The background, key features and main steps of the concise analysis method are described, discussed and applied in this module together with the main tools used during a concise analysis (timeline, guiding questions, constellation diagram, and statements of findings).
Planning & Writing Your Rationale Essay
Rationale Essay? Are you unsure of how to begin? Of what to include?
Designing your own degree plan is difficult; writing about that plan is even harder. Thinking about your degree plan as your resume & the rationale essay as your cover letter is the approach we take in this workshop that will introduce you to the steps & strategies necessary to complete the most unique piece of writing that you will do at ESC .
IMPACT OF NESTLE PHILIPPINE'S CORPORATE SOCIAL RESPONSIBILITY PROGRAMS ON CON...Carl Marvin Yabut
The main objective of the study was to assess the Impact of Nestle Philippines’ Corporate Social Responsibility Programs on Consumer Buying Behavior. It also sought to determine the level of awareness of the respondents towards the different Corporate Social Responsibility Programs of Nestle’ Philippines and to assess the effectiveness of the Corporate Social Responsibility Programs in terms of Nutrition, Environment, and Rural Development.
Planning & Writing Your Rationale Essay
Rationale Essay? Are you unsure of how to begin? Of what to include?
Designing your own degree plan is difficult; writing about that plan is even harder. Thinking about your degree plan as your resume & the rationale essay as your cover letter is the approach we take in this workshop that will introduce you to the steps & strategies necessary to complete the most unique piece of writing that you will do at ESC .
IMPACT OF NESTLE PHILIPPINE'S CORPORATE SOCIAL RESPONSIBILITY PROGRAMS ON CON...Carl Marvin Yabut
The main objective of the study was to assess the Impact of Nestle Philippines’ Corporate Social Responsibility Programs on Consumer Buying Behavior. It also sought to determine the level of awareness of the respondents towards the different Corporate Social Responsibility Programs of Nestle’ Philippines and to assess the effectiveness of the Corporate Social Responsibility Programs in terms of Nutrition, Environment, and Rural Development.
The 2011-2016 SOCCSKSARGEN Regional Development Plan (RDP) serve as the region’s blueprint to achieve its twin goals of inclusive growth and poverty reduction.
This chapter tackles about the historical milestones of the tourism industry. It also discusses the important historical events in the development of tourism in the Philippines.
The National Tourism Development Strategy and Programs Improving Human Resour...TIBFI
Briefing on the National Tourism Development Plan, 2011 - 2016, Presentation during the Second Tourism Human Resources Congress “Building Tourism Human Capital for Global Competitiveness” - 2 October 2012
According to the Physical Activity Council Report, close to 60% of Americans (6 years and older) engaged in some type of outdoor sport in 2018. 4% of that number were people ones who tried something new and 5% who went back to outdoor activities after a break. In another study, the Outdoor Participation Report found the rate to be a bit lower with 49.9% of Americans participating in outdoor recreational activities in 2017.
While it's great that about of half of all Americans get outside for both fitness and recreation, 30% reported ZERO time engaging in outdoor activities.
If you're an outdoor enthusiast like we are, we bet you can't imagine life without regularly enjoying your favorite outdoor sports and activities. In fact, 80% of us wish we had MORE time to spend outside.
In hopes of inspiring people to get outside more for recreation, or to try an outdoor sport or activity that's brand new to them, we put together this infographic. It's filled with fun facts about the most popular outdoor recreation activities in the United States.
Proyekto sa FIL4: Panitikan ng Rehiyon
Halaw sa librong "Literatura ng Iba't-Ibang Rehiyon ng Pilipinas" (2001) ni Carmelita S. Lorenzo, et. al.
Presentasyon ni Marlene C. Panaglima
BSED IIB - FILIPINO
Proyekto sa FIL4: Panitikan ng Rehiyon
Halaw sa librong "Literatura ng Iba't-Ibang Rehiyon ng Pilipinas" (2001) ni Carmelita S. Lorenzo, et. al.
Presentasyon ni Alia Janiel Sultan
BSED IIB - FILIPINO
During this module, the key features and main steps to analyze an incident using the comprehensive method will be described, discussed and applied. In addition, the tools that facilitate a comprehensive analysis will be introduced: the timeline, human factors, diagramming contributing factors and their interconnection (using the constellation diagram), guiding questions and the statements of findings.
To increase the effectiveness of the incident analysis in improving care, analysis can’t be addressed in isolation from incident management (the multitude of activities that take place before and after an incident). Three main topics will be covered in this module: the main steps in the incident management continuum; differentiating between incident analysis (focused on system improvement) and accountability reviews (focused on individual performance), and selecting an incident analysis method.
The 2011-2016 SOCCSKSARGEN Regional Development Plan (RDP) serve as the region’s blueprint to achieve its twin goals of inclusive growth and poverty reduction.
This chapter tackles about the historical milestones of the tourism industry. It also discusses the important historical events in the development of tourism in the Philippines.
The National Tourism Development Strategy and Programs Improving Human Resour...TIBFI
Briefing on the National Tourism Development Plan, 2011 - 2016, Presentation during the Second Tourism Human Resources Congress “Building Tourism Human Capital for Global Competitiveness” - 2 October 2012
According to the Physical Activity Council Report, close to 60% of Americans (6 years and older) engaged in some type of outdoor sport in 2018. 4% of that number were people ones who tried something new and 5% who went back to outdoor activities after a break. In another study, the Outdoor Participation Report found the rate to be a bit lower with 49.9% of Americans participating in outdoor recreational activities in 2017.
While it's great that about of half of all Americans get outside for both fitness and recreation, 30% reported ZERO time engaging in outdoor activities.
If you're an outdoor enthusiast like we are, we bet you can't imagine life without regularly enjoying your favorite outdoor sports and activities. In fact, 80% of us wish we had MORE time to spend outside.
In hopes of inspiring people to get outside more for recreation, or to try an outdoor sport or activity that's brand new to them, we put together this infographic. It's filled with fun facts about the most popular outdoor recreation activities in the United States.
Proyekto sa FIL4: Panitikan ng Rehiyon
Halaw sa librong "Literatura ng Iba't-Ibang Rehiyon ng Pilipinas" (2001) ni Carmelita S. Lorenzo, et. al.
Presentasyon ni Marlene C. Panaglima
BSED IIB - FILIPINO
Proyekto sa FIL4: Panitikan ng Rehiyon
Halaw sa librong "Literatura ng Iba't-Ibang Rehiyon ng Pilipinas" (2001) ni Carmelita S. Lorenzo, et. al.
Presentasyon ni Alia Janiel Sultan
BSED IIB - FILIPINO
During this module, the key features and main steps to analyze an incident using the comprehensive method will be described, discussed and applied. In addition, the tools that facilitate a comprehensive analysis will be introduced: the timeline, human factors, diagramming contributing factors and their interconnection (using the constellation diagram), guiding questions and the statements of findings.
To increase the effectiveness of the incident analysis in improving care, analysis can’t be addressed in isolation from incident management (the multitude of activities that take place before and after an incident). Three main topics will be covered in this module: the main steps in the incident management continuum; differentiating between incident analysis (focused on system improvement) and accountability reviews (focused on individual performance), and selecting an incident analysis method.
MEDICAL AUDIT
Evaluation of data, documents, and resources to check performance of systems meets specified standards
PRESCRIPTION MONITORING, ADR, DRUG RELATED PROBLEMS, staff safety, data,defining standards,
collecting data,
identifying areas for improvement,
making necessary changes
back round to defining new standards.
The fifth webinar continues the momentum of the series as it focuses on providing concrete approaches for identifying barriers and enablers, emphasising behaviour change approaches.
READ MORE: http://bit.ly/2LOwbj0
Health CIO Network Webinar: Overcoming the Challenges of Clinical DocumentationNuance Healthcare EMEA
Nuance commissioned an independent research company, Ignetica, to carry out research into the Challenge of Clinical Documentation in NHS England Secondary Care Trusts (Jan to April 2015). The results are now out and have great relevance and value for Health CIO/CCIOs and other decision makers within UK Healthcare making investments in EPRs and other digital healthcare projects
Get the headlines from the research and hear how Alder Hey’s Paediatric Intensive Care Unit are overcoming some of the challenges highlighted in the research
Presented by: Frederik Brabant, CMIO, Nuance, Peter Booth, MD, Ignetica & Elaine Scott and Peter White, Nurse Leads of e-health projects at Alder Hey Paediatric Intensive Care Unit
Presented by: Frederik Brabant, CMIO, Nuance, Peter Booth, MD, Ignetica & Elaine Scott and Peter White, Nurse Leads of e-health projects at Alder Hey Paediatric Intensive Care Unit
Chaired By: Jon Hoeskma, CEO, Digital Health
As patients and families impacted by harm, we imagine progressive approaches in responding to patient safety incidents – focused on restoring health and repairing trust.
We can change how we respond to healthcare harm by shifting the focus away from what happened, towards who has been affected and in what way. This is your opportunity to hear about innovative approaches in Canada, New Zealand, and the United States that appreciate these human impacts.
This interactive webinar is hosted by Patients for Patient Safety Canada, the patient-led program of the Canadian Patient Safety Institute and the Canadian arm of the World Health Organization Patients for Patient Safety Global Network.
This interactive webinar is part of the world tour series designed by the World Health Organization's Patients for Patient Safety (PFPS) Global Network and hosted by Patients for Patient Safety Canada, the patient-led program of the Canadian Patient Safety Institute, a WHO Collaborating Centre on Patient Safety and Patient Engagement.
The goal of this virtual discussion is to explore practical solutions for keeping seniors safe. The ideas are drawn from real life experiences noting how COVID-19 impacted seniors, their loved ones as well as healthcare workers and leaders.
The focus of the discussion is on identifying safety risks together with practical solutions for seniors who live at home, in residences and long-term care facilities.
After hearing the perspectives of patients, providers and leaders from Indigenous communities on how they perceive safety and what solutions are/ can be implemented, we will leave the session with at least one practical idea for engaging all patients, families and/or the public in improving patient safety.
Healthcare providers and leaders will address three types of silences in healthcare: organizational silence, patient-related silence, and provider to provider silence.
Read More: www.conquersilence.ca
Healthcare providers and leaders will address three types of silences in healthcare: organizational silence, patient-related silence, and provider to provider silence.
Read More: www.conquersilence.ca
Enhanced Recovery After Surgery (ERAS®) is the Enhanced Recovery After Surgery (ERAS®) is the implementation of patient-focused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidence-based, interdisciplinary perioperative guidelines.
Learn more about Enhanced Recovery Canada:
http://ow.ly/hR3j30jsnjR
Dr. Dee Mangin, Professor of Family Medicine and the Associate Chair and Director, Research, at McMaster University, will join practicing pharmacist, and Vice President, Pharmacy Affairs, Sandra Hanna of the Neighbourhood Pharmacy Association of Canada to discuss medication risks, deprescribing and the dangers of polypharmacy in this one hour webinar. Learn more at www.asklistentalk.ca
Joshua Myers, Terry Brock - Fraser Health (BC) - We Want to Hear from You: Fraser Health Real-Time Experience Survey
Leading organizations in Canada invite, listen and act on feedback from patients in their care to improve the safety and quality of care. Explore the three award-winning practices linked below then join us in a conversation to learn more about each approach and reflect on how you may apply it in your organization. This webinar promises practical ideas to help you engage patients in making care safer.
Leading organizations in Canada invite, listen and act on feedback from patients in their care to improve the safety and quality of care. Explore the three award-winning practices linked below then join us in a conversation to learn more about each approach and reflect on how you may apply it in your organization. This webinar promises practical ideas to help you engage patients in making care safer.
Cathy Masuda, Leslie Louie - BC Children's Hospital, an Agency of the Provincial Health Services Authority -Patient's View: Engaging Patients and Families in Patient Safety Incident Reporting
Leading organizations in Canada invite, listen and act on feedback from patients in their care to improve the safety and quality of care. Explore the three award-winning practices linked below then join us in a conversation to learn more about each approach and reflect on how you may apply it in your organization. This webinar promises practical ideas to help you engage patients in making care safer.
Alberta Health Services: Family Volunteers or Advisors Gathering Real-time Patient Experiences
Leading organizations in Canada invite, listen and act on feedback from patients in their care to improve the safety and quality of care. Explore the three award-winning practices linked below then join us in a conversation to learn more about each approach and reflect on how you may apply it in your organization. This webinar promises practical ideas to help you engage patients in making care safer.
This final webinar will emphasise the importance of understanding the problem before brainstorming solutions to better ensure a match between barriers and the solutions.
MORE INFO: http://bit.ly/2KctiLH
The fourth webinar picks-up directly from the third session, focusing on the next key step to inform implementation initiatives: identifying barriers and enablers to implementation.
READ MORE: http://bit.ly/2kIxtQo
Please join CPSI as we conclude our Human Factors webinar series with our final presentation Collaborative "Spaces" and Health Information Technology Design
Professor Benedetta Allegranzi,World Health Organisation
Dr. Benedetta Allegranzi is a specialist in infectious diseases, tropical medicine, infection prevention and control and hospital epidemiology. She currently works at the World Health Organization HQ (Service Delivery and Safety department), leading the "Clean Care is Safer Care" programme. Since 2013, Dr Allegranzi has gathered the title of professor of infectious diseases in the official Italian professorship list and is adjunct professor attached to the Institute of Global Health at the Faculty of Medicine, University of Geneva, Switzerland. She closely collaborates with the team at the IPC and WHO Collaborating Center on Patient Safety, University of Geneva Hospitals (Geneva, Switzerland), as well as with the Armstrong Institute for Patient Safety and Quality, John Hopkins University, (Baltimore, USA) for clinical research projects. She is currently involved in the leadership on the WHO Ebola Response in the field of IPC and supervises IPC activities in Sierra Leone and Guinea. She has experience in clinical management of infectious diseases and tropical medicine, and clinical research in healthcare settings in both developing and developed countries. She has thorough skills and experience in training and education.
She is also the author or coauthor of more than 150 scientific publications, including articles published in high-profile medical journal such as the Lancet, Lancet Infectious Diseases, New England Journal of Medicine and the WHO Bulletin, and six book chapters.
Lori Moore joined GOJO Industries in 2013 as a Clinical Application Specialist. In this position, she provided leadership and support to healthcare organizations as they implemented electronic compliance monitoring (ECM) to more accurately measure hand hygiene performance. She has been a trusted partner to hospital key stakeholders in the development, design and implementation of hand hygiene improvement efforts. Areas of expertise include root cause analysis with targeted solutions, just-in-time coaching and ECM software data analytics. In January 2017, she transitioned to the position of Clinical Educator for Healthcare.
She began her professional career in healthcare in 2010 as a registered nurse in the medical intensive care unit at the Cleveland Clinic Foundation (where she continues to work on the weekends). Her passion for patient safety and quality of care sparked her interest in infection prevention, and she worked as an infection preventionist prior to joining GOJO.
Lori has a well-rounded academic background which includes a Bachelor’s of Arts in Management from Malone College, a Bachelor’s of Science in Nursing from the University of Akron, and a Master’s degree in Public Health from the University of Akron. She is a member of the Association for Professionals in Infection Control and Epidemiology, American Society of Professionals in Patient Safety, and the American Medical Writers Association. She has also earned the credential of Certified Health Education Specialist (CHES) and Certified Professional in Patient Safety (CPPS).
The third interactive webinar in the series builds on the second session by focusing on the question: once we have evidence to justify implementing a new patient safety initiative, what next?
This second interactive webinar in the series will draw upon Dr. Ian Graham's Knowledge to Action cycle and focus specifically on the central role of developing and synthesising evidence of what to implement and which knowledge translation and implementation strategies are most effective for promoting implementation, and developing the knowledge infrastructure to make best use of evidence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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.
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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.
3. Learning Program
What was learned?
What can be done?
How and why?
What happened?
Multi-incident
Concise
Comprehensive
4. Learning Objectives
• The similarities and differences between a comprehensive
and concise individual incident analysis
• The main steps in conducting a concise analysis
• Give examples or scenarios of incidents where concise
analysis is recommended
5. Agenda
3-parts
• Knowledge expert + Q&A
• Practice leader + Q&A
• Facilitated discussion or Q&A
6. Introducing: WebEx
Be prepared to use:
- Raise Hand & Checkmark
- Chat & Q&A
- Pointer & Text
6
14-Mar-13 6
7. About You
0 Experience with [any] CONCISE analysis 10
9. Background and Features
Need for a “concise” method
• Informal (mini-RCA) Formal (NPSA, M&M)
Consistent with the principles and methodology of
analysis
Conscious and deliberate decision to focus on the:
• Agreed-upon facts
• Key contributing factors and findings
• Actions for improvement (if any)
• Evaluation
10. Concise and Comprehensive
Action Concise Comprehensive
Include person(s) with knowledge of IA, HF, solutions
development
Facilitated by an individual with input from patient,
local staff & physicians
Conducted by an inter-disciplinary medium to large ad
hoc group (includes also external experts / consultants)
facilitated by a knowledgeable individual.
Short Longer
Time taken for analysis (hours-days) (45-90 days)
Identifies contributing factors as well as remedial
action(s) taken (if any) and recommendations for
improvement
Reflects intent Incorporates all
Principles of Incident Analysis principles
Evaluation Component
12. Case: Medication Incident
Setting:
Community hospital & busy home care services
Current process:
hospital faxes referrals to fax line
if 9-5, M-F, home care coordinator reviews faxes & accesses the
home care central record schedule home care visits
if outside business hours home care nursing staff periodically
check faxes sorts by ongoing and new clients referrals for
ongoing given to responsible nurse
pharmacist dispense meds from drug stores in the community.
some attending physicians at comm. hosp fax prescriptions to
patients’ drug store for ease of pickup
Incident
Client (discharged from hospital with meds) found in bathroom.
Moderate amount of bright red blood. Transfer to ED.
14. Case: What Happened
Based on the
• incident report
• a review of the home care record
• hospital chart
• referral form
…the facilitator responsible to conduct this concise analysis
started to draft a timeline of the incident.
Timeline confirmed and expanded by
• Interviews with the client, pharmacist and RNs,
• Examination of the drugs involved in the incident
17. Analyze Information
• Use guiding questions to briefly explore all
categories (Appendix G, Page 89)
• Use some questions or develop incident specific questions to
informally discuss the incident with those involved and
external experts
• Ask
• What was this influenced by?
• What else affected the circumstances?
• Use constellation diagram
• Systemic approach
• Visual representation
• Linkages
• Summarize findings
19. Case: Findings
Work environment
• The lack of a standardized home care risk assessment tool or protocol
increased the likelihood that clients discharged from hospital back
to the community would not be accurately triaged to ensure appropriate
and timely home care services are provided.
Patient
• The deterioration in the client’s physical and cognitive abilities
increased the likelihood of a medication error in his self medication
management.
Care team and organization
• The lack of a formalized, system-wide and communicated Discharge
Medication Reconciliation process (including an updated Best Possible
Medication History) decreased the likelihood that the client would
receive the appropriate and timely support required for safe medication
management.
20. WHAT CAN BE DONE…?
WHAT CAN BE DONE TO REDUCE THE RISK OF
RECURRENCE AND MAKE CARE SAFER
23. WHAT WAS LEARNED?
The ultimate objective of analysis
Feedback
• To the organization: patient family, those involved in
the incident, the analysis team, etc
Feed-forward
• Externally to prevent similar incidents from
occurring in other organizations, systems, countries
• Informing the public and/or media
26. Safety at Home: A Pan-Canadian Home Care
Safety Study, Root Cause Analysis Sub-Project
- Project #4 – Falls by Home Care Clients
(Canadian Patient Safety Institute)
Gordon Luy, BSW, MSW
Patient Safety Consultant
Winnipeg Regional Health Authority
Quality Improvement & Patient Safety Unit
27. Safety At Home Study
Led by Dr. G. Ross Baker of the Institute of Health Policy,
Management and Evaluation, at the University of Toronto.
A qualitative study to investigate the root causes and contributing
factors that lead to {Falls-; Medication-} related adverse events
suffered by patients in home care, and help to form
recommendations to prevent similar events in the future.
The study was conducted at three provincial sites:
Alberta Health Services - Edmonton Zone Home Living Portfolio.
Winnipeg Regional Health Authority
Community Care Access Centres (CCAC) of the Greater Toronto Area (GTA)
28. Winnipeg Regional Health Authority
Quality & Patient Safety Unit
Part of the Research and Applied Learning
Division of the WRHA
3 Units in division
Health Information Services
Research and Evaluation
Quality Improvement & Patient Safety
29. WRHA Quality Improvement & Patient Safety Unit
• Under the Chief QIPS Officer
• Composed of 3 teams each under a regional
Director:
o Clinical Office of Patient Safety: 2 Analysts; and, 1
Auditor
o Quality Improvement Team: 7 Quality Managers; 2
Coordinators; and, 3 Analysts
o Patient Safety Team: 8 Patient Safety Consultants;
1 Patient Safety Pharmacist; and, 1 Education
Consultant
30. WRHA Patient Safety Consultant
A Patient Safety Consultant (PSC) works in collaboration with
healthcare sites/settings/program leaders and other members of
the Quality and Patient Safety Unit to facilitate the development,
implementation and maintenance of the quality and patient safety
strategy.
Through system safety reviews (Critical Incident Reviews),
PSCs assist staff and physicians throughout the Region to gain an
understanding of the complex systems in which people work for
potential healthcare system improvements.*
* The Regional Health Authorities Amendment And Manitoba Evidence Amendment Act (2005)
31. Safety At Home:
Sub-Project #4 – Falls by Home Care Clients
Five specific Home Care cases were selected
from the Manitoba site (WRHA) for a detailed
review using the CPSI Concise Methodology.
The review included interviewing caregivers,
managers, clients and their families regarding
events related to a fall which occurred during the
period of time that the client was receiving Home
Care.
32. CPSI Concise Analysis Methodology
I. Understand WHAT HAPPENED:
i. Information gathering (medical records; interviewing clients, case
coordinators and direct service providers (nurses, health care aides)
ii. Construct a a brief timeline.
II. Analyze information to identify contributing factors and the
relationships among them:
i. Systems theory and human factors
ii. Describe the incident and outcome
iii. Identify and define relationships between potential contributing
factors
iv. Formulate findings
III. (Develop and manage Recommended Actions)
The final report contains the facts, contributing factors, a brief context
analysis, and where applicable, recommended actions and a plan for
evaluation and dissemination.
33. I. Understand WHAT HAPPENED:
1. We reviewed the client’s medical record: (assessments; client
characteristics (e.g. co-morbidities), medications and changes; equipment;
professional consultation; process(es) of care delivery (e.g. history,
frequency and purpose of visits); circumstances of fall; etc.
2. We interviewed:
- Clients (and family): (recollection of event, factors (e.g. environment –
photos taken), services)
- Case coordinators: (organization, policies, care plan; roles, workload,
resources, training, communication, etc.)
- Direct service providers (nurses, health care aides): (roles,
workload, scheduling, resources, etc.)
3. We constructed a brief timeline (chronology) of event
34. Incident Analysis – Systems Theory
A system is described as the coming together
of parts, interconnections and purpose.*
Human Factors: how humans interact with the world
around them. Human error is viewed as a symptom of
broader issues within what may be a poorly designed
system, such as an adverse physical or organizational
environment.**
* Institute of Medicine. Crossing the Quality Chasm: A new health system for the
21st century. Washington, DC: The National Academy Press; 2001.
** Dekker S. The Field Guide to Human Error Investigations. Aldershot, UK: Ashgate
Publishing; 2002.
35. II. Incident Analysis
• Task (care/work process)
• Equipment
• Work environment
• Patient (client) characteristics
• Caregiver
• Care team (direct service providers and support
team)
• Organization (policies, culture, capacity-resources)
37. Case Example
• Equipment: Motorized wheelchair; manual wheelchair;
hospital bed; transfer poles in bedroom and bathroom; bath
seat; Hoyer Lift and slings; Life line.
• Work environment: Customized private bungalow; guide
dog; client alone at times.
• Patient characteristics: Parkinson’s Disease; chronic
back pain and hip pain; physically compromised; alert &
oriented but at times has impaired judgment and memory
issues; quiet and slurred speech; functional hearing; wears
glasses.
38. Factors of Influence in Event
Equipment: Motorized wheelchair: client sits too far forward and does not use
the seatbelt.
Client: Lack of leg strength to push self
Environment: The client and family
back in the seat of the motorized
prefer that the client lives in the
wheelchair. Seating position increases the
residence as long as possible. While
risk for a fall. Motorized wheelchair is
cared for by extended family and
preferred for mobility over the manual
through Home Care much of the day,
wheelchair even though the seating
there are periods of time when the
position is safer in the manual wheelchair.
client is alone. Due to compromised
Risk for a fall is increased if the client falls
judgment and toileting issues, the
asleep in the wheelchair - tendency to fall
client may attempt to transfer when
asleep is exacerbated by medications.
assistance not available which has
Also, the client at times attempts to reach
led to falls in the past and increases
or ambulate without assistance present.
the risk for a fall.
39. Summary Statements/Findings
• The client is more at risk for a fall when using the motorized
wheelchair, than the manual wheelchair, due to the seating
position in the motorized wheelchair and consequent inability
to use the seat belt.
• Preference for using the motorized wheelchair at home
predisposes the client to this risk especially if the client falls
asleep while in the wheelchair or forgets that he/she in the
wheelchair.
• The tendency to fall asleep is exacerbated by medications
prescribed to address medical conditions.
• The Home Care services provided were maximized according
to the funding formula.
40. Report Format
• Date of Event
• Date Event was discovered
• Brief Description of event
• Date Event Analysis process was initiated
• Date Event Analysis process was completed
• Describe what Home Care Services received prior to the fall.
• Describe what Home Care Services received after the fall
• Describe the Client’s primary and secondary medical conditions.
• Does the Client live alone?
• The extent of harm as assessed 24 hours post event.
• Outcome of event
• Additional Issues
• Medications and how related to event
• Chronology
• Constellation Map
• Identification of factors that contributed to the occurrence of this
event
• Summary Statement
41. Reflection
• CPSI Concise Methodology
– Very similar to the what we have been using in the
region to review some Critical Incidents (falls and
pressure ulcers).
– Is a useful framework for the review of an adverse
event of limited harm to the patient (client):
• Conceptualizing;
• Planning;
• Conducting; and
• Documenting.
44. Options
1. Learn from each other
• Suggested topics
o Do you use concise now? For what cases?
o Is it helpful? How long it takes? How is it done?
o How did you get started? How did you spread it?
2. Q&A with the 2 presenters
45. Breakout Session
Some participants will Some participants will
stay in the main “move” to breakout
room rooms
- No phone next to
your name
- Say no when
invited to breakout
47. Recap and Next Steps
End of session evaluation; Follow up survey
• Follow-through and share
what was learned
March 28, 2013
• Recommendations
management
March 7, 2013
• Multi-incident analysis
February 21, 2013
48. Resources
Learning Program – previous modules:
http://www.patientsafetyinstitute.ca/English/news/Inci
dentAnalysisLearningProgram/Pages/Session-
Recordings-and-Documents.aspx
National Health System – UK
• Three Levels of RCA Investigation – Guidance
• Example concise RCA investigation reports
Incident Analysis Tools
http://www.patientsafetyinstitute.ca/English/toolsReso
urces/IncidentAnalysis/Pages/Tools.aspx
Good morning/ afternoon Welcome back those who were part of the our previous modules Welcome those who just came on board
I am Ioana P., PM with CPSI responsible with the management of the framework revisions, design and delivery of the education program and other resources to support you analyze incidents more effectively in order to make care safer. I will be your moderator today.The wonderful people that you see on the screen are contributors to today’s session and you will meet them later in the program
Previously on the learning program AND the scope of today’s call Assume that the previous steps in the incident management continuum have been executedConcise method is NEW additionWHAT HAPPENED; HOW AND WHY IT HAPPENED; WHAT CAN BE DONE TO REDUCE THE RISK OF RECURRENCE AND MAKE CARE SAFER; WHAT WAS LEARNED
Ioana: due to the increase in the number of participants and their learning needs (the registration form has a few questions about the level of experience and learning objectives)…. And the feedback received following module 1-3 … and iN AN EFFORT TO GIVE EVERYONE AT LEAST ONE NUGGET OF LEARNINGWe changed the original performance elements and decided to offer a deep dive
Lines will be muted. Enter questions in the chat box or put your hand up during Q&A and you will be able to ask your question live. The first 2 parts of the meeting are recorded but not the facilitated discussion
1. Raise hand: have you participated in previous modules 2. In chat: what is your learning objective for today? 3. Pointer: next slide
Profile experienced participants as experts and encourage them to share their wisdom in the chat box or breakout room. In the evaluations we heard that real life stories are very valuable to you and we should continue to include them. Try to pick names?
Carolyn is the Vice President, Clinical Performance Improvement for Alberta Health Services, the largest healthcare delivery organization in Canada. In this role, Carolyn leads a variety of teams including Patient Safety, Clinical Quality, Design & Delivery, and Capacity Building. She is also Senior Advisor to the World Health Organization’s High 5s Initiative with responsibilities that include chairing the Event Analysis Subcommittee. Carolyn is one of the authors of the CIAF and a faculty member for the learning program. Carolyn`s relationship with CPSI is as long as CPSI`s existence. I had the pleasure to learn from and work with her since 2009 and I must say that no matter what the project or task both the journey and reaching the destination was a true joy. I am confident that you will enjoy the concise analysis learning journey Carolyn will take us through in the next 20 minutes. She is expecting some very good questions from you, so make sure you type them in the chat box or write them down so she can answer them in the Q&A following her presentation. Ladies and gentlemen, our concise analysis knowledge expert Carolyn Hoffman!
Comprehensive: permanent harm or death occurred (or risk thereof), incident is complicated or complex, area impacted is micro, meso or macro; contextual pressures are high Concise: incidents or concerns that resulted in no or low harm; may focus on a new incident for which a comprehensive analysis was conductedCarolyn, can you provide an example here?
Note that this is an iterative process – not a straight step 1, then 2, etc.May be an opportunity here to engage the participants such as asking them where they USUALLY do to gather information and understand what happened?
After gathering all the information, those gaps can start to be filled.Provide in the form of a narrative chronological description.The Detailed Timeline is a collation of information from various sources.This is your starting point for identifying system based factors underlying the incident.You may have IA team members who were not directly related to the event…in fact, consider involving such individuals as appropriate. Often, these “outside eyes” can ask different questions, or identify other factors for team consideration—improves credibility of the review while fostering and nurturing the just and trusting culture.
The guiding questions are meant to facilitate a thorough and complete picture of informationThe intent is to leave no information behindBased upon and adapted from international experts in incident analysisFocus on the person is like plucking Kleenex from the box. If you just pull the person and do nothing else…there will be another person coming behind who can potentially experience the same event because we have done nothing to address the system of contributing factors.
We don’t expect participants to read. Refer to pg. 115The facilitator created a constellation diagram to visualize and better understand the factors that contributed to the incident and their interconnections.The factors were confirmed by consultation with those engaged in the incident and operational and/or medical leaders. This step was very helpful in summarizing the findings and developing recommended actions.
The ultimate goal of incident analysis is to take action to reduce the risk of recurrence and make care saferWhether you are a member of the analysis team, or you are facilitating the analysis process, maintain focus by reminding yourself that if we do nothing, the dark persists, if we use facts as our illumination (not judgement, not punishment, not discipline), we are better able to determine exactly where we can focus attention and effort to make care saferAn upcoming learning module focuses entirely on developing and managing recommended actions. Refer to Section 3.6.6 in the CIAF (Canadian Incident Analysis Framework) document
• W1: Establish a standardized home care risk assessment tool for screening patients that are transitioning back to the community from hospital. Consider the feasibility and effectiveness of the regularly assigned home care nurse beginning the screening process with a call from the acute care nurse planning for the patient discharge then completing the assessment with a telephone or in-person client assessment.• CO 1: Develop, implement and evaluate a system-wide Discharge Medication Reconciliation Process. Consider using a pilot test approach initially to determine a successful strategy for spread.
Follow-throughAn evaluation was completed by the QI Director one year after the incident analysiswas completed:
Raise your hand, your line will be unmuted
Gordon is a Patient Safety Consultant with the Quality Improvement and Patient Safety Unit of the Winnipeg Regional Health Authority. His background is in Social Work with a graduate degree in Social Policy and Administration and his work experience includes Children’s Mental Health and Child Welfare. He has been leading Critical Incident Reviews for about 3 ½ years. We heard about the great work Gordon and his team are doing only 2 months ago. In November, Sandi and me met one of Gordon’s colleagues at a learning event organized by our colleagues from the HQCA. Shirley she told us about the great work the Winnipeg team is doing with Concise analysis. Excited to find a great organization to profile and put in the spotlight for the rest of the country we begin to learn more about the team, had a few calls and email exchanges with Gordon and felt very confident that the experience of this team will be valuable to all of you. As you listen to this very practical application of the concise method Carolyn introduced please make sure you capture your questions and comments in the chat box or on paper. Gordon will answer your questions following his presentation. Please join me in welcoming Gordon to our session. Gordon Luy, BSW, MSW WRHA Patient Safety Consultant364-99 Cornish AvenueWinnipeg, MB R3C 1A2Telephone: 204-788-8361Fax: 204-788-8430
Raise your hand, your line will be unmuted
Facilitated small group discussion20 minute breakout session. Ioana: recognize different levels of experience. Our goal is that each person leave having learned something - if you are new share your questions and challenges- If you are experienced share your solutions If chat box is “hot” say no to breakout Facilitation tips:Begin with a roundtable: name, organization and what you’d like to take home at the end of the sessionAsk to use the pointer to share their level of experiencePick on people to break the ice – point to what was presented earlier and use the one pager for comprehensive as guideCareful not to overwhelm them – ask, listen then talkMake sure they have the feeling that they accomplished something.Additional facilitation questions:What does one need to do to make this completely fail What is the role of patient/ family in the analysis process Describe the steps to create a timeline of the eventPerform the main steps to analyze information to identify contributing factors and relationships
Most participants will “move” to breakout roomsSome participants will stay in the main roomThose prompted: click YES to bothpop-up screens to “move”If chat box is “hot” say no to brekout
NadineFacilitators report back on process
Quick review of what was discussed during the call: Carolyn – background, features and comparision with comprehensive, overview of the steps in concise as presented in CIAF Gordon – practical application of the steps in CIAF concise in both a research study and regular work processesLearn from each other’s experience tips, stories, examples, scenarios Participants will be sent a link for an evaluation of the session immediately following. Please complete in 1 week while fresh in mind. You will need to complete in order to receive your certificate of completion for the module.We will also send you a survey in 6 months to let us know how you are doing and how you have used the principles and learning from the Framework and Learning Program to improve your practice with incident analysis and management.Of course, we invite your feedback, questions or suggestions at any time as to how we might improve the learning program
NadineDuring our discussion today, we have referenced a number of resources which can provide you with additional information. Links for these references are provided above.We hope that you will join us for subsequent learning modules.Thank you so much for the opportunity to speak with you today.