Journal Of Patient safety and quality improvement
Volume:9 Issue: 1, Winter 2021

Patient safety indicators (PSIs) focus on the prevention of complications and minimization of unnecessary patient risk. Using the methodology known as SMART, the most suitable indicators may be selected by the evaluation of five essential criteria (i.e., specificity, measurability, attainability, relevance, and timeliness).Therefore, the current study aimed to collect and analyze information regarding PSIs related to clinical laboratories in order to support organizations in the process of indicator selection.

The most widely accepted PSIs for clinical laboratories were identified through a literature review. The indicators were evaluated by conducting a survey on a deliberate sample of 77 laboratory professionals. The answers were analyzed in terms of the frequency of responses for sensitivity, measurability, attainability, relevance, and timeliness. The overall performance of the indicators was assessed using a composite score encompassing the five SMART criteria.

The indicators with the best overall performance were tests without internal controls, internal controls with unacceptable performance, critical values communicated in time, unacceptable performance in external controls, and requests with errors concerning patient identification. Significant differences were observed among the top-, mid-, and bottom-performing groups of indicators.

The results of the present study revealed the importance of the active participation of the professional community as an essential activity to determine the most appropriate PSIs. In the case of this study in Costa Rica, this community seems to value quality control processes and pre-analytical requirements as key indicators to monitor patient safety in clinical laboratories.

The present study aimed to assess the effectiveness of the current hospital-based electronic patient safety incident reporting system (IRS) in the improvement of patient safety in home hospitalization (HH).

Out of 6381 patient safety reports voluntarily presented by healthcare professionals in a tertiary hospital in Barcelona between 2016 and 2019, all those related to HH were analyzed.  They were characterized by incident type, description, risk and year, the ways to get notified, patient’s age, and the results of the analysis. Moreover, falls were classified depending on circumstances.

Based on the results, 68 HH incident reports were related to the following factors: use of medication (n=2), procedures (1), patient’s behavior (n=1), and falls (n=64). Regarding the damage degree, the incidents were reported as extreme risk (n=1), high (n=8), moderate (n=27),  low (29),  and very low risk (n=3). The majority of patients involved in the incidents were more than 60 years old. Out of the reported falls, 8 cases were categorized as high risk, and 32 cases reported health consequences. Moreover, 19 falls from height, 31 cases of falling while sitting or lying, and 30 incidents classified as unknown were identified.

Patient safety is a matter of great concern, especially in HH but with some differential features. The IRS can play a peculiar role in minimizing patient safety risks and promoting a safety culture. The results of the present study pointed to some frequent risks and suggested improving opportunities in HH. Nonetheless, further studies are needed to design tailored patient safety interventions in HH, as well as a tailored IRS adapted to this growing setting.

Poor medication adherence is a known preventable factor which can adversely affect   desired achievable blood pressure (BP) target. Strict control of blood pressure is essential among patients who have diabetes and hypertension (HT) in order to prevent complications. This is the first study conducted among 371diabetic patients with co-existing HT to examine the antihypertensive medication adherence in Sri Lanka to date.
 
This cross-sectional study was done in the general medical clinics of Jaffna Teaching Hospital from October 2019 to November 2019.
 
The majority (66.6%) of the patients were female. Mean age of the participants was 60.93 ± 9.77. The total mean score for modified MASES (Medication Adherence Self Efficacy Scale) was 48.1 ± 3.81. A negative correlation was noted between MASES scores and systolic (r= -0.033) and diastolic (r=- 0.083) blood pressure. Median score 49 was used to classify the patients into optimal or suboptimal adherence to antihypertensive medication. A significant percentage (43.4%CI: 38.4-48.5) of research participants were sub optimally adhered to antihypertensive medication. Among the associated factors explored, gender (P-0.007), low-income (P-0.002) and employed people (P-0.046) showed significant association with poor adherence. However, the number of co-morbidities (P-0.335), number of medications (P-0.454), duration of hypertension (P-0.440), and frequency of clinical visits (P-0.373) were not significantly associated with anti-hypertensive medication adherence.
This finding has an implication in clinical practice to improve the quality of care. Professionals should give consideration to above socio-demographic factors (gender, income, and occupation) before prescribing appropriate medication and its dosing schedule for hypertension.

Coronavirus disease 2019 (COVID-19) initially appeared in China, in December 2019 and has already evolved into a pandemic spreading rapidly throughout the world. The present study aimed to determine the relationship between hematologic and biochemical parameters associated with the mortality rate in COVID-19 infection and their correlation with smoking. This study was performed on 388 patients affected by COVID-19 who were admitted to Imam Reza Hospital in Mashhad, Iran from February 20, 2020, to May 21, 2020. The patients were within the age range of 18-94 years old, and 341 of them were nonsmokers, while 47 of them were smokers. Moreover, chronic obstructive pulmonary diseases were more frequent among smokers. The mean of initial (on admission) white blood cell (WBC) count in smokers was significantly higher than nonsmokers (P=0.015). Males were more prone to death due to COVID-19 infection than females (P=0.035). In total, 60 (15.46%) out of 388 patients died because of COVID-19, while 84.5% of them survived. The results indicated a higher WBC count among smokers. Moreover, a higher WBC count on admission was associated with higher mortality. However, hospitalization duration was not different among smokers and nonsmokers groups. It was found that higher CRP levels and hospitalization periods were associated with an increased risk of death. The COVID-19 mortality rate was higher in men, compared to women. Eventually, no significant correlation was found between smoking and the mortality of patients with COVID-19.

Medication reconciliation is the process of comparing a patient’s ordered medications to what the patient is actually taking. For several years, it has been included as part of The Joint Commission National Patient Safety Goals for improving medication safety.  Our study investigated the impact of pharmacy personnel involvement in the medication reconciliation process on a family medicine unit in a large, urban, academic medical center.
A prospective, non-randomized, cross-sectional study was conducted from November 2017 through March 2018. The number of medication discrepancies identified as well as the characteristics of the patients, types and medication classes most commonly associated with discrepancies were assessed.
Approximately 104 out of 134 or 78% of patients had at least one discrepancy at the time of admission. The most common discrepancy type was related to the electronic medical record followed by omissions, patient non-compliance and the drug being held.  The medication classes mostly commonly associated with discrepancies were over the counter medications, cardiac medications and analgesics. Of the 104 patients that had at least one discrepancy, 31 (30%) required an intervention by a member of the pharmacy team.
Pharmacy interns identified additional prescription and non-prescription medication discrepancies after the medication reconciliation process had already been completed. Involving pharmacy interns in a formal, standardized medication reconciliation process can help maintain and communicate accurate patient information.

The improvement of Patient Safety Culture (PSC) is the first step in patient immunity promotion. This study aimed to investigate the viewpoints of nurses and therapeutic staff toward PSC.

This cross-sectional study was conducted on 70 nurses and staff working at Alavi Hospital, Ardabil, Iran, in 2019. The data were collected using a patient safety culture standard questionnaire entitled "A Hospital Survey on Patient Safety Culture", which was completed by all participants. Subsequently, the collected data were analyzed in SPSS software (version 24) according to the questionnaire guideline.

According to the results, 56 (80%) and 14 (20%) participants had moderate and high levels of PSC, respectively. The highest level of respecting PSC was observed in those with work experience of up to 21 years and operating room staff. Furthermore, PSC showed a significant relationship with hospital work experience and organizational position.

The obtained results revealed the moderate level of PSC among nurses and hospital staff in Ardabil, Iran, which required future programing by hospital managers to promote PSC. Moreover, it is recommended to provide a reporting system and encourage the personnel to report the errors and modify the nurses in sections based on work loading.

The present nationwide survey was carried on new graduate nurses in Japan who were identified with difficulties in acquiring occupational skills in their first year of employment by their nursing managers. The characteristics of the nurses in their first year of employment, reported by their direct supervisors, were assessed to identify developmental disorder tendencies (DDT). The errors committed during the first year of employment were compared between the nurses with and without DDT. The level of incident aftermath, developed by the National University Hospital Council of Japan, was used for comparison. The nurses with DDT committed higher levels of clinical errors, compared to those without DDT; however, mild levels of sequential injuries were reported. The results of this study indicated that support provided to such nurses may be insufficient. Support programs particularly focusing on DDT may reduce the clinical errors committed by new graduate nurses. Additionally, the determination of specific tendencies contributing to clinical errors is warranted.

Transient hypotension has been commonly associated with metoclopramide hydrochloride, particularly with intravenous use. However, the risk of sustained hypotension that lasts for hours has not been previously associated with metoclopramide, except for one published.

case report:

This case report is aimed at documenting the second case of unusual and serious sustained hypotension that lasted for more than six hours following rapid intravenous use of metoclopramide prescribed for the prevention of cesarean section delivery related intra/postoperative nausea and vomiting. Case Report: A 33-year-old gravida III and para II woman was admitted to a hospital for an elective cesarean section delivery with normal baseline blood pressure. Following metoclopramide 10 mg intravenous push administration, over 5-10 seconds, the mother encountered sustained hypotension (60/40 mmHg) that lasted for 120 minutes. After resuscitation, her blood pressure raised to 105/60 mmHg. However, after spinal anesthesia with bupivacaine hydrochloride, her diastolic arterial blood pressure dropped back again to 40 mmHg which persisted for about six hours post-operation. Upon investigation, the sustained hypotension was found to be probably related to inappropriate and rapid administration of intravenous bolus dose of metoclopramide hydrochloride that could have been prevented since it should be administered slowly over at least three minutes.

The risk of metoclopramide-induced hypotension should not be underestimated as it sometimes might be much severe than the risk of nausea and vomiting that warrants immediate attention from healthcare professionals and program managers.