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Patient safety and quality improvement - Volume:4 Issue: 2, Spring 2016

Journal Of Patient safety and quality improvement
Volume:4 Issue: 2, Spring 2016

  • تاریخ انتشار: 1395/02/18
  • تعداد عناوین: 8
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  • Seher, Uuml, Nver* , Zeynep Ki, Zi, Lcik., Ouml, Zkan , Hatice Merve Alptekin , Sacide Yi, Ldi, Zeli TopÇu Pages 346-350
    Introduction
    To introduce different types of foods and beverages visitors bring for postoperative patients.
    Materials And Methods
    This descriptive study was conducted on 96 visitors of postoperative patients at Trakya University Hospital in Edirne, Turkey. Data were collected in face-to-face interviews (15 min) during visiting hours (02:00-04:00 p.m.) between August and September, 2015. The questionnaire included 15 questions on demographic characteristics, patient/visitor relation, visitor's knowledge of the type of patient's surgery, date of surgery, and the onset of patient's oral intake, the selected foods and/or drinks, and cause of such selection.
    Results
    Based on the findings, 72.9% of the visitors had brought food for the patients, and soup was the most frequently selected food type (25.7%); also, 41.4% of the visitors had brought the food the patient had requested. In total, 74% of the visitors had brought drinks, with fruit juice accounting for 63.4% of the selected beverages; also, 53.5% of the visitors had brought the drink the patient had requested. By comparing the type of foods and drinks with the type and date of surgery, it was revealed that some visitors had brought pastries and biscuits for patients undergoing gastrectomy on the first postoperative day.
    Conclusion
    It is recommended to control and manage the type of food products visitors bring for the patients during visiting hours. Moreover, visitors should be instructed on how to select foods or drinks for the patients.
    Keywords: Drinks, Food, Patient safety, Surgery, Visitors
  • Seyed Mohammad Hadi Musavi, Hojjat Zeraati, Mahmoud Jabbarvand, Hadi Mokhatre, Akram Asadollahi, Hossein Dargahi* Pages 351-357
    Introduction
    Quality improvement and patient safety are the most important aspects of health care delivery systems. Improving quality and safety in health care organizations is assured through accreditation.
    To evaluate patient safety in Farabi Eye Hospital by Joint Commission International (JCI) accreditation standards for quality improvement.
    Materials And Methods
    This descriptive-analytical study was carried out in 2014. The data collection instrument was the translated version of JCI checklist, the validity of which was confirmed by a panel of Iranian experts. The data were obtained through interviews with all heads of departments (n=80) and observation of documentation in each department by appraisers in Farabi Hospital. To analyze the data, Spearman's rank correlation coefficient and Mann-Whitney U tests were run using SPSS Version 16.
    Results
    The highest rate of compliance with JCI standards was 91.1%, pertaining to infection control and adopting an approach to reduce contamination. The lowest rate was associated with management monitoring of patients’ demographic information. In general, Farabi Eye Hospital observed the standards to a high level.
    Conclusion
    Our findings exhibited that Farabi Eye Hospital is relatively efficient as to patient safety as a quality improvement factor. However, there were some shortcomings regarding some standards, which indicate deficient compliance with the JCI standards in this hospital. Absence of comprehensive training programs and defective policies and documentation are the key factors for patient safety quality improvement.
    Keywords: Accreditation, Farabi Eye Hospital, Join Commission International, Patient safety, Quality improvement
  • The Relationship between Organizational Justice and Turnover Intention: A Survey on Hospital Nurses
    Mobin Sokhanvar, Edris Hasanpoor, Soodeh Hajihashemi, Edris Kakemam* Pages 359-363
    Introduction
    High organizational justice and its factors are associated with reduced turnover intention. Therefore, in this study, we aimed to examine the relationship between organizational justice and turnover intention among hospital nurses.
    Materials And Methods
    This descriptive, analytical study was conducted on 135 nurses working in Labafi Nejad Hospital in Tehran, Iran, 2015. The data were collected using Beugre's (1998) questionnaire of organizational justice questionnaire. To analyze the data, Pearson’s correlation and ANOVA tests were performed using SPSS, version 20.
    Results
    Mean organizational justice and turnover intention scores were 68.85±7.67 and 47.8±12.47, respectively. Among the different types of organizational justice, the highest mean score was pertinent to interactional justice (75.24±16.68). A significant inverse correlation was observed between turnover intention and organizational justice (r=-0.36), interactional justice (r=-0.38), and procedural justice (r=-0.36), while no association was noted between turnover intention and systemic and distributive types of justice. Furthermore, there was no link between demographic variables, organizational justice, and turnover intention.
    Conclusion
    Considering the prominent role of organizational justice in personnel’s intention to leave their job, and given high costs of recruiting and training new staff, managers should pay especial attention to promoting justice and employees’ satisfaction and enhancing stability in their organizations by reinforcing positive attitudes in the employees.
    Keywords: Nurses, Organizational justice, Turnover intention
  • Fereydoon Laal, Babak Fazli, Davoud Balarak, Forouzan Dalir, Mahdi Mohammadi, Ramazan Mirzaei* Pages 364-369
    Introduction
    Patient Safety Culture (PSC) involves a harmonious pattern of individual and organization behaviors based on common beliefs and values. This study aimed to evaluate the attitude of healthcare providers toward PSC in the hospitals and clinics of Zabol city, Iran.
    Materials And Methods
    This descriptive cross-sectional study was conducted in 2015. Sample population consisted of the physicians, nurses, and paraclinical staff (radiologists and laboratory experts) engaged in different healthcare centers of Zabol city, Iran. Data were collected using the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire. Data analysis was performed in SPSS V.22 at the significance level of 0.05.
    Results
    In total, 231 healthcare practitioners were enrolled in this study. Participants were divided into three groups of physicians, nurses, and paraclinical staff (n=77, 33.33%). Mean of age and clinical experience was 29.94 and 6.23 years, respectively. Among the main aspects of PSC, “general understanding of patient safety” had the highest mean score (13.53), and the lowest mean score was achieved in “non-punitive response to error” (8.89). In the aspect of “manager expectations and actions promoting safety”, a significant difference was observed in the mean scores of the study groups (P=0.030). Moreover, our results showed a significant difference between the mean scores of physicians and nurses in the aspect of “openness and honesty in communication” (P=0.023).
    Conclusion
    According to the results of this study, improvement of PSC is necessary for the efficient management of hospitals and clinics. This is attainable through collaborative and instructive workshops, developing educational programs, and designing incident reporting systems.
    Keywords: Health, medical staff, hospital, Patient safety culture
  • Mohammadkarim Bahadori, Ahmad Reza Izadi*, Ramin Ravangard, Seyed Mojtaba Hosseini Pages 370-375
    Introduction
    Transformation of patient safety culture towards developing an open culture can be the greatest challenge for achieving a safe healthcare system. This study aimed to carry out a structural analysis of the Persian translation version of a questionnaire assessing patient safety culture.
    Materials And Methods
    The study was conducted to evaluate the Persian translation of patient safety culture questionnaire, developed by the National Patient Safety Agency. The questionnaire includes seven sections and 43 items investigating 12 dimensions of patient safety culture. The reliability of this questionnaire was confirmed with Cronbach's alpha (α>0.8). The questionnaire was distributed among employees of the Fatemeh Zahra Hospital in Najafabad, Iran, 2015. The collected data were analyzed using SPSS 18 and Amos 18.
    Results
    Sufficiency of the sample size, as determined by Kaiser-Meyer-Olkin measure, was 0.809, which was significantly associated with zero; therefore, performing factor analysis was acceptable and justifiable. The value of Bartlett's test was 696, P-value was less than 0.001, and degree of freedom was equal to 91. In the final model, the relative Chi-square was equal to 1.75 and P-value was less than 0.001. Also, parsimony normed fit index, parsimony-adjusted comparative fit index, and root mean square error of approximation were equal to 0.571, 0.621, and 0.065, respectively.
    Conclusion
    Based on the results of fitting indices for the model and the questionnaire used in the present study for assessing patient safety culture, it can be stated that the Persian translation of this instrument is valid and hospitals can use it to monitor patient safety culture improvement.
    Keywords: Factor analysis, hospital, Patient safety culture, Structural equation modeling
  • Mehryar Taghavi Gilani*, Alireza Bameshki, Arash Peivandi Yazdi, Reihaneh Hasanzadeh Pages 376-379
    Introduction
    Postoperative pain control plays a pivotal role in reducing postoperative complications, hospitality time, and increasing satisfaction. This study aimed to evaluate the effect of paracetamol on the pain and complications caused by gastrectomy.
    Materials And Methods
    This randomized prospective study was conducted on 60 patients (two same group) who were candidate for gastrectomy in Imam Reza Hospital of Mashhad, Iran during August-September 2015. The first group received Patient-Controlled Analgesia (PCA) with morphine only, and in the second group, paracetamol (1 gram) infused with morphine every six hours. Level of pain, morphine intake, and side effects were evaluated in both groups.
    Results
    No significant difference was observed in the four-scale score of pain in the patients (morphine group: 0.64±0.1, morphine-paracetamol group: 0.6±0.1) (P=0.72). During the first 24 hours after the surgery, the morphine group had lower consciousness level (2.3±0.2) compared to the morphine-paracetamol group (1.7±0.3) (P=0.001). Moreover, infusion of paracetamol with morphine to control the pain after gastrectomy reduced the need for morphine analgesia. Morphine intake was 21.4±7.7 in morphine group, while it was 14.3±5.8 in the morphine-paracetamol group within the first 24 hours after the surgery (P=0.001). However, this level had no significant effect on postoperative complications such as itching, nausea, and arterial oxygen saturation.
    Conclusion
    According to the results of this study, intravenous paracetamol (one gram) administered every six hours with PCA using morphine could decrease morphine intake leading to better consciousness level during the first 24 hours after gastrectomy without further complications.
    Keywords: Morphine, Paracetamol, Patient, controlled analgesia
  • Mostafa Dastani, Somaye Alirezaei* Pages 380-385
    Introduction
    The investigation of no-reflow phenomenon after Percutaneous Coronary Intervention (PCI) in patients with acute ST-segment Elevation Myocardial Infarction (STEMI) has therapeutic implications. Several vasodilators were administered through intracoronary injection to treat this phenomenon. We aimed to elucidate the risk factors, predictors, and long-term effects of no-reflow phenomenon, and to compare the effects of various vasodilators on re-opening the obstructed vessels.
    Materials And Methods
    All the reviewed articles were retrieved from MEDLINE and Science Direct (up to October 2014). All no-reflow cases were determined through Thrombolysis in Myocardial Infarction grading (TIMI) system.
    Results
    Four articles were included, two of which mainly focused on risk factors, predictors, and long-term prognosis of no-reflow phenomenon, and its association with patient mortality and morbidity. The other two articles evaluated therapeutic interventions and compared their efficacy in treating no-reflow.
    Conclusion
    Development of no-reflow in patients with STEMI after primary PCI is associated with low myocardial salvage by primary PCI, large scintigraphic infarct size, deteriorated left ventricle ejection fraction at six months, and increased risk of first-year mortality. During primary PCI, intracoronary infusion of diltiazem and verapamil can reverse no-reflow more effectively than nitroglycerin.
    Keywords: No reflow phenomenon, Risk factor, TIMI grading system, Vasodilators
  • Kambiz Alizadeh, Masoomeh Tabari* Pages 386-388
    Introduction
    Cardiopulmonary bypass in pregnant patient is considered a high-risk procedure. Maternal mortality is similar to that of the non-pregnant females about 1.5-5%. Variations in the timing of surgical intervention, gestational age, maternal health sta­­­­tus, perfusion protocol, and pharmacologic therapy are all factors that can influence fetomaternal outcome.
    Case Report: We present a case of 26- year- old pregnant woman (G1, Ab0, D0) in gestational age of 36 weeks with sudden CVA and neurological sequelae (disartheria, paresthesia of right side of face). In her past medical history, she had no positive history of neurologic problems, diabetes mellitus, hyperlipidemia or cardiovascular diseases. Left perisylvian encephalitis was reported in her brain MRI. In trans-thoracic echocardiography moderate Mitral Regurgitation (MR), severe mitral stenosis with gradient of 9mmHg, and valve surface of 1cm2 was observed. In obstetrics consultation, a healthy male fetus with approximate gestational age of 37 weeks was reported. Finally the pregnancy ended by caesarean section under general anesthesia, with presence of cardiologist and a healthy newborn was delivered at age of 37 weeks. Four days after caesarean section, Mitral Valve Replacement (MVR) was measured which proceeded successfully.
    Conclusion
    Due to the risk of further neurological complications in a pregnant mother who suffers from mitral valve stenosis, provided the gestational age permits harmless termination of pregnancy, it is possible to perform the mitral valve replacement procedure during the same hospital stay after termination of pregnancy.
    Keywords: Mitral valve replacement, Pregnancy