Introduction of 'Anaphylaxis Packs' to improve patient safety in a hospital setting.
Ontology highlight
ABSTRACT:
SUBMITTER: Meade S
PROVIDER: S-EPMC4652734 | biostudies-literature | 2013
REPOSITORIES: biostudies-literature
Publications
Introduction of 'Anaphylaxis Packs' to improve patient safety in a hospital setting.
Meade Susanna S Douglas Jenny J
BMJ quality improvement reports 20130227 1
Three reported episodes of anaphylaxis, where 1:1000 adrenaline was not immediately obtainable, triggered us to assess its availability on all adult wards. We found adrenaline was unavailable on 50% of audited wards. A questionnaire for doctors and nurses revealed lack of knowledge on both the management of anaphylaxis and location of emergency drugs. Given that anaphylaxis is a treatable but potentially fatal condition, we held a meeting to discuss the situation with senior pharmacists, resusci ...[more]
Similar Datasets
Project description:BackgroundCurrent "flags" for adverse events (AEs) are biased towards those with serious outcomes, potentially leading to failure to address mundane common problems.AimTo provide a basis for setting priorities to improve patient safety by ranking adverse events by resource consumption as well as by outcome. This was done by classifying a set of AEs, according to how they may be prevented, into "Principal Natural Categories" (PNCs).SettingAEs associated with a representative sample of admissions to Australian acute care hospitals.DesignAEs were classified into PNCs which were ranked by overall frequency, an index of resource consumption (a function of mean extended hospital stay and the number of cases in each PNC), and severity of outcome.ResultsThe 1712 AEs analysed fell into 581 PNCs; only 28% had more than two cases. Most resource use (60%) was by AEs which led to minor disabilities, 36% was by those which led to major disabilities, and 4% by those associated with death. Most of the events with serious outcomes fell into fewer than 50 PNCs; only seven of these PNCs had more than six cases resulting in serious outcomes.ConclusionsIf interventions for AEs are triggered only by serious outcomes by, for example, using recommended risk scoring methods, most problems would not be addressed, particularly the large number of mundane problems which consume the majority of resources. Both serious and mundane problems should be addressed. Most types of events occur too infrequently to be characterised at a hospital level and require large scale (preferably national) collections of incidents and events.
| S-EPMC1743639 | biostudies-literature
Project description:To examine the relationship between hospital volume and in-hospital adverse events.Patient safety indicator (PSI) was used to identify hospital-acquired adverse events in the Nationwide Inpatient Sample database in abdominal aortic aneurysm, coronary artery bypass graft, and Roux-en-Y gastric bypass from 2005 to 2008.In this observational study, volume thresholds were defined by mean year-specific terciles. PSI risk-adjusted rates were analyzed by volume tercile for each procedure.Overall, hospital volume was inversely related to preventable adverse events. High-volume hospitals had significantly lower risk-adjusted PSI rates compared to lower volume hospitals (p < .05).These data support the relationship between hospital volume and quality health care delivery in select surgical cases. This study highlights differences between hospital volume and risk-adjusted PSI rates for three common surgical procedures and highlights areas of focus for future studies to identify pathways to reduce hospital-acquired events.
| S-EPMC3419887 | biostudies-other
Project description:To improve the transparency of the local health care system, treatment cost was recently referenced to disease related groups. Treatment quality must be legally documented in a patient registry, in particular for the highly specialized treatments provided by neurosurgery departments.In 2013 we have installed a patient registry focused on cranial neurosurgery. Surgeries are characterized by indication, treatment, location and other specific neurosurgical parameters. Preoperative state and postoperative outcome are recorded prospectively using neurological and sociological scales. Complications are graded by their severity in a therapy-oriented complication score system (Clavien-Dindo-Grading system, CDG). Results are presented at the monthly clinical staff meeting.Data acquisition compatible with the clinic workflow permitted to include all eligible patients into the registry. Until December 2015, we have registered 2880 patients that were treated in 3959 surgeries and 8528 consultations. Since the registry is fully operational (August 2014), we have registered 325 complications on 1341 patient discharge forms (24%). In 64% of these complications, no or only pharmacological treatment was required. At discharge, there was a clear correlation of the severity of the complication and the Karnofsky Performance Status (KPS, ? = -0.3, slope -6 KPS percentage points per increment of CDG) and the length of stay (? = 0.4, slope 1.5 days per increment of CDG).While the therapy-oriented complication scores correlate reasonably well with outcome and length of stay, they do not account for new deficits that cannot be treated. Outcome grading and complication severity grading thus serve a complimentary purpose. Overall, the registry serves to streamline and to complete information flow in the clinic, to identify complication rates and trends early for the internal quality monitoring and communication with patients. Conversely, the registry influences clinical practice in that it demands rigorous documentation and standard operating procedures.
| S-EPMC5036891 | biostudies-literature
Project description:ObjectiveThe Hospital Survey on Patient Safety Culture (HSPSC) was designed to assess staff views on patient safety and has been translated and validated into several languages and settings. This study developed a Latin American Spanish version of the HSPSC for use in perioperative settings and examines its psychometric properties.MethodsAfter translation and adjustments, a web-based questionnaire was administered to all health care personnel at operating room in a public university-affiliated hospital in Popayán, Colombia. Descriptive statistics, internal reliability, confirmatory and exploratory factor analysis, and intercorrelations among survey composites were calculated.ResultsConfirmatory factor analysis showed inadequate model fit for the original 12-factor structure of the HSPSC. Rather, a 9-factor, 36-item instrument showed acceptable factor loadings, internal consistency, and psychometric properties. Five factors were formed with minor changes. Adjusted factors emerged, like "staffing and work pressure" and "supervisor/manager expectations and actions promoting patient safety," "organizational learning-continuous improvement," and "hospital management support for safety," as well as "repeated errors and perception of safety." Internal consistency for each remaining composite met or exceeded a Cronbach α value of 0.60.ConclusionsPsychometric analyses provided overall support for 9 of the 12 initial factors of patient safety culture. Our findings suggest that more validation studies need to be conducted before applying safety dimensions from the original HSPSC to perioperative settings only. By providing this initial tool, we hope to stimulate further studies and the patient safety research agenda in this part of the world.
| S-EPMC8612909 | biostudies-literature
Project description:BackgroundPatients within psychiatric rehabilitation services have multiple, complex and enduring difficulties, and are frequently described as 'treatment resistant'. This group have diagnoses of major mental health conditions, most commonly schizophrenia, often alongside a history of complex trauma, co-morbid alcohol/ substance misuse, and cognitive impairment. There is no known effective medical treatment other than Clozapine in this patient group, however, there is preliminary evidence that mindfulness can help individuals with psychosis by improving their ability to cope with stressful internal experiences. This study aimed to determine if mindfulness practice groups are an acceptable therapeutic intervention in an in-patient rehabilitation setting. The study also aimed to monitor the well-being of those who participated.MethodsMindfulness practice groups were offered three times weekly on a 15-bedded rehabilitation ward in a psychiatric hospital over 5 months, and weekly in a second ward over an 18?month period. The sessions were delivered by Clinical Psychologists in accordance with adaptations for a psychosis population. Attendance data were gathered on both wards and additional measures of well-being were collected on one ward. Qualitative interviews were conducted with a sample of patients, group facilitators, and staff, to provide supplementary information about the acceptability of the intervention.ResultsIn both wards around two thirds (65, 67%) of in-patients attended at least one group and smaller proportion (around a third) went on to attend regularly. There was no discernible impact on well-being using the Warwick-Edinburgh well-being scale. Qualitative interviews suggested a number of benefits to individuals attending as well as the potential for groups to enhance the therapeutic culture within wards.ConclusionsClinical guidelines suggest that all patients with a diagnosis of psychosis should have access to psychological therapies, but delivering psychological therapy within an in-patient rehabilitation setting can be challenging. This preliminary feasibility study suggests that mindfulness practice groups are an acceptable intervention, and that further research to look at the effectiveness of mindfulness for symptoms of treatment-resistant psychosis is both possible and merited.
| S-EPMC7305618 | biostudies-literature
Project description:Checklists have been shown to improve care and reduce morbidity and mortality in the healthcare setting.[1] Their application in safety-critical industries outside of medicine continues to offer a strong argument for their application to medicine.[2] The daily in-patient medical ward round is a complex process and includes multiple potential risks to patient safety. This project aims to evaluate the effectiveness of a ward round review checklist on one general medical ward in a district general hospital in the UK. A baseline audit was performed, examining case-notes for a set of pre-defined outcome measures relevant to patient safety. Compliance with documentation of each outcome measure was assessed prior to the introduction of a ward round checklist. This was followed by a quality improvement project through the use of PDSA cycles, with the aim of introducing and developing a ward round checklist over a nine month period. Following the introduction of a checklist, overall compliance with documentation of each outcome measure improved from 45% to 89%. In conclusion, a quality improvement project involving the introduction of a ward round checklist for daily use has resulted in improved documentation of outcome measures that are relevant to patient safety. Teamwork and leadership skills from clinicians committed to improving patient safety is essential to sustaining improvements in traditional ward round practice.
| S-EPMC4645926 | biostudies-literature
Project description:BackgroundThe Medicare Rural Hospital Flexibility Program of the 1997 Balanced Budget Act allowed hospitals meeting certain criteria to convert to critical access hospitals (CAH) and changed their Medicare reimbursement mechanism from prospective payment system (PPS) to cost-based.ObjectiveTo examine the impact of CAH conversion on hospital patient safety.Data sourceSecondary data on hospital patient safety indicators (PSIs), hospital CAH status, patient case-mix, and market variables, for 89 Iowa rural hospitals during 1997-2004.Study designWe employed quasi-experimental designs that use both control groups and pretests. The hospital-year was the unit of analysis. We used generalized estimating equations logit and random-effects Tobit models to assess the effects of CAH conversion on hospital patient safety. The models were adjusted for patient case-mix and market variables. Sensitivity analyses, which varied by sample and statistical model, were used to examine the robustness of our findings.Data extraction methodsPSIs were computed from Iowa State Inpatient Databases (SIDs) using Agency for Healthcare Research and Quality indicators software. Hospital CAH status was extracted from Iowa Hospital Association. Patient case-mix variables were extracted from Iowa SIDs. Market variables came from Area Resource File (ARF).Principal findingsCAH conversion in Iowa rural hospitals was associated with better performance of risk-adjusted rates of iatrogenic pneumothorax, selected infections due to medical care, accidental puncture or laceration, and composite score of four PSIs, but had no significant impact on the observed rates of death in low-mortality diagnosis-related groups (DRGs), foreign body left during procedure, risk-adjusted rate of decubitus ulcer, or composite score of six PSIs. Conclusion. CAH conversion is associated with enhanced performance of certain PSIs.
| S-EPMC2151405 | biostudies-literature
Project description:BackgroundEarly warning tools identify patients at risk of deterioration in hospitals. Electronic medical records in hospitals offer real-time data and the opportunity to automate early warning tools and provide real-time, dynamic risk estimates.ObjectiveThis review describes published studies on the development, validation, and implementation of tools for predicting patient deterioration in general wards in hospitals.MethodsAn electronic database search of peer reviewed journal papers from 2008-2020 identified studies reporting the use of tools and algorithms for predicting patient deterioration, defined by unplanned transfer to the intensive care unit, cardiac arrest, or death. Studies conducted solely in intensive care units, emergency departments, or single diagnosis patient groups were excluded.ResultsA total of 46 publications were eligible for inclusion. These publications were heterogeneous in design, setting, and outcome measures. Most studies were retrospective studies using cohort data to develop, validate, or statistically evaluate prediction tools. The tools consisted of early warning, screening, or scoring systems based on physiologic data, as well as more complex algorithms developed to better represent real-time data, deal with complexities of longitudinal data, and warn of deterioration risk earlier. Only a few studies detailed the results of the implementation of deterioration warning tools.ConclusionsDespite relative progress in the development of algorithms to predict patient deterioration, the literature has not shown that the deployment or implementation of such algorithms is reproducibly associated with improvements in patient outcomes. Further work is needed to realize the potential of automated predictions and update dynamic risk estimates as part of an operational early warning system for inpatient deterioration.
| S-EPMC8517822 | biostudies-literature
Project description:BACKGROUND:Telemedicine and telephone-triage may compromise patient safety, particularly if urgency is underestimated. We aimed to explore the level of safety of a pediatric telemedicine service, with particular reference to the appropriateness of the medical diagnoses made by the online physicians and the reasonableness of their decisions. METHODS:This retrospective multi-method study investigated the decision-making process of physicians in a pediatric tele-triage service provided in Israel. The first section of the study investigates several measures relating to patient safety in the telemedicine setting. Two physicians reviewed a random sample of 339 parent-physician consultations conducted via a pediatric telemedicine service provided by a healthcare organization during 2014-2017. The consultations were analyzed for factors that may have affected the online physicians' decisions, with an emphasis on the appropriateness of the diagnoses and the reasonableness of the decisions. The online physicians' decisions were also compared to the subsequent outcomes (i.e., parental compliance with the recommendations and medical follow-ups within the healthcare system) after each consultation. The second section of the study (using a qualitative approach) consisted of interviews with 15 physicians who work in the pediatric telemedicine service, in order to explore their subjective experiences and efforts for assuring patient safety. The physicians were asked about factors that may have affected their reaching an appropriate diagnosis and a reasonable decision while maintaining patient safety. RESULTS:The first section of the study demonstrates high levels of diagnosis appropriateness (98.5%) and decision reasonableness (92%), as well as low levels of false-positive (2.65%) and false-negative (5.3%), good sensitivity (82.85%), and high specificity (96.15%). A high association between the online decisions and the subsequent outcomes was also observed. The second section of the study presents physicians' means for ensuring high patient safety - by implementing a range of factors that helped them reach appropriate diagnoses and reasonable decisions. CONCLUSIONS:The results show overall high patient safety in the pediatric tele-triage service that was examined. However, decision makers must strive to implement additional means for further enhancing the clinicians' ability to reach accurate diagnoses and provide optimal treatments within the tele-triage settings - with the aim of ensuring patient safety.
| S-EPMC7126468 | biostudies-literature
Project description:Study objectivesTo assess the patient safety culture in Primary Health Care (PHC) setting after the transition to the Family Health Strategy (FHS) model in a Brazilian metropolitan area and compare the results between the categories of health care professionals.MethodsA cross-sectional study including 246 workers from primary health care services in Federal District, Brazil. Data collection took place from October to December 2019 through the Medical Office Survey on Patient Safety Culture (MOSPSC) application. Patient safety culture was considered positive when the score was above 60%. For comparisons between the categories of health care professionals', the ANOVA and Kruskal-Wallis test were used for composite percent positive scores, and Pearson's chi-square or Fishers exact test for frequency and percentage of positive responses.ResultsThe overall MOSPSC composite percent positive score was 49.9%. Among the 12 dimensions, only three showed a positive patient safety culture: Teamwork (73.1%), Organizational learning (62.9%), and Patient care tracking/follow-up (60.1%). The percentage of positive responses on overall quality assessment (78.1%) and overall patient safety assessment (78.0%) showed a positive evaluation. There was no significant difference in the composite percent positive score of overall MOSPSC (p = 0.135) and the percentage of positive responses on overall patient safety assessment (p = 0.156) between the categories of health care professionals. Overall quality assessment showed a significant difference between job roles (p < 0.001), in which nursing /health care technicians showed a significantly lower score than other job roles.ConclusionThe patient safety culture assessment showed a weakness in the patient safety in the PHC services. The MOSPSC and nine of its dimensions presented a negative safety culture assessment, regardless of the high scores in the overall patient safety and quality assessments.
| S-EPMC9321378 | biostudies-literature