فهرست مطالب

  • Volume:8 Issue: 1, 2020
  • تاریخ انتشار: 1399/02/01
  • تعداد عناوین: 8
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  • Azra Alizadeh *, Milad Eshkevari, Mohammad Reza Pashaei, Mustafa Jahangoshai Rezaee Pages 3-12
    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.
    Keywords: Elective surgery cancellation, Fuzzy failure mode, effects analysis, Quality Improvement, Operating room, Patient-facing risk assessment
  • Indira, Puspita Prihartono *, Adik Wibowo Pages 13-23
    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.
    Keywords: Incident reporting, medication administration error, nurse
  • Chioma Akuchukwu Okafor *, Ime Okon, Anthony Ugwu, Emmanuel Chukwuemeka Pages 25-30
    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.

    Keywords: health institution, Leadership, patient, Radiodiagnosis, Safety culture
  • Morteza Talebi Doluee, Sayyed Majid Sadrzadeh, Elnaz Vafadar, Moradi *, Hamid Zamani Moghadam, Sanaz Javdani Pages 31-36
    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.
    Keywords: Intubation, Gastrointestinal hemorrhage, Tranexamic acid
  • Jila Najafpour, Fatemeh Keshmiri, Soosan Rahimi, Zahra Bigdeli, Parastoo Niloofar, Abbas Homauni * Pages 37-43
    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.
    Keywords: Emotional intelligence, Nursing care, Tehran University of medical sciences Hospitals
  • José Sousa Vale *, João Miranda, Joana Sousa Nunes, Mariana Veiga Pages 45-52
    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.

    Keywords: Breast Feeding, Infant formula, Milk Banks, Low birth weight, Very low birth weight
  • Marjo Kervinen *, Kaisa Haatainen Pages 53-63
    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.
    Keywords: Organizational improvement, Patient safety, Preventable adverse events
  • Elnaz Vafadar Moradi *, Hamid Reza Mokhtari, Sayyed Majid Sadrzadeh, Behrang Rezvani Kakhki Pages 65-67
    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.

    Keywords: Aluminum Phosphate, Inhalation, Hemorrhage Poising