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Patient safety and quality improvement - Volume:4 Issue: 4, Automn 2016

Journal Of Patient safety and quality improvement
Volume:4 Issue: 4, Automn 2016

  • تاریخ انتشار: 1395/08/04
  • تعداد عناوین: 8
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  • Mohammad Saadati *, Mehdi Nouri, Robert Mcsherry Pages 426-426
    Patient safety is the cornerstone of health care quality and governance(1). Globally the emergence of what could be regarded as a ‘patient safety movement’can be attributed to the following: firstly, health care organizations were trailing to develop and promote a positive attitude and safety culture(2). Secondly, apositive patient safety culture is one in which every individual, providing the care, should have the necessaryknowledge, understanding and is competent in skills of risk evaluation and reduction. Thirdly, where safety is a potential issue individuals should be encouraged and supported to promote changes through education and training(3). Fourthly, promotion patient safety culture interventions need to be rooted in the principles of teamwork, hospital leadership and behavioural change(4). Finally, an effective way to translate clinical leadership into health care quality improvement and patient safety is to focus on promoting the principles aligned to a duty of candour into frontline practice (5).
    Various interventions and strategies are available to improve safety culture(3). For example, Patient Safety Leadership Walkrounds (PSLW) is a strategy engaging directly hospital leadership with frontline staff(4, 6). A multidisciplinary team of hospital executives visit the patient care areas in hospital to observe and identify the current and potential risks and discuss with the frontline care providers to eliminate them. In a walkround, the team and staff discus about safety issues only and they plan to improve safety issues (such as safety culture, equipment, patient safety, building safety and etc).Walkrounds show the commitment of hospital leadership and foster trust and psychological support for frontline staff(7).
    The way forward for hospitals, especially in developing countries with restricted resources, where urgent interventions are required like patient safety leadership walkrounds. The aim of this initiative is to improve safety culture, care effectiveness and patients’ outcomes. It brings leadership commitment to the front-line efforts to improve patient safety.
    Keywords: Patient safety culture, Patient safety leadership walkround, Health care quality
  • Opal Malone Davidson*, Helen Salisbury, Denice Curtis Pages 427-433
    Introduction
    This study aimed to compare the principal strategies used by the healthcare providers at a rural hospital in Jamaica (JA) with the data published in the Hospital Survey on Patient Safety Culture report in the United States (2014) regarding the promotion of patient safety.
    Materials And Methods
    This cross-sectional study was conducted during two months via the non-probability sampling method. Data of 240 healthcare providers were collected using the Hospital Survey on Patient Safety Culture (HSOPSC). Comparative data analysis was performed using IBM SPSS version 21, Excel TM software, and the Hospital Survey on Patient Safety Culture report (United States, 2014).
    Results
    Response rate of the survey was 25%. Composite scores of the Excel TM software determined the most prominent strategies of patient safety promotion in hospitals, as follows: “supervisor/manager expectations and actions to promote patient safety” (JA: 78%, US: 76%), “teamwork within units” (JA: 77%, US: 81%), and “organizational learning/continuous improvement” (JA: 72%, US: 73%). However, dimensions of “staffing” (JA: 47%, US: 55%) and “non-punitive response to error” (JA: 37%, US: 44%) required improvement in both countries. Positive perception of the patient safety culture was higher in the United States (66%) compared to Jamaica (59%).
    Conclusion
    According to the results of this study, further improvement is required in the aspects of open communication to report medical errors, supervisory/healthcare management, and collaboration of all stakeholders to enhance the quality of care delivery and patient safety across the world.
    Keywords: Patient safety culture, Medical errors, Hospital survey on patient safety culture instrument, Healthcare delivery
  • Javad Shahinfar, Hossein Zeraati *, Mahnaz Masrorniya, Saeid Shojaei Pages 434-440
    Introduction
    anxiety has a negative effect on healing and tissue repair and spending too much mental and physical energy during prolonged stress can cause hospitalization and delay in discharge of patients. One method of reducing anxiety is the use of medicinal plants that in this study the effects of valerian root on the anxiety was examined. The aim of this study was to Comparison of valerian extract and diazepam on anxiety before orthopedic surgery
    Materials And Methods
    In this double blind clinical trial study, 60 patients 15-60 years old referred to Imam Ali (AS) hospital of Bojnoord were selected as available and were also randomly divided into two groups of 30 individuals. At 21 pm before surgery, group 1 received 10 drops of valerian edible oil and group 2 received diazepam (5 mg) mixed in 50 ml of tap water. The Spielberger questionnaire was used to assess anxiety before intervention and one hour before initiation of surgery was recorded. Data was analyzed using statistical tests . The level of significance was measured 0/05 in this study.
    Results
    In this study, in the valerian group there were 83.8% male and 16.7%% female while diazepam group included 23.3% male and 76.7 females. The Difference score of overt and covert anxiety in valerian group was 10.1±1.0 and 12.4±1.3 and in the diazepam group was 9.3±1.1 and 10.7±.03. Comparison of two groups showed no significant difference .
    Conclusion
    Valerian has a good anti-anxiety and can be a substitute for chemical medicines after enough studies
    Keywords: Valerian, Diazepam, Anxiety
  • Kenan Gozlu *, Si, Di, Ka Kaya Pages 441-449
    Introduction
    The first step to provide patient safety and reduce medical errors is to evaluate patient safety culture. This study aimed to evaluate patient safety culture as perceived by nurses in a Joint Commission International (JCI) accredited hospital in Turkey and compare it with Agency for Healthcare Research and Quality (AHRQ) data.
    Materials and Methods
    This cross-sectional study was conducted on 70 nurses working in the clinics of a private hospital with JCI accreditation certificate in Ankara, Turkey. For the purpose of data collection, ‘‘Hospital Survey on Patient Safety Culture’’ was used. Data were analyzed using SPSS version 15. The rates of positive responses were calculated and compared with AHRQ data. The mean of 12 dimensions of the survey were calculated and compared with independent variables, using t-test and Kruskal Wallis test.
    Results
    According to the results, ‘‘teamwork within units’’ and ‘‘staffing’’ were found to be the dimensions with the highest and lowest positive response rates, respectively. Furthermore, 78% of the nurses graded patient safety as excellent or very good and 53% of them did not report any events within the last 12 months.
    Conclusion
    This study demonstrated that ‘‘staffing’’, ‘‘non-punitive response to errors’’, ‘‘supervisor/manager expectations & actions promoting patient safety’’, ‘‘communication openness’’, and ‘‘teamwork across units’’ are the areas that need to be improved in terms of patient safety culture. Health services can be provided in a safer way in the future by conducting further studies on patient safety culture and sharing knowledge between countries.
    Keywords: Patient safety culture, Nurse, Accreditation, Hospital
  • Masoud Pezeshki Rad, Maryam Salehi, Hasan Ravari, Reihaneh Kazemi *, Mehdi Darzi Pages 450-454
    Introduction
    Peripheralvascular injuriesinclude about 80% of allvascular injuries andthe studiesperformed so farin this areashowedthat the prevalence ofvasculartrauma is higher in menthanwomen.The aim ofthis study was to evaluate the frequencyandtypesof traumatic arterial injuries in patientsreferred toComputed Tomography (CT)department of Imam Reza Hospital.
    Materials And Methods
    This cross sectional study was approved by the ethics committee of Mashhad University of Medical Sciences. Patients’ information were recorded in a checklist, all patients who were referred to CT scan department of Imam Reza Hospitalfor Computed Tomography angiography (CTA) because of traumatic vascular injuries were enrolled the study. Data were recorded aboutpatients’ demographic characteristics (age and sex), mechanism of traumasuch ad accident (motorcyclist, pedestrian, car-rider), assaults, falls and so on, clinical symptoms at admission, type of arterial injury, and the report of CTA and the existence ofmusculoskeletal or neurologic comorbities. Patients’ management details were also evaluated. Data were coded and analyzed by SPSS version 16.
    Results
    200 patients were evaluated in this study. The most common sites of involvement were the lower limbs (76%), thorax (16%), and upper limbs (8%). The most common abnormal angiographic pattern was run-off/ cut-off (52%), hematoma (15%), and aneurysm (5.5%). There was also nerve damage in 19% of patients. Surgical management was performed and included, end to end anastomosis in 32% of patients, thrombectomy in 23%, amputation in 18%, and ligation in 4% and vascular graft in 7%.
    Conclusion
    In ourstudy, there wasvascular injury in63.5% of patients based on the results of CTA. All vascular injuries were diagnosed by CTA were confirmed after vascular intervention and no serious vascular injury was reported in patients with negative CTA result at the follow-up period. So, CTA is a noninvasive and accurate diagnostic test.
    Keywords: Computed Tomography angiography, Trauma, Vascular injury
  • Siavash Vaziri, Parisa Khansari, Fiezollah Mansouri, Mandana Afsharian, Babak Sayad, Alireza Janbakhsh, Mohammad Asghari, Jafarabadi, Maryam Mirzaei* Pages 455-459
    Introduction
    Medical errors have significant economic and clinical consequences and are considered as great challenges for the healthcare systems of different countries. With regard to the importance of medical errors, this study aimed to evaluate the frequency and type of medical errors in infected patients, admitted to the emergency department of Imam Reza (AS) Hospital in Kermanshah, Iran in 2014-2015.
    Materials And Methods
    In this cross-sectional, descriptive study, we evaluated medical errors affecting infected patients, admitted to the emergency department of Imam Reza (AS) Hospital in Kermanshah, Iran. Data were collected, using a questionnaire including demographic and clinical information and type of medical errors.
    Results
    Data were collected from 385 clinical records available at the emergency department of the hospital. In a total of 809 distinguished errors, the highest rates of error were as follows: medication errors (30%), CI 95%: 0.26-0.34), diagnostic errors (24.60%, CI 95%: 0.22-0.28), and admission for more than 6 h in the emergency room (14.34%, CI 95%: 0.12-0.16). Based on the findings, unnecessary prescription of antibiotics accounted for the highest percentage of medication errors (16.07%, CI 95%: 13.52-18.62).
    Conclusion
    According to the results of the present study, errors in diagnosis and treatment were the most frequent medical errors. Therefore, it is necessary to plan on reducing the frequency of these errors.
    Keywords: Emergency department, Hospital, Medical errors
  • Salah Addin Asadi, Ali Shargh, Saeed Husseini Barghazan, Jamal Eftekhari, Morteza Arab, Zozani* Pages 460-464
    Introduction
    Safe injection is a kind of injection that not hurts the one who receives service, not injures the providers and its leftovers wont make harm or damage to the society and environment. The purpose of this study was to investigate the rate of the observance of the standards with safe injection in the inpatient units of teaching hospitals in Tabriz.
    Materials And Methods
    In this cross-sectional study, 399 samples were examined by Cochran formula. Samples were selected randomly as clusters from each hospital and inpatient units and data were gathered in all three working shifts. The data collection tools used in this study was a checklist which its reliability has been proved. Data were analyzed by using the SPSS 21 and were reported by relevant analytic and descriptive statistics.
    Results
    73.4% of subjects were woman. 63.90% of people in the past year have been passed the course related to infection and safe injections. The observance of the standards of safe injection in “preparation phase”, “during the injection” and “after injection” was 64.84, 58.95, and 63.95%, respectively, which had in fairly good condition.
    Conclusions
    Performing the retraining programs in injections and nosocomial infections, employing people with work experiences in teaching hospitals, providing individual protection equipment such as glasses and mask, educations about hand washing, providing and using auto disable syringes and safety boxes and immunizing the staffs against hepatitis B and C can be the most important actions in doing safe injection.
    Keywords: Safe injection, Observance of the standards, Inpatient unit, Teaching hospitals
  • Mohammad Tayyebi, Ali Eshraghi, Zahra Alizadeh, Khosro Moravveji Far* Pages 465-470
    Introduction
    QT interval represents duration of ventricular electrical systole, i.e., the time required for completion of both ventricular depolarization and repolarization. QT interval duration normally varies between leads on the electrocardiography due to variation of repolarization and re-excitability of different ventricular regions. QT dispersion, defined as the difference between maximum and minimum of QT interval duration, is considered a strong predictor of myocardial viability in cardiac disorders, particularly in ischemic heart diseases and myocardial infarction (MI). Regarding this, the current systematic review aimed to evaluate QT dispersion measurement as a simple and powerful prognostic indicator for predicting the risk of life-threatening arrhythmia, cardiac sudden death, and ventricular dysfunction in patients with MI. Furthermore, this study attempted to establish the reliability of QT dispersion in assessing the efficacy of reperfusion therapeutic strategies.
    Materials And Methods
    For the purpose of data collection, PubMed was searched for all prospective English trials, using keywords of “QT dispersion”, “myocardial viability”, and “myocardial infarction” or “MI”. Out of the 294 retrieved articles, seven studies met the inclusion criteria.
    Results
    QT dispersion was concluded to be instrumental in predicting the risk of post-MI life-threatening ventricular arrhythmia and cardiac sudden death, as well as assessment of ventricular wall motion and response to reperfusion therapeutic strategies.
    Conclusion
    According to the findings of the reviewed studies, QT dispersion is a reliable, simple, and applicable tool for myocardial viability assessment in patients with MI.
    Keywords: Myocardial infarction, Myocardial viability, QT dispersion