Goal 1 improve the accuracy of patient identification.npsssuser47f0be
The document discusses patient identification and reducing errors related to misidentification. It focuses on using two patient identifiers, which can help reliably identify individuals and match them to the correct service or treatment. Newborns are at higher risk given their inability to communicate and lack of distinguishing features. The document provides examples of methods to prevent misidentification of newborns such as distinct naming systems and standardized identification banding practices.
This document summarizes the key points from a document about patient safety goals for 2010. It discusses goals around improving patient identification, communication among caregivers, medication safety, reducing healthcare associated infections, medication reconciliation, and identifying patients at risk for suicide. The goals cover topics like using two patient identifiers, reporting critical test results in a timely manner, properly labeling medications, implementing best practices to prevent infections from multi-drug resistant organisms and central lines, and reconciling medications when patients transfer between care settings.
This document outlines patient safety goals and standards. It defines key terms like risk and safety. It lists international patient safety goals such as identifying patients correctly and reducing healthcare associated infections. National patient safety goals are discussed in more detail and include accurately identifying patients, improving caregiver communication, safely using medications, reducing anticoagulant therapy harm, maintaining accurate medication information, reducing clinical alarm hazards, and preventing healthcare associated infections. The document provides specific requirements for implementing several of the national goals.
Patient safety goals effective january 1, 2016Hisham Aldabagh
Includes the patient safety goals which must be achieved during the year 2016, focusing on patient identification, proper patient medication, protection patient against infection, and strict per operative patient safety procedures
The document summarizes the presentation given by Ms. Eloisa E. Ramos on patient safety goals at Procare Riaya Hospital. It discusses the 6 International Patient Safety Goals including identifying patients correctly, improving communication, safety of high-alert medications, ensuring correct-site surgery, reducing healthcare-associated infections, and reducing falls. Key points from each goal are provided such as using two patient identifiers, implementing processes for verbal orders and reporting critical test results, and assessing and mitigating patient fall risks. The document aims to improve safety and quality of care through understanding and implementing the Joint Commission International's patient safety standards.
The document discusses the International Patient Safety Goals (IPSG) which were developed by the Joint Commission International to help improve patient safety. It provides background on how the IPSG were adapted from the National Patient Safety Goals established by the Joint Commission. The document then outlines several of the IPSG, including proper patient identification, improving staff communication, reducing risks associated with medications, and preventing wrong site/procedure surgery. The goals are aimed at reducing common safety issues and medical errors in healthcare facilities.
This document discusses key considerations for clinical trial design, size, and study population. It outlines common trial designs like parallel group, crossover, and factorial designs. Appropriate study design and adequate sample size are important to achieve study objectives and answer key questions. Sample size calculations should account for the primary endpoint, expected treatment effect, variability, type I and II errors. Selection of subjects and controls also impacts trial validity. An independent data monitoring committee provides trial oversight.
This document provides an overview of phase 3 clinical trials. Phase 3 trials involve large randomized controlled trials of up to 3000 patients to generate statistically significant data on a drug's safety and efficacy in different patient populations. The objectives are to demonstrate therapeutic efficacy and safety/tolerability in a representative sample. Results are submitted to regulatory agencies for marketing approval. Challenges include long duration, large sample sizes, high costs, and coordinating multiple study sites. If approved, the new drug application process requires submission of all safety, efficacy and manufacturing data to the regulatory agency for review and potential approval.
Goal 1 improve the accuracy of patient identification.npsssuser47f0be
The document discusses patient identification and reducing errors related to misidentification. It focuses on using two patient identifiers, which can help reliably identify individuals and match them to the correct service or treatment. Newborns are at higher risk given their inability to communicate and lack of distinguishing features. The document provides examples of methods to prevent misidentification of newborns such as distinct naming systems and standardized identification banding practices.
This document summarizes the key points from a document about patient safety goals for 2010. It discusses goals around improving patient identification, communication among caregivers, medication safety, reducing healthcare associated infections, medication reconciliation, and identifying patients at risk for suicide. The goals cover topics like using two patient identifiers, reporting critical test results in a timely manner, properly labeling medications, implementing best practices to prevent infections from multi-drug resistant organisms and central lines, and reconciling medications when patients transfer between care settings.
This document outlines patient safety goals and standards. It defines key terms like risk and safety. It lists international patient safety goals such as identifying patients correctly and reducing healthcare associated infections. National patient safety goals are discussed in more detail and include accurately identifying patients, improving caregiver communication, safely using medications, reducing anticoagulant therapy harm, maintaining accurate medication information, reducing clinical alarm hazards, and preventing healthcare associated infections. The document provides specific requirements for implementing several of the national goals.
Patient safety goals effective january 1, 2016Hisham Aldabagh
Includes the patient safety goals which must be achieved during the year 2016, focusing on patient identification, proper patient medication, protection patient against infection, and strict per operative patient safety procedures
The document summarizes the presentation given by Ms. Eloisa E. Ramos on patient safety goals at Procare Riaya Hospital. It discusses the 6 International Patient Safety Goals including identifying patients correctly, improving communication, safety of high-alert medications, ensuring correct-site surgery, reducing healthcare-associated infections, and reducing falls. Key points from each goal are provided such as using two patient identifiers, implementing processes for verbal orders and reporting critical test results, and assessing and mitigating patient fall risks. The document aims to improve safety and quality of care through understanding and implementing the Joint Commission International's patient safety standards.
The document discusses the International Patient Safety Goals (IPSG) which were developed by the Joint Commission International to help improve patient safety. It provides background on how the IPSG were adapted from the National Patient Safety Goals established by the Joint Commission. The document then outlines several of the IPSG, including proper patient identification, improving staff communication, reducing risks associated with medications, and preventing wrong site/procedure surgery. The goals are aimed at reducing common safety issues and medical errors in healthcare facilities.
This document discusses key considerations for clinical trial design, size, and study population. It outlines common trial designs like parallel group, crossover, and factorial designs. Appropriate study design and adequate sample size are important to achieve study objectives and answer key questions. Sample size calculations should account for the primary endpoint, expected treatment effect, variability, type I and II errors. Selection of subjects and controls also impacts trial validity. An independent data monitoring committee provides trial oversight.
This document provides an overview of phase 3 clinical trials. Phase 3 trials involve large randomized controlled trials of up to 3000 patients to generate statistically significant data on a drug's safety and efficacy in different patient populations. The objectives are to demonstrate therapeutic efficacy and safety/tolerability in a representative sample. Results are submitted to regulatory agencies for marketing approval. Challenges include long duration, large sample sizes, high costs, and coordinating multiple study sites. If approved, the new drug application process requires submission of all safety, efficacy and manufacturing data to the regulatory agency for review and potential approval.
Dispensing of Prescription Rx & Ethic of Pharmacist with PatientsDashty Rihany
A prescription is an order form a registered practitioner or another properly licensed practitioner such as a physician, dentist, Doctor veterinarian or dermatologists etc. to a pharmacist to compound Pharmacy and dispense a specific medicine for the patient.
SDTM Training for personnel with Junior and Intermediate level Clinical Trial Experience. Covers summary of most domains. Salient features include order of domain creation, importance of making programming Data/Metadata Driven, Nature of Clinical Raw Data, Summary of the Clinical Trial process with regards to the data flow to arrive at the Study data to be submitted to regulatory authorities like FDA, Importance of deriving ADAM from SDTM and not directly from raw data, Information has been put together from variety of sources including my own programming work.
International Patient Safety Goals (IPSG) help accredited organizations address specific areas of concern in some of the most problematic areas of patient safety.
International-Patient-Safety-GoalsGoal 1: Identify patients correctly
Goal 2: Improve effective communication
Goal 3: Improve the safety of high-alert medications
Goal 4: Ensure safe surgery
Goal 5: Reduce the risk of health care-associated infections
Goal 6: Reduce the risk of patient harm resulting from falls
This document discusses management control systems in hospitals. It begins by classifying hospitals based on objective, ownership, path of treatment, and size. It then discusses the management model of hospitals and various flowcharts from the perspectives of patients, doctors, and receptionists. It also includes content on classification of hospitals, benchmarking process and levels, and use case and class diagrams. Specific areas like pharmacy are then discussed in more detail, outlining goals, scope, and examples of standard operating procedures for dispensing medications.
1 week 6 assignment ebp change process form ace star model SUKHI5
This document outlines a nursing student's plan to implement a change project to reduce postoperative surgical site infections. Specifically, the student proposes prohibiting artificial nails among clinical staff members. The rationale is that artificial nails harbor pathogens and have been linked to outbreaks of similar infections in surgical patients. The student identifies relevant stakeholders, including nurses, technicians, managers, and administrators. The plan involves educating staff on the new policy, conducting audits to collect infection rate data before and after implementation, and reporting outcomes to stakeholders. If successful, the policy would become permanent. The goal is to improve patient outcomes and safety by reducing opportunities for infection transmission in the operating room.
1/8/15, 4:15 PMPrint Course | Safety First > CE694
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Back
Safety First
The Joint Commission’s National Patient Safety Goals for
2013-2014
CE694 :: 1.00 Hours
Authors:
Connie Kirkpatrick, RN, MS, PhD
Connie Kirkpatrick, RN, MS, PhD, is administrator for quality and patient safety at Good Samaritan
Hospital in Puyallup, Wash. The author has declared no real or perceived conflicts of interest that
relate to this educational activity.
Charles F. Bombard, RN, MHA, CPHQ, FACHE
Charles F. Bombard, RN, MHA, CPHQ, FACHE, is director of quality improvement at Tampa General
Hospital in Florida.
Doris Schmidt, RN, BSN, MS, LRM
Doris Schmidt, RN, BSN, MS, LRM, is the manager of regulatory compliance at Tampa General
Hospital in Florida.
Objectives
The purpose of this National Patient Safety Goal program is to inform nurses about The Joint
Commission’s current NPSGs that apply to hospitals. After studying the information presented
here, you will be able to:
Name the current goals and elements of performance (requirements)
Explain the new goal effective January 1, 2014
Describe the intent of the patient safety goals
Consider this patient scenario. Amberly was scheduled for an arthroscopy on her right knee. Her
orthopedic surgeon wrote instructions to his administrative assistant that he would be operating
on Amberly’s left knee. She called the OR scheduling office and gave them Amberly’s name and
the physician’s request to schedule her for a left knee arthroscopy. Amberly was put on the OR
schedule as a left knee arthroscopy. Upon admission to the hospital, Amberly was prepared for
surgery. When consenting for surgery, she stated that her right knee was to have the operation.
In the OR, the nurse checked Amberly in to the preop holding area and verified her name and date
of birth with her ID wristband. The nurse asked Amberly what surgery she was scheduled for and
found that the OR schedule and consent form, along with the patient, did not agree on the site of
the surgery. The OR nurse stopped all activity associated with her surgery until the discrepancy
was resolved.
This stoppage by the nurse is part of the universal protocol, one of the original (and continuing)
National Patient Safety Goals, or NPSGs, that contains three requirements: verification of correct
procedure, patient and site against all relevant documentation; marking of the surgical site by the
proceduralist; and conducting a timeout just before the start of the procedure, when the
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physician, nurse and anesthesia provider agree that they have the right patient and are doing the
right procedure at the right site. For Amberly, there would have been two other stops along the
way that would have prevented this error: site marking and the timeout before surg.
Development safety update report (dsur) pharmacovigilance and safetyAzierta
According to ICH guideline E2F (Step 5) on Development Safety Update Reports (DSURs) already implemented since 2011, companies must submit DSURs on a yearly basis for medicinal products involved in clinical trials. The focus of the DSUR is on data and findings from clinical trials of drugs and biologicals, whether they are authorized or not.
DSURs are internationally-harmonized, safety documents covering the safety summary of medicinal products during their development or clinical trial phase.
They are based heavily on the PSUR format already used for updating the safety record of drugs in their marketing phase.
A DSUR should be prepared after the first authorization of a clinical trial worldwide. A copy of the DSUR should be submitted to each concerned European Member State (MS) if a clinical trial is authorized in this MS for this investigational drug (still using the DIBD). Therefore, the first DSUR can be submitted to a concerned MS earlier than 1 year, but the covered reporting period should not be longer than 1 year.
The DSUR presents an annual review & evaluation of safety information:
• Information reported during the current review period and analysis based on previous knowledge of the products’ safety
• Description of new issues that may impact the overall program or specific clinical trials.
• Summarization of current understanding and management of known and potential safety risks to exposed patients.
• Provide an update on the status of the clinical development program.
In Azierta, scientific and healthcare consulting, we are experts in Pharmacovigilance and we have a team of highly qualified drug safety experts who support our clients to manage pharmacovigilance in an optimal way. Our work covers all areas of pharmacovigilance, both at the level of medicines, as well as medical devices and cosmetic products.
If you are interested in the contents of the good practices of pharmacovigilance (GVPs), as well as in other products related to pharmacovigilance visit our safety reports website for more details and feel free to contact us, we will be pleased to help you.
The document outlines the top 10 most frequent recommendations made by TMLT's Risk Managers during on-site practice reviews in 2017. These include: 1) updating medical records to ensure consistency and accuracy of information; 2) establishing policies for electronic health record security and documentation of review; 3) documenting diagnostic report review, patient instructions, and emergency protocols; and 4) properly recording injections administered and patient monitoring. The goal is to help physicians address medical liability risks through improving documentation practices.
This document provides an overview of clinical trial protocols. It discusses developing protocols, different trial designs (e.g. parallel vs. crossover), blinding techniques, and key elements of a protocol. The objective of most clinical trials is to scientifically evaluate a treatment's efficacy and safety so valid conclusions can be drawn. Well-designed protocols and trials that follow the protocol are essential to meeting research objectives and regulatory requirements for drug approval.
This document provides an overview of key concepts in randomized clinical trials. It discusses how randomized clinical trials scientifically assess the safety and efficacy of new drugs or therapies using human subjects. The document outlines different types of blinding in clinical trials, such as single-blind, double-blind, and triple-blind designs. It also describes the different phases of clinical drug trials from Phase I to Phase IV and how each phase contributes to understanding a drug's safety, efficacy, and suitability for specific diseases.
The document provides an overview of regulatory training on national patient safety goals. It discusses the Joint Commission's role in developing patient safety standards and how facilities are reviewed. It then summarizes several key national patient safety goals, including: accurately identifying patients; preventing transfusion errors; timely reporting of critical test results; safe medication use; preventing healthcare-associated infections; medication reconciliation; minimizing suicide risk; and using a universal protocol for surgeries.
This document discusses challenges in using Bayesian and decision analysis approaches for regulating medical products. It notes issues like subjectivity in choosing priors, controlling type I error rates, and the need for legal availability of prior information. Promising areas for using prior information include pediatric trials, rare diseases, safety, and expedited access programs. Bayesian adaptive designs allow interim analyses to optimize sample size and model-based likelihoods. Decision analysis can make benefit-risk determinations more explicit through tools like influence diagrams and considering patient preferences. The highest value of Bayesian approaches is in accounting for external evidence, using flexible trial designs, modeling likelihoods, developing transparent decision rules based on factors like medical need and patient perspectives.
Strategies for Considerations Requirement Sample Size in Different Clinical T...IJMREMJournal
-------------------------------------------------------ABSTRACT ---------------------------------------------------
Usually the main problem face any investigation it how to determent a sample size, however, some
considerations required in sample size to conduct the efficacy and make realistic well-researched before began
study. This study aimed to determine the maximum possible sample size at different phases of clinical trials and
attempt to achieve the best accuracy of the results. To achieve that the maximum sample size in different phases
we found that the maximum sample size of phase I was (75) relies on largest response rate 20% and the minimal
clinically important difference (MCID) 15%, and because the participants are healthy often that means 15%
enough to show positive results of the transition to the second phase. for the phase II clinical trials; the
maximum sample size was (388) depend on the error 5% and largest response rate 50% when the response rate
should not be less than 20% according to the design used in this phase. Depend on the endpoint and hazard
ratio in phase III clinical trials when the probability of survival of the treatment group equal to median of the
probability of survival 50% we found that the maximum sample size (4796). For the phase IV the maximum
sample size in different phases of clinical trials does not affect whatever the large of the population size and
remains constant as large as possible size.
This document discusses patient safety and the International Patient Safety Goals. It defines patient safety as the prevention of errors and adverse effects associated with healthcare. It also defines key terms like sentinel events and near misses. The document then summarizes each of the 6 International Patient Safety Goals which focus on correctly identifying patients, improving communication, safety of high-alert medications, correct site surgery, reducing healthcare associated infections, and reducing falls. It provides examples of processes to meet each goal.
The document describes a learning module on pharmacology for nursing students. It includes an overview of the module, learning outcomes, content topics, and activities. The module aims to teach students how to apply the nursing process, including assessment, planning, intervention, education, and evaluation, when administering drugs to patients. It focuses on important aspects like taking drug histories, interpreting medication orders, ensuring safety, and educating clients. A variety of teaching methods are outlined like discussions, case studies, skills practice, and quizzes to reinforce the concepts.
The document discusses "core measures", which are evidence-based guidelines established by CMS and the Joint Commission for treating patients with certain diagnoses. The core measure patient groups include CHF, pneumonia, AMI, surgical care improvement, psychiatry, and patient satisfaction. Hospitals must follow specific treatment protocols for these patients and are audited to ensure compliance. Identifying core measure patients early and using established protocols and tools is key to improving outcomes and quality measures.
The document provides an overview of clinical study protocols, including their purpose, key components, and importance. It describes the various sections of a protocol, such as the background and objectives, study design, subject selection criteria, study procedures, safety and efficacy assessments, and data handling. Maintaining adherence to the protocol is important to ensure the safety of participants and integrity of the clinical trial.
This document outlines 5 medication management safety standards:
1) Prohibiting dangerous abbreviations
2) Obtaining and documenting a complete list of patient medications upon admission
3) Labeling all medications and containers in procedural settings
4) Removing concentrated electrolytes from patient care areas when possible and labeling those that remain
5) Identifying, storing, and dispensing look-alike and sound-alike medications to minimize risk of error
For each standard, it provides the rationale and outlines a survey process to evaluate compliance which includes reviewing policies and procedures, interviewing staff, and making observations.
ScanScan 1Scan 2Scan 3Scan 4Scan 5Scan 6Scan 7Scan 8Scan 9Scan 10Scan 11Scan 12Scan 13
Chapter 13 Global Health Challenges
MANY INDIVIDUALS AND NONGOVERNMENTAL ORGANIZATIONS (NGOS) HELP FIGHT GLOBAL DISEASE. The Bill and Melinda Gates Foundation plays a key role in the war against malaria, AIDS, and other diseases. Melinda and Bill Gates met with doctors and patients at the Manhica Research Center and Hospital in an area of Mozambique heavily affected by malaria.
Learning Objectives
1. 13.1Recall the causes and effects of noncommunicable diseases
2. 13.2Evaluate the role of global travel and trade in facilitating the globalization of infectious diseases
3. 13.3Outline the three developments that gave rise to the concept of human security
4. 13.4Describe the three epidemiologic transitions to better understand contemporary concerns about infectious diseases
5. 13.5Report the cause, spread, effects, and control measures of influenza and avian flu
6. 13.6Report the cause, spread, effects, and control measures of malaria
7. 13.7Recognize the causes and preventive measures of HIV
8. 13.8Report the origin, spread, effects, and control measures of SARS
9. 13.9Report the origin, spread, effects, and control measures of Ebola
10. 13.10Outline role of the WHO in preventing the spread of infectious diseases
Noncommunicable diseases (NCDs) such as heart disease, cancer, diabetes, chronic respiratory disease, and mental illness in general and Alzheimer’s disease in particular are the leading causes of death and disability globally. Long associated with affluent Western standards of living, NCDs are now a global problem. While rich countries are better equipped to deal with chronic diseases, they are far more deadly in poor countries. Growing numbers of old people and the spread of middle-class lifestyles make NCDs more prevalent than infectious diseases. Globalization also contributes to the growth of NCDs by helping expand the global middle class and by promoting fast foods, sugary drinks, alcohol, smoking, processed foods, and sedentary lifestyles. A major global health threat that undermines efforts to cure diseases is the emergence of germs that are resistant to antibiotics. This is due mainly to the excessive use of antibiotics in medicine and agriculture.
Infectious diseases are intertwined with numerous global issues and are inseparable from political, economic, and cultural components of globalization. Ethnic conflicts make populations vulnerable to infectious diseases. Fighting contributes to the collapse of public services, which means that many people die from what would ordinarily be treatable diseases, such as diarrhea and respiratory infections. Conflicts also create refugees, overcrowding, and unsanitary conditions, thereby creating environments conducive to the spread of infectious diseases.
Environmental degradation and deforestation expose humans to a variety of infectious diseases. They also contribute to global warming and flooding,.
Scapegoating is a theory of prejudice and discrimination. Societ.docxtodd331
Scapegoating is a theory of prejudice and discrimination. Society looks at the weakest group, and places blame on that group for all ills. That group then becomes the bottom level of society. We've seen this over the past 18 months. Illegal immigrants have been blamed for many issues, in particular crime and unemployment rates. Yet, I know few in my own area who will do the jobs these folks do every day. As for crime, please see the link below for a journal article that addresses this issue. Most crimes committed by immigrants without papers are misdemeanors.
What are your thoughts?
.
More Related Content
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Dispensing of Prescription Rx & Ethic of Pharmacist with PatientsDashty Rihany
A prescription is an order form a registered practitioner or another properly licensed practitioner such as a physician, dentist, Doctor veterinarian or dermatologists etc. to a pharmacist to compound Pharmacy and dispense a specific medicine for the patient.
SDTM Training for personnel with Junior and Intermediate level Clinical Trial Experience. Covers summary of most domains. Salient features include order of domain creation, importance of making programming Data/Metadata Driven, Nature of Clinical Raw Data, Summary of the Clinical Trial process with regards to the data flow to arrive at the Study data to be submitted to regulatory authorities like FDA, Importance of deriving ADAM from SDTM and not directly from raw data, Information has been put together from variety of sources including my own programming work.
International Patient Safety Goals (IPSG) help accredited organizations address specific areas of concern in some of the most problematic areas of patient safety.
International-Patient-Safety-GoalsGoal 1: Identify patients correctly
Goal 2: Improve effective communication
Goal 3: Improve the safety of high-alert medications
Goal 4: Ensure safe surgery
Goal 5: Reduce the risk of health care-associated infections
Goal 6: Reduce the risk of patient harm resulting from falls
This document discusses management control systems in hospitals. It begins by classifying hospitals based on objective, ownership, path of treatment, and size. It then discusses the management model of hospitals and various flowcharts from the perspectives of patients, doctors, and receptionists. It also includes content on classification of hospitals, benchmarking process and levels, and use case and class diagrams. Specific areas like pharmacy are then discussed in more detail, outlining goals, scope, and examples of standard operating procedures for dispensing medications.
1 week 6 assignment ebp change process form ace star model SUKHI5
This document outlines a nursing student's plan to implement a change project to reduce postoperative surgical site infections. Specifically, the student proposes prohibiting artificial nails among clinical staff members. The rationale is that artificial nails harbor pathogens and have been linked to outbreaks of similar infections in surgical patients. The student identifies relevant stakeholders, including nurses, technicians, managers, and administrators. The plan involves educating staff on the new policy, conducting audits to collect infection rate data before and after implementation, and reporting outcomes to stakeholders. If successful, the policy would become permanent. The goal is to improve patient outcomes and safety by reducing opportunities for infection transmission in the operating room.
1/8/15, 4:15 PMPrint Course | Safety First > CE694
Page 1 of 10http://ce.nurse.com/PrintTopic.aspx?TopicId=8781
Back
Safety First
The Joint Commission’s National Patient Safety Goals for
2013-2014
CE694 :: 1.00 Hours
Authors:
Connie Kirkpatrick, RN, MS, PhD
Connie Kirkpatrick, RN, MS, PhD, is administrator for quality and patient safety at Good Samaritan
Hospital in Puyallup, Wash. The author has declared no real or perceived conflicts of interest that
relate to this educational activity.
Charles F. Bombard, RN, MHA, CPHQ, FACHE
Charles F. Bombard, RN, MHA, CPHQ, FACHE, is director of quality improvement at Tampa General
Hospital in Florida.
Doris Schmidt, RN, BSN, MS, LRM
Doris Schmidt, RN, BSN, MS, LRM, is the manager of regulatory compliance at Tampa General
Hospital in Florida.
Objectives
The purpose of this National Patient Safety Goal program is to inform nurses about The Joint
Commission’s current NPSGs that apply to hospitals. After studying the information presented
here, you will be able to:
Name the current goals and elements of performance (requirements)
Explain the new goal effective January 1, 2014
Describe the intent of the patient safety goals
Consider this patient scenario. Amberly was scheduled for an arthroscopy on her right knee. Her
orthopedic surgeon wrote instructions to his administrative assistant that he would be operating
on Amberly’s left knee. She called the OR scheduling office and gave them Amberly’s name and
the physician’s request to schedule her for a left knee arthroscopy. Amberly was put on the OR
schedule as a left knee arthroscopy. Upon admission to the hospital, Amberly was prepared for
surgery. When consenting for surgery, she stated that her right knee was to have the operation.
In the OR, the nurse checked Amberly in to the preop holding area and verified her name and date
of birth with her ID wristband. The nurse asked Amberly what surgery she was scheduled for and
found that the OR schedule and consent form, along with the patient, did not agree on the site of
the surgery. The OR nurse stopped all activity associated with her surgery until the discrepancy
was resolved.
This stoppage by the nurse is part of the universal protocol, one of the original (and continuing)
National Patient Safety Goals, or NPSGs, that contains three requirements: verification of correct
procedure, patient and site against all relevant documentation; marking of the surgical site by the
proceduralist; and conducting a timeout just before the start of the procedure, when the
http://ce.nurse.com/PrintTopic.aspx?TopicId=8781#
1/8/15, 4:15 PMPrint Course | Safety First > CE694
Page 2 of 10http://ce.nurse.com/PrintTopic.aspx?TopicId=8781
physician, nurse and anesthesia provider agree that they have the right patient and are doing the
right procedure at the right site. For Amberly, there would have been two other stops along the
way that would have prevented this error: site marking and the timeout before surg.
Development safety update report (dsur) pharmacovigilance and safetyAzierta
According to ICH guideline E2F (Step 5) on Development Safety Update Reports (DSURs) already implemented since 2011, companies must submit DSURs on a yearly basis for medicinal products involved in clinical trials. The focus of the DSUR is on data and findings from clinical trials of drugs and biologicals, whether they are authorized or not.
DSURs are internationally-harmonized, safety documents covering the safety summary of medicinal products during their development or clinical trial phase.
They are based heavily on the PSUR format already used for updating the safety record of drugs in their marketing phase.
A DSUR should be prepared after the first authorization of a clinical trial worldwide. A copy of the DSUR should be submitted to each concerned European Member State (MS) if a clinical trial is authorized in this MS for this investigational drug (still using the DIBD). Therefore, the first DSUR can be submitted to a concerned MS earlier than 1 year, but the covered reporting period should not be longer than 1 year.
The DSUR presents an annual review & evaluation of safety information:
• Information reported during the current review period and analysis based on previous knowledge of the products’ safety
• Description of new issues that may impact the overall program or specific clinical trials.
• Summarization of current understanding and management of known and potential safety risks to exposed patients.
• Provide an update on the status of the clinical development program.
In Azierta, scientific and healthcare consulting, we are experts in Pharmacovigilance and we have a team of highly qualified drug safety experts who support our clients to manage pharmacovigilance in an optimal way. Our work covers all areas of pharmacovigilance, both at the level of medicines, as well as medical devices and cosmetic products.
If you are interested in the contents of the good practices of pharmacovigilance (GVPs), as well as in other products related to pharmacovigilance visit our safety reports website for more details and feel free to contact us, we will be pleased to help you.
The document outlines the top 10 most frequent recommendations made by TMLT's Risk Managers during on-site practice reviews in 2017. These include: 1) updating medical records to ensure consistency and accuracy of information; 2) establishing policies for electronic health record security and documentation of review; 3) documenting diagnostic report review, patient instructions, and emergency protocols; and 4) properly recording injections administered and patient monitoring. The goal is to help physicians address medical liability risks through improving documentation practices.
This document provides an overview of clinical trial protocols. It discusses developing protocols, different trial designs (e.g. parallel vs. crossover), blinding techniques, and key elements of a protocol. The objective of most clinical trials is to scientifically evaluate a treatment's efficacy and safety so valid conclusions can be drawn. Well-designed protocols and trials that follow the protocol are essential to meeting research objectives and regulatory requirements for drug approval.
This document provides an overview of key concepts in randomized clinical trials. It discusses how randomized clinical trials scientifically assess the safety and efficacy of new drugs or therapies using human subjects. The document outlines different types of blinding in clinical trials, such as single-blind, double-blind, and triple-blind designs. It also describes the different phases of clinical drug trials from Phase I to Phase IV and how each phase contributes to understanding a drug's safety, efficacy, and suitability for specific diseases.
The document provides an overview of regulatory training on national patient safety goals. It discusses the Joint Commission's role in developing patient safety standards and how facilities are reviewed. It then summarizes several key national patient safety goals, including: accurately identifying patients; preventing transfusion errors; timely reporting of critical test results; safe medication use; preventing healthcare-associated infections; medication reconciliation; minimizing suicide risk; and using a universal protocol for surgeries.
This document discusses challenges in using Bayesian and decision analysis approaches for regulating medical products. It notes issues like subjectivity in choosing priors, controlling type I error rates, and the need for legal availability of prior information. Promising areas for using prior information include pediatric trials, rare diseases, safety, and expedited access programs. Bayesian adaptive designs allow interim analyses to optimize sample size and model-based likelihoods. Decision analysis can make benefit-risk determinations more explicit through tools like influence diagrams and considering patient preferences. The highest value of Bayesian approaches is in accounting for external evidence, using flexible trial designs, modeling likelihoods, developing transparent decision rules based on factors like medical need and patient perspectives.
Strategies for Considerations Requirement Sample Size in Different Clinical T...IJMREMJournal
-------------------------------------------------------ABSTRACT ---------------------------------------------------
Usually the main problem face any investigation it how to determent a sample size, however, some
considerations required in sample size to conduct the efficacy and make realistic well-researched before began
study. This study aimed to determine the maximum possible sample size at different phases of clinical trials and
attempt to achieve the best accuracy of the results. To achieve that the maximum sample size in different phases
we found that the maximum sample size of phase I was (75) relies on largest response rate 20% and the minimal
clinically important difference (MCID) 15%, and because the participants are healthy often that means 15%
enough to show positive results of the transition to the second phase. for the phase II clinical trials; the
maximum sample size was (388) depend on the error 5% and largest response rate 50% when the response rate
should not be less than 20% according to the design used in this phase. Depend on the endpoint and hazard
ratio in phase III clinical trials when the probability of survival of the treatment group equal to median of the
probability of survival 50% we found that the maximum sample size (4796). For the phase IV the maximum
sample size in different phases of clinical trials does not affect whatever the large of the population size and
remains constant as large as possible size.
This document discusses patient safety and the International Patient Safety Goals. It defines patient safety as the prevention of errors and adverse effects associated with healthcare. It also defines key terms like sentinel events and near misses. The document then summarizes each of the 6 International Patient Safety Goals which focus on correctly identifying patients, improving communication, safety of high-alert medications, correct site surgery, reducing healthcare associated infections, and reducing falls. It provides examples of processes to meet each goal.
The document describes a learning module on pharmacology for nursing students. It includes an overview of the module, learning outcomes, content topics, and activities. The module aims to teach students how to apply the nursing process, including assessment, planning, intervention, education, and evaluation, when administering drugs to patients. It focuses on important aspects like taking drug histories, interpreting medication orders, ensuring safety, and educating clients. A variety of teaching methods are outlined like discussions, case studies, skills practice, and quizzes to reinforce the concepts.
The document discusses "core measures", which are evidence-based guidelines established by CMS and the Joint Commission for treating patients with certain diagnoses. The core measure patient groups include CHF, pneumonia, AMI, surgical care improvement, psychiatry, and patient satisfaction. Hospitals must follow specific treatment protocols for these patients and are audited to ensure compliance. Identifying core measure patients early and using established protocols and tools is key to improving outcomes and quality measures.
The document provides an overview of clinical study protocols, including their purpose, key components, and importance. It describes the various sections of a protocol, such as the background and objectives, study design, subject selection criteria, study procedures, safety and efficacy assessments, and data handling. Maintaining adherence to the protocol is important to ensure the safety of participants and integrity of the clinical trial.
This document outlines 5 medication management safety standards:
1) Prohibiting dangerous abbreviations
2) Obtaining and documenting a complete list of patient medications upon admission
3) Labeling all medications and containers in procedural settings
4) Removing concentrated electrolytes from patient care areas when possible and labeling those that remain
5) Identifying, storing, and dispensing look-alike and sound-alike medications to minimize risk of error
For each standard, it provides the rationale and outlines a survey process to evaluate compliance which includes reviewing policies and procedures, interviewing staff, and making observations.
Similar to Sample Session PlanNameDateInstructionsPlease list the.docx (20)
ScanScan 1Scan 2Scan 3Scan 4Scan 5Scan 6Scan 7Scan 8Scan 9Scan 10Scan 11Scan 12Scan 13
Chapter 13 Global Health Challenges
MANY INDIVIDUALS AND NONGOVERNMENTAL ORGANIZATIONS (NGOS) HELP FIGHT GLOBAL DISEASE. The Bill and Melinda Gates Foundation plays a key role in the war against malaria, AIDS, and other diseases. Melinda and Bill Gates met with doctors and patients at the Manhica Research Center and Hospital in an area of Mozambique heavily affected by malaria.
Learning Objectives
1. 13.1Recall the causes and effects of noncommunicable diseases
2. 13.2Evaluate the role of global travel and trade in facilitating the globalization of infectious diseases
3. 13.3Outline the three developments that gave rise to the concept of human security
4. 13.4Describe the three epidemiologic transitions to better understand contemporary concerns about infectious diseases
5. 13.5Report the cause, spread, effects, and control measures of influenza and avian flu
6. 13.6Report the cause, spread, effects, and control measures of malaria
7. 13.7Recognize the causes and preventive measures of HIV
8. 13.8Report the origin, spread, effects, and control measures of SARS
9. 13.9Report the origin, spread, effects, and control measures of Ebola
10. 13.10Outline role of the WHO in preventing the spread of infectious diseases
Noncommunicable diseases (NCDs) such as heart disease, cancer, diabetes, chronic respiratory disease, and mental illness in general and Alzheimer’s disease in particular are the leading causes of death and disability globally. Long associated with affluent Western standards of living, NCDs are now a global problem. While rich countries are better equipped to deal with chronic diseases, they are far more deadly in poor countries. Growing numbers of old people and the spread of middle-class lifestyles make NCDs more prevalent than infectious diseases. Globalization also contributes to the growth of NCDs by helping expand the global middle class and by promoting fast foods, sugary drinks, alcohol, smoking, processed foods, and sedentary lifestyles. A major global health threat that undermines efforts to cure diseases is the emergence of germs that are resistant to antibiotics. This is due mainly to the excessive use of antibiotics in medicine and agriculture.
Infectious diseases are intertwined with numerous global issues and are inseparable from political, economic, and cultural components of globalization. Ethnic conflicts make populations vulnerable to infectious diseases. Fighting contributes to the collapse of public services, which means that many people die from what would ordinarily be treatable diseases, such as diarrhea and respiratory infections. Conflicts also create refugees, overcrowding, and unsanitary conditions, thereby creating environments conducive to the spread of infectious diseases.
Environmental degradation and deforestation expose humans to a variety of infectious diseases. They also contribute to global warming and flooding,.
Scapegoating is a theory of prejudice and discrimination. Societ.docxtodd331
Scapegoating is a theory of prejudice and discrimination. Society looks at the weakest group, and places blame on that group for all ills. That group then becomes the bottom level of society. We've seen this over the past 18 months. Illegal immigrants have been blamed for many issues, in particular crime and unemployment rates. Yet, I know few in my own area who will do the jobs these folks do every day. As for crime, please see the link below for a journal article that addresses this issue. Most crimes committed by immigrants without papers are misdemeanors.
What are your thoughts?
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INSTRUCTIONS
Write a brief case study (ALZHIEMER DISEASE) of a real or hypothetical issue or problem that needs investigation (approx. 200-250 words max).
Discussion 3.2: Hypothesis Test Tag Team
Corporate Responsibility 8;
The Social Responsibility of Business Is
to Increase Its Profits
Milton Friedman
When I hear businessmen speak eloquently
about the “social responsibilities of business
in a free-enterprise system,” I am reminded
of the wonderful line about the Frenchman
who discovered at the age of 70 that he had
been speaking prose all his life. The busi
nessmen believe that they are defending free
enterprise when they declaim that business
is not concerned “merely” with profit but
also with promoting desirable “social” ends;
that business has a “social conscience” and
takes seriously its responsibilities for provid
ing employment, eliminating discrimina
tion, avoiding pollution and whatever else
may be the catchwords of the contemporary
crop of reformers. In fact they are—or
would be if they or anyone else took them
seriously—preaching pure and unadulter
ated socialism. Businessmen who talk this
way are unwitting puppets of the intellectual
forces that have been undermining the basis
of a free society these past decades.
The discussions of the “social responsibil
ities of business” are notable for their analyt
ical looseness and lack of rigor. What does it
mean to say that “business” has responsibili
ties? Only people can have responsibilities.
A corporation is an artificial person and in
this sense may have artificial responsibili
ties, but “business” as a whole cannot be said
to have responsibilities, even in this vague
sense. The first step toward clarity in ex
amining the doctrine of the social responsi
bility of business is to ask precisely what it
implies for whom.
Presumably, the individuals who are to be
responsible are businessmen, which means
individual proprietors or corporate execu
tives. Most of the discussion of social respon
sibility is directed at corporations, so in what
follows I shall mostly neglect the individual
proprietors and speak of corporate execu
tives.
In a free-enterprise, private-property sys
tem, a corporate executive is an employee of
the owners of the business. He has direct re
sponsibility to his employers. That responsi
bility is to conduct the business in accord
ance with their desires, which generally will
be to make as much money as possible while
conforming to the basic rules of the society,
both those embodied in law and those em
bodied in ethical custom. Of course, in some
cases his employers may have a different ob
jective. A group of persons might establish a
corporation for an eleemosynary purpose—
for example, a hospital or a school. The
manager of such a corporation will not have
money profit as his objectives but the ren
dering of certain services.
In either case,.
Sara Mohammed1991 Washington St.Indiana, PA 15701(571) 550-3.docxtodd331
Sara Mohammed
1991 Washington St.
Indiana, PA 15701
(571) 550-3232
[email protected]
EDUCATION
Indiana University of Pennsylvania (IUP) Expected December 2020
Bachelor of Science in Business
Northern Virginia Community College (NOVA), Woodbridge, VA May 2016
English As a Second Language
Volunteerism
Saudi club association at Gannon University Fall 2018
SKILLS
· Speak three languages (Arabic, English, and Turkish)
· Knowledge with technology
· Experience with Microsoft, Word, Excel, and PowerPoint
· Looking for helping others always
· Familiar with taking care of kids
.
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Application Assignment 2: Part 2 - Developing an Advocacy Campaign
The following application, Part 2, will be due in Week 7.
To prepare:
· Review Chapter 3 of Health policy and politics: A nurse’s guide.
· In the first assignment, you reflected on whether the policy you would like to promote could best be achieved through the development of new legislation, or a change in an existing law or regulation. Refine as necessary using any feedback from your first paper.
· Contemplate how existing laws or regulations may affect how you proceed in advocating for your proposed policy.
· Consider how you could influence legislators or other policymakers to enact the policy you propose.
· Think about the obstacles of the legislative process that may prevent your proposed policy from being implemented as intended.
·
To complete:
Part Two will have approximately 3–4 pages of content plus a title page and references. Part Two will address the following:
· Explain whether your proposed policy could be enacted through a modification of existing law or regulation or the creation of new legislation/regulation.
· Explain how existing laws or regulations could affect your advocacy efforts. Be sure to cite and reference the laws and regulations using primary sources.
· Provide an analysis of the methods you could use to influence legislators or other policymakers to support your policy. In particular, explain how you would use the “three legs” of lobbying in your advocacy efforts.
· Summarize obstacles that could arise in the legislative process and how to overcome these hurdles.
Milstead: 3 Legs of Lobbying
“According to Milstead (2013), Leg One of the Three-Legged Stool consists of lobbying which is the act of influencing – the art of persuading-a government entity. “Legislators often rely on lobbyists’ expertise to help them understand what they are voting for or against.” (Milstead, 2013, p. 53). Local State Representatives should be targeted as a champion for the bill and that’s likely where an average voter can begin for their voice to be heard at the local and state levels.Leg Two of the Three-Legged Stool also includes the grassroots lobbyists. The AmericanNurses Association often spear-heads lobbying efforts in the best interest of the public on healthcare related issues and has a strong history of working with Congress on these important issues. “Grassroots lobbyists are constituents who have the power to elect officials through their vote and have expertise and knowledge about a particular issue (such as nurses in healthcare reform debates)” (Milstead, 2013, p. 54). Nurses can become a member of the American Nurses Association or other associations to ensure nurses have a voice on these important issues”
Reflection
Associate Professor Michael Segon
Director MBA
1
Reflection
Reflection is used as a learning tool to make sense of what we have experienced and how we can optimise our learning from that experience.
.
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Chapter 13:The Bureaucracy
ADA Text Version
Learning Objectives
1. Describe the formal organization of the federal bureaucracy.
2. Classify the vital functions performed by the bureaucracy.
3. Explain the present Civil Service system and contrast it with the 19th century spoils system.
4. Identify the various factors contributing to bureaucracy's growth over time.
5. Compare the means by which Congress and the president attempt to maintain control over the bureaucracy.
6. Analyze and evaluate the problems that bureaucratic organization poses for American democracy.
Introduction
The very word "bureaucracy" often carries negative connotations. To refer to an institution as a "bureaucracy" or characterize it as "bureaucratic" is usually intended as an insult. But the national bureaucracy, sometimes called the "fourth branch of government", is responsible for practically all of the day-to-day work of governing the country. While bureaucracy in the United States, consistent with our tradition of more limited government, is smaller than its counterparts in other longstanding democracies, its influence extends to almost every corner of American society. From delivery of the mail to regulation of the stock market to national defense, federal employees plan, regulate, adjudicate, enforce, and implement federal law. Despite recurrent calls to "shrink" the size of government, the federal bureaucracy remains the largest single employer in the United States. This lesson examines the bureaucracy's formal organization, its critical role in the American economy and society, and its perceived weaknesses.
Study Questions
1. How did sociologist Max Weber define bureaucracy?
2. Identify the various functions federal bureaucracies perform giving at least one example each:
a. Implementation
b. Regulation
c. Adjudication
d. Enforcement
e. Policy-making
3. How many people does the federal government employ? For what percentage of GDP does federal spending account? How does this compare to other economically advanced democracies?
4. Classify and distinguish the major types of bureaucracy in the federal government:
a. Cabinet Departments
b. Independent Agencies
c. Independent Regulatory Commissions
d. Government Corporations
5. How does the federal bureaucracy select and recruit personnel? Contrast the present civil service system with the spoils system. What advantages does the present system provide?
6. What factors explain the growth of bureaucracy over time despite recurrent calls for limiting the size of government?
7. Identify those factors in the budget process making it difficult to cut bureaucratic funding.
8. Describe the way Congress authorizes funding for the federal bureaucracy.
9. How does Congress attempt to control the federal bureaucracy?
10. How does the president attempt to control the federal bureaucracy?
11. What special problems does bureaucratic independence present in a democracy? Discuss with re.
SANS SIFT tool Final project , related to (digital foren.docxtodd331
SANS SIFT tool Final project , related to (digital forensics tools and technique)
Description : A 500-700 word, double spaced paper, written in APA format, showing sources and a bibliography and ppt presentation too
Presentation materials
.
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TABLE 2.2 Connecting Knowledge of Development and Learning to Teaching Practices
Principles of Child Development and Learning
Developmentally Appropriate Teaching Practices
Children develop holistically
• Teachers plan daily activities and routines to address aesthetic, emotional, cognitive, language, physical, and social development.
• Teachers integrate learning across the curriculum (e.g., mixing language, physical, and social; combining math, science, and reading).
Child development follows an orderly sequence
• Teachers use their knowledge of developmental sequences to gauge whether children are developing as expected, to determine reasonable expectations, and to plan next steps in the learning process.
Children develop at varying rates
• Teachers give children opportunities to pursue activities at their own pace.
• Teachers repeat activities more than once so children can participate according to changing needs and abilities.
• Teachers plan activities with multiple learning objectives to address the needs of more and less advanced learners.
Children learn best when they feel safe and secure
• Teachers develop nurturing relationships with children and remain with children long enough so children can easily identify a specific adult from whom to seek help, comfort, attention, and guidance.
• Daily routines are predictable. Changes in routine are explained in advance so children can anticipate what will happen.
• There is two-way communication between teachers and families, and families are welcome in the program.
• Children have access to images, objects, and activities that reflect their home experiences.
• The early childhood environment complies with all safety requirements.
• Adults use positive discipline to enhance children’s self-esteem, self-control, and problem-solving abilities.
• Teachers address aggression and bullying calmly, firmly, and proactively.
Children are active learners
• Activities, transitions, and routines respect children’s attention span, need for activity and need for social interaction. Inactive segments of the day are short.
• Children participate in gross motor activities every day.
Children learn through a combination of physical experience, social experience, and reflection
• Adults encourage children to explore and investigate. They pose questions, offer information, and challenge children’s thinking.
• Children have many chances to document and reflect on their ideas.
Children learn through mastery and challenge
• Practitioners simplify, maintain, or extend activities in response to children’s functioning and comprehension.
Children’s learning profiles vary
• Teachers present the same information in more than one modality (seeing, hearing, touching) and through different types of activities.
• Children have opportunities to play on their own and with others; indoors and outdoors; with natural and manufactured materials.
Chil.
Sandro Reyes 1
5
Human Impact on the Environment
Every day, I see the harmful impacts of humans on the environment. Just 13 percent of the globe’s oceans remain unsoiled by humanity’s damaging impacts (Carrington, 2018). In the remotest poles and Pacific areas, most of the ocean has no natural marine wildlife. Pollution, huge fishing fleets, and global shipping along with climate change are all degrading the oceans. The vehicles we drive every day, industrial wastes, overpopulation, and fossil fuels, all have negative effects on the environment. Human activities are negatively affecting the environment by degrading it and sooner or later, the earth will not be able to sustain humans.
Overpopulation is now an epidemic with decreased mortality rates, improved medicine, and food sustainability. We are living longer, which is increasing population. The impact of overpopulation includes environmental degradation due to cutting down of trees to create space. With less trees to filter the air, an increase in carbon dioxide levels is damaging every single organism (Interesting Engineering, 2019). Another effect of overpopulation is overdependence on fossil fuels such as coal and oil, which emit plentiful carbon oxide into the air. With increased population, humans need more space, which damage ecosystems and augment carbon dioxide emissions.
Pollution is another impact of human activities on the environment. From trash, industrial wastes to carbon dioxide emissions into the air, pollutions is inevitable. Over 2.4 billion individuals have no access to sources of clean water. Human activities continue to deplete indispensable resources such as soil, water, and air. United States, for example, produces 147 million metric tons of air pollution annually (Interesting Engineering, 2019). Air quality in developing nations continues to plummet as well. This means that we are engaging in activities that are hurting the environment.
Global warming is one of the greatest causes of environmental degradation contributed by human activities. Some people do not believe that global warming is real. However, that is not true, and its major contributors include carbon dioxide emissions from respiration, deforestation, and burning fossil fuels. Each year, we continue to contribute to levels of carbon dioxide globally. Current levels exceed 400 PPM, and the rise in carbon dioxide emissions are attributed to an increase in global temperatures (Interesting Engineering, 2019). The result is the melting of arctic glaciers and land ice, which will increase sea levels, and have negative effects on oceanic life.
Climate change is another impact on the environment that is being caused by us. It is linked .
Scanned with CamScannerResearch Summary (paper)For thi.docxtodd331
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Research Summary (paper)
For this assignment you summarize one of the experimental research studies from your research collection.
(I did not make one, feel free to choose any research that has to do with psychology.)
Check out Audris Oh's research summary I put in the files -- it's a great model.
Write your summary in 5 pages or so, basically summarizing each of the major sections - literature review, methods section, results section and discussion. Let the abstract at the beginning of the paper guide you (It's just one paragraph but is a great guide). Why was the study done and how does it fit in with other work in the field (the intro or lit review)? What was the actual experiment (the methods section)? What were the results (the results section)? Why is it important (the discussion section)? Conclude your paper with a personal reaction -- does this fit with what you’ve seen? How might you use any insight the study provides?
Include the pdf of the article (or link to it) and the reference to the article in APA style. Here's an example of a reference:
Stein, S., Isaacs, G., & Andrews, T. (2004). Incorporating authentic learning experiences within a university course. Studies in Higher Education, 29(2), 239-258.
Example of how the essay should look like: https://middlesexcc.libguides.com/ld.php?content_id=7578609
Mendel, 150 years on
T.H. Noel Ellis1, Julie M.I. Hofer1, Gail M. Timmerman-Vaughan2, Clarice J. Coyne3
and Roger P. Hellens4
1
Institute of Biological, Environmental & Rural Sciences, Aberystwyth University, Gogerddan Campus, Aberystwyth,
Ceredigion, SY23 3EB, UK
2
The New Zealand Institute for Plant & Food Research Ltd, Christchurch 8140, New Zealand
3
USDA-ARS Western Regional Plant Introduction Station, Washington State University, Pullman, Washington, USA
4
The New Zealand Institute for Plant & Food Research Ltd, Auckland, New Zealand
Review
Mendel’s paper ‘Versuche über Pflanzen-Hybriden’ is the
best known in a series of studies published in the late 18th
and 19th centuries that built our understanding of the
mechanism of inheritance. Mendel investigated the seg-
regation of seven gene characters of pea (Pisum sativum),
of which four have been identified. Here, we review what
is known about the molecular nature of these genes,
which encode enzymes (R and Le), a biochemical regula-
tor (I) and a transcription factor (A). The mutations are: a
transposon insertion (r), an amino acid insertion (i), a
splice variant (a) and a missense mutation (le-1). The
nature of the three remaining uncharacterized characters
(green versus yellow pods, inflated versus constricted
pods, and axial versus terminal flowers) is discussed.
Mendel’s studies: species, traits and genes
Mendel’s paper ‘Versuche ü ber Pflanzen-Hybriden’ [1] is
the best known in a series of studies published in the late
18th and 19th centuries [2–4] that built our understanding
of the mechanism of inheritance [5]. The title of M.
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HACCP Recipe Terms
Check temperature of food at least every four hours and record
Check temperature of storage area at beginning of shift.
Cook eggs, poultry, fish, and meat in a microwave oven to a minimum temperature of 165 degrees F.
Cook fish to a minimum of 145 degrees F for 15 seconds.
Cook ground meats to a minimum of 155 degrees F for 15 seconds.
Cook poultry to a minimum of 165 degrees F for 15 seconds.
Cook vegetables to a temperature of 135 degrees F or higher.
Cooked food should be cooled from 135 degrees F to 70 degrees F within 2 hours and from 70 degrees F to 41 degrees F or lower in an additional 4 hours.
Cool foods to at least 70 degrees F before refrigerating or freezing.
Crack egg in separate bowl before combining to larger bowl.
Discard food held in the temperature danger zone for longer than four hours.
Hold cold foods at an internal temperature of 41 degrees F or lower.
Hold frozen foods at a temperature of 0 degrees F or lower.
Thaw food in a microwave oven if it will be cooked immediately after.
Hold hot foods at a minimum internal temperature of 135 degrees F or higher.
Hold hot foods at a minimum internal temperature of 135 degrees F or higher.
Inspect can before opening for swollen ends, rust, or dents.
Label food for storage with ingredient list and date of preparation.
Prepare raw foods separately from ready to eat foods.
Reduce the size or quantity of food to be cooled.
Reheat food to 165 degrees F for 15 seconds.
Remove from the refrigerator only as much product as can be prepared at one time.
Remove jewelry
Rotate products to ensure that the oldest inventory is used first.
Sanitize work surface, equipment, and utensils.
Store chemicals away from food products.
Store cut melons at 41 degrees F or lower.
Store fresh-cut produce between 33 to 41 degrees F to maintain quality.
Store raw meat, poultry, and fish in the bottom of the refrigerator.
Thaw food by submerging under running potable water at a temperature of 70 degrees F or lower.
Thaw food in a microwave oven if it will be cooked immediately after.
Thaw food in the refrigerator at 41 degrees F or lower.
Use a clean, sanitized, and calibrated thermometer to measure the internal temperature of foods.
Wash all fresh fruit prior to serving
Wash your hands
Wear gloves
Wear hairnet
Standardized Recipe Form
Recipe Name_____________________________________ Category_______________________________ Recipe #__________________________
(i.e., entrée, breads)
HACCP Process: _____ 1 – No Cook _____ 2 – Cook & Same Day Serve _____ 3 – Cook, Cool, Reheat, Serve
Ingredients
For ___________Servings
Directions: Include step by step instructions, the critical control points (CCP-specific points at which a hazard can be reduced, eliminated or prevented) and critical limit (time and/or temperature that must be achieved to control a hazard).
Weight
Measure
Serving Size___________________ Pan Size_______________.
Scanned with CamScanner1 STANDARIZATION OF A B.docxtodd331
This document provides instructions for a two-part experiment involving titration. In part A, students will standardize a NaOH solution by titrating it against a primary standard of KHP. In part B, students will use their standardized NaOH solution to determine the concentration of acetic acid in a vinegar sample through titration. Key steps and concepts discussed include buret usage, endpoint determination, stoichiometric calculations to determine concentration from titration data, and the purpose and characteristics of primary standards.
Scanlon Technologies, Inc. Anne Scanlon founded Scanlon Technol.docxtodd331
Scanlon Technologies, Inc.
*
Anne Scanlon founded Scanlon Technologies, Inc., in 1993. The company designed and manufactured high-tech products that were used in various industries ranging from semiconductor to aviation. Over the years, Scanlon Technologies reported a compound annual growth rate in revenues of over 20% due to high demand for the company’s products and Anne’s superior management skills. By the end of 1996, it was clear that any further growth would have to come from international expansion. However, establishing manufacturing operations and opening up sales and marketing offices abroad required a significant amount of capital. Anne considered investing more of her own money into the business; however, given that she already had most of her wealth tied up in the company, she decided against the idea. Moreover, she believed that the amount of funds Scanlon Technologies needed to raise for expansion was in the tens of millions. In her mind, there was only one clear solution—go public.
In September 1996, Anne hired J.P. Suisse, a top tier investment bank, to take Scanlon Technologies public. On January 1, 1997, the company, which was authorized by the State of Delaware to sell 20 million common stock and 10 million preferred stock, issued one million shares of common stock in an Initial Public Offering (IPO) and began trading on the New York Stock Exchange under the ticker symbol STI. The stock, which had a par value of $1, was sold for $20 per share and climbed to $26 a share by the end of its first trading day.
As expected, the funds raised in the IPO were used to open offices all over the world as well as build a second manufacturing plant in Toronto, Canada. Over the next couple of years, business was good and the company was able to generate enough cash to maintain its level of operations.
In October 1999, Anne learned that Kadehjian
Solution
s Coporation, a competitor, was considering the option of being acquired. Anne believed that such an acquisition would position Scanlon Technologies as the industry leader. One of Kadehjian’s requirements for such an acquisition was that it be an all-cash transaction. Anne knew that this would require Scanlon Technologies to raise approximately $7 million.
Ann contracted J.P. Suisse to discuss raising these funds through the capital markets. The managing directors at J.P. Suisse recommended that Scanlon Technologies employ a combination of debt and equity securities. Anne agreed and on January 1, 2000, the company issued an additional one hundred thousand shares of its $1 par value common stock at $40 per share. On the same day, the company issued $2 million in bonds at 95.8, due in 5 years with 5% interest payable annually (at year end). The market interest rate at the time was 6% per year. Also on January 1, 2000, Scanlon Technologies issued $1.3 million in zero-coupon (i.e. no interest) convertible bonds, also due in 5 years. Each $1,000 bond converted into 20 shares of its commo.
scan the following 2 poems by Robert Herrick. analyze each poems rhy.docxtodd331
scan the following 2 poems by Robert Herrick. analyze each poems rhyme and verse and its meter and number of feet. then in a short paragraph, tell me what you think.
Upon Julia's Breasts
Display thy breasts, my Julia, there let me
Behold that circummortal purity;
Between whose glories, there my lips I'll lay,
Ravished in that fair Via Lactea.
Upon a Child That Died
Here she lies, a pretty bud,
Lately made of flesh and blood,
Who as soon fell fast asleep
As her little eyes did peep.
Give her strewings, but not stir
The earth that lightly covers her.
.
SBUX ISIncome Statement - As Reported 10K in millionsIncome Statem.docxtodd331
SBUX ISIncome Statement - As Reported 10K in millionsIncome Statement - As Reported 10Q in millions9/30/139/30/149/30/159/30/169/30/179/30/18TTM12/30/173/30/186/30/189/30/1812/29/18TTM Company-operated stores$11,793.2$12,977.9$15,197.3$16,844.1$17,650.719,690.320,318.8 Company-operated stores4,741.84,828.05,060.45,060.1$5,370.3020,318.8 Total specialty$3,073.6$3,469.9$3,965.4$4,471.8$4,736.15,029.24,959.6 Total specialty1,331.91,203.81,249.91,243.5$1,262.404,959.6 Licensed stores$1,360.5$1,588.6$1,861.9$2,154.2$2,355.02,652.22,706.9 Licensed stores682.4625.6660.6683.6$737.102,706.9 CPG, foodservice and other$1,713.1$1,881.3$2,103.5$2,317.6$2,381.12,377.02,252.7 CPG, foodservice and other649.5578.2589.3559.9$525.302,252.7Total net revenues$14,866.8$16,447.8$19,162.7$21,315.9$22,386.8$24,719.525,278.4Total net revenues6,073.76,031.86,310.36,303.6$6,632.7025,278.4 Cost of sales including occupancy costs-$6,382.3-$6,858.8-$7,787.5-$8,511.1-$9,038.2-10,174.5-10,434.2 Cost of sales including occupancy costs-2,502.9-2,516.0-2,554.9-2,604.6($2,758.70)-10,434.2 Store operating expenses-$4,286.1-$4,638.2-$5,411.1-$6,064.3-$6,493.3-7,193.2-7,449.2 Store operating expenses-1,737.0-1,789.6-1,825.0-1,841.6($1,993.00)-7,449.2 Other operating expenses-$431.8-$457.3-$522.4-$545.4-$553.8-539.3-532.2 Other operating expenses-141.6-134.3-148.0-156.7($93.20)-532.2 Depreciation and amortization expenses-$621.4-$709.6-$893.9-$980.8-$1,011.4-1,247.0-1,321.6 Depreciation and amortization expenses-258.8-331.6-330.0-326.6($333.40)-1,321.6 General and administrative expenses-$937.9-$991.3-$1,196.7-$1,360.6-$1,393.3-1,759.0-1,797.8 General and administrative expenses-379.1-405.8-468.7-460.0($463.30)-1,797.8 Restructuring and impairments$0.0$0.0$0.0$0.0-$153.5-224.4-240.0 Restructuring and impairments-27.6-134.7-16.9-45.2($43.20)-240.0 Litigation credit / charge-$2,784.1$20.2$0.0$0.0$0.0$0.0Income from equity investees89.452.771.487.7$67.80279.6Income from equity investees$251.4$268.3$249.9$318.2$391.4301.2279.6Operating income / loss1,116.1772.51,038.2956.6$1,015.703,783.0Operating income / loss-$325.4$3,081.1$3,601.0$4,171.9$4,134.7$3,883.33,783.0Gain resulting from acquisition of joint venture1,326.3Net interest and other income62.3483-$24.8074.9 Gain resulting from acquisition of joint venture$0.0$0.0$390.6$0.0$0.01,376.4$0.0 Interest income and other, net88.2313239$24.80126.0Loss on divestiture of certain operations$0.0$0.0-$61.1$0.0$0.0499.2 Interest expense-25.9-503($75.00)-77.0 Interest income and other, net$123.6$142.7$43.0$108.0$275.3191.4$126.0Earnings / loss before income taxes3,005.9363236$965.501,068.7 Interest expense-$28.1-$64.1-$70.5-$81.3-$92.5-170.3-$77.0Income tax expense / benefit-755.8-35-45-64($205.10)-349.4Earnings / loss before income taxes-$229.9$3,159.7$3,903.0$4,198.6$4,317.5$5,780.0$1,068.7Net earnings / loss including noncontrolling interests2,250.18161,027932$760.403,534.721.83%Net earnings / loss attributab.
Scan the articles in the attached course text. Write a discussi.docxtodd331
Scan the articles in the attached course text. Write a discussion initial post on one of the articles. Choose the one that interests you most.
1.Provide a very brief overview of what you think are the key points (a literature review).
2.What about the policy area interests you?
3.What about the information systems involved in the article interested you?
4.How might this article’s research approach help you in your dissertation research project?
(NOTE: Please cut and paste the above-numbered list into your reply to help with organization.)
.
Scale Ratio Variable Histograms are useful for presenting qu.docxtodd331
Scale Ratio Variable
Histograms are useful for presenting quantitative data such as the example variable ADULT_CT which describes the number of individuals per household. The variable measurement is scale ratio and as it depicts a number, a histogram is able to reflect the number of individuals belonging to each variable value or interval of values (Mishra, Pandey, Singh & Gupta, 2018).). Histograms divide the variable into equal intervals as shown below in individuals reported per home. The graph indicates nearly 3,000 reporting and displays the individual numbers per interval. The bar levels of the graph make it is easy to discern the average number reporting as 2 per household.
Nominal Variable
As nominal variables depict qualitative data such as in the variable Q87 which describes the level of trust individuals felt towards others, a pie graph would be beneficial to use as it easily displays each group or individual share in the total being examined (Mishra, Pandey, Singh & Gupta, 2018). For example, the pie graph here which shows what percentage of trust was and wasn’t felt toward others. Graphs like these are appropriate for showing a variable that cannot be ordered or numerical in value such as feelings of trust (Frankfort-Nachmias, Leon-Guerrero & Davis, 2020).
References
Frankfort-Nachmias, C., Leon-Guerrero, A., & Davis, G. (2020). Social statistics for a diverse society (9th ed.). Thousand Oaks, CA: Sage Publications.
Mishra, P., Pandey, C. M., Singh, U., & Gupta, A. (2018). Scales of measurement and presentation of statistical data.
Annals of cardiac anesthesia
,
21
(4), 419.
Wagner, III, W.E. (2020).
Using IBM® SPSS® statistics for research methods and social science statistics
(7th ed.). Thousand Oaks, CA: Sage Publications.
Be sure to support your Main Post and Response Post with reference to the week’s Learning Resources and other scholarly evidence in APA Style.
.
Scan 12Scan 13Scan 14Scan 15Scan 16Scan 17Scan 18Scan 19
HIST 308
Sofia Clark
Spring 2020
Research Paper
Sample Outline:
1) Introduction
2) Story of capture
3) Background on British antislavery
4) Background on Royal Navy
5) Background on this specific Royal Navy vessel
6) Story of what treaty was used to condemn the slave ship
7) Background on treaty
8) Background on British relations with treaty country
9) Background on slave trade in this particular region
10) Story of what happens to the captives removed from this particular slave ship
11) Background on the general treatment of liberated Africans
12) Explanation of how the story of your ship exemplifies the broader history of slavery and anti-slavery
Bibliography
1) The slave trade in general (i.e., either the Transatlantic slave trade or Indian Ocean slave trade depending on your ship)
Article (JSTOR): Alkalimat, Abdul. "Slave Trade." In The African American Experience in Cyberspace: A Resource Guide to the Best Web Sites on Black Culture and History, 34-42. LONDON; STERLING, VIRGINIA: Pluto Press, 2004. Accessed May 30, 2020. doi:10.2307/j.ctt183q64x.8.
Article (JSTOR): JUNKER, CARSTEN. "Containing Bodies—Enscandalizing Enslavement: Stasis and Movement at the Juncture of Slave-Ship Images and Texts." In Migrating the Black Body: The African Diaspora and Visual Culture, edited by RAIFORD LEIGH and RAPHAEL-HERNANDEZ HEIKE, 13-29. Seattle; London: University of Washington Press, 2017. Accessed May 30, 2020. www.jstor.org/stable/j.ctvcwnj4v.5.
2) The slave trade in the specific area of Africa in which your ship embarked enslaved African captives (e.g., Bight of Benin, Senegambia, Angola).
Book (JSTOR): Strickrodt, Silke. "The Atlantic Connection: Little Popo & the Rise of Afro-European Trade on the Western Slave Coast, C. 1600 to 1702." In Afro-European Trade in the Atlantic World: The Western Slave Coast, C. 1550- C. 1885, 65-101. Woodbridge, Suffolk; Rochester, NY: Boydell & Brewer, 2015. Accessed May 30, 2020. doi:10.7722/j.ctt7zst5n.9.
Article (JSTOR): Graham, James D. "The Slave Trade, Depopulation and Human Sacrifice in Benin History: The General Approach." Cahiers D'Études Africaines 5, no. 18 (1965): 317-34. Accessed May 30, 2020. www.jstor.org/stable/4390897.
3) Slavery in the region to which your ship was heading (e.g., Cuba, Bahia, Pernambuco).
Book (One Search): Schneider, Elena Andrea. The Occupation of Havana: War, Trade, and Slavery in the Atlantic World. North Carolina Scholarship Online. Williamsburg, Virginia : Chapel Hill: Omohundro Institute of Early American History and Culture ; University of North Carolina Press, 2018.
Article (Project Muse): Garrigus, John. "Cuba, Haiti, and the Age of Atlantic Revolution." Reviews in American History 44, no. 1 (2016): 52-57. doi:10.1353/rah.2016.0012.
4) British antislavery policy toward the country your ship was from (e.g., Portugal, Spain, USA)
Book- page 14(Academic Search Premiere- also works for #.
Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
The temple and the sanctuary around were dedicated to Asklepios Zmidrenus. This name has been known since 1875 when an inscription dedicated to him was discovered in Rome. The inscription is dated in 227 AD and was left by soldiers originating from the city of Philippopolis (modern Plovdiv).
A Free 200-Page eBook ~ Brain and Mind Exercise.pptxOH TEIK BIN
(A Free eBook comprising 3 Sets of Presentation of a selection of Puzzles, Brain Teasers and Thinking Problems to exercise both the mind and the Right and Left Brain. To help keep the mind and brain fit and healthy. Good for both the young and old alike.
Answers are given for all the puzzles and problems.)
With Metta,
Bro. Oh Teik Bin 🙏🤓🤔🥰
How to Manage Reception Report in Odoo 17Celine George
A business may deal with both sales and purchases occasionally. They buy things from vendors and then sell them to their customers. Such dealings can be confusing at times. Because multiple clients may inquire about the same product at the same time, after purchasing those products, customers must be assigned to them. Odoo has a tool called Reception Report that can be used to complete this assignment. By enabling this, a reception report comes automatically after confirming a receipt, from which we can assign products to orders.
How to Setup Default Value for a Field in Odoo 17Celine George
In Odoo, we can set a default value for a field during the creation of a record for a model. We have many methods in odoo for setting a default value to the field.
Andreas Schleicher presents PISA 2022 Volume III - Creative Thinking - 18 Jun...EduSkills OECD
Andreas Schleicher, Director of Education and Skills at the OECD presents at the launch of PISA 2022 Volume III - Creative Minds, Creative Schools on 18 June 2024.
Information and Communication Technology in EducationMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 2)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐈𝐂𝐓 𝐢𝐧 𝐞𝐝𝐮𝐜𝐚𝐭𝐢𝐨𝐧:
Students will be able to explain the role and impact of Information and Communication Technology (ICT) in education. They will understand how ICT tools, such as computers, the internet, and educational software, enhance learning and teaching processes. By exploring various ICT applications, students will recognize how these technologies facilitate access to information, improve communication, support collaboration, and enable personalized learning experiences.
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐫𝐞𝐥𝐢𝐚𝐛𝐥𝐞 𝐬𝐨𝐮𝐫𝐜𝐞𝐬 𝐨𝐧 𝐭𝐡𝐞 𝐢𝐧𝐭𝐞𝐫𝐧𝐞𝐭:
-Students will be able to discuss what constitutes reliable sources on the internet. They will learn to identify key characteristics of trustworthy information, such as credibility, accuracy, and authority. By examining different types of online sources, students will develop skills to evaluate the reliability of websites and content, ensuring they can distinguish between reputable information and misinformation.
Gender and Mental Health - Counselling and Family Therapy Applications and In...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
2. Page 1 of 1
Hospital Accreditation Program
National Patient Safety Goals Effective January 2019
Goal 1
Improve the accuracy of patient identification.
Use at least two patient identifiers when providing care,
treatment, and services.
NPSG.01.01.01
Elements of Performance for NPSG.01.01.01
Wrong-patient errors occur in virtually all stages of diagnosis
and treatment. The intent for this goal is two-fold: first,
to reliably identify the individual as the person for whom the
service or treatment is intended; second, to match the
service or treatment to that individual. Acceptable identifiers
may be the individual’s name, an assigned
identification number, telephone number, or other person-
specific identifier.
Newborns are at higher risk of misidentification due to their
inability to speak and lack of distinguishable features. In
addition to well-known misidentification errors such as wrong
patient/wrong procedure, misidentification has also
resulted in feeding a mother’s expressed breastmilk to the
wrong newborn, which poses a risk of passing bodily
3. fluids and potential pathogens to the newborn. A reliable
identification system among all providers is necessary to
prevent error.
--Rationale for NPSG.01.01.01--
Use at least two patient identifiers when administering
medications, blood, or blood
components; when collecting blood samples and other
specimens for clinical testing; and
when providing treatments or procedures. The patient's room
number or physical location is
not used as an identifier. (See also MM.05.01.09, EPs 7 and 10;
NPSG.01.03.01, EP 1)
1.
Label containers used for blood and other specimens in the
presence of the patient. (See
also NPSG.01.03.01, EP 1)
2.
Use distinct methods of identification for newborn patients.
Note: Examples of methods to prevent misidentification may
include the following:
- Distinct naming systems could include using the mother’s first
and last names and the
newborn’s gender (for example, “Smith, Judy Girl” or “Smith,
Judy Girl A” and “Smith, Judy
Girl B” for multiples).
- Standardized practices for identification banding (for example,
using two body sites and/or
bar coding for identification).
- Establish communication tools among staff (for example,
visually alerting staff with signage
5. When using a two-person verification process, the second
individual conducting the
identification verification is qualified to participate in the
process, as determined by the
hospital.
3.
Goal 2
Improve the effectiveness of communication among caregivers.
Report critical results of tests and diagnostic procedures on a
timely basis.
NPSG.02.03.01
Elements of Performance for NPSG.02.03.01
Critical results of tests and diagnostic procedures fall
significantly outside the normal range and may indicate a life-
threatening situation. The objective is to provide the
responsible licensed caregiver these results within an
established time frame so that the patient can be promptly
treated.
--Rationale for NPSG.02.03.01--
Develop written procedures for managing the critical results of
tests and diagnostic
procedures that address the following:
- The definition of critical results of tests and diagnostic
procedures
- By whom and to whom critical results of tests and diagnostic
procedures are reported
7. Medications or other solutions in unlabeled containers are
unidentifiable. Errors, sometimes tragic, have resulted
from medications and other solutions removed from their
original containers and placed into unlabeled containers.
This unsafe practice neglects basic principles of safe medication
management, yet it is routine in many
organizations.
The labeling of all medications, medication containers, and
other solutions is a risk-reduction activity consistent with
safe medication management. This practice addresses a
recognized risk point in the administration of medications
in perioperative and other procedural settings. Labels for
medications and medication containers are also
addressed at MM.05.01.09.
--Rationale for NPSG.03.04.01--
In perioperative and other procedural settings both on and off
the sterile field, label
medications and solutions that are not immediately
administered. This applies even if there is
only one medication being used.
Note: An immediately administered medication is one that an
authorized staff member
prepares or obtains, takes directly to a patient, and administers
to that patient without any
break in the process. Refer to NPSG.03.04.01, EP 5, for
information on timing of labeling.
1.
In perioperative and other procedural settings both on and off
the sterile field, labeling occurs
when any medication or solution is transferred from the original
8. packaging to another
container.
2.
In perioperative and other procedural settings both on and off
the sterile field, medication or
solution labels include the following:
- Medication or solution name
- Strength
- Amount of medication or solution containing medication (if
not apparent from the container)
- Diluent name and volume (if not apparent from the container)
- Expiration date when not used within 24 hours
- Expiration time when expiration occurs in less than 24 hours
Note: The date and time are not necessary for short procedures,
as defined by the hospital.
3.
Verify all medication or solution labels both verbally and
visually. Verification is done by two
individuals qualified to participate in the procedure whenever
the person preparing the
medication or solution is not the person who will be
administering it.
4.
Label each medication or solution as soon as it is prepared,
unless it is immediately
administered.
Note: An immediately administered medication is one that an
authorized staff member
prepares or obtains, takes directly to a patient, and administers
to that patient without any
10. prophylaxis (for example, atrial fibrillation) where the clinical
expectation is that the patient’s laboratory values for
coagulation will remain outside normal values. This requirement
does not apply to routine situations in which short-
term prophylactic anticoagulation is used for venous thrombo-
embolism prevention (for example, related to
procedures or hospitalization) and the clinical expectation is
that the patient’s laboratory values for coagulation will
remain within, or close to, normal values.
NPSG.03.05.01
Elements of Performance for NPSG.03.05.01
Anticoagulation therapy can be used as therapeutic treatment
for a number of conditions, the most common of
which are atrial fibrillation, deep vein thrombosis, pulmonary
embolism, and mechanical heart valve implant.
However, it is important to note that anticoagulation
medications are more likely than others to cause harm due to
complex dosing, insufficient monitoring, and inconsistent
patient compliance. This National Patient Safety Goal has
great potential to positively impact the safety of patients on this
class of medications and result in better outcomes.
To achieve better patient outcomes, patient education is a vital
component of an anticoagulation therapy program.
Effective anticoagulation patient education includes face-to-
face interaction with a trained professional who works
closely with patients to be sure that they understand the risks
involved with anticoagulation therapy, the precautions
they need to take, and the need for regular International
Normalized Ratio (INR) monitoring. The use of
standardized practices for anticoagulation therapy that include
patient involvement can reduce the risk of adverse
drug events associated with heparin (unfractionated), low
11. molecular weight heparin, and warfarin.
--Rationale for NPSG.03.05.01--
Use only oral unit-dose products, prefilled syringes, or
premixed infusion bags when these
types of products are available.
Note: For pediatric patients, prefilled syringe products should
be used only if specifically
designed for children.
1.
Use approved protocols for the initiation and maintenance of
anticoagulant therapy.2.
Before starting a patient on warfarin, assess the patient’s
baseline coagulation status; for all
patients receiving warfarin therapy, use a current International
Normalized Ratio (INR) to
adjust this therapy. The baseline status and current INR are
documented in the medical
record.
Note: The patient’s baseline coagulation status can be assessed
in a number of ways,
including through a laboratory test or by identifying risk factors
such as age, weight, bleeding
tendency, and genetic factors.
3.
Use authoritative resources to manage potential food and drug
interactions for patients
receiving warfarin.
4.
13. Hospital National Patient Safety Goals Effective January 1,
2019
Maintain and communicate accurate patient medication
information.
NPSG.03.06.01
Elements of Performance for NPSG.03.06.01
There is evidence that medication discrepancies can affect
patient outcomes. Medication reconciliation is intended
to identify and resolve discrepancies—it is a process of
comparing the medications a patient is taking (and should
be taking) with newly ordered medications. The comparison
addresses duplications, omissions, and interactions,
and the need to continue current medications. The types of
information that clinicians use to reconcile medications
include (among others) medication name, dose, frequency,
route, and purpose. Organizations should identify the
information that needs to be collected to reconcile current and
newly ordered medications and to safely prescribe
medications in the future.
--Rationale for NPSG.03.06.01--
Introduction to Reconciling Medication Information
The large number of people receiving health care who take
multiple medications and the complexity of managing
those medications make medication reconciliation an important
safety issue. In medication reconciliation, a clinician
compares the medications a patient should be using (and is
actually using) to the new medications that are ordered
for the patient and resolves any discrepancies.
The Joint Commission recognizes that organizations face
14. challenges with medication reconciliation. The best
medication reconciliation requires a complete understanding of
what the patient was prescribed and what
medications the patient is actually taking. It can be difficult to
obtain a complete list from every patient in an
encounter, and accuracy is dependent on the patient’s ability
and willingness to provide this information. A good
faith effort to collect this information is recognized as meeting
the intent of the requirement. As health care evolves
with the adoption of more sophisticated systems (such as
centralized databases for prescribing and collecting
medication information), the effectiveness of these processes
will grow.
This National Patient Safety Goal (NPSG) focuses on the risk
points of medication reconciliation. The elements of
performance in this NPSG are designed to help organizations
reduce negative patient outcomes associated with
medication discrepancies. Some aspects of the care process that
involve the management of medications are
addressed in the standards rather than in this goal. These
include coordinating information during transitions in care
both within and outside of the organization (PC.02.02.01),
patient education on safe medication use (PC.02.03.01),
and communications with other providers (PC.04.02.01).
In settings where medications are not routinely prescribed or
administered, this NPSG provides organizations with
the flexibility to decide what medication information they need
to collect based on the services they provide to
patients. It is often important for clinicians to know what
medications the patient is taking when planning care,
treatment, and services, even in situations where medications
are not used. A new requirement in this NPSG
addresses the patient’s role in medication safety: it requires
organizations to inform the patient about the
16. Hospital National Patient Safety Goals Effective January 1,
2019
Compare the medication information the patient brought to the
hospital with the medications
ordered for the patient by the hospital in order to identify and
resolve discrepancies.
Note: Discrepancies include omissions, duplications,
contraindications, unclear information,
and changes. A qualified individual, identified by the hospital,
does the comparison. (See also
HR.01.06.01, EP 1)
3.
Provide the patient (or family as needed) with written
information on the medications the
patient should be taking when he or she is discharged from the
hospital or at the end of an
outpatient encounter (for example, name, dose, route,
frequency, purpose).
Note: When the only additional medications prescribed are for a
short duration, the
medication information the hospital provides may include only
those medications. For more
information about communications to other providers of care
when the patient is discharged
or transferred, refer to Standard PC.04.02.01.
4.
Explain the importance of managing medication information to
the patient when he or she is
18. multifaceted problem. In some situations, individual alarm
signals are difficult to detect. At the same time, many patient
care areas have numerous alarm signals and the
resulting noise and displayed information tends to desensitize
staff and cause them to miss or ignore alarm signals
or even disable them. Other issues associated with effective
clinical alarm system management include too many
devices with alarms, default settings that are not at an
actionable level, and alarm limits that are too narrow. These
issues vary greatly among hospitals and even within different
units in a single hospital.
There is general agreement that this is an important safety issue.
Universal solutions have yet to be identified, but it
is important for a hospital to understand its own situation and to
develop a systematic, coordinated approach to
clinical alarm system management. Standardization contributes
to safe alarm system management, but it is
recognized that solutions may have to be customized for
specific clinical units, groups of patients, or individual
patients. This NPSG focuses on managing clinical alarm
systems that have the most direct relationship to patient
safety. As alarm system management solutions are identified,
this NPSG will be updated to reflect best practices. *
Footnote *: Additional information on alarm safety can be
found on the AAMI website
http://www.aami.org/htsi/alarms/. Also, the ECRI Institute has
identified alarm hazards as one of the top technology
hazards for 2013; more information on this hazard list can be
found at
http://www.ecri.org/Forms/Pages/Alarm_Safety_Resource.aspx.
--Rationale for NPSG.06.01.01--
Leaders establish alarm system safety as a hospital priority.1.
19. Identify the most important alarm signals to manage based on
the following:
- Input from the medical staff and clinical departments
- Risk to patients if the alarm signal is not attended to or if it
malfunctions
- Whether specific alarm signals are needed or unnecessarily
contribute to alarm noise and
alarm fatigue
- Potential for patient harm based on internal incident history
- Published best practices and guidelines
(For more information on managing medical equipment risks,
refer to Standard EC.02.04.01.)
2.
Establish policies and procedures for managing the alarms
identified in EP 2 above that, at a
minimum, address the following:
- Clinically appropriate settings for alarm signals
- When alarm signals can be disabled
- When alarm parameters can be changed
- Who in the organization has the authority to set alarm
parameters
- Who in the organization has the authority to change alarm
parameters
- Who in the organization has the authority to set alarm
parameters to “off”
- Monitoring and responding to alarm signals
- Checking individual alarm signals for accurate settings, proper
operation, and detectability
(For more information, refer to Standard EC.02.04.03)
3.
Educate staff and licensed independent practitioners about the
21. reduce the transmission of infectious agents by staff to patients,
thereby decreasing the incidence of HAIs. To
ensure compliance with this National Patient Safety Goal, an
organization should assess its compliance with the
CDC and/or WHO guidelines through a comprehensive program
that provides a hand hygiene policy, fosters a
culture of hand hygiene, and monitors compliance and provides
feedback.
--Rationale for NPSG.07.01.01--
Implement a program that follows categories IA, IB, and IC of
either the current Centers for
Disease Control and Prevention (CDC) or the current World
Health Organization (WHO)
hand hygiene guidelines. (See also IC.01.04.01, EP 1)
1.
Set goals for improving compliance with hand hygiene
guidelines. (See also IC.03.01.01, EP
1)
2.
Improve compliance with hand hygiene guidelines based on
established goals.3.
Implement evidence-based practices to prevent health care–
associated infections due to multidrug-resistant
organisms in acute care hospitals.
Note: This requirement applies to, but is not limited to,
epidemiologically important organisms such as methicillin-
resistant Staphylococcus aureus (MRSA), Clostridium difficile
(CDI), vancomycin-resistant enterococci (VRE),
carbapenem-resistant enterobacteriaceae (CRE), and other
22. multidrug-resistant gram-negative bacteria.
NPSG.07.03.01
Elements of Performance for NPSG.07.03.01
Patients continue to acquire health care–associated infections at
an alarming rate. Risks and patient populations,
however, differ between hospitals. Therefore, prevention and
control strategies must be tailored to the specific
needs of each hospital based on its risk assessment. The
elements of performance for this requirement are
designed to help reduce or prevent health care–associated
infections from epidemiologically important multidrug-
resistant organisms (MDROs).
Note: Hand hygiene, contact precautions, as well as cleaning
and disinfecting patient care equipment and the
patient’s environment are essential strategies for preventing the
spread of health care–associated infections. Hand
hygiene is addressed in NPSG.07.01.01. Contact precautions for
patients with epidemiologically significant
multidrug-resistant organisms (MDROs) are covered in
IC.02.01.01, EP 3. Cleaning and disinfecting patient care
equipment are addressed in IC.02.02.01.
--Rationale for NPSG.07.03.01--
Conduct periodic risk assessments (in time frames defined by
the hospital) for multidrug-
resistant organism acquisition and transmission. (See also
IC.01.03.01, EPs 1–3)
1.
Educate staff and licensed independent practitioners about
24. including the following:
- Multidrug-resistant organism infection rates using evidence-
based metrics
- Compliance with evidence-based guidelines or best practices
- Evaluation of the education program provided to staff and
licensed independent practitioners
(See also MM.09.01.01, EP 5)
Note: Surveillance may be targeted rather than hospitalwide.
5.
Provide multidrug-resistant organism process and outcome data
to key stakeholders,
including leaders, licensed independent practitioners, nursing
staff, and other clinicians.
6.
Implement policies and practices aimed at reducing the risk of
transmitting multidrug-
resistant organisms. These policies and practices meet
regulatory requirements and are
aligned with evidence-based standards (for example, the Centers
for Disease Control and
Prevention (CDC) and/or professional organization guidelines).
7.
When indicated by the risk assessment, implement a laboratory-
based alert system that
identifies new patients with multidrug-resistant organisms.
Note: The alert system may use telephones, faxes, pagers,
automated and secure electronic
alerts, or a combination of these methods.
8.
25. When indicated by the risk assessment, implement an alert
system that identifies readmitted
or transferred patients who are known to be positive for
multidrug-resistant organisms.
Note 1: The alert system information may exist in a separate
electronic database or may be
integrated into the admission system. The alert system may be
either manual or electronic or
a combination of both.
Note 2: Each hospital may define its own parameters in terms of
time and clinical
manifestation to determine which readmitted patients require
isolation.
9.
Implement evidence-based practices to prevent central line–
associated bloodstream infections.
Note: This requirement covers short- and long-term central
venous catheters and peripherally inserted central
catheter (PICC) lines.
NPSG.07.04.01
Elements of Performance for NPSG.07.04.01
Educate staff and licensed independent practitioners who are
involved in managing central
lines about central line–associated bloodstream infections and
the importance of prevention.
Education occurs upon hire or granting of initial privileges and
periodically thereafter as
determined by the organization.
1.
27. Provide central line–associated bloodstream infection rate data
and prevention outcome
measures to key stakeholders, including leaders, licensed
independent practitioners, nursing
staff, and other clinicians.
5.
Use a catheter checklist and a standardized protocol for central
venous catheter insertion.6.
Use a standardized supply cart or kit that contains all necessary
components for the insertion
of central venous catheters.
7.
Perform hand hygiene prior to catheter insertion or
manipulation.8.
Use maximum sterile barrier precautions during central venous
catheter insertion.9.
For adult patients, do not insert catheters into the femoral vein
unless other sites are
unavailable.
10.
Use an alcoholic chlorhexidine antiseptic for skin preparation
during central venous catheter
insertion unless contraindicated.
11.
28. Use a standardized protocol to disinfect catheter hubs and
injection ports before accessing
the ports.
12.
Evaluate all central venous catheters routinely and remove
nonessential catheters.13.
Implement evidence-based practices for preventing surgical site
infections.
NPSG.07.05.01
Elements of Performance for NPSG.07.05.01
Educate staff and licensed independent practitioners involved in
surgical procedures about
surgical site infections and the importance of prevention.
Education occurs upon hire,
annually thereafter, and when involvement in surgical
procedures is added to an individual’s
job responsibilities.
1.
Educate patients, and their families as needed, who are
undergoing a surgical procedure
about surgical site infection prevention.
2.
Implement policies and practices aimed at reducing the risk of
surgical site infections. These
policies and practices meet regulatory requirements and are
aligned with evidence-based
29. guidelines (for example, the Centers for Disease Control and
Prevention (CDC) and/or
professional organization guidelines).
3.
As part of the effort to reduce surgical site infections:
- Conduct periodic risk assessments for surgical site infections
in a time frame determined by
the hospital.
- Select surgical site infection measures using best practices or
evidence-based guidelines.
- Monitor compliance with best practices or evidence-based
guidelines.
- Evaluate the effectiveness of prevention efforts.
Note: Surveillance may be targeted to certain procedures based
on the hospital’s risk
assessment.
4.
Measure surgical site infection rates for the first 30 or 90 days
following surgical procedures
based on National Healthcare Safety Network (NHSN)
procedural codes. The hospital’s
measurement strategies follow evidence-based guidelines.
Note 1: Surveillance may be targeted to certain procedures
based on the hospital's risk
assessment.
Note 2: The NHSN is the Centers for Disease Control and
Prevention’s health
care–associated infection tracking system. NHSN provides
facilities, states, regions, and the
nation with data needed to identify problem areas, measure
progress of prevention efforts,
and ultimately eliminate health care–associated infections. For
31. that practice or endorsement
of the practice by a professional organization(s) and/or a
government agency(ies). It is not
acceptable to follow a practice that is not supported by evidence
or widespread consensus.
During the on-site survey, surveyors will explore the source of
the practices the hospital
follows.
7.
When hair removal is necessary, use a method that is cited in
scientific literature or endorsed
by professional organizations. *
Footnote *: A limited number of National Patient Safety Goals
contain requirements for
practices that reflect current science and medical knowledge. In
these cases, the element of
performance refers to a practice that is cited in scientific
literature or endorsed by
professional organizations. This means that the practice used by
the hospital must be
validated by an authoritative source. The authoritative source
may be a study published in a
peer-reviewed journal that clearly demonstrates the efficacy of
that practice or endorsement
of the practice by a professional organization(s) and/or a
government agency(ies). It is not
acceptable to follow a practice that is not supported by evidence
or widespread consensus.
During the on-site survey, surveyors will explore the source of
the practices the hospital
follows.
8.
32. Implement evidence-based practices to prevent indwelling
catheter-associated urinary tract infections (CAUTI).
Note: Evidence-based guidelines for CAUTI are located at:
- Compendium of Strategies to Prevent Healthcare-Associated
Infections in Acute Care Hospitals, 2014 at
http://journals.cambridge.org/action/displayAbstract?fromPage=
online&aid=10312260&fulltextType=RA&fileId=S089
9823X00193845
- APIC Implementation Guide: Guide to Preventing Catheter-
Associated Urinary Tract Infections, 2014 at
http://apic.org/Resource_/EliminationGuideForm/0ff6ae59-
0a3a-4640-97b5-eee38b8bed5b/File/CAUTI_06.pdf
- Guideline for Prevention of Catheter-associated Urinary Tract
Infections, 2009 at
https://www.cdc.gov/infectioncontrol/pdf/guidelines/cauti-
guidelines.pdf
NPSG.07.06.01
Elements of Performance for NPSG.07.06.01
Educate staff and licensed independent practitioners involved in
the use of indwelling urinary
catheters about CAUTI and the importance of infection
prevention. Education occurs upon
hire or granting of initial privileges and when involvement in
indwelling catheter care is added
to an individual’s job responsibilities. Ongoing education and
competence assessment occur
at intervals established by the organization.
1.
Educate patients who will have an indwelling catheter, and their
families as needed, on
CAUTI prevention and the symptoms of a urinary tract
34. genitourinary tract; patients who will
have a prolonged duration of surgery (catheters inserted for this
reason should be removed in a post-anesthesia care unit);
patients anticipated to receive
large-volume infusions or diuretics during surgery; patients
needing intraoperative monitoring
of urinary output
- End-of-life care
- Neurogenic bladder
3.
Follow written procedures based on established evidence-based
guidelines for inserting and
maintaining an indwelling urinary catheter. The procedures
address the following:
- Limiting use and duration
- Performing hand hygiene prior to catheter insertion or
maintenance care
- Using aseptic techniques for site preparation, equipment, and
supplies
- Securing catheters for unobstructed urine flow and drainage
- Maintaining the sterility of the urine collection system
- Replacing the urine collection system when required
- Collecting urine samples
Note: There are medical conditions that require a prolonged use
of an indwelling urinary
catheter in order to avoid adverse events and promote patient
safety. Examples can include,
but are not limited to, patients with a spinal cord injury,
multiple sclerosis, Parkinson’s
disease, and spina bifida.
4.
Measure and monitor catheter-associated urinary tract infection
37. 2019
Introduction to the Universal Protocol for Preventing Wrong
Site, Wrong
Procedure, and Wrong Person Surgery™
The Universal Protocol applies to all surgical and nonsurgical
invasive procedures. Evidence indicates that
procedures that place the patient at the most risk include those
that involve general anesthesia or deep sedation,
although other procedures may also affect patient safety.
Hospitals can enhance safety by correctly identifying the
patient, the appropriate procedure, and the correct site of the
procedure.
The Universal Protocol is based on the following principles:
- Wrong-person, wrong-site, and wrong-procedure surgery can
and must be prevented.
- A robust approach using multiple, complementary strategies is
necessary to achieve the goal of always conducting
the correct procedure on the correct person, at the correct site.
- Active involvement and use of effective methods to improve
communication among all members of the procedure
team are important for success.
- To the extent possible, the patient and, as needed, the family
are involved in the process.
- Consistent implementation of a standardized protocol is most
effective in achieving safety.
The Universal Protocol is implemented most successfully in
hospitals with a culture that promotes teamwork and
where all individuals feel empowered to protect patient safety.
A hospital should consider its culture when designing
processes to meet the Universal Protocol. In some hospitals, it
may be necessary to be more prescriptive on certain
elements of the Universal Protocol or to create processes that
38. are not specifically addressed within these
requirements.
Hospitals should identify the timing and location of the
preprocedure verification and site marking based on what
works best for their own unique circumstances. The frequency
and scope of the preprocedure verification will
depend on the type and complexity of the procedure. The three
components of the Universal Protocol are not
necessarily presented in chronological order (although the
preprocedure verification and site marking precede the
final verification in the time-out). Preprocedure verification,
site marking, and the time-out procedures should be as
consistent as possible throughout the hospital.
Note: Site marking is not required when the individual doing
the procedure is continuously with the patient from the
time of the decision to do the procedure through to the
performance of the procedure.
Conduct a preprocedure verification process.
UP.01.01.01
Hospitals should always make sure that any procedure is what
the patient needs and is performed on the right
person. The frequency and scope of the verification process will
depend on the type and complexity of the
procedure.
The preprocedure verification is an ongoing process of
information gathering and confirmation. The purpose of the
preprocedure verification process is to make sure that all
relevant documents and related information or equipment
are:
- Available prior to the start of the procedure
40. the correct site.
Note: The patient is involved in the verification process when
possible.
1.
Identify the items that must be available for the procedure and
use a standardized list to
verify their availability. At a minimum, these items include the
following:
- Relevant documentation (for example, history and physical,
signed procedure consent form,
nursing assessment, and preanesthesia assessment)
- Labeled diagnostic and radiology test results (for example,
radiology images and scans, or
pathology and biopsy reports) that are properly displayed
- Any required blood products, implants, devices, and/or special
equipment for the procedure
Note: The expectation of this element of performance is that the
standardized list is available
and is used consistently during the preprocedure verification. It
is not necessary to document
that the standardized list was used for each patient.
2.
Match the items that are to be available in the procedure area to
the patient.3.
Mark the procedure site.
UP.01.02.01
Elements of Performance for UP.01.02.01
Introduction to UP.01.02.01
41. Wrong site surgery should never happen. Yet it is an ongoing
problem in health care that compromises patient
safety. Marking the procedure site is one way to protect
patients; patient safety is enhanced when a consistent
marking process is used throughout the hospital. Site marking is
done to prevent errors when there is more than
one possible location for a procedure. Examples include
different limbs, fingers and toes, lesions, level of the spine,
and organs. In cases where bilateral structures are removed
(such as tonsils or ovaries) the site does not need to
be marked.
Responsibility for marking the procedure site is a hotly debated
topic. One position is that since the licensed
independent practitioner is accountable for the procedure, he or
she should mark the site. Another position is that
other individuals should be able to mark the site in the interests
of work flow and efficiency.
There is no evidence that patient safety is affected by the job
function of the individual who marks the site. The
incidence of wrong-site surgery is low enough that it is unlikely
that valid data on this subject will ever be available.
Furthermore, there is no clear consensus in the field on who
should mark the site. Rather than remaining silent on
the subject of site marking, The Joint Commission sought a
solution that supports the purpose of the site mark. The
mark is a communication tool about the patient for members of
the team. Therefore, the individual who knows the
most about the patient should mark the site. In most cases, that
will be the person performing the procedure.
Recognizing the complexities of the work processes supporting
invasive procedures, The Joint Commission
believes that delegation of site marking to another individual is
acceptable in limited situations as long as the
43. Mark the procedure site before the procedure is performed and,
if possible, with the patient
involved.
2.
The procedure site is marked by a licensed independent
practitioner who is ultimately
accountable for the procedure and will be present when the
procedure is performed. In
limited circumstances, the licensed independent practitioner
may delegate site marking to an
individual who is permitted by the organization to participate in
the procedure and has the
following qualifications:
- An individual in a medical postgraduate education program
who is being supervised by the
licensed independent practitioner performing the procedure;
who is familiar with the patient;
and who will be present when the procedure is performed
- A licensed individual who performs duties requiring a
collaborative agreement or
supervisory agreement with the licensed independent
practitioner performing the procedure
(that is, an advanced practice registered nurse [APRN] or
physician assistant [PA]); who is
familiar with the patient; and who will be present when the
procedure is performed.
Note: The hospital's leaders define the limited circumstances (if
any) in which site marking
may be delegated to an individual meeting these qualifications.
3.
The method of marking the site and the type of mark is
44. unambiguous and is used
consistently throughout the hospital.
Note: The mark is made at or near the procedure site and is
sufficiently permanent to be
visible after skin preparation and draping. Adhesive markers are
not the sole means of
marking the site.
4.
A written, alternative process is in place for patients who refuse
site marking or when it is
technically or anatomically impossible or impractical to mark
the site (for example, mucosal
surfaces or perineum).
Note: Examples of other situations that involve alternative
processes include:
- Minimal access procedures treating a lateralized internal
organ, whether percutaneous or
through a natural orifice
- Teeth
- Premature infants, for whom the mark may cause a permanent
tattoo
5.
A time-out is performed before the procedure.
UP.01.03.01
Elements of Performance for UP.01.03.01
The purpose of the time-out is to conduct a final assessment that
the correct patient, site, and procedure are
identified. This requirement focuses on those minimum features
of the time-out. Some believe that it is important to