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Patient safety and quality improvement - Volume:5 Issue: 4, Automn 2017

Journal Of Patient safety and quality improvement
Volume:5 Issue: 4, Automn 2017

  • تاریخ انتشار: 1396/10/25
  • تعداد عناوین: 8
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  • Application of the 5S-KAIZEN Approach in Improving the Productivity and Quality of the Healthcare System: An Operational Research
    Naglaa Abdel Khalek El-Sherbiny, Asmaa Younis Elsary *, Eman H. Ibrahim Page 1
    Introduction
    Quality is an important index in various aspects of life. The 5S-KAIZEN method is widely applied for the improvement of work environments. This systematic approach is fundamentally used to enhance the quality of services in all types of organizations. The present study aimed to assess the application of the 5S-KAIZEN approach in improving the quality of care provision in hospitals and evaluate its effects on the job satisfaction of the healthcare providers.
    Materials And Methods
    This interventional, operational research was conducted at a teaching hospital. In-depth interviews were performed to obtain the viewpoints of the physicians, and group discussions were held for nurses in order to assess their satisfaction with the implementation of the 5S-KAIZEN approach in the work environment.
    Results
    Patient-hospital cycle time decreased by more than 50% after implementing the 5S-KAIZEN approach. In addition, the healthcare professionals believed that applying the 5S-KAIZEN approach saved time, money, and efforts, while reducing their daily workload and stress.
    Conclusion
    According to the results, the 5S-KAIZEN approach could improve the standards in the healthcare work environment, support the safe practices leading to high-quality and efficient care services, enhance productivity at a low cost, and increase the satisfaction of the healthcare staff with their professional image and communication with the other personnel.
    Keywords: Approach, Operational, Quality, 5S, KAIZEN, Staff
  • Mohd. Nasir Bin Mohd. Ismail * Pages 592-593
    Patient safety is an important branch of knowledge, which has emerged within the past two decades1. However, the definition and structure of the field remain nebulous despite its wide acceptance and legitimacy. Therefore, it is crucial to define and present the structure of patient safety in order to create a shared image of the concept.
    Patient safety could be defined as the elimination of damages in patients, as well as a state of no possible harms to patients. In this regard, ‘patients’ and ‘harm’ are defined based on the cultural constructs in different regions and epochs. With the progress of communities, individuals might be included and excluded from the proposed definitions of ‘patients’ and ‘harms’ as these concepts constantly evolve throughout time.
    Keywords: Components, Definition, Patient safety
  • Gemma Fairclough, Thomas S. Fitzmaurice, Mark Lewis, Arpan Guha * Pages 601-605
    Introduction
    The present study aimed to evaluate the quality of the inter-hospital transfers (IHTs) of the patients in a tertiary referral hospital in the United Kingdom.
    Materials And Methods
    This collaborative, multi-professional study was conducted in three stages. Qualitative and quantitative data were collected from a tertiary referral hospital in the United Kingdom using the case notes of the patients and surveys of junior physicians during training. The primary outcome was to examine the quality of the handover of patients during IHT.
    Results
    In total, 95.5% of the responding foundation year 1 doctors believed the current system of patient transfer to be unsafe. In terms of medical information handover, 62.5% of the physicians could not recall receiving a verbal handover, while 25% mentioned not receiving a written handover. In addition, 81.5% had difficulty clarifying the medications of the transferred patients, and 66%, 22%, and 26% of the physicians received the most recent results on blood tests, blood gas tests, and cultures, respectively. Also, 93% were not informed on the expected performance of the transfer team.
    Conclusion
    According to the results, IHT required improvement in the studied hospital, and similar findings are likely to be obtained by repeating the investigation in other health centers. Furthermore, a trainee-led collaborative research was initiated in order to develop an online transfer system to reduce the risk of poor medical information handover in the patients transferred between hospitals, which is potentially a major patient safety issue and could be mitigated through proper healthcare technology platforms.
    Keywords: Handover, Inter, Hospital Transfers, Quality, Safety
  • Nasrin Sharbafchi-Zadeh, Saeed Karimi, Yasamin Molavi Taleghani *, Marjan Vejdani Pages 606-615
    Introduction
    Unpleasant incidents are one of the biggest problems in health system and error reporting system is an efficient way to improve patient’s safety. Therefore, this study was conducted with the purpose of assess reporting error system in one of the pediatric hospitals in Tehran and finally a proposed model for health centers was presented.
    Materials And Methods
    This was qualitative study. The procedures of study included four phases such as identifying status of selected hospitals in the error management system, identifying the status of error reporting systems in selected countries, identifying the features, requirements and benefits of setting up an error reporting system and develop a proposed model for health centers. Triangular method was used to collect information and descriptive content analysis and consensus opinion was used to analyze the data.
    Results
    Demographic, cultural, organizational, legal-regulatory and financial factors have been introduced as the main barriers of error reporting in the respective hospital. Structural and process criteria should be strengthened to establish a desired reporting system. The process of incidents detection, incidents drawing, incident analysis, review and share errors, implementing solutions and monitoring and evaluation are recommended to design an error reporting system.
    Conclusion
    The competitive key to manage medical’s error successfully is to establish a voluntary reporting system, commitment of senior managers, change the culture of blame and removing barriers of reporting errors. So, healthcare system needs to provide an error reporting system with learning and proactive approach to improve quality of services and safety of infrastructure.
    Keywords: Hospital, Medical's Errors, Patient's Safety, Reporting
  • Amir Emami *, Neda Pirbonyeh, Abdollah Bazargani, Abdolkhalegh Keshavarzi, Bahram Derakhshan, Mitra Zardosht, Seyed Mohsen Hoseini Pages 616-620
    Introduction
    Although Coagulase Negative Staphylococci (CoNS) were previously considered to be harmless bacteria, some species have recently been shown to be potential pathogens in humans. One of these species, which has emerged in nosocomial infections, is Staphylococcus lugdunensis. Given the importance of recognizing new infections in hospital settings and their prevention, the present study aimed to investigate the presence of S. lugdunensis in patients with burn injuries.
    Materials And Methods
    In this study, 124 CoNS isolates were evaluated in the patients admitted in a burn injury center in the southwest of Iran during January 2016-May 2017. The detected S. lugdunensis isolates were assessed in terms of drug susceptibility pattern, β-lactamase production, mecA-mediated oxacillin resistance, and inducible clindamycin resistance. The applied methods included disk diffusion, penicillin minimal inhibitory concentration, cefoxitin broth microdilution, and erythromycin/clindamycin disk diffusion, respectively.
    Results
    Among the CoNS samples, 25 cases (20.2%) were S. lugdunensis. In the confirmed isolates, mecA-mediated oxacillin resistance was detected in 21 cases (84%), and 18 isolates (72.0%) produced β-lactamase. In addition, 23 isolates (88.5%) showed inducible clindamycin resistance. In the antibiogram pattern, more than 70% of the methicillin-resistant isolates were also resistant to chloramphenicol, trimethoprim/sulfamethoxazole, gentamicin, azithromycin, and ceftazidime.
    Conclusion
    According to the results, S. lugdunensis was the cause of a new infection emerging in the studied burn injury center. Considering the resistance of the isolates against the most routine antibiotics, vancomycin is suggested as an alternative. Due to the prevalence of S. lugdunensis in different hospital wards, it is strongly recommended that CoNS isolates be evaluated for the detection of this bacterium.
    Keywords: Burn, Coagulase, Negative Staphylococci, Methicillin, resistant, S. lugdunensis
  • Chioma Okafor *, Ugwu C. Anthony, Okon E. Ime Pages 621-624
    Introduction
    Medical errors are inevitable adverse events in the field of health care, and the establishment of a safety culture could potentially improve patient safety. The present study aimed to evaluate the patient safety culture in the radiodiagnosis units of two tertiary centers in Nigeria.
    Materials And Methods
    This study was conducted on the health workers in the radiodiagnosis units of Nnamdi Azikiwe University Teaching Hospital in Nnewi and University of Nigeria Teaching Hospital in Enugu, Nigeria during May-July 2017. Data collection tool was the hospital survey on patient safety culture (HSOPSC), a validated questionnaire by the Agency for Health Research and Quality (AHRQ). Data analysis was performed in SPSS version 17.
    Results
    Response rate in the HSOPSC was 70%. In total, 55.4% of the respondents were radiographers, and 41.1% rated patient safety culture as favorable. The highest range of the reported events was 3-5 (28.6%). The composite with the highest positive response was ‘teamwork within units’ (81.3%), while the dimension of ‘events reported’ had the lowest frequency. Results of t-test indicated no significant association between the positive responses in the present study and benchmark of AHRQ.
    Conclusion
    According to the results, the patient safety culture in the studied tertiary institutions was barely above average. Therefore, it is recommended that improvements be made in patient safety culture through emphasis on the dimensions of ‘staffing’, ‘non-punitive response to error’, ‘communication openness’, and ‘frequency of events reported’.
    Keywords: Health Workers, Nigeria, Patient Safety Culture, Radiodiagnosis
  • Mohammad Ahangarzadeh Rezaee, Babak Abdinia *, Farshad Ghaderi Pages 625-629
    Introduction
    The present study aimed to investigate the prevalence, inductive agents, potential risk factors, and prognosis pertaining to the specific risk factors of fungal infections in the hospitalized children in the northwest of Iran.
    Materials And Methods
    This descriptive-analytical, retrospective study was conducted on all the children who were hospitalized in the Pediatric Hospital of Tabriz, Iran due to positive fungal culture during 23 August 2010-23 September 2013. The culture samples were collected from various positive fungal body fluids, secretions, and/or catheters.
    Results
    In total, 40,638 patients were hospitalized during the study period, 191 of whom had fungal cultures and were enrolled in the study. Among the studied patients, 58% were male, and 42% were female. The prevalence of fungal infections in the pediatric healthcare center was 0.47% (approximately four infections per 1,000 cases). The most common comorbidities in the hospitalized children with positive fungal culture were aspiration pneumonia (15%), urinary tract infections (9%), and septicemia (7%). In addition, the most frequently infected area was the urinary system (37%). Candida albicans and mycelial fungi accounted for the most common varieties of the fungal isolates obtained from the patients. The mortality rate among the studied children with fungal infections was estimated at 27%.
    Conclusion
    According to the results, the main risk factors for fungal infections included the use of intravenous catheters, urinary catheters, intubation, and history of surgery. Therefore, it is recommended that the potential risk factors of these infections be screened and investigated in the patients admitted to the Pediatric Teaching Hospital of Tabriz.
    Keywords: Children, Fungal, Systemic
  • Olugbenga Arole *, Kavitha Rajan, Sana Khan, Saif Ullah, Valentine Y. Njike Pages 630-633
    Introduction
    The utilization of laboratory services has increased across various healthcare settings. We assessed the impact of the implementation of a Quality Improvement project aimed at reducing Complete Blood Count (CBC) and Basic Electrolyte Panel (BEP) ordered by house staff physicians.
    Materials And Methods
    This study with a pre-post design was conducted in a community hospital in Connecticut, USA. The study was performed between January 2014 and December 2016. At initiation of the project, a taskforce consisting of attending doctors and house staff physicians was created. The taskforce reviewed and determined the current practices of ordering CBC and BEP. The taskforce members analyzed every step of the process and unveiled circumstances where unnecessary CBC and BEPs were ordered. Based on the results of the analysis, a multi-level intervention of one-year duration was then developed to address the ordering of unnecessary CBC and BEPs. The intervention consisted of daily decision making about labs during rounds, incorporating lab documentations planned for the next day into daily progress notes, including the rationale for these labs, audit and reporting of ordering practices to each medical team, and providing direct feedback to each house staff not providing appropriate documentation of lab rationale. The average numbers of CBC and BEP orders per patient days were used to assess the impact of our intervention.
    Results
    After implementing this Quality Improvement program, the average number of CBC and BEPs per patient days ordered by the house staff physicians decreased (i.e., from 1.20 to 1.09; P
    Conclusion
    Our Quality Improvement initiative resulted in a reduction in CBC and BEP orderings per patient days by the house staff without adversely affecting our patients’ length of stay or mortality.
    Keywords: Choosing wisely, Quality improvement, Unnecessary labs