Causal Inference and Analysis of Surgery Cancellation Risks
Azra
Alizadeh
Department of Internal Medicine, Urmia University of Medical Sciences, Urmia, Iran.
author
Milad
Eshkevari
Faculty of Industrial Engineering, Urmia University of Technology, Urmia, Iran.
author
Mohammad Reza
Pashaei
Department of Gastroenterology, Urmia University of Medical Sciences, Urmia, Iran.
author
Mustafa
Jahangoshai Rezaee
Faculty of Industrial Engineering, Urmia University of Technology, Urmia, Iran.
author
text
article
2020
eng
Introduction: The provision of services in hospitals is the final level of the health care system chain, which usually provides the patients with advanced medical services, such as surgery. On the other hand, the cancellation of elective surgeries is one of the problems, which reduces the quality of service delivery and decreases hospital's efficiency and patients' satisfaction followed by increases in patients' costs. This study presented an approach based on a fuzzy inference system to better assess these hazards and eliminate the related risks and investigate effective factors in the cancellation of elective surgeries. Materials and Methods: The present study conducted a case study in Shahid Arefian Hospital Urmia, Iran, during 2016-2017. Principal factors of surgery cancellations were collected from surgery documents in the hospital. These factors were divided into five classes, including paraclinical, clinical, systematic, surgeon, and patient. The hazards identified in these classes caused surgery cancellation. They were identified using the contribution of an expert team, including operating room supervisors, female and male surgery hospitalization supervisors, as well as two physicians. Results: According to the results, the proposed approach was more appropriate for creating discrimination between surgery cancellation hazards, compared to the traditional risk priority number (RPN) method. Surgeon fatigue, high PPT and PT, and airway problems were the first to third important hazards with RPNs equal to 120, 105, and 96, respectively. On the other hand, according to obtained results, not having internal medicine specialist counseling, low thyroid stimulating hormone, and unavailability of beds at intensive care units were three important and priority potential hazards with FRPNs equal to 8, 8, and 6, respectively. Conclusion: The proposed approach can better map hospital experts’ opinions to the fuzzy-based risk assessment system since it employs linguistic variables by hospitals’ experts, compared to conventional approaches. Moreover, it can help the hospital managements apply hospital resources to maximise their impacts on improving hospital efficiency.
Journal of Patient Safety & Quality Improvement
Mashhad University of Medical Sciences
2345-4482
8
v.
1
no.
2020
3
12
https://psj.mums.ac.ir/article_15169_040ae77f9ce1d9b00d0c593a06df1b50.pdf
dx.doi.org/10.22038/psj.2020.38946.1218
Assessment of Medication Administration Error Reporting Among Hospital Nurses in Indonesia
Indira- Puspita
Prihartono
Health Administration and Policy, Faculty of Public Health, University of Indonesia, Depok, Indonesia
author
Adik
Wibowo
Health Administration and Policy, Faculty of Public Health, University of Indonesia, Depok, Indonesia
author
text
article
2020
eng
Introduction: Nurses play a vital role in the maintenance and promotion of patient safety, as well as medication administration in hospitals. In one small state government-owned hospital in South Jakarta, medication errors were the most reported type of patient safety incidents accounting for 52.5% of incidents which occurred within 2016 to September 2018. Nonetheless, only a small percentage (9.25%) of those reports was presented by nurses. The present study aimed to determine the factors associated with medication administration error (MAE) reporting among nurses. Materials and Methods: A cross-sectional study, followed by qualitative research, was conducted at a state government-owned hospital in Jakarta Indonesia within November 2018-April 2019. Total sampling was used to obtain the 44 clinical nurses included in the quantitative study. The qualitative study used focus group discussion and in-depth interviews of selected informants. Results: Consequences of reporting was found to be correlated with MAE reporting among nurses (P=0.013). There was no statistically significant organizational factor or socio-demographic characteristic associated with medication administration error reporting. Through qualitative measures, the factors that most influenced and inhibited error reporting included administrative response and the consequences of reporting. Moreover, managers’ support, understanding and self- awareness of the importance of reporting, and a non-blaming culture were recognized as the factors which support error reporting. Conclusion: As evidenced by the obtained results, medication administration error reporting is still low. Reporting incidents can be improved by fostering a non-blaming safety culture. Further studies are recommended to investigate the occurrence of medication errors, as well as reported errors.
Journal of Patient Safety & Quality Improvement
Mashhad University of Medical Sciences
2345-4482
8
v.
1
no.
2020
13
23
https://psj.mums.ac.ir/article_15204_23d0994d0f3d9843f613fbe7830fff70.pdf
dx.doi.org/10.22038/psj.2020.43466.1244
Impact of Leadership Style on Patient Safety Culture in the Department of Radiodiagnosis
Chioma
Akuchukwu-Okafor
Nnamdi Azikiwe University Teaching Hospital, Nnewi Anambra State ,Nigeria.
author
Ime
Okon
Uyo Teaching Hospital Cross River, Nigeria.
author
Anthony
Ugwu
Nnamdi Azikiwe University Faculty of Health sciences and Technology, Okofia campus NNewi.
author
Emmanuel
Chukwuemeka
Nnamdi Azikiwe University, Awka
author
text
article
2020
eng
Background: Healthcare organisation is a high reliability establishment hence, tackles safety on daily basis. To achieve the desired level of safety, leaders need to work and behave in a way to make it a priority. This is because leadership principles have a relationship with patient safety culture. Objective: To assess the impact of leadership style on patient safety culture in Radiodiagnosis. Materials and Method: This study was carried out among 80 health workers in Radiodiagnostic department of two tertiary health institutions. Two adopted questionnaires were used to collect data. Leadership style was assessed from subordinates’ perspective so questionnaires on leadership style were administered to 76 out of the 80 enrollees; excluding to 4 leaders in both units of the study areas. All enrollees were given questionnaires on patient safety culture to fill. The impact of leadership styles on patient safety culture was determined using Chi-square test of association, Results: Transformational and lassiez faire leadership styles have no significant association with all the domains of patient safety culture. Transactional leadership style shows a significant association with two domains of patient safety culture. However, it does not have a significant association with other domains of patient safety culture. An overall chi-square analysis shows that no significant association exists between patient safety culture and transformational (p= 0.156), transactional (p= 0.156) and lassiez faire (p= 0.659) leadership styles. Conclusion: There is no significant association between any of the leadership styles and culture of patient safety. Keywords: Leadership, Patient, safety culture, Radiodiagnosis, Health Institution.
Journal of Patient Safety & Quality Improvement
Mashhad University of Medical Sciences
2345-4482
8
v.
1
no.
2020
25
30
https://psj.mums.ac.ir/article_15207_b98e121c99772df2b499412545f8a4a2.pdf
dx.doi.org/10.22038/psj.2020.41439.1236
Evaluation of Tranexamic Acid Effect on Consequences of Upper Gastrointestinal Bleeding in Patients Referring to the Emergency Department; a Randomized Clinical Trial
Morteza
Talebi doluee
Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
author
Sayyed Majid
Sadrzadeh
Department of Emergency Medicine. Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
author
Elnaz
Vafadar-Moradi
Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran
author
Hamid
Zamani moghadam
Department of Emergency Medicine, Faculty Of Medicine, Mashhad University of Medical science , Mashhad, Iran
author
Sanaz
Javdani
Department of Emergency Medicine, Faculty Of Medicine, Mashhad University of Medical science , Mashhad, Iran
author
text
article
2020
eng
Introduction: Upper gastrointestinal bleeding is one of the major and emergent causes of mortality and morbidity around the world. The tranexamic acid has been raised since years ago as a therapeutic intervention. Therefore, prize of exact and timely treatment of upper gastrointestinal bleeding, the present study aimed to evaluate the effects of systemic tranexamic acid on the possible consequences of upper gastrointestinal bleeding such as need for blood transfusion, admission in intensive care unit (ICU), surgery to control bleeding or eventually short-term mortality. Materials and Methods: This double-blind randomized clinical trial included 88 patients with upper gastrointestinal bleeding in a referral academic gastrointestinal center. Patients with symptoms of upper gastrointestinal bleeding referred to the emergency department were randomly divided into two groups: intervention group (n=45) who treated with tranexamic acid in addition to receive standard therapy for upper gastrointestinal bleeding, and control group (n=43) treated with standard therapy for upper gastrointestinal bleeding and placebo (distilled water). Results: Administration of tranexamic acid along with the standard therapy for upper gastrointestinal bleeding in the intervention group caused reduction in mortality and recurrent bleeding compared to the control group. There is no difference between two groups in need for surgery, hemotransfusion and ICU admission. Conclusion: Due to the beneficial effects of tranexamic acid administration on reducing mortality and bleeding recurrence in patients with upper gastrointestinal bleeding, added this drug to the standard therapy may have a favorable potential for upper gastrointestinal bleeding.
Journal of Patient Safety & Quality Improvement
Mashhad University of Medical Sciences
2345-4482
8
v.
1
no.
2020
31
36
https://psj.mums.ac.ir/article_15308_006289b4b575f4cc45cc3f4caa5c2ad1.pdf
dx.doi.org/10.22038/psj.2020.43904.1246
Effect of Emotional Intelligence on the Quality of Nursing Care from the Perspectives of Patients in Educational Hospitals
Jila
Najafpour
School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, Tehran, Iran.
author
Fatemeh
Keshmiri
Educational Development Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
author
Soosan
Rahimi
School of Allied Medical, Tehran University of Medical sciences, Tehran, Iran.
author
Zahra
Bigdeli
School of Allied Medical, Tehran University of Medical sciences, Tehran, Iran.
author
Parastoo
Niloofar
Department of Epidemiology and Biostatistics, Tehran University of Medical sciences, Tehran, Iran.
author
Abbas
Homauni
School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, Tehran, Iran.
author
text
article
2020
eng
Introduction: Nurses often work in stressful environments and it is widely accepted that emotions can exert profound effects on the quality of care in hospital settings. Therefore, the impact of emotional intelligence on the performance of nurses has been the focus of numerous studies. The present study aimed to assess the relationship between emotional intelligence and quality of nursing care from the perspectives of patients in hospitals affiliated to Tehran University of medical sciences. Materials and Methods: The current descriptive-analytic cross-sectional study was conducted on nurses and patients in four selected hospitals affiliated to Tehran University of medical sciences in 2016. Sample size was based on sample size formula in nurses with limited population and patients with unlimited population with 95% confidence level. Finally, a total number of 300 nurses and 270 patients were selected. Data collection tools included standardized Emotional Intelligence Questionnaire and Parasuraman Questionnaire (hospital quality assessment). Results: The best score of nurses’ emotional intelligence was reported in the social self- awareness domain (3.9), while the lowest score was detected in self- motivation domain (3.02). In general, it can be concluded that emotional intelligence in nurses was higher than average with 3.2. The results of the present study indicated that there was no significant relationship between emotional intelligence and the quality of nursing care in selected hospitals. Conclusion: As evidenced by the obtained results, there is a significant relationship between some aspects of the quality of hospital services (e.g., sympathy, assurance, and tangible) and emotional intelligence. Nonetheless, a significant relationship was not confirmed between nurses’ emotional intelligence and the quality of hospital services.
Journal of Patient Safety & Quality Improvement
Mashhad University of Medical Sciences
2345-4482
8
v.
1
no.
2020
37
43
https://psj.mums.ac.ir/article_15309_95a18b9ca11ca2ee204608f40c4cfd2f.pdf
dx.doi.org/10.22038/psj.2020.41216.1233
Human Milk Banks: A Narrative Review
José-Sousa
Vale
ARSLVT, USF Marginal - R. Egas Moniz 9010, Piso 2, 2765-618 São João do Estoril, Lisboa, Portugal.
author
João
Miranda
Serviço Pediatria Centro Hospitalar Vila Nova Gaia/Espinho - R. Conceição Fernandes 1079, Vila Nova de Gaia, 4434-502 Vila Nova de Gaia.
author
Joana-Sousa
Nunes
Serviço Ginecologia/Obstetrícia Hospital Senhora da Oliveira Guimarães, R. dos Cutileiros 114, Creixomil, 4835-044 Guimarães.
author
Mariana
Veiga
Serviço de Ginecologia/Obstetrícia Hospital de Cascais Dr. José Almeida - Avenida Brigadeiro Victor Novais Gonçalves 2755-009 Alcabideche.
author
text
article
2020
eng
Introduction: Not all mothers can provide sufficient milk, and infants admitted to a neonatal ward are less likely to be exclusively breastfed. Current recommendations are for the use of mother’s own milk (MOM), and pasteurized donor human milk (PDHM) is the next best choice. The present article was prepared as a tool to study the optimal organization of Human milk banks (HMB) and to contribute to the diffusion of the culture and promotion of breastfeeding and summarize current best practices for the handling of PDHM. Materials and Methods: PubMed, Embase and Cochrane were searched using the search term combination “human milk banks” OR “pasteurized donor human milk”. Results: HMB are responsible for human milk (HM) promotion, collection, processing, protection, quality control, distribution and support. The quality of expressed HM is the result of adequate hygienic-sanitary conditions, from expression to administration, and the evaluation of nutritional, immunological, chemical, and microbiological characteristics. It is essential a multidisciplinary team to support an HMB. Conclusion: In settings where donor HM supplies are limited, prioritization of infants by medical status is key. The manner in how investments in human milk feeding are applied should be targeted. The purchase cost of PDHM should be compared with the purchase costs of other nutrition interventions routinely used in care for critically ill neonates.
Journal of Patient Safety & Quality Improvement
Mashhad University of Medical Sciences
2345-4482
8
v.
1
no.
2020
45
52
https://psj.mums.ac.ir/article_15310_eeb97f14da6598e61f32506561feca0a.pdf
dx.doi.org/10.22038/psj.2020.42356.1239
Risk and Preventability of Adverse Events at a Finnish Tertiary Hospital Using Modified Global Trigger Tool
Marjo
Kervinen
Kuopio University Hospital, Medical Center, Kuopio, Finland.
author
Kaisa
Haatainen
Kuopio University Hospital, Medical Administration, Kuopio, Finland and University of Eastern Finland, Kuopio campus, Kuopio, Finland.
author
text
article
2020
eng
Objective: To evaluate the risk and preventability of adverse events (AEs) at a 600-bed, tertiary teaching hospital in Kuopio, Finland. Material and methods: The review of patient records was organized using the Institute for Healthcare Improvement’s Global Trigger Tool which was modified so that patient's point of view was emphasized. A bi-monthly random sample of hospital charts was selected between October 2014 and April 2016. The association with AEs of factors such as patients' age, sex, emergency vs. elective admission, multimedication, nursing care intensity raw points and categorized reasons for arrival were studied. A binary logistic regression model was employed to evaluate the risk of AEs. Result: We found 140 AEs / 1000 patient days and 91 AEs / 100 admissions. Overall, 46 % of hospital admissions (n=305) had an AE. Nursing care intensity raw points influenced the incidence of AEs (OR 1.238, P<0.001), and multimedication (OR 2.897, P=0.001) and nursing care intensity (OR 1.158, P=0.008) predicted preventable AEs. The incidence of all and preventable AEs were significantly influenced by age group (≥65-year vs younger, OR 2.303, P Conclusion: Focusing on the patient's point of view, we found a high number of AEs in the study population. The risk for AE was influenced by age group ≥65 years and high nursing care intensity, especially in internal medicine/pulmonology and oncology. Efforts should be focused on these patients to improve patient safety.
Journal of Patient Safety & Quality Improvement
Mashhad University of Medical Sciences
2345-4482
8
v.
1
no.
2020
53
63
https://psj.mums.ac.ir/article_15243_9178d90b564de76d9b53c45d54c21015.pdf
dx.doi.org/10.22038/psj.2020.42781.1241
Hemoptysis and Upper Gastrointestinal Bleeding In Two Patients Presenting With Aluminum Phosphate Intoxication (Oral and Inhaled): A Case Study
Elnaz
Vafadar Moradi
Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran
author
Hamid Reza
Mokhtari
Department of Emergency Medicine. Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
author
Sayyed Majid
Sadrzadeh
Department of Emergency Medicine. Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
author
Behrang
Rezvani Kakhki
Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran
author
text
article
2020
eng
Introduction: The inhalation of aluminum phosphate and ingestion of aluminum phosphate tablets lead to clinical toxicity with different and nonspecific clinical symptoms. Two patients referred to Imam Reza Hospital Poisoning Emergency Center of Mashhad, Iran, one of whom was a 28-year-old male with oral consumption of four aluminum phosphide tablets, and the second case was a 29-year-old woman who was poisoned by inhalation. Both cases had symptoms of pulmonary and upper gastrointestinal bleeding during the brief hospitalization that resulted in their mortalities. Case Report: The first case is a 29-year-old man who consumed four oral tablets about 1.5 h before referral. He was intubated with the evidence of hemoptysis and upper gastrointestinal bleeding after about 4 h. The second patient is a young woman who had abdominal pain, nausea, and vomiting since the day before referral, and she told that she did not have any underlying diseases. During stabilization and patient evaluation, she suddenly became unresponsive with asystole. The CPR started with the evidence of hemorrhage within the intubation tube. Conclusion: There are currently no studies or reports of hemorrhagic complications in patients. In these two cases, there was no evidence of pulmonary hemorrhage and upper gastrointestinal bleeding which warrants further investigation and evaluation considering that these patients were young and with no underlying disease.
Journal of Patient Safety & Quality Improvement
Mashhad University of Medical Sciences
2345-4482
8
v.
1
no.
2020
65
67
https://psj.mums.ac.ir/article_15206_a25d76750da3c9cfd05832f132db3735.pdf
dx.doi.org/10.22038/psj.2020.46055.1261