidance on safety standards for the geological disposal of radioactive waste is being elaborated by IAEA. A comparison of experiences acquired in developing deep repository projects shows that many important issues related to the progressive building of confidence in the safety demonstration of such facilities are commonly addressed by the various organisations involved in radioactive waste management. However, there is still some discrepancies in defining the steps that form the staged elaboration of a safety case. This paper intends to propose a framework for defining the safety case in describing the main issues to be addressed and highlighting questions of consistency between former steps. (author)

  13. Measuring patient safety culture in Taiwan using the Hospital Survey on Patient Safety Culture (HSOPSC).

    Chen, I-Chi; Li, Hung-Hui

    2010-06-07

    Patient safety is a critical component to the quality of health care. As health care organizations endeavour to improve their quality of care, there is a growing recognition of the importance of establishing a culture of patient safety. In this research, the authors use the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire to assess the culture of patient safety in Taiwan and attempt to provide an explanation for some of the phenomena that are unique in Taiwan. The authors used HSOPSC to measure the 12 dimensions of the patient safety culture from 42 hospitals in Taiwan. The survey received 788 respondents including physicians, nurses, and non-clinical staff. This study used SPSS 15.0 for Windows and Amos 7 software tools to perform the statistical analysis on the survey data, including descriptive statistics and confirmatory factor analysis of the structural equation model. The overall average positive response rate for the 12 patient safety culture dimensions of the HSOPSC survey was 64%, slightly higher than the average positive response rate for the AHRQ data (61%). The results showed that hospital staff in Taiwan feel positively toward patient safety culture in their organization. The dimension that received the highest positive response rate was "Teamwork within units", similar to the results reported in the US. The dimension with the lowest percentage of positive responses was "Staffing". Statistical analysis showed discrepancies between Taiwan and the US in three dimensions, including "Feedback and communication about error", "Communication openness", and "Frequency of event reporting". The HSOPSC measurement provides evidence for assessing patient safety culture in Taiwan. The results show that in general, hospital staffs in Taiwan feel positively toward patient safety culture within their organization. The existence of discrepancies between the US data and the Taiwanese data suggest that cultural uniqueness should be taken into

  14. Application of a methodology to determine priorities for nuclear power plant safety issues

    Daling, P.M.

    1988-01-01

    The Nuclear Regulatory Commission (NRC) Office of Nuclear Regulatory Research (RES) is sponsoring a research program to determine priorities of nuclear power plant safety issues. A methodology has been developed at the Pacific Northwest Laboratory (PNL) to provide technical assistance in the development of risk and cost estimates for implementing resolutions to the safety issues. The information development methods are intended to provide the NRC with a consistent level of information for use in ranking the issues. The NRC uses this information, along with judgmental factors, to rank the issues for further consideration by the NRC staff. The primary purpose of the priority rankings are to assist in the allocation of resources to issues that have high potential for reducing public risk as well as to remove issues from further consideration that have little safety significance

  15. Measuring patient safety in a UK dental hospital: development of a dental clinical effectiveness dashboard.

    Pemberton, M N; Ashley, M P; Shaw, A; Dickson, S; Saksena, A

    2014-10-01

    Patient safety is an important marker of quality for any healthcare organisation. In 2008, the British Government white paper entitled High quality care for all, resulting from a review led by Lord Darzi, identified patient safety as a key component of quality and discussed how it might be measured, analysed and acted upon. National and local clinically curated metrics were suggested, which could be displayed via a 'clinical dashboard'. This paper explains the development of a clinical effectiveness dashboard focused on patient safety in an English dental hospital and how it has helped us identify relevant patient safety issues in secondary dental care.

  16. Nurse working conditions and patient safety outcomes.

    Stone, Patricia W; Mooney-Kane, Cathy; Larson, Elaine L; Horan, Teresa; Glance, Laurent G; Zwanziger, Jack; Dick, Andrew W

    2007-06-01

    System approaches, such as improving working conditions, have been advocated to improve patient safety. However, the independent effect of many working condition variables on patient outcomes is unknown. To examine effects of a comprehensive set of working conditions on elderly patient safety outcomes in intensive care units. Observational study, with patient outcome data collected using the National Nosocomial Infection Surveillance system protocols and Medicare files. Several measures of health status and fixed setting characteristics were used to capture distinct dimensions of patient severity of illness and risk for disease. Working condition variables included organizational climate measured by nurse survey; objective measures of staffing, overtime, and wages (derived from payroll data); and hospital profitability and magnet accreditation. The sample comprised 15,846 patients in 51 adult intensive care units in 31 hospitals depending on the outcome analyzed; 1095 nurses were surveyed. Central line associated bloodstream infections (CLBSI), ventilator-associated pneumonia, catheter-associated urinary tract infections, 30-day mortality, and decubiti. Units with higher staffing had lower incidence of CLBSI, ventilator-associated pneumonia, 30-day mortality, and decubiti (P working conditions were associated with all outcomes measured. Improving working conditions will most likely promote patient safety. Future researchers and policymakers should consider a broad set of working condition variables.

  17. Anesthesia Quality and Patient Safety in China: A Survey.

    Zhu, Bin; Gao, Huan; Zhou, Xiangyong; Huang, Jeffrey

    There has been no nationwide investigation into anesthesia quality and patient safety in China. The authors surveyed Chinese anesthesiologists about anesthesia quality by sending a survey to all anesthesiologist members of the New Youth Anesthesia Forum via WeChat. The respondents could choose to use a mobile device or desktop to complete the survey. The overall response rate was 43%. Intraoperative monitoring: 77.9% of respondents reported that electrocardiogram monitoring was routinely applied for all patients; only 55% of the respondents reported that they routinely used end-tidal carbon dioxide monitoring for their patients under general anesthesia. 10.3% of respondents admitted that they had at least one wrong medicine administration in the past 3 months; 12.4% reported that they had at least one case of cardiac arrest in the past year. This is the first anesthesia quality survey in China. The findings revealed potential anesthesia safety issues in China.

  18. 78 FR 12065 - Patient Safety Organizations: Delisting for Cause for Independent Data Safety Monitoring, Inc.

    2013-02-21

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety... Safety Monitoring, Inc. due to its failure to correct a deficiency. The Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act) authorizes the listing of PSOs, which are entities or component...

  19. Safety issues in robotic handling of nuclear weapon parts

    Drotning, W.; Wapman, W.; Fahrenholtz, J.

    1993-01-01

    Robotic systems are being developed by the Intelligent Systems and Robotics Center at Sandia National Laboratories to perform automated handling tasks with radioactive weapon parts. These systems will reduce the occupational radiation exposure to workers by automating operations that are currently performed manually. The robotic systems at Sandia incorporate several levels of mechanical, electrical, and software safety for handling hazardous materials. For example, tooling used by the robot to handle radioactive parts has been designed with mechanical features that allow the robot to release its payload only at designated locations in the robotic workspace. In addition, software processes check for expected and unexpected situations throughout the operations. Incorporation of features such as these provides multiple levels of safety for handling hazardous or valuable payloads with automated intelligent systems

  20. Radiation Protection, Safety and Security Issues in Ghana.

    Boadu, Mary; Emi-Reynolds, Geoffrey; Amoako, Joseph Kwabena; Akrobortu, Emmanuel; Hasford, Francis

    2016-11-01

    Although the use of radioisotopes in Ghana began in 1952, the Radiation Protection Board of Ghana was established in 1993 and served as the national competent authority for authorization and inspection of practices and activities involving radiation sources until 2015. The law has been superseded by an Act of Parliament, Act 895 of 2015, mandating the Nuclear Regulatory Authority of Ghana to take charge of the regulation of radiation sources and their applications. The Radiation Protection Institute in Ghana provided technical support to the regulatory authority. Regulatory and service activities that were undertaken by the Institute include issuance of permits for handling of a radiation sources, authorization and inspection of radiation sources, radiation safety assessment, safety assessment of cellular signal towers, and calibration of radiation-emitting equipment. Practices and activities involving application of radiation are brought under regulatory control in the country through supervision by the national competent authority.

  1. OCCUPATIONAL HEALTH AND SAFETY ISSUES IN VICTORIAN CONSTRUCTION INDUSTRY, AUSTRALIA

    M. Asad, Abdurrahman

    2010-01-01

    The construction industry has one of the highest injury ratios of all Australian industries. Individuals employed on the construction industries find themselves confronted with dangerous and life-threatening work conditions. However, it appears that the trend in Occupational Health and Safety (OHS) performance of construction industry has improved consistently compared with the other industries. The enforcement of OHS law and regulation, and the outcome of authority function to assist and pro...

  2. Joint operating agreements - health and safety and employment issues

    Molnar, L.F.

    1999-01-01

    The extent of non-operator exposure to health and safety and other employment liability is considered. Under the terms of the Canadian Association of Petroleum Landman agreements, the designated operator is the sole employer for joint operations. By these terms, the placement of responsibility for employees involved in a joint operation appears clear. It is to rest with the operator alone. As such, one would expect that the non-operator would be free from liabilities arising out of the employment relations of a project. It has been held, in cases of interrelated companies, that an individual can be an employee of more than one company at the same time. Alberta's Occupational Health and Safety Act, as well as the similar Acts in other provinces, impose a hierarchy of duties and obligations not only on employers but also upon contractors, suppliers and workers to ensure that safety is secured. Relevant definitions in the Act state this. An employer of an employee is vicariously liable for torts committed by the employee in the course of his employment. The questions are asked of what happens if a non-operator lends an employee to the operator and the employee tortiously injures a third party, and if the temporary employer, the operator, becomes the employer in the event of vicarious liability. 20 refs

  3. The use of human factors methods to identify and mitigate safety issues in radiation therapy

    Chan, Alvita J.; Islam, Mohammad K.; Rosewall, Tara; Jaffray, David A.; Easty, Anthony C.; Cafazzo, Joseph A.

    2010-01-01

    Background and purpose: New radiation therapy technologies can enhance the quality of treatment and reduce error. However, the treatment process has become more complex, and radiation dose is not always delivered as intended. Using human factors methods, a radiotherapy treatment delivery process was evaluated, and a redesign was undertaken to determine the effect on system safety. Material and methods: An ethnographic field study and workflow analysis was conducted to identify human factors issues of the treatment delivery process. To address specific issues, components of the user interface were redesigned through a user-centered approach. Sixteen radiation therapy students were then used to experimentally evaluate the redesigned system through a usability test to determine the effectiveness in mitigating use errors. Results: According to findings from the usability test, the redesigned system successfully reduced the error rates of two common errors (p < .04 and p < .01). It also improved the mean task completion time by 5.5% (p < .02) and achieved a higher level of user satisfaction. Conclusions: These findings demonstrated the importance and benefits of applying human factors methods in the design of radiation therapy systems. Many other opportunities still exist to improve patient safety in this area using human factors methods.

  4. Patient Safety in Pediatrics: a Developing Discipline

    C. van der Starre (Cynthia)

    2011-01-01

    markdownabstract__Abstract__ The publication of the breakthrough report “To Err is Human” by the Institute of Medicine was the launch of patient safety initiatives all over the world. In the intensive care unit (ICU) of the Erasmus MC-Sophia Children’s Hospital this resulted in the institution

  5. Patient involvement in patient safety: Protocol for developing an intervention using patient reports of organisational safety and patient incident reporting

    Armitage Gerry

    2011-05-01

    Full Text Available Abstract Background Patients have the potential to provide a rich source of information on both organisational aspects of safety and patient safety incidents. This project aims to develop two patient safety interventions to promote organisational learning about safety - a patient measure of organisational safety (PMOS, and a patient incident reporting tool (PIRT - to help the NHS prevent patient safety incidents by learning more about when and why they occur. Methods To develop the PMOS 1 literature will be reviewed to identify similar measures and key contributory factors to error; 2 four patient focus groups will ascertain practicality and feasibility; 3 25 patient interviews will elicit approximately 60 items across 10 domains; 4 10 patient and clinician interviews will test acceptability and understanding. Qualitative data will be analysed using thematic content analysis. To develop the PIRT 1 individual and then combined patient and clinician focus groups will provide guidance for the development of three potential reporting tools; 2 nine wards across three hospital directorates will pilot each of the tools for three months. The best performing tool will be identified from the frequency, volume and quality of reports. The validity of both measures will be tested. 300 patients will be asked to complete the PMOS and PIRT during their stay in hospital. A sub-sample (N = 50 will complete the PMOS again one week later. Health professionals in participating wards will also be asked to complete the AHRQ safety culture questionnaire. Case notes for all patients will be reviewed. The psychometric properties of the PMOS will be assessed and a final valid and reliable version developed. Concurrent validity for the PIRT will be assessed by comparing reported incidents with those identified from case note review and the existing staff reporting scheme. In a subsequent study these tools will be used to provide information to wards/units about their

  6. A prioritization of generic safety issues. Supplement 19, Revision insertion instructions

    1995-11-01

    The report presents the safety priority ranking for generic safety issues related to nuclear power plants. The purpose of these rankings is to assist in the timely and efficient allocation of NRC resources for the resolution of those safety issues that have a significant potential for reducing risk. The safety priority rankings are HIGH, MEDIUM, LOW, and DROP, and have been assigned on the basis of risk significance estimates, the ratio of risk to costs and other impacts estimated to result if resolution of the safety issues were implemented, and the consideration of uncertainties and other quantitative or qualitative factors. To the extent practical, estimates are quantitative. This document provides revisions and amendments to the report

  7. A prioritization of generic safety issues. Supplement 19, Revision insertion instructions

    None

    1995-11-01

    The report presents the safety priority ranking for generic safety issues related to nuclear power plants. The purpose of these rankings is to assist in the timely and efficient allocation of NRC resources for the resolution of those safety issues that have a significant potential for reducing risk. The safety priority rankings are HIGH, MEDIUM, LOW, and DROP, and have been assigned on the basis of risk significance estimates, the ratio of risk to costs and other impacts estimated to result if resolution of the safety issues were implemented, and the consideration of uncertainties and other quantitative or qualitative factors. To the extent practical, estimates are quantitative. This document provides revisions and amendments to the report.

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

    Kristensen, Solvejg; Mainz, Jan; Bartels, Paul

    2009-01-01

    such as culture, infections, surgical complications, medication errors, obstetrics, falls and specific diagnostic areas. CONCLUSION: The patient safety indicators recommended present a set of possible measures of patient safety. One of the future perspectives of implementing patient safety indicators...... for systematic monitoring is that it will be possible to continuously estimate the prevalence and incidence of patient safety quality problems. The lesson learnt from quality improvement is that it will pay off in terms of improving patient safety....

  9. Measurement tools and process indicators of patient safety culture in primary care. A mixed methods study by the LINNEAUS collaboration on patient safety in primary care

    Parker, Dianne; Wensing, Michel; Esmail, Aneez; Valderas, Jose M

    2015-01-01

    ABSTRACT Background: There is little guidance available to healthcare practitioners about what tools they might use to assess the patient safety culture. Objective: To identify useful tools for assessing patient safety culture in primary care organizations in Europe; to identify those aspects of performance that should be assessed when investigating the relationship between safety culture and performance in primary care. Methods: Two consensus-based studies were carried out, in which subject matter experts and primary healthcare professionals from several EU states rated (a) the applicability to their healthcare system of several existing safety culture assessment tools and (b) the appropriateness and usefulness of a range of potential indicators of a positive patient safety culture to primary care settings. The safety culture tools were field-tested in four countries to ascertain any challenges and issues arising when used in primary care. Results: The two existing tools that received the most favourable ratings were the Manchester patient safety framework (MaPsAF primary care version) and the Agency for healthcare research and quality survey (medical office version). Several potential safety culture process indicators were identified. The one that emerged as offering the best combination of appropriateness and usefulness related to the collection of data on adverse patient events. Conclusion: Two tools, one quantitative and one qualitative, were identified as applicable and useful in assessing patient safety culture in primary care settings in Europe. Safety culture indicators in primary care should focus on the processes rather than the outcomes of care. PMID:26339832

  10. Ethnic inequalities in patient safety in Dutch hospital care

    van Rosse, F.

    2015-01-01

    This thesis shows the first results of Dutch studies on the relation between ethnicity and patient safety. We used mixed methods to identify patient safety outcomes and patient safety risks in a cohort study in 4 urban hospitals among 763 Dutch patients and 576 ethnic minority patients. In a record

  11. Explaining Ethnic Disparities in Patient Safety: A Qualitative Analysis

    Suurmond, Jeanine; Uiters, Ellen; de Bruijne, Martine C.; Stronks, Karien; Essink-Bot, Marie-Louise

    2010-01-01

    Objectives. We explored characteristics of in-hospital care and treatment of immigrant patients to better understand the processes underlying ethnic disparities in patient safety. Methods. We conducted semistructured interviews with care providers regarding patient safety events involving immigrant

  12. The perceptions of patient safety culture: A difference between physicians and nurses in Taiwan.

    Huang, Chih-Hsuan; Wu, Hsin-Hung; Lee, Yii-Ching

    2018-04-01

    In order to pursue a better patient safety culture and provide a superior medical service for patients, this study aims to respectively investigate the perceptions of patient safety from the viewpoints of physicians and nurses in Taiwan. Little knowledge has clearly identified the difference of perceptions between physicians and nurses in patient safety culture. Understanding physicians and nurses' attitudes toward patient safety is a critical issue for healthcare organizations to improve medical quality. Confirmatory factor analysis (CFA) is used to verify the structure of data (e.g. reliability and validity), and Pearson's correlation analysis is conducted to demonstrate the relationships among seven patient safety culture dimensions. Research results illustrate that more teamwork is exhibited among team members, the more safety of a patient is committed. Perceptions of management and emotional exhaustion are important components that contribute to a better patient safety. More importantly, working conditions and stress recognition are found to be negatively related from the perceptions of nurses. Compared to physicians, nurses reported higher stress and challenges which result from multi-task working conditions in the hospital. This study focused on the contribution of a better patient safety culture from different viewpoints of physicians and nurses for healthcare organizations in Taiwan. A different attitudes toward patient safety is found between physicians and nurses. The results enable the hospital management to realize and design appropriate implications for hospital staffs to establish a better patient safety culture. Copyright © 2017. Published by Elsevier Inc.

  13. Microbiological food safety issues in Brazil: bacterial pathogens.

    Gomes, Bruna Carrer; Franco, Bernadette Dora Gombossy de Melo; De Martinis, Elaine Cristina Pereira

    2013-03-01

    The globalization of food supply impacts patterns of foodborne disease outbreaks worldwide, and consumers are having increased concern about microbiological food safety. In this sense, the assessment of epidemiological data of foodborne diseases in different countries has not only local impact, but it can also be of general interest, especially in the case of major global producers and exporters of several agricultural food products, such as Brazil. In this review, the most common agents of foodborne illnesses registered in Brazil will be presented, compiled mainly from official databases made available to the public. In addition, some representative examples of studies on foodborne bacterial pathogens commonly found in Brazilian foods are provided.

  14. Resolution of Hanford tanks organic complexant safety issue

    Kirch, N.W.

    1998-01-01

    The Hanford Site tanks have been assessed for organic complexant reaction hazards. The results have shown that most tanks contain insufficient concentrations of TOC to support a propagating reaction. It has also been shown that those tanks where the TOC concentration approaches levels of concern, degradation of the organic complexants to less energetic compounds has occurred. The results of the investigations have been documented. The residual organic complexants in the Hanford Site waste tanks do not present a safety concern for long-term storage

  15. Workshop on Regulatory Review and Safety Assessment Issues in Repository Licensing

    Wilmot, Roger D.

    2011-02-01

    The workshop described here was organised to address more general issues regarding regulatory review of SKB's safety assessment and overall review strategy. The objectives of the workshop were: - to learn from other programmes' experiences on planning and review of a license application for a nuclear waste repository, - to offer newly employed SSM staff an opportunity to learn more about selected safety assessment issues, and - to identify and document recommendations and ideas for SSM's further planning of the licensing review

  16. Confined Site Construction: A qualitative investigation of critical issues affecting management of Health and Safety

    Spillane, John P.; Oyedele, Lukumon O.; Von Meding, Jason; Konanahalli, Ashwini; Jaiyeoba, Babatunde E.; Tijani, Iyabo K.

    2011-01-01

    The construction industry is inherently risky, with a significant number of accidents and disasters occurring, particularly on confined construction sites. This research investigates and identifies the various issues affecting successful management of health and safety in confined construction sites. The rationale is that identifying the issues would assist the management of health and safety particularly in inner city centres which are mostly confined sites. Using empiricism epistemology, th...

  17. U.S. Food System Working Conditions as an Issue of Food Safety.

    Clayton, Megan L; Smith, Katherine C; Pollack, Keshia M; Neff, Roni A; Rutkow, Lainie

    2017-02-01

    Food workers' health and hygiene are common pathways to foodborne disease outbreaks. Improving food system jobs is important to food safety because working conditions impact workers' health, hygiene, and safe food handling. Stakeholders from key industries have advanced working conditions as an issue of public safety in the United States. Yet, for the food industry, stakeholder engagement with this topic is seemingly limited. To understand this lack of action, we interviewed key informants from organizations recognized for their agenda-setting role on food-worker issues. Findings suggest that participants recognize the work standards/food safety connection, yet perceived barriers limit adoption of a food safety frame, including more pressing priorities (e.g., occupational safety); poor fit with organizational strategies and mission; and questionable utility, including potential negative consequences. Using these findings, we consider how public health advocates may connect food working conditions to food and public safety and elevate it to the public policy agenda.

  18. Resolution of Generic Safety Issue 29: Bolting degradation or failure in nuclear power plants

    Johnson, R.E.

    1990-06-01

    This report describes the US Nuclear Regulatory Commission's (NRC's) Generic Safety Issue 29, ''Bolting Degradation or Failure in Nuclear Power Plants,'' including the bases for establishing the issue and its historical highlights. The report also describes the activities of the Atomic Industrial Forum (AIF) relevant to this issue, including its cooperation with the Materials Properties Council (MPC) to organize a task group to help resolve the issue. The Electric Power Research Institute, supported by the AIF/MPC task group, prepared and issued a two-volume document that provides, in part, the technical basis for resolving Generic Safety Issue 29. This report presents the NRC's review and evaluation of the two-volume document and NRC's conclusion that this document, in conjunction with other information from both industry and NRC, provides the bases for resolving this issue

  19. Ferrocyanide Safety Program: Data requirements for the ferrocyanide safety issue developed through the data quality objectives (DQO) process

    Buck, J.W.; Anderson, C.M.; Pulsipher, B.A.; Toth, J.J.; Turner, P.J.; Cash, R.J.; Dukelow, G.T.; Meacham, J.E.

    1993-12-01

    This document records the data quality objectives (DQO) process applied to the Ferrocyanide Waste Tank Safety Issue at the Hanford Site by the Pacific Northwest Laboratory and Westinghouse Hanford Company. Specifically, the major recommendations and findings from this Ferrocyanide DQO process are presented so that decision makers can determine the type, quantity, and quality of data required for addressing tank safety issues. The decision logic diagrams and error tolerance equations also are provided. Finally, the document includes the DQO sample-size formulas for determining specific tank sampling requirements

  20. Major nuclear safety and regulatory issues in Korea

    Chang, Soon Heung

    2004-01-01

    Recently the value of nuclear energy is being re-considered due to the increase of oil price, the lack of energy supply, and the competition with renewable energy source. In Unites States, Europe, and East Asia, the prospects for continuous nuclear energy development or the policy for retaining nuclear energy have been announced. According to the nuclear energy promotion plan in Korea, there are 19 operating nuclear plants currently and more 7 plants will be constructed in the future. Until now, qualitative as well as quantitative growth is remarkable. Korean nuclear power plants achieved world-best level of capacity factor. However, because of the various nuclear industrial activities, we have a lot of regulatory issues for operating plants, building new plants, and other nuclear related facilities such as research reactors or radioactive waste storage facility. In this article, important regulatory issues which are emerging in Korea will be reviewed and the approaches to solve the issues including public acceptance will be presented. Especially, I will go into detail of two special case studies: The one is the thermal sleeve separation incident in Younggwang nuclear units 5 and 6 whose outage lasts about 80 days and 90 days respectively, which is not common in worldwide nuclear history. The other is about consensus meeting of Korea nuclear energy policy which was managed by a non-governmental organization. (author)

  1. Patient Involvement in Patient Safety: A Qualitative Study of Nursing Staff and Patient Perceptions.

    Bishop, Andrea C; Macdonald, Marilyn

    2017-06-01

    The risk associated with receiving health care has called for an increased focus on the role of patients in helping to improve safety. Recent research has highlighted that patient involvement in patient safety practices may be influenced by patient perceptions of patient safety practices and the perceptions of their health care providers. The objective of this research was to describe patient involvement in patient safety practices by exploring patient and nursing staff perceptions of safety. Qualitative focus groups were conducted with a convenience sample of nursing staff and patients who had previously completed a patient safety survey in 2 tertiary hospital sites in Eastern Canada. Six focus groups (June 2011 to January 2012) were conducted and analyzed using inductive thematic analysis. Four themes were identified: (1) wanting control, (2) feeling connected, (3) encountering roadblocks, and (4) sharing responsibility for safety. Both patient and nursing staff participants highlighted the importance of building a personal connection as a precursor to ensuring that patients are involved in their care and safety. However, perceptions of provider stress and nursing staff workload often reduced the ability of the nursing staff and patient participants to connect with one another and promote involvement. Current strategies aimed at increasing patient awareness of patient safety may not be enough. The findings suggest that providing the context for interaction to occur between nursing staff and patients as well as targeted interventions aimed at increasing patient control may be needed to ensure patient involvement in patient safety.

  2. Safety issues in established predisposal waste management practices

    Thomas, W.

    2000-01-01

    Radioactive wastes generated at various stages in the nuclear fuel cycle vary considerably in relation to volume, physical and chemical properties, and radioactivity. The management of these wastes prior to disposal has to be adapted to these conditions, which calls for suitable characterization and minimization, collection, interim storage and conditioning of the wastes. Experience gained over decades shows that current predisposal waste management practices are well advanced. Whereas problems related to inadequate waste management practices in the past have been encountered at several sites and need ongoing remedial actions, modern practices have good safety records. Considerable development and improvement of waste management practices have been achieved and as a consequence of delays in implementing repositories in several countries they remain important tasks. Decommissioning and dismantling of nuclear facilities also have to be taken into account. In most cases, these activities can be performed using existing technical means and practices. No significant safety concerns have been found for the long term storage of spent fuel and vitrified waste. Dry storage has reached technical maturity and appears to be attractive, especially for aged fuel. It has, however, to be stressed that long term storage is not the ultimate solution. Continued efforts to implement repositories are mandatory in order to maintain a credible and responsible strategy for waste management. (author)

  3. Training and Action for Patient Safety: Embedding Interprofessional Education for Patient Safety within an Improvement Methodology

    Slater, Beverley L.; Lawton, Rebecca; Armitage, Gerry; Bibby, John; Wright, John

    2012-01-01

    Introduction: Despite an explosion of interest in improving safety and reducing error in health care, one important aspect of patient safety that has received little attention is a systematic approach to education and training for the whole health care workforce. This article describes an evaluation of an innovative multiprofessional, team-based…

  4. Legislation for the countermeasures on special issues of nuclear safety regulations

    Cho, Byung Sun; Lee, Mo Sung; Chung, Gum Chun; Kim, Heon Jin; Oh, Ho Chul

    2004-02-01

    Since the present nuclear safety regulation has some legal problems that refer to special issues and contents of regulatory provisions, this report has preformed research on the legal basic theory of nuclear safety regulation to solve the problems. In addition, this report analyzed the problems of each provisions and suggested the revision drafts on the basis of analyzing problems and the undergoing theory of nuclear safety regulation

  5. Legislation for the countermeasures on special issues of nuclear safety regulations

    Cho, Byung Sun; Lee, Mo Sung; Chung, Gum Chun; Kim, Heon Jin; Oh, Ho Chul [Chongju Univ., Cheongju (Korea, Republic of)

    2004-02-15

    Since the present nuclear safety regulation has some legal problems that refer to special issues and contents of regulatory provisions, this report has preformed research on the legal basic theory of nuclear safety regulation to solve the problems. In addition, this report analyzed the problems of each provisions and suggested the revision drafts on the basis of analyzing problems and the undergoing theory of nuclear safety regulation.

  6. 14 CFR 414.35 - Public notification of the criteria by which a safety approval was issued.

    2010-01-01

    ... issued. For each grant of a safety approval, the FAA will publish in the Federal Register a notice of the... which a safety approval was issued. 414.35 Section 414.35 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION LICENSING SAFETY APPROVALS Safety...

  7. Use of feedback control to address flight safety issues

    Ganguli, Subhabrata

    This thesis addresses three control problems related to flight safety. The first problem relates to the scope of improvement in performance of conventional flight control laws. In particular, aircraft longitudinal axis control based on the Total Energy Control System (TECS) is studied. The research draws attention to a potentially sluggish and undesirable aircraft response when the engine dynamics is slow (typically the case). The proposed design method uses a theoretically well-developed modern design method based on Hinfinity optimization to improve the aircraft dynamic behavior in spite of slow engine characteristics. At the same time, the proposed design method achieves other desirable performance goals such as insensitivity to sensor noise and wind gust rejection: all addressed in one unified framework. The second problem is based on a system level analysis of control structure hierarchy for aircraft flight control. The objective of the analysis problem is to translate outer-loop stability and performance specifications into a comprehensive inner-loop metric. The prime motivation is to make the flight control design process more systematic and the system-integration reliable and independent of design methodology. The analysis problem is posed within the robust control analysis framework. Structured singular value techniques and free controller parameterization ideas are used to impose a hierarchical structure for flight control architecture. The third problem involves development and demonstration of a new reconfiguration strategy in the flight control architecture that has the potential of improving flight safety while keeping cost and complexity low. This research proposes a fault tolerant feature based on active robust reconfiguration. The fault tolerant control problem is formulated in the Linear Parameter Varying (LPV) design framework. A prime advantage of this approach is that the synthesis results in a single nonlinear controller (as opposed to a bank

  8. John M. Eisenberg Patient Safety Awards. System innovation: Veterans Health Administration National Center for Patient Safety.

    Heget, Jeffrey R; Bagian, James P; Lee, Caryl Z; Gosbee, John W

    2002-12-01

    In 1998 the Veterans Health Administration (VHA) created the National Center for Patient Safety (NCPS) to lead the effort to reduce adverse events and close calls systemwide. NCPS's aim is to foster a culture of safety in the Department of Veterans Affairs (VA) by developing and providing patient safety programs and delivering standardized tools, methods, and initiatives to the 163 VA facilities. To create a system-oriented approach to patient safety, NCPS looked for models in fields such as aviation, nuclear power, human factors, and safety engineering. Core concepts included a non-punitive approach to patient safety activities that emphasizes systems-based learning, the active seeking out of close calls, which are viewed as opportunities for learning and investigation, and the use of interdisciplinary teams to investigate close calls and adverse events through a root cause analysis (RCA) process. Participation by VA facilities and networks was voluntary. NCPS has always aimed to develop a program that would be applicable both within the VA and beyond. NCPS's full patient safety program was tested and implemented throughout the VA system from November 1999 to August 2000. Program components included an RCA system for use by caregivers at the front line, a system for the aggregate review of RCA results, information systems software, alerts and advisories, and cognitive acids. Following program implementation, NCPS saw a 900-fold increase in reporting of close calls of high-priority events, reflecting the level of commitment to the program by VHA leaders and staff.

  9. The Anesthesia Patient Safety Foundation at 25: a pioneering success in safety, 25th anniversary provokes reflection, anticipation.

    Eichhorn, John H

    2012-04-01

    The Anesthesia Patient Safety Foundation (APSF) was created in 1985. Its founders coined the term "patient safety" in its modern public usage and created the very first patient safety organization, igniting a movement that is now universal in all of health care. Driven by the vision "that no patient shall be harmed by anesthesia," the APSF has worked tirelessly for more than a quarter century to promote safety education and communication through its widely read Newsletter, its programs, and its presentations. The APSF's extensive research grant program has supported a great many projects leading to key safety improvements and, in particular, was central in the development of high-fidelity mannequin simulation as a research and teaching tool. With its pioneering collaboration, the APSF is unique in incorporating the talents and resources of anesthesia professionals of all types, safety scientists, pharmaceutical and equipment manufacturers, regulators, liability insurance companies, and also surgeons. Specific alerts, campaigns, discussions, and projects have targeted a host of safety issues and dangers over the years, starting with minimal intraoperative monitoring in 1986 and all the way up to beach-chair position cerebral perfusion pressure, operating room medication errors, and the extremely popular DVD on operating room fire safety in 2010; the list is long and expansive. The APSF has served as a model and inspiration for subsequent patient safety organizations and has been recognized nationally as having a dramatic positive impact on the safety of anesthesia care. Recognizing that the work is not over, that systems, organizations, and equipment still at times fail, that basic preventable human errors still do sometimes occur, and that "production pressure" in anesthesia practice threatens past safety gains, the APSF is firmly committed and continues to work hard both on established tenets and new patient safety principles.

  10. AVAILABILITY, ACCESSIBILITY, PRIVACY AND SAFETY ISSUES FACING ELECTRONIC MEDICAL RECORDS

    Nisreen Innab

    2018-01-01

    Patient information recorded in electronic medical records is the most significant set of information of the healthcare system. It assists healthcare providers to introduce high quality care for patients. The aim of this study identifies the security threats associated with electronic medical records and gives recommendations to keep them more secured. The study applied the qualitative research method through a case study. The study conducted seven interviews with medical staff and informatio...

  11. The Danish patient safety experience: the Act on Patient Safety in the Danish Health care system

    Lundgaard, Mette; Rabøl, Louise; Jensen, Elisabeth Agnete Brøgger

    2005-01-01

    This paper describes the process that lead to the passing of the Act for Patient Safety in the Danisk health care sytem, the contents of the act and how the act is used in the Danish health care system. The act obligates frontline health care personnel to report adverse events, hospital owners...... to act on the reports and the National Board of Health to commuicate the learning nationally. The act protects health care providers from sanctions as a result of reporting. In January 2004, the Act on Patient Safety in the Danish health care system was put into force. In the first twelve months 5740...... adverse events were reported. the reports were analyzed locally (hospital and region), anonymized ad then sent to the National Board af Health. The Act on Patient Safety has driven the work with patient safety forward but there is room for improvement. Continuous and improved feedback from all parts...

  12. Software Reliability Issues Concerning Large and Safety Critical Software Systems

    Kamel, Khaled; Brown, Barbara

    1996-01-01

    This research was undertaken to provide NASA with a survey of state-of-the-art techniques using in industrial and academia to provide safe, reliable, and maintainable software to drive large systems. Such systems must match the complexity and strict safety requirements of NASA's shuttle system. In particular, the Launch Processing System (LPS) is being considered for replacement. The LPS is responsible for monitoring and commanding the shuttle during test, repair, and launch phases. NASA built this system in the 1970's using mostly hardware techniques to provide for increased reliability, but it did so often using custom-built equipment, which has not been able to keep up with current technologies. This report surveys the major techniques used in industry and academia to ensure reliability in large and critical computer systems.

  13. Main safety issues related to IPSN severe accident research

    LeComte, C.

    1991-01-01

    The work performed at IPSN concerning accident studies on nuclear installations is focused on the characterization of accidental sequences with three major aims: prevention, mitigation, and organization of counter-measures. As criteria to optimize all efforts made to improve nuclear safety, the radioactive dispersal in the environment must be quantified as function of internal and external radioactive products transfers. During the short-term phase of the accident, potential radioactive releases can be evaluated by the realistic code system ESCADRE. This system is validated by numerous analytical studies related to containment and fission product behavior. It will be further qualified by the results of the global experiments performed in the PHEBUS FP facility at IPSN

  14. Safety margins of PWR irradiated vessels - The Chooz A issue

    Hedin, F; Barthelet, B [Electricite de France (EDF), 75 - Paris (France); Guilleret, J C

    1988-12-31

    In 1986, some irradiated specimen of CHOOZ A (SENA) vessel showed a significant excess of {delta} RTNDT to former previsions. The lack of data on one of the two irradiated shells, and discrepancies between dosimeters results and available previous fluence calculations whose accuracy was questionable, cause the safety authorities to require an important complementary work program before putting again the plant on the grid after 1987 fuel reloading. These works are presented and discussed. They lead to a state that a conservative to day value of the vessel RTNDT is 64 degrees Celsius and that there is no underclad defect in the vessel wall and welds. Then the plant was allowed to restart with certitude that vessel irradiation will not impair its lifetime. (author). 4 refs.

  15. Nuclear energy in Lithuania: Its role, efficiency and safety issues

    Miskinis, V.; Galinis, A.; Streimikiene, D.

    2000-01-01

    This paper describes the present status of the Lithuanian economy and the power sector as well as problems related to further operation of the Ignalina Nuclear Power Plant (Ignalina NPP) which plays a crucial role in the Lithuanian energy sector. Recent studies have validated that it is economical to keep the Ignalina NPP in operation as long as it is possible and the necessary licenses can be obtained. However, its safe operation remains a very important issue determining its lifetime. Development of an infrastructure and activities necessary for safe and reliable operation of the plant are also very important. (author)

  16. Consideration of social scientific issues in a safety case. Final report

    Sailer, Michael; Kallenbach-Herbert, Beate; Brohmann, Bettina; Spieth-Achtnich, Angelika

    2010-01-01

    The research outcome presented here - a model for identifying and describing safety-relevant social scientific issues - provides a scientific basis for addressing these issues in a safety case. In order for them to be implemented in a repository process, it would be necessary to elaborate in greater detail the initial conceptual foundations that have been laid in this research project in line with the project's terms of reference. The requisite elaboration relates to binding rules for designing the repository process, particularly with regard to the stages in which the safety case is to be developed during planning, approval, construction and operation through to repository closure. Such detailed elaboration also needs to involve specifying the extent to which each social scientific issue and sub-issue is to be addressed in the different stages. Consideration would need to be given not only to the relevance of the issue for a given stage but also to the various options and methods for providing proof of safety. It would be possible to draw on experiences with handling safety management in nuclear power plants - a sphere in which over the last ten years efforts have been ongoing to develop methods for presentation by the operator and review by the authorities. Furthermore, it is likely that the social scientific issues relevant to a safety case cannot be defined once and for all in a single process, but that the need for continual revision and adaptation will arise due to both the increasing knowledge acquired during the course of the repository process and the experiences and expectations of stakeholders (similarly to experiences in the sphere of scientific-technological requirements). Appropriate conditions need to be defined for such a process. This process could be supported by implementing the option mentioned above whereby a regulatory definition of safety management for geological disposal is formulated which encompasses all safety-relevant social scientific

  17. [Nursing students' point of view on biosecurity and patient safety].

    Cararro, Telma Elisa; Gelbcke, Francine Lima; Sebold, Luciara Fabiane; Kempfer, Silvana Silveira; Zapelini, Maria Christina; Waterkemper, Roberta

    2012-09-01

    This study is aimed at identifying the knowledge of nursing students about the subject area of patient safety and its relationship with the teaching of biosecurity. Exploratory qualitative study conducted at the Universidade Federal de Santa Catarina (Federal University of Santa Catarina), with 17 students in the third phase of the Undergraduate Nursing Program. Three categories emerged after an exhaustive reading of the responses caring for self and others; biosecurity and care for the environment; biosecurity: health education and continuing education in health services. The following issues were identified, students' concern about risk prevention, care and self care as prerogatives for patient's safety; and education as a proposal for the minimization of risks. The study of biosecurity is considered important in undergraduate studies, minimizing losses and mistakes in the undergraduate students' conduct.

  18. Containment-emergency-sump performance. Technical findings related to Unresolved Safety Issue A-43

    1983-04-01

    This report summarizes key technical findings related to the Unresolved Safety Issue A-43, Containment Emergency Sump Performance, and provides recommendations for resolution of attendant safety issues. The key safety questions relate to: (a) effects of insulation debris on sump performance; (b) sump hydraulic performance as determined by design features, submergence, and plant induced effects, and (c) recirculation pump performance wherein air and/or particulate ingestion can occur. The technical findings presented in this report provide information relevant to the design and performance evaluation of the containment emergency sump

  19. Effects of gamma radiation on raspberries: safety and quality issues.

    Verde, S Cabo; Trigo, M J; Sousa, M B; Ferreira, A; Ramos, A C; Nunes, I; Junqueira, C; Melo, R; Santos, P M P; Botelho, M L

    2013-01-01

    There is an ever-increasing global demand from consumers for high-quality foods with major emphasis placed on quality and safety attributes. One of the main demands that consumers display is for minimally processed, high-nutrition/low-energy natural foods with no or minimal chemical preservatives. The nutritional value of raspberry fruit is widely recognized. In particular, red raspberries are known to demonstrate a strong antioxidant capacity that might prove beneficial to human health by preventing free radical-induced oxidative stress. However, food products that are consumed raw, are increasingly being recognized as important vehicles for transmission of human pathogens. Food irradiation is one of the few technologies that address both food quality and safety by virtue of its ability to control spoilage and foodborne pathogenic microorganisms without significantly affecting sensory or other organoleptic attributes of the food. Food irradiation is well established as a physical, nonthermal treatment (cold pasteurization) that processes foods at or nearly at ambient temperature in the final packaging, reducing the possibility of cross contamination until the food is actually used by the consumer. The aim of this study was to evaluate effects of gamma radiation on raspberries in order to assess consequences of irradiation. Freshly packed raspberries (Rubus idaeus L.) were irradiated in a (60)Co source at several doses (0.5, 1, or 1.5 kGy). Bioburden, total phenolic content, antioxidant activity, physicochemical properties such as texture, color, pH, soluble solids content, and acidity, and sensorial parameters were assessed before and after irradiation and during storage time up to 14 d at 4°C. Characterization of raspberries microbiota showed an average bioburden value of 10(4) colony-forming units (CFU)/g and a diverse microbial population predominantly composed of two morphological types (gram-negative, oxidase-negative rods, 35%, and filamentous fungi, 41

  20. Divertor armour issues: lifetime, safety and influence on ITER performance

    Pestchanyi, S.

    2009-01-01

    Comprehensive simulations of the ITER divertor armour vaporization and brittle destruction under ELMs of different sizes have revealed that the erosion rate of CFC armour is intolerable for an industrial reactor, but it can be considerably reduced by the armour fibre structure optimization. The ITER core contamination with carbon is tolerable for medium size ELMs, but large type I ELM can run the confinement into the disruption. Erosion of tungsten, an alternative armour material, under ELMs influence is satisfactory, but the danger of the core plasma contamination with tungsten is still not enough understood and potentially it could be very dangerous. Vaporization of tungsten, its cracking and dust production during ELMs are rather urgent issues to be investigated for proper choice of the divertor armour material for ITER. However, the erosion rate under action of the disruptive heat loads is tolerable for both armour materials assuming few hundred disruptions falls out during ITER lifetime

  1. Flu vaccine shortage creates ethical issues, safety challenges.

    2004-12-01

    Decisions may have to be made as to whether staff or patients get priority. Centers for Disease Control and Prevention guidelines help ease choices when it comes to inoculating workers. Quality professionals should be aware of the legal implications of their decisions.

  2. NS [Nuclear Safety] update. Current safety and security activities and developments taking place in the Department of Nuclear Safety and Security, Issue no. 6, March 2008

    2008-03-01

    The current issue presents information about the following activities: 1) International Conference on Illicit Nuclear Trafficking which took place in November 2007 in Edinburgh. The principal aim of the conference was to examine the threat and context of illicit nuclear trafficking of radioactive material, specifically, what is being done to combat such trafficking and where more needs to be done. The conference was also to consider how the obligations and commitments of the legally binding and non-binding international instruments could be and are being implemented by various States. 2) INSAG Message on Nuclear Safety Infrastructure in which the INSAG Chairman Richard Meserve addressed nuclear safety in the current context and various issues that warrant special attention. 3) approved for publication the Safety Requirements publication on Safety of Nuclear Fuel Cycle Facilities. 4) The Asian Nuclear Safety Network (ANSN)

  3. Bio-markers: traceability in food safety issues.

    Raspor, Peter

    2005-01-01

    Research and practice are focusing on development, validation and harmonization of technologies and methodologies to ensure complete traceability process throughout the food chain. The main goals are: scale-up, implementation and validation of methods in whole food chains, assurance of authenticity, validity of labelling and application of HACCP (hazard analysis and critical control point) to the entire food chain. The current review is to sum the scientific and technological basis for ensuring complete traceability. Tracing and tracking (traceability) of foods are complex processes due to the (bio)markers, technical solutions and different circumstances in different technologies which produces various foods (processed, semi-processed, or raw). Since the food is produced for human or animal consumption we need suitable markers to be stable and traceable all along the production chain. Specific biomarkers can have a function in technology and in nutrition. Such approach would make this development faster and more comprehensive and would make possible that food effect could be monitored with same set of biomarkers in consumer. This would help to develop and implement food safety standards that would be based on real physiological function of particular food component.

  4. Patient safety--worker safety: building a culture of safety to improve healthcare worker and patient well-being.

    Yassi, Annalee; Hancock, Tina

    2005-01-01

    Patient safety within the Canadian healthcare system is currently a high national priority, which merits a comprehensive understanding of the underlying causes of adverse events. Not least among these is worker health and safety, which is linked to patient outcomes. Healthcare workers have a high risk of workplace injuries and more mental health problems than most other occupational groups. Many healthcare professionals feel fatigued, stressed, in pain, or at risk of illness or injury-factors they feel impede their ability to provide consistent quality care. With this background, the Occupational Health and Safety Agency for Healthcare (OHSAH) in British Columbia, jointly governed by healthcare unions and healthcare employers, launched several major initiatives to improve the healthcare workplace. These included the promotion of safe patient handling, adaptive clothing, scheduled toileting, stroke management training, measures to improve management of aggressive behaviour and, of course, infection control-all intended to improve the safety of workers, but also to improve patient safety and quality of care. Other projects also explicitly promoting physical and mental health at work, as well as patient safety are also underway. Results of the projects are at various stages of completion, but ample evidence has already been obtained to indicate that looking after the well-being of healthcare workers results in safer and better quality patient care. While more research is needed, our work to date suggests that a comprehensive systems approach to promoting a climate of safety, which includes taking into account workplace organizational factors and physical and psychological hazards for workers, is the best way to improve the healthcare workplace and thereby patient safety.

  5. Conclusions and Recommendations of the IAEA International Conference on Topical Issues in Nuclear Safety: Ensuring Safety for Sustainable Nuclear Development

    El-Shanawany, Mamdouh

    2011-01-01

    programmes. National safety authorities could take the initiative of organizing international workshops on how OEF has been used and implemented. Moreover, lessons learned from new construction should be provided and shared between all countries embarking and considering new build. 5. It is vital in today's environment that the synergies between safety and security are maximized, and that culture be developed that integrates safety and security requirements. Safety and security have the same purpose: protecting people, society, environment and both could be based on similar principles even if there are some differences in implementation such as openness and transparency. There are important advantages from integrating the regulation of safety and security as much as possible. 6. The quality of the supply chain is an emerging issue. Harmonization of safety requirements, design codes and quality standards within the supply chain is acknowledged as requiring further collaboration among Member States, international organizations and supplier companies. Multinational Design Evaluation Programme (MDEP) is an important first step towards this goal. 7. Transparency, collaboration, information sharing and openness is responsibility of all Member States to assure not only safety but to foster confidence and trust among all stakeholders. 8. Despite NPPs high level of safety, emergency preparedness and response is an important issue in the context of developing nuclear energy. Through international cooperation, emergency and response plans need to be developed and well coordinated within all relevant entities. 9. In the context of developing nuclear energy the generation gap in education and training as well as the necessity to build technical capacity to properly address safety issues has been acknowledged by the Conference. Therefore, adequate education and training programmes should be developed and implemented.

  6. Main Conclusions and Recommendations of International Conference on Topical Issues in Nuclear Installation Safety: Ensuring Safety for Sustainable Nuclear Development

    El-Shanawany, Mamdouh

    2011-01-01

    programmes. National safety authorities could take the initiative of organizing international workshops on how OEF has been used and implemented. Moreover, lessons learned from new construction should be provided and shared between all countries embarking and considering new build. 5. It is vital in today's environment that the synergies between safety and security are maximized, and that culture be developed that integrates safety and security requirements. Safety and security have the same purpose: protecting people, society, environment and both could be based on similar principles even if there are some differences in implementation such as openness and transparency. There are important advantages from integrating the regulation of safety and security as much as possible. 6. The quality of the supply chain is an emerging issue. Harmonization of safety requirements, design codes and quality standards within the supply chain is acknowledged as requiring further collaboration among Member States, international organizations and supplier companies. Multinational Design Evaluation Programme (MDEP) is an important first step towards this goal. 7. Transparency, collaboration, information sharing and openness is responsibility of all Member States to assure not only safety but to foster confidence and trust among all stakeholders. 8. Despite NPPs high level of safety, emergency preparedness and response is an important issue in the context of developing nuclear energy. Through international cooperation, emergency and response plans need to be developed and well coordinated within all relevant entities. 9. In the context of developing nuclear energy the generation gap in education and training as well as the necessity to build technical capacity to properly address safety issues has been acknowledged by the Conference. Therefore, adequate education and training programmes should be developed and implemented.

  7. Non-technical skills training to enhance patient safety.

    Gordon, Morris

    2013-06-01

    Patient safety is an increasingly recognised issue in health care. Systems-based and organisational methods of quality improvement, as well as education focusing on key clinical areas, are common, but there are few reports of educational interventions that focus on non-technical skills to address human factor sources of error. A flexible model for non-technical skills training for health care professionals has been designed based on the best available evidence, and with sound theoretical foundations.   Educational sessions to improve non-technical skills in health care have been described before. The descriptions lack the details to allow educators to replicate and innovate further.   A non-technical skills training course that can be delivered as either a half- or full-day intervention has been designed and delivered to a number of mixed groups of undergraduate medical students and doctors in postgraduate training. Participant satisfaction has been high and patient safety attitudes have improved post-intervention.   This non-technical skills educational intervention has been built on a sound evidence base, and is described so as to facilitate replication and dissemination. With the key themes laid out, clinical educators will be able to build interventions focused on numerous clinical issues that pay attention to human factor contributors to safety. © 2013 John Wiley & Sons Ltd.

  8. Assessment of policy issues in nuclear safety regulation according to circumstantial changes

    Chang, Soon Heung; Lee, Byong Ho; Baek, Won Pil; Lee, Kwang Gu; Huh, Gyun Young; Hahn, Young Tae [Korea Advanced Institute of Science and Technology, Taejon (Korea, Republic of)

    2000-03-15

    The objective of the work is to assess various issues in nuclear safety regulation in consideration of circumstantial changes. Emphasis is given to the safety of operating NPPs. It is concluded that the Periodic Safety Review (PSR) should be implemented in Korea as soon as possible, in harmonization with the regulation for life extension of NPPs. The IAEA guidelines, including 10 year intervals and 11 safety factors, should be used as the basic guidelines. The approach to improve regulatory effectiveness is also reviewed and a transition to 'knowledge-based regulation' is suggested.

  9. Assessment of policy issues in nuclear safety regulation according to circumstantial changes

    Chang, Soon Heung; Chang, Soon Heung; Lee, Byong Ho; Baek, Won Pil; Roh, Chang Hyun; Lee, Kwang Gu; Kim, Hong Chae; Lee, Yong Ho [Korea Advanced Institute of Science and Technology, Taejon (Korea, Republic of)

    1999-03-15

    The objective of the work is to assess various issues in nuclear safety regulation in consideration of circumstantial changes. Emphasis is given to the safety of operating NPPs. It is concluded that the Periodic Safety Review (PSR) should be implemented in Korea as soon as possible, in harmonization with the regulation for life extension of NPPs. The IAEA guidelines, including 10 year intervals and 11 safety factors, should be used as the basic guidelines. Efforts are also required to cope with other circumstantial changes such as the establishment of International Nuclear Regulators Association (INRA)

  10. Expediting Clinician Adoption of Safety Practices: The UCSF Venous Access Patient Safety Interdisciplinary Education Project

    Donaldson, Nancy E; Plank, Rosemary K; Williamson, Ann; Pearl, Jeffrey; Kellogg, Jerry; Ryder, Marcia

    2005-01-01

    ...) Venous Access Device (VAD) Patient Safety Interdisciplinary Education Project was to develop a 30-hour/one clinical academic unit VAD patient safety course with the aim of expediting clinician adoption of critical concepts...

  11. Effects of an educational patient safety campaign on patients' safety behaviours and adverse events.

    Schwappach, David L B; Frank, Olga; Buschmann, Ute; Babst, Reto

    2013-04-01

    Rationale, aims and objectives  The study aims to investigate the effects of a patient safety advisory on patients' risk perceptions, perceived behavioural control, performance of safety behaviours and experience of adverse incidents. Method  Quasi-experimental intervention study with non-equivalent group comparison was used. Patients admitted to the surgical department of a Swiss large non-university hospital were included. Patients in the intervention group received a safety advisory at their first clinical encounter. Outcomes were assessed using a questionnaire at discharge. Odds ratios for control versus intervention group were calculated. Regression analysis was used to model the effects of the intervention and safety behaviours on the experience of safety incidents. Results  Two hundred eighteen patients in the control and 202 in the intervention group completed the survey (75 and 77% response rates, respectively). Patients in the intervention group were less likely to feel poorly informed about medical errors (OR = 0.55, P = 0.043). There were 73.1% in the intervention and 84.3% in the control group who underestimated the risk for infection (OR = 0.51, CI 0.31-0.84, P = 0.009). Perceived behavioural control was lower in the control group (meanCon  = 3.2, meanInt  = 3.5, P = 0.010). Performance of safety-related behaviours was unaffected by the intervention. Patients in the intervention group were less likely to experience any safety-related incident or unsafe situation (OR for intervention group = 0.57, CI 0.38-0.87, P = 0.009). There were no differences in concerns for errors during hospitalization. There were 96% of patients (intervention) who would recommend other patients to read the advisory. Conclusions  The results suggest that the safety advisory decreases experiences of adverse events and unsafe situations. It renders awareness and perceived behavioural control without increasing concerns for safety and

  12. Critical issues of alcohol safety in the region

    Svetlana Vasil’evna Aksyutina

    2015-03-01

    Full Text Available The paper presents results of the research into the economic and socio-demographic indicators associated with the production and consumption of alcoholic beverages. It discloses the analysis of the alcoholic beverage market structure in the Vologda Oblast. The authors have identified the threshold of the safe alcohol production volume in the region taking into account the World Health Organization standards of alcohol consumption and the share of illegally produced goods. The article states that the increased alcohol production contributes to the rise in tax revenues, but the state fiscal policy to regulate the alcoholic beverage market leads to an increase in the share of shadow turnover. The authors have calculated the economic loss connected with the illegal production of alcoholic beverages in the Vologda Oblast. The alcohol consumption is a destructive socio-demographic process and one of the threats to the health of the nation. Excessive alcohol consumption leads to alcohol dependence, regression of the society and increases the threat to national and economic security. The study reveals a direct correlation between the consumption of alcoholic beverages per capita and mortality rates in men and women of working age from the causes related to the consumption of alcoholic beverages. The study of the international experience to regulate alcohol consumption has showed the need to tighten state control in the sphere of production and turnover of alcoholic products. The conduct of the unified state alcohol policy substantiates the selection of the alcohol industry in the all-Russian classifier of economic activity types. The authors have elaborated the concept and conditions of alcoholic security from the point of view of economic growth and social development. The article substantiates the necessity to monitor alcohol safety indicators when considering the regional development. It presents the complex system of socio-economic and demographic

  13. Safety And Reduce In Pollution Issues For Inland Waterway Transportation

    Van Huong Dong

    2017-04-01

    Full Text Available According to the Ministry of Transport inland water transport is one of the five modes of transport in our country play a very important role. Inland waterway transport not only plays a major role in transporting large volumes of goods and passengers but also creates millions of jobs contributing to ensuring social security and national defense and security. However there are still many inadequacies in waterway transportation such as unequal waterway traffic The phenomenon of exploitation of river resources as planned or Process technology is not as planned exploitation of sand gravel etc. are common in most rivers and canals in the country. The signaling system is not synchronized between the signal of the inland waterway management unit and the signal of the owner The handling of domestic goods transportation and inland port management is inadequate The force of the means of development is fast uneven but concentrated in some urban areas and industrial parks. Therefore the Ministry of Transport has proposed a scheme to facilitate the development of a synchronized inland waterway infrastructure linking with other modes of transport To improve the capacity of the crew and the inland waterway transport crews. To create favorable conditions for inland waterway transportation business with reasonable transportation costs Improve the quality of water transport services Ensure safety and environmental friendliness Make a distinct advantage over other modes of transport. Specifically will develop promulgate mechanisms The policy is to facilitate the development of inland waterway infrastructure Build and promulgate mechanism The policy of supporting the development of the fleet has a reasonable structure with a fleet of about 30 self-propelled ships accounting for about 70 of the total number of inland waterway vessels To prioritize the development of the container fleet Inland waterway transportation and training retraining of human resources for

  14. Improving patient safety through quality assurance.

    Raab, Stephen S

    2006-05-01

    Anatomic pathology laboratories use several quality assurance tools to detect errors and to improve patient safety. To review some of the anatomic pathology laboratory patient safety quality assurance practices. Different standards and measures in anatomic pathology quality assurance and patient safety were reviewed. Frequency of anatomic pathology laboratory error, variability in the use of specific quality assurance practices, and use of data for error reduction initiatives. Anatomic pathology error frequencies vary according to the detection method used. Based on secondary review, a College of American Pathologists Q-Probes study showed that the mean laboratory error frequency was 6.7%. A College of American Pathologists Q-Tracks study measuring frozen section discrepancy found that laboratories improved the longer they monitored and shared data. There is a lack of standardization across laboratories even for governmentally mandated quality assurance practices, such as cytologic-histologic correlation. The National Institutes of Health funded a consortium of laboratories to benchmark laboratory error frequencies, perform root cause analysis, and design error reduction initiatives, using quality assurance data. Based on the cytologic-histologic correlation process, these laboratories found an aggregate nongynecologic error frequency of 10.8%. Based on gynecologic error data, the laboratory at my institution used Toyota production system processes to lower gynecologic error frequencies and to improve Papanicolaou test metrics. Laboratory quality assurance practices have been used to track error rates, and laboratories are starting to use these data for error reduction initiatives.

  15. Radiation Safety Issues in High Altitude Commercial Aircraft

    Wilson, John W.; Cucinotta, Francis A.; Shinn, Judy L.

    1995-01-01

    The development of a global economy makes the outlook for high speed commercial intercontinental flight feasible, and the development of various configurations operating from 20 to 30 km have been proposed. In addition to the still unresolved issues relating to current commercial operations (12-16 km), the higher dose rates associated with the higher operating altitudes makes il imperative that the uncertainties in the atmospheric radiation environment and the associated health risks be re-examined. Atmospheric radiation associated with the galactic cosmic rays forms a background level which may, under some circumstances, exceed newly recommended allowable exposure limits proposed on the basis of recent evaluations of the A -bomb survivor data (due to increased risk coefficients). These larger risk coefficients, within the context of the methodology for estimating exposure limits, are resulting in exceedingly low estimated allowable exposure limits which may impact even present day flight operations and was the reason for the CEC workshop in Luxembourg (1990). At higher operating altitudes, solar particles events can produce exposures many orders of magnitude above background levels and pose significant health risks to the most sensitive individuals (such as during pregnancy). In this case the appropriate quality factors are undefined, and some evidence exists which indicates that the quality factor for stochastic effects is a substantial underestimate.

  16. Nuclear choice: are health and safety issues pre-empted

    Henderson, G.B. II.

    1980-01-01

    This article examines the scope of the NRC's regulatory jurisdiction under the Atomic Energy Act in order to determine its proper effect on state siting laws. At the outset, a brief history of federal regulation of commercial nuclear power plants is set forth, and the cases that have dealt with the pre-emption issue in this area are reviewed. Next, an examination of the doctrine of federal pre-emption is conducted, focussing on the legal principles as they have been developed by the Supreme Court. Since the application of the pre-emption doctrine turns largely on the intent of Congress, the Atomic Energy Act and other pertinent federal legislation are examined to discern how far Congress has sought to extend its power over regulation of nuclear power. Some policy questions are also explored to determine whether it is appropriate to imply an intent on the part of Congress to pre-empt the field. Finally, a conclusion having been reached, the practical problems of what types of evidence may be admitted into the state siting agency's hearing are discussed and some solutions offered

  17. Taking up national safety alerts to improve patient safety in hospitals: The perspective of healthcare quality and risk managers.

    Pfeiffer, Yvonne; Schwappach, David

    2016-01-01

    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.

  18. Evaluation of patient safety culture among Malaysian retail pharmacists: results of a self-reported survey

    Sivanandy P

    2016-07-01

    Full Text Available Palanisamy Sivanandy,1 Mari Kannan Maharajan,1 Kingston Rajiah,1 Tan Tyng Wei,2 Tan Wee Loon,2 Lim Chong Yee2 1Department of Pharmacy Practice, School of Pharmacy, 2School of Pharmacy, International Medical University, Wilayah Persekutuan Kuala Lumpur, Malaysia Background: Patient safety is a major public health issue, and the knowledge, skills, and experience of health professionals are very much essential for improving patient safety. Patient safety and medication error are very much associated. Pharmacists play a significant role in patient safety. The function of pharmacists in the medication use process is very different from medical and nursing colleagues. Medication dispensing accuracy is a vital element to ensure the safety and quality of medication use.Objective: To evaluate the attitude and perception of the pharmacist toward patient safety in retail pharmacies setup in Malaysia.Methods: A Pharmacy Survey on Patient Safety Culture questionnaire was used to assess patient safety culture, developed by the Agency for Healthcare Research and Quality, and the convenience sampling method was adopted.Results: The overall positive response rate ranged from 31.20% to 87.43%, and the average positive response rate was found to be 67%. Among all the eleven domains pertaining to patient safety culture, the scores of “staff training and skills” were less. Communication openness, and patient counseling are common, but not practiced regularly in the Malaysian retail pharmacy setup compared with those in USA. The overall perception of patient safety of an acceptable level in the current retail pharmacy setup.Conclusion: The study revealed that staff training, skills, communication in patient counseling, and communication across shifts and about mistakes are less in current retail pharmacy setup. The overall perception of patient safety should be improved by educating the pharmacists about the significance and essential of patient safety. Keywords

  19. Pesticide Exposure, Safety Issues, and Risk Assessment Indicators

    Damalas, Christos A.; Eleftherohorinos, Ilias G.

    2011-01-01

    approved pesticides and the approval of the new compounds in the near future. Thus, new tools or techniques with greater reliability than those already existing are needed to predict the potential hazards of pesticides and thus contribute to reduction of the adverse effects on human health and the environment. On the other hand, the implementation of alternative cropping systems that are less dependent on pesticides, the development of new pesticides with novel modes of action and improved safety profiles, and the improvement of the already used pesticide formulations towards safer formulations (e.g., microcapsule suspensions) could reduce the adverse effects of farming and particularly the toxic effects of pesticides. In addition, the use of appropriate and well-maintained spraying equipment along with taking all precautions that are required in all stages of pesticide handling could minimize human exposure to pesticides and their potential adverse effects on the environment. PMID:21655127

  20. Pesticide Exposure, Safety Issues, and Risk Assessment Indicators

    Christos A. Damalas

    2011-05-01

    of the already approved pesticides and the approval of the new compounds in the near future. Thus, new tools or techniques with greater reliability than those already existing are needed to predict the potential hazards of pesticides and thus contribute to reduction of the adverse effects on human health and the environment. On the other hand, the implementation of alternative cropping systems that are less dependent on pesticides, the development of new pesticides with novel modes of action and improved safety profiles, and the improvement of the already used pesticide formulations towards safer formulations (e.g., microcapsule suspensions could reduce the adverse effects of farming and particularly the toxic effects of pesticides. In addition, the use of appropriate and well-maintained spraying equipment along with taking all precautions that are required in all stages of pesticide handling could minimize human exposure to pesticides and their potential adverse effects on the environment.

  1. Workplace engagement and workers' compensation claims as predictors for patient safety culture.

    Thorp, Jonathon; Baqai, Waheed; Witters, Dan; Harter, Jim; Agrawal, Sangeeta; Kanitkar, Kirti; Pappas, James

    2012-12-01

    Demonstrate the relationship between employee engagement and workplace safety for predicting patient safety culture. Patient safety is an issue for the U.S. health-care system, and health care has some of the highest rates of nonfatal workplace injuries. Understanding the types of injuries sustained by health-care employees, the type of safety environment employees of health-care organizations work in, and how employee engagement affects patient safety is vital to improving the safety of both employees and patients. The Gallup Q survey and an approved, abbreviated, and validated subset of questions from the Hospital Survey on Patient Safety Culture were administered to staff at a large tertiary academic medical center in 2007 and 2009. After controlling for demographic variables, researchers conducted a longitudinal, hierarchical linear regression analysis to study the unique contributions of employee engagement, changes in employee engagement, and employee safety in predicting patient safety culture. Teams with higher baseline engagement, more positive change in engagement, fewer workers' compensation claims, and fewer part-time associates in previous years had stronger patient safety cultures in 2009. Baseline engagement and change in engagement were the strongest independent predictors of patient safety culture in 2009. Engagement and compensation claims were additive and complimentary predictors, independent of other variables in the analysis, including the demographic composition of the workgroups in the study. A synergistic effect exists between employee engagement and decreased levels of workers' compensation claims for improving patient safety culture. Organizations can improve engagement and implement safety policies, procedures, and devices for employees with an ultimate effect of improving patient safety culture.

  2. Role of a quality management system in improving patient safety - laboratory aspects.

    Allen, Lynn C

    2013-09-01

    The aim of this study is to describe how implementation of a quality management system (QMS) based on ISO 15189 enhances patient safety. A literature review showed that several European hospitals implemented a QMS based on ISO 9001 and assessed the impact on patient safety. An Internet search showed that problems affecting patient safety have occurred in a number of laboratories across Canada. The requirements of a QMS based on ISO 15189 are outlined, and the impact of the implementation of each requirement on patient safety is summarized. The Quality Management Program - Laboratory Services in Ontario is briefly described, and the experience of Ontario laboratories with Ontario Laboratory Accreditation, based on ISO 15189, is outlined. Several hospitals that implemented ISO 9001 reported either a positive impact or no impact on patient safety. Patient safety problems in Canadian laboratories are described. Implementation of each requirement of the QMS can be seen to have a positive effect on patient safety. Average laboratory conformance on Ontario Laboratory Accreditation is very high, and laboratories must address and resolve any nonconformities. Other standards, practices, and quality requirements may also contribute to patient safety. Implementation of a QMS based on ISO 15189 provides a solid foundation for quality in the laboratory and enhances patient safety. It helps to prevent patient safety issues; when such issues do occur, effective processes are in place for investigation and resolution. Patient safety problems in Canadian laboratories might have been prevented had effective QMSs been in place. Ontario Laboratory Accreditation has had a positive impact on quality in Ontario laboratories. Copyright © 2013 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  3. 78 FR 17212 - Patient Safety Organizations: Voluntary Relinquishment From Universal Safety Solution PSO

    2013-03-20

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety... Research and Quality (AHRQ), HHS. ACTION: Notice of delisting. SUMMARY: The Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act), Public Law 109-41, 42 U.S.C. 299b-21--b-26, provides for the...

  4. The future of nuclear power after Sizewell B. 3 v.: v. 1 Economic issues; v. 2 Environmental and safety issues; v. 3 Public perception issues

    1987-01-01

    The three days of conference proceedings are published in three separate volumes. The first includes 7 papers relating to economic issues - those presented at the Sizewell-B public inquiry and the changes in the economic situation since the inquiry ended. The electricity demand, how this demand is to be met by nuclear and other fuel sources and how energy conservation might be an economic alternative to simply building more generating capacity are all issues discussed. The possible privatisation of the industry is also touched on. Volume two has 8 papers concerned with environmental and safety issues. These include the influence of the Sizewell-B decision on nuclear licensing and reactor safety, the technical and safety aspects of pressurized water reactors (PWR), the roles of British Nuclear Fuels and the United Kingdom Atomic Energy Authority, and radiation protection and effluent discharge control. The six papers in volume 3 look at public perception issues - not only towards nuclear power but towards the public inquiry process. The local authority view, the Friends of the Earth case against the PWR, and technical expertise in the decision process are also topics covered. All the papers are indexed separately. (UK)

  5. Reimbursement issues facing patients, providers, and payers.

    Antman, K

    1993-11-01

    Escalating costs of health care delivery and the current constraints imposed by the federal budget deficit seriously threaten to compromise patient care and innovative biomedical research. Recent third-party refusal to cover some patients treated in protocols has had considerable impact on trial research. In addition, reimbursement for conventional care sometimes has been refused if delivered as part of a study (e.g., MOPP therapy versus ABVD therapy) or for an indication that is not specifically cited on the Food and Drug Administration label. Who should cover the patient care costs of patients participating in clinical trials? One approach would have patients cover these costs themselves. A second approach is the reinstitution of patient care costs into research grants. A third possibility is that the pharmaceutical industry support patient care costs of clinical research. Historically, hospital expenses of patients participating in studies have been paid by health insurance policies. In the absence of a clinical trial, many patients would be treated with Food and Drug Administration-approved therapies despite a lack of substantial benefit. Such marginal treatments are compensated by third-party payers routinely. The current system is arbitrary and expensive, compromises research and development, and equates new treatment with no treatment. By refusing to reimburse the patient care costs of investigational therapy, third-party carriers are, in fact, making medical decisions. There is a growing and legitimate concern that the pace of clinical research will be impeded significantly at a time when many exciting developments will be ready for clinical trials. The molecular steps in carcinogenesis are being documented rapidly for common malignancies, such as colon cancer. Immunologic, biologic, and hormonal approaches, and emerging technologies, such as marrow transplant or antibody toxin conjugates, already are being studied in the clinic. Health policy legislation

  6. Healthcare professionals’ views of feedback on patient safety culture assessment.

    Zwijnenberg, N.C.; Hendriks, M.; Hoogervorst-Schilp, J.; Wagner, C.

    2016-01-01

    Background: By assessing patient safety culture, healthcare providers can identify areas for improvement in patient safety culture. To achieve this, these assessment outcomes have to be relevant and presented clearly. The aim of our study was to explore healthcare professionals’ views on the feedback of a patient safety culture assessment. Methods: Twenty four hospitals participated in a patient safety culture assessment in 2012. Hospital departments received feedback in a report and on a web...

  7. Knowledge Representation in Patient Safety Reporting: An Ontological Approach

    Liang Chen; Yang Gong

    2016-01-01

    Purpose: The current development of patient safety reporting systems is criticized for loss of information and low data quality due to the lack of a uniformed domain knowledge base and text processing functionality. To improve patient safety reporting, the present paper suggests an ontological representation of patient safety knowledge. Design/methodology/approach: We propose a framework for constructing an ontological knowledge base of patient safety. The present paper describes our desig...

  8. Non-technical issues in safety assessments for nuclear disposal facilities

    Kallenbach-Herbert, Beate; Brohmann, Bettina

    2010-09-01

    The paper highlights that a comprehensive approach to safety affords the consideration of technology, organisation, personnel and social environment. In several safety relevant contexts of nuclear waste disposal these fields are closely interrelated. The approach for the consideration of socio-scientific aspects which is sketched in this paper supports the systematic treatment of safety relevant non-technical issues in the safety case or in safety assessments for a disposal project. Furthermore it may foster the dialogue among specialists from the technical, the natural- and the socio-scientific field on questions of disposal safety. In this way it may contribute to a better understanding among the affected scientific disciplines in nuclear waste disposal.

  9. Safety culture and organizational issues during transition from operation to decommissioning of NPPs

    Slavcheva, K.; Mori, M.; D'Amico, N.; Sollima, C.

    2005-01-01

    The paper highlights the critical safety issues in a Nuclear Power Plant (NPP) to be managed during the transition period from operation to decommissioning. Pre-shutdown is an important period of a NPP lifetime due to the changes and issues to be faced by the NPP management, which include safety culture issues, organizational issues, plant safety issues and nuclear waste issues. Preservation of staff competence and moral, management and organizational capability, preservation of knowledge and corporate memory, preservation of safety culture, surveillance and permanent control to maintain adequate level of nuclear and radiation safety, development of appropriate solutions for the new incoming issues are the key challenges to be timely faced. The uncertainty regarding the future of the site, the future of the workers and the incoming re-organization originate numerous additional issues including stress for the personnel. It is necessary to take appropriate actions to reduce the uncertainty. The regulatory regime continues with the same rules as during operation. Responsibility for safety remains with the licensee and the regulatory supervision continues and oversees the safe operation and security of the NPP, the safe management and storage of spent nuclear fuel and radioactive waste. Anticipated attention from the Operator and the Regulator to key organizational and safety culture issues during the pre-shutdown phase has shown to be an effective preventive action. The Operator has to aim to preserve staff competence and motivation, preserve corporate memory, safety culture, reinforce monitoring and control on the health risk of workers and population, preserve the technical part of the organization from external disturb and distractions, ensure transparency and develop strategies to solve forthcoming issues. The Regulator has to aim to reorient its supervision, train its personnel and adapt its tools to the new situation, keep adequate presence onsite, keep dialogue

  10. Patient safety challenges in a case study hospital--of relevance for transfusion processes?

    Aase, Karina; Høyland, Sindre; Olsen, Espen; Wiig, Siri; Nilsen, Stein Tore

    2008-10-01

    The paper reports results from a research project with the objective of studying patient safety, and relates the finding to safety issues within transfusion medicine. The background is an increased focus on undesired events related to diagnosis, medication, and patient treatment in general in the healthcare sector. The study is designed as a case study within a regional Norwegian hospital conducting specialised health care services. The study includes multiple methods such as interviews, document analysis, analysis of error reports, and a questionnaire survey. Results show that the challenges for improved patient safety, based on employees' perceptions, are hospital management support, reporting of accidents/incidents, and collaboration across hospital units. Several of these generic safety challenges are also found to be of relevance for a hospital's transfusion service. Positive patient safety factors are identified as teamwork within hospital units, a non-punitive response to errors, and unit manager's actions promoting safety.

  11. Ranking of safety issues for WWER-440 model 230 nuclear power plants

    1992-02-01

    In response to requests from Member States operating Soviet designed WWER-440/230 nuclear power plants (NPPs) for assistance through the IAEA's nuclear safety services, a major international project was established to evaluate these first generation reactors as a complement to relevant ongoing national, bilateral and multilateral activities. The objective is to assist countries operating WWER-440/230 NPPs in performing comprehensive safety reviews aimed at identifying design and operational weaknesses. The scope of the project includes a review of the conceptual design of WWER-440/230 NPPs, safety review missions to each one of the operating reactors to review design and operational aspects and studies to resolve issues of generic safety concern. This report was prepared by a group of international experts and the IAEA staff and discussed by the Project Steering Committee, December 9-13, 1991 in Vienna. An overview of the safety issues identified is presented indicating their effect on the performance of the basic safety functions. Conceptual recommendations related to design issues are given as a technical basis for the safety modifications required

  12. Evaluation of patient safety culture among Malaysian retail pharmacists: results of a self-reported survey

    Sivanandy, Palanisamy; Maharajan, Mari Kannan; Rajiah, Kingston; Wei, Tan Tyng; Loon, Tan Wee; Yee, Lim Chong

    2016-01-01

    Background Patient safety is a major public health issue, and the knowledge, skills, and experience of health professionals are very much essential for improving patient safety. Patient safety and medication error are very much associated. Pharmacists play a significant role in patient safety. The function of pharmacists in the medication use process is very different from medical and nursing colleagues. Medication dispensing accuracy is a vital element to ensure the safety and quality of medication use. Objective To evaluate the attitude and perception of the pharmacist toward patient safety in retail pharmacies setup in Malaysia. Methods A Pharmacy Survey on Patient Safety Culture questionnaire was used to assess patient safety culture, developed by the Agency for Healthcare Research and Quality, and the convenience sampling method was adopted. Results The overall positive response rate ranged from 31.20% to 87.43%, and the average positive response rate was found to be 67%. Among all the eleven domains pertaining to patient safety culture, the scores of “staff training and skills” were less. Communication openness, and patient counseling are common, but not practiced regularly in the Malaysian retail pharmacy setup compared with those in USA. The overall perception of patient safety of an acceptable level in the current retail pharmacy setup. Conclusion The study revealed that staff training, skills, communication in patient counseling, and communication across shifts and about mistakes are less in current retail pharmacy setup. The overall perception of patient safety should be improved by educating the pharmacists about the significance and essential of patient safety. PMID:27524887

  13. 76 FR 7855 - Patient Safety Organizations: Voluntary Delisting From Community Medical Foundation for Patient...

    2011-02-11

    ... Organizations: Voluntary Delisting From Community Medical Foundation for Patient Safety AGENCY: Agency for... Medical Foundation for Patient Safety, of its status as a Patient Safety Organization (PSO). The Patient... notification from Community Medical Foundation for Patient Safety, PSO number P0029, to voluntarily relinquish...

  14. 75 FR 57281 - Patient Safety Organizations: Voluntary delisting

    2010-09-20

    ... Organizations: Voluntary delisting AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS ACTION: Notice... Patient Safety Corporation of its status as a Patient Safety Organization (PSO). The Patient Safety and... the listing of PSOs, which are entities or component organizations whose mission and primary activity...

  15. Towards an international classification for patient safety : the conceptual framework

    Sherman, H.; Castro, G.; Fletcher, M.; Hatlie, M.; Hibbert, P.; Jakob, R.; Koss, R.; Lewalle, P.; Loeb, J.; Perneger, Th.; Runciman, W.; Thomson, R.; Schaaf, van der T.W.; Virtanen, M.

    2009-01-01

    Global advances in patient safety have been hampered by the lack of a uniform classification of patient safety concepts. This is a significant barrier to developing strategies to reduce risk, performing evidence-based research and evaluating existing healthcare policies relevant to patient safety.

  16. Laser exposure incidents: pilot ocular health and aviation safety issues.

    Nakagawara, Van B; Wood, Kathryn J; Montgomery, Ron W

    2008-09-01

    A database of aviation reports involving laser illumination of flight crewmembers has been established and maintained at the Civil Aerospace Medical Institute. A review of recent laser illumination reports was initiated to investigate the significance of these events. Reports that involved laser exposures of civilian aircraft in the United States were analyzed for the 13-month period (January 1, 2004, through January 31, 2005). There were 90 reported instances of laser illumination during the study period. A total of 53 reports involved laser exposure of commercial aircraft. Lasers illuminated the cockpit in 41 (46%) of the incidents. Of those, 13 (32%) incidents resulted in a visual impairment or distraction to a pilot, including 1 incident that reportedly resulted in an ocular injury. Nearly 96% of these reports occurred in the last 3 months of the study period. There were no aviation accidents in which laser light illumination was found to be a contributing factor. Operational problems have resulted from laser illumination incidents in the national airspace system. Eye care practitioners, to provide effective consultations to their pilot patients, should be familiar with the problems that can occur with laser exposure.

  17. Factor Analysis and Framework Development for Incorporating Public Trust on Nuclear Safety issues

    Cho, Seongkyung; Lee, Gyebong [The Myongji Univ., Seoul (Korea, Republic of); Lee, Gihyung; Lee, Gyehwi; Jeong, Jina [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)

    2014-05-15

    The Korea Institute of Nuclear Safety (KINS), a regulatory expert organization in charge of nuclear safety in Korea, realized that a more fundamental and systematic analysis of activities is needed to actively meet the greater variety of concerns people have and increase the reliability of the results of regulation. Nuclear safety, a highly specialized field, has previously been discussed primarily from the viewpoint of the engineers who deal with the technology, but now 'public trust in nuclear safety' has to be viewed from the standpoint of the general public and from the socio-cultural perspective. Specific measures must be taken to examine which factors affect public trust and how we can secure and reproduce those factors to gain it. Also, an efficient system for incorporating public trust in nuclear safety must be established. In this study, various case studies were examined to identify the factors that affect public trust in nuclear safety. First, nuclear safety laws and information disclosure systems of major countries were examined by investigating data and conducting in-depth interviews. To explore a public framework concerning nuclear safety, big data of social media were analyzed. Also, Q methodology was used to analyze the risk schemata of the opinion leaders living in areas near nuclear power plants. Several surveys were conducted to analyze the amount of trust the public had in nuclear safety as well as their awareness of nuclear safety issues. Based on these analyses, factors affecting public trust in nuclear safety were extracted, and measures to build systems incorporating public trust in nuclear safety were proposed. This study addresses the public trust in nuclear safety on condition that the safety is ensured technically and mechanically.

  18. Factor Analysis and Framework Development for Incorporating Public Trust on Nuclear Safety issues

    Cho, Seongkyung; Lee, Gyebong; Lee, Gihyung; Lee, Gyehwi; Jeong, Jina

    2014-01-01

    The Korea Institute of Nuclear Safety (KINS), a regulatory expert organization in charge of nuclear safety in Korea, realized that a more fundamental and systematic analysis of activities is needed to actively meet the greater variety of concerns people have and increase the reliability of the results of regulation. Nuclear safety, a highly specialized field, has previously been discussed primarily from the viewpoint of the engineers who deal with the technology, but now 'public trust in nuclear safety' has to be viewed from the standpoint of the general public and from the socio-cultural perspective. Specific measures must be taken to examine which factors affect public trust and how we can secure and reproduce those factors to gain it. Also, an efficient system for incorporating public trust in nuclear safety must be established. In this study, various case studies were examined to identify the factors that affect public trust in nuclear safety. First, nuclear safety laws and information disclosure systems of major countries were examined by investigating data and conducting in-depth interviews. To explore a public framework concerning nuclear safety, big data of social media were analyzed. Also, Q methodology was used to analyze the risk schemata of the opinion leaders living in areas near nuclear power plants. Several surveys were conducted to analyze the amount of trust the public had in nuclear safety as well as their awareness of nuclear safety issues. Based on these analyses, factors affecting public trust in nuclear safety were extracted, and measures to build systems incorporating public trust in nuclear safety were proposed. This study addresses the public trust in nuclear safety on condition that the safety is ensured technically and mechanically

  19. Conservation of resources theory in nurse burnout and patient safety.

    Prapanjaroensin, Aoyjai; Patrician, Patricia A; Vance, David E

    2017-11-01

    To examine how the Conservation of Resources theory explains burnout in the nursing profession. Burnout, which is an accumulation of work-related mental stress in people-oriented occupations, has been an issue of concern for decades for healthcare workers, especially nurses. Yet, few studies have examined a unified theory that explains the aetiology, progression and consequences of nurse burnout. This discussion article integrates current knowledge on nurse burnout using Conservation of Resources theory, which focuses on four resources (i.e., objects, conditions, personal characteristics and energy). The databases that were used in this study included CINAHL, PubMed and PsycINFO. All reviewed articles were published between January 2006 - June 2016. The Conservation of Resources theory explains that burnout will occur as a result of perceived or actual loss of these four resources. Furthermore, nurse burnout could affect work performance, leading to lower alertness and overall quality of care. Healthcare organizations and nursing administration should develop strategies to protect nurses from the threat of resource loss to decrease nurse burnout, which may improve nurse and patient safety. The Conservation of Resources theory can guide interventions to decrease burnout and future research that examines the relationship between professional nurse burnout and patient safety. The Conservation of Resources theory explains the aetiology, progression and consequences of nurse burnout. Future studies must explore whether nurse performance is a mediating factor between nurse burnout and patient safety. © 2017 John Wiley & Sons Ltd.

  20. Implementation of Safety and Security Issues in the Transport of Radioactive Material in Argentina

    López Vietri, J.; Elechosa, C.; Gerez Miranda, C.; Menossi, S.; Rodríguez Roldán, M.S.; Fernández, A.

    2016-01-01

    This paper is intended to describe implementation of safety and security issues in the transport of radioactive material by the Nuclear Regulatory Authority (in Spanish Autoridad Regulatoria Nuclear, ARN), which is the Competent Authority of Argentina in Safety, Security and Safeguards of radioactive and nuclear material. There are depicted main regulatory activities dealing with the mentioned issues, and relevant milestones of national regulatory standards and guidance applied, that are based on requirements and guides from IAEA. Interfaces between Safety and Security sections are most of the times complementary but sometimes conflictive, therefore the resolution of such conflicts and goals achieved during their implementation are also commented; as well as future joint planned activities between both sections of ARN as a way to provide safety and security without compromising one or the other. (author)

  1. The contribution of safety issues to public perceptions of energy systems

    Otway, H.J.; Thomas, Kerry

    1978-01-01

    Public opposition is an important consideration for those responsible for energy planning. An attitude model was applied to identify the underlying determinants of public perceptions of five energy systems: nuclear, coal, oil, solar and hydro. Empirical results are reported in which these energy systems were found to be perceived in terms of four basic dimensions: psychological aspects; economics benefits; socio-political implications; environmental and physical safety issues. For the total sample, safety issues made an appreciable contribution to attitudes toward all of the systems except nuclear energy, where it was not significant. A differential analysis of two sub-samples, those respondents PRO and CON nuclear energy, showed that benefits and safety issues were important determinants of PRO attitudes while CON attitudes were primarily due to psychological aspects and concerns about personal and political power. The role of technical information in the formation of public attitudes toward technological policies is discussed [fr

  2. Influence of workplace demands on nurses' perception of patient safety.

    Ramanujam, Rangaraj; Abrahamson, Kathleen; Anderson, James G

    2008-06-01

    Patient safety is an ongoing challenge in the design and delivery of health-care services. As registered nurses play an integral role in patient safety, further examination of the link between nursing work and patient safety is warranted. The present study examines the relationship between nurses' perceptions of job demands and nurses' perceptions of patient safety. Structural equation modeling is used to analyze the data collected from a survey of 430 registered nurses at two community hospitals in the USA. As hypothesized, nurses' perception of patient safety decreases as the job demands increase. The level of personal control over practice directly affects nurses' perception of the ability to assure patient well-being. Nurses who work full-time and are highly educated have a decreased perception of patient safety, as well. The significant relationship between job demands and patient safety confirms that nurses make a connection between their working conditions and the ability to deliver safe care.

  3. Health innovation for patient safety improvement

    Renukha Sellappans

    2013-01-01

    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.

  4. Health innovation for patient safety improvement.

    Sellappans, Renukha; Chua, Siew Siang; Tajuddin, Nur Amani Ahmad; Mei Lai, Pauline Siew

    2013-01-01

    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.

  5. Decommissioning: Regulatory activities and identification of key organizational and human factors safety issues

    Durbin, N.E.; Melber, B.D.; Lekberg, A.

    2001-12-01

    In the late 1990's the Swedish government decided to shut down Unit 1 of the Barsebaeck nuclear power plant. This report documents some of the efforts made by the Swedish Nuclear Power Inspectorate (SKI) to address human factors and organizational issues in nuclear safety during decommissioning of a nuclear facility. This report gives a brief review of the background to the decommissioning of Barsebaeck 1 and points out key safety issues that can arise during decommissioning. The main regulatory activities that were undertaken were requirements that the plant provide special safety reports on decommissioning focusing on first, the operation of both units until closure of Unit 1 and second, the operation of Unit 2 when Unit 1 was closed. In addition, SKI identified areas that might be affected by decommissioning and called these areas out for special attention. With regard to these areas of special attention, SKI required that the plant provide monthly reports on changing and emerging issues as well as self-assessments of the areas to be addressed in the special safety reports. Ten key safety issues were identified and evaluated with regard to different stages of decommissioning and with regard to the actions taken by Barsebaeck. Some key conclusions from SKI's experience in regulating a decommissioning nuclear power plant conclude the report

  6. An Evaluation Methodology Development and Application Process for Severe Accident Safety Issue Resolution

    Robert P. Martin

    2012-01-01

    Full Text Available A general evaluation methodology development and application process (EMDAP paradigm is described for the resolution of severe accident safety issues. For the broader objective of complete and comprehensive design validation, severe accident safety issues are resolved by demonstrating comprehensive severe-accident-related engineering through applicable testing programs, process studies demonstrating certain deterministic elements, probabilistic risk assessment, and severe accident management guidelines. The basic framework described in this paper extends the top-down, bottom-up strategy described in the U.S Nuclear Regulatory Commission Regulatory Guide 1.203 to severe accident evaluations addressing U.S. NRC expectation for plant design certification applications.

  7. Workshop on Regulatory Review and Safety Assessment Issues in Repository Licensing

    Wilmot, Roger D. (Galson Sciences Limited (United Kingdom))

    2011-02-15

    The workshop described here was organised to address more general issues regarding regulatory review of SKB's safety assessment and overall review strategy. The objectives of the workshop were: - to learn from other programmes' experiences on planning and review of a license application for a nuclear waste repository, - to offer newly employed SSM staff an opportunity to learn more about selected safety assessment issues, and - to identify and document recommendations and ideas for SSM's further planning of the licensing review

  8. Issue on NPP-I and C important to safety-Data Communication

    Koo, I. S.; Hong, S. B.; Cho, J. W.; Choi, Y. S.; Lee, J. C.

    2010-01-01

    1. Issue on CDV and FDIS of IEC61500 - Nuclear Power Plants - Instrumentation and control important to safety -Data communication - Activities on IEC TC45, SC45A/WGA3. 2. As issue the requirements for safety data communication which is essential part of digital I and C systems, the fundamental technology for IT based nuclear I and C is established. 3. Approval and circulation of IED61500 CDV and FDIS - Issue of the international standard, IEC 61500. 4. Issue one IEC61500, three interim documents, three presentations and five technical support to industry, and participation in IEC TC45 and SC45A plenary meeting and intermediate meeting on SC45A/WGA3. 5. Based on IEC61500, an new project on wireless technologyes application to NPP will be proceeded

  9. Assessment of policy issues in nuclear safety regulation according to circumstantial changes

    Chang, Soon Heung; Lee, Byong Ho; Baek, Woon Pil; Lee, Seong Wook; Choi, Seong Soo; Roh, Chang Hyun; Lee, Kwang Gu [Korea Advanced Institute of Scienc and Technology, Taejon (Korea, Republic of)

    1998-03-15

    The objective of the work is to assess various issues in nuclear safety regulation in consideration of circumstantial changes. Emphasis is given to the safety of operating NPPs. The derivation of an effective regulation system considering 'Rhodic Safety Review (PSR)', 'operating License Renewal (LR)', 'backfitting' and 'maintenance rule' is the main objective of the first two years. It is found that those approaches should be introduced in Korea as soon as possible, with cross lingkage to maximize the effectiveness of regulation. In particular, the approaches for PSR are discussed with consultation of IAEA document and foreign practices.

  10. Patient Safety in Spine Surgery: Regarding the Wrong-Site Surgery

    Lee, Seung-Hwan; Kim, Ji-Sup; Jeong, Yoo-Chul; Kwak, Dae-Kyung; Chun, Ja-Hae; Lee, Hwan-Mo

    2013-01-01

    Patient safety regarding wrong site surgery has been one of the priority issues in surgical fields including that of spine care. Since the wrong-side surgery in the DM foot patient was reported on a public mass media in 1996, the wrong-site surgery issue has attracted wide public interest as regarding patient safety. Despite the many wrong-site surgery prevention campaigns in spine care such as the operate through your initial program by the Canadian Orthopaedic Association, the sign your sit...

  11. 77 FR 42738 - Patient Safety Organizations: Voluntary Relinquishment From the Coalition for Quality and Patient...

    2012-07-20

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From the Coalition for Quality and Patient Safety of Chicagoland (CQPS.... SUMMARY: The Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act), Public Law 109-41,42...

  12. Undergraduate medical students' perceptions and intentions regarding patient safety during clinical clerkship.

    Lee, Hoo-Yeon; Hahm, Myung-Il; Lee, Sang Gyu

    2018-04-04

    The purpose of this study was to examine undergraduate medical students' perceptions and intentions regarding patient safety during clinical clerkships. Cross-sectional study administered in face-to-face interviews using modified the Medical Student Safety Attitudes and Professionalism Survey (MSSAPS) from three colleges of medicine in Korea. We assessed medical students' perceptions of the cultures ('safety', 'teamwork', and 'error disclosure'), 'behavioural intentions' concerning patient safety issues and 'overall patient safety'. Confirmatory factor analysis and Spearman's correlation analyses was performed. In total, 194(91.9%) of the 211 third-year undergraduate students participated. 78% of medical students reported that the quality of care received by patients was impacted by teamwork during clinical rotations. Regarding error disclosure, positive scores ranged from 10% to 74%. Except for one question asking whether the disclosure of medical errors was an important component of patient safety (74%), the percentages of positive scores for all the other questions were below 20%. 41.2% of medical students have intention to disclose it when they saw a medical error committed by another team member. Many students had difficulty speaking up about medical errors. Error disclosure guidelines and educational efforts aimed at developing sophisticated communication skills are needed. This study may serve as a reference for other institutions planning patient safety education in their curricula. Assessing student perceptions of safety culture can provide clerkship directors and clinical service chiefs with information that enhances the educational environment and promotes patient safety.

  13. Communication elements supporting patient safety in psychiatric inpatient care.

    Kanerva, A; Kivinen, T; Lammintakanen, J

    2015-06-01

    culture is connected with the cultural issues of communication; and being active in information collecting is related to a nurse's personal working style, which affects communication. It is important to pay attention to all the three areas and use this knowledge in developing patient safety practices and strategies where communication aspect and culture are noted and developed. In mental health nursing, it is important to develop processes concerning communication in multidisciplinary teams and across unit boundaries. © 2015 John Wiley & Sons Ltd.

  14. Package leaflets of the most consumed medicines in Portugal: safety and regulatory compliance issues. A descriptive study

    Carla Pires

    Full Text Available CONTEXT AND OBJECTIVES: Package leaflets are necessary for safe use of medicines. The aims of the present study were: 1 to assess the compliance between the content of the package leaflets and the specifications of the pharmaceutical regulations; and 2 to identify potential safety issues for patients. DESIGN AND SETTING: Qualitative descriptive study, involving all the package leaflets of branded medicines from the three most consumed therapeutic groups in Portugal, analyzed in the Department of Pharmacoepidemiology, School of Pharmacy, University of Lisbon. METHODS: A checklist validated through an expert consensus process was used to gather the data. The content of each package leaflet in the sample was classified as compliant or non-compliant with compulsory regulatory issues (i.e. stated dosage and descriptions of adverse reactions and optional regulatory issues (i.e. adverse reaction frequency, symptoms and procedures in cases of overdose. RESULTS: A total of 651 package leaflets were identified. Overall, the package leaflets were found to be compliant with the compulsory regulatory issues. However, the optional regulatory issues were only addressed in around half of the sample of package leaflets, which made it possible to identify some situations of potentially compromised drug safety. CONCLUSION: Ideally, the methodologies for package leaflet approval should be reviewed and optimized as a way of ensuring the inclusion of the minimum essential information for safe use of medicines.

  15. Climate and climate-related issues for the safety assessment SR-Can

    Naeslund, Jens-Ove

    2006-11-01

    The purpose of this report is to document current scientific knowledge of the climate-related conditions and processes relevant to the long-term safety of a KBS-3 repository to a level required for an adequate treatment in the safety assessment SR-Can. The report also includes a concise background description of the climate system. The report includes three main chapters: A description of the climate system (Chapter 2); Identification and discussion of climate-related issues (Chapter 3); and, A description of the evolution of climate-related conditions for the safety assessment (Chapter 4). Chapter 2 includes an overview of present knowledge of the Earth climate system and the climate conditions that can be expected to occur in Sweden on a 100,000 year time perspective. Based on this, climate-related issues relevant for the long-term safety of a KBS-3 repository are identified. These are documented in Chapter 3 'Climate-related issues' to a level required for an adequate treatment in the safety assessment. Finally, in Chapter 4, 'Evolution of climate-related conditions for the safety assessment' an evolution for a 120,000 year period is presented, including discussions of identified climate-related issues of importance for repository safety. The documentation is from a scientific point of view not exhaustive, since such a treatment is neither necessary for the purposes of the safety assessment nor possible within the scope of a safety assessment. As further described in the SR-Can Main Report and in the Features Events and Processes report, the content of the present report has been audited by comparison with FEP databases compiled in other assessment projects. This report follows as far as possible the template for documentation of processes regarded as internal to the repository system. However, the term processes is not used in this report, instead the term issue has been used. Each issue includes a set of processes together resulting in the behaviour of a

  16. Climate and climate-related issues for the safety assessment SR-Can

    Naeslund, Jens-Ove (comp.)

    2006-11-15

    The purpose of this report is to document current scientific knowledge of the climate-related conditions and processes relevant to the long-term safety of a KBS-3 repository to a level required for an adequate treatment in the safety assessment SR-Can. The report also includes a concise background description of the climate system. The report includes three main chapters: A description of the climate system (Chapter 2); Identification and discussion of climate-related issues (Chapter 3); and, A description of the evolution of climate-related conditions for the safety assessment (Chapter 4). Chapter 2 includes an overview of present knowledge of the Earth climate system and the climate conditions that can be expected to occur in Sweden on a 100,000 year time perspective. Based on this, climate-related issues relevant for the long-term safety of a KBS-3 repository are identified. These are documented in Chapter 3 'Climate-related issues' to a level required for an adequate treatment in the safety assessment. Finally, in Chapter 4, 'Evolution of climate-related conditions for the safety assessment' an evolution for a 120,000 year period is presented, including discussions of identified climate-related issues of importance for repository safety. The documentation is from a scientific point of view not exhaustive, since such a treatment is neither necessary for the purposes of the safety assessment nor possible within the scope of a safety assessment. As further described in the SR-Can Main Report and in the Features Events and Processes report, the content of the present report has been audited by comparison with FEP databases compiled in other assessment projects. This report follows as far as possible the template for documentation of processes regarded as internal to the repository system. However, the term processes is not used in this report, instead the term issue has been used. Each issue includes a set of processes together resulting in the

  17. Patient-led training on patient safety: a pilot study to test the feasibility and acceptability of an educational intervention.

    Jha, V; Winterbottom, A; Symons, J; Thompson, Z; Quinton, N; Corrado, O J; Melville, C; Watt, I; Torgerson, D; Wright, J

    2013-09-01

    Training in patient safety is an important element of medical education. Most educational interventions on patient safety training adopt a 'health-professional lens' with limited consideration on the impact of safety lapses on the patient and their families and little or no involvement of patients in the design or delivery of the training. This paper describes a pilot study to test the feasibility and acceptability of implementing a patient-led educational intervention to facilitate safety training amongst newly qualified doctors. Patients and/or carers who had experienced harm during their care shared narratives of their stories with trainees; this was followed by a focused discussion on patient safety issues exploring the causes and consequences of safety incidents and lessons to be learned from these. The intervention, which will be further tested in an NIHR-funded randomised controlled trial (RCT), was successfully implemented into an existing training programme and found acceptance amongst the patients and trainees. The pilot study proved to be a useful step in refining the intervention for the RCT including identifying appropriate outcome measures and highlighting organisational issues.

  18. Radiation safety and care of patients

    Das, B.K.; Noreen Norfaraheen Lee Abdullah

    2012-01-01

    The objective of this chapter is to acquaint the reader with radiation safety measures which can be pursued to minimize radiation load to the patient and staff. The basic principle is that all unnecessary administration should be avoided and a number of simple techniques be used to reduce radiation dose. For example, the kidney excretes many radionuclides. Drinking plenty of fluid and frequent bladder emptying can minimize absorbed dose to the bladder. Thyroid blocking agents must be used if radioactive iodine is being administered to avoid unnecessary radiation exposure to the thyroid gland. When it is necessary to administer radioactive substances to a female of childbearing age, the radiation exposure should be minimum and information whether the patient is pregnant or not must be obtained. Alternatives techniques, which do not involve ionizing radiation, should also be considered. (author)

  19. [Electronic patient record as the tool for better patient safety].

    Schneider, Henning

    2015-01-01

    Recent studies indicate again that there is a deficit in the use of electronic health records (EHR) in German hospitals. Despite good arguments in favour of their use, such as the rapid availability of data, German hospitals shy away from a wider implementation. The reason is the high cost of installing and maintaining the EHRs, for the benefit is difficult to evaluate in monetary terms for the hospital. Even if a benefit can be shown it is not necessarily evident within the hospital, but manifests itself only in the health system outside. Many hospitals only manage to partly implement EHR resulting in increased documentation requirements which reverse their positive effect.In the United States, electronic medical records are also viewed in light of their positive impact on patient safety. In particular, electronic medication systems prove the benefits they can provide in the context of patient safety. As a result, financing systems have been created to promote the digitalisation of hospitals in the United States. This has led to a large increase in the use of IT systems in the United States in recent years. The Universitätsklinikum Eppendorf (UKE) introduced electronic patient records in 2009. The benefits, in particular as regards patient safety, are numerous and there are many examples to illustrate this position. These positive results are intended to demonstrate the important role EHR play in hospitals. A financing system of the ailing IT landscape based on the American model is urgently needed to benefit-especially in terms of patient safety-from electronic medical records in the hospital.

  20. Improving ICU risk management and patient safety.

    Kielty, Lucy Ann

    2017-06-12

    Purpose The purpose of this paper is to describe a study which aimed to develop and validate an assessment method for the International Electrotechnical Commission (IEC) 80001-1 (IEC, 2010) standard (the Standard); raise awareness; improve medical IT-network project risk management processes; and improve intensive care unit patient safety. Design/methodology/approach An assessment method was developed and piloted. A healthcare IT-network project assessment was undertaken using a semi-structured group interview with risk management stakeholders. Participants provided feedback via a questionnaire. Descriptive statistics and thematic analysis was undertaken. Findings The assessment method was validated as fit for purpose. Participants agreed (63 per cent, n=7) that assessment questions were clear and easy to understand, and participants agreed (82 per cent, n=9) that the assessment method was appropriate. Participant's knowledge of the Standard increased and non-compliance was identified. Medical IT-network project strengths, weaknesses, opportunities and threats in the risk management processes were identified. Practical implications The study raised awareness of the Standard and enhanced risk management processes that led to improved patient safety. Study participants confirmed they would use the assessment method in future projects. Originality/value Findings add to knowledge relating to IEC 80001-1 implementation.

  1. [Improving patient safety through voluntary peer review].

    Kluge, S; Bause, H

    2015-01-01

    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.

  2. 21 CFR 312.88 - Safeguards for patient safety.

    2010-04-01

    ... 21 Food and Drugs 5 2010-04-01 2010-04-01 false Safeguards for patient safety. 312.88 Section 312... Severely-debilitating Illnesses § 312.88 Safeguards for patient safety. All of the safeguards incorporated within parts 50, 56, 312, 314, and 600 of this chapter designed to ensure the safety of clinical testing...

  3. Verification and validation issues for digitally-based NPP safety systems

    Ets, A.R.

    1993-01-01

    The trend toward standardization, integration and reduced costs has led to increasing use of digital systems in reactor protection systems. While digital systems provide maintenance and performance advantages, their use also introduces new safety issues, in particular with regard to software. Current practice relies on verification and validation (V and V) to ensure the quality of safety software. However, effective V and V must be done in conjunction with a structured software development process and must consider the context of the safety system application. This paper present some of the issues and concerns that impact on the V and V process. These include documentation of systems requirements, common mode failures, hazards analysis and independence. These issues and concerns arose during evaluations of NPP safety systems for advanced reactor designs and digital I and C retrofits for existing nuclear plants in the United States. The pragmatic lessons from actual systems reviews can provide a basis for further refinement and development of guidelines for applying V and V to NPP safety systems. (author). 14 refs

  4. Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety.

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

    2014-10-01

    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.

  5. State Legislative Developments on Campus Sexual Violence: Issues in the Context of Safety

    Morse, Andrew; Sponsler, Brian A.; Fulton, Mary

    2015-01-01

    NASPA--Student Affairs Administrators in Higher Education and Education Commission of the States (ECS) have partnered to address legislative developments and offer considerations for leaders in higher education and policy on two top-level safety issues facing the higher education community: campus sexual violence and guns on campus. The first in a…

  6. Ethical issues in engineering design processes ; regulative frameworks for safety and sustainability

    Gorp, A. van

    2007-01-01

    The ways designers deal with ethical issues that arise in their consideration of safety and sustainability in engineering design processes are described. In the case studies, upon which this article is based, a difference can be seen between normal and radical design. Designers refer to regulative

  7. IAEA databases on safety issues and plant status for Central and Eastern European NPPs

    Czibolya, L.

    1995-01-01

    The main principles of the database development for safety issues of WWER and RBMK reactors are described. The IAEA contribution to the G-24 Project Data Bank and an analysis of gaps and overlaps in assistance projects is given. As an example the database on WWER-440/VV-230 type reactors is shown. (HP)

  8. Japan's regulatory and safety issues regarding nuclear materials transport

    Saito, T. [Nuclear and Industrial Safety Agency, Ministry of Economy, Trade and Industry, Government of Japan, Tokyo (Japan); Yamanaka, T. [Japan Nuclear Energy Safety Organization, Government of Japan, Tokyo (Japan)

    2004-07-01

    This paper focuses on the regulatory and safety issues on nuclear materials transport which the Government of Japan (GOJ) faces and needs to well handle. Background information about the status of nuclear power plants (NPP) and nuclear fuel cycle (NFC) facilities in Japan will promote a better understanding of what this paper addresses.

  9. The progress and issues of national nuclear and radiation safety supervision and MIS

    Zhou Kefei; Sun Guochen; Jiang Guang; Li Jingxi; Zhang Lin

    2009-01-01

    The article briefly describes the pre-planning construction of 'National Nuclear and Radiation Safety Supervision and Management Information System', Including the overall frame of the system and the main issues found in the work which affect and confine the progress of the program. Some recommendations are put forward. (authors)

  10. Current Status of Health and Safety Issues of Sodium/Metal Chloride (Zebra) Batteries

    David Trickett

    1998-01-01

    This report addresses environmental, health, and safety (EH ampersand S) issues associated with sodium/ metal chloride batteries, in general, although most references to specific cell or battery types refer to units developed or being developed under the Zebra trademark. The report focuses on issues pertinent to sodium/metal chloride batteries and their constituent components; however, the fact that some ''issues'' arise from interaction between electric vehicle (EV) and battery design com- pels occasional discussion amid the context of EV vehicle design and operation. This approach has been chosen to provide a reasonably comprehensive account of the topic from a cell technology perspective and an applications perspective

  11. Current Status of Health and Safety Issues of Sodium/Metal Chloride (Zebra) Batteries

    Trickett, D.

    1998-12-15

    This report addresses environmental, health, and safety (EH&S) issues associated with sodium/ metal chloride batteries, in general, although most references to specific cell or battery types refer to units developed or being developed under the Zebra trademark. The report focuses on issues pertinent to sodium/metal chloride batteries and their constituent components; however, the fact that some ''issues'' arise from interaction between electric vehicle (EV) and battery design compels occasional discussion amid the context of EV vehicle design and operation. This approach has been chosen to provide a reasonably comprehensive account of the topic from a cell technology perspective and an applications perspective.

  12. Planning exercise for the resolution of high level waste tank safety issues

    Bunting, J.; Saveland, J.

    1992-01-01

    Several conditions have been found to exist within high level radioactive waste storage tanks at the Hanford site which could lead to uncontrolled exothermic reactions and/or to the release of tank contents into the environment. These conditions have led to the establishment of four priority 1 safety issues for the Hanford tanks. Resolution of these safety issues will require the coordinated efforts of professionals in chemical, nuclear, operations, safety, and other technical areas. A coordinated and integrated approach is necessary in order to achieve resolution in the shortest possible time, while ensuring that the steps taken do not complicate the later jobs of vitrification and ultimate disposal. This paper describes the purpose, process, and results of an effort to develop a suggested approach. (author)

  13. Resolution of the ferrocyanide safety issue for the Hanford site high-level waste tanks

    Cash, R.J.

    1996-01-01

    This paper describes the approach used to resolve the ferrocyanide safety issue, a process that began in 1990 after heightened concern was expressed by various government agencies about the safety of Hanford site high-level waste tanks. At the time, little was known about ferrocyanide-nitrate/nitrite reactions and the potential for offsite releases of radioactivity from the Hanford Site. Recent studies have shown that the combined effects of temperature, radiation, and pH during more than 38 years of storage have destroyed most of the ferrocyanide originally added to tanks. This has been proven in the laboratory using flowsheet-derived waste simulants and confirmed by waste samples obtained from the ferrocyanide tanks. The resulting tank waste sludges are too dilute to support a sustained exothermic reaction, even if dried out and heated to temperatures of at least 250 C. The US Department of Energy (DOE) has been requested to close the ferrocyanide safety issue

  14. Materials-related issues in the safety and licensing of nuclear fusion facilities

    Taylor, N.; Merrill, B.; Cadwallader, L.; Di Pace, L.; El-Guebaly, L.; Humrickhouse, P.; Panayotov, D.; Pinna, T.; Porfiri, M.-T.; Reyes, S.; Shimada, M.; Willms, S.

    2017-09-01

    Fusion power holds the promise of electricity production with a high degree of safety and low environmental impact. Favourable characteristics of fusion as an energy source provide the potential for this very good safety and environmental performance. But to fully realize the potential, attention must be paid in the design of a demonstration fusion power plant (DEMO) or a commercial power plant to minimize the radiological hazards. These hazards arise principally from the inventory of tritium and from materials that become activated by neutrons from the plasma. The confinement of these radioactive substances, and prevention of radiation exposure, are the primary goals of the safety approach for fusion, in order to minimize the potential for harm to personnel, the public, and the environment. The safety functions that are implemented in the design to achieve these goals are dependent on the performance of a range of materials. Degradation of the properties of materials can lead to challenges to key safety functions such as confinement. In this paper the principal types of material that have some role in safety are recalled. These either represent a potential source of hazard or contribute to the amelioration of hazards; in each case the related issues are reviewed. The resolution of these issues lead, in some instances, to requirements on materials specifications or to limits on their performance.

  15. IAEA Issues Report on Mission to Review Japan's Nuclear Power Plant Safety Assessment Process

    2012-01-01

    Full text: A team of international nuclear safety experts has delivered its report on a mission it conducted from 21-31 January 2012 to review Japan's process for assessing nuclear safety at the nation's nuclear power plants. International Atomic Energy Agency (IAEA) officials delivered the IAEA Mission Report to Japanese officials yesterday and made it publicly available today. Following the 11 March 2011 accident at TEPCO's Fukushima Daiichi Nuclear Power Station, Japan's Nuclear and Industrial Safety Agency (NISA) announced the development of a revised safety assessment process for the nation's nuclear power reactors. At the request of the Government of Japan, the IAEA organized a team of five IAEA and three international nuclear safety experts and visited Japan to review NISA's approach to the Comprehensive Assessments for the Safety of Existing Power Reactor Facilities and how NISA examines the results submitted by nuclear operators. A Preliminary Summary Report was issued on 31 January. 'The mission report provides additional information regarding the team's recommendations and overall finding that NISA's instructions to power plants and its review process for the Comprehensive Safety Assessments are generally consistent with IAEA Safety Standards', said team leader James Lyons, Director of the IAEA's Nuclear Installation Safety Division. National safety assessments and their peer review by the IAEA are a key component of the IAEA Action Plan on Nuclear Safety, which was approved by the Agency's Member States following last year's nuclear accident at Fukushima Daiichi Nuclear Power Station. The IAEA safety review mission held meetings in Tokyo with officials from NISA, the Japanese Nuclear Energy Safety Organization (JNES), and the Kansai Electric Power Company (KEPCO), and the team visited the Ohi Nuclear Power Station to see an example of how Japan's Comprehensive Safety Assessment is being implemented by nuclear operators. In its report delivered today

  16. Patient and nurse safety: how information technology makes a difference.

    Simpson, Roy L

    2005-01-01

    The Institute of Medicine's landmark report asserted medical error is seldom the fault of individuals, but the result of faulty healthcare policy/procedure systems. Numerous studies have shown that information technology can shore up weak systems. For nursing, information technology plays a key role in protecting patients by eliminating nursing mistakes and protecting nurses by reducing their negative exposure. However, managing information technology is a function of managing the people who use it. This article examines critical issues that impact patient and nurse safety, both physical and professional. It discusses the importance of eliminating the culture of blame, the requirements of process change, how to implement technology in harmony with the organization and the significance of vision.

  17. Patient safety in primary care: a survey of general practitioners in the Netherlands

    Wensing Michel

    2010-01-01

    Full Text Available Abstract Background Primary care encompasses many different clinical domains and patient groups, which means that patient safety in primary care may be equally broad. Previous research on safety in primary care has focused on medication safety and incident reporting. In this study, the views of general practitioners (GPs on patient safety were examined. Methods A web-based survey of a sample of GPs was undertaken. The items were derived from aspects of patient safety issues identified in a prior interview study. The questionnaire used 10 clinical cases and 15 potential risk factors to explore GPs' views on patient safety. Results A total of 68 GPs responded (51.5% response rate. None of the clinical cases was uniformly judged as particularly safe or unsafe by the GPs. Cases judged to be unsafe by a majority of the GPs concerned either the maintenance of medical records or prescription and monitoring of medication. Cases which only a few GPs judged as unsafe concerned hygiene, the diagnostic process, prevention and communication. The risk factors most frequently judged to constitute a threat to patient safety were a poor doctor-patient relationship, insufficient continuing education on the part of the GP and a patient age over 75 years. Language barriers and polypharmacy also scored high. Deviation from evidence-based guidelines and patient privacy in the reception/waiting room were not perceived as risk factors by most of the GPs. Conclusion The views of GPs on safety and risk in primary care did not completely match those presented in published papers and policy documents. The GPs in the present study judged a broader range of factors than in previously published research on patient safety in primary care, including a poor doctor-patient relationship, to pose a potential threat to patient safety. Other risk factors such as infection prevention, deviation from guidelines and incident reporting were judged to be less relevant than by policy

  18. Patient safety in primary care: a survey of general practitioners in The Netherlands.

    Gaal, Sander; Verstappen, Wim; Wensing, Michel

    2010-01-21

    Primary care encompasses many different clinical domains and patient groups, which means that patient safety in primary care may be equally broad. Previous research on safety in primary care has focused on medication safety and incident reporting. In this study, the views of general practitioners (GPs) on patient safety were examined. A web-based survey of a sample of GPs was undertaken. The items were derived from aspects of patient safety issues identified in a prior interview study. The questionnaire used 10 clinical cases and 15 potential risk factors to explore GPs' views on patient safety. A total of 68 GPs responded (51.5% response rate). None of the clinical cases was uniformly judged as particularly safe or unsafe by the GPs. Cases judged to be unsafe by a majority of the GPs concerned either the maintenance of medical records or prescription and monitoring of medication. Cases which only a few GPs judged as unsafe concerned hygiene, the diagnostic process, prevention and communication. The risk factors most frequently judged to constitute a threat to patient safety were a poor doctor-patient relationship, insufficient continuing education on the part of the GP and a patient age over 75 years. Language barriers and polypharmacy also scored high. Deviation from evidence-based guidelines and patient privacy in the reception/waiting room were not perceived as risk factors by most of the GPs. The views of GPs on safety and risk in primary care did not completely match those presented in published papers and policy documents. The GPs in the present study judged a broader range of factors than in previously published research on patient safety in primary care, including a poor doctor-patient relationship, to pose a potential threat to patient safety. Other risk factors such as infection prevention, deviation from guidelines and incident reporting were judged to be less relevant than by policy makers.

  19. Applying importance-performance analysis to patient safety culture.

    Lee, Yii-Ching; Wu, Hsin-Hung; Hsieh, Wan-Lin; Weng, Shao-Jen; Hsieh, Liang-Po; Huang, Chih-Hsuan

    2015-01-01

    The Sexton et al.'s (2006) safety attitudes questionnaire (SAQ) has been widely used to assess staff's attitudes towards patient safety in healthcare organizations. However, to date there have been few studies that discuss the perceptions of patient safety both from hospital staff and upper management. The purpose of this paper is to improve and to develop better strategies regarding patient safety in healthcare organizations. The Chinese version of SAQ based on the Taiwan Joint Commission on Hospital Accreditation is used to evaluate the perceptions of hospital staff. The current study then lies in applying importance-performance analysis technique to identify the major strengths and weaknesses of the safety culture. The results show that teamwork climate, safety climate, job satisfaction, stress recognition and working conditions are major strengths and should be maintained in order to provide a better patient safety culture. On the contrary, perceptions of management and hospital handoffs and transitions are important weaknesses and should be improved immediately. Research limitations/implications - The research is restricted in generalizability. The assessment of hospital staff in patient safety culture is physicians and registered nurses. It would be interesting to further evaluate other staff's (e.g. technicians, pharmacists and others) opinions regarding patient safety culture in the hospital. Few studies have clearly evaluated the perceptions of healthcare organization management regarding patient safety culture. Healthcare managers enable to take more effective actions to improve the level of patient safety by investigating key characteristics (either strengths or weaknesses) that healthcare organizations should focus on.

  20. Resolution of thermal-hydraulic safety and licensing issues for the system 80+trademark design

    Carpentino, S.E.; Ritterbusch, S.E.; Schneider, R.E.

    1995-01-01

    The System 80+ trademark Standard Design is an evolutionary Advanced Light Water Reactor (ALWR) with a generating capacity of 3931 MWt (1350 MWe). The Final Design Approval (FDA) for this design was issued by the Nuclear Regulatory Commission (NRC) in July 1994. The design certification by the NRC is anticipated by the end of 1995 or early 1996. NRC review of the System 80+ design has involved several new safety issues never before addressed in a regulatory atmosphere. In addition, conformance with the Electric Power Research Institute (EPRI) ALWR Utility Requirements Document (URD) required that the System 80+ plant address nuclear industry concerns with regard to design, construction, operation and maintenance of nuclear power plants. A large number of these issues/concerns deals with previously unresolved generic thermal-hydraulic safety issues and severe accident prevention and mitigation. This paper discusses the thermal-hydraulic analyses and evaluations performed for the System 80+ design to resolve safety and licensing issues relevant to both the Nuclear Stream Supply System (NSSS) and containment designs. For the NSSS design, the Safety Depressurization System mitigation capability and resolution of the boron dilution concern are described. Examples of containment design issues dealing with containment shell strength, robustness of the reactor cavity walls and hydrogen mixing under severe accident conditions are also provided. Finally, the overall approach used in the application of NRC's new (NUREG-1465) radiological source term for System 80+ evaluation is described. The robustness of the System 80+ containment design to withstand severe accident consequences was demonstrated through detailed thermal-hydraulic analyses and evaluations. This advanced design to shown to meet NRC severe accident policy goals and ALWR URD requirements without any special design features and unnecessary costs

  1. Resolution of thermal-hydraulic safety and licensing issues for the system 80+{sup {trademark}} design

    Carpentino, S.E.; Ritterbusch, S.E.; Schneider, R.E. [ABB-Combustion Engineering, Windsor, CT (United States)] [and others

    1995-09-01

    The System 80+{sup {trademark}} Standard Design is an evolutionary Advanced Light Water Reactor (ALWR) with a generating capacity of 3931 MWt (1350 MWe). The Final Design Approval (FDA) for this design was issued by the Nuclear Regulatory Commission (NRC) in July 1994. The design certification by the NRC is anticipated by the end of 1995 or early 1996. NRC review of the System 80+ design has involved several new safety issues never before addressed in a regulatory atmosphere. In addition, conformance with the Electric Power Research Institute (EPRI) ALWR Utility Requirements Document (URD) required that the System 80+ plant address nuclear industry concerns with regard to design, construction, operation and maintenance of nuclear power plants. A large number of these issues/concerns deals with previously unresolved generic thermal-hydraulic safety issues and severe accident prevention and mitigation. This paper discusses the thermal-hydraulic analyses and evaluations performed for the System 80+ design to resolve safety and licensing issues relevant to both the Nuclear Stream Supply System (NSSS) and containment designs. For the NSSS design, the Safety Depressurization System mitigation capability and resolution of the boron dilution concern are described. Examples of containment design issues dealing with containment shell strength, robustness of the reactor cavity walls and hydrogen mixing under severe accident conditions are also provided. Finally, the overall approach used in the application of NRC`s new (NUREG-1465) radiological source term for System 80+ evaluation is described. The robustness of the System 80+ containment design to withstand severe accident consequences was demonstrated through detailed thermal-hydraulic analyses and evaluations. This advanced design to shown to meet NRC severe accident policy goals and ALWR URD requirements without any special design features and unnecessary costs.

  2. Patient Safety Incidents and Nursing Workload 1

    Carlesi, Katya Cuadros; Padilha, Kátia Grillo; Toffoletto, Maria Cecília; Henriquez-Roldán, Carlos; Juan, Monica Andrea Canales

    2017-01-01

    ABSTRACT Objective: to identify the relationship between the workload of the nursing team and the occurrence of patient safety incidents linked to nursing care in a public hospital in Chile. Method: quantitative, analytical, cross-sectional research through review of medical records. The estimation of workload in Intensive Care Units (ICUs) was performed using the Therapeutic Interventions Scoring System (TISS-28) and for the other services, we used the nurse/patient and nursing assistant/patient ratios. Descriptive univariate and multivariate analysis were performed. For the multivariate analysis we used principal component analysis and Pearson correlation. Results: 879 post-discharge clinical records and the workload of 85 nurses and 157 nursing assistants were analyzed. The overall incident rate was 71.1%. It was found a high positive correlation between variables workload (r = 0.9611 to r = 0.9919) and rate of falls (r = 0.8770). The medication error rates, mechanical containment incidents and self-removal of invasive devices were not correlated with the workload. Conclusions: the workload was high in all units except the intermediate care unit. Only the rate of falls was associated with the workload. PMID:28403334

  3. Patient Safety Incidents and Nursing Workload

    Katya Cuadros Carlesi

    Full Text Available ABSTRACT Objective: to identify the relationship between the workload of the nursing team and the occurrence of patient safety incidents linked to nursing care in a public hospital in Chile. Method: quantitative, analytical, cross-sectional research through review of medical records. The estimation of workload in Intensive Care Units (ICUs was performed using the Therapeutic Interventions Scoring System (TISS-28 and for the other services, we used the nurse/patient and nursing assistant/patient ratios. Descriptive univariate and multivariate analysis were performed. For the multivariate analysis we used principal component analysis and Pearson correlation. Results: 879 post-discharge clinical records and the workload of 85 nurses and 157 nursing assistants were analyzed. The overall incident rate was 71.1%. It was found a high positive correlation between variables workload (r = 0.9611 to r = 0.9919 and rate of falls (r = 0.8770. The medication error rates, mechanical containment incidents and self-removal of invasive devices were not correlated with the workload. Conclusions: the workload was high in all units except the intermediate care unit. Only the rate of falls was associated with the workload.

  4. Patients' perspective on controversial issues in total knee arthroplasty.

    Kim, Tae Kyun; Choi, Jinbae; Shin, Kwang Sook; Chang, Chong Bum; Seong, Sang Cheol

    2008-03-01

    We investigated the level of patient knowledge and preferences over the currently controversial issues in TKA. One hundred patients who had decided to undergo TKA for advanced osteoarthritis were asked to complete a questionnaire inquiring their knowledge and preferences over three controversial issues: (1) computer assisted surgery (CAS), (2) minimal invasive surgery (MIS), and (3) ceramic femoral component. The patient preferences over the three issues were questioned again after they had been informed of advantages and disadvantages of each option using an explanatory document. Most (more than 75%) of the patients did not have sufficient knowledge and their knowledge was based on non-professional sources (more than 85%). Before the information was given, most (more than 80%) of the patients preferred a new option. After the information was provided, more patients preferred a standard option in the issues of CAS (60%) and MIS (88%). This study prompts health care providers to become more active in providing accurate information and to consider patients perspective in making decisions which will influence the benefits and risk of the patients.

  5. Food safety issues in China: a case study of the dairy sector.

    Dong, Xiaoxia; Li, Zhemin

    2016-01-15

    Over the past 10 years, food safety incidents have occurred frequently in China. Food safety issues in the dairy sector have increasingly gained the attention of the Chinese government and the public. The objective of this research is to explore consumption changes of dairy products of different income groups after these dairy safety incidents. The research indicates that consumers' response to dairy safety risk is very intense. Dairy consumption has experienced a declining trend in recent years, and the impact of dairy safety incidents has lasted for at least 5 years. Until 2012, dairy consumption had not yet fully recovered from this influence. Using the random effects model, this study examined the relationship between food safety incident and consumption. Overall, the results show that consumers in the low-income group are more sensitive to safety risk than those in the high-income group. It can be seen from this paper that the decrease of urban residents' dairy consumption was mainly driven by changes in fresh milk consumption, while the decline of milk powder consumption, which was affected by the melamine incident, was relatively moderate, and milk powder consumption for the high-income group even increased. © 2015 Society of Chemical Industry.

  6. Exploring relationships between hospital patient safety culture and Consumer Reports safety scores.

    Smith, Scott Alan; Yount, Naomi; Sorra, Joann

    2017-02-16

    A number of private and public companies calculate and publish proprietary hospital patient safety scores based on publicly available quality measures initially reported by the U.S. federal government. This study examines whether patient safety culture perceptions of U.S. hospital staff in a large national survey are related to publicly reported patient safety ratings of hospitals. The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture (Hospital SOPS) assesses provider and staff perceptions of hospital patient safety culture. Consumer Reports (CR), a U.S. based non-profit organization, calculates and shares with its subscribers a Hospital Safety Score calculated annually from patient experience survey data and outcomes data gathered from federal databases. Linking data collected during similar time periods, we analyzed relationships between staff perceptions of patient safety culture composites and the CR Hospital Safety Score and its five components using multiple multivariate linear regressions. We analyzed data from 164 hospitals, with patient safety culture survey responses from 140,316 providers and staff, with an average of 856 completed surveys per hospital and an average response rate per hospital of 56%. Higher overall Hospital SOPS composite average scores were significantly associated with higher overall CR Hospital Safety Scores (β = 0.24, p Consumer Reports Hospital Safety Score, which is a composite of patient experience and outcomes data from federal databases. As hospital managers allocate resources to improve patient safety culture within their organizations, their efforts may also indirectly improve consumer-focused, publicly reported hospital rating scores like the Consumer Reports Hospital Safety Score.

  7. The complexity of patient safety reporting systems in UK dentistry.

    Renton, T; Master, S

    2016-10-21

    Since the 'Francis Report', UK regulation focusing on patient safety has significantly changed. Healthcare workers are increasingly involved in NHS England patient safety initiatives aimed at improving reporting and learning from patient safety incidents (PSIs). Unfortunately, dentistry remains 'isolated' from these main events and continues to have a poor record for reporting and learning from PSIs and other events, thus limiting improvement of patient safety in dentistry. The reasons for this situation are complex.This paper provides a review of the complexities of the existing systems and procedures in relation to patient safety in dentistry. It highlights the conflicting advice which is available and which further complicates an overly burdensome process. Recommendations are made to address these problems with systems and procedures supporting patient safety development in dentistry.

  8. Managing patient safety through NPSGs and employee performance.

    Adair, Liberty

    2010-01-01

    Patient safety can only exist in a culture of patient safety, which implies it is a value perceived by all. Culture predicts safety outcomes and leadership predicts the culture. Leaders are obligated to continually mitigate hazard and take action consciously. Healthcare workers should focus on preventing and reporting mistakes with the National Patient Safety Goals (NPSGs) in mind. These include: accuracy of patient identification, effectiveness of communication among caregivers, improving safety of medications, reducing infections, reducing risk of falls, and encouraging patients to be involved in care. Poor performers and reckless behavior need to be mitigated. If employees recognize their roles in the process, feel empowered,and have appropriate tools, resources,and data to implement solutions, errors can be avoided and patient safety becomes paramount.

  9. Review of EU-APR Design for Selected Safety Issues of WERNA RHWG 2013

    Kim, Yong Soo; Kim, Ji Hwan [KHNP CRI, Daejeon (Korea, Republic of)

    2016-10-15

    Western European Nuclear Regulators' Association (WENRA) was established in 1999 to develop a harmonized approach to nuclear safety and radiation protection and their regulation. In 2013, the Reactor Harmonization Working Group (RHWG) of WENRA sets out the common positions on the seven selected key safety issues. This paper is to introduce the regulatory positions of WENRA RHWG 2013 and to review the compliance of the EU-APR with them. In this paper, we reviewed the compliance of the EUAPR regarding seven safety issues for new NPPs presented by WERNA RHWG in 2013. The EU-APR design fully complies with all WERNA RHWG safety issues since the following measures have been incorporated in it: - Successive five levels of DiD maintaining independence between different levels of DiD - Diverse design against multiple failure events such as ATWS, SBO, Loss of Ultimate Heat Sink, and Loss of Spent Fuel Pool Cooling - SAs dedicated mitigation systems to ensure the containment integrity during the SAs. - Practically eliminates accident sequences with a large or early release of radiological materials by diverse designs for multiple failure events, SAs dedicated mitigation system, and double containment design - Standard site parameters not lead to core melt accidents due to natural or man-made external hazards.

  10. Patient safety: knowledge between multiprofessional residents.

    Oliveira, João Lucas Campos de; Silva, Simone Viana da; Santos, Pamela Regina Dos; Matsuda, Laura Misue; Tonini, Nelsi Salete; Nicola, Anair Lazzari

    2017-01-01

    To assess the knowledge of multiprofesional residents in health about the security of the patient theme. Cross-sectional study, quantitative, developed with graduate courses/residence specialties of health in a public university of Paraná, Brazil. Participants (n=78) answered a questionnaire containing nine objective questions related to patient safety. Data were analyzed using descriptive statistics, in proportion measures. The minimum 75% of correct answers was considered the cutoff for positive evaluation. The sample was predominantly composed of young people from medical programs. Almost half of the items evaluated (n=5) achieved the established positive pattern, especially those who dealt with the hand hygiene moments (98.8%) and goal of the Patient Safety National Program (92.3%). The identification of the patient was the worst rated item (37.7%). In the analysis by professional areas, only the Nursing reached the standard of hits established. Knowledge of the residents was threshold. Verificar o conhecimento de residentes multiprofissionais na área da saúde sobre o tema segurança do paciente. Estudo transversal, quantitativo, desenvolvido com pós-graduandos dos cursos/especialidades de residência da área da saúde de uma universidade pública do Paraná. Os participantes (n=78) responderam um questionário contendo nove questões objetivas relacionadas com a segurança do paciente. Os dados foram analisados por estatística descritiva, em medidas de proporção. O mínimo de 75% de acertos foi considerado ponto de corte para avaliação positiva. A amostra foi composta por profissionais predominantemente jovens, oriundos de programas médicos. Quase metade dos itens avaliados (n=5) alcançou o padrão de positividade estabelecido, com destaque para os que trataram dos momentos de higienização das mãos (98,8%) e o objetivo do Programa Nacional de Segurança do Paciente (92,3%). A identificação do paciente foi o pior item avaliado (37,7%). Na an

  11. Patient Safety Outcomes in Small Urban and Small Rural Hospitals

    Vartak, Smruti; Ward, Marcia M.; Vaughn, Thomas E.

    2010-01-01

    Purpose: To assess patient safety outcomes in small urban and small rural hospitals and to examine the relationship of hospital and patient factors to patient safety outcomes. Methods: The Nationwide Inpatient Sample and American Hospital Association annual survey data were used for analyses. To increase comparability, the study sample was…

  12. The impact of nursing leadership on patient safety in a developing country.

    Stewart, Lee; Usher, Kim

    2010-11-01

    This article is a report of a study to identify the ways nursing leaders and managers in a developing country have an impact on patient safety. The attempt to address the problem of patient safety in health care is a global issue. Literature addressing the significant impact that nursing leadership has on patient safety is extensive and focuses almost exclusively on the developed world. A critical ethnography was conducted with senior registered nursing leaders and managers throughout the Fiji Islands, specifically those in the Head Office of the Fiji Ministry of Health and the most senior nurse in a hospital or community health service. Semi-structured interviews were conducted with senior nursing leaders and managers in Fiji. Thematic analysis of the interviews was undertaken from a critical theory perspective, with reference to the macro socio-political system of the Fiji Ministry of Health. Four interrelated issues regarding the nursing leaders and managers' impact on patient safety emerged from the study. Empowerment of nursing leaders and managers, an increased focus on the patient, the necessity to explore conditions for front-line nurses and the direct relationship between improved nursing conditions and increased patient safety mirrored literature from developed countries. The findings have significant implications for developing countries and it is crucial that support for patient safety in developing countries become a focus for the international nursing community. Nursing leaders and managers' increased focus on their own place in the hierarchy of the health care system and on nursing conditions as these affect patient safety could decrease adverse patient outcomes. The findings could assist the global nursing community to better support developing countries in pursuing a patient safety agenda. © 2010 Blackwell Publishing Ltd.

  13. Issues of Safety and Security: New Challenging to Malaysia Tourism Industry

    Mohd Ayob Norizawati

    2014-01-01

    Full Text Available The safety and security issues nowadays become one of the forces causing changes in tourism industry in era of millennium. The main concern of this issues more focus on crime rates, terrorism, food safety, health issues and natural disaster. This topic gained the popularity in tourism research after 9/11 tragedy and since then the academicians and practitioners started seeking the best solution in ways to mitigate these negative impacts. For Malaysia, the image as safety and secure destination was tarnished a few years lately and new unfortunates incident in this year bring more damage to Malaysia image. Healthy issues, terrorism, Lahad Datu intrusion, repeated kidnapping and shooting in Sabah, twin airlines incident, riot and illegal demonstration and false reporting by international media brings new challenging to Malaysia. Although some incident may be had short-term impact to Malaysia tourism industry, but it’s still gave the big impact to Malaysia branding process. Many travellers and Malaysian itself still believe that Malaysia is a one of safer destination and country to visit and stayed in, but more outstanding efforts was require to make sure Malaysia tourism industry was capable to recover from this negative impact as soon as possible.

  14. Safety criteria for the future LMFBR's in France and main safety issues for the rapide 1500 project

    Justin, F.; Natta, M.; Orzoni, G.

    1985-04-01

    The main safety criteria for future LMFBR in France and the related issues for the RAPIDE 1500 project are presented and discussed. The evolutions with respect to SUPERPHENIX options and requirements are emphasized, in particular for the concerns of the prevention of core melt accidents, fuel damage limits and related required performances of the protection system, since one main option is not to consider whole core melt accidents in the containment design. One shall also point out the advantages of some mitigating features which were nevertheless added in the containment design, although without any explicit consideration for core melt accidents

  15. Data requirements for the Ferrocyanide Safety Issue developed through the data quality objectives process

    Meacham, J.E.; Cash, R.J.; Dukelow, G.T.; Babad, H.; Buck, J.W.; Anderson, C.M.; Pulsipher, B.A.; Toth, J.J.; Turner, P.J.

    1994-08-01

    This document records the data quality objectives (DQO) process applied to the Ferrocyanide Safety Issue at the Hanford Site. Specifically, the major recommendations and findings from this Ferrocyanide DQO process are presented. The decision logic diagrams and decision error tolerances also are provided. The document includes the DQO sample-size formulas for determining specific tank sampling requirements, and many of the justifications for decision thresholds and decision error tolerances are briefly described. More detailed descriptions are presented in other Ferrocyanide Safety Program companion documents referenced in this report. This is a living document, and the assumptions contained within will be refined as more data from sampling and characterization become available

  16. LMFBR safety. 5. Review of current issues and bibliography of literature (1975--1976)

    Buchanan, J.R.; Keilholtz, G.W.

    1977-01-01

    The current status of liquid-metal fast breeder reactor (LMFBR) development and one of the principal safety issues, a hypothetical core-disruptive accident (HCDA), are discussed. Bibliographic information on worldwide LMFBRs relative to the development and safety of the breeder reactor is presented for the period 1975 through 1976. The bibliography consists of approximately 1618 abstracts covering early research and development and operating experiences leading up to the present design practices that are necessary for the licensing of breeder reactors. Keyword, author, and permuted-title indexes are included for completeness

  17. LMFBR safety. 5. Review of current issues and bibliography of literature (1975--1976)

    Buchanan, J.R.; Keilholtz, G.W.

    1977-06-08

    The current status of liquid-metal fast breeder reactor (LMFBR) development and one of the principal safety issues, a hypothetical core-disruptive accident (HCDA), are discussed. Bibliographic information on worldwide LMFBRs relative to the development and safety of the breeder reactor is presented for the period 1975 through 1976. The bibliography consists of approximately 1618 abstracts covering early research and development and operating experiences leading up to the present design practices that are necessary for the licensing of breeder reactors. Keyword, author, and permuted-title indexes are included for completeness.

  18. Lessons Learned and Regulatory Countermeasures of Nuclear Safety Issues Last Year

    Lee, Y. E. [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)

    2013-05-15

    Competitiveness of nuclear as the electric resource in terms of the least cost and the carbon abatement has been debated. Some institutions insist that the radioactive wastes management cost, nuclear accident cost and cheap shale gas would make the nuclear energy less competitive, while others still address the ability of nuclear energy as economical and low-carbon electric resource. This situation reminds that ensuring nuclear safety is the most important prerequisite to use of nuclear energy. Therefore, this paper will compare the different views on future nuclear competitiveness discussed right after the Fukushima accident and summarize the lessons learned and regulatory countermeasures from nuclear safety issues last year. Korea has improved the effectiveness of safety regulation up to now and still has been making efforts on further enhancing nuclear safety. The outcomes of these efforts have resulted in a high level of safety in Korean NPPs and contributing largely to the global nuclear safety through sharing and exchanging the information and knowledge of our nuclear experiences. However, now we are faced with the new challenges such as decreasing the public. Additionally, public criticism of the regulatory activities demands more clear regulatory guides and transparent process. Recently, new president announced the 'Priority to Safety and Public Trust' as the precondition to utilize the nuclear energy. We will continue to make much more efforts for the improvement of the quality of regulatory activities and effectiveness of regulatory decision making process than we have done so far. Competence through effective capacity building would be a helpful pathway to build up the public trust and ensure the acceptable level of nuclear safety. We are set to prepare the action items to be taken in the near future for improving the technical competency and transparency as the essential components of the national safety and will make efforts to implement them

  19. The sociotechnical configuration of the problem of Patient Safety

    Danholt, Peter

    2010-01-01

    Abstract. This paper presents and discusses two approaches to “the sociotechnical”, one coming from the Tavistock tradition and the other from actor network theory. These two differ in important ways and from the latter it follows that what patient safety means must be scrutinized and unpacked....... The paper thus rudimentarily discusses central contributions to the problematization of patient safety. Last it is argued that research that provide data on the processes of medical interventions where events, decisions and entities become transformed through their interactions is needed in order to further...... nuance the problem of patient safety. Keywords. Sociotechnical, patient safety, actor network theory, adverse events....

  20. The Role of Patient Safety in the Device Purchasing Process

    Johnson, Todd R; Zhang, Jiajie; Patel, Vimla L; Keselman, Alla; Tang, Xiaozhou; Brixey, Juliana J; Paige, Danielle; Turley, James P

    2005-01-01

    To examine how patient safety considerations are incorporated into medical device purchase decisions, individuals involved in recent infusion pump purchasing decisions at three different health care...

  1. Environmental, health, and safety issues of sodium-sulfur batteries for electric and hybrid vehicles

    Ohi, J.M.

    1992-09-01

    This report is the first of four volumes that identify and assess the environmental, health, and safety issues involved in using sodium-sulfur (Na/S) battery technology as the energy source in electric and hybrid vehicles that may affect the commercialization of Na/S batteries. This and the other reports on recycling, shipping, and vehicle safety are intended to help the Electric and Hybrid Propulsion Division of the Office of Transportation Technologies in the US Department of Energy (DOE/EHP) determine the direction of its research, development, and demonstration (RD D) program for Na/S battery technology. The reports review the status of Na/S battery RD D and identify potential hazards and risks that may require additional research or that may affect the design and use of Na/S batteries. This volume covers cell design and engineering as the basis of safety for Na/S batteries and describes and assesses the potential chemical, electrical, and thermal hazards and risks of Na/S cells and batteries as well as the RD D performed, under way, or to address these hazards and risks. The report is based on a review of the literature and on discussions with experts at DOE, national laboratories and agencies, universities, and private industry. Subsequent volumes will address environmental, health, and safety issues involved in shipping cells and batteries, using batteries to propel electric vehicles, and recycling and disposing of spent batteries. The remainder of this volume is divided into two major sections on safety at the cell and battery levels. The section on Na/S cells describes major component and potential failure modes, design, life testing and failure testing, thermal cycling, and the safety status of Na/S cells. The section on batteries describes battery design, testing, and safety status. Additional EH S information on Na/S batteries is provided in the appendices.

  2. Nurses' perceptions of patient safety culture in Jordanian hospitals.

    Khater, W A; Akhu-Zaheya, L M; Al-Mahasneh, S I; Khater, R

    2015-03-01

    Patients' safety culture is a key aspect in determining healthcare organizations' ability to address and reduce risks of patients. Nurses play a major role in patients' safety because they are accountable for direct and continuous patient care. There is little known information about patients' safety culture in Jordanian hospitals, particularly from the perspective of healthcare providers. The study aimed to assess patient safety culture in Jordanian hospitals from nurses' perspective. A cross-sectional, descriptive design was utilized. A total number of 658 nurses participated in the current study. Data were collected using an Arabic version of the hospital survey of patients' safety culture. Teamwork within unit dimensions had a high positive response, and was perceived by nurses to be the only strong suit in Jordanian hospitals. Areas that required improvement, as perceived by nurses, are as follows: communication openness, staffing, handoff and transition, non-punitive responses to errors, and teamwork across units. Regression analysis revealed factors, from nurses' perspectives, that influenced patients' safety culture in Jordanian hospital. Factors included age, total years of experience, working in university hospitals, utilizing evidence-based practice and working in hospitals that consider patient safety to be a priority. Participants in this study were limited to nurses. Therefore, there is a need to assess patient safety culture from other healthcare providers' perspectives. Moreover, the use of a self-reported questionnaire introduced the social desirability biases. The current study provides insight into how nurses perceive patient safety culture. Results of this study have revealed that there is a need to replace the traditional culture of shame/blame with a non-punitive culture. Study results implied that improving patient safety culture requires a fundamental transformation of nurses' work environment. New policies to improve collaboration between

  3. The role of the ward manager in promoting patient safety.

    Pinnock, David

    In this article the role of the ward manager in promoting patient safety is explored. The background to the development of the patient safety agenda is briefly discussed and the relationship between quality and safety is illustrated. The pivotal importance of the role of the ward manager in delivering services to patients is underlined and literature on patient safety is examined to identify what a ward manager can do to make care safer. Possible actions of the ward manager to improve safety discussed in the literature are structured around the Leadership Framework. This framework identifies seven domains for the leadership of service delivery. Ward managers use their personal qualities, and network and work within teams, while managing performance and facilitating innovation, change and measurement for improvement. The challenge of promoting patient safety for ward managers is briefly explored and recommendations for further research are made.

  4. Evaluation of systems interactions in nuclear power plants: Technical findings related to Unresolved Safety Issue A-17

    Thatcher, D.

    1989-05-01

    This report presents a summary of the activities related to Unresolved Safety Issue (USI)A-17, ''Systems Interactions in Nuclear Power Plants,'' and also includes the NRC staff's conclusions based on those activities. The staff's technical findings provide the framework for the final resolution of this unresolved safety issue. The final resolution will be published later as NUREG-1229. 52 refs., 4 tabs

  5. How to bring issues of health and safety closer to young workers during their work training

    Helena Mesarič

    2016-06-01

    Full Text Available The data collected by the European Community indicates that the young, economically active population, aged from 18 to 24 years, is more likely to suffer from occupational injuries and occupational diseases in comparison with the rest of the working population, due to the lack of experience and knowledge about health and safety in the workplace, and insufficient training for safe and healthy work practices. Employers must establish an adequate system to ensure workplace health and safety, with an emphasis on providing safety training for pupils and students undergoing apprenticeship and the newly-employed young people. The Ministry of Labour, Family, Social Affairs and Equal Opportunities runs a series of projects aiming to promote health and safety culture among young people in Slovenia. The goal of the national programme for introducing occupational health and safety into the education process is offering a variety of tools and devices for educators and teachers, which can be employed to introduce the issues of occupational health and safety to young people in an exciting and engaging manner.

  6. Application of the risk-based strategy to the Hanford tank waste organic-nitrate safety issue

    Hunter, V.L.; Colson, S.D.; Ferryman, T.; Gephart, R.E.; Heasler, P.; Scheele, R.D.

    1997-12-01

    This report describes the results from application of the Risk-Based Decision Management Approach for Justifying Characterization of Hanford Tank Waste to the organic-nitrate safety issue in Hanford single-shell tanks (SSTs). Existing chemical and physical models were used, taking advantage of the most current (mid-1997) sampling and analysis data. The purpose of this study is to make specific recommendations for planning characterization to help ensure the safety of each SST as it relates to the organic-nitrate safety issue. An additional objective is to demonstrate the viability of the Risk-Based Strategy for addressing Hanford tank waste safety issues

  7. Current status of environmental, health, and safety issues of nickel metal-hydride batteries for electric vehicles

    Corbus, D; Hammel, C J; Mark, J

    1993-08-01

    This report identifies important environment, health, and safety issues associated with nickel metal-hydride (Ni-MH) batteries and assesses the need for further testing and analysis. Among the issues discussed are cell and battery safety, workplace health and safety, shipping requirements, and in-vehicle safety. The manufacture and recycling of Ni-MH batteries are also examined. This report also overviews the ``FH&S`` issues associated with other nickel-based electric vehicle batteries; it examines venting characteristics, toxicity of battery materials, and the status of spent batteries as a hazardous waste.

  8. Application of the risk-based strategy to the Hanford tank waste organic-nitrate safety issue

    Hunter, V.L.; Colson, S.D.; Ferryman, T.; Gephart, R.E.; Heasler, P.; Scheele, R.D.

    1997-12-01

    This report describes the results from application of the Risk-Based Decision Management Approach for Justifying Characterization of Hanford Tank Waste to the organic-nitrate safety issue in Hanford single-shell tanks (SSTs). Existing chemical and physical models were used, taking advantage of the most current (mid-1997) sampling and analysis data. The purpose of this study is to make specific recommendations for planning characterization to help ensure the safety of each SST as it relates to the organic-nitrate safety issue. An additional objective is to demonstrate the viability of the Risk-Based Strategy for addressing Hanford tank waste safety issues.

  9. Current status of environmental, health, and safety issues of nickel metal-hydride batteries for electric vehicles

    Corbus, D.; Hammel, C.J.; Mark, J.

    1993-08-01

    This report identifies important environment, health, and safety issues associated with nickel metal-hydride (Ni-MH) batteries and assesses the need for further testing and analysis. Among the issues discussed are cell and battery safety, workplace health and safety, shipping requirements, and in-vehicle safety. The manufacture and recycling of Ni-MH batteries are also examined. This report also overviews the ''FH ampersand S'' issues associated with other nickel-based electric vehicle batteries; it examines venting characteristics, toxicity of battery materials, and the status of spent batteries as a hazardous waste

  10. A review of occupational safety and health issues relevant to the Environmental Restoration Program: Selected case histories and associated issues

    Lesperance, A.M.; Siegel, M.R.; McKinney, M.C.

    1994-08-01

    Since the 1940s, US Department of Energy (DOE) sites have been used for nuclear materials processing and production, warhead testing, and weapons research and development. These activities have resulted in extensive environmental contamination. DOE has established a goal to cleanup and restore the groundwater, soils, sediments, and surface water at its facilities across the nation. To achieve this goal, many workers will be needed to conduct the cleanup. These workers will need training and will be required to follow occupational safety and health (OSH) regulations and guidelines. Compliance with the OSH regulations and guidelines will have an anomous influence on the schedule, money, and technology needed for environmental restoration. Therefore, one area that must be considered in the early stages of long-term planning is the impact of OSH issues on the environmental restoration process. The DOE Office of Environmental Restoration and Waste Management has requested that the Pacific Northwest Laboratory (PNL) investigate the impact of these issues on the environmental restoration process

  11. NS [Nuclear Safety] update. Current safety and security activities and developments taking place in the Department of Nuclear Safety and Security. Issue no. 4, June 2007

    2007-04-01

    This newsletter contains information on the Centre for Advanced Safety Assessment Tools (CASAT), the new strategy for the recovery of radioactive sources, the Technical Support Organization Conference and a message form the Director of the Division of Nuclear Installation Safety. To improve the efficiency of safety assessment methods, ensure transparency in their validation and application and establish an excellent knowledge base and training programmes, the IAEA's Centre for Advanced Safety Assessment Tools (CASAT) has therefore been formed. The Centre addresses the need for continuous technical support mechanisms for safety assessment methods. It provides support to Member States to enhance their safety assessment capabilities for present and future generations of nuclear systems, with a special focus on countries with a developing nuclear technology and nuclear safety infrastructure. It serves as a consolidated repository of relevant safety analysis knowledge, provides for focused training including advanced analytical simulations, and supports collaboration on safety assessment projects among Member States. The resources provided through CASAT include codes, models, databases, verification and validation information, analytical procedures and guides. The main purpose of the recently established Radioactive Source Technical Coordination Group (RSTCG) is to facilitate the technical coordination of activities of the IAEA related to the control and management of radioactive sources through the development of common approaches in technical matters and to advise the management of the relevant Divisions. It is the task of the RSTCG to provide the programme managers of the participating divisions/sections with a common opinion/advice on technical issues related to the control and management of radioactive sources. The RSTCG members obtain, inter alia from programme managers, information on all relevant project proposals, and share relevant materials in due time to

  12. Guidelines for nuclear power plant safety issue prioritization information development. Supplement 3

    Andrews, W.B.; Bickford, W.E.; Counts, C.A.; Gallucci, R.H.V.; Heaberlin, S.W.; Powers, T.B.; Weakley, S.A.

    1985-09-01

    This supplemental report is the fourth in a series that document and use methods developed to calculate, for prioritization purposes, the risk, dose and cost impacts of implementing resolutions to reactor safety issues. The initial report in this series was published by Andrews et al. in 1983 as NUREG/CR-2800. This supplement consists of two parts describing separate research efforts: (1) an alternative human factors methodology approach, and (2) a prioritization of the NRC's Human Factors Program Plan. The alternative human factors methodology approach may be used in specific future cases in which the methods identified in the initial report (NUREG/CR-2800) may not adequately assess the proper impact for resolution of new safety issues. The alternative methodology included in this supplement is entitled ''Methodology for Estimating the Public Risk Reduction Affected by Human Factors Improvement.'' The prioritization section of this report is entitled ''Prioritization of the US Nuclear Regulatory Commission Human Factors Program Plan.''

  13. Engineering approach to relative quantitative assessment of safety culture and related social issues in NPP operation

    Sivokon, V.; Gladyshev, M.; Malkin, S.

    2005-01-01

    The report is devoted to presentation of engineering approach and software tool developed for Safety Culture (SC) assessment as well as to the results of their implementation at Smolensk NPP. The engineering approach is logic evolution of the IAEA ASSET method broadly used at European NPPs in 90-s. It was implemented at Russian and other plants including Olkiluoto NPP in Finland. The approach allows relative quantitative assessing and trending the aspects of SC by the analysis of evens features and causes, calculation and trending corresponding indicators. At the same time plant's operational performances and related social issues, including efficiency of plant operation and personnel reliability, can be monitored. With the help of developed tool the joint team combined from personnel of Smolensk NPP and RRC 'Kurchatov Institute' ('KI') issued the SC self-assessment report, which identifies: families of recurrent events, main safety and operational problems ; their trends and importance to SC and plant efficiency; recommendations to enhance SC and operational performance

  14. Review of criticality safety and shielding analysis issues for transportation packages

    Parks, C.V.; Broadhead, B.L.

    1995-01-01

    The staff of the Nuclear Engineering Applications Section (NEAS) at Oak Ridge National Laboratory (ORNL) have been involved for over 25 years with the development and application of computational tools for use in analyzing the criticality safety and shielding features of transportation packages carrying radioactive material (RAM). The majority of the computational tools developed by ORNL/NEAS have been included within the SCALE modular code system (SCALE 1995). This code system has been used throughout the world for the evaluation of nuclear facility and package designs. With this development and application experience as a basis, this paper highlights a number of criticality safety and shielding analysis issues that confront the designer and reviewer of a new RAM package. Changes in the types and quantities of material that need to be shipped will keep these issues before the technical community and provide challenges to future package design and certification

  15. Workplace health and safety issues among community nurses: a study regarding the impact on providing care to rural consumers.

    Terry, Daniel; Lê, Quynh; Nguyen, Uyen; Hoang, Ha

    2015-08-12

    The objective of the study was to investigate the types of workplace health and safety issues rural community nurses encounter and the impact these issues have on providing care to rural consumers. The study undertook a narrative inquiry underpinned by a phenomenological approach. Community nursing staff who worked exclusively in rural areas and employed in a permanent capacity were contacted among 13 of the 16 consenting healthcare services. All community nurses who expressed a desire to participate were interviewed. Data were collected using semistructured interviews with 15 community nurses in rural and remote communities. Thematic analysis was used to analyse interview data. The role, function and structures of community nursing services varied greatly from site to site and were developed and centred on meeting the needs of individual communities. In addition, a number of workplace health and safety challenges were identified and were centred on the geographical, physical and organisational environment that community nurses work across. The workplace health and safety challenges within these environments included driving large distances between client's homes and their office which lead to working in isolation for long periods and without adequate communication. In addition, other issues included encountering, managing and developing strategies to deal with poor client and carer behaviour; working within and negotiating working environments such as the poor condition of patient homes and clients smoking; navigating animals in the workplace; vertical and horizontal violence; and issues around workload, burnout and work-related stress. Many nurses achieved good outcomes to meet the needs of rural community health consumers. Managers were vital to ensure that service objectives were met. Despite the positive outcomes, many processes were considered unsafe by community nurses. It was identified that greater training and capacity building are required to meet the

  16. Key regulatory and safety issues emerging NEA activities. Lessons Learned from Fukushima Dai-ichi NPS Accident - Key Regulatory and Safety Issues

    Nakoski, John

    2013-01-01

    A presentation was provided on the key safety and regulatory issues and an update of activities undertaken by the NEA and its members in response to the accident at the Fukushima Daiichi nuclear power stations (NPS) on 11 March 2011. An overview of the accident sequence and the consequences was provided that identified the safety functions that were lost (electrical power, core cooling, and primary containment) that lead to units 1, 2, and 3 being in severe accident conditions with large off-site releases. Key areas identified for which activities of the NEA and member countries are in progress include accident management; defence-in-depth; crisis communication; initiating events; operating experience; deterministic and probabilistic assessments; regulatory infrastructure; radiological protection and public health; and decontamination and recovery. For each of these areas, a brief description of the on-going and planned NEA activities was provided within the three standing technical committees of the NEA with safety and regulatory mandates (the Committee on Nuclear Regulatory Activities - CNRA, the Committee on the Safety of Nuclear Installations - CSNI, and the Committee on Radiation Protection and Public Health - CRPPH). On-going activities of CNRA include a review of enhancement being made to the regulatory aspects for the oversight of on-site accident management strategies and processes in light of the lessons learned from the accident; providing guidance to regulators on crisis communication; and supporting the peer review of the safety assessments of risk-significant research reactor facilities in light of the accident. Within the scope of the CSNI mandate, activities are being undertaken to better understand accident progression; characteristics of new fuel designs; and a benchmarking study of fast-running software for estimating source term under severe accident conditions to support protective measure recommendations. CSNI also has ongoing work in human

  17. Safety issues related to the intermediate heat storage for the EU DEMO

    Carpignano, Andrea [NEMO group, Dipartimento Energia, Politecnico di Torino, C.so Duca degli Abruzzi 24, 10129 Torino (Italy); Pinna, Tonio [ENEA, 00044 Frascati (Italy); Savoldi, Laura; Sobrero, Giulia; Uggenti, Anna Chiara [NEMO group, Dipartimento Energia, Politecnico di Torino, C.so Duca degli Abruzzi 24, 10129 Torino (Italy); Zanino, Roberto, E-mail: roberto.zanino@polito.it [NEMO group, Dipartimento Energia, Politecnico di Torino, C.so Duca degli Abruzzi 24, 10129 Torino (Italy)

    2016-11-01

    Highlights: • IHS affects only the PHTS and the BoP (Balance of Plant). • PIEs list does not change but IHS influences PIEs evolution. • Additional issues to be addressed in PIEs study due to the implementation of HIS. • No safety/operational major obstacles were found for IHS concept. - Abstract: The functional deviations able to compromise system safety in the EU DEMO Primary Heat Transfer System (PHTS) with intermediate heat storage (IHS) based on molten salts are identified and compared to the deviations identified with PHTS without IHS. The resulting safety issues for the Balance of Plant (BoP) have been taken into account. Functional Failure Mode and Effects Analysis (FFMEA) is used to highlight the Postulated Initiating Events (PIE) of incident/accident sequences and to provide some safety insights during the preliminary design. The architecture of the system with IHS does not introduce new PIE with respect to the case without IHS, but it modifies some of them. In particular the two Postulated Initiating Events that are affected by the presence of IHS are the LOCA in the tubes of the HX between primary and intermediate circuit and the loss of heat sink for the first wall or the breeding zone. In fact the IHS introduces some advantages concerning the stability of the secondary circuit, but some weaknesses are associated to the physical-chemical nature of molten salts, especially oxidizing power, corrosive nature and risk of solidification. These issues can be managed in the design by the introduction of new safety functions.

  18. Resolution of Unresolved Safety Issue A-48, ''Hydrogen control measures and effects of hydrogen burns on safety equipment''

    Ferrell, C.M.; Soffer, L.

    1989-09-01

    Unresolved Safety Issue (USI) A-48 arose as a result of the large amount of hydrogen generated and burned within containment during the Three Mile Island accident. This issue covers hydrogen control measures for recoverable degraded-core accidents for all boiling-water reactors (BWRs) and those pressurized-water reactors (PWRs) with ice-condenser containments. The Commission and the nuclear industry have sponsored extensive research in this area, which has led to significant revision of the Commission's hydrogen control regulations, given in Title 10, Code of Federal Regulations, Part 50 (10 CFR 50), Section 50.44. BWRs having Mark I and II containments are presently required to operate with inerted containment atmospheres that effectively prevent hydrogen combustion. BWRs with Mark III containments and PWRs with ice-condenser containments are now required to be equipped with hydrogen control systems to protect containment integrity and safety systems inside containment. Industry has chosen to use hydrogen igniter systems to burn hydrogen produced in a controlled fashion to prevent damage. An independent review by a Committee of the National Research Council concluded that, for most accident scenarios, current regulatory requirements make it highly unlikely that hydrogen detonation would be the cause of containment failure. On the basis of the extensive research effort conducted and current regulatory requirements, including their implementation, the staff concludes that no new regulatory guidance on hydrogen control for recoverable degraded-core accidents for these types of plants is necessary and that USI A-48 is resolved

  19. 76 FR 7854 - Patient Safety Organizations: Voluntary Delisting From Lumetra PSO

    2011-02-11

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety... Safety Organization (PSO). The Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act... delivery. The Patient Safety and Quality Improvement Final Rule (Patient Safety Rule), 42 CFR part 3...

  20. EDF ageing management program of nuclear components: a safety and economical issue

    Faidy, C.

    2005-01-01

    Ageing management of Nuclear Power Plants is an essential issue for utilities, in term of safety and availability and corresponding economical consequences. Practically all nuclear countries have developed a systematic program to deal with ageing of components on their plants. This paper presents the ageing management program developed by EDF and that are compared with different other approaches in other countries (IAEA guidelines and GALL report). The paper presents a general overview of the programs, the major results, recommendations and conclusions. (author)

  1. Worker health and safety and climate change in the Americas: issues and research needs

    Max Kiefer

    Full Text Available SYNOPSIS This report summarizes and discusses current knowledge on the impact that climate change can have on occupational safety and health (OSH, with a particular focus on the Americas. Worker safety and health issues are presented on topics related to specific stressors (e.g., temperature extremes, climate associated impacts (e.g., ice melt in the Arctic, and a health condition associated with climate change (chronic kidney disease of non-traditional etiology. The article discusses research needs, including hazards, surveillance, and risk assessment activities to better characterize and understand how OSH may be associated with climate change events. Also discussed are the actions that OSH professionals can take to ensure worker health and safety in the face of climate change.

  2. Road safety in a globalised and more sustainable world: current issues and future challenges.

    Daniels, Stijn; Risser, Ralf

    2014-01-01

    Although many countries have had considerable success in reducing traffic injuries over recent decades, there are still some fundamental problems in this area. At the same time, there is increasing focus on road safety research and policy development in the context of globalisation, sustainability, liveability and health. This special section presents a selection of papers that were presented at the annual ICTCT workshop held on the 8th and 9th of November 2012 in Hasselt, Belgium, and accepted for publication in Accident Analysis and Prevention following the journal's reviewing procedure. The aim of the ICTCT workshop was to analyse road safety facts, data and visions for the future in the wider context of current issues and future challenges in road safety. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. High level issues in reliability quantification of safety-critical software

    Kim, Man Cheol

    2012-01-01

    For the purpose of developing a consensus method for the reliability assessment of safety-critical digital instrumentation and control systems in nuclear power plants, several high level issues in reliability assessment of the safety-critical software based on Bayesian belief network modeling and statistical testing are discussed. Related to the Bayesian belief network modeling, the relation between the assessment approach and the sources of evidence, the relation between qualitative evidence and quantitative evidence, how to consider qualitative evidence, and the cause-consequence relation are discussed. Related to the statistical testing, the need of the consideration of context-specific software failure probabilities and the inability to perform a huge number of tests in the real world are discussed. The discussions in this paper are expected to provide a common basis for future discussions on the reliability assessment of safety-critical software. (author)

  4. The Patient Safety Attitudes among the Operating Room Personnel

    Cherdsak Iramaneerat

    2016-07-01

    Full Text Available Background: The first step in cultivating the culture of safety in the operating room is the assessment of safety culture among operating room personnel. Objective: To assess the patient safety culture of operating room personnel at the Department of Surgery, Faculty of Medicine Siriraj Hospital, and compare attitudes among different groups of personnel, and compare them with the international standards. Methods: We conducted a cross-sectional survey of safety attitudes among 396 operating room personnel, using a short form of the Safety Attitudes Questionnaire (SAQ. The SAQ employed 30 items to assess safety culture in six dimensions: teamwork climate, safety climate, stress recognition, perception of hospital management, working conditions, and job satisfaction. The subscore of each dimension was calculated and converted to a scale score with a full score of 100, where higher scores indicated better safety attitudes. Results: The response rate was 66.4%. The overall safety culture score of the operating room personnel was 65.02, higher than an international average (61.80. Operating room personnel at Siriraj Hospital had safety attitudes in teamwork climate, safety climate, and stress recognition lower than the international average, but had safety attitudes in the perception of hospital management, working conditions, and job satisfaction higher than the international average. Conclusion: The safety culture attitudes of operating room personnel at the Department of Surgery, Siriraj Hospital were comparable to international standards. The safety dimensions that Siriraj Hospital operating room should try to improve were teamwork climate, safety climate, and stress recognition.

  5. Critical roles of orthopaedic surgeon leadership in healthcare systems to improve orthopaedic surgical patient safety.

    Kuo, Calvin C; Robb, William J

    2013-06-01

    The prevention of medical and surgical harm remains an important public health problem despite increased awareness and implementation of safety programs. Successful introduction and maintenance of surgical safety programs require both surgeon leadership and collaborative surgeon-hospital alignment. Documentation of success of such surgical safety programs in orthopaedic practice is limited. We describe the scope of orthopaedic surgical patient safety issues, define critical elements of orthopaedic surgical safety, and outline leadership roles for orthopaedic surgeons needed to establish and sustain a culture of safety in contemporary healthcare systems. We identified the most common causes of preventable surgical harm based on adverse and sentinel surgical events reported to The Joint Commission. A comprehensive literature review through a MEDLINE(®) database search (January 1982 through April 2012) to identify pertinent orthopaedic surgical safety articles found 14 articles. Where gaps in orthopaedic literature were identified, the review was supplemented by 22 nonorthopaedic surgical references. Our final review included 36 articles. Six important surgical safety program elements needed to eliminate preventable surgical harm were identified: (1) effective surgical team communication, (2) proper informed consent, (3) implementation and regular use of surgical checklists, (4) proper surgical site/procedure identification, (5) reduction of surgical team distractions, and (6) routine surgical data collection and analysis to improve the safety and quality of surgical patient care. Successful surgical safety programs require a culture of safety supported by all six key surgical safety program elements, active surgeon champions, and collaborative hospital and/or administrative support designed to enhance surgical safety and improve surgical patient outcomes. Further research measuring improvements from such surgical safety systems in orthopaedic care is needed.

  6. Implementation of patient safety strategies in European hospitals.

    Suñol, R; Vallejo, P; Groene, O; Escaramis, G; Thompson, A; Kutryba, B; Garel, P

    2009-02-01

    This study is part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) research project on cross-border care, investigating quality improvement strategies in healthcare systems across the European Union (EU). To explore to what extent a sample of acute care European hospitals have implemented patient safety strategies and mechanisms and whether the implementation is related to the type of hospital. Data were collected on patient safety structures and mechanisms in 389 acute care hospitals in eight EU countries using a web-based questionnaire. Subsequently, an on-site audit was carried out by independent surveyors in 89 of these hospitals to assess patient safety outputs. This paper presents univariate and bivariate statistics on the implementation and explores the associations between implementation of patient safety strategies and hospital type using the chi(2) test and Fisher exact test. Structures and plans for safety (including responsibilities regarding patient safety management) are well developed in most of the hospitals that participated in this study. The study found greater variation regarding the implementation of mechanisms or activities to promote patient safety, such as electronic drug prescription systems, guidelines for prevention of wrong patient, wrong site and wrong surgical procedure, and adverse events reporting systems. In the sample of hospitals that underwent audit, a considerable proportion do not comply with basic patient safety strategies--for example, using bracelets for adult patient identification and correct labelling of medication.

  7. Using network screening methods to determine locations with specific safety issues: A design consistency case study.

    Butsick, Andrew J; Wood, Jonathan S; Jovanis, Paul P

    2017-09-01

    The Highway Safety Manual provides multiple methods that can be used to identify sites with promise (SWiPs) for safety improvement. However, most of these methods cannot be used to identify sites with specific problems. Furthermore, given that infrastructure funding is often specified for use related to specific problems/programs, a method for identifying SWiPs related to those programs would be very useful. This research establishes a method for Identifying SWiPs with specific issues. This is accomplished using two safety performance functions (SPFs). This method is applied to identifying SWiPs with geometric design consistency issues. Mixed effects negative binomial regression was used to develop two SPFs using 5 years of crash data and over 8754km of two-lane rural roadway. The first SPF contained typical roadway elements while the second contained additional geometric design consistency parameters. After empirical Bayes adjustments, sites with promise (SWiPs) were identified. The disparity between SWiPs identified by the two SPFs was evident; 40 unique sites were identified by each model out of the top 220 segments. By comparing sites across the two models, candidate road segments can be identified where a lack design consistency may be contributing to an increase in expected crashes. Practitioners can use this method to more effectively identify roadway segments suffering from reduced safety performance due to geometric design inconsistency, with detailed engineering studies of identified sites required to confirm the initial assessment. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. The challenges for global harmonisation of food safety norms and regulations: issues for India.

    Prakash, Jamuna

    2014-08-01

    Safe and adequate food is a human right, safety being a prime quality attribute without which food is unfit for consumption. Food safety regulations are framed to exercise control over all types of food produced, processed and sold so that the customer is assured that the food consumed will not cause any harm. From the Indian perspective, global harmonisation of food regulations is needed to improve food and nutrition security, the food trade and delivery of safe ready-to-eat (RTE) foods at all places and at all times. The Millennium Development Goals (MDGs) put forward to transform developing societies incorporate many food safety issues. The success of the MDGs, including that of poverty reduction, will in part depend on an effective reduction of food-borne diseases, particularly among the vulnerable group, which includes women and children. Food- and water-borne illnesses can be a serious health hazard, being responsible for high incidences of morbidity and mortality across all age groups of people. Global harmonisation of food regulations would assist in facilitating food trade within and outside India through better compliance, ensuring the safety of RTE catered foods, as well as addressing issues related to the environment. At the same time, regulations need to be optimum, as overregulation may have undue negative effects on the food trade. © 2013 Society of Chemical Industry.

  9. Issues regarding Risk Effect Analysis of Digitalized Safety Systems and Main Risk Contributors

    Kang, Hyun Gook; Jang, Seung-Cheol

    2008-01-01

    Risk factors of safety-critical digital systems affect overall plant risk. In order to assess this risk effect, a risk model of a digitalized safety system is required. This article aims to provide an overview of the issues when developing a risk model and demonstrate their effect on plant risk quantitatively. Research activities in Korea for addressing these various issues, such as the software failure probability and the fault coverage of self monitoring mechanism are also described. The main risk contributors related to the digitalized safety system were determined in a quantitative manner. Reactor protection system and engineered safety feature component control system designed as part of the Korean Nuclear I and C System project are used as example systems. Fault-tree models were developed to assess the failure probability of a system function which is designed to generate an automated signal for actuating both of the reactor trip and the complicated accident-mitigation actions. The developed fault trees were combined with a plant risk model to evaluate the effect of a digitalized system's failure on the plant risk. (authors)

  10. Assessment of Patient Safety Culture in Primary Health Care Settings in Kuwait

    Maha Mohamed Ghobashi

    2014-01-01

    Full Text Available Background Patient safety is critical component of health care quality. We aimed to assess the awareness of primary healthcare staff members about patient safety culture and explore the areas of deficiency and opportunities for improvement concerning this issue.Methods: This descriptive cross sectional study surveyed 369 staff members in four primary healthcare centers in Kuwait using self-administered “Hospital Survey on Patient Safety Culture” adopted questionnaire. The total number of respondents was 276 participants (response rate = 74.79%.Results: Five safety dimensions with lowest positivity (less than 50% were identified and these are; the non – punitive response to errors, frequency of event reporting, staffing, communication openness, center handoffs and transitions with the following percentages of positivity 24%, 32%, 41%, 45% and 47% respectively. The dimensions of highest positivity were teamwork within the center’s units (82% and organizational learning (75%.Conclusion: Patient safety culture in primary healthcare settings in Kuwait is not as strong as improvements for the provision of safe health care. Well-designed patient safety initiatives are needed to be integrated with organizational policies, particularly the pressing need to address the bioethical component of medical errors and their disclosure, communication openness and emotional issues related to them and investing the bright areas of skillful organizational learning and strong team working attitudes.    

  11. Establishing research priorities for patient safety in emergency medicine: a multidisciplinary consensus panel.

    Plint, Amy C; Stang, Antonia S; Calder, Lisa A

    2015-01-01

    Patient safety in the context of emergency medicine is a relatively new field of study. To date, no broad research agenda for patient safety in emergency medicine has been established. The objective of this study was to establish patient safety-related research priorities for emergency medicine. These priorities would provide a foundation for high-quality research, important direction to both researchers and health-care funders, and an essential step in improving health-care safety and patient outcomes in the high-risk emergency department (ED) setting. A four-phase consensus procedure with a multidisciplinary expert panel was organized to identify, assess, and agree on research priorities for patient safety in emergency medicine. The 19-member panel consisted of clinicians, administrators, and researchers from adult and pediatric emergency medicine, patient safety, pharmacy, and mental health; as well as representatives from patient safety organizations. In phase 1, we developed an initial list of potential research priorities by electronically surveying a purposeful and convenience sample of patient safety experts, ED clinicians, administrators, and researchers from across North America using contact lists from multiple organizations. We used simple content analysis to remove duplication and categorize the research priorities identified by survey respondents. Our expert panel reached consensus on a final list of research priorities through an in-person meeting (phase 3) and two rounds of a modified Delphi process (phases 2 and 4). After phases 1 and 2, 66 unique research priorities were identified for expert panel review. At the end of phase 4, consensus was reached for 15 research priorities. These priorities represent four themes: (1) methods to identify patient safety issues (five priorities), (2) understanding human and environmental factors related to patient safety (four priorities), (3) the patient perspective (one priority), and (4) interventions for

  12. Developing a research agenda for patient safety in primary care. Background, aims and output of the LINNEAUS collaboration on patient safety in primary care.

    Esmail, Aneez; Valderas, Jose M; Verstappen, Wim; Godycki-Cwirko, Maciek; Wensing, Michel

    2015-09-01

    This paper is an introduction to a supplement to The European Journal of General Practice, bringing together a body of research focusing on the issue of patient safety in relation to primary care. The supplement represents the outputs of the LINNEAUS collaboration on patient safety in primary care, which was a four-year (2009-2013) coordination and support action funded under the Framework 7 programme by the European Union. Being a coordination and support action, its aim was not to undertake new research, but to build capacity through engaging primary care researchers and practitioners in identifying some of the key challenges in this area and developing consensus statements, which will be an essential part in developing a future research agenda. This introductory article describes the aims of the LINNEAUS collaboration, provides a brief summary of the reasons to focus on patient safety in primary care, the epidemiological and policy considerations, and an introduction to the papers included in the supplement.

  13. Generic safety issues for nuclear power plants with light water reactors and measures taken for their resolution

    1998-09-01

    The IAEA Conference on 'The Safety of Nuclear Power: Strategy for the Future' in 1991 was a milestone in nuclear safety. Two of the important items addressed by this conference were ensuring and enhancing safety of operating plants and treatment of nuclear power plants built to earlier safety standards. A number of publications related to these two items issued subsequent to this conference were: A Common Basis for Judging the Safety of Nuclear Power Plants Built to Earlier Standards, INSAG-9 (1995), the IAEA Safety Guide 50-SG-O12, periodic Safety Review of Operational Nuclear Power Plants (1994) and an IAEA publication on the Safety Evaluation of Operating Nuclear Power Plants Built to Earlier Standards - A Common Basis for Judgement (1997). Some of the findings of the 1991 Conference have not yet been fully addressed. An IAEA Symposium on reviewing the Safety of Existing Nuclear Power Plants in 1996 showed that there is an urgent need for operating organizations and national authorities to review operating nuclear power plants which do not meet the high safety levels of the vast majority of plants and to undertake improvements with assistance from the international community if required. Safety reviews of operating nuclear power plants take on added importance in the context of the Convention on Nuclear safety and its implementation. The purpose of this TECDOC compilation based on broad international experience, is to assist the Member States in the reassessment of operating plants by providing a list of generic safety issues identified in nuclear power plants together with measures taken to resolve these issues. These safety issues are generic in nature with regard to light water reactors and the measures for their resolution are for use as a reference for the safety reassessment of operating plants. The TECDOC covers issues thought to be significant to Member States based on consensus process. It provides an introduction to the use of generic safety issues for

  14. The relationship between organizational leadership for safety and learning from patient safety events.

    Ginsburg, Liane R; Chuang, You-Ta; Berta, Whitney Blair; Norton, Peter G; Ng, Peggy; Tregunno, Deborah; Richardson, Julia

    2010-06-01

    To examine the relationship between organizational leadership for patient safety and five types of learning from patient safety events (PSEs). Forty-nine general acute care hospitals in Ontario, Canada. A nonexperimental design using cross-sectional surveys of hospital patient safety officers (PSOs) and patient care managers (PCMs). PSOs provided data on organization-level learning from (a) minor events, (b) moderate events, (c) major near misses, (d) major event analysis, and (e) major event dissemination/communication. PCMs provided data on organizational leadership (formal and informal) for patient safety. Hospitals were the unit of analysis. Seemingly unrelated regression was used to examine the influence of formal and informal leadership for safety on the five types of learning from PSEs. The interaction between leadership and hospital size was also examined. Formal organizational leadership for patient safety is an important predictor of learning from minor, moderate, and major near-miss events, and major event dissemination. This relationship is significantly stronger for small hospitals (learning from safety events. Formal leadership support for safety is of particular importance in small organizations where the economic burden of safety programs is disproportionately large and formal leadership is closer to the front lines.

  15. Strengthening leadership as a catalyst for enhanced patient safety culture

    Kristensen, Solvejg; Christensen, Karl Bang; Jaquet, Annette

    2016-01-01

    OBJECTIVES: Current literature emphasises that clinical leaders are in a position to enable a culture of safety, and that the safety culture is a performance mediator with the potential to influence patient outcomes. This paper aims to investigate staff's perceptions of patient safety culture...... in a Danish psychiatric department before and after a leadership intervention. METHODS: A repeated cross-sectional experimental study by design was applied. In 2 surveys, healthcare staff were asked about their perceptions of the patient safety culture using the 7 patient safety culture dimensions...... in the Safety Attitudes Questionnaire. To broaden knowledge and strengthen leadership skills, a multicomponent programme consisting of academic input, exercises, reflections and discussions, networking, and action learning was implemented among the clinical area level leaders. RESULTS: In total, 358 and 325...

  16. Specific issues, exact locations: case study of a community mapping project to improve safety in a disadvantaged community.

    Qummouh, Rana; Rose, Vanessa; Hall, Pat

    2012-12-01

    Safety is a health issue and a significant concern in disadvantaged communities. This paper describes an example of community-initiated action to address perceptions of fear and safety in a suburb in south-west Sydney which led to the development of a local, community-driven research project. As a first step in developing community capacity to take action on issues of safety, a joint resident-agency group implemented a community safety mapping project to identify the extent of safety issues in the community and their exact geographical location. Two aerial maps of the suburb, measuring one metre by two metres, were placed on display at different locations for four months. Residents used coloured stickers to identify specific issues and exact locations where crime and safety were a concern. Residents identified 294 specific safety issues in the suburb, 41.9% (n=123) associated with public infrastructure, such as poor lighting and pathways, and 31.9% (n=94) associated with drug-related issues such as drug activity and discarded syringes. Good health promotion practice reflects community need. In a very practical sense, this project responded to community calls for action by mapping resident knowledge on specific safety issues and exact locations and presenting these maps to local decision makers for further action.

  17. Assessing the relationship between patient safety culture and EHR strategy.

    Ford, Eric W; Silvera, Geoffrey A; Kazley, Abby S; Diana, Mark L; Huerta, Timothy R

    2016-07-11

    Purpose - The purpose of this paper is to explore the relationship between hospitals' electronic health record (EHR) adoption characteristics and their patient safety cultures. The "Meaningful Use" (MU) program is designed to increase hospitals' adoption of EHR, which will lead to better care quality, reduce medical errors, avoid unnecessary cost, and promote a patient safety culture. To reduce medical errors, hospital leaders have been encouraged to promote safety cultures common to high-reliability organizations. Expecting a positive relationship between EHR adoption and improved patient safety cultures appears sound in theory, but it has yet to be empirically demonstrated. Design/methodology/approach - Providers' perceptions of patient safety culture and counts of patient safety incidents are explored in relationship to hospital EHR adoption patterns. Multi-level modeling is employed to data drawn from the Agency for Healthcare Research and Quality's surveys on patient safety culture (level 1) and the American Hospital Association's survey and healthcare information technology supplement (level 2). Findings - The findings suggest that the early adoption of EHR capabilities hold a negative association to the number of patient safety events reported. However, this relationship was not present in providers' perceptions of overall patient safety cultures. These mixed results suggest that the understanding of the EHR-patient safety culture relationship needs further research. Originality/value - Relating EHR MU and providers' care quality attitudes is an important leading indicator for improved patient safety cultures. For healthcare facility managers and providers, the ability to effectively quantify the impact of new technologies on efforts to change organizational cultures is important for pinpointing clinical areas for process improvements.

  18. Regulatory aspects of oncology drug safety evaluation: Past practice, current issues, and the challenge of new drugs

    Rosenfeldt, Hans; Kropp, Timothy; Benson, Kimberly; Ricci, M. Stacey; McGuinn, W. David; Verbois, S. Leigh

    2010-01-01

    The drug development of new anti-cancer agents is streamlined in response to the urgency of bringing effective drugs to market for patients with limited life expectancy. FDA's regulation of oncology drugs has evolved from the practices set forth in Arnold Lehman's seminal work published in the 1950s through the current drafting of a new International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) safety guidance for anti-cancer drug nonclinical evaluations. The ICH combines the efforts of the regulatory authorities of Europe, Japan, and the United States and the pharmaceutical industry from these three regions to streamline the scientific and technical aspects of drug development. The recent development of new oncology drug classes with novel mechanisms of action has improved survival rates for some cancers but also brings new challenges for safety evaluation. Here we present the legacy of Lehman and colleagues in the context of past and present oncology drug development practices and focus on some of the current issues at the center of an evolving harmonization process that will generate a new safety guidance for oncology drugs, ICH S9. The purpose of this new guidance will be to facilitate oncology drug development on a global scale by standardizing regional safety requirements.

  19. Improving Patient Safety With the Military Electronic Health Record

    Charles, Marie-Jocelyne; Harmon, Bart J; Jordan, Pamela S

    2005-01-01

    The United States Department of Defense (DoD) has transformed health care delivery in its use of information technology to automate patient data documentation, leading to improvements in patient safety...

  20. [Patient safety in antibiotics administration: Risk assessment].

    Maqueda Palau, M; Pérez Juan, E

    To determine the level of risk in the preparation and administration of antibiotics frequently used in the Intensive Care Unit using a risk matrix. A study was conducted using situation analysis and literature review of databases, protocols and good practice guidelines on intravenous therapy, drugs, and their administration routes. The most used antibiotics in the ICU registered in the ENVIN-HELICS program from 1 April to 30 June 2015 were selected. In this period, 257 patients received antimicrobial treatment and 26 antibiotics were evaluated. Variables studied: A risk assessment of each antibiotic using the scale Risk Assessment Tool, of the National Patient Safety Agency, as well as pH, osmolarity, type of catheter recommended for administration, and compatibility and incompatibility with other antibiotics studied. Almost two-thirds (65.3%) of antibiotics had more than 3 risk factors (represented by a yellow stripe), with the remaining 34.7% of antibiotics having between 0 and 2 risk factors (represented by a green stripe). There were no antibiotics with 6 or more risk factors (represented by a red stripe). Most drugs needed reconstitution, additional dilution, and the use of part of the vial to administer the prescribed dose. More than half of the antibiotics studied had a moderate risk level; thus measures should be adopted in order to reduce it. The risk matrix is a useful tool for the assessment and detection of weaknesses associated with the preparation and administration of intravenous antibiotics. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Assessing patient safety culture in hospitals across countries

    Wagner, C.; Smits, M.; Sorra, J.; Huang, C.C.

    2013-01-01

    Objective. It is believed that in order to reduce the number of adverse events, hospitals have to stimulate a more open culture and reflective attitude towards errors and patient safety. The objective is to examine similarities and differences in hospital patient safety culture in three countries:

  2. Assessing patient safety culture in hospitals across countries.

    Wagner, C.; Smits, M.; Sorra, J.; Huang, C.C.

    2013-01-01

    Objective: It is believed that in order to reduce the number of adverse events, hospitals have to stimulate a more open culture and reflective attitude towards errors and patient safety. The objective is to examine similarities and differences in hospital patient safety culture in three countries:

  3. Assessing patient safety culture in hospitals across countries

    Wagner, C.; Smits, M.; Sorra, J.; Huang, C.C.

    2013-01-01

    OBJECTIVE: It is believed that in order to reduce the number of adverse events, hospitals have to stimulate a more open culture and reflective attitude towards errors and patient safety. The objective is to examine similarities and differences in hospital patient safety culture in three countries:

  4. 75 FR 57477 - Patient Safety Organizations: Voluntary Delisting

    2010-09-21

    ... Organizations: Voluntary Delisting AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS. ACTION... Creighton Center for Health Services Research and Patient Safety (CHRP) Patient Safety Organization (PSO... the listing of PSOs, which are entities or component organizations whose mission and primary activity...

  5. 75 FR 75473 - Patient Safety Organizations: Voluntary Delisting

    2010-12-03

    ... Organizations: Voluntary Delisting AGENCY: Agency for Healthcare Research and Quality, HHS. ACTION: Notice of... entity of Harbor Medical, Inc., of its status as a Patient Safety Organization (PSO). The Patient Safety... the listing of PSOs, which are entities or component organizations whose mission and primary activity...

  6. 75 FR 75471 - Patient Safety Organizations: Voluntary Delisting

    2010-12-03

    ... Organizations: Voluntary Delisting AGENCY: Agency for Healthcare Research and Quality, HHS. ACTION: Notice of..., LLC of its status as a Patient Safety Organization (PSO). The Patient Safety and Quality Improvement... or component organizations whose mission and primary activity is to conduct activities to improve...

  7. 75 FR 75472 - Patient Safety Organizations: Voluntary Delisting

    2010-12-03

    ... Organizations: Voluntary Delisting AGENCY: Agency for Healthcare Research and Quality, HHS. ACTION: Notice of.... Patient Safety Group (A Component of Helmet Fire, Inc. of its status as a Patient Safety Organization (PSO... the listing of PSOs, which are entities or component organizations whose mission and primary activity...

  8. 75 FR 57048 - Patient Safety Organizations: Voluntary Delisting

    2010-09-17

    ... Organizations: Voluntary Delisting AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS. ACTION... Organization (PSO). The Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act), Public Law 109... the listing of PSOs, which are entities or component organizations whose mission and primary activity...

  9. Perceptions of medication safety among patients with inflammatory bowel disease.

    Cullen, Garret

    2010-09-01

    The aim of this study was to assess attitudes towards and knowledge of medication safety in inflammatory bowel disease (IBD). IBD patients frequently require long-term treatment with potentially toxic medications. Techniques are employed to improve patient awareness of medication safety, but there are sparse data on their effectiveness.

  10. 75 FR 63498 - Patient Safety Organizations: Voluntary Delisting

    2010-10-15

    ... Healthcare Technology Foundation of its status as a Patient Safety Organization (PSO). The Patient Safety and... notification from the ACCE Healthcare Technology Foundation, PSO number P0017, to voluntarily relinquish its status as a PSO. Accordingly, the ACCE Healthcare Technology Foundation was delisted effective at 12:00...

  11. Using safety crosses for patient self-reflection.

    Silverton, Sarah

    The Productive Mental Health Ward programme has been developed to improve efficiency and safety in the NHS. Patients in a medium-secure mental health unit used patient safety crosses as a tool for self-reflection as part of their recovery journey. This article describes how the project was set up as well as initial findings.

  12. Healthcare professionals’ views of feedback on patient safety culture assessment.

    Zwijnenberg, N.C.; Hendriks, M.; Hoogervorst-Schilp, J.; Wagner, C.

    2016-01-01

    Background: By assessing patient safety culture, healthcare providers can identify areas for improvement in patient safety culture. To achieve this, these assessment outcomes have to be relevant and presented clearly. The aim of our study was to explore healthcare professionals’ views on the

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

    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

  14. Patient Safety and Workplace Bullying: An Integrative Review.

    Houck, Noreen M; Colbert, Alison M

    Workplace bullying is strongly associated with negative nursing outcomes, such as work dissatisfaction, turnover, and intent to leave; however, results of studies examining associations with specific patient safety outcomes are limited or nonspecific. This integrative review explores and synthesizes the published articles that address the impact of workplace nurse bullying on patient safety.

  15. Patient participation in patient safety and nursing input - a systematic review.

    Vaismoradi, Mojtaba; Jordan, Sue; Kangasniemi, Mari

    2015-03-01

    This systematic review aims to synthesise the existing research on how patients participate in patient safety initiatives. Ambiguities remain about how patients participate in routine measures designed to promote patient safety. Systematic review using integrative methods. Electronic databases were searched using keywords describing patient involvement, nursing input and patient safety initiatives to retrieve empirical research published between 2007 and 2013. Findings were synthesized using the theoretical domains of Vincent's framework for analysing risk and safety in clinical practice: "patient", "healthcare provider", "task", "work environment", "organisation & management". We identified 17 empirical research papers: four qualitative, one mixed-method and 12 quantitative designs. All 17 papers indicated that patients can participate in safety initiatives. Improving patient participation in patient safety necessitates considering the patient as a person, the nurse as healthcare provider, the task of participation and the clinical environment. Patients' knowledge, health conditions, beliefs and experiences influence their decisions to engage in patient safety initiatives. An important component of the management of long-term conditions is to ensure that patients have sufficient knowledge to participate. Healthcare providers may need further professional development in patient education and patient care management to promote patient involvement in patient safety, and ensure that patients understand that they are 'allowed' to inform nurses of adverse events or errors. A healthcare system characterised by patient-centredness and mutual acknowledgement will support patient participation in safety practices. Further research is required to improve international knowledge of patient participation in patient safety in different disciplines, contexts and cultures. Patients have a significant role to play in enhancing their own safety while receiving hospital care. This

  16. Patient safety culture among medical students in Singapore and Hong Kong.

    Leung, Gilberto Ka Kit; Ang, Sophia Bee Leng; Lau, Tang Ching; Neo, Hong Jye; Patil, Nivritti Gajanan; Ti, Lian Kah

    2013-09-01

    Undergraduate education in medical schools plays an important role in promoting patient safety. Medical students from different backgrounds may have different perceptions and attitudes toward issues concerning safety. This study aimed to investigate whether patient safety cultures differed between students from two Asian countries, and if they did, to find out how they differed. This study also aimed to identify the educational needs of these students. A voluntary, cross-sectional and self-administered questionnaire survey was conducted on 259 students from two medical schools - one in Hong Kong and the other in Singapore. None of the students had received any formal teaching on patient safety. We used a validated survey instrument, the Attitudes to Patient Safety Questionnaire III (APSQ-III), which was designed specifically for students and covered nine key factors of patient safety culture. Of the 259 students, 81 (31.3%) were from Hong Kong and 178 (68.7%) were from Singapore. The overall response rate was 66.4%. Significant differences between the two groups of students were found for two key factors - 'patient safety training', with Hong Kong students being more likely to report having received more of such training (p = 0.007); and 'error reporting confidence', which Singapore students reported having less of (p working hours and professional incompetence were important causes of medical errors. The importance of patient involvement and team functioning were ranked relatively lower by the students. Students from different countries with no prior teaching on patient safety may differ in their baseline patient safety cultures and educational needs. Our findings serve as a reference for future longitudinal studies on the effects of different teaching and healthcare development programmes.

  17. Role of effective nurse-patient relationships in enhancing patient safety.

    Conroy, Tiffany; Feo, Rebecca; Boucaut, Rose; Alderman, Jan; Kitson, Alison

    2017-08-02

    Ensuring and maintaining patient safety is an essential aspect of care provision. Safety is a multidimensional concept, which incorporates interrelated elements such as physical and psychosocial safety. An effective nurse-patient relationship should ensure that these elements are considered when planning and providing care. This article discusses the importance of an effective nurse-patient relationship, as well as healthcare environments and working practices that promote safety, thus ensuring optimal patient care.

  18. Public involvement in environmental, safety and health issues at the DOE Nuclear Weapons Complex

    Taylor, Laura L.; Morgan, Robert P.

    1992-01-01

    The state of public involvement in environmental, safety, and health issues at the DOE Nuclear Weapons Complex is assessed through identification of existing opportunities for public involvement and through interviews with representatives of ten local citizen groups active in these issues at weapons facilities in their communities. A framework for analyzing existing means of public involvement is developed. On the whole, opportunities for public involvement are inadequate. Provisions for public involvement are lacking in several key stages of the decision-making process. Consequently, adversarial means of public involvement have generally been more effective than cooperative means in motivating change in the Weapons Complex. Citizen advisory boards, both on the local and national level, may provide a means of improving public involvement in Weapons Complex issues. (author)

  19. Variability of patient safety culture in Belgian acute hospitals.

    Vlayen, Annemie; Schrooten, Ward; Wami, Welcome; Aerts, Marc; Barrado, Leandro Garcia; Claes, Neree; Hellings, Johan

    2015-06-01

    The aim of this study was to measure differences in safety culture perceptions within Belgian acute hospitals and to examine variability based on language, work area, staff position, and work experience. The Hospital Survey on Patient Safety Culture was distributed to hospitals participating in the national quality and safety program (2007-2009). Hospitals were invited to participate in a comparative study. Data of 47,136 respondents from 89 acute hospitals were used for quantitative analysis. Percentages of positive response were calculated on 12 dimensions. Generalized estimating equations models were fitted to explore differences in safety culture. Handoffs and transitions, staffing, and management support for patient safety were considered as major problem areas. Dutch-speaking hospitals had higher odds of positive perceptions for most dimensions in comparison with French-speaking hospitals. Safety culture scores were more positive for respondents working in pediatrics, psychiatry, and rehabilitation compared with the emergency department, operating theater, and multiple hospital units. We found an important gap in safety culture perceptions between leaders and assistants within disciplines. Administration and middle management had lower perceptions toward patient safety. Respondents working less than 1 year in the current hospital had more positive safety culture perceptions in comparison with all other respondents. Large comparative databases provide the opportunity to identify distinct high and low scoring groups. In our study, language, work area, and profession were identified as important safety culture predictors. Years of experience in the hospital had only a small effect on safety culture perceptions.

  20. 76 FR 60494 - Patient Safety Organizations: Voluntary Relinquishment From HPI-PSO

    2011-09-29

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety... a Patient Safety Organization (PSO). The Patient Safety and Quality Improvement Act of 2005 (Patient... delivery. The Patient Safety and Quality Improvement Final Rule (Patient Safety Rule), 42 CFR Part 3...