This document summarizes a presentation given at a patient safety conference about implementing a "just culture" approach at Tawam Hospital in the United Arab Emirates. It discusses adopting the Comprehensive Unit-based Safety Program (CUSP) to assess safety culture, educate staff, and improve communication and teamwork. Initial surveys found room for improvement in safety attitudes. CUSP was expanded to more units over time and subsequent surveys showed increases in positive safety culture scores. Infection rates like CLABSI declined as well. The presentation highlights challenges faced and lessons learned from the culture change journey.
CLINICAL GOVERNANCE SYSTEMS - AS A TOOL FOR IMPROVING PATIENT SAFETY Ruby Med Plus
This essay explores how Clinical governance as a process is interpreted,
understood and practiced for improving the quality of patient care and Patient
safety.
Specific Objectives-
1. To give an overview of corporate governance and Clinical governance and
to focus on Definition, principles, need, components, key features and
benefits of Clinical governance.
2. To Understand the principles and Pre-requisites of Governance and
clinical governance.
3. To comprehend Power Culture, Quality Assurance, Clinical Audit, and
Clinical Governance.
4. To analyse decision making, safety culture, Integrated pathways,
informed consent, right clinical information, Acrediation and Clinical
Governance.
Medication Administration Errors at Children's University Hospitals: Nurses P...iosrjce
Medication administration errors(MAE) can threaten patient outcomes and are a dimension of
patient safety directly linked to nursing care. Children are particularly vulnerable to medication errors because
of their unique physiology and developmental needs.
Aims: The present study aims to examine types, stages and causes of medication errors. Barriers of medication
administration errors reporting and its facilitator at pediatric University hospitals from nurses point of view.
Methods: A descriptive study was conducted in Pediatric intensive care units, medical, surgical and urology
ward of children's university hospital at Mansoura University, intensive care units, kidney dialysis at
Abouelrash pediatric hospital and general wards of Elmonaira at Cairo University Hospitals. 80 nurses were
included in the study after fulfilling the criteria of selection. A structured interview questionnaire that consists
of four sections was used.
Results: The highest types of medication errors as reported by studied nurses occurred when the medication is
delivered by the wrong route, the highest stage of medication errors done by nurses was missing of medication
then patient monitoring and administration and the highest cause of medication errors was due to heavy
workload. The results of this study indicated that the strongest perceived barriers to medication administration
errors reporting were fear from consequences of reporting, then managerial factor and then the process of
reporting from the nurse's viewpoint. The nurses agree that identifying benefits of reporting followed agree that
feeling safe about working environment, and agree that good professional relationship with physicians was the
most facilitating factors of reporting medication errors.
Conclusions: It was concluded that medication errors result from interrelated factors, the strongest perceived
barriers to medication administration errors reporting were fear from consequences of reporting, and good
relationship with nurse managers and physicians were the most facilitators of reporting medication errors.
Recommendation: The study recommended that the assessment of medication errors should be done
periodically and in- service training program about medication administrations should be applied
CLINICAL GOVERNANCE SYSTEMS - AS A TOOL FOR IMPROVING PATIENT SAFETY Ruby Med Plus
This essay explores how Clinical governance as a process is interpreted,
understood and practiced for improving the quality of patient care and Patient
safety.
Specific Objectives-
1. To give an overview of corporate governance and Clinical governance and
to focus on Definition, principles, need, components, key features and
benefits of Clinical governance.
2. To Understand the principles and Pre-requisites of Governance and
clinical governance.
3. To comprehend Power Culture, Quality Assurance, Clinical Audit, and
Clinical Governance.
4. To analyse decision making, safety culture, Integrated pathways,
informed consent, right clinical information, Acrediation and Clinical
Governance.
Medication Administration Errors at Children's University Hospitals: Nurses P...iosrjce
Medication administration errors(MAE) can threaten patient outcomes and are a dimension of
patient safety directly linked to nursing care. Children are particularly vulnerable to medication errors because
of their unique physiology and developmental needs.
Aims: The present study aims to examine types, stages and causes of medication errors. Barriers of medication
administration errors reporting and its facilitator at pediatric University hospitals from nurses point of view.
Methods: A descriptive study was conducted in Pediatric intensive care units, medical, surgical and urology
ward of children's university hospital at Mansoura University, intensive care units, kidney dialysis at
Abouelrash pediatric hospital and general wards of Elmonaira at Cairo University Hospitals. 80 nurses were
included in the study after fulfilling the criteria of selection. A structured interview questionnaire that consists
of four sections was used.
Results: The highest types of medication errors as reported by studied nurses occurred when the medication is
delivered by the wrong route, the highest stage of medication errors done by nurses was missing of medication
then patient monitoring and administration and the highest cause of medication errors was due to heavy
workload. The results of this study indicated that the strongest perceived barriers to medication administration
errors reporting were fear from consequences of reporting, then managerial factor and then the process of
reporting from the nurse's viewpoint. The nurses agree that identifying benefits of reporting followed agree that
feeling safe about working environment, and agree that good professional relationship with physicians was the
most facilitating factors of reporting medication errors.
Conclusions: It was concluded that medication errors result from interrelated factors, the strongest perceived
barriers to medication administration errors reporting were fear from consequences of reporting, and good
relationship with nurse managers and physicians were the most facilitators of reporting medication errors.
Recommendation: The study recommended that the assessment of medication errors should be done
periodically and in- service training program about medication administrations should be applied
The best way to enhance patient safety is to build a culture of safety at the hospital. The Johns Hopkins Hospital Comprehensive Unit-based Safety Program (CUSP)
HRSA Comprehensive Geriatric Education Grant Posternomadicnurse
This grant funds a Clinical Nurse Specialist position to work with current Gerontological CNS in providing education, mentoring / support, developing / measuring outcomes for knowledge, practice change and patient outcomes by:
Expanding NICHE training at Piedmont Hospital in Atlanta beyond Acute Care nurses to include Emergency Department nurses;
2) Introducing NICHE training at Piedmont Fayette, Piedmont Newnan and Piedmont Mountainside for Acute Care and Emergency Department nurses;
3) Introducing NICHE training for nursing staff at two of our Long-Term Care facility partners; and
4) Disseminating program materials and information to other healthcare entities throughout Georgia and the U.S. through local workshops and presentations at national healthcare conferences.
Strategic priorities in Patient Safety. Philip Hassen. IV International Conference on Patient Safety. (Madrid, Ministry of Health and Consumer Affairs, 2008)
[HOW TO] Create High Performance Emergency DepartmentsEmCare
EmCare’s latest White Paper on implementing a system-wide approach to providing emergency care. At Baylor Health Care System, the initiative has fostered the development of numerous approaches to managing the challenges faced by its emergency departments, including an innovative protocol to manage overcrowding at the system’s flagship facility.
Clinical Governance Presentation by Michael Gorton AM - 21 July 2016Russell_Kennedy
Clinical governance in the health sector. This presentation covers the issues of liability, accountability, risk management and compliance that all health organisations must address.
Evidence demonstrates that communication is one of the leading contributors to adverse events. Transitions of care epitomize this challenge.
WATCH ON DEMAND: https://goo.gl/M1ovsS
Accident Investigations - Blame and Shame or Listen and Learn? SAMTRAC International
Are all accidents preventable? Steve Woodward walks NOSHCON 2015 attendees through the seven delusions under which safety officials function, and challenges outdated, unsafe habits.
The best way to enhance patient safety is to build a culture of safety at the hospital. The Johns Hopkins Hospital Comprehensive Unit-based Safety Program (CUSP)
HRSA Comprehensive Geriatric Education Grant Posternomadicnurse
This grant funds a Clinical Nurse Specialist position to work with current Gerontological CNS in providing education, mentoring / support, developing / measuring outcomes for knowledge, practice change and patient outcomes by:
Expanding NICHE training at Piedmont Hospital in Atlanta beyond Acute Care nurses to include Emergency Department nurses;
2) Introducing NICHE training at Piedmont Fayette, Piedmont Newnan and Piedmont Mountainside for Acute Care and Emergency Department nurses;
3) Introducing NICHE training for nursing staff at two of our Long-Term Care facility partners; and
4) Disseminating program materials and information to other healthcare entities throughout Georgia and the U.S. through local workshops and presentations at national healthcare conferences.
Strategic priorities in Patient Safety. Philip Hassen. IV International Conference on Patient Safety. (Madrid, Ministry of Health and Consumer Affairs, 2008)
[HOW TO] Create High Performance Emergency DepartmentsEmCare
EmCare’s latest White Paper on implementing a system-wide approach to providing emergency care. At Baylor Health Care System, the initiative has fostered the development of numerous approaches to managing the challenges faced by its emergency departments, including an innovative protocol to manage overcrowding at the system’s flagship facility.
Clinical Governance Presentation by Michael Gorton AM - 21 July 2016Russell_Kennedy
Clinical governance in the health sector. This presentation covers the issues of liability, accountability, risk management and compliance that all health organisations must address.
Evidence demonstrates that communication is one of the leading contributors to adverse events. Transitions of care epitomize this challenge.
WATCH ON DEMAND: https://goo.gl/M1ovsS
Accident Investigations - Blame and Shame or Listen and Learn? SAMTRAC International
Are all accidents preventable? Steve Woodward walks NOSHCON 2015 attendees through the seven delusions under which safety officials function, and challenges outdated, unsafe habits.
Most frameworks involving a “culture of safety” place patients at the center of the care delivery model (Sammer & James, 2011). In view of health policy, Ostrom (2007) stated that frameworks are meant to organize inquiry through identification of elements and potential relationship, but not intended to specifically test, explain, or predict behavioral outcomes or strengths of association as theory would test. In the healthcare setting patients occupy the center prominence of our safety efforts; however, we offer that care providers play an equally important role in optimizing patient safety and caregivers hold a position of equivalent actors in such frameworks. Furthermore, extrinsic factors such as government agencies are at times excluded in these discussions and some frameworks are structurally complex making it difficult for end users to retain, remember, and apply concepts consistently in practice.
Although a culture of safety is serious business (Denham, 2007a), it does not have to be implemented with a grim face. Joy and spirit of caregiving is also linked to patient safety. Joy comes from witnessing successful patient outcomes, and seeing the patient and family experiences of their healing journey (Hinz, 2011). Leape (2013) offers that joy and meaning will be created when the care providers feel valued, safe from harm, and being part of the solutions for change.
How then do we approach a complex system framework, such as patient safety, with a program that is meaningful, sustainable, and consistently recognizable, if not marketable, to the bedside caregivers? We have found that correlation of thoughts plays a significant role in retention and recognition of information for our multicultural staff. Gigerenzer (2007) posited that the strength of recognition surpasses that of simple recall in humans. When recall memory is impaired, recognition memory often remains (Gigerenzer, 2007, p. 111).
One way to strengthen recognition and information recall is through the use of mnemonics (Bakken & Simpson, 2011). Mnemonics encode complex information in which unfamiliar information to be learned is linked with known information, pictures, or symbols (Bakken & Simpson, 2011). Visual cues and auditory reminders enhance meaningfulness of new information and promote overall strength of association between novel learning and known or familiar patterns (Mastropieri, 1988).
Professional Association MembershipExamine the importance ofdavieec5f
Professional Association Membership
Examine the importance of professional associations in nursing. Choose a professional nursing organization that relates to your specialty area, or a specialty area in which you are interested. In a 750-1,000 word paper, provide a detailed overview the organization and its advantages for members. Include the following:
Describe the organization and its significance to nurses in the specialty area. Include its purpose, mission, and vision. Describe the overall benefits, or "perks," of being a member.
Explain why it is important for a nurse in this specialty field to network. Discuss how this organization creates networking opportunities for nurses.
Discuss how the organization keeps its members informed of health care changes and changes to practice that affect the specialty area.
Discuss opportunities for continuing education and professional development.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
References:
Explore the Advocacy page of the American Nurses Association (ANA) website.
URL:
https://www.nursingworld.org/practice-policy/advocacy/
Read Chapter 5 in
Dynamics in Nursing: Art and Science of Professional Practice.
URL:
https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/dynamics-in-nursing_art-and-science-of-professional-practice_1e.php
this is the chapter 5
By June Helbig
“… nurses provide services that maintain respect for human dignity and embrace the uniqueness of each patient and the nature of his or her health problems, without restriction with regard to social or economic status.” (American Nurses Association, n.d.a, para 1)
Essential Questions
What significance does joining a professional organization have on nursing practice?
How can nurses contribute to legislative changes that impact nursing practice and patient outcomes?
Why is evidence-based practice (EBP) the gold standard in patient care protocol improvements?
Introduction
According to the American Nurses Association (ANA) there are currently 3.6 million registered nurses in the United States (American Nurses Association [ANA], n.d.b, para 12). The ANA is a professional nursing organization, which began when fewer than 20 nurses attended a convention in 1896. Nurses at the time were concerned with nursing practice standards and nurse competency. The ANA has since grown into an organization with interests in improving health care and setting standards for nursing practice. All nurses are represented regardless of status within the organization. The goal of professional organizations is to support nurses and improve the profession (ANA, n.d.c).
This chapter will explore the significance of joining professional organizati ...
Patient safety is the cornerstone of high-quality healthcare services. In the presentation, A summary of the frameworks & practical approaches to improve safety of patient care.
2 8 5L e a r n I n g o b j e c t I v e sC H A P T E R.docxlorainedeserre
2 8 5
L e a r n I n g o b j e c t I v e s
C H A P T E R 1 0
Q U A L I T Y M A N A G E M E N T I N
T H E P H Y S I C I A N P R A C T I C E
Quality and reliability are system properties.
—W. Edwards Deming
➤ Articulate the nature of performance management.
➤ Describe the approaches to performance improvement.
➤ Appreciate the impact of variation on performance.
➤ Discuss the components of the Triple Aim.
➤ Describe process improvement.
In t r o d u c t I o n
One of the most important issues to address in the medical practice is the quality and
safety of the care provided to patients. The Institute of Medicine (IOM 2001), a presti-
gious branch of the National Institutes of Health, stated in its landmark report Crossing the
Quality Chasm: A New Health System for the 21st Century, “In its current form, habits, and
environment, American health care is incapable of providing the public with the quality
health care it expects and deserves.”
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EBSCO Publishing : eBook Academic Collection (EBSCOhost) - printed on 4/16/2020 7:48 PM via SUNY CANTON
AN: 1839064 ; Wagner, Stephen L..; Fundamentals of Medical Practice Management
Account: s8846236.main.ehost
F u n d a m e n t a l s o f M e d i c a l P r a c t i c e M a n a g e m e n t2 8 6
Another historic IOM (2000) report, To Err Is Human: Building a Safer Health
System, indicated that a shocking number of people—an estimated 44,000 to 98,000 per
year—are harmed by the healthcare system. A more recent study found that this number
has increased since publication of the 2000 IOM report despite substantial efforts to
improve. Medical errors have now become the third leading cause of death in the United
States (Makary and Daniel 2016).
The complexity of medical service and the inconsistency with which these services
are delivered, not to mention the fragmented nature of the system, have led to a number
of quality concerns (Mosadeghrad 2014), including a lack of systematic approaches to care
delivery and quality improvement. Efforts to improve quality in the medical profession
have a long tradition of focusing on individual performance versus system performance.
Exhibit 10.1 illustrates the potential flaw in this thinking. The bell-shaped curve, P-1,
represents the overall performance of any given system. Curve P-2 illustrates an improved
system of performance where the median performance is moved from M-1 to M-2. If an
organization seeks to improve by only focusing on the low performers, it experiences only
a small improvement, shown as I-1. By improving th ...
In the presentation, a summary of initiatives to be taken by hospitals in different areas for patient safety have been described for the knowledge, practices and implementation of patient safety initiative by hospital managers/Administrators.
Joint Commission defines Disruptive Behavior as “conduct by a health care professional that intimidates others working in the organization to the extent that quality and safety are compromised”.
Research has found that disruptive behavior not only impacts the morale and staffing of an organization but can lead to medical errors and breakdowns in the quality of care, treatment, and services delivered.
Safety Event Analysis Teams (SEAT) comprised of believers & opinion builders. The team identified defects from the event reports. Implemented systems changes to reduce the probability of recurring. At least one defect was investigated each month.
The implications of SEAT were, staff came open and reported the incidents. It helped institute a Fair and Just Culture. Investigation examined the processes and not just people. Staff share their experiences with other CUSP units. SEAT helped turn these staff in to champions
Back ground
Tawam hospital faced many of the same barriers to patient safety present in hospitals elsewhere. The Leadership realized that the best way to enhance patient safety is to build a Culture of Safety at the hospital and hence has been implementing the Johns Hopkins Comprehensive Unit based Safety Program (CUSP). CUSP started as a pilot project in 2008 and now being implemented in ten units. Prior to implementation the leadership decided to measure staff perception of safety using evidence based tool.
Method
The Safety Attitudes Questionnaire (SAQ) was administered to all Tawam Hospital staff in three phases understand staff perception of safety. SAQ measures culture along 7 dimensions. The survey results are graded against percentage positive responses.
Results
A comparison of the SAQ’s pre & post CUSP implementation. ICU and Pediatric Oncology had six domains in the danger zone. NNU had four domains in the danger zone.
2010 & 2011 SAQ survey, the overall hospital score on all the domain scores were in the danger zone. 20 clinical locations in 2010 and 7 clinical locations in 2011 had less than 60% scores in the primary dependent variables.
Conclusion
SAQ results were disseminated department wise in the presence of a hospital Senior Executive. The unit staff selected one or two areas of concern and developed action plans for improvement.
CUSP was rolled out in Six more units. Safety Analysis Teams have been established in the CUSP pilot units to analyze and learn from defects.
Although the culture of safety is a serious business, it does not have to be implemented with a grim face. Joy and spirit of care giving are also linked to patient safety. Joy comes from witnessing successful patient outcomes and seeing a patient and family experience their healing journey.The use of emoticons to convey information saturates our wired world. One of the more popular emoticons is the smile. The smile is ubiquitous throughout computer generated communication such as emails, texts and social networking applications. Could we parlay its popularity in our patient safety efforts? We surmised that a healthcare provider, who is trained in the SMILE culture of safety model, would more easily recognize our culture of safety framework when this emoticon was used as a part of their daily communicating life.
Healthcare Associated Infections (HAIs) are the fourth leading cause of death in the USA. About 1.8 million patients suffer annually from care-related infections. HAIs cause 99,000 deaths every year in the US alone, at a cost of $3.1 billion dollars in excess healthcare costs in acute care hospitals. Besides HAIs kill more people than AIDS, breast cancer and auto accidents combined.
It is estimated that 271 people died each day from healthcare-associated infections (HAIs) such as Methicillin-resistant Staphylococcus aureus (MRSA) infections. Which is equivalent to one airline crash per day.
Measuring “Culture of Safety” Tawam’s Experience
Discovery:
Tawam Hospital’s Executive leadership realized the need to establish a “Culture of Safety” within the organization and implemented the Johns Hopkins Medicine “Comprehensive Unit based Safety Program” (CUSP). CUSP was introduced as a pilot project in the Intensive Care Unit (ICU), Neonatal Intensive Care Unit (NNU) and Paediatric Oncology Unit (Peds Onc).
Prior to implementation the leadership decided to measure staff perception of safety using evidence based tool.
Solution:
Tawam partnered with Pascal Metrics to implement the Safety Attitude Questionnaire survey. The SAQ was administered to all Tawam Hospital staff in three phases (2008, 2010 and 2011). In 2010 the pilot CUSP units were also resurveyed to determine the status of safety culture since its introduction in 2008.
An email from the CEO was sent to the participants encouraging them to participate in the SAQ survey.
Physicians, nurses, ward-clerks; respiratory therapist, physiotherapist, dieticians etc were included in the survey.
Those who spent at least 50% of their time in the identified units were only included to participate in the survey.
Survey was administered during departmental meetings to increase response rate.
Conducted separate sessions of physicians.
Staff dropped the completed surveys in an envelope.
82% of staff in the patient care areas of the whole hospital participated in the overall 3 phases of SAQ Survey.
The three CUSP pilot units were re-surveyed in 2010.
Anonymity, privacy and confidentiality were maintained from the beginning till the end.
Outcome:
The survey results were graded against percentage positive responses. Responses that were less than 60% mark were graded in the danger zone and anything above the 80% mark were graded in the goal zone. Teamwork climate and Safety climate scale scores are considered to be primary dependent variables, because they are important in preventing patient harm.
The overall hospital score on all the domain scores were in the danger zone, less than 60%. 20 clinical locations in 2010 and 7 clinical locations in 2011 had less than 60% scores in the primary dependent variables.
The SAQ results were disseminated department wise in the presence of a hospital Senior Executive. Every department did an action plan using the SAQ de-briefer tool. The hospital administrators to bring about the change played a facilitators role and helped the departments to come up with their actionable plans.
The hospital leadership in their pursuit to continuing the culture of safety journey, identified six more units for CUSP implementation based on the Phase 2 SAQ scores of 2010. Accordingly the Medical 1, Medical 2, Surgical 1, Surgical 2, Day Case and OBGYN Units were identified for the CUSP roll out. Senior Executive leaders were assigned to each of these new CUSP units to ensure leadership commi
More from Krishnan Sankara Narayanan MS, MBA, CPHQ, FASHRM, LHRM (6)
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
A paradigm shift from blame to fair and just culture –a middle east hospital experience
1. “A Paradigm Shift From Blame To Fair And Just Culture”
A Middle East Hospital Experience
Krishnan Sankaranarayanan MS, MBA, CPHQ
Senior Safety Officer- Tawam Hospital
Presented at the NPSF Patient Safety Congress
8-10 May 2013 New Orleans USA
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Disclosure
The presenter has nothing to disclose, nor has any
commercial interest with any of those information's
displayed in this presentation.
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About Tawam Hospital
• Tawam is a 466-bed tertiary care facility located in the garden city Al Ain in the
middle of the desert, and one among the largest healthcare facilities in the United
Arab Emirates.
• In 2006 the General Authority of Heath Services now called as the Abu Dhabi
Health Services Company PJSC (SEHA) entered in to a ten year affiliation contract
with Johns Hopkins Medicine.
• Tawam Hospital has current status with
• Joint Commission International Accreditation (2006; 2009; 2012),
• College of American Pathology (CAP; 2011) and
• American College of Graduate Medical Education- International (ACGME; Program
Accreditation)
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Items for discussion
• Ice breaker- Eric Cropp a pharmacist, the error that
sent him to prison (Video)
• Second Victim
• Comprehensive Unit-based Patient Safety program
• Understanding the Culture of Safety journey from a
Middle East perceptive
• Understanding how the concepts of leadership
engagement and learning from defects translated
in to the organization
• Celebrating Safety- The Best Catch Award
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Common Response After An Error
The types of suffering are
• Increased anxiety about the future possibility of errors,
• Loss of confidence in the work they do,
• Some face difficulty sleeping,
• Concern about their reputation as a care giver
• Reduction in their sense of job satisfaction.
• Excellent clinicians may leave the profession prematurely
when involved in a preventable error.
Rossheim J. To err is human—even for medical workers. Healthcare monster. http://healthcare.monster.ca/8099_en-CA_pf.asp (accessed 21 Jan
2009).
Waterman AD, Garbutt J, Hazel E, et al. The emotional impact of medical errors on practicing physicians in the United States and Canada. Jt Comm J
Qual Patient Saf 2007;33:467–76.
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Medical error: the second victim..
The term second victim was initially coined by Wu in his
description of the impact of errors on professionals. The doctor
who makes the mistake needs help too.
In the aftermath of a mistake, it's important the doctor seek
support to deal with the consequences.
Albert W Wu associate professor
School of Hygiene and Public Health and School of Medicine, Johns
Hopkins University, Baltimore, MD
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Middle East: There no or lack of statistical evidence in this
region to showcase patient deaths happening due to medical
error
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The patients saw an average of 17.8 health
professionals during their hospitalization
How many health professionals does a patient see during an average hospital
stay? N Whitt, R Harvey, S Child
The patients saw an average of 17.8 health
professionals during their hospitalization
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Definition- Culture of Safety
• Safety culture is the ways in which safety is managed in the
workplace, and often reflects "the attitudes, beliefs, perceptions
and values that employees share in relation to safety" (Cox and
Cox, 1991).
• The safety culture of an organization is the product of individual
and group values, attitudes, perceptions, competencies, and
patterns of behavior that determine the commitment to, and the
style and proficiency of, an organization's health and safety
management. Organizations with a positive safety culture are
characterized by communications founded on mutual trust, by
shared perceptions of the importance of safety, and by confidence
in the efficacy of preventive measures. (AHRQ)
Source: Organising for Safety: Third Report of the ACSNI (Advisory Committee on the Safety of Nuclear
Installations) Study Group on Human Factors. Health and Safety Commission (of Great Britain).
Sudbury, England: HSE Books, 1993.
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Characteristics of Culture in safe organizations
• Commit to no harm
• Focus on systems not people
• Value Communication/teamwork
• Assertive communication
• Teamwork
• Situational awareness
• Accept responsibility for systems in which we work
• Recognize culture is local
• Seek to expose (not hide) defects
• Celebrate safety
• Workers viewed as heroes
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February
22, 2001, eighteen-month
old Josie King died from
medical errors at the
Johns Hopkins Hospital
Peter J. Pronovost, MD, PhD
is a practicing anesthesiologist and
critical care physician,
teacher, researcher, and
international patient safety leader.
Johns Hopkins Medicine
Comprehensive Unit-based Safety Program-(CUSP)
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Comprehensive Unit-based Safety Program (CUSP)
6-step safety program
Step 1: Safety Attitude Questionnaire (SAQ)
Step 2:Staff education on the Science of Safety
Step 3: 2-item Staff Safety Survey
▪ Please describe how you think the next patient in your unit/clinical area will be
harmed?
▪ Please describe what you think can be done to prevent or minimize this harm?
Step 4: Executive Walk Rounds
Step 5:
a) Learning from defects
b) Improving teamwork and communication
Step 6 : Resurvey staff about Safety Culture (annually)
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How we started at Tawam?
• January-08 Created the Patient Safety dept.
recruited 4 patient safety officers and a medication
safety officer.
• February-08 Leadership training on Patient Safety
• April-08 Comprehensive Unit based Safety Program
Roll-Out.
• 2008- ICU, NNU, Peds Onc (Pilot Units)
• 2011- Medical 1 & 2, Surgical 1& 2, Daycase, PICU
• 2012- OBGYN
• 2013- OR & ED
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Challenges faced at Tawam
• Employees hail from 60 different nations
• Hierarchies between providers
• A culture that isn’t accustomed to acknowledging
medical errors.
• Tendency for poor communication and teamwork
that lead to adverse events.
• Tawam had a history of, “you made a mistake, and
you’re terminated.”
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CUSP -Pilot Test
Executive Leaders Adopted Units
• These units were selected partly due to their high
risk & high volume nature and closed medical staff.
The units were selected in part due to;-
their high-risk, high-volume nature and use of closed medical staffs.
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Baseline assessment-
Safety Attitudes Questionnaire
Culture of Safety Survey- Domains
1.Teamwork Climate
2.Safety Climate
3.Job Satisfaction
4.Stress Recognition
5.Working Conditions
6.Perceptions of Hospital Management
7.Perceptions of Unit Management
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Dependent Variables of SAQ
• The primary dependent variables -teamwork
climate and safety climate scale scores.
• These primary dependent variables were chosen
because they are important in preventing patient
harm.
• The rest of them are secondary dependent
variables.
Sexton J.B., et al.: The Safety Attitudes Questionnaire: Psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res
6(44):Apr. 3, 2006.
Timmel J, Kent PS, Holzmueller CG, Paine L, Schulick RD, Pronovost PJ. Impact of the Comprehensive Unit-Based Safety Program (CUSP) on safety
culture in a surgical inpatient unit. Jt Comm J Qual Patient Saf 2010;36(6):252-260.
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Location Year
Targeted
staff
Surveys
Administered
Survey
Returned
Survey
response
rate
Phase 1 CUSP Pilot Units 2008 199 199 199 100%
Phase 2 In-patient areas 2010 1600 1476 1450 98%
Phase 3
Out-Patient & satellite
locations
Qtr 4
2011 805 497 483 60%
Total 2604 2172 2132
82% of staff in patient care areas have participated in the overall 3 phases of SAQ Survey.
81% overall response rate in all the 3 phases of SAQ Survey.
Safety Attitude Questionnaire-(SAQ)
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2008 SAQ Phase-1 (CUSP Pilot Units)
0%
20%
40%
60%
80%
100%
Teamwork Safety Job
Satisfaction
Stress
Recognition
Perceptions
of Hospital
Management
Perceptions
of Unit
Management
Working
Conditions
Average%Positive
Domain
SAQ Results 2008
ICU
Pediatric Oncology
NNU
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2 question survey: Pilot Units- 2008
Please describe how you think the next patient in your unit/clinical area will be harmed.
Please describe what you think can be done to prevent or minimize this harm.
0%
5%
10%
15%
20%
25%
30%
Communication
& Teamwork
Staffing Medication
Errors
Infection Control Policies &
Procedures
Education Equipment Others
Areas of concern
2-item Staff Safety Survey
ICU N=93
NICU N=73
Peds Onc N=39
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SAQ- Action Plan
• De-briefer tool- least positive and most positive
scores.
• Unit staff identified specific areas of concern and
developed action plans for improvement.
• Rolled out CUSP in more units.
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CUSP Executive walk rounds
Steve Talking to the House Keeping staff
COO ICU CUSP Executive Walk rounds CFO Peds Oncology - CUSP Executive Walk rounds
CEO NNU- CUSP Executive Walk rounds
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Executive walk rounds- Challenges
• Leaders asked frontline staff their safety
concerns
• Instead of bringing up safety issues, staff
typically talked about the protocols they
followed to prevent harm.
• Nowadays they ask pointed question:- For
instance
• “Have you had any problems with pharmacy recently on
medications prepared for the ICU?”
• How is your communication with the Physicians??
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Culture linkages to Clinical, Operational & other
Outcomes
•Wrong Site Surgeries
•Decubitus Ulcers
•Delays
•Bloodstream
Infections
•Post-Op Sepsis
•Post-Op Infections
•Post-Op Bleeding
•PE/DVT
•RN Turnover
•Absenteeism
•VAP
•Burnout
•Unit size
•Communication
breakdowns
•Familiarity
•Spirituality
•Most validated:
Qual. Saf. Health
Care
2005;14;364-366
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0
1
0.3
0
0.2
0.4
0.6
0.8
1
1.2
2009 2010 2011
Infections/1000devicedays
year
Ventilator Associated Pneumonia -NICU
6 5.9
3.6
0
1
2
3
4
5
6
7
2009 2010 2011
Infections/1000devicedays
year
Central Line Associated Blood Stream
Infections -NICU
NICU -VAP & CLABSI
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2.04
1.55
4.07
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
2010 2011 2012
CABSI/1000devicedays
year
Central Line Associated Blood Stream Infections - Peds Oncology
Peds Oncology- CLABSI
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CLABSI Free Days
ICU
• 323 CLABSI free days until 25th Dec 2012
• Recounting -42 CLABSI free days until 5th February.
• Recounting -23 CLABSI free days until 28th Feb.
NNU-183 days until 28th Feb.
PICU- 115 days until 28th Feb.
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“I Watch The Line”- Campaign
• To increase staff awareness
• To ensure staff active involvement
• To ensure conscientious implementation
ICU NNU PICU
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Error Prevention
“Learning from Defects”
“Smart people learn from their
own mistakes, wise people learn
from other's mistakes.”
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Formula 1 Pit stop
• Takes six to twelve seconds in duration.
• Every pit stop is filmed and monitored by
human factor experts
• Errors are scored in five levels
• Highest score goes to the smallest
error, because people are unaware of it.
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Aviation-Sterile cockpit rule
• Prohibits crew member performance of non-
essential duties or activities while the aircraft is
involved in taxi, takeoff, landing, and all other flight
operations conducted below 10,000 feet, except
cruise flight.
• Prohibits the personal use of a personal wireless
communications device or laptop computer while a
flight crew member is at duty station during all
ground operations
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Learning from Defects- Tawam
Created Safety Event Analysis Teams in
each CUSP unit.
Identified a team of believers
Team identified defects from Patient Safety Net
(PSN)
Implemented systems changes to reduce the
probability of recurring.
At least one defect was investigated each
month.
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System changes due to PSN’s on Narcotic
medication error
Verbal order carried out against policy for Narcotic
medication. (Fentanyl Patch)
Analyzed usage of each Narcotic and Controlled medication (for
the previous six months).
Determined Critical/emergency need of each n drug.
List of Narcotic and Controlled medications were reduced to half.
ICU physicians and nurses informed about the changes.
Review the usage every 3 months.
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Team members involved being felicitated
In the picture:
Iyad Mahmoud; Jainy Mathew; Lynn Petrie; Krish and Dr. Said Abuhasna
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System changes due to PSN’s on Pressure Ulcers
9 PU’s reported between Oct 2011 &Mar 2012
Joint investigation conducted Wound care nurse and wound care
link nurse.
Developed Nursing care plan.
Conducted 0ne to one education.
Involved Respiratory Therapists.
BIPAP gel masks will be used to prevent PU’s related to BIPAP.
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Team members involved being felicitated -
Wound care & RT
In the picture:
Priya Padmanabhan; Stephanie Woodworth; Lynn Petrie; Krish and Dr. Said Abuhasna
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When errors occur one of the three things happen
• It can cause people to become champions
Or
• It can cause people to leave the profession
prematurely
Or
• It can make people go in to a shell and completely
feel withdrawn- Disengaged.
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Medication Error Story-1(Peds Oncology CUSP)
Double check for
expiration date not
done properly
First Nurse proceeded
to administer the
vaccine without taking
the tablet PC to the
patient bed side
Vaccine Injected and
asked second Nurse to
chart in Cerner on his
behalf
Second Nurse baffled after seeing
the expiration date and the
missing expiration date in the
label
Error reached
the patient but
did not cause
harm
Expired vaccine
arrived from
Pharmacy
SWISS CHEESE MODEL
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Medication Error Story-2 (Peds Oncology CUSP)
Chemotherapy
Written by MD.
Vincristine
doxorubicin
And
l_aspargenes
Checked
according
To the protocol
Then faxed
to pharmacy
Prepared by
Pharmacy
Medication
Received from
Pharmacy,
Checked with
Another
Chemotherapy
Competent
Nurse
VCR
DOXO
L-Asp
Two medication
taken to
patient room
VCR
and
DOXO
And
Emla cream
L-Asp returned to
fridge
602013-4-29
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Medication Error Story-3 (Day Surgery CUSP)
What
Happened
• Remicade a non formulary was administered to the patient (order was
in paper)
• Premedication of antihistamine, paracetamol was ordered in CERNER
which was not communicated to the nurse
• The patient developed allergic reactions
What Next
• Investigation revealed that there was no set protocols or guidelines
• Break down in communication & information transfer
Action
• Guidelines, protocols and checklist were developed
• No incidents since then
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Implication of the errors
• The staff came open and reported the incidents
• Since CUSP was in place it helped institute a Fair
and Just Culture
• Investigation of the incidents, examined the
processes and not just people.
• The three nurses have now become advocates of
patient safety by sharing their experiences.
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Distribution of Harmful Events by Care Units, 2010
0 20 40 60 80 100 120 140 160 180 200
Medical 1
Naima Pharmacy
OR
Paeds Medical
Medical 2
Paeds Oncology
113
128
139
152
163
183
13
0
29
10
11
3
No. Harmful event
No. of Reported Event
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Medication Error Story-4-(Second Victim)
A nurse inadvertently administered a chemotherapy drug to a wrong patient.
The patient was ok and the error was openly disclosed to the family. It was a
clear case of the nurse not adhering to the principles of five rights and
independently double checking the high alert medication. A case of
negligence!!!
The nurse had no previous history of such an error, was emotionally so
distressed that the nurse could no more work in the unit. The patient family
members did realize that the error was not intentional and did support the
nurse who was devastated due to the incident.
Despite the fact that CUSP was existence in that unit for over four
years, there was no established mechanism to console the nurse. Due to the
increased anxiety about the future possibility of errors and loss of confidence
in ones own work, tragically the nurse chose to leave the specialty
prematurely, the one that the nurse had been working for over fifteen years.
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Best Catch Award program
Celebrating Safety – Viewing workers as
heroes
• Instituted in 2009 for the best near miss caught.
• Now in the fifth year of implementation.
• Provided opportunity for staff to proactively
identify and implement risk reduction strategies.
• 2010, 2011 & 2012 Best Catch awards went to
CUSP units.
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Best Catch Award 2010
Peds Oncology CUSP
Synopsis :
Chemotherapy IFOSFAMIDE per protocol is for four doses, and it was written for 5 days.
The fifth dose arrived , nurse checked protocol and prevented.
Systemic change :
A copy of the protocol in pharmacy and patient chart to double check and prevent errors.
Prevented excess dose of
Chemotherapy medication
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Best Catch Award 2011
ICU CUSP
Rhian Evans
Associate Nurse Manager - ICU
Tawam Hospital
Synopsis :
Prevented family from approaching patient on ventilator with hot burning coal in patient room.
Coal was extinguished safely. Resulted in system and policy changes.
Prevented cauterization and
accidental fire in the ICU
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Best Catch Award 2012
Peds Oncology CUSP
Synopsis
The physician had ordered Metototrexate IT for this patient. In OR the mother of the
patient told the nurse that the patient should receive Cytarabin IT, not Metotrexate. The
Physician had prescribed the wrong drug.
Prevented administration of wrong
chemotherapy medication
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Up coming book called “Patients Come Second” by Paul
Spiegelman & Britt Berrett
The book talks about caring for those (employees), who care for
the patients. Employee engagement, getting them excited about
providing good service to patients, which reflects on patient
loyalty and good outcomes.
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Healthcare Needs Robust System
• A cooperative effort between government agencies
(regulatory authorities), Health Policy makers and
industry to lead improvements in safety.
• Healthcare needs an independent body modeled after
the National Transportation and Safety Board (NTSB).
National Medical Safety Board (NMSBSM)
http://psoservices.net/nmsb/
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Positive things happening in the Middle East region
United Arab Emirates-
SEHA one of the largest healthcare systems in the region has
established the PSN reporting tool in all its business entities.
DHA Implements New Patient Safety System called “Aman”
based on a global healthcare safety system called DATIX
Saudi Arabia- Is now asking all hospitals, government
or private, to use online reporting for any serious
medical error.
Qatar- HMC has introduced real time incident reporting
system at its chain of hospitals.
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Culture of Safety is a journey
• It takes as long as 5 years to develop a
culture of safety that is felt throughout
an organization. (Ginsburg et.al 2005)
• Need
Patience, Perseverance, Commitment &
Engagement.
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References
• Kohn LT, Corrigan JM, Donaldson MS, editors. To Err Is Human: Building a Safer Health System.
Washington: National Academy Press; 1999
• How many health professionals does a patient see during an average hospital stay? N Whitt, R Harvey, S
Child
• Sexton J.B., et al.: The Safety Attitudes Questionnaire: Psychometric properties, benchmarking data, and
emerging research. BMC Health Serv Res 6(44):Apr. 3, 2006.
• Pronovost PJ, Holzmueller CG, et al. A practical tool to learn from defects in patient care. Jt Comm J Qual
and Saf 2006 32(2):102-8.
• Ginsburg, L., P. G. Norton, A. Casebeer, and S. Lewis. 2005. ‘‘An Educational Intervention to Enhance Nurse
Leaders’ Perceptions of Patient Safety Culture.’’ Health Services Research 40 (4): 997–1020.
• Timmel J, Kent PS, Holzmueller CG, Paine L, Schulick RD, Pronovost PJ. Impact of the Comprehensive Unit-
Based Safety Program (CUSP) on safety culture in a surgical inpatient unit. Jt Comm J Qual Patient Saf
2010;36(6):252-260.
• Waterman AD, Garbutt J, Hazel E, et al. The emotional impact of medical errors on practicing physicians in
the United States and Canada. Jt Comm J Qual Patient Saf 2007;33:467–76
• Rossheim J. To err is human—even for medical workers. Healthcare monster.
http://healthcare.monster.ca/8099_en-CA_pf.asp (accessed 21 Jan 2009).
• Wu AW (2000). "Medical error: the second victim. The doctor who makes the mistake needs help too".
BMJ 320 (7237): 726–7.
• How many health professionals does a patient see during an average hospital stay? N Whitt, R Harvey, S
Child
• Ginsburg, L., P. G. Norton, A. Casebeer, and S. Lewis. 2005. ‘‘An Educational Intervention to Enhance Nurse
Leaders’ Perceptions of Patient Safety Culture.’’ Health Services Research 40 (4): 997–1020.
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Thank You
Patient Safety Top Priority
Patient Safety Everyone's Responsibility
Contacts:
ksankara@tawamhospital.ae
+971 -50-9211649