فهرست مطالب

Patient safety and quality improvement - Volume:9 Issue: 2, Spring 2021

Journal Of Patient safety and quality improvement
Volume:9 Issue: 2, Spring 2021

  • تاریخ انتشار: 1400/04/15
  • تعداد عناوین: 8
|
  • Shahram Samadi, Fatemeh Alipour, Zahra Shahvari * Pages 65-71
    Introduction

    This study aimed to emphasize the challenges in the error reporting system as one of the professionalism codes in clinical settings in hospitals affiliated to Tehran University of Medical Sciences, Tehran, Iran.

    Materials and Methods

    In total, 23 focused group discussion sessions were conducted with 85 faculty members, assistants, and interns, as well as 165 staff members in 2016. The participants were selected using a purposeful sampling method. Furthermore, the views of four faculty members were gathered again via emails in 2020 to ensure data accuracy. The extracted codes were managed using conventional content analysis through MAXQDA software.

    Results

    Analysis of participants' discussions led to the identification of 105 codes, which were classified into six sub-categories and two main categories, including "barriers to reporting errors of peers " and "barriers to self-reporting errors".

    Conclusion

    Most of the non-reporting errors are due to participant’s concerns. Such concerns are generally the result of poor system management or are merely misunderstandings; accordingly, errors' addressing only requires gaining a person's trust. The seriousness of the system in persuading people to report errors is one of the most important ways to gain a person's trust.

    Keywords: Concern, Professionalism, Reporting error, Tehran University of Medical Sciences
  • Mahmoud Tavakkoli, Atena Aghaee, Saeed Eslami Hasan Abadi, Amir Yarahmadi, Ali Sharif, Salman Soltani * Pages 73-77
    Introduction
    Urinary tract stones are recognized as the third most prevalent disease in urology. Transurethral lithotripsy (TUL) is the most prevalent surgical modality for ureteral stones. Some patients experience hospital readmission and possibly another surgical intervention after TUL. The present study aimed to assess the causes and risk factors of readmission in patients with ureteral stones treated with TUL.
    Materials and Methods
    This cross-sectional study was conducted on all the patients who underwent TUL in Imam Reza Hospital in Mashhad, northeast of Iran, from March 2018 to September 2019. The case group consisted of 67 patients who were hospitalized due to primary urinary stone-related complications. The patients who were admitted for the removal of double J (DJ) catheter (n=118) were regarded as the control group.
    Results
    The most common causes of hospital readmission were re-TUL for the removal of the remnant urinary stones when patients came back for DJ catheter removal (29.9%). The second and third causes of readmission were fever after DJ catheter removal (20.9%) and fever after TUL (14.9%). The main risk factors for hospital readmission were stone size, age, and male gender.
    Conclusion
    As evidenced by the results of the present study, stone size, age, and male gender were the major risk factors for hospital readmission after TUL. The most common causes of readmission were re-TUL at the time of DJ catheter removal, fever after DJ catheter removal, and fever after TUL.
    Keywords: readmission, Risk factors, Ureteral stones, Transurethral lithotripsy
  • Ali Vafaee Najar, Seyed Saeed Tabatabaee, Elaheh Houshmand, Hosein Ebrahimipour, Hadi Zomorodi Niat * Pages 79-90
    Introduction
    This study aimed to compare the performance evaluation of a selected hospital through weighting and not weighting the indices using a hybrid approach.
    Materials and Methods
    This mixed-method study was conducted in a Specialized Hospital in Mashhad, Iran. In the group discussion sessions of the scorecard team, a list of performance indices was prepared in four perspectives using a balanced scorecard approach. The indices were selected using the Delphi method and measured in the hospital afterward. In the first method, the percentage of realization of each index was measured based on the expected value of the index in the hospital, and the overall performance score was obtained. In the second method, the weight of each perspective and index was calculated using the standard hierarchy analysis questionnaire, and the coefficient of the significance of each index and perspective was considered in hospital performance based on the expected quantity of the index. Eventually, the performance of the hospital was compared using these two methods.
    Results
    Based on the results obtained from the application of the weighting method, the processes and customer perspectives obtained the highest and the lowest scores, respectively. The score of the hospital’s performance in this method was obtained at 89.27%. However, in the method without weighting, the processes and financial perspectives obtained the highest and the lowest scores, respectively, and the score of the hospital’s performance was estimated at 82.63%.
    Conclusion
    The score of perspectives and indices will be different when the significance of perspectives and indices are ignored, which results in an incorrect (downgraded) estimation of the organization performance.
    Keywords: Analytic hierarchy process, balanced scorecard, Hospital, Performance evaluation
  • Mahtab Bayani *, Ladan Fakhriyehasl, Seyed Kazem Nezam, Baktash Bayani Pages 91-97
    Introduction
    Portal hypertension is one of the main clinical complications of chronic liver diseases. In only 30% of cirrhotic patients who take propranolol the hepatic venous pressure reduces to under 12 mm/Hg. The results of studies on efficiency of losartan, an angiotensin II receptor antagonist, in reducing portal hypertension is controversial. Hepatic venous pressure gradient (HVPG) is measured with invasive method of catheterization. Studies have shown that measuring renal resistive index (RI) by Doppler ultrasonography have direct relation with HVPG. Our study population is cirrhotic patients who referred to Ali-ibn-Abitaleb clinic in Zahedan. The study method was self-controlled clinical trial.
    Method
    Thirty cirrhotic patients with considering inclusion criteria were selected for the study. Patients treated with propranolol 10 mg twice a day for one month, then losartan was added to their drug regimen. Renal RI of patients was measured before and after losartan administration.
    Results
    The mean of renal RI for patients treated with both propranolol and losartan (0.659±0.58) was higher than the mean of renal RI for patients treated with only propranolol (0.635±0.597) (P value=0.005).
    Discussion
    Our results showed that cirrhotic patients who are under propranolol have high renal RI before and after receiving losartan, therefore it doesn`t seems that losartan is an effective drug for reducing HVPG hypertension in patients taking propranolol.
    Keywords: Portal Hypertension, Hepatic venous pressure gradient, Renal resistive index, Doppler ultrasonography, Losartan
  • Olufemi Oyebanji Oyediran *, Helen Chinyere Ofor, Emmaunel Olufemi Ayandiran, Iyanuoluwa Oreoofe Ojo Pages 99-107
    Introduction

    The study investigated the knowledge, attitude, sources of knowledge, as well as the relationship between knowledge and attitude towards patients' safety among clinical students in Obafemi Awolowo University.

    Materials and Methods

    The study adopted a descriptive cross-sectional design and 281 students were selected from the Department of Nursing Science, Medicine, Dentistry, Medical Rehabilitation and Pharmacy using a convenient sampling technique. A semi-structured questionnaire was used to collect data and the data were analyzed by using Statistical Package for Social Sciences (version 25). Data were presented with descriptive and inferential statistics.

    Results

    Findings from this study revealed that respondents' mean age was 21.56±3.20 with the majority of the respondents (65.5%) being within 20-24 years old. 68.7% of the respondents had good knowledge, 19.6% had fair knowledge and 11.7% had poor knowledge. The result also showed that more than half of the respondents ((69.4%) were taught about patient safety as part of my course of study in my department while less than half (46.3%) learnt about patient safety on their own.  The result further showed that 64.1% had a negative attitude while 35.9% had a positive attitude towards patient safety. There was a significant relationship between clinical students’ knowledge and their course of study (Chi-square value =26.90, P-value >0.01).

    Conclusion

    This study established that clinical students have a good knowledge of patient safety but with negative attitude towards patient safety. Hence, the health professionals’ educators need to integrate patient safety curriculum into the education of young health professionals.

    Keywords: Attitude, Clinical Students, Knowledge, Patient safety
  • Lydia Chowa * Pages 109-119
    Introduction
    To examine the effectiveness of a multifactorial intervention to reduce falls for elderly hospice patients who live at home and in skilled nursing facilities.
    Materials and Methods
    This pre--post intervention study was conducted in a local agency of a healthcare organization for hospice patients in California. The study included 51 hospice patients who did not object to the intervention at the local agency. The multifactorial intervention consisted of four components: (1) fall risk assessment, (2) post-fall huddle session, (3) universal fall precautions education, and (4) the 5 Ps to reduce falls for elderly hospice patients. The primary outcome was the fall rates (falls per 1,000 occupied bed days). Other outcomes included patient fall risk scores, post-fall huddle compliance, and compliance of universal fall precautions and the 5 Ps.
    Results
    The multifactorial intervention reduced the fall rates for hospice patients from 6.9 in 2017 (baseline period) to 1.7 in 2019 (implementation period) per 1,000 occupied bed days. There was 100% compliance with fall risk assessment, post-fall huddle administration, universal fall prevention documentation, 5 Ps education, and care plan initiation and modification.
    Conclusion
    The finding of this study indicated a significantly positive effect of a nurse-led multifactorial intervention on fall prevention of hospice patients cared for at home or at skilled nursing facilities. The intervention was easy to implement, cost effective, and took a very short time to complete, which would allow nursing leadership to initiate such interventions to prioritize fall prevention in every hospice healthcare organization.
    Keywords: Elderly, fall rates, hospice patients, multifactorial intervention
  • Jhessie Abella * Pages 121-128
    Introduction
    Study findings pertain to a private healthcare facility in the Eastern Region of Saudi Arabia, which highlighted its healthcare organization’s implementation of hospital-wide approach aimed at promoting culture change to enhance patient safety. Patient safety is a vital component of quality health care. Health care organizations continually strive for improvement, leading to a growing recognition of the importance of establishing a safe culture, most especially within the Kingdom of Saudi.
    Materials and Methods
    The hospital's culture of safety was investigated using a descriptive research design. The study further discusses how the hospital was able to improve the safety culture within the confines of their organization by instituting several programs which forms as the framework of the hospital’s commitment to safety. The study covers all the healthcare professional of the hospital (clinical and non-clinical) to provide their perception on the topic.
    Results
    This study yielded more than sixty percent (60%) response rate for three consecutive years which strongly supports the findings of the study. The institution’s safety culture has dramatically improved from 2017’s result of 46.4%, 58.6% (2018) and 74.4% in 2019 after engaging an organizational intervention which includes; leadership patient safety walk rounds, good catch campaign, improvement projects, adoption of lean management, continuous organization learning and development, quality accreditation and an intensified leadership support. A number of dimensions contributed to the highest perception of patient safety, including teamwork within and across units, organizational learning and continuous quality improvement, management support for patient safety, and an increase in the perception of overall patient safety culture by staff.
    Conclusion
    The result suggested that the commitment of all healthcare professionals within the organization and an active engagement of managers and executives will absolutely result to positive change in the institution’s culture of safety.
    Keywords: Best Practices, Institutional Practices, Patient Safety Culture, Safety
  • Sian Hughes * Pages 129-132
    Introduction

    The use of topical mydriatics is well described in ophthalmic surgery, one of these being phenylephrine eye drops which are available in 1%, 2.5% and 10% solutions. They are classically used to improve operating conditions but there have been recurrent concerns regarding serious adverse reactions as a direct consequence of systemic absorption.

    Case Reports:

     We present the case of a 10-year-old boy who presented for eyelid laceration repair and examination under general anaesthesia of the eye, after a severe dog bite injury. Shortly after instillation of 10% phenylephrine eye drops, the anaesthetist noticed a sudden bradycardia associated with profound hypertension. Surgery was temporarily stopped, volatile anaesthetic reduced and atropine boluses administered. Within minutes, blood pressure and heart rate normalized. The administration of the eye drops was determined to be the cause of this haemodynamic instability.

    Conclusion

    A brief literature review has enabled us to raise awareness within our department regarding this important safety concern in paediatric ophthalmic surgery, in addition to exploring management options in the case of inadvertent intravascular absorption.

    Keywords: Anaesthesia, Ophthalmic surgery, Paediatrics, Patient safety