Journal Of Patient safety and quality improvement
Volume:7 Issue: 4, Autumn 2019

Understanding the nature of errors and the way errors are detected by nurses has a major role in preventing and reducing complications of errors. The present study aims to investigate the nature of errors and identify factors detecting errors in the emergency department.

The present qualitative study was conducted with participation of 20 emergency department nurses according to Elo & Kyngas (2008) content analysis method. Data were collected through semi-structured in-depth interviews. Sampling began purposively and continued until data saturation was reached.

Analysis of data led to the extraction of two main categories, including nature of errors and error detectors. The nature of errors consisted of two subcategories, namely, lurking errors and indistinguishable of errors. Error detectors comprised four subcategories, namely, personal detectors, team detectors, client detectors, and organizational detectors.

The present study results showed that errors in the emergency department are vague in nature and difficult to detect. Nurses use various sources to identify errors. In the context of the present study, human sources, especially nurses and patients have a key role in identifying and detecting errors. These sources of error detection should be reinforced by health organizations.

Triage in the interactive atmosphere of the emergency department (ED) has been described as complex and challenging. The influence of nurses’ belief systems on triage decision making has not to the authors’ knowledge been addressed. This study attempted to gain an understanding of the ED nurses’ culture of practice with respect to contextual factors that affect triage decision making.

A focused micro-ethnographic study based on Spradley’s developmental research sequence (DRS) has been conducted in the emergency department of the Mashhad University hospital, Iran, from February 2014 to February 2015. Data were collected during 300 hours of participant observations that were accompanied by formal and informal interviews, then analyzed based on Spradley’s DRS.

Nine study participants were formally interviewed. From these interviews, eight core beliefs emerged related to nurses’ culture of practice: namely, triage decision making is arbitrary; the facility/locale of the emergency medicine department is the pivotal contextual factor affecting decision making; not every nurse can be assigned to triage; each patient assumes the existence of an emergency condition; the on-duty physician must be known; triage decision making must be considered plausible by colleagues; “they” tell us something, we should do something else; and triage guidelines are not practical.

Contextual factors have a strong tendency to guide triage decision making and violate the principle of patient acuity (that is, that patients with the most acute medical conditions should be prioritized). In response, triage guidelines need to integrate the priorities of patients, nurses, physicians, and administrators.

Family planning is aimed at improving the health and well-being of women, children and the family and affecting the quality of life and sexual health. Today, the quality of services has a profound effect on the economic situation. Knowing the expectations of service providers and checking the status of existing weaknesses and strength is revealed. The purpose of this study was to determine the quality of family planning services from the viewpoint of service recipients using the SERVQUAL model in Sanandaj comprehensive health centers in 2018. In this descriptive-analytical study, 384 women who received family planning services in Sanandaj comprehensive health centers were evaluated. Sampling was done by stratified random sampling. The data was collected by a SERVQUAL Questionnaire 22 pair questions with five dimensions. Data were analyzed by SPSS-23 software and descriptive statistics, t-test and ANOVA. P The results of the study showed a negative gap in all aspects of quality. The highest gap was in the dimension of empathy (-1.84) and the lowest gap in the responsiveness dimension (-1.61). There was also no significant relationship between quality gap and demographic characteristics. The existence of a gap in the five dimensions of service quality suggests that at all levels, average expectations exceeded perceptions, requiring serious efforts to improve the quality of service gap.

Death has long been considered because of its substantial impacts on population dynamics. Specifically, child mortality is one of the most important indicators of development and one of the determinants of life expectancy. Investigation of child mortality causes and elimination of preventable cases can play a major role in the health and productivity of the community.

The present research was a retrospective study in which the medical records of dead children in Children’s Hospital of Tabriz were extracted from 2011 to 2016 and their demographics were recorded in special checklists. Finally, the obtained data were statistically analyzed.

The most common causes of child mortality in the studied hospital were congenital heart defects (15%), cancer (8.8%), and other congenital anomalies (8.6%), respectively. The mortality rate for males and females was equal to 55.8% and 44.2%. In addition, the highest mortality rate was related to those aged one month to 2 years (83.8%) and then 2-7 years (10.2%), and 7-18 years (6.1%). The findings also indicated that most dead children were living in urban areas.

Maternal nutrition improvement, gestational diabetes control, vaccination improvement, and increased awareness of health sector staff can be effective in reducing genetic anomalies and deaths caused by them. Therefore, special planning should be done for interventions such as referral for genetic counseling and genetic tests before cousin marriages. Moreover, pregnant women should be trained in unnecessary drug use and non-exposure to radiation and chemicals.

In Ethiopia, the overall incidence of medication administration errors (MAEs) has been variously estimated within the range of 16% to 99%; a wide range and difficult to conclude. Thus, this study aimed to assess the pooled incidence of MAEs in Ethiopia.

A systematic literature search in the databases of Pub-Med, Cochrane, and Google Scholar were performed. The quality of study was assessed using criteria adopted from similar studies. Heterogeneity test and evidence of publication bias were assessed. Sensitivity test and trim and fill analysis was also performed. Pooled incidence of MAE was calculated using random effects model.

A total of nine studies, including a total of 46,426 medication administrations interventions, were included in this systematic review and meta-analysis. The frequently reported MAEs were wrong dose, wrong time, and wrong route. The reported error was ranged from 0.1% for wrong medication to 95.8% for omitted drug error. Overall the pooled incidence of MAE was found to be 37.9% (95% CI, 34%-41.9%). It has no evidence of significant heterogeneity (I2 = 0%, p <0.820) and publication bias from the visual inspection of funnel plot and Egger’s test (P =0.481).

The incidence of MAE was high. Wrong dose, wrong time, and wrong route were the frequently reported errors. Omission error was the most incident errors. Authors suggested to give more attentions to the rights of medication administration guide, particularly to prevent omission error.

Nowadays, patients referring to emergency department due to poisoning and its complications, make up most of the patients in emergency wards. One of the major complications of these poisonings is heart problems. With this in mind, we decided on training courses to repeat the topics and cardiovascular emergencies for toxicology assistants and other toxicology specialists.
For this study invited of clinical toxicology residents and toxicologists and forensic specialists and other specialists in toxicology ward to attend ECG training classes and cardiac emergencies. Ten people attended classes. Pre-test training with eight items was taken before the start of training. It was explained that individuals should score from 1(very poor) to 5(very strong) based on Likert. And after the end of the course, the post- test was done with the same condition.
According to the results obtained from the table and questions, we came to the conclusion that the training courses have improved results in all items and courses are required at least once a year.
It seems that cardiovascular training is repeated annually for toxicology assistants and other toxicology specialists can be helpful in remembering previous material and better treating patients in toxicology emergency.

Today, with the advances in the treatment of cardiovascular patients such as intravascular stents, cardiac valves and intraventricular pacing and heart transplantation, many patients require the use of anticoagulants such as warfarin, sprain, Plavix, osvix, Ticlopidine and other drugs. Drugs that cause warfarin toxicity can also disrupt patients' hemodynamic conditions and can be dangerous in older people with underlying diseases. This review study examines some of the most common drug interactions with warfarin. Considering the increasing use of herbal medicine by patients, the importance of educating patients on warfarin is crucial, as many of these drug interactions are dangerous and life-threatening. Due to widespread drug interactions with warfarin and comprehensive use of non-prescription drugs in our country, accurate education and training of warfarin users is of paramount importance. Today, with the advances in the treatment of cardiovascular patients such as intravascular stents, cardiac valves and intraventricular pacing and heart transplantation, many patients require the use of anticoagulants such as warfarin, sprain, Plavix, osvix, Ticlopidine and other drugs. Drugs that cause warfarin toxicity can also disrupt patients' hemodynamic conditions and can be dangerous in older people with underlying diseases. This review study examines some of the most common drug interactions with warfarin. Considering the increasing use of herbal medicine by patients, the importance of educating patients on warfarin is crucial, as many of these drug interactions are dangerous and life-threatening.

We report our experience with a modified audit tool, the modified Cappuccini test used to assess the availability and readiness of senior and expert help and supervision for trainee anaesthetists in the operating environment.
We sought to provide assurance as to the level of supervision for surgical and anaesthetic trainees within our organisation, a large tertiary centre in an urban environment. We would expect this to have a direct impact on patient safety in the operative environment and also on the training experience. We modified the Cappuccini test so that it could be used for surgical and anaesthetic trainees .Over 11 days we visited operating theatres across our institution and interviewed 195 trainees (anaesthetists and surgeons) undertaking operating lists.
96 (49.2%) anaesthetic trainees and 99 (50.8%) surgical trainees were interviewed. 166 (85.1%) trainees were being directly supervised by a consultant. 29 (14.9%) trainees were being remotely supervised without a physical consultant presence16 (55.2%) of these were anaesthetic trainees and the remainder were surgical trainees2 (6.9%) trainees stated that they were unsure who was directly supervising them. For the 29 remotely supervised trainees, we contacted 19(65.5%) supervising consultants/senior doctors all of whom were aware that they were supervising the operating list and confirmed that they were available to attend if required.
The modified Cappuccini test is a simple and helpful tool, providing assurance as to the level of and access to senior and skilled supervision in the operating theatre and with the potential to be modified and deployed in a number environments. We suggest that it is a useful proxy indicator of supervision and potentially also, patient safety in the operating theatre environment. We recommend that for operating lists which are remotely supervised, the name and method of contact for the senior supervising anaesthetist or surgeon should be explicitly stated at the beginning of each case.