Case study: reconciling the quality and safety gap through strategic planning.

PubMed

Jeffs, Lianne; Merkley, Jane; Jeffrey, Jana; Ferris, Ella; Dusek, Janice; Hunter, Catherine

2006-05-01

An essential outcome of professional practice environments is the provision of high-quality, safe nursing care. To mitigate the quality and safety chasm, nursing leadership at St. Michael's Hospital undertook a strategic plan to enhance the nursing professional practice environment. This case study outlines the development of the strategic planning process: the driving forces (platform); key stakeholders (process and players); vision, guiding principles, strategic directions, framework for action and accountability (plan); lessons learned (pearls); and next steps to moving forward the vision, strategic directions and accountability mechanisms (passion and perseverance).

Active transportation safety features around schools in Canada.

PubMed

Pinkerton, Bryn; Rosu, Andrei; Janssen, Ian; Pickett, William

2013-10-31

The purpose of this study was to describe the presence and quality of active transportation safety features in Canadian school environments that relate to pedestrian and bicycle safety. Variations in these features and associated traffic concerns as perceived by school administrators were examined by geographic status and school type. The study was based on schools that participated in 2009/2010 Health Behaviour in School-aged Children (HBSC) survey. ArcGIS software version 10 and Google Earth were used to assess the presence and quality of ten different active transportation safety features. Findings suggest that there are crosswalks and good sidewalk coverage in the environments surrounding most Canadian schools, but a dearth of bicycle lanes and other traffic calming measures (e.g., speed bumps, traffic chokers). Significant urban/rural inequities exist with a greater prevalence of sidewalk coverage, crosswalks, traffic medians, and speed bumps in urban areas. With the exception of bicycle lanes, the active transportation safety features that were present were generally rated as high quality. Traffic was more of a concern to administrators in urban areas. This study provides novel information about active transportation safety features in Canadian school environments. This information could help guide public health efforts aimed at increasing active transportation levels while simultaneously decreasing active transportation injuries.

Active Transportation Safety Features around Schools in Canada

PubMed Central

Pinkerton, Bryn; Rosu, Andrei; Janssen, Ian; Pickett, William

2013-01-01

The purpose of this study was to describe the presence and quality of active transportation safety features in Canadian school environments that relate to pedestrian and bicycle safety. Variations in these features and associated traffic concerns as perceived by school administrators were examined by geographic status and school type. The study was based on schools that participated in 2009/2010 Health Behaviour in School-aged Children (HBSC) survey. ArcGIS software version 10 and Google Earth were used to assess the presence and quality of ten different active transportation safety features. Findings suggest that there are crosswalks and good sidewalk coverage in the environments surrounding most Canadian schools, but a dearth of bicycle lanes and other traffic calming measures (e.g., speed bumps, traffic chokers). Significant urban/rural inequities exist with a greater prevalence of sidewalk coverage, crosswalks, traffic medians, and speed bumps in urban areas. With the exception of bicycle lanes, the active transportation safety features that were present were generally rated as high quality. Traffic was more of a concern to administrators in urban areas. This study provides novel information about active transportation safety features in Canadian school environments. This information could help guide public health efforts aimed at increasing active transportation levels while simultaneously decreasing active transportation injuries. PMID:24185844

Training in quality and safety: the current landscape.

PubMed

Karasick, Andrew S; Nash, David B

2015-01-01

The current US health care environment requires and encourages the development and implementation of training programs focusing on quality improvement and patient safety. This article offers a new resource that details the basic characteristics of such physician-inclusive training programs. Specifically, program type, objectives, eligibility, cost, training length, and modality are aggregated and displayed to provide health care professionals with a new tool to facilitate individual education in the field of quality improvement and patient safety. © The Author(s) 2014.

Embracing Safe Ground Test Facility Operations and Maintenance

NASA Technical Reports Server (NTRS)

Dunn, Steven C.; Green, Donald R.

2010-01-01

Conducting integrated operations and maintenance in wind tunnel ground test facilities requires a balance of meeting due dates, efficient operation, responsiveness to the test customer, data quality, effective maintenance (relating to readiness and reliability), and personnel and facility safety. Safety is non-negotiable, so the balance must be an "and" with other requirements and needs. Pressure to deliver services faster at increasing levels of quality in under-maintained facilities is typical. A challenge for management is to balance the "need for speed" with safety and quality. It s especially important to communicate this balance across the organization - workers, with a desire to perform, can be tempted to cut corners on defined processes to increase speed. Having a lean staff can extend the time required for pre-test preparations, so providing a safe work environment for facility personnel and providing good stewardship for expensive National capabilities can be put at risk by one well-intending person using at-risk behavior. This paper documents a specific, though typical, operational environment and cites management and worker safety initiatives and tools used to provide a safe work environment. Results are presented and clearly show that the work environment is a relatively safe one, though still not good enough to keep from preventing injury. So, the journey to a zero injury work environment - both in measured reality and in the minds of each employee - continues. The intent of this paper is to provide a benchmark for others with operational environments and stimulate additional sharing and discussion on having and keeping a safe work environment.

Reducing Central Line-Associated Bloodstream Infection Rates in the Context of a Caring-Healing Environment: A Patient Safety Program Evaluation.

PubMed

Hanson, Daphne

Central line-associated bloodstream infections (CLABSIs) prove to be detrimental to both the patient and the hospital. The present study was a quality improvement training project to affect CLABSI rates in the cardiac intensive care unit in the context of a caring-healing environment, and contributed to a culture of patient safety to empower staff to speak up if they see a breach in protocol at any time. A caring-healing environment encouraged staff to take the extra time and precautions to prevent infections for their patients and created a better quality of care for the patients.

Healthcare quality and safety: a review of policy, practice and research.

PubMed

Waring, Justin; Allen, Davina; Braithwaite, Jeffrey; Sandall, Jane

2016-02-01

Over the last two decades healthcare quality and safety have risen to the fore of health policy and research. This has largely been informed by theoretical and empirical ideas found in the fields of ergonomics and human factors. These have enabled significant advances in our understanding and management of quality and safety. However, a parallel and at time neglected sociological literature on clinical quality and safety is presented as offering additional, complementary, and at times critical insights on the problems of quality and safety. This review explores the development and contributions of both the mainstream and more sociological approaches to safety. It shows that where mainstream approaches often focus on the influence of human and local environment factors in shaping quality, a sociological perspective can deepen knowledge of the wider social, cultural and political factors that contextualise the clinical micro-system. It suggests these different perspectives can easily complement one another, offering a more developed and layered understanding of quality and safety. It also suggests that the sociological literature can bring to light important questions about the limits of the more mainstream approaches and ask critical questions about the role of social inequality, power and control in the framing of quality and safety. © 2015 Foundation for the Sociology of Health & Illness.

Factors influencing nurses' perceptions of occupational safety.

PubMed

Samur, Menevse; Intepeler, Seyda Seren

2017-01-02

To determine nurses' perceptions of occupational safety and their work environment and examine the sociodemographic traits and job characteristics that influence their occupational safety, we studied a sample of 278 nurses. According to the nurses, the quality of their work environment is average, and occupational safety is insufficient. In the subdimensions of the work environment scale, it was determined that the nurses think "labor force and other resources" are insufficient. In the occupational safety subdimensions "occupational illnesses and complaints" and "administrative support and approaches," they considered occupational safety to be insufficient. "Doctor-nurse-colleague relationships," "exposure to violence," and "work unit" (eg, internal medicine, surgical, intensive care) are the main factors that affect occupational safety. This study determined that hospital administrations should develop and immediately implement plans to ameliorate communication and clinical precautions and to reduce exposure to violence.

Bridging the Gap: A Framework and Strategies for Integrating the Quality and Safety Mission of Teaching Hospitals and Graduate Medical Education.

PubMed

Tess, Anjala; Vidyarthi, Arpana; Yang, Julius; Myers, Jennifer S

2015-09-01

Integrating the quality and safety mission of teaching hospitals and graduate medical education (GME) is a necessary step to provide the next generation of physicians with the knowledge, skills, and attitudes they need to participate in health system improvement. Although many teaching hospital and health system leaders have made substantial efforts to improve the quality of patient care, few have fully included residents and fellows, who deliver a large portion of that care, in their efforts. Despite expectations related to the engagement of these trainees in health care quality improvement and patient safety outlined by the Accreditation Council for Graduate Medical Education in the Clinical Learning Environment Review program, a structure for approaching this integration has not been described.In this article, the authors present a framework that they hope will assist teaching hospitals in integrating residents and fellows into their quality and safety efforts and in fostering a positive clinical learning environment for education and patient care. The authors define the six essential elements of this framework-organizational culture, teaching hospital-GME alignment, infrastructure, curricular resources, faculty development, and interprofessional collaboration. They then describe the organizational characteristics required for each element and offer concrete strategies to achieve integration. This framework is meant to be a starting point for the development of robust national models of infrastructure, alignment, and collaboration between GME and health care quality and safety leaders at teaching hospitals.

Optimizing Quality of Care and Patient Safety in Malaysia: The Current Global Initiatives, Gaps and Suggested Solutions.

PubMed

Jarrar, Mu'taman; Abdul Rahman, Hamzah; Don, Mohammad Sobri

2015-10-20

Demand for health care service has significantly increased, while the quality of healthcare and patient safety has become national and international priorities. This paper aims to identify the gaps and the current initiatives for optimizing the quality of care and patient safety in Malaysia. Review of the current literature. Highly cited articles were used as the basis to retrieve and review the current initiatives for optimizing the quality of care and patient safety. The country health plan of Ministry of Health (MOH) Malaysia and the MOH Malaysia Annual Reports were reviewed. The MOH has set four strategies for optimizing quality and sustaining quality of life. The 10th Malaysia Health Plan promotes the theme "1 Care for 1 Malaysia" in order to sustain the quality of care. Despite of these efforts, the total number of complaints received by the medico-legal section of the MOH Malaysia is increasing. The current global initiatives indicted that quality performance generally belong to three main categories: patient; staffing; and working environment related factors. There is no single intervention for optimizing quality of care to maintain patient safety. Multidimensional efforts and interventions are recommended in order to optimize the quality of care and patient safety in Malaysia.

Optimizing Quality of Care and Patient Safety in Malaysia: The Current Global Initiatives, Gaps and Suggested Solutions

PubMed Central

Jarrar, Mu’taman; Rahman, Hamzah Abdul; Don, Mohammad Sobri

2016-01-01

Background and Objective: Demand for health care service has significantly increased, while the quality of healthcare and patient safety has become national and international priorities. This paper aims to identify the gaps and the current initiatives for optimizing the quality of care and patient safety in Malaysia. Design: Review of the current literature. Highly cited articles were used as the basis to retrieve and review the current initiatives for optimizing the quality of care and patient safety. The country health plan of Ministry of Health (MOH) Malaysia and the MOH Malaysia Annual Reports were reviewed. Results: The MOH has set four strategies for optimizing quality and sustaining quality of life. The 10th Malaysia Health Plan promotes the theme “1 Care for 1 Malaysia” in order to sustain the quality of care. Despite of these efforts, the total number of complaints received by the medico-legal section of the MOH Malaysia is increasing. The current global initiatives indicted that quality performance generally belong to three main categories: patient; staffing; and working environment related factors. Conclusions: There is no single intervention for optimizing quality of care to maintain patient safety. Multidimensional efforts and interventions are recommended in order to optimize the quality of care and patient safety in Malaysia. PMID:26755459

Nursing Workload and the Changing Health Care Environment: A Review of the Literature

ERIC Educational Resources Information Center

Neill, Denise

2011-01-01

Changes in the health care environment have impacted nursing workload, quality of care, and patient safety. Traditional nursing workload measures do not guarantee efficiency, nor do they adequately capture the complexity of nursing workload. Review of the literature indicates nurses perceive the quality of their work has diminished. Research has…

General Employee Training Live, Course 15503

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gabel, Daniel Glen; Hughes, Heather

This training at Los Alamos National Laboratory contains the following sections: Introduction to the Laboratory, Institutional Quality Assurance, Facilities, Policies, Procedures, and Other Requirements, Safety Expectations, Worker Protection: Occupational Safety and Health, Industrial Hygiene and Safety, Lockout/Tagout, General Employee Radiological Training, Fire Protection, Security, Emergency Operations, Occupational Health, and Environment.

Maintaining a Quality Environmental Health & Safety Program.

ERIC Educational Resources Information Center

Otto, Ann K.; And Others

1994-01-01

The college or university human resources department's responsibilities in assuring a healthy and safe environment are enumerated. First, issues to be considered in school safety are outlined, and then the role of the health and safety officer is discussed. A sample job description and list of duties are included. (MSE)

The introduction of DRG funding and hospital nurses' changing perceptions of their practice environment, quality of care and satisfaction: comparison of cross-sectional surveys over a 10-year period.

PubMed

Zander, Britta; Dobler, Lydia; Busse, Reinhard

2013-02-01

As other countries which have introduced diagnosis-related groups (DRGs) to pay their hospitals Germany initially expected that quality of care could deteriorate. Less discussed were potential implications for nurses, who might feel the efficiency-increasing effects of DRGs on their daily work, which in turn may lead to an actual worsening of care quality. To analyze whether the DRG implementation in German acute hospitals (as well as other changes over the 10-year period) had measurable effects on (1) the nurse work environment (including e.g. an adequate number of nursing staff to provide quality patient care), (2) quality of patient care and safety (incl. confidence into patients' ability to manage care when discharged), and (3) whether the effects from (1) and (2)--if any--impacted on the nurses themselves (satisfaction with their current job and their choice of profession as well as emotional exhaustion). Two rounds of nurse surveys with the Practice Environment Scale of the Nursing Work Index (PES-NWI), five years before DRG implementation (i.e. in 1998/1999; n=2681 from 29 hospitals) and five years after (i.e. in 2009/2010; n=1511 from 49 hospitals). The analysis utilized 15 indicators as outcomes for (1) practice environment, (2) quality of patient care and safety, as well as (3) nurses' satisfaction and emotional exhaustion. Multivariate analyses were performed for all three sets of outcomes using SPSS version 20. Aspects of the practice environment (especially adequate staffing and supportive management) worsened within the examined time span of 10 years, which as a consequence had significant negative impact on the nurse-perceived quality of care (except for patient safety, which improved). Both the aspects of the practice environment and the quality aspects impacted substantially on satisfaction and emotional exhaustion among nurses. The DRG implementation in Germany has apparently had measurable negative effects on nurses and nurse-perceived patient outcomes, however, not as distinct as often assumed. Copyright © 2012 Elsevier Ltd. All rights reserved.

Structural empowerment and patient safety culture among registered nurses working in adult critical care units.

PubMed

Armellino, Donna; Quinn Griffin, Mary T; Fitzpatrick, Joyce J

2010-10-01

The aim of the present study was to examine the relationship between structural empowerment and patient safety culture among staff level Registered Nurses (RNs) within adult critical care units (ACCU). There is literature to support the value of RNs' structurally empowered work environments and emerging literature towards patient safety culture; the link between empowerment and patient safety culture is being discovered. A sample of 257 RNs, working within adult critical care of a tertiary hospital in the United States, was surveyed. Instruments included a background data sheet, the Conditions of Workplace Effectiveness and the Hospital Survey on Patient Safety Culture. Structural empowerment and patient safety culture were significantly correlated. As structural empowerment increased so did the RNs' perception of patient safety culture. To foster patient safety culture, nurse leaders should consider providing structurally empowering work environments for RNs. This study contributes to the body of knowledge linking structural empowerment and patient safety culture. Results link structurally empowered RNs and increased patient safety culture, essential elements in delivering efficient, competent, quality care. They inform nursing management of key factors in the nurses' environment that promote safe patient care environments. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

49 CFR 520.1 - Purpose and scope.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY... and other major Federal actions significantly affecting the quality of the human environment. The... environmental aspects of proposed actions. (b) This part specifies National Highway Traffic Safety...

49 CFR 520.1 - Purpose and scope.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY... and other major Federal actions significantly affecting the quality of the human environment. The... environmental aspects of proposed actions. (b) This part specifies National Highway Traffic Safety...

49 CFR 520.1 - Purpose and scope.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY... and other major Federal actions significantly affecting the quality of the human environment. The... environmental aspects of proposed actions. (b) This part specifies National Highway Traffic Safety...

49 CFR 520.1 - Purpose and scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY... and other major Federal actions significantly affecting the quality of the human environment. The... environmental aspects of proposed actions. (b) This part specifies National Highway Traffic Safety...

49 CFR 520.1 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY... and other major Federal actions significantly affecting the quality of the human environment. The... environmental aspects of proposed actions. (b) This part specifies National Highway Traffic Safety...

Person-centered work environments, psychological safety, and positive affect in healthcare: a theoretical framework.

PubMed

Rathert, Cheryl; May, Douglas R

2008-01-01

We propose that in order to systematically improve healthcare quality, healthcare organizations (HCOs) need work environments that are person-centered: environments that support the careprovider as well as the patient. We further argue that HCOs have a moral imperative to provide a workplace where professional care standards can be achieved. We draw upon a large body of research from several disciplines to propose and articulate a theoretical framework that explains how the work environment should be related to the well-being of patients and careproviders, that is, the potential mediating mechanisms. Person-centered work environments include: 1. Climates for patient-centered care. 2. Climates for quality improvement. 3. Benevolent ethical climates. Such a work environment should support the provision of patient-centered care, and should lead to positive psychological states for careproviders, including psychological safety and positive affect. The model contributes to theory by specifying relationships between important organizational variables. The model can potentially contribute to practice by linking specific work environment attributes to outcomes for careproviders and patients.

A strategic approach to quality improvement and patient safety education and resident integration in a general surgery residency.

PubMed

O'Heron, Colette T; Jarman, Benjamin T

2014-01-01

To outline a structured approach for general surgery resident integration into institutional quality improvement and patient safety education and development. A strategic plan to address Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review assessments for resident integration into Quality Improvement and Patient Safety initiatives is described. Gundersen Lutheran Medical Foundation is an independent academic medical center graduating three categorical residents per year within an integrated multi-specialty health system serving 19 counties over 3 states. The quality improvement and patient safety education program includes a formal lecture series, online didactic sessions, mandatory quality improvement or patient safety projects, institutional committee membership, an opportunity to serve as a designated American College of Surgeons National Surgical Quality Improvement Project and Quality in Training representative, mandatory morbidity and mortality conference attendance and clinical electives in rural surgery and international settings. Structured education regarding and participation in quality improvement and patient safety programs are able to be accomplished during general surgery residency. The long-term outcomes and benefits of these strategies are unknown at this time and will be difficult to measure with objective data. © 2013 Published by Association of Program Directors in Surgery on behalf of Association of Program Directors in Surgery.

Fertilizer Use and Water Quality.

ERIC Educational Resources Information Center

Reneau, Fred; And Others

This booklet presents informative materials on fertilizer use and water quality, specifically in regard to environmental pollution and protection in Illinois. The five chapters cover these topics: Fertilizer and Water Quality, Fertilizer Use, Fertilizers and the Environment, Safety Practices, and Fertilizer Management Practices. Key questions are…

Association between perceived neighborhood environment and health of middle-aged women living in rapidly changing urban Mongolia.

PubMed

Shagdarsuren, Tserendulam; Nakamura, Keiko; McCay, Layla

2017-05-31

This study was conducted in rapidly urbanizing Ulaanbaatar, Mongolia, to examine patterns of perceived neighborhood quality by residents and the associations between these patterns and self-reported general and mental health in middle-aged women. A questionnaire survey was administered to 960 women aged 40-60 years. Demographic and socio-economic characteristics, subjects' perception of their neighborhood environment, general health status, and mental health as measured using a 12-item General Health Questionnaire (GHQ12) were reported. A total of 830 women completed the questionnaire. Subjects reporting their general health as very good or good accounted for 80.3% and those with a GHQ12 ≥16, which reflects psychological distress or severe distress, accounted for 16.1%. A principal component analysis of the perceptions of neighborhood environment by the residents identified six qualities: physical environment, designed environment, neighborhood community, public safety, natural environment, and citizen services. The perception of better-quality citizen services in the neighborhood was associated with better self-reported general health (odds ratio [OR] = 1.330, 95% confidence interval [CI] 1.093-1.618), and the perception of better-quality public safety was associated with less psychological distress (OR = 0.718, 95% CI 0.589-0.876); these associations were independent of education, income, occupation, type of residential area, and number of years living in the current khoroo. The perception of the quality of a neighborhood environment can affect the self-reported general and mental health of residents, even after accounting for the type of residential area and individual socio-economic status. Developing high-quality neighborhoods is an essential component of good planning to promote population health in urban environments.

Improving work environments in health care: test of a theoretical framework.

PubMed

Rathert, Cheryl; Ishqaidef, Ghadir; May, Douglas R

2009-01-01

In light of high levels of staff turnover and variability in the quality of health care, much attention is currently being paid to the health care work environment and how it potentially relates to staff, patient, and organizational outcomes. Although some attention has been paid to staffing variables, more attention must be paid to improving the work environment for patient care. The purpose of this study was to empirically explore a theoretical model linking the work environment in the health care setting and how it might relate to work engagement, organizational commitment, and patient safety. This study also explored how the work environment influences staff psychological safety, which has been show to influence several variables important in health care. Clinical care providers at a large metropolitan hospital were surveyed using a mail methodology. The overall response rate was 42%. This study analyzed perceptions of staff who provided direct care to patients. Using structural equation modeling, we found that different dimensions of the work environment were related to different outcome variables. For example, a climate for continuous quality improvement was positively related to organizational commitment and patient safety, and psychological safety partially mediated these relationships. Patient-centered care was positively related to commitment but negatively related to engagement. Health care managers need to examine how organizational policies and practices are translated into the work environment and how these influence practices on the front lines of care. It appears that care provider perceptions of their work environments may be useful to consider for improvement efforts.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Poncio, S.; Adkison, P.

Coating costs are escalating due to increased awareness of the environment and safety and health issues. Owners can reduce the overall cost of maintenance painting projects through the implementation of a total quality program. This program should encompass project pre-planning, evaluation of safety and quality assurance programs, and analysis of employee absenteeism and turnover. The information presented is a case history of one utility's experience managing a maintenance painting program during a five-year period.

Association of nurse work environment and safety climate on patient mortality: A cross-sectional study.

PubMed

Olds, Danielle M; Aiken, Linda H; Cimiotti, Jeannie P; Lake, Eileen T

2017-09-01

There are two largely distinct research literatures on the association of the nurse work environment and the safety climate on patient outcomes. To determine whether hospital safety climate and work environment make comparable or distinct contributions to patient mortality. Cross-sectional secondary analysis of linked datasets of Registered Nurse survey responses, adult acute care discharge records, and hospital characteristics. Acute care hospitals in California, Florida, New Jersey, and Pennsylvania. The sample included 600 hospitals linked to 27,009 nurse survey respondents and 852,974 surgical patients. Nurse survey data included assessments of the nurse work environment and hospital safety climate. The outcome of interest was in-hospital mortality. Data analyses included descriptive statistics and multivariate random intercept logistic regression. In a fully adjusted model, a one standard deviation increase in work environment score was associated with an 8.1% decrease in the odds of mortality (OR 0.919, p<0.001). A one-standard deviation increase in safety climate score was similarly associated with a 7.7% decrease in the odds of mortality (OR 0.923, p<0.001). However, when work environment and safety climate were modeled together, the effect of the work environment remained significant, while safety climate became a non-significant predictor of mortality odds (OR 0.940, p=0.035 vs. OR 0.971, p=0.316). We found that safety climate perception is not predictive of patient mortality beyond the effect of the nurse work environment. To advance hospital safety and quality and improve patient outcomes, organizational interventions should be directed toward improving nurse work environments. Copyright © 2017 Elsevier Ltd. All rights reserved.

Safety considerations in providing allergen immunotherapy in the office.

PubMed

Mattos, Jose L; Lee, Stella

2016-06-01

This review highlights the risks of allergy immunotherapy, methods to improve the quality and safety of allergy treatment, the current status of allergy quality metrics, and the future of quality measurement. In the current healthcare environment, the emphasis on outcomes measurement is increasing, and providers must be better equipped in the development, measurement, and reporting of safety and quality measures. Immunotherapy offers the only potential cure for allergic disease and asthma. Although well tolerated and effective, immunotherapy can be associated with serious consequence, including anaphylaxis and death. Many predisposing factors and errors that lead to serious systemic reactions are preventable, and the evaluation and implementation of quality measures are crucial to developing a safe immunotherapy practice. Although quality metrics for immunotherapy are in their infancy, they will become increasingly sophisticated, and providers will face increased pressure to deliver safe, high-quality, patient-centered, evidence-based, and efficient allergy care. The establishment of safety in the allergy office involves recognition of potential risk factors for anaphylaxis, the development and measurement of quality metrics, and changing systems-wide practices if needed. Quality improvement is a continuous process, and although national allergy-specific quality metrics do not yet exist, they are in development.

Recognizing and Responding to the "Toxic" Work Environment: Worker Safety, Patient Safety, and Abuse/Neglect in Nursing Homes.

PubMed

Pickering, Carolyn E Z; Nurenberg, Katie; Schiamberg, Lawrence

2017-10-01

This grounded theory study examined how the certified nursing assistant (CNA) understands and responds to bullying in the workplace. Constant comparative analysis was used to analyze data from in-depth telephone interviews with CNAs ( N = 22) who experienced bullying while employed in a nursing home. The result of the analysis is a multistep model describing CNA perceptions of how, over time, they recognized and responded to the "toxic" work environment. The strategies used in responding to the "toxic" environment affected their care provision and were attributed to the development of several resident and worker safety outcomes. The data suggest that the etiology of abuse and neglect in nursing homes may be better explained by institutional cultures rather than individual traits of CNAs. Findings highlight the relationship between worker and patient safety, and suggest worker safety outcomes may be an indicator of quality in nursing homes.

An observational study: associations between nurse-reported hospital characteristics and estimated 30-day survival probabilities

PubMed Central

Tvedt, Christine; Sjetne, Ingeborg Strømseng; Helgeland, Jon; Bukholm, Geir

2014-01-01

Background There is a growing body of evidence for associations between the work environment and patient outcomes. A good work environment may maximise healthcare workers’ efforts to avoid failures and to facilitate quality care that is focused on patient safety. Several studies use nurse-reported quality measures, but it is uncertain whether these outcomes are correlated with clinical outcomes. The aim of this study was to determine the correlations between hospital-aggregated, nurse-assessed quality and safety, and estimated probabilities for 30-day survival in and out of hospital. Methods In a multicentre study involving almost all Norwegian hospitals with more than 85 beds (sample size=30, information about nurses’ perceptions of organisational characteristics were collected. Subscales from this survey were used to describe properties of the organisations: quality system, patient safety management, nurse–physician relationship, staffing adequacy, quality of nursing and patient safety. The average scores for these organisational characteristics were aggregated to hospital level, and merged with estimated probabilities for 30-day survival in and out of hospital (survival probabilities) from a national database. In this observational, ecological study, the relationships between the organisational characteristics (independent variables) and clinical outcomes (survival probabilities) were examined. Results Survival probabilities were correlated with nurse-assessed quality of nursing. Furthermore, the subjective perception of staffing adequacy was correlated with overall survival. Conclusions This study showed that perceived staffing adequacy and nurses’ assessments of quality of nursing were correlated with survival probabilities. It is suggested that the way nurses characterise the microsystems they belong to, also reflects the general performance of hospitals. PMID:24728887

The role of constructive feedback in patient safety and continuous quality improvement.

PubMed

Altmiller, Gerry

2012-09-01

Constructive feedback is essential for personal and professional growth. It is an integral part of continuous quality improvement and essential in maintaining patient safety in the clinical environment. The perception of feedback can interfere with professionals giving and receiving feedback, which can have negative consequences on patient outcomes. Delivering and receiving feedback effectively are learned skills that should be introduced early in prelicensure education. Faculty have the opportunity to influence the perception of feedback to be viewed as an opportunity so that students can learn to appreciate its value in maintaining patient safety and high-quality care in clinical practice. Copyright © 2012 Elsevier Inc. All rights reserved.

Quality and safety aspects in histopathology laboratory

PubMed Central

Adyanthaya, Soniya; Jose, Maji

2013-01-01

Histopathology is an art of analyzing and interpreting the shapes, sizes and architectural patterns of cells and tissues within a given specific clinical background and a science by which the image is placed in the context of knowledge of pathobiology, to arrive at an accurate diagnosis. To function effectively and safely, all the procedures and activities of histopathology laboratory should be evaluated and monitored accurately. In histopathology laboratory, the concept of quality control is applicable to pre-analytical, analytical and post-analytical activities. Ensuring safety of working personnel as well as environment is also highly important. Safety issues that may come up in a histopathology lab are primarily those related to potentially hazardous chemicals, biohazardous materials, accidents linked to the equipment and instrumentation employed and general risks from electrical and fire hazards. This article discusses quality management system which can ensure quality performance in histopathology laboratory. The hazards in pathology laboratories and practical safety measures aimed at controlling the dangers are also discussed with the objective of promoting safety consciousness and the practice of laboratory safety. PMID:24574660

Psychosocial work environment and prediction of quality of care indicators in one Canadian health center.

PubMed

Paquet, Maxime; Courcy, François; Lavoie-Tremblay, Mélanie; Gagnon, Serge; Maillet, Stéphanie

2013-05-01

Few studies link organizational variables and outcomes to quality indicators. This approach would expose operant mechanisms by which work environment characteristics and organizational outcomes affect clinical effectiveness, safety, and quality indicators. What are the predominant psychosocial variables in the explanation of organizational outcomes and quality indicators (in this case, medication errors and length of stay)? The primary objective of this study was to link the fields of evidence-based practice to the field of decision making, by providing an effective model of intervention to improve safety and quality. The study involved healthcare workers (n = 243) from 13 different care units of a university affiliated health center in Canada. Data regarding the psychosocial work environment (10 work climate scales, effort/reward imbalance, and social support) was linked to organizational outcomes (absenteeism, turnover, overtime), to the nurse/patient ratio and quality indicators (medication errors and length of stay) using path analyses. The models produced in this study revealed a contribution of some psychosocial factors to quality indicators, through an indirect effect of personnel- or human resources-related variables, more precisely: turnover, absenteeism, overtime, and nurse/patient ratio. Four perceptions of work environment appear to play an important part in the indirect effect on both medication errors and length of stay: apparent social support from supervisors, appreciation of the workload demands, pride in being part of one's work team, and effort/reward balance. This study reveals the importance of employee perceptions of the work environment as an indirect predictor of quality of care. Working to improve these perceptions is a good investment for loyalty and attendance. In general, better personnel conditions lead to fewer medication errors and shorter length of stay. © Sigma Theta Tau International.

Software Design Improvements. Part 2; Software Quality and the Design and Inspection Process

NASA Technical Reports Server (NTRS)

Lalli, Vincent R.; Packard, Michael H.; Ziemianski, Tom

1997-01-01

The application of assurance engineering techniques improves the duration of failure-free performance of software. The totality of features and characteristics of a software product are what determine its ability to satisfy customer needs. Software in safety-critical systems is very important to NASA. We follow the System Safety Working Groups definition for system safety software as: 'The optimization of system safety in the design, development, use and maintenance of software and its integration with safety-critical systems in an operational environment. 'If it is not safe, say so' has become our motto. This paper goes over methods that have been used by NASA to make software design improvements by focusing on software quality and the design and inspection process.

Need for an "integrated safety assessment" of GMOs, linking food safety and environmental considerations.

PubMed

Haslberger, Alexander G

2006-05-03

Evidence for substantial environmental influences on health and food safety comes from work with environmental health indicators which show that agroenvironmental practices have direct and indirect effects on human health, concluding that "the quality of the environment influences the quality and safety of foods" [Fennema, O. Environ. Health Perspect. 1990, 86, 229-232). In the field of genetically modified organisms (GMOs), Codex principles have been established for the assessment of GM food safety and the Cartagena Protocol on Biosafety outlines international principles for an environmental assessment of living modified organisms. Both concepts also contain starting points for an assessment of health/food safety effects of GMOs in cases when the environment is involved in the chain of events that could lead to hazards. The environment can act as a route of unintentional entry of GMOs into the food supply, such as in the case of gene flow via pollen or seeds from GM crops, but the environment can also be involved in changes of GMO-induced agricultural practices with relevance for health/food safety. Examples for this include potential regional changes of pesticide uses and reduction in pesticide poisonings resulting from the use of Bt crops or influences on immune responses via cross-reactivity. Clearly, modern methods of biotechnology in breeding are involved in the reasons behind the rapid reduction of local varieties in agrodiversity, which constitute an identified hazard for food safety and food security. The health/food safety assessment of GM foods in cases when the environment is involved needs to be informed by data from environmental assessment. Such data might be especially important for hazard identification and exposure assessment. International organizations working in these areas will very likely be needed to initiate and enable cooperation between those institutions responsible for the different assessments, as well as for exchange and analysis of information. An integrated assessment might help to focus and save capacities in highly technical areas such as molecular characterization or profiling, which are often necessary for both assessments. In the area of establishing international standards for traded foods, such as for the newly created Standards in Trade and Development Facility (STDF), an integrated assessment might help in the consideration of important environmental aspects involved in health and food safety. Furthermore, an established integrated view on GMOs may create greater consumer confidence in the technology.

TH-E-19A-01: Quality and Safety in Radiation Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ford, E; Ezzell, G; Miller, B

2014-06-15

Clinical radiotherapy data clearly demonstrate the link between the quality and safety of radiation treatments and the outcome for patients. The medical physicist plays an essential role in this process. To ensure the highest quality treatments, the medical physicist must understand and employ modern quality improvement techniques. This extends well beyond the duties traditionally associated with prescriptive QA measures. This session will review the current best practices for improving quality and safety in radiation therapy. General elements of quality management will be reviewed including: what makes a good quality management structure, the use of prospective risk analysis such as FMEA,more » and the use of incident learning. All of these practices are recommended in society-level documents and are incorporated into the new Practice Accreditation program developed by ASTRO. To be effective, however, these techniques must be practical in a resource-limited environment. This session will therefore focus on practical tools such as the newly-released radiation oncology incident learning system, RO-ILS, supported by AAPM and ASTRO. With these general constructs in mind, a case study will be presented of quality management in an SBRT service. An example FMEA risk assessment will be presented along with incident learning examples including root cause analysis. As the physicist's role as “quality officer” continues to evolve it will be essential to understand and employ the most effective techniques for quality improvement. This session will provide a concrete overview of the fundamentals in quality and safety. Learning Objectives: Recognize the essential elements of a good quality management system in radiotherapy. Understand the value of incident learning and the AAPM/ASTRO ROILS incident learning system. Appreciate failure mode and effects analysis as a risk assessment tool and its use in resource-limited environments. Understand the fundamental principles of good error proofing that extends beyond traditional prescriptive QA measures.« less

For all the right reasons. Approaching CPOE from a patient safety and care quality perspective is the first critical step toward success.

PubMed

Hagland, Mark

2009-09-01

True CPOE success is about facilitating improved patient safety, care quality, and efficiency in a multidisciplinar environment, and on an ongoing basis. CPOE implementation forces clinician leaders to examine and rework long-ingrained care delivery processes, especially as they build or adapt order sets. The likelihood that CPOE will be a requirement of meaningful use could compel a rapid acceleration in implementation.

Changing conversations: teaching safety and quality in residency training.

PubMed

Voss, John D; May, Natalie B; Schorling, John B; Lyman, Jason A; Schectman, Joel M; Wolf, Andrew M D; Nadkarni, Mohan M; Plews-Ogan, Margaret

2008-11-01

Improving patient safety and quality in health care is one of medicine's most pressing challenges. Residency training programs have a unique opportunity to meet this challenge by training physicians in the science and methods of patient safety and quality improvement (QI).With support from the Health Resources and Services Administration, the authors developed an innovative, longitudinal, experiential curriculum in patient safety and QI for internal medicine residents at the University of Virginia. This two-year curriculum teaches the critical concepts and skills of patient safety and QI: systems thinking and human factors analysis, root cause analysis (RCA), and process mapping. Residents apply these skills in a series of QI and patient safety projects. The constructivist educational model creates a learning environment that actively engages residents in improving the quality and safety of their medical practice.Between 2003 and 2005, 38 residents completed RCAs of adverse events. The RCAs identified causes and proposed useful interventions that have produced important care improvements. Qualitative analysis demonstrates that the curriculum shifted residents' thinking about patient safety to a systems-based approach. Residents completed 237 outcome assessments during three years. Results indicate that seminars met predefined learning objectives and were interactive and enjoyable. Residents strongly believe they gained important skills in all domains.The challenge to improve quality and safety in health care requires physicians to learn new knowledge and skills. Graduate medical education can equip new physicians with the skills necessary to lead the movement to safer and better quality of care for all patients.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

40 CFR 50.2 - Scope.

Code of Federal Regulations, 2012 CFR

2012-07-01

... of safety, to protect the public health. National secondary ambient air quality standards define... 40 Protection of Environment 2 2012-07-01 2012-07-01 false Scope. 50.2 Section 50.2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS NATIONAL PRIMARY AND SECONDARY AMBIENT...

Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events--a cross-sectional survey.

PubMed

Van Bogaert, Peter; Timmermans, Olaf; Weeks, Susan Mace; van Heusden, Danny; Wouters, Kristien; Franck, Erik

2014-08-01

To investigate the impact of nurse practice environment factors, nurse work characteristics, and burnout on nurse reported job outcomes, quality of care, and patient adverse events variables at the nursing unit level. Nurse practice environment studies show growing insights and knowledge about determining factors for nurse workforce stability, quality of care, and patient safety. Until now, international studies have primarily focused on variability at the hospital level; however, insights at the nursing unit level can reveal key factors in the nurse practice environment. A cross-sectional design with a survey. In a cross-sectional survey, a sample of 1108 nurses assigned to 96 nursing units completed a structured questionnaire composed of various validated instruments measuring nurse practice environment factors, nurse work characteristics, burnout, nurse reported job outcomes, quality of care, and patient adverse events. Associations between the variables were examined using multilevel modelling techniques. Various unit-level associations (simple models) were identified between nurse practice environment factors, nurse work characteristics, burnout dimensions, and nurse reported outcome variables. Multiple multilevel models showed various independent variables such as nursing management at the unit level, social capital, emotional exhaustion, and depersonalization as important predictors of nurse reported outcome variables such job satisfaction, turnover intentions, quality of care (at the unit, the last shift, and in the hospital within the last year), patient and family complaints, patient and family verbal abuse, patient falls, nosocomial infections, and medications errors. Results suggested a stable nurse work force, with the capability to achieve superior quality and patient safety outcomes, is associated with unit-level favourable perceptions of nurse work environment factors, workload, decision latitude, and social capital, as well low levels of burnout. Nurses, physicians, nursing leaders, and executives share responsibility to create an environment supportive of interdisciplinary team development. Copyright © 2013 Elsevier Ltd. All rights reserved.

Quality and human society

NASA Astrophysics Data System (ADS)

Stoll, W.

1991-02-01

Quality of products and services is seen as a necessity in our modern world. Quality also has important cross-links to safety in our society. It is however suggested, that human beings are living in their industrial environment under the stress of a fractured personality with anxieties and frustrations. Some cultural comparisons with other industrial nations are given. Quality control tailored to human nature is recommended.

Transforming communication and safety culture in intrapartum care: a multi-organization blueprint.

PubMed

Lyndon, Audrey; Johnson, M Christina; Bingham, Debra; Napolitano, Peter G; Joseph, Gerald; Maxfield, David G; O'Keeffe, Daniel F

2015-01-01

Effective, patient-centered communication facilitates interception and correction of potentially harmful conditions and errors. All team members, including women, their families, physicians, midwives, nurses, and support staff, have a role in identifying the potential for harm during labor and birth. However, the results of collaborative research studies conducted by organizations that represent professionals who care for women during labor and birth indicate that health care providers may frequently witness, but may not always report, problems with safety or clinical performance. Some of these health care providers felt resigned to the continuation of such problems and fearful of retribution if they tried to address them. Speaking up to address safety and quality concerns is a dynamic social process. Every team member must feel empowered to speak up about concerns without fear of put-downs, retribution, or receiving poor-quality care. Patient safety requires mutual accountability: individuals, teams, health care facilities, and professional associations have a shared responsibility for creating and sustaining environments of mutual respect and engaging in highly reliable perinatal care. Defects in human factors, communication, and leadership have been the leading contributors to sentinel events in perinatal care for more than a decade. Organizational commitment and executive leadership are essential to creating an environment that proactively supports safety and quality. The problem is well-known; the time for action is now. © 2015 by the American College of Obstetricians and Gynecologists.

Transforming communication and safety culture in intrapartum care: a multi-organization blueprint.

PubMed

Lyndon, Audrey; Johnson, M Christina; Bingham, Debra; Napolitano, Peter G; Joseph, Gerald; Maxfield, David G; OʼKeeffe, Daniel F

2015-05-01

Effective, patient-centered communication facilitates interception and correction of potentially harmful conditions and errors. All team members, including women, their families, physicians, midwives, nurses, and support staff, have a role in identifying the potential for harm during labor and birth. However, the results of collaborative research studies conducted by organizations that represent professionals who care for women during labor and birth indicate that health care providers may frequently witness, but may not always report, problems with safety or clinical performance. Some of these health care providers felt resigned to the continuation of such problems and fearful of retribution if they tried to address them. Speaking up to address safety and quality concerns is a dynamic social process. Every team member must feel empowered to speak up about concerns without fear of put-downs, retribution, or receiving poor-quality care. Patient safety requires mutual accountability: individuals, teams, health care facilities, and professional associations have a shared responsibility for creating and sustaining environments of mutual respect and engaging in highly reliable perinatal care. Defects in human factors, communication, and leadership have been the leading contributors to sentinel events in perinatal care for more than a decade. Organizational commitment and executive leadership are essential to creating an environment that proactively supports safety and quality. The problem is well-known; the time for action is now.

Transforming communication and safety culture in intrapartum care: a multi-organization blueprint.

PubMed

Lyndon, Audrey; Johnson, M Christina; Bingham, Debra; Napolitano, Peter G; Joseph, Gerald; Maxfield, David G; O'Keeffe, Daniel F

2015-01-01

Effective, patient-centered communication facilitates interception and correction of potentially harmful conditions and errors. All team members, including women, their families, physicians, midwives, nurses, and support staff, have roles in identifying the potential for harm during labor and birth. However, the results of collaborative research studies conducted by organizations that represent professionals who care for women during labor and birth indicate that health care providers may frequently witness, but may not always report, problems with safety or clinical performance. Some of these health care providers felt resigned to the continuation of such problems and fearful of retribution if they tried to address them. Speaking up to address safety and quality concerns is a dynamic social process. Every team member must feel empowered to speak up about concerns without fear of put-downs, retribution, or receiving poor-quality care. Patient safety requires mutual accountability: individuals, teams, health care facilities, and professional associations have a shared responsibility for creating and sustaining environments of mutual respect and engaging in highly reliable perinatal care. Defects in human factors, communication, and leadership have been the leading contributors to sentinel events in perinatal care for more than a decade. Organizational commitment and executive leadership are essential to creating an environment that proactively supports safety and quality. The problem is well-known; the time for action is now. © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Evaluating the Clinical Learning Environment: Resident and Fellow Perceptions of Patient Safety Culture.

PubMed

Bump, Gregory M; Calabria, Jaclyn; Gosman, Gabriella; Eckart, Catherine; Metro, David G; Jasti, Harish; McCausland, Julie B; Itri, Jason N; Patel, Rita M; Buchert, Andrew

2015-03-01

The Accreditation Council for Graduate Medical Education has begun to evaluate teaching institutions' learning environments with Clinical Learning Environment Review visits, including trainee involvement in institutions' patient safety and quality improvement efforts. We sought to address the dearth of metrics that assess trainee patient safety perceptions of the clinical environment. Using the Hospital Survey on Patient Safety Culture (HSOPSC), we measured resident and fellow perceptions of patient safety culture in 50 graduate medical education programs at 10 hospitals within an integrated health system. As institution-specific physician scores were not available, resident and fellow scores on the HSOPSC were compared with national data from 29 162 practicing providers at 543 hospitals. Of the 1337 residents and fellows surveyed, 955 (71.4%) responded. Compared with national practicing providers, trainees had lower perceptions of patient safety culture in 6 of 12 domains, including teamwork within units, organizational learning, management support for patient safety, overall perceptions of patient safety, feedback and communication about error, and communication openness. Higher perceptions were observed for manager/supervisor actions promoting patient safety and for staffing. Perceptions equaled national norms in 4 domains. Perceptions of patient safety culture did not improve with advancing postgraduate year. Trainees in a large integrated health system have variable perceptions of patient safety culture, as compared with national norms for some practicing providers. Administration of the HSOPSC was feasible and acceptable to trainees, and may be used to track perceptions over time.

Evaluating the Clinical Learning Environment: Resident and Fellow Perceptions of Patient Safety Culture

PubMed Central

Bump, Gregory M.; Calabria, Jaclyn; Gosman, Gabriella; Eckart, Catherine; Metro, David G.; Jasti, Harish; McCausland, Julie B.; Itri, Jason N.; Patel, Rita M.; Buchert, Andrew

2015-01-01

Background The Accreditation Council for Graduate Medical Education has begun to evaluate teaching institutions' learning environments with Clinical Learning Environment Review visits, including trainee involvement in institutions' patient safety and quality improvement efforts. Objective We sought to address the dearth of metrics that assess trainee patient safety perceptions of the clinical environment. Methods Using the Hospital Survey on Patient Safety Culture (HSOPSC), we measured resident and fellow perceptions of patient safety culture in 50 graduate medical education programs at 10 hospitals within an integrated health system. As institution-specific physician scores were not available, resident and fellow scores on the HSOPSC were compared with national data from 29 162 practicing providers at 543 hospitals. Results Of the 1337 residents and fellows surveyed, 955 (71.4%) responded. Compared with national practicing providers, trainees had lower perceptions of patient safety culture in 6 of 12 domains, including teamwork within units, organizational learning, management support for patient safety, overall perceptions of patient safety, feedback and communication about error, and communication openness. Higher perceptions were observed for manager/supervisor actions promoting patient safety and for staffing. Perceptions equaled national norms in 4 domains. Perceptions of patient safety culture did not improve with advancing postgraduate year. Conclusions Trainees in a large integrated health system have variable perceptions of patient safety culture, as compared with national norms for some practicing providers. Administration of the HSOPSC was feasible and acceptable to trainees, and may be used to track perceptions over time. PMID:26217435

NIOSH testimony on indoor air quality: Selected references before the Subcommittee on Superfund, Ocean and Water Protection, Committee on Environment and Public Works, United States Senate by J. Donald Millar, May 26, 1989

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1989-09-01

The National Institute for Occupational Safety and Health (NIOSH) has compiled the document in response to an increasing number of requests for information about indoor air quality (IAQ), including sick building syndrome. Included in the publication are: NIOSH Congressional testimony that describes the NIOSH IAQ investigations program and summarizes the results of NIOSH research and findings on IAQ problems, NIOSH guidance for conducting indoor air quality investigations, NIOSH journal article on evaluating building ventilation systems, and list of non-NIOSH publications on indoor air quality. As the Federal agency responsible for conducting research and making recommendations for occupational safety and healthmore » standards, NIOSH limits its IAQ activities to the occupational environment. The U.S. Environmental Protection Agency (EPA) also conducts an IAQ program and can be contacted for information regarding both occupational and non-occupational settings.« less

Quality and strength of patient safety climate on medical-surgical units.

PubMed

Hughes, Linda C; Chang, Yunkyung; Mark, Barbara A

2009-01-01

Describing the safety climate in hospitals is an important first step in creating work environments where safety is a priority. Yet, little is known about the patient safety climate on medical-surgical units. Study purposes were to describe quality and strength of the patient safety climate on medical-surgical units and explore hospital and unit characteristics associated with this climate. Data came from a larger organizational study to investigate hospital and unit characteristics associated with organizational, nurse, and patient outcomes. The sample for this study was 3,689 RNs on 286 medical-surgical units in 146 hospitals. Nursing workgroup and managerial commitment to safety were the two most strongly positive attributes of the patient safety climate. However, issues surrounding the balance between job duties and safety compliance and nurses' reluctance to reveal errors continue to be problematic. Nurses in Magnet hospitals were more likely to communicate about errors and participate in error-related problem solving. Nurses on smaller units and units with lower work complexity reported greater safety compliance and were more likely to communicate about and reveal errors. Nurses on smaller units also reported greater commitment to patient safety and participation in error-related problem solving. Nursing workgroup commitment to safety is a valuable resource that can be leveraged to promote a sense of personal responsibility for and shared ownership of patient safety. Managers can capitalize on this commitment by promoting a work environment in which control over nursing practice and active participation in unit decisions are encouraged and by developing channels of communication that increase staff nurse involvement in identifying patient safety issues, prioritizing unit-level safety goals, and resolving day-to-day operational problems the have the potential to jeopardize patient safety.

The business case for building better hospitals through evidence-based design.

PubMed

Sadler, Blair L; DuBose, Jennifer; Zimring, Craig

2008-01-01

After establishing the connection between building well-designed evidence-based facilities and improved safety and quality for patients, families, and staff, this article presents the compelling business case for doing so. It demonstrates why ongoing operating savings and initial capital costs must be analyzed and describes specific steps to ensure that design innovations are implemented effectively. Hospital leaders and boards are now beginning to face a new reality: They can no longer tolerate preventable hospital-acquired conditions such as infections, falls, and injuries to staff or unnecessary intra-hospital patient transfers that can increase errors. Nor can they subject patients and families to noisy, confusing environments that increase anxiety and stress. They must effectively deploy all reasonable quality improvement techniques available. To be optimally effective, a variety of tactics must be combined and implemented in an integrated way. Hospital leadership must understand the clear connection between building well-designed healing environments and improved healthcare safety and quality for patients, families, and staff, as well as the compelling business case for doing so. Emerging pay-for-performance (P4P) methodologies that reward hospitals for quality and refuse to pay hospitals for the harm they cause (e.g., infections and falls) further strengthen this business case. When planning to build a new hospital or to renovate an existing facility, healthcare leaders should address a key question: Will the proposed project incorporate all relevant and proven evidence-based design innovations to optimize patient safety, quality, and satisfaction as well as workforce safety, satisfaction, productivity, and energy efficiency? When conducting a business case analysis for a new project, hospital leaders should consider ongoing operating savings and the market share impact of evidence-based design interventions as well as initial capital costs. They should consider taking the 10 steps recommended to ensure an optimal, cost-effective hospital environment. A return-on-investment (ROI) framework is put forward for the use of individual organizations.

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Food Safety. Nourishing News. Volume 3, Issue 10

ERIC Educational Resources Information Center

Idaho State Department of Education, 2009

2009-01-01

Serving safe food is a critical responsibility for maintaining quality foodservice programs and healthy environments at schools and child care facilities. Child Nutrition Programs hopes you find this newsletter of assistance when reviewing the food safety program you have at each serving site. The articles contained in this issue are: (1) A…

[Aquaculture in Italy. An integrated model of product quality control].

PubMed

De Giusti, Maria; Cocchieri, Renata Amodio; De Vito, Elisabetta; Grasso, Guido Maria; Ortaggi, Giancarlo; Reali, Daniela; Ricciardi, Gualtiero; Romano-Spica, Vincenzo; Boccia, Antonio

2007-01-01

Aquaculture is becoming increasingly diffuse even in Italy. The increased production introduces new problems such as product quality control and process safety. This article presents the results of a research project, funded by the Ministry of the Environment, whose aim was to evaluate and promote aquaculture product quality and safety in an environmentally responsible way. Four intensive land-based and offshore aquaculture sites were monitored to evaluate microbiological, biological and chemical (i.e. polychlorinated biphenyls and endocrine disruptors) quality of water, products and fish feed. In total 154 samples were analysed, of which 66 were water samples, 55 product samples and 33 feed samples. Salmonella and other enteric pathogens were absent in products and the aquatic environment, while other environmental pathogens of the Vibrio species were detected. Bacterial load and fecal indicators were found to be higher in off-shore products and in mussels from all aquaculture sites. PCBs were detected in all products in concentrations below 2 microg/g fresh product (Food and Drug Administration), but on average, higher concentrations were detected in off-shore products. No estrogen mimetic activity was detected in fish feed, in contrast it was detected in offshore products and water. Product quality was found to be strictly correlated with the quality of the environment. Genetically modified organisms were detected in fish feed but no integration of genetic material in products occurred.

[The concept of the development of the state of chemical-analytical environmental monitoring].

PubMed

Rakhmanin, Iu A; Malysheva, A G

2013-01-01

Chemical and analytical monitoring of the quality of environment is based on the accounting of the trace amount of substances. Considering the multicomponent composition of the environment and running processes of transformation of substances in it, in determination of the danger of the exposure to the chemical pollution of environment on population health there is necessary evaluation based on the simultaneous account of complex of substances really contained in the environment and supplying from different sources. Therefore, in the analytical monitoring of the quality and safety of the environment there is a necessary conversion from the orientation, based on the investigation of specific target substances, to estimation of real complex of compounds.

Quality and Safety in Health Care, Part XIV: The External Environment and Research for Diagnostic Processes.

PubMed

Harolds, Jay A

2016-09-01

The work system in which diagnosis takes place is affected by the external environment, which includes requirements such as certification, accreditation, and regulations. How errors are reported, malpractice, and the system for payment are some other aspects of the external environment. Improving the external environment is expected to decrease errors in diagnosis. More research on improving the diagnostic process is needed.

Assuring fish safety and quality in international fish trade.

PubMed

Ababouch, Lahsen

2006-01-01

International trade in fishery commodities reached US 58.2 billion dollars in 2002, a 5% improvement relative to 2000 and a 45% increase over 1992 levels. Within this global trade, developing countries registered a net trade surplus of US 17.4 billion dollars in 2002 and accounted for almost 50% by value and 55% of fish exports by volume. This globalization of fish trade, coupled with technological developments in food production, handling, processing and distribution, and the increasing awareness and demand of consumers for safe and high quality food have put food safety and quality assurance high in public awareness and a priority for many governments. Consequently, many countries have tightened food safety controls, imposing additional costs and requirements on imports. As early as 1980, there was an international drive towards adopting preventative HACCP-based safety and quality systems. More recently, there has been a growing awareness of the importance of an integrated, multidisciplinary approach to food safety and quality throughout the entire food chain. Implementation of this approach requires an enabling policy and regulatory environment at national and international levels with clearly defined rules and standards, establishment of appropriate food control systems and programmes at national and local levels, and provision of appropriate training and capacity building. This paper discusses the international framework for fish safety and quality, with particular emphasis on the United Nation's Food and Agricultural Organization's (FAO) strategy to promote international harmonization and capacity building.

Creating Ideal Facilities.

ERIC Educational Resources Information Center

Kennedy, Mike

2002-01-01

Reviews ways that schools can provide effective indoor learning environments by paying attention to the following areas: daylighting, acoustics, space allocation, technology implementation, ergonomics, maintenance, indoor air quality, safety, restrooms, and roofing. (GR)

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Setting quality and safety priorities in a target-rich environment: an academic medical center's challenge.

PubMed

Mort, Elizabeth A; Demehin, Akinluwa A; Marple, Keith B; McCullough, Kathryn Y; Meyer, Gregg S

2013-08-01

Hospitals are continually challenged to provide safer and higher-quality patient care despite resource constraints. With an ever-increasing range of quality and safety targets at the national, state, and local levels, prioritization is crucial in effective institutional quality goal setting and resource allocation.Organizational goal-setting theory is a performance improvement methodology with strong results across many industries. The authors describe a structured goal-setting process they have established at Massachusetts General Hospital for setting annual institutional quality and safety goals. Begun in 2008, this process has been conducted on an annual basis. Quality and safety data are gathered from many sources, both internal and external to the hospital. These data are collated and classified, and multiple approaches are used to identify the most pressing quality issues facing the institution. The conclusions are subject to stringent internal review, and then the top quality goals of the institution are chosen. Specific tactical initiatives and executive owners are assigned to each goal, and metrics are selected to track performance. A reporting tool based on these tactics and metrics is used to deliver progress updates to senior hospital leadership.The hospital has experienced excellent results and strong organizational buy-in using this effective, low-cost, and replicable goal-setting process. It has led to improvements in structural, process, and outcomes aspects of quality.

Exploring staff perceptions on the role of physical environment in dementia care setting.

PubMed

Lee, Sook Y; Chaudhury, Habib; Hung, Lillian

2016-07-01

This study explored staff perceptions of the role of physical environment in dementia care facilities in affecting resident's behaviors and staff care practice. We conducted focus groups with staff (n = 15) in two purposely selected care facilities in Vancouver, Canada. Focus group participants included nurses, care aides, recreation staff, administrative staff, and family. Data analysis revealed two themes: (a) a supportive physical environment contributes positively to both quality of staff care interaction and residents' quality of life and (b) an unsupportive physical environment contributes negatively to residents' quality of life and thereby makes the work of staff more challenging. The staff participants collectively viewed that comfort, familiarity, and an organized space were important therapeutic resources for supporting the well-being of residents. Certain behaviors of residents were influenced by poor environmental factors, including stimulation overload, safety risks, wayfinding challenge, and rushed care This study demonstrates the complex interrelationships among the dementia care setting's physical environment, staff experiences, and residents' quality of life. © The Author(s) 2014.

Strategies for enhancing perioperative safety: promoting joy and meaning in the workforce.

PubMed

Morath, Julianne; Filipp, Rhonda; Cull, Michael

2014-10-01

Workforce safety is a precondition of patient safety, and safety from both physical and psychological harm in the workplace is the foundation for an environment in which joy and meaning can exist. Achieving joy and meaning in the workplace allows health care workers to continuously improve the care they provide. This requires an environment in which disrespectful and harmful behaviors are not tolerated or ignored. Health care leaders have an obligation to create workplace cultures that are characterized by respect, transparency, accountability, learning, and quality care. Evidence suggests, however, that health care settings are rife with disrespectful behavior, poor teamwork, and unsafe working conditions. Solutions for addressing workplace safety problems include defining core values, tasking leaders to act as role models, and committing to becoming a high-reliability organization. Copyright © 2014 AORN, Inc. Published by Elsevier Inc. All rights reserved.

[Organize quality assurance as in aviation; improve patient safety in Dutch hospitals].

PubMed

Haerkens, Marck H T M; Beekmann, Roland T A; van den Elzen, Guus J P; Lansbergen, Michael D I; Berlijn, Dick L

2009-01-01

Failing teamwork is a major cause of adverse events in hospitals in the Netherlands. Training team-skills can improve the safety standards in clinical heath care. An adapted version of Crew Resource Management (CRM) training is proving to be a usable format in the hospital environment. We emphasize that paying attention to the subject of safety has to start early in medical education in order to incorporate non-technical skills into the hospital culture.

The health care work environment and adverse health and safety consequences for nurses.

PubMed

Geiger-Brown, Jeanne; Lipscomb, Jane

2010-01-01

Nurses' working conditions are inextricably linked to the quality of care that is provided to patients and patients' safety. These same working conditions are associated with health and safety outcomes for nurses and other health care providers. This chapter describes aspects of the nursing work environment that have been linked to hazards and adverse exposures for nurses, as well as the most common health and safety outcomes of nursing work. We include studies from 2000 to the present by nurse researchers, studies of nurses as subjects, and studies of workers under similar working conditions that could translate to nurses' work environment. We explore a number of work organization factors including shift work and extended work hours, safety climate and culture, teamwork, and communication. We also describe environmental hazards, including chemical hazards (e.g., waste anesthetics, hazardous drugs, cleaning compounds) and airborne and bloodborne pathogen exposure. Nurses' health and safety outcomes include physical (e.g., musculoskeletal disorders, gastrointestinal, slips, trips and falls, physical assault) and psychosocial outcomes (e.g., burnout, work-family conflict). Finally, we present recommendations for future research to further protect nurses and all health care workers from a range of hazardous working conditions.

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Presence and Persistence of Salmonella in Water: The Impact on Microbial Quality of Water and Food Safety.

PubMed

Liu, Huanli; Whitehouse, Chris A; Li, Baoguang

2018-01-01

Salmonella ranks high among the pathogens causing foodborne disease outbreaks. According to the Centers for Disease Control and Prevention, Salmonella contributed to about 53.4% of all foodborne disease outbreaks from 2006 to 2017, and approximately 32.7% of these foodborne Salmonella outbreaks were associated with consumption of produce. Trace-back investigations have suggested that irrigation water may be a source of Salmonella contamination of produce and a vehicle for transmission. Presence and persistence of Salmonella have been reported in surface waters such as rivers, lakes, and ponds, while ground water in general offers better microbial quality for irrigation. To date, culture methods are still the gold standard for detection, isolation and identification of Salmonella in foods and water. In addition to culture, other methods for the detection of Salmonella in water include most probable number, immunoassay, and PCR. The U.S. Food and Drug Administration (FDA) issued the Produce Safety Rule (PSR) in January 2013 based on the Food Safety Modernization Act (FSMA), which calls for more efforts toward enhancing and improving approaches for the prevention of foodborne outbreaks. In the PSR, agricultural water is defined as water used for in a way that is intended to, or likely to, contact covered produce, such as spray, wash, or irrigation. In summary, Salmonella is frequently present in surface water, an important source of water for irrigation. An increasing evidence indicates irrigation water as a source (or a vehicle) for transmission of Salmonella . This pathogen can survive in aquatic environments by a number of mechanisms, including entry into the viable but nonculturable (VBNC) state and/or residing within free-living protozoa. As such, assurance of microbial quality of irrigation water is critical to curtail the produce-related foodborne outbreaks and thus enhance the food safety. In this review, we will discuss the presence and persistence of Salmonella in water and the mechanisms Salmonella uses to persist in the aquatic environment, particularly irrigation water, to better understand the impact on the microbial quality of water and food safety due to the presence of Salmonella in the water environment.

Presence and Persistence of Salmonella in Water: The Impact on Microbial Quality of Water and Food Safety

PubMed Central

Liu, Huanli; Whitehouse, Chris A.; Li, Baoguang

2018-01-01

Salmonella ranks high among the pathogens causing foodborne disease outbreaks. According to the Centers for Disease Control and Prevention, Salmonella contributed to about 53.4% of all foodborne disease outbreaks from 2006 to 2017, and approximately 32.7% of these foodborne Salmonella outbreaks were associated with consumption of produce. Trace-back investigations have suggested that irrigation water may be a source of Salmonella contamination of produce and a vehicle for transmission. Presence and persistence of Salmonella have been reported in surface waters such as rivers, lakes, and ponds, while ground water in general offers better microbial quality for irrigation. To date, culture methods are still the gold standard for detection, isolation and identification of Salmonella in foods and water. In addition to culture, other methods for the detection of Salmonella in water include most probable number, immunoassay, and PCR. The U.S. Food and Drug Administration (FDA) issued the Produce Safety Rule (PSR) in January 2013 based on the Food Safety Modernization Act (FSMA), which calls for more efforts toward enhancing and improving approaches for the prevention of foodborne outbreaks. In the PSR, agricultural water is defined as water used for in a way that is intended to, or likely to, contact covered produce, such as spray, wash, or irrigation. In summary, Salmonella is frequently present in surface water, an important source of water for irrigation. An increasing evidence indicates irrigation water as a source (or a vehicle) for transmission of Salmonella. This pathogen can survive in aquatic environments by a number of mechanisms, including entry into the viable but nonculturable (VBNC) state and/or residing within free-living protozoa. As such, assurance of microbial quality of irrigation water is critical to curtail the produce-related foodborne outbreaks and thus enhance the food safety. In this review, we will discuss the presence and persistence of Salmonella in water and the mechanisms Salmonella uses to persist in the aquatic environment, particularly irrigation water, to better understand the impact on the microbial quality of water and food safety due to the presence of Salmonella in the water environment. PMID:29900166

Perception of the quality of care, work environment and sleep characteristics of nurses working in the National Health System.

PubMed

Moreno-Casbas, María Teresa; Alonso-Poncelas, Emma; Gómez-García, Teresa; Martínez-Madrid, María José; Escobar-Aguilar, Gema

2018-03-19

To describe nurses' perception in relation to the quality of care and their work environment, as well as to describe their quality of sleep. To analyze the relationship between ward and work shift with nurses' perception of their work environment, sleep quality and day time drowsiness. A multicentre, observational and descriptive study carried out between 2012-2014 in seven hospitals of the Spanish National Health System. Work environment, work satisfaction, sleep quality and quality of patient care were evaluated through validated tools. 635 registered nurses participated in the study. Eighty-three point seven percent perceived the quality of cares as good/excellent, and 55.1% rated the work environment of their hospital as good/excellent. PES-NWI classified 39% of hospitals as unfavourable and 20% as favourable. Fifteen point four percent of the nurses had a high level of burnout and 58.3% had low burnout. Sleep quality was 6.38 for nurses working on day shifts, 6.78 for the rotational shifts and 7.93 for night shifts. Significant differences were found between subjective sleep quality score, sleep duration, sleep disturbances and daytime dysfunction. In the provision of quality care services, there is a multitude of related factors such as shift, ward, satisfaction, and nurses' perceptions of patient safety and sleep quality. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

Effects of Individual Nurse and Hospital Characteristics on Patient Adverse Events and Quality of Care: A Multilevel Analysis.

PubMed

Lee, Seung Eun; Vincent, Catherine; Dahinten, V Susan; Scott, Linda D; Park, Chang Gi; Dunn Lopez, Karen

2018-06-14

This study aimed to investigate effects of individual nurse and hospital characteristics on patient adverse events and quality of care using a multilevel approach. This is a secondary analysis of a combination of nurse survey data (N = 1,053 nurses) and facility data (N = 63 hospitals) in Canada. Multilevel ordinal logistic regression was employed to examine effects of individual nurse and hospital characteristics on patient adverse events. Multilevel linear regressions were used to investigate effects of individual nurse and hospital characteristics on quality of care. Organizational safety culture was associated with patient adverse events and quality of care. Controlling for effects of nurse and hospital characteristics, nurses in hospitals with a stronger safety culture were 64% less likely to report administration of wrong medication, time, or dose; 58% less likely to report patient falls with injury; and 60% less likely to report urinary tract infections; and were more likely to report higher levels of quality of care. Additionally, the effects of individual-level baccalaureate education and years of experience on quality of care differed across hospitals, and hospital-level nurse education interacted with individual-level baccalaureate education. This study makes significant contributions to existing knowledge regarding the positive effect of organizational safety culture on patient adverse events and quality of care. Healthcare organizations should strive to improve their safety culture by creating environments where healthcare providers trust each other, work collaboratively, and share accountability for patient safety and care quality. © 2018 Sigma Theta Tau International.

Classification of antecedents towards safety use of health information technology: A systematic review.

PubMed

Salahuddin, Lizawati; Ismail, Zuraini

2015-11-01

This paper provides a systematic review of safety use of health information technology (IT). The first objective is to identify the antecedents towards safety use of health IT by conducting systematic literature review (SLR). The second objective is to classify the identified antecedents based on the work system in Systems Engineering Initiative for Patient Safety (SEIPS) model and an extension of DeLone and McLean (D&M) information system (IS) success model. A systematic literature review (SLR) was conducted from peer-reviewed scholarly publications between January 2000 and July 2014. SLR was carried out and reported based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. The related articles were identified by searching the articles published in Science Direct, Medline, EMBASE, and CINAHL databases. Data extracted from the resultant studies included are to be analysed based on the work system in Systems Engineering Initiative for Patient Safety (SEIPS) model, and also from the extended DeLone and McLean (D&M) information system (IS) success model. 55 articles delineated to be antecedents that influenced the safety use of health IT were included for review. Antecedents were identified and then classified into five key categories. The categories are (1) person, (2) technology, (3) tasks, (4) organization, and (5) environment. Specifically, person is attributed by competence while technology is associated to system quality, information quality, and service quality. Tasks are attributed by task-related stressor. Organisation is related to training, organisation resources, and teamwork. Lastly, environment is attributed by physical layout, and noise. This review provides evidence that the antecedents for safety use of health IT originated from both social and technical aspects. However, inappropriate health IT usage potentially increases the incidence of errors and produces new safety risks. The review cautions future implementation and adoption of health IT to carefully consider the complex interactions between social and technical elements propound in healthcare settings. Copyright © 2015. Published by Elsevier Ireland Ltd.

49 CFR 520.2 - Policy.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 6 2012-10-01 2012-10-01 false Policy. 520.2 Section 520.2 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION, DEPARTMENT... affect the quality of the human environment. ...

49 CFR 520.2 - Policy.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 6 2014-10-01 2014-10-01 false Policy. 520.2 Section 520.2 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION, DEPARTMENT... affect the quality of the human environment. ...

49 CFR 520.2 - Policy.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 6 2011-10-01 2011-10-01 false Policy. 520.2 Section 520.2 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION, DEPARTMENT... affect the quality of the human environment. ...

49 CFR 520.2 - Policy.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 6 2013-10-01 2013-10-01 false Policy. 520.2 Section 520.2 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION, DEPARTMENT... affect the quality of the human environment. ...

49 CFR 520.2 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 6 2010-10-01 2010-10-01 false Policy. 520.2 Section 520.2 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION, DEPARTMENT... affect the quality of the human environment. ...

Patient safety incidents in hospice care: observations from interdisciplinary case conferences.

PubMed

Oliver, Debra Parker; Demiris, George; Wittenberg-Lyles, Elaine; Gage, Ashley; Dewsnap-Dreisinger, Mariah L; Luetkemeyer, Jamie

2013-12-01

In the home hospice environment, issues arise every day presenting challenges to the safety, care, and quality of the dying experience. The literature pertaining to the safety challenges in this environment is limited. The study explored two research questions; 1) What types of patient safety incidents occur in the home hospice setting? 2) How many of these incidents are recognized by the hospice staff and/or the patient or caregiver as a patient safety incident? Video-recordings of hospice interdisciplinary team case conferences were reviewed and coded for patient safety incidents. Patient safety incidents were defined as any event or circumstance that could have resulted or did result in unnecessary harm to the patient or caregiver, or that could have resulted or did result in a negative impact on the quality of the dying experience for the patient. Codes for categories of patient safety incidents were based on the International Classification for Patient Safety. The setting for the study included two rural hospice programs in one Midwestern state in the United States. One hospice team had two separately functioning teams, the second hospice had three teams. 54 video-recordings were reviewed and coded. Patient safety incidents were identified that involved issues in clinical process, medications, falls, family or caregiving, procedural problems, documentation, psychosocial issues, administrative challenges and accidents. This study distinguishes categories of patient safety events that occur in home hospice care. Although the scope and definition of potential patient safety incidents in hospice is unique, the events observed in this study are similar to those observed with in other settings. This study identifies an operating definition and a potential classification for further research on patient safety incidents in hospice. Further research and consensus building of the definition of patient safety incidents and patient safety incidents in this setting is recommended.

A cross-sectional study to identify organisational processes associated with nurse-reported quality and patient safety

PubMed Central

Tvedt, Christine; Sjetne, Ingeborg Strømseng; Helgeland, Jon; Bukholm, Geir

2012-01-01

Objectives The purpose of this study was to identify organisational processes and structures that are associated with nurse-reported patient safety and quality of nursing. Design This is an observational cross-sectional study using survey methods. Setting Respondents from 31 Norwegian hospitals with more than 85 beds were included in the survey. Participants All registered nurses working in direct patient care in a position of 20% or more were invited to answer the survey. In this study, 3618 nurses from surgical and medical wards responded (response rate 58.9). Nurses' practice environment was defined as organisational processes and measured by the Nursing Work Index Revised and items from Hospital Survey on Patient Safety Culture. Outcome measures Nurses' assessments of patient safety, quality of nursing, confidence in how their patients manage after discharge and frequency of adverse events were used as outcome measures. Results Quality system, nurse–physician relation, patient safety management and staff adequacy were process measures associated with nurse-reported work-related and patient-related outcomes, but we found no associations with nurse participation, education and career and ward leadership. Most organisational structures were non-significant in the multilevel model except for nurses’ affiliations to medical department and hospital type. Conclusions Organisational structures may have minor impact on how nurses perceive work-related and patient-related outcomes, but the findings in this study indicate that there is a considerable potential to address organisational design in improvement of patient safety and quality of care. PMID:23263021

Associations of neighborhood characteristics with sleep timing and quality: the Multi-Ethnic Study Of Atherosclerosis.

PubMed

Desantis, Amy S; Diez Roux, Ana V; Moore, Kari; Baron, Kelly G; Mujahid, Mahasin S; Nieto, F Javier

2013-10-01

To investigate the associations of specific neighborhood features (disorder, safety, social cohesion, physical environment, and socioeconomic status) with sleep duration and quality. Cross-sectional. One wave of a population-based study (Multi-Ethnic Study of Atherosclerosis). Community-dwelling participants in New York, NY and Los Angeles, CA. There were 1,406 participants (636 males, 770 females). NA. Sleep was assessed using reported hours of sleep, the Epworth Sleepiness Scale, and insomnia symptoms. Neighborhood characteristics were assessed via questionnaires administered to neighbors of study participants and were aggregated to the neighborhood (census tract) level using empirical Bayes estimation. An adverse social environment (characterized by high disorder, and low safety and social cohesion) was associated with shorter sleep duration after adjustment for the physical environment, neighborhood and individual-level socioeconomic status (SES), and other short sleep risk factors (mean difference per standard deviation increase in summary social environment scale 0.24 h 95% confidence interval 0.08, 0.43). Adverse neighborhood social and physical environments, and neighborhood SES were associated with greater sleepiness, but associations with physical environments were no longer statistically significant after adjustment for sociodemographic characteristics. Neighborhood SES was a weaker and less consistent predictor of specific measures of neighborhood social and physical environments. Neighborhood characteristics were not associated with insomnia. Shortened sleep related to adverse social environments represents one potential pathway through which neighborhoods may influence health.

Code of Conduct: Safety, Discipline, and School Climate. Quality Counts, 2013

ERIC Educational Resources Information Center

Education Week, 2013

2013-01-01

This 17th edition of "Education Week's" annual "Quality Counts" report takes aim at an issue freighted with emotional as well as policy implications: the impact of a school's social and disciplinary environment on students' ability to learn and on the teachers and administrators tasked with guiding them. National initiatives to improve schools…

The role of the physical environment in crossing the quality chasm.

PubMed

Henriksen, Kerm; Isaacson, Sandi; Sadler, Blair L; Zimring, Craig M

2007-11-01

Evidence-based design findings are available to help inform hospital decision makers of opportunities for ensuring that quality and safety are designed into new and refurbished facilities. The Institute of Medicine's six quality aims of patient centeredness, safety, effectiveness, efficiency, timeliness, and equity provide an organizing framework for introducing a representative portion of the evidence. Design improvements include single-bed and variable-acuity rooms; electronic access to medical records; greater accommodation for families and visitors; handrails to prevent patient falls; standardization (room layout, equipment, and supplies for improved efficiencies); improved work process flow to reduce delays and wait times; and better assessment of changing demographics, disease conditions, and community needs for appropriately targeted health care services. A recent analysis of the business case suggests that a slight, one-time incremental cost for ensuring safety and quality would be paid back in two to three years in the form of operational savings and increased revenues. Hospitals leaders anticipating new construction projects should take advantage of evidence-based design findings that have the potential of raising the quality of acute care for decades to come.

Impact of hospital security programmes and workplace aggression on nurse perceptions of safety.

PubMed

Blando, James D; O'Hagan, Emily; Casteel, Carri; Nocera, Mary-Alice; Peek-Asa, Corinne

2013-04-01

To assess how nurses' perception of their safety and risk of violence was affected by their work environment and whether this perception correlated with their actual risk. The work environment has an impact on nurses' perception of their risk of violence and this perception affects worker productivity, quality, employee retention, worker satisfaction and their actual safety. A cross-sectional survey was conducted in person of 314 emergency department nurses and 143 psychiatric nurses, and assault data was collected from injury logs. This study found that nurses in the emergency and psychiatric units differed in their perception of violence and safety. The workplace elements that led to a perception of lower risk of violence were not correlated with a lower rate of injury from violent acts. The nurses' beliefs about the adequacy of security equipment, security guards and the frequency of verbal abuse were strongly correlated with perceived safety. Several factors that influence nurses' perception of their risk of violence are not well correlated with their actual risk. Managers must address workplace elements that affect nurse perceptions because this has an impact on quality and employee retention. They must also address factors that have an impact on the actual risk of violence because this study showed, for the first time, that these may differ from perceptions. © 2012 Blackwell Publishing Ltd.

Factors Related to Healthcare Service Quality in Long-term Care Hospitals in South Korea: A Mixed-methods Study.

PubMed

Sohn, Minsung; Choi, Mankyu

2017-10-01

The environment of long-term care hospitals (LTCHs) is critical to the management of the quality of their services and to patient safety, as highlighted by international studies. However, there is a lack of evidence on this topic in South Korea. This study aimed to examine the factors affecting healthcare quality in LTCHs and to explore the effectiveness of their quality management. This study used a mixed methods approach with quantitative data collected in a national survey and qualitative data from semi-structured interviews with practice-based managers. The samples included 725 nationally representative LTCHs in South Korea for the quantitative analysis and 15 administrators for the in-depth interviews. A higher installation rate of patient-safety and hygiene-related facilities and staff with longer-tenures, especially nurses, were more likely to have better healthcare quality and education for both employees and patients. The need for patient-safety- and hygiene-related facilities in LTCHs that serve older adults reflects their vulnerability to certain adverse events (e.g., infections). Consistent and skillful nursing care to improve the quality of LTCHs can be achieved by developing relevant educational programs for staff and patients, thereby strengthening the relationships between them.

Making patient safety the focus: crisis resource management in the undergraduate curriculum.

PubMed

Flanagan, Brendan; Nestel, Debra; Joseph, Michele

2004-01-01

This paper examines the role of high fidelity simulation and crisis resource management in bridging the gap between theory and practice. Patient safety is fundamental to healthcare professional practice and is a common goal for healthcare providers. It provides a focus to motivate practitioners. Patient safety issues are not a priority in undergraduate curricula. Raising the profile at this level is crucial to improving the safety and quality of healthcare delivery. This paper explores the role of simulation in providing a realistic, safe environment for participants with different levels of experience to manage evolving crises in the context of their work environment. The Southern Health Simulation and Skills Centre uses a patient safety focus in delivering a specialised educational programme adapted from aviation to healthcare. The programme, crisis resource management, enables participants to consolidate knowledge, attitudes and skills to achieve a deeper understanding of how their performance impacts on patient safety and the quality of healthcare provided. Self-reported written evaluation data was collected from participants of three different courses at Southern Health. Participants consistently report that these courses offer unique learning experiences that address aspects of workplace learning in ways that have not previously been possible. A video-assisted reflective process powerfully reinforces learning. Crisis resource management courses demonstrate the value of simulation in bridging the gap between 'knowing' and 'doing' and keeping the focus on patient safety. Recommendations are made for ways in which the core elements of crisis resource management philosophy can influence the conceptualization of a new medical curriculum.

Safe use of vaccines and vaccine compliance with food safety requirements.

PubMed

Grein, K; Papadopoulos, O; Tollis, M

2007-08-01

Advanced technologies and regulatory regimes have contributed to the availability of veterinary vaccines that have high quality and favourable safety profiles in terms of potential risks posed to the target animals, the persons who come into contact with the vaccine, the consumers of food derived from vaccinated animals and the environment. The authorisation process requires that a range of safety studies are provided to evaluate the products. The design and production of vaccines, and their safe use, are primarily assessed by using data gathered from extensive pre-marketing studies performed on target animals and specific quality tests. The current post-marketing safeguards include good manufacturing practices, batch safety testing, inspections and pharmacovigilance. In addition to hazard identification, a full benefit/risk evaluation needs to be undertaken. The outcome of that evaluation will determine options for risk management and affect regulatory decisions on the safety of the vaccine; options might, for example, include special warnings on package inserts and labels.

No Effect of Ambient Odor on the Affective Appraisal of a Desktop Virtual Environment with Signs of Disorder

PubMed Central

Toet, Alexander; van Schaik, Martin; Theunissen, Nicolet C. M.

2013-01-01

Background Desktop virtual environments (VEs) are increasingly deployed to study the effects of environmental qualities and interventions on human behavior and safety related concerns in built environments. For these applications it is essential that users appraise the affective qualities of the VE similar to those of its real world counterpart. Previous studies have shown that factors like simulated lighting, sound and dynamic elements all contribute to the affective appraisal of a desktop VE. Since ambient odor is known to affect the affective appraisal of real environments, and has been shown to increase the sense of presence in immersive VEs, it may also be an effective tool to tune the affective appraisal of desktop VEs. This study investigated if exposure to ambient odor can modulate the affective appraisal of a desktop VE with signs of public disorder. Method Participants explored a desktop VE representing a suburban neighborhood with signs of public disorder (neglect, vandalism and crime), while being exposed to either room air or subliminal levels of unpleasant (tar) or pleasant (cut grass) ambient odor. Whenever they encountered signs of disorder they reported their safety related concerns and associated affective feelings. Results Signs of crime in the desktop VE were associated with negative affective feelings and concerns for personal safety and personal property. However, there was no significant difference between reported safety related concerns and affective connotations in the control (no-odor) and in each of the two ambient odor conditions. Conclusion Ambient odor did not affect safety related concerns and affective connotations associated with signs of disorder in the desktop VE. Thus, semantic congruency between ambient odor and a desktop VE may not be sufficient to influence its affective appraisal, and a more realistic simulation in which simulated objects appear to emit scents may be required to achieve this goal. PMID:24250810

No effect of ambient odor on the affective appraisal of a desktop virtual environment with signs of disorder.

PubMed

Toet, Alexander; van Schaik, Martin; Theunissen, Nicolet C M

2013-01-01

Desktop virtual environments (VEs) are increasingly deployed to study the effects of environmental qualities and interventions on human behavior and safety related concerns in built environments. For these applications it is essential that users appraise the affective qualities of the VE similar to those of its real world counterpart. Previous studies have shown that factors like simulated lighting, sound and dynamic elements all contribute to the affective appraisal of a desktop VE. Since ambient odor is known to affect the affective appraisal of real environments, and has been shown to increase the sense of presence in immersive VEs, it may also be an effective tool to tune the affective appraisal of desktop VEs. This study investigated if exposure to ambient odor can modulate the affective appraisal of a desktop VE with signs of public disorder. Participants explored a desktop VE representing a suburban neighborhood with signs of public disorder (neglect, vandalism and crime), while being exposed to either room air or subliminal levels of unpleasant (tar) or pleasant (cut grass) ambient odor. Whenever they encountered signs of disorder they reported their safety related concerns and associated affective feelings. Signs of crime in the desktop VE were associated with negative affective feelings and concerns for personal safety and personal property. However, there was no significant difference between reported safety related concerns and affective connotations in the control (no-odor) and in each of the two ambient odor conditions. Ambient odor did not affect safety related concerns and affective connotations associated with signs of disorder in the desktop VE. Thus, semantic congruency between ambient odor and a desktop VE may not be sufficient to influence its affective appraisal, and a more realistic simulation in which simulated objects appear to emit scents may be required to achieve this goal.

The Impact of System Factors on Quality and Safety in Arterial Surgery: A Systematic Review.

PubMed

Lear, R; Godfrey, A D; Riga, C; Norton, C; Vincent, C; Bicknell, C D

2017-07-01

A systems approach to patient safety proposes that a wide range of factors contribute to surgical outcome, yet the impact of team, work environment, and organisational factors, is not fully understood in arterial surgery. The aim of this systematic review is to summarize and discuss what is already known about the impact of system factors on quality and safety in arterial surgery. A systematic review of original research papers in English using MEDLINE, Embase, PsycINFO, and Cochrane databases, was performed according to PRISMA guidelines. Independent reviewers selected papers according to strict inclusion and exclusion criteria, and using predefined data fields, extracted relevant data on team, work environment, and organisational factors, and measures of quality and/or safety, in arterial procedures. Twelve papers met the selection criteria. Study endpoints were not consistent between papers, and most failed to report their clinical significance. A variety of tools were used to measure team skills in five papers; only one paper measured the relationship between team factors and patient outcomes. Two papers reported that equipment failures were common and had a significant impact on operating room efficiency. The influence of hospital characteristics on failure-to-rescue rates was tested in one large study, although their conclusions were limited to the American Medicare population. Five papers implemented changes in the patient pathway, but most studies failed to account for potential confounding variables. A small number of heterogenous studies have evaluated the relationship between system factors and quality or safety in arterial surgery. There is some evidence of an association between system factors and patient outcomes, but there is more work to be done to fully understand this relationship. Future research would benefit from consistency in definitions, the use of validated assessment tools, measurement of clinically relevant endpoints, and adherence to national reporting guidelines. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

The perception of the patient safety climate by professionals of the emergency department.

PubMed

Rigobello, Mayara Carvalho Godinho; Carvalho, Rhanna Emanuela Fontenele Lima de; Guerreiro, Juliana Magalhães; Motta, Ana Paula Gobbo; Atila, Elizabeth; Gimenes, Fernanda Raphael Escobar

2017-07-01

The aim of this study was to assess the patient safety climate from the perspective of healthcare professionals working in the emergency department of a hospital in Brazil. Emergency departments are complex and dynamic environments. They are prone to adverse events that compromise the quality of care provided and reveal the importance of patient safety culture and climate. This was a quantitative, descriptive, cross-sectional study. The Safety Attitudes Questionnaire (SAQ) - Short Form 2006 was used for data collection, validated and adapted into Portuguese. The study sample consisted of 125 participants. Most of the participants were female (57.6%) and had worked in emergency department for more than 10years (56.8%). Sixty-two participants (49.6%) were nursing professionals. The participants demonstrated satisfaction with their jobs and dissatisfaction with the actions of management with regard to safety issues. Participants' perceptions about the patient safety climate were found to be negative. Knowledge of professionals' perceptions of patient safety climate in the context of emergency care helps with assessments of the safety culture, contributes to improvement of health care, reduces adverse events, and can focus efforts to improve the quality of care provided to patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

ADSA Foundation Scholar Award: Trends in culture-independent methods for assessing dairy food quality and safety: emerging metagenomic tools.

PubMed

Yeung, Marie

2012-12-01

Enhancing the quality and safety of dairy food is critical to maintaining the competitiveness of dairy products in the food and beverage market and in reinforcing consumer confidence in the dairy industry. Raw milk quality has a significant effect on finished product quality. Several microbial groups found in raw milk have been shown to adversely affect the shelf life of pasteurized milk. Current microbiological criteria used to define milk quality are based primarily on culture-dependent methods, some of which are perceived to lack the desired sensitivity and specificity. To supplement traditional methods, culture-independent methods are increasingly being used to identify specific species or microbial groups, and to detect indicator genes or proteins in raw milk or dairy products. Some molecular subtyping techniques have been developed to track the transmission of microbes in dairy environments. The burgeoning "-omics" technologies offer new and exciting opportunities to enhance our understanding of food quality and safety in relation to microbes. Metagenomics has the potential to characterize microbial diversity, detect nonculturable microbes, and identify unique sequences or other factors associated with dairy product quality and safety. In this review, fluid milk will be used as the primary example to examine the adequacy and validity of conventional methods, the current trend of culture-independent methods, and the potential applications of metagenomics in dairy food research. Copyright © 2012 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

77 FR 21776 - Announcement of Requirements and Registration for “Reporting Patient Safety Events Challenge”

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-11

... Healthcare Research and Quality (AHRQ) create a safe environment for health care providers to collect... the scope of their employment. (5) Shall not be an HHS employee working on their applications or...

Staff Turnover in Assertive Community Treatment (Act) Teams: The Role of Team Climate.

PubMed

Zhu, Xi; Wholey, Douglas R; Cain, Cindy; Natafgi, Nabil

2017-03-01

Staff turnover in Assertive Community Treatment (ACT) teams can result in interrupted services and diminished support for clients. This paper examines the effect of team climate, defined as team members' shared perceptions of their work environment, on turnover and individual outcomes that mediate the climate-turnover relationship. We focus on two climate dimensions: safety and quality climate and constructive conflict climate. Using survey data collected from 26 ACT teams, our analyses highlight the importance of safety and quality climate in reducing turnover, and job satisfaction as the main mediator linking team climate to turnover. The findings offer practical implications for team management.

Patient safety in anesthesia: learning from the culture of high-reliability organizations.

PubMed

Wright, Suzanne M

2015-03-01

There has been an increased awareness of and interest in patient safety and improved outcomes, as well as a growing body of evidence substantiating medical error as a leading cause of death and injury in the United States. According to The Joint Commission, US hospitals demonstrate improvements in health care quality and patient safety. Although this progress is encouraging, much room for improvement remains. High-reliability organizations, industries that deliver reliable performances in the face of complex working environments, can serve as models of safety for our health care system until plausible explanations for patient harm are better understood. Copyright © 2015 Elsevier Inc. All rights reserved.

Effects of a performance and quality improvement intervention on the work environment in HIV-related care: a quasi-experimental evaluation in Zambia.

PubMed

Bazant, Eva; Sarkar, Supriya; Banda, Joseph; Kanjipite, Webby; Reinhardt, Stephanie; Shasulwe, Hildah; Mulilo, Joyce Monica Chongo; Kim, Young Mi

2014-12-20

Human resource shortages and reforms in HIV-related care make it challenging for frontline health care providers in southern Africa to deliver high-quality services. At health facilities of the Zambian Defence Forces, a performance and quality improvement approach was implemented to improve HIV-related care and was evaluated in 2010/2011. Changes in providers' work environment and perceived quality of HIV-related care were assessed to complement data of provider performance. The intervention involved on-site training, supportive supervision, and action planning focusing on detailed service delivery standards. The quasi-experimental evaluation collected pre- and post-intervention data from eight intervention and comparison facilities matched on defence force branch and baseline client volume. Overall, 101 providers responded to a 24-item questionnaire on the work environment, covering topics of drugs, supplies, and equipment; training, feedback, and supervision; compensation; staffing; safety; fulfilment; and HIV services quality. In bivariate analysis and multivariate analyses, we assessed changes within each study group and between the two groups. In the bivariate analysis, the intervention group providers reported improvements in the work environment on adequacy of equipment, feeling safe from harm, confidence in clinical skills, and reduced isolation, while the comparison group reported worsening of the work environment on supplies, training, safety, and departmental morale.In the multivariate analysis, the intervention group's improvement and the comparison group's decline were significant on perceived adequacy of drugs, supplies, and equipment; constructive feedback received from supervisor and co-workers; and feeling safe from physical harm (all P <0.01, except P <0.04 for equipment). Further, the item "provider lacks confidence in some clinical skills" declined in the intervention group but increased in the comparison group (P = -0.005). In multivariate analysis, changes in perceived quality of HIV care did not differ between study groups. Provider perceptions were congruent with observations of preparing drugs, supplies, equipment, and in service delivery of prevention of mother-to-child transmission of HIV and antiretroviral therapy follow-up care. The performance and quality improvement intervention implemented at Zambian Defence Forces' health facilities was associated with improvements in providers' perceptions of work environment consistent with the intervention's focus on commodities, skills acquisition, and receipt of constructive feedback.

The Impact of eHealth on the Quality and Safety of Healthcare

NASA Astrophysics Data System (ADS)

Majeed, Azeem; Black, Ashly; Car, Josip; Anandan, Chantelle; Cresswell, Kathrin; McKinstry, Brian; Pagliari, Claudia; Procter, Rob; Sheikh, Aziz

There is considerable interest in using information technology (IT) to enhance the quality and safety of healthcare. We undertook a systematic literature review to assess the impact of eHealth applications on the quality and safety of healthcare. We retrieved 46,349 potentially relevant publications, from which we selected 67 relevant systematic reviews for inclusion. The literature was found to be poorly collated and of variable quality in its methodology, reporting and utility. We categorised eHealth applications into three main areas: i). storing, managing and transmission of data; ii). supporting clinical decision-making; and iii). facilitating care from a distance. We found that relative to the potential benefits noted within the literature, little empirical evidence exists in support of these applications. Of the few studies revealing the clearest evidence of benefits, many are from academic clinical centres where developers of new applications have also been directly associated with their evaluation. It is therefore unclear how effective these applications would be if deployed outside the environment in which they were developed. Our review of the impact of eHealth applications on quality and safety of healthcare demonstrated a vast gap between the postulated and empirically demonstrated benefits. In addition, there is a lack of robust research on risks and costs. Consequently, the cost-effectiveness of these interventions has yet to be demonstrated.

Quality and Safety Implications of Emergency Department Information Systems

PubMed Central

Farley, Heather L.; Baumlin, Kevin M.; Hamedani, Azita G.; Cheung, Dickson S.; Edwards, Michael R.; Fuller, Drew C.; Genes, Nicholas; Griffey, Richard T.; Kelly, John J.; McClay, James C.; Nielson, Jeff; Phelan, Michael P.; Shapiro, Jason S.; Stone-Griffith, Suzanne; Pines, Jesse M.

2013-01-01

The Health Information Technology for Economic and Clinical Health Act of 2009 and the Centers for Medicare & Medicaid Services “meaningful use” incentive programs, in tandem with the boundless additional requirements for detailed reporting of quality metrics, have galvanized hospital efforts to implement hospital-based electronic health records. As such, emergency department information systems (EDISs) are an important and unique component of most hospitals’ electronic health records. System functionality varies greatly and affects physician decisionmaking, clinician workflow, communication, and, ultimately, the overall quality of care and patient safety. This article is a joint effort by members of the Quality Improvement and Patient Safety Section and the Informatics Section of the American College of Emergency Physicians. The aim of this effort is to examine the benefits and potential threats to quality and patient safety that could result from the choice of a particular EDIS, its implementation and optimization, and the hospital’s or physician group’s approach to continuous improvement of the EDIS. Specifically, we explored the following areas of potential EDIS safety concerns: communication failure, wrong order–wrong patient errors, poor data display, and alert fatigue. Case studies are presented that illustrate the potential harm that could befall patients from an inferior EDIS product or suboptimal execution of such a product in the clinical environment. The authors have developed 7 recommendations to improve patient safety with respect to the deployment of EDISs. These include ensuring that emergency providers actively participate in selection of the EDIS product, in the design of processes related to EDIS implementation and optimization, and in the monitoring of the system’s ongoing success or failure. Our recommendations apply to emergency departments using any type of EDIS: custom-developed systems, best-of-breed vendor systems, or enterprise systems. PMID:23796627

Linking Nurses' Clinical Leadership to Patient Care Quality: The Role of Transformational Leadership and Workplace Empowerment.

PubMed

Boamah, Sheila

2018-03-01

Background While improving patient safety requires strong nursing leadership, there has been little empirical research that has examined the mechanisms by which leadership influences patient safety outcomes. Aim To test a model examining relationships among transformational leadership, structural empowerment, staff nurse clinical leadership, and nurse-assessed adverse patient outcomes. Methods A cross-sectional survey was conducted with a randomly selected sample of 378 registered nurses working in direct patient care in acute care hospitals across Ontario, Canada. Structural equation modeling was used to test the hypothesized model. Results The model had an acceptable fit, and all paths were significant. Transformational leadership was significantly associated with decreased adverse patient outcomes through structural empowerment and staff nurse clinical leadership. Discussion This study highlights the importance of transformational leadership in creating empowering practice environments that foster high-quality care. The findings indicate that a more complete understanding of what drives desired patient outcomes warrants the need to focus on how to empower nurses and foster clinical leadership practices at the point of care. Conclusion In planning safety strategies, managers must demonstrate transformational leadership behaviors in order to modify the work environment to create better defenses for averting adverse events.

Factors Related to Healthcare Service Quality in Long-term Care Hospitals in South Korea: A Mixed-methods Study

PubMed Central

Sohn, Minsung; Choi, Mankyu

2017-01-01

Objectives The environment of long-term care hospitals (LTCHs) is critical to the management of the quality of their services and to patient safety, as highlighted by international studies. However, there is a lack of evidence on this topic in South Korea. This study aimed to examine the factors affecting healthcare quality in LTCHs and to explore the effectiveness of their quality management. Methods This study used a mixed methods approach with quantitative data collected in a national survey and qualitative data from semi-structured interviews with practice-based managers. The samples included 725 nationally representative LTCHs in South Korea for the quantitative analysis and 15 administrators for the in-depth interviews. Results A higher installation rate of patient-safety and hygiene-related facilities and staff with longer-tenures, especially nurses, were more likely to have better healthcare quality and education for both employees and patients. Conclusion The need for patient-safety- and hygiene-related facilities in LTCHs that serve older adults reflects their vulnerability to certain adverse events (e.g., infections). Consistent and skillful nursing care to improve the quality of LTCHs can be achieved by developing relevant educational programs for staff and patients, thereby strengthening the relationships between them. PMID:29164045

Liquid and gaseous oxygen safety review

NASA Technical Reports Server (NTRS)

Lapin, A.

1973-01-01

Materials used in oxygen systems and allowable oxygen environments are specified for each material. Design criteria, cleaning procedures and quality control methods are covered. Guidelines for protection against hazards involved with production, transportation, storage and use of oxygen are presented. Study also lists extensive references.

Work environment and health promotion needs among personnel in the faculty of medicine, Thammasat university.

PubMed

Buranatrevedh, Surasak

2013-04-01

Work environment and health promotion needs are important factors for quality of life of workers. Study occupational health and safety hazards and control measures as well as health status and health promotion needs among personnel in Faculty of Medicine, Thammasat University. This was a cross sectional study. Questionnaires were designed to collect demographic data, health status, health promotion needs, occupational health and safety hazards, and job demand/control data. Questionnaires were sent out to 181 personnel and 145 were returned filled-out (80.1%). Among them, 42.8% had physical illness or stress, 68.3% had debt problem, 20% had some problems with coworker or work environment, 65.5% had a high workload, and 64.1% felt they did not get enough work benefits. Job demand and control factors included attention from leaders, fast-pace work, relationship among coworkers, repetitive work, hard work, high stress work, and high workload The occupational safety and health system included training to use new equipment, supervisor training, work skill training, work in sitting position for long period of time, appropriate periodic health exam, appropriate medical service, proper canteen, proper salary raise, and facilities for health promotion. In the occupational health hazards, employees were working in low temperature, bright light, and had a lack of health promotion programs. Requested programs to improve quality of life were Thai traditional massage, workplace improvement, health promotion, one-day travel, and Friday's happy and healthy program. Results from the present study can be used to improve workplace environment and health of personnel in the Faculty of Medicine, Thammasat University.

Loglines. July - August 2010

DTIC Science & Technology

2010-08-01

that particular activity or not. assist this effort. We are DLA will help we work toward creating a single-agency environment , we will also build a...24 helps services test renewable fuels. We are DLA 30 single-agency environment , create a sense of community among global workforce...lock? And for a basic light double switch? Do they want steel or The pricing and quality of each justify costs. Product safety is also considered

Critical access hospital informatics: how two rural Iowa hospitals overcame challenges to achieve IT excellence.

PubMed

Bahensky, James A; Moreau, Brian; Frieden, Rob; Ward, Marcia M

2008-01-01

Critical access hospitals often have limited financial and personnel resources to implement today's healthcare IT solutions. Two CAHs in rural Iowa overcame these obstacles and found innovative ways to implement information technology. These hospitals earned recognition from Hospitals & Health Network's Most Wired Magazine for excellence in business processes, customer service, safety and quality, work force management, and public health and safety. Though the hospitals come from different environments-one is part of a system and the other is independent-both exemplify best practices on how to use healthcare IT solutions; engage clinicians from a community setting in informatics decisions; integrate technology into an organization's strategic directions; and support healthcare IT environments.

Human factors and safety in emergency medicine

NASA Technical Reports Server (NTRS)

Schaefer, H. G.; Helmreich, R. L.; Scheidegger, D.

1994-01-01

A model based on an input process and outcome conceptualisation is suggested to address safety-relevant factors in emergency medicine. As shown in other dynamic and demanding environments, human factors play a decisive role in attaining high quality service. Attitudes held by health-care providers, organisational shells and work-cultural parameters determine communication, conflict resolution and workload distribution within and between teams. These factors should be taken into account to improve outcomes such as operational integrity, job satisfaction and morale.

Early experience of a safety net provider reorganizing into an accountable care organization.

PubMed

Hacker, Karen; Santos, Palmira; Thompson, Douglas; Stout, Somava S; Bearse, Adriana; Mechanic, Robert E

2014-08-01

Although safety net providers will benefit from health insurance expansions under the Affordable Care Act, they also face significant challenges in the postreform environment. Some have embraced the concept of the accountable care organization to help improve quality and efficiency while addressing financial shortfalls. The experience of Cambridge Health Alliance (CHA) in Massachusetts, where health care reform began six years ago, provides insight into the opportunities and challenges of this approach in the safety net. CHA's strategies include care redesign, financial realignment, workforce transformation, and development of external partnerships. Early results show some improvement in access, patient experience, quality, and utilization; however, the potential efficiencies will not eliminate CHA's current operating deficit. The patient population, payer mix, service mix, cost structure, and political requirements reduce the likelihood of financial sustainability without significant changes in these factors, increased public funding, or both. Thus the future of safety net institutions, regardless of payment and care redesign success, remains at risk. Copyright © 2014 by Duke University Press.

[Management, quality of health and occupational safety and hospital organization: is integration possible?].

PubMed

Corrao, Carmela Romana Natalina

2011-01-01

The evolution of the national and European legislation has progressively transformed the working environments into organized environments. Specific models for its management are being proposed, which should be integrated into general management strategies. In the case of hospitals this integration should consider the peculiar organizational complexity, where the management of the occupational risk needs to be integrated with clinical risk management and economic risk management. Resources management should also consider that Occupational Medicine has not a direct monetary benefit for the organisation, but only indirect health consequences in terms of reduction of accidents and occupational diseases. The deep and simultaneous analysis of the current general management systems and the current management methods of occupational safety and health protection allows one to hyphotesise a possible integration between them. For both of them the Top Management is the main responsible of the quality management strategies and the use of specific documents in the managerial process, such as the document of risks evaluation in the occupational management and the quality manual in the general management, is of paramount importance. An integrated management has also the scope to pursue a particular kind of quality management, where ethics and job satisfaction are innovative, as established by recent European guidelines, management systems and national legislations.

El Camino Hospital: using health information technology to promote patient safety.

PubMed

Bukunt, Susan; Hunter, Christine; Perkins, Sharon; Russell, Diana; Domanico, Lee

2005-10-01

El Camino Hospital is a leader in the use of health information technology to promote patient safety, including bar coding, computerized order entry, electronic medical records, and wireless communications. Each year, El Camino Hospital's board of directors sets performance expectations for the chief executive officer, which are tied to achievement of local, regional, and national safety and quality standards, including the six Institute of Medicine quality dimensions. He then determines a set of explicit quality goals and measurable actions, which serve as guidelines for the overall hospital. The goals and progress reports are widely shared with employees, medical staff, patients and families, and the public. For safety, for example, the medication error reduction team tracks and reviews medication error rates. The hospital has virtually eliminated transcription errors through its 100% use of computerized physician order entry. Clinical pathways and standard order sets have reduced practice variation, providing a safer environment. Many projects focused on timeliness, such as emergency department wait time, lab turnaround time, and pneumonia time to initial antibiotic. Results have been mixed, with projects most successful when a link was established with patient outcomes, such as in reducing time to percutaneous transluminal coronary angioplasty for patients with acute myocardial infarction.

A sustainable city environment through child safety and mobility-a challenge based on ITS?

PubMed

Leden, Lars; Gårder, Per; Schirokoff, Anna; Monterde-i-Bort, Hector; Johansson, Charlotta; Basbas, Socrates

2014-01-01

Our cities should be designed to accommodate everybody, including children. We will not move toward a more sustainable society unless we accept that children are people with transportation needs, and 'bussing' them around, or providing parental limousine services at all times, will not lead to sustainability. Rather, we will need to make our cities walkable for children, at least those above a certain age. Safety has two main aspects, traffic safety and personal safety (risk of assault). Besides being safe, children will also need an urban environment with reasonable mobility, where they themselves can reach destinations with reasonable effort; else they will still need to be driven. This paper presents the results of two expert questionnaires focusing on the potential safety and mobility benefits to child pedestrians of targeted types of intelligent transportation systems (ITS). Five different types of functional requests for children were identified based on previous work. The first expert questionnaire was structured to collect expert opinions on which ITS solutions or devices would be, and why, the most relevant ones to satisfy the five different functional requests of child pedestrians. Based on the first questionnaire, fifteen problem areas were defined. In the second questionnaire, the experts ranked the fifteen areas, and prioritized related ITS services, according to their potential for developing ITS services beneficial to children. Several ITS systems for improving pedestrian quality are discussed. ITS services can be used when a pedestrian route takes them to a dangerous street, dangerous crossing point or through a dangerous neighborhood. An improvement of safety and other qualities would lead to increased mobility and a more sustainable way of living. Children would learn how to live to support their own health and a sustainable city environment. But it will be up to national, regional and local governments, through their ministries and agencies and public works departments, to promote, fund, and possibly mandate such systems. It is clear that we need to offer an acceptable level of convenience, efficiency, comfort, safety and security to pedestrians but it is less clear if society will prioritize resources toward this. Copyright © 2013 Elsevier Ltd. All rights reserved.

Concept analysis of safety climate in healthcare providers.

PubMed

Lin, Ying-Siou; Lin, Yen-Chun; Lou, Meei-Fang

2017-06-01

To report an analysis of the concept of safety climate in healthcare providers. Compliance with safe work practices is essential to patient safety and care outcomes. Analysing the concept of safety climate from the perspective of healthcare providers could improve understanding of the correlations between safety climate and healthcare provider compliance with safe work practices, thus enhancing quality of patient care. Concept analysis. The electronic databases of CINAHL, MEDLINE, PubMed and Web of Science were searched for literature published between 1995-2015. Searches used the keywords 'safety climate' or 'safety culture' with 'hospital' or 'healthcare'. The concept analysis method of Walker and Avant analysed safety climate from the perspective of healthcare providers. Three attributes defined how healthcare providers define safety climate: (1) creation of safe working environment by senior management in healthcare organisations; (2) shared perception of healthcare providers about safety of their work environment; and (3) the effective dissemination of safety information. Antecedents included the characteristics of healthcare providers and healthcare organisations as a whole, and the types of work in which they are engaged. Consequences consisted of safety performance and safety outcomes. Most studies developed and assessed the survey tools of safety climate or safety culture, with a minority consisting of interventional measures for improving safety climate. More prospective studies are needed to create interventional measures for improving safety climate of healthcare providers. This study is provided as a reference for use in developing multidimensional safety climate assessment tools and interventional measures. The values healthcare teams emphasise with regard to safety can serve to improve safety performance. Having an understanding of the concept of and interventional measures for safety climate allows healthcare providers to ensure the safety of their operations and their patients. © 2016 John Wiley & Sons Ltd.

A Systematic Review of Primary Care Safety Climate Survey Instruments: Their Origins, Psychometric Properties, Quality, and Usage.

PubMed

Curran, Ciara; Lydon, Sinéad; Kelly, Maureen; Murphy, Andrew; Walsh, Chloe; OʼConnor, Paul

2018-06-01

Safety climate (SC) measurement is a common and feasible method of proactive safety assessment in primary care. However, there is no consensus on which instrument is "best" to use. The aim of the study was to identify the origins, psychometric properties, quality, and SC domains measured by survey instruments used to assess SC in primary care settings. Systematic searches were conducted using Medline, Embase, CINAHL, and PsycInfo in February 2016. English-language, peer-reviewed studies that reported the development and/or use of a SC survey in a primary care setting were included. Two reviewers independently extracted data (survey characteristics, origins, and psychometric properties) from studies and applied the Quality Assessment Tool for Studies with Diverse Designs to assess methodological rigour. Safety climate domains within surveys were deductively analyzed and categorized into common healthcare SC themes. Seventeen SC surveys were identified, of which 16 had been adapted from 2 main U.S. hospital-based surveys. Only 1 survey was developed de novo for a primary care setting. The quantity and quality of psychometric testing varied considerably across the surveys. Management commitment to safety was the most frequently measured SC theme (87.5%). Workload was infrequently measured (25%). Valid and reliable instruments, which are context specific to the healthcare environment for intentional use, are essential to accurately assess SC. Key recommendations include further establishing the construct and criterion-related validity of existing instruments as opposed to developing additional surveys.

A Comprehensive Approach Towards Quality and Safety in Diagnostic Imaging Services: Our Experience at a Rural Tertiary Health Care Center

PubMed Central

Sindhwani, Geetika; Gupta, Monica; Arora, Sweta; Mishra, Arpita; Bhatt, Jayesh; Arora, Manali; Gehani, Anisha

2017-01-01

Introduction An organization’s transformation from imple-mentation of small, distinct Quality Improvement (QI) efforts to complete incorporation of Quality Improvement Program (QIP) into its culture occurs through a process of churning the foundational elements over time. Aim To develop a quality culture across the employees, identify measurable indicators and various tools to impart effective quality care and develop a learning culture for continuous quality improvement in the field of imaging services. Materials and Methods To establish a QIP, the bare minimum requirement started with forming a quality committee. The committee identified the areas of improvement and ascertaining the core principle of Quality Management System (QMS) by having a Quality Manual, Standard Operating Procedures (SOP’s), work-instructions, identification and monitoring of quality indicators and a training calendar. Appropriate tools like formatted daily registers, periodic check lists, run charts etc., were developed to collect the data followed by multiple PDSA cycles (Plan, Do, Study and Act) which helped identify the process bottlenecks, followed by implementing solutions and reanalysis. Results A total of 17 measurable key performance indicators were identified from the four major quality tasks namely Safety, Process Improvement, Professional Outcome and Satisfaction, to assess the performance measures and targets of QIP. Conclusion Diagnostic services should evaluate how to choose the most appropriate method and develop a comprehensive QIP to meet the needs of the staff and the end users, thus, creating a working environment, where people constitutes the intrinsic value in attaining the ultimate quality and safety. PMID:28969238

Simulation in the clinical setting: towards a standard lexicon.

PubMed

Posner, Glenn D; Clark, Marcia L; Grant, Vincent J

2017-01-01

Simulation-based educational activities are happening in the clinical environment but are not all uniform in terms of their objectives, delivery, or outputs. While these activities all provide an opportunity for individual and team training, nuances in the location, timing, notification, and participants impact the potential outcomes of these sessions and objectives achieved. In light of this, there are actually many different types of simulation-based activity that occur in the clinical environment, which has previously all been grouped together as "in situ" simulation. However, what truly defines in situ simulation is how the clinical environment responds in its' natural state, including the personnel, equipment, and systems responsible for care in that environment. Beyond individual and team skill sets, there are threats to patient safety or quality patient care that result from challenges with equipment, processes, or system breakdowns. These have been labeled "latent safety threats." We submit that the opportunity for discovery of latent safety threats is what defines in situ simulation and truly differentiates it from what would be more rightfully called "on-site" simulation. The distinction between the two is highlighted in this article, as well as some of the various sub-types of in situ simulation.

Surgical robotics for patient safety in the perioperative environment: realizing the promise.

PubMed

Fuji Lai; Louw, Deon

2007-06-01

Surgery is at a crossroads of complexity. However, there is a potential path toward patient safety. One such course is to leverage computer and robotic assist techniques in the reduction and interception of error in the perioperative environment. This white paper attempts to facilitate the road toward realizing that promise by outlining a research agenda. The paper will briefly review the current status of surgical robotics and summarize any conclusions that can be reached to date based on existing research. It will then lay out a roadmap for future research to determine how surgical robots should be optimally designed and integrated into the perioperative workflow and process. Successful movement down this path would involve focused efforts and multiagency collaboration to address the research priorities outlined, thereby realizing the full potential of surgical robotics to augment human capabilities, enhance task performance, extend the reach of surgical care, improve health care quality, and ultimately enhance patient safety.

Relationship Between State Malpractice Environment and Quality of Health Care in the United States.

PubMed

Bilimoria, Karl Y; Chung, Jeanette W; Minami, Christina A; Sohn, Min-Woong; Pavey, Emily S; Holl, Jane L; Mello, Michelle M

2017-05-01

One major intent of the medical malpractice system in the United States is to deter negligent care and to create incentives for delivering high-quality health care. A study was conducted to assess whether state-level measures of malpractice risk were associated with hospital quality and patient safety. In an observational study of short-term, acute-care general hospitals in the United States that publicly reported in the Centers for Medicaid & Medicare Services Hospital Compare in 2011, hierarchical regression models were used to estimate associations between state-specific malpractice environment measures (rates of paid claims, average Medicare Malpractice Geographic Practice Cost Index [MGPCI], absence of tort reform laws, and a composite measure) and measures of hospital quality (processes of care, imaging utilization, 30-day mortality and readmission, Agency for Healthcare Research and Quality Patient Safety Indicators, and patient experience from the Hospital Consumer Assessment of Healthcare Providers and Systems [HCAHPS]). No consistent association between malpractice environment and hospital process-of-care measures was found. Hospitals in areas with a higher MGPCI were associated with lower adjusted odds of magnetic resonance imaging overutilization for lower back pain but greater adjusted odds of overutilization of cardiac stress testing and brain/sinus computed tomography (CT) scans. The MGPCI was negatively associated with 30-day mortality measures but positively associated with 30-day readmission measures. Measures of malpractice risk were also negatively associated with HCAHPS measures of patient experience. Overall, little evidence was found that greater malpractice risk improves adherence to recommended clinical standards of care, but some evidence was found that malpractice risk may encourage defensive medicine. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Effect of Practice Ownership on Work Environment, Learning Culture, Psychological Safety, and Burnout.

PubMed

Cuellar, Alison; Krist, Alex H; Nichols, Len M; Kuzel, Anton J

2018-04-01

Physicians have joined larger groups and hospital systems in the face of multiple environmental challenges. We examine whether there are differences across practice ownership in self-reported work environment, a practice culture of learning, psychological safety, and burnout. Using cross-sectional data from staff surveys of small and medium-size practices that participated in EvidenceNOW in Virginia, we tested for differences in work environment, culture of learning, psychological safety, and burnout by practice type. We conducted weighted multivariate linear regression of outcomes on ownership, controlling for practice size, specialty mix, payer mix, and whether the practice was located in a medically underserved area. We further analyzed clinician and staff responses separately. Participating were 104 hospital-owned and 61 independent practices and 24 federally qualified health centers (FQHCs). We analyzed 2,005 responses from practice clinicians and staff, a response rate of 49%. Working in a hospital-owned practice was associated with favorable ratings of work environment, psychological safety, and burnout compared with independent practices. When we examined separately the responses of clinicians vs staff, however, the association appears to be largely driven by staff. Hospital ownership was associated with positive perceptions of practice work environment and lower burnout for staff relative to independent ownership, whereas clinicians in FQHCs perceive a more negative, less joyful work environment and burnout. Our findings are suggestive that clinician and nonclinician staff perceive practice adaptive reserve differently, which may have implications for creating the energy for ongoing quality improvement work. © 2018 Annals of Family Medicine, Inc.

Life in a Regulated Environment: Do You Comply with Environmental Laws?

ERIC Educational Resources Information Center

McKeague, Kevin J.

1994-01-01

Discusses the following issues: (1) implications of the Americans with Disabilities Act; (2) Asbestos Hazard Emergency Response Act regulations; (3) new lead guidelines; (4) requirements regarding underground storage tanks; (5) potential indoor air quality requirements; and (6) Occupational Safety and Health Administration guidelines. (MLF)

ASAP Aerospace Safety Advisory Panel

NASA Technical Reports Server (NTRS)

2004-01-01

This is the First Quarterly Report for the newly reconstituted Aerospace Safety Advisory Panel (ASAP). The NASA Administrator rechartered the Panel on November 18,2003, to provide an independent, vigilant, and long-term oversight of NASA's safety policies and programs well beyond Return to Flight of the Space Shuttle. The charter was revised to be consistent with the original intent of Congress in enacting the statute establishing ASAP in 1967 to focus on NASA's safety and quality systems, including industrial and systems safety, risk-management and trend analysis, and the management of these activities.The charter also was revised to provide more timely feedback to NASA by requiring quarterly rather than annual reports, and by requiring ASAP to perform special assessments with immediate feedback to NASA. ASAP was positioned to help institutionalize the safety culture of NASA in the post- Stafford-Covey Return to Flight environment.

Traffic information computing platform for big data

DOE Office of Scientific and Technical Information (OSTI.GOV)

Duan, Zongtao, E-mail: ztduan@chd.edu.cn; Li, Ying, E-mail: ztduan@chd.edu.cn; Zheng, Xibin, E-mail: ztduan@chd.edu.cn

Big data environment create data conditions for improving the quality of traffic information service. The target of this article is to construct a traffic information computing platform for big data environment. Through in-depth analysis the connotation and technology characteristics of big data and traffic information service, a distributed traffic atomic information computing platform architecture is proposed. Under the big data environment, this type of traffic atomic information computing architecture helps to guarantee the traffic safety and efficient operation, more intelligent and personalized traffic information service can be used for the traffic information users.

[Environmental quality: wellfare, confort and health].

PubMed

Vargas Marcos, Francisco; Gallego Pulgarín, Isabel

2005-01-01

Different ways of interpreting environmental conditions have led to the development of concepts such as the sick building, indoor air quality or indoor environment quality, for understanding the complexity of the pollutants in enclosed environments and the implications thereof on the health. The "Indoor Environment Quality" proposal is an advancement, operative and conceptual, surpassing amply prior ones, given that it orients the actions toward healthy environments without limiting the idea of pollution to the air alone. The aim is identifying the competence to preventing hazards related to exposure to pollutants within the confines of indoor environments and know the legislative framework useful for taking the actions. Optimum conditions within indoor environments must redound in health, well-being and comfort with regard to both working life as well as the environments in which everyday activities outside of work, extracurricular, leisure-time and entertainment activities are carried out. Today's society is demanding safe, clean, well-climatized places, for this is necessary to integrate the inhabitant's perceptions and demands and achieve an optimum balance among social standards, energy use and sustainable development. Legislation is being further expanded upon in the direction of occupational health and safety and the regulation of chemical substances. Environmental Health carries out prevention and control tasks, takes part in the enforcement of international pollution and waste reduction agreements and promotes measures for carrying out the European Environment and Health Strategy. It is considered useful the elaboration of protocols for the evaluation and administration gives the risks associated to the interior pollutants.

Aligning institutional priorities: engaging house staff in a quality improvement and safety initiative to fulfill Clinical Learning Environment Review objectives and electronic medical record Meaningful Use requirements.

PubMed

Flanagan, Meghan R; Foster, Carolyn C; Schleyer, Anneliese; Peterson, Gene N; Mandell, Samuel P; Rudd, Kristina E; Joyner, Byron D; Payne, Thomas H

2016-02-01

House staff quality improvement projects are often not aligned with training institution priorities. House staff are the primary users of inpatient problem lists in academic medical centers, and list maintenance has significant patient safety and financial implications. Improvement of the problem list is an important objective for hospitals with electronic health records under the Meaningful Use program. House staff surveys were used to create an electronic problem list manager (PLM) tool enabling efficient problem list updating. Number of new problems added and house staff perceptions of the problem list were compared before and after PLM intervention. The PLM was used by 654 house staff after release. Surveys demonstrated increased problem list updating (P = .002; response rate 47%). Mean new problems added per day increased from 64 pre-PLM to 125 post-PLM (P < .001). This innovative project serves as a model for successful engagement of house staff in institutional quality and safety initiatives with tangible institutional benefits. Copyright © 2016 Elsevier Inc. All rights reserved.

Fostering Future Leadership in Quality and Safety in Health Care through Systems Thinking.

PubMed

Phillips, Janet M; Stalter, Ann M; Dolansky, Mary A; Lopez, Gloria McKee

2016-01-01

There is a critical need for leadership in quality and safety to reform today's disparate spectrum of health services to serve patients in complex health care environments. Nurse graduates of degree completion programs (registered nurse-bachelor of science in nursing [RN-BSN]) are poised for leadership due to their recent education and nursing practice experience. The authors propose that integration of systems thinking into RN-BSN curricula is essential for developing these much needed leadership skills. The purpose of this article is to introduce progressive teaching strategies to help nurse educators achieve the student competencies described in the second essential of the BSN Essentials document (American Association of Colleges of Nursing, 2009), linking them with the competencies in Quality and Safety Education for Nurses (QSEN; L. Cronenwett et al., 2007) using an author-created model for curricular design, the Systems-level Awareness Model. The Systems Thinking Tool (M. A. Dolansky & S. M. Moore, 2013) can be used to evaluate systems thinking in the RN-BSN curriculum. Copyright © 2016 Elsevier Inc. All rights reserved.

Numerical modeling of chemical spills and assessment of their environmental impacts

USDA-ARS?s Scientific Manuscript database

Chemical spills in surface water bodies often occur in modern societies, which cause significant impacts on water quality, eco-environment and drinking water safety. In this paper, chemical spill contamination in water resources was studied using a depth-integrated computational model, CCHE2D, for p...

Residents' and attendings' perceptions of a night float system in an internal medicine program in Canada.

PubMed

Saxena, Anurag; Desanghere, Loni; Skomro, Robert P; Wilson, Thomas W

2015-01-01

The Night Float system (NFS) is often used in residency training programs to meet work hour regulations. The purpose of this study was to examine resident and attendings' perceptions of the NFS on issues of resident learning, well-being, work, non-educational activities and the health care system (patient safety and quality of care, inter-professional teams, workload on attendings and costs of on-call coverage). A survey questionnaire with closed and open-ended questions (26 residents and eight attendings in an Internal Medicine program), informal discussions with the program and moonlighting and financial data were collected. The main findings included, (i) an overall congruency in opinions between resident and attendings across all mean comparisons, (ii) perceptions of improvement for most aspects of resident well-being (e.g. stress, fatigue) and work environment (e.g. supervision, support), (iii) a neutral effect on the resident learning environment, except resident opinions on an increase in opportunities for learning, (iv) perceptions of improved patient safety and quality of care despite worsened continuity of care, and (v) no increases in work-load on attendings or the health care system (cost-neutral call coverage). Patient safety, handovers and increased utilization of moonlighting opportunities need further exploration.

Design of the environment of care for safety of patients and personnel: does form follow function or vice versa in the intensive care unit?

PubMed

Bartley, Judene; Streifel, Andrew J

2010-08-01

We review the context of the environment of care in the intensive care unit setting in relation to patient safety and quality, specifically addressing healthcare-associated infection issues and solutions involving interdisciplinary teams. Issues addressed include current and future architectural design and layout trends, construction trends affecting intensive care units, and prevention of construction-associated healthcare-associated infections related to airborne and waterborne risks and design solutions. Specific elements include single-occupancy, acuity-scalable intensive care unit rooms; environmental aspects of hand hygiene, such as water risks, sink design/location, human waste management, surface selection (floor covering, countertops, furniture, and equipment) and cleaning, antimicrobial-treated or similar materials, ultraviolet germicidal irradiation, specialized rooms (airborne infection isolation and protective environments), and water system design and strategies for safe use of potable water and mitigation of water intrusion. Effective design and operational use of the intensive care unit environment of care must engage critical care personnel from initial planning and design through occupancy of the new/renovated intensive care unit as part of the infection control risk assessment team. The interdisciplinary infection control risk assessment team can address key environment of care design features to enhance the safety of intensive care unit patients, personnel, and visitors. This perspective will ensure the environment of care supports human factors and behavioral aspects of the interaction between the environment of care and its occupants.

Sandia National Laboratories/New Mexico Environmental Information Document - Volume 1

DOE Office of Scientific and Technical Information (OSTI.GOV)

BAYLISS, LINDA S.; GUERRERO, JOSEPH V.; JOHNS, WILLIAM H.

This Sandia National Laboratories/New Mexico Environmental Information Document (EID) compiles information on the existing environment, or environmental baseline, for SNUNM. Much of the information is drawn from existing reports and databases supplemented by new research and data. The SNL/NM EID, together with the Sandia National Laboratories/New Mexico Facilities and Safety Information Document, provide a basis for assessing the environment, safety, and health aspects of operating selected facilities at SNL/NM. The environmental baseline provides a record of the existing physical, biological, and socioeconomic environment at SNL/NLM prior to being altered (beneficially or adversely) by proposed programs or projects. More specifically, themore » EID provides information on the following topics: Geology; Land Use; Hydrology and Water Resources; Air Quality and Meteorology; Ecology; Noise and Vibration; Cultural Resources; Visual Resources; Socioeconomic and Community Services; Transportation; Material Management; Waste Management; and Regulatory Requirements.« less

The role of internationally educated nurses in a quality, safe workforce.

PubMed

D Sherwood, Gwen; Shaffer, Franklin A

2014-01-01

Migration and globalization of the nursing workforce affect source countries and destination countries. Policies and regulations governing the movement of nurses from one country to another safeguard the public by ensuring educational comparability and competence. The global movement of nurses and other health care workers calls for quality and safety competencies that meet standards such as those defined by the Institute of Medicine. This article examines nurse migration and employment of internationally educated nurses (IENs) in the context of supporting and maintaining safe, quality patient care environments. Migration to the United States is featured as an exemplar to consider the following key factors: the impact of nurse migration on the nursing workforce; issues in determining educational comparability of nursing programs between countries; quality and safety concerns in transitioning IENs into the workforce; and strategies for helping IENs transition as safe, qualified members of the nursing workforce in the destination country. Copyright © 2014 Elsevier Inc. All rights reserved.

The Australian radiation protection and nuclear safety agency megavoltage photon thermoluminescence dosimetry postal audit service 2007-2010.

PubMed

Oliver, C P; Butler, D J; Webb, D V

2012-03-01

The Australian radiation protection and nuclear safety agency (ARPANSA) has continuously provided a level 1 mailed thermoluminescence dosimetry audit service for megavoltage photons since 2007. The purpose of the audit is to provide an independent verification of the reference dose output of a radiotherapy linear accelerator in a clinical environment. Photon beam quality measurements can also be made as part of the audit in addition to the output measurements. The results of all audits performed between 2007 and 2010 are presented. The average of all reference beam output measurements calculated as a clinically stated dose divided by an ARPANSA measured dose is 0.9993. The results of all beam quality measurements calculated as a clinically stated quality divided by an ARPANSA measured quality is 1.0087. Since 2011 the provision of all auditing services has been transferred from the Ionizing Radiation Standards section to the Australian Clinical Dosimetry Service (ACDS) which is currently housed within ARPANSA.

The effectiveness of an aged care specific leadership and management program on workforce, work environment, and care quality outcomes: design of a cluster randomised controlled trial.

PubMed

Jeon, Yun-Hee; Simpson, Judy M; Chenoweth, Lynn; Cunich, Michelle; Kendig, Hal

2013-10-25

A plethora of observational evidence exists concerning the impact of management and leadership on workforce, work environment, and care quality. Yet, no randomised controlled trial has been conducted to test the effectiveness of leadership and management interventions in aged care. An innovative aged care clinical leadership program (Clinical Leadership in Aged Care--CLiAC) was developed to improve managers' leadership capacities to support the delivery of quality care in Australia. This paper describes the study design of the cluster randomised controlled trial testing the effectiveness of the program. Twenty-four residential and community aged care sites were recruited as managers at each site agreed in writing to participate in the study and ensure that leaders allocated to the control arm would not be offered the intervention program. Sites undergoing major managerial or structural changes were excluded. The 24 sites were randomly allocated to receive the CLiAC program (intervention) or usual care (control), stratified by type (residential vs. community, six each for each arm). Treatment allocation was masked to assessors and staff of all participating sites. The objective is to establish the effectiveness of the CLiAC program in improving work environment, workforce retention, as well as care safety and quality, when compared to usual care. The primary outcomes are measures of work environment, care quality and safety, and staff turnover rates. Secondary outcomes include manager leadership capacity, staff absenteeism, intention to leave, stress levels, and job satisfaction. Differences between intervention and control groups will be analysed by researchers blinded to treatment allocation using linear regression of individual results adjusted for stratification and clustering by site (primary analysis), and additionally for baseline values and potential confounders (secondary analysis). Outcomes measured at the site level will be compared by cluster-level analysis. The overall costs and benefits of the program will also be assessed. The outcomes of the trial have the potential to inform actions to enhance leadership and management capabilities of the aged care workforce, address pressing issues about workforce shortages, and increase the quality of aged care services. Australian New Zealand Clinical Trials Registry (ACTRN12611001070921).

An Internet of Things System for Underground Mine Air Quality Pollutant Prediction Based on Azure Machine Learning

PubMed Central

Jo, ByungWan

2018-01-01

The implementation of wireless sensor networks (WSNs) for monitoring the complex, dynamic, and harsh environment of underground coal mines (UCMs) is sought around the world to enhance safety. However, previously developed smart systems are limited to monitoring or, in a few cases, can report events. Therefore, this study introduces a reliable, efficient, and cost-effective internet of things (IoT) system for air quality monitoring with newly added features of assessment and pollutant prediction. This system is comprised of sensor modules, communication protocols, and a base station, running Azure Machine Learning (AML) Studio over it. Arduino-based sensor modules with eight different parameters were installed at separate locations of an operational UCM. Based on the sensed data, the proposed system assesses mine air quality in terms of the mine environment index (MEI). Principal component analysis (PCA) identified CH4, CO, SO2, and H2S as the most influencing gases significantly affecting mine air quality. The results of PCA were fed into the ANN model in AML studio, which enabled the prediction of MEI. An optimum number of neurons were determined for both actual input and PCA-based input parameters. The results showed a better performance of the PCA-based ANN for MEI prediction, with R2 and RMSE values of 0.6654 and 0.2104, respectively. Therefore, the proposed Arduino and AML-based system enhances mine environmental safety by quickly assessing and predicting mine air quality. PMID:29561777

An Internet of Things System for Underground Mine Air Quality Pollutant Prediction Based on Azure Machine Learning.

PubMed

Jo, ByungWan; Khan, Rana Muhammad Asad

2018-03-21

The implementation of wireless sensor networks (WSNs) for monitoring the complex, dynamic, and harsh environment of underground coal mines (UCMs) is sought around the world to enhance safety. However, previously developed smart systems are limited to monitoring or, in a few cases, can report events. Therefore, this study introduces a reliable, efficient, and cost-effective internet of things (IoT) system for air quality monitoring with newly added features of assessment and pollutant prediction. This system is comprised of sensor modules, communication protocols, and a base station, running Azure Machine Learning (AML) Studio over it. Arduino-based sensor modules with eight different parameters were installed at separate locations of an operational UCM. Based on the sensed data, the proposed system assesses mine air quality in terms of the mine environment index (MEI). Principal component analysis (PCA) identified CH₄, CO, SO₂, and H₂S as the most influencing gases significantly affecting mine air quality. The results of PCA were fed into the ANN model in AML studio, which enabled the prediction of MEI. An optimum number of neurons were determined for both actual input and PCA-based input parameters. The results showed a better performance of the PCA-based ANN for MEI prediction, with R ² and RMSE values of 0.6654 and 0.2104, respectively. Therefore, the proposed Arduino and AML-based system enhances mine environmental safety by quickly assessing and predicting mine air quality.

Microbiological Quality and Food Safety of Plants Grown on ISS Project

NASA Technical Reports Server (NTRS)

Wheeler, Raymond M. (Compiler)

2014-01-01

The goal of this project is to select and advance methods to enable real-time sampling, microbiological analysis, and sanitation of crops grown on the International Space Station (ISS). These methods would validate the microbiological quality of crops grown for consumption to ensure safe and palatable fresh foods. This would be achieved through the development / advancement of microbiological sample collection, rapid pathogen detection and effective sanitation methods that are compatible with a microgravity environment.

Key Performance Indicators in the Evaluation of the Quality of Radiation Safety Programs.

PubMed

Schultz, Cheryl Culver; Shaffer, Sheila; Fink-Bennett, Darlene; Winokur, Kay

2016-08-01

Beaumont is a multiple hospital health care system with a centralized radiation safety department. The health system operates under a broad scope Nuclear Regulatory Commission license but also maintains several other limited use NRC licenses in off-site facilities and clinics. The hospital-based program is expansive including diagnostic radiology and nuclear medicine (molecular imaging), interventional radiology, a comprehensive cardiovascular program, multiple forms of radiation therapy (low dose rate brachytherapy, high dose rate brachytherapy, external beam radiotherapy, and gamma knife), and the Research Institute (including basic bench top, human and animal). Each year, in the annual report, data is analyzed and then tracked and trended. While any summary report will, by nature, include items such as the number of pieces of equipment, inspections performed, staff monitored and educated and other similar parameters, not all include an objective review of the quality and effectiveness of the program. Through objective numerical data Beaumont adopted seven key performance indicators. The assertion made is that key performance indicators can be used to establish benchmarks for evaluation and comparison of the effectiveness and quality of radiation safety programs. Based on over a decade of data collection, and adoption of key performance indicators, this paper demonstrates one way to establish objective benchmarking for radiation safety programs in the health care environment.

Relationship of the Perceived Social and Physical Environment with Mental Health-Related Quality of Life in Middle-Aged and Older Adults: Mediating Effects of Physical Activity

PubMed Central

Van Dyck, Delfien; Teychenne, Megan; McNaughton, Sarah A.; De Bourdeaudhuij, Ilse; Salmon, Jo

2015-01-01

Background Mental health conditions are among the leading non-fatal diseases in middle-aged and older adults in Australia. Proximal and distal social environmental factors and physical environmental factors have been associated with mental health, but the underlying mechanisms explaining these associations remain unclear. The study objective was to examine the contribution of different types of physical activity in mediating the relationship of social and physical environmental factors with mental health-related quality of life in middle-aged and older adults. Methods Baseline data from the Wellbeing, Eating and Exercise for a Long Life (WELL) study were used. WELL is a prospective cohort study, conducted in Victoria, Australia. Baseline data collection took place in 2010. In total, 3,965 middle-aged and older adults (55–65 years, 47.4% males) completed the SF-36 Health Survey, the International Physical Activity Questionnaire, and a questionnaire on socio-demographic, social and physical environmental attributes. Mediation analyses were conducted using the MacKinnon product-of-coefficients test. Results Personal safety, the neighbourhood physical activity environment, social support for physical activity from family or friends, and neighbourhood social cohesion were positively associated with mental health-related quality of life. Active transportation and leisure-time physical activity mediated 32.9% of the association between social support for physical activity from family or friends and mental health-related quality of life. These physical activity behaviours also mediated 11.0%, 3.4% and 2.3% respectively, of the relationship between the neighbourhood physical activity environment, personal safety and neighbourhood social cohesion and mental health-related quality of life. Conclusions If these results are replicated in future longitudinal studies, tailored interventions to improve mental health-related quality of life in middle-aged and older adults should use a combined strategy, focusing on increasing physical activity as well as social and physical environmental attributes. PMID:25799269

Relationship of the perceived social and physical environment with mental health-related quality of life in middle-aged and older adults: mediating effects of physical activity.

PubMed

Van Dyck, Delfien; Teychenne, Megan; McNaughton, Sarah A; De Bourdeaudhuij, Ilse; Salmon, Jo

2015-01-01

Mental health conditions are among the leading non-fatal diseases in middle-aged and older adults in Australia. Proximal and distal social environmental factors and physical environmental factors have been associated with mental health, but the underlying mechanisms explaining these associations remain unclear. The study objective was to examine the contribution of different types of physical activity in mediating the relationship of social and physical environmental factors with mental health-related quality of life in middle-aged and older adults. Baseline data from the Wellbeing, Eating and Exercise for a Long Life (WELL) study were used. WELL is a prospective cohort study, conducted in Victoria, Australia. Baseline data collection took place in 2010. In total, 3,965 middle-aged and older adults (55-65 years, 47.4% males) completed the SF-36 Health Survey, the International Physical Activity Questionnaire, and a questionnaire on socio-demographic, social and physical environmental attributes. Mediation analyses were conducted using the MacKinnon product-of-coefficients test. Personal safety, the neighbourhood physical activity environment, social support for physical activity from family or friends, and neighbourhood social cohesion were positively associated with mental health-related quality of life. Active transportation and leisure-time physical activity mediated 32.9% of the association between social support for physical activity from family or friends and mental health-related quality of life. These physical activity behaviours also mediated 11.0%, 3.4% and 2.3% respectively, of the relationship between the neighbourhood physical activity environment, personal safety and neighbourhood social cohesion and mental health-related quality of life. If these results are replicated in future longitudinal studies, tailored interventions to improve mental health-related quality of life in middle-aged and older adults should use a combined strategy, focusing on increasing physical activity as well as social and physical environmental attributes.

Differences in work environment for staff as an explanation for variation in central line bundle compliance in intensive care units.

PubMed

Lee, Yuna S H; Stone, Patricia W; Pogorzelska-Maziarz, Monika; Nembhard, Ingrid M

Central line-associated bloodstream infections (CLABSIs) are a common and costly quality problem, and their prevention is a national priority. A decade ago, researchers identified an evidence-based bundle of practices that reduce CLABSIs. Compliance with this bundle remains low in many hospitals. The aim of this study was to assess whether differences in core aspects of work environments-workload, quality of relationships, and prioritization of quality-are associated with variation in maximal CLABSI bundle compliance, that is, compliance 95%-100% of the time in intensive care units (ICUs). A cross-sectional study of hospital medical-surgical ICUs in the United States was done. Data on work environment and bundle compliance were obtained from the Prevention of Nosocomial Infections and Cost-Effectiveness Refined Survey completed in 2011 by infection prevention directors, and data on ICU and hospital characteristics were obtained from the National Healthcare Safety Network. Factor and multilevel regression analyses were conducted. Reasonable workload and prioritization of quality were positively associated with maximal CLABSI bundle compliance. High-quality relationships, although a significant predictor when evaluated apart from workload and prioritization of quality, had no significant effect after accounting for these two factors. Aspects of the staff work environment are associated with maximal CLABSI bundle compliance in ICUs. Our results suggest that hospitals can foster improvement in ensuring maximal CLABSI bundle compliance-a crucial precursor to reducing CLABSI infection rates-by establishing reasonable workloads and prioritizing quality.

Factors influencing work productivity and intent to stay in nursing.

PubMed

Letvak, Susan; Buck, Raymond

2008-01-01

The researchers document the individual and workplace characteristics associated with decreased work productivity and intent to stay in nursing for nurses employed in direct patient care in the hospital setting. Factors associated with decreased work productivity were age, total years worked as a RN, quality of care provided, job stress score, having had a job injury, and having a health problem. Nurse leaders must place additional efforts on changes needed to improve the hospital workplace environment to decrease job stress, improve RNs' ability to provide quality care, and to assure the health and safety of nurses. Reducing job stress and providing adequate staffing so quality of care can be provided will enhance job satisfaction which will also encourage RNs to stay at the bedside. Improved work environments may delay older RNs' retirement from the workforce.

From the traditional concept of safety management to safety integrated with quality.

PubMed

García Herrero, Susana; Mariscal Saldaña, Miguel Angel; Manzanedo del Campo, Miguel Angel; Ritzel, Dale O

2002-01-01

This editorial reviews the evolution of the concepts of safety and quality that have been used in the traditional workplace. The traditional programs of safety are explored showing strengths and weaknesses. The concept of quality management is also viewed. Safety management and quality management principles, stages, and measurement are highlighted. The concepts of quality and safety guarantee are assessed. Total Quality Management concepts are reviewed and applied to safety quality. Total safety management principles are discussed. Finally, an analysis of the relationship between quality and safety from data collected from a company in Spain is presented.

Defining quality metrics and improving safety and outcome in allergy care.

PubMed

Lee, Stella; Stachler, Robert J; Ferguson, Berrylin J

2014-04-01

The delivery of allergy immunotherapy in the otolaryngology office is variable and lacks standardization. Quality metrics encompasses the measurement of factors associated with good patient-centered care. These factors have yet to be defined in the delivery of allergy immunotherapy. We developed and applied quality metrics to 6 allergy practices affiliated with an academic otolaryngic allergy center. This work was conducted at a tertiary academic center providing care to over 1500 patients. We evaluated methods and variability between 6 sites. Tracking of errors and anaphylaxis was initiated across all sites. A nationwide survey of academic and private allergists was used to collect data on current practice and use of quality metrics. The most common types of errors recorded were patient identification errors (n = 4), followed by vial mixing errors (n = 3), and dosing errors (n = 2). There were 7 episodes of anaphylaxis of which 2 were secondary to dosing errors for a rate of 0.01% or 1 in every 10,000 injection visits/year. Site visits showed that 86% of key safety measures were followed. Analysis of nationwide survey responses revealed that quality metrics are still not well defined by either medical or otolaryngic allergy practices. Academic practices were statistically more likely to use quality metrics (p = 0.021) and perform systems reviews and audits in comparison to private practices (p = 0.005). Quality metrics in allergy delivery can help improve safety and quality care. These metrics need to be further defined by otolaryngic allergists in the changing health care environment. © 2014 ARS-AAOA, LLC.

Innovative Training for Occupational Health and Infection Control Workplace Assessment in Health Care

ERIC Educational Resources Information Center

O'Hara, Lyndsay; Bryce, Elizabeth Ann; Scharf, Sydney; Yassi, Annalee

2012-01-01

A user-friendly, high quality workplace assessment field guide and an accompanying worksheet are invaluable tools for recognizing hazards in the hospital environment. These tools ensure that both front line workers as well as health and safety and infection control professionals can systematically evaluate hazards and formulate recommendations.…

75 FR 2480 - Wildlife Services; Availability of an Environmental Assessment and Finding of No Significant Impact

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-15

... DEPARTMENT OF AGRICULTURE Animal and Plant Health Inspection Service [Docket No. APHIS-2009-0087... program will not have a significant impact on the quality of the human environment. Based on its finding... implement the best methods of managing conflicts between wildlife and human health and safety, agriculture...

Strategies for field use of baculoviruses

Treesearch

J.D. Podgwaite

1985-01-01

In recent years, there has been increased awareness in maintaining the quality of the environment. This has led to the development and use of microbial agents as alternatives to chemicals for controlling noxious insect populations. The insect pathogens in the family Baculoviridae, by virtue of their specificity, virulence, and safety for nontarget species, have become...

Tiger Team Assessment of the Ames Laboratory

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1992-03-01

This report documents the Tiger Assessment of the Ames Laboratory (Ames), located in Ames, Iowa. Ames is operated for the US Department of Energy (DOE) by Iowa State University. The assessment was conducted from February 10 to March 5, 1992, under the auspices of the Office of Special Projects, Office of the Assistant Secretary of Environment, Safety and Health, Headquarters, DOE. The assessment was comprehensive, encompassing Environment, Safety, and Health (ES H) disciplines; management practices; and contractor and DOE self-assessments. Compliance with applicable Federal, State of Iowa, and local regulations; applicable DOE Orders; best management practices; and internal requirements atmore » Ames Laboratory were assessed. In addition, an evaluation of the adequacy and effectiveness of DOE and the site contractor's management of ES H/quality assurance program was conducted.« less

Home and Work Neighborhood Environments in Relation to Body Mass Index: The Multi-Ethnic Study of Atherosclerosis (MESA)

PubMed Central

Moore, Kari; Diez Roux, Ana V.; Auchincloss, Amy; Evenson, Kelly R.; Kaufman, Joel; Mujahid, Mahasin; Williams, Kayleen

2013-01-01

Background Little is known about neighborhood characteristics of workplaces, the extent to which they are independently and synergistically correlated with residential environments, and their impact on health. Methods This study investigated cross-sectional relationships between home and workplace neighborhood environments with body mass index (BMI) in 1,503 working participants of the Multi-Ethnic Study of Atherosclerosis (MESA) with mean age 59.6 (SD=7.4). Neighborhood features were socioeconomic status (SES), social environment (aesthetic quality, safety, and social cohesion), and physical environment (walking environment, recreational facilities, and food stores) derived from census data, locational data on businesses, and survey data. Paired t-tests and correlations compared environments overall and by distance between locations. Cross-classified multi-level models estimated associations with BMI. Results Home neighborhoods had more favorable social environments while workplaces had more favorable SES and physical environments. Workplace and home measures were correlated (0.39–0.70) and differences between home and workplaces were larger as distance increased. Associations between BMI and neighborhood SES and recreational facilities were stronger for home environment (P≤0.05) but did not significantly differ for healthy food, safety, or social cohesion. Healthy food availability at home and work appeared to act synergistically (interaction P=0.01). Conclusions Consideration of workplace environment may enhance our understanding of how place affects BMI. PMID:23868527

Creating a Highly Reliable Neonatal Intensive Care Unit Through Safer Systems of Care.

PubMed

Panagos, Patoula G; Pearlman, Stephen A

2017-09-01

Neonates requiring intensive care are at high risk for medical errors due to their unique characteristics and high acuity. Designing a safer work environment begins with safe processes. Creating a culture of safety demands the involvement of all organizational levels and an interdisciplinary approach. Adverse events can result from suboptimal communication and lack of a shared mental model. This chapter describes tools to promote better patient safety in the NICU through monitoring adverse events, improving communication and using information technology. Unplanned extubation is an example of a neonatal safety concern that can be reduced by employing quality improvement methodology. Copyright © 2017 Elsevier Inc. All rights reserved.

Survey of safety practices among hospital laboratories in Oromia Regional State, Ethiopia.

PubMed

Sewunet, Tsegaye; Kebede, Wakjira; Wondafrash, Beyene; Workalemau, Bereket; Abebe, Gemeda

2014-10-01

Unsafe working practices, working environments, disposable waste products, and chemicals in clinical laboratories contribute to infectious and non-infectious hazards. Staffs, the community, and patients are less safe. Furthermore, such practices compromise the quality of laboratory services. We conducted a study to describe safety practices in public hospital laboratories of Oromia Regional State, Ethiopia. Randomly selected ten public hospital laboratories in Oromia Regional State were studied from Oct 2011- Feb 2012. Self-administered structured questionnaire and observation checklists were used for data collection. The respondents were heads of the laboratories, senior technicians, and safety officers. The questionnaire addressed biosafety label, microbial hazards, chemical hazards, physical/mechanical hazards, personal protective equipment, first aid kits and waste disposal system. The data was analyzed using descriptive analysis with SPSS version16 statistical software. All of the respondents reported none of the hospital laboratories were labeled with the appropriate safety label and safety symbols. These respondents also reported they may contain organisms grouped under risk group IV in the absence of microbiological safety cabinets. Overall, the respondents reported that there were poor safety regulations or standards in their laboratories. There were higher risks of microbial, chemical and physical/mechanical hazards. Laboratory safety in public hospitals of Oromia Regional State is below the standard. The laboratory workers are at high risk of combined physical, chemical and microbial hazards. Prompt recognition of the problem and immediate action is mandatory to ensure safe working environment in health laboratories.

The electromagnetic environment of Magnetic Resonance Imaging systems. Occupational exposure assessment reveals RF harmonics

NASA Astrophysics Data System (ADS)

Gourzoulidis, G.; Karabetsos, E.; Skamnakis, N.; Kappas, C.; Theodorou, K.; Tsougos, I.; Maris, T. G.

2015-09-01

Magnetic Resonance Imaging (MRI) systems played a crucial role in the postponement of the former occupational electromagnetic fields (EMF) European Directive (2004/40/EC) and in the formation of the latest exposure limits adopted in the new one (2013/35/EU). Moreover, the complex MRI environment will be finally excluded from the implementation of the new occupational limits, leading to an increased demand for Occupational Health and Safety (OHS) surveillance. The gradient function of MRI systems and the application of the RF excitation frequency result in low and high frequency exposures, respectively. This electromagnetic field exposure, in combination with the increased static magnetic field exposure, makes the MRI environment a unique case of combined EMF exposure. The electromagnetic field levels in close proximity of different MRI systems have been assessed at various frequencies. Quality Assurance (QA) & safety issues were also faced. Preliminary results show initial compliance with the forthcoming limits in each different frequency band, but also revealed peculiar RF harmonic components, of no safety concern, to the whole range detected (20-1000MHz). Further work is needed in order to clarify their origin and characteristics.

Effects of nursing unit spatial layout on nursing team communication patterns, quality of care, and patient safety.

PubMed

Hua, Ying; Becker, Franklin; Wurmser, Teri; Bliss-Holtz, Jane; Hedges, Christine

2012-01-01

Studies investigating factors contributing to improved quality of care have found that effective team member communication is among the most critical and influential aspects in the delivery of quality care. Relatively little research has examined the role of the physical design of nursing units on communication patterns among care providers. Although the concept of decentralized unit design is intended to increase patient safety, reduce nurse fatigue, and control the noisy, chaotic, and crowded space associated with centralized nursing stations, until recently little attention has been paid to how such nursing unit designs affected communication patterns or other medical and organizational outcomes. Using a pre/post research design comparing more centralized or decentralized unit designs with a new multi-hub design, the aim of this study was to describe the relationship between the clinical spatial environment and its effect on communication patterns, nurse satisfaction, distance walked, organizational outcomes, patient safety, and patient satisfaction. Hospital institutional data indicated that patient satisfaction increased substantially. Few significant changes were found in communication patterns; no significant changes were found in nurse job satisfaction, patient falls, pressure ulcers, or organizational outcomes such as average length of stay or patient census.

Efforts to improve patient safety in large, capitated medical groups: description and conceptual model.

PubMed

Miller, Robert H; Bovbjerg, Randall R

2002-06-01

Medical care should be safer. Inpatient problems and solutions have received the most attention; this outpatient qualitative case study addresses a gap in knowledge. We describe safety improvements among large physician groups, model the key influences on their behavior, and identify beneficial public and private policies. All groups were trying to reduce medical injury, which was part of the sample design. The most commonly targeted problems are those that are similar across groups: shortcomings in diagnosis, abnormal tests follow-up, scope of practice and referral patterns, and continuity of care. Medical group innovators vary greatly, however, in implementation of improvements, that is, in the extent to which they implement process changes that identify events/problems, analyze and track incidents, decide how to change clinical and administrative practices, and monitor impacts of the changes. Our conceptual model identifies key determinants: (1) demand for safety comes from external factors: legal, market, and professional; (2) organizational responses depend on internal factors: group size, scope, and integration; leadership and governance; professional culture; information-system assets; and financial and intellectual capital. Further, safety is an aspect of quality (the same tools, decision making, interventions, and monitoring apply), and safety management benefits from prior efficiency management (similar skills and culture of innovation). Observed variation in even simple safeguards shows that existing safety incentives are too weak. Our model suggests that the biggest improvement would come from boosting the demand for quality and safety from both private and public larger group purchasers. Current policy relies too much on litigation and discipline, which have sometimes helped, but not solved, problems because they are inefficient, tend to drive needed information underground, and complicate needed cultural change. Patients' safety demand is also weak for want of information and market power. Big purchasers' demands, however, quickly influence the internal environment of medical groups, helping managers advance quality safety toward the top of groups' congested decision-making "queues."

Health care work environments, employee satisfaction, and patient safety: Care provider perspectives.

PubMed

Rathert, Cheryl; May, Douglas R

2007-01-01

Experts continue to decry the lack of progress made in decreasing the alarming frequency of medical errors in health care organizations (Leape, L. L., & Berwick, D. M. (2005). Five years after to err is human: What have we learned?. Journal of the American Medical Association, 293(19), 2384-2390). At the same time, other experts are concerned about the lack of job satisfaction and turnover among nurses (. Keeping patients safe: Transforming the work environment of nurses. Washington, DC: National Academy Press). Research and theory suggest that a work environment that facilitates patient-centered care should increase patient safety and nurse satisfaction. The present study began with a conceptual model that specifies how work environment variables should be related to both nurse and patient outcomes. Specifically, we proposed that health care work units with climates for patient-centered care should have nurses who are more satisfied with their jobs. Such units should also have higher levels of patient safety, with fewer medication errors. We examined perceptions of nurses from three acute care hospitals in the eastern United States. Nurses who perceived their work units as more patient centered were significantly more satisfied with their jobs than were those whose units were perceived as less patient centered. Those whose work units were more patient centered reported that medication errors occurred less frequently in their units and said that they felt more comfortable reporting errors and near-misses than those in less patient-centered units. Patients and quality leaders continue to call for delivery of patient-centered care. If climates that facilitate such care are also related to improved patient safety and nurse satisfaction, proactive, patient-centered management of the work environment could result in improved patient, employee, and organizational outcomes.

Environmental Quality of Schools. Report to the New York State Board of Regents.

ERIC Educational Resources Information Center

New York State Education Dept., Albany.

Education reform, besides focusing on teaching and learning, must also address the need to maintain a safe, secure, and healthy school environment. As outlined in "A New Compact for Learning," the New York State Education Department and New York educators are responsible for ensuring the safety of school buildings. Students in school…

Can the Tools of Activity Theory Help Us in Advancing Understanding and Organisational Change in Undergraduate Medical Education?

ERIC Educational Resources Information Center

Reid, Anne-Marie; Ledger, Alison; Kilminster, Sue; Fuller, Richard

2015-01-01

Continued changes to healthcare delivery in the UK, and an increasing focus on patient safety and quality improvement, require a radical rethink on how we enable graduates to begin work in challenging, complex environments. Professional regulatory bodies now require undergraduate medical schools to implement an "assistantship" period in…

Discrimination of crop and weeds on visible and visible/near-infrared spectrums using support vector machines, artificial neural network and decision tree

USDA-ARS?s Scientific Manuscript database

Weeds are regarded as farmers' natural enemy. In order to avoid excessive pesticide residues, the destruction of ecological environment, and to guarantee the quality and safety of agricultural products, it is urgent to develop highly-efficient weed management methods. Amongst, weed discrimination is...

Sustainable waste management through end-of-waste criteria development.

PubMed

Zorpas, Antonis A

2016-04-01

The Waste Framework Directive 2000/98 (WFD) contains specific requirements to define end-of-waste criteria (EWC). The main goal of EWC is to remove and eliminate the administrative loads of waste legislation for safe and high-quality waste materials, thereby facilitating and assisting recycling. The target is to produce effective with high quality of recyclables materials, promoting product standardization and quality and safety assurance, and improving harmonization and legal certainty in the recyclable material markets. At the same time, those objectives aim to develop a plan in order to improve the development and wider use of environmental technologies, which reduce pressure on environment and at the same time address the three dimensions of the Lisbon strategy: growth, jobs and environment. This paper presents the importance of EWC, and the approach of setting EWC as EWC affect several management systems as well as sustainable and clean technologies.

Using Smart Pumps to Understand and Evaluate Clinician Practice Patterns to Ensure Patient Safety

PubMed Central

Mansfield, Jennifer; Jarrett, Steven

2013-01-01

Background: Safety software installed on intravenous (IV) infusion pumps has been shown to positively impact the quality of patient care through avoidance of medication errors. The data derived from the use of smart pumps are often overlooked, although these data provide helpful insight into the delivery of quality patient care. Objective: The objectives of this report are to describe the value of implementing IV infusion safety software and analyzing the data and reports generated by this system. Case study: Based on experience at the Carolinas HealthCare System (CHS), executive score cards provide an aggregate view of compliance rate, number of alerts, overrides, and edits. The report of serious errors averted (ie, critical catches) supplies the location, date, and time of the critical catch, thereby enabling management to pinpoint the end-user for educational purposes. By examining the number of critical catches, a return on investment may be calculated. Assuming 3,328 of these events each year, an estimated cost avoidance would be $29,120,000 per year for CHS. Other reports allow benchmarking between institutions. Conclusion: A review of the data about medication safety across CHS has helped garner support for a medication safety officer position with the goal of ultimately creating a safer environment for the patient. PMID:24474836

Effect of gallic acid/chitosan coating on fresh pork quality in modified atmosphere packaging.

PubMed

Fang, Zhongxiang; Lin, Daniel; Warner, Robyn Dorothy; Ha, Minh

2018-09-15

Fresh meat safety and quality is a major concern of consumers in the current food market. The objective of this research was to investigate a newly developed gallic acid/chitosan edible coating on the preservation of fresh pork quality in modified atmosphere package (MAP) stored at 4 °C. The pork loins were coated with 2% chitosan (CHI), 0.2% gallic acid in 2% chitosan (CHI/0.2G), or 0.4% gallic acid in 2% chitosan (CHI/0.4G). Results showed that the antimicrobial activity of the chitosan coating was increased with the incorporation of gallic acid. The CHI/0.2G and CHI/0.4G pork loins also had lower lipid oxidation and myoglobin oxidation. However, the CHI/0.4G sample exhibited a pro-protein oxidation effect, suggesting an optimal concentration of gallic acid should be incorporated. This research provides a practical method in application of gallic acid/chitosan coatings on preservation of fresh pork to improve the safety and quality in MAP environment. Copyright © 2018 Elsevier Ltd. All rights reserved.

Are Staffing, Work Environment, Work Stressors, and Rationing of Care Related to Care Workers' Perception of Quality of Care? A Cross-Sectional Study.

PubMed

Zúñiga, Franziska; Ausserhofer, Dietmar; Hamers, Jan P H; Engberg, Sandra; Simon, Michael; Schwendimann, René

2015-10-01

To describe care worker-reported quality of care and to examine its relationship with staffing variables, work environment, work stressors, and implicit rationing of nursing care. Cross-sectional study. National, randomly selected sample of Swiss nursing homes, stratified according to language region and size. A total of 4311 care workers of all educational backgrounds (registered nurses, licensed practical nurses, nurse aides) from 402 units in 155 nursing homes completed a survey between May 2012 and April 2013. Care worker-reported quality of care was measured with a single item; predictors were assessed with established instruments (eg, Practice Environment Scale-Nurse Working Index) adapted for nursing home use. A multilevel logistic regression model was applied to assess predictors for quality of care. Overall, 7% of care workers rated the quality of care provided as rather low or very low. Important factors related to better quality of care were higher teamwork and safety climate (odds ratio [OR] 6.19, 95% confidence interval [CI] 4.36-8.79); better staffing and resources adequacy (OR 2.94, 95% CI 2.08-4.15); less stress due to workload (OR 0.71, 95% CI 0.55-0.93); less implicit rationing of caring, rehabilitation, and monitoring (OR 0.34, 95% CI 0.24-0.49); and less rationing of social care (OR 0.80, 95% CI 0.69-0.92). Neither leadership nor staffing levels, staff mix, or turnover was significantly related to quality of care. Work environment factors and organizational processes are vital to provide high quality of care. The improvement of work environment, support in handling work stressors, and reduction of rationing of nursing care might be intervention points to promote high quality of care in nursing homes. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Regulatory Science in Professional Education.

PubMed

Akiyama, Hiroshi

2017-01-01

In the field of pharmaceutical sciences, the subject of regulatory science (RS) includes pharmaceuticals, food, and living environments. For pharmaceuticals, considering the balance between efficacy and safety is a point required for public acceptance, and in that balance, more importance is given to efficacy in curing disease. For food, however, safety is the most important consideration for public acceptance because food should be essentially free of risk. To ensure food safety, first, any hazard that is an agent in food or condition of food with the potential to cause adverse health effects should be identified and characterized. Then the risk that it will affect public health is scientifically analyzed. This process is called risk assessment. Second, risk management should be conducted to reduce a risk that has the potential to affect public health found in a risk assessment. Furthermore, risk communication, which is the interactive exchange of information and opinions concerning risk and risk management among risk assessors, risk managers, consumers, and other interested parties, should be conducted. Food safety is ensured based on risk analysis consisting of the three components of risk assessment, risk management, and risk communication. RS in the field of food safety supports risk analysis, such as scientific research and development of test methods to evaluate food quality, efficacy, and safety. RS is also applied in the field of living environments because the safety of environmental chemical substances is ensured based on risk analysis, similar to that conducted for food.

[The value of glucose-positive coliform bacteria and potentially pathogenic bacteria as indicators of epidemiological safety of tap water].

PubMed

Zhuravlev, P V; Aleshnia, V V; Panasovets, O P; Morozova, A A; Artemova, T Z; Talaeva, Iu G; Zagaĭnova, A V; Gipp, E K

2012-01-01

Due to intensive anthropogenic pollution of water environment generally accepted indicators of epidemic security of water bodies - common bacteria and thermotolerant coliform bacteria do not always permit to obtain an objective characterization of bacterial contamination of tap water. From the point of view of authors the integral index - glucose positive coliform bacteria most adequately reflect the sanitary-hygienic and epidemiological situation of water bodies. In monitoring for bacterial quality of tap water it is advisable to determine glucose positive coliform bacteria, that will provide the relevance of estimation of the epidemiological safety of water use. According to the method developed by the authors the calculation of the index of population risk of acute intestinal infections occurrence in dependence on the quality of tap water in Azov and Tsimlyansk towns.

Climate Change and Food Security: Health Impacts in Developed Countries

PubMed Central

Hooper, Lee; Abdelhamid, Asmaa; Bentham, Graham; Boxall, Alistair B.A.; Draper, Alizon; Fairweather-Tait, Susan; Hulme, Mike; Hunter, Paul R.; Nichols, Gordon; Waldron, Keith W.

2012-01-01

Background: Anthropogenic climate change will affect global food production, with uncertain consequences for human health in developed countries. Objectives: We investigated the potential impact of climate change on food security (nutrition and food safety) and the implications for human health in developed countries. Methods: Expert input and structured literature searches were conducted and synthesized to produce overall assessments of the likely impacts of climate change on global food production and recommendations for future research and policy changes. Results: Increasing food prices may lower the nutritional quality of dietary intakes, exacerbate obesity, and amplify health inequalities. Altered conditions for food production may result in emerging pathogens, new crop and livestock species, and altered use of pesticides and veterinary medicines, and affect the main transfer mechanisms through which contaminants move from the environment into food. All these have implications for food safety and the nutritional content of food. Climate change mitigation may increase consumption of foods whose production reduces greenhouse gas emissions. Impacts may include reduced red meat consumption (with positive effects on saturated fat, but negative impacts on zinc and iron intake) and reduced winter fruit and vegetable consumption. Developed countries have complex structures in place that may be used to adapt to the food safety consequences of climate change, although their effectiveness will vary between countries, and the ability to respond to nutritional challenges is less certain. Conclusions: Climate change will have notable impacts upon nutrition and food safety in developed countries, but further research is necessary to accurately quantify these impacts. Uncertainty about future impacts, coupled with evidence that climate change may lead to more variable food quality, emphasizes the need to maintain and strengthen existing structures and policies to regulate food production, monitor food quality and safety, and respond to nutritional and safety issues that arise. PMID:23124134

Climate change and food security: health impacts in developed countries.

PubMed

Lake, Iain R; Hooper, Lee; Abdelhamid, Asmaa; Bentham, Graham; Boxall, Alistair B A; Draper, Alizon; Fairweather-Tait, Susan; Hulme, Mike; Hunter, Paul R; Nichols, Gordon; Waldron, Keith W

2012-11-01

Anthropogenic climate change will affect global food production, with uncertain consequences for human health in developed countries. We investigated the potential impact of climate change on food security (nutrition and food safety) and the implications for human health in developed countries. Expert input and structured literature searches were conducted and synthesized to produce overall assessments of the likely impacts of climate change on global food production and recommendations for future research and policy changes. Increasing food prices may lower the nutritional quality of dietary intakes, exacerbate obesity, and amplify health inequalities. Altered conditions for food production may result in emerging pathogens, new crop and livestock species, and altered use of pesticides and veterinary medicines, and affect the main transfer mechanisms through which contaminants move from the environment into food. All these have implications for food safety and the nutritional content of food. Climate change mitigation may increase consumption of foods whose production reduces greenhouse gas emissions. Impacts may include reduced red meat consumption (with positive effects on saturated fat, but negative impacts on zinc and iron intake) and reduced winter fruit and vegetable consumption. Developed countries have complex structures in place that may be used to adapt to the food safety consequences of climate change, although their effectiveness will vary between countries, and the ability to respond to nutritional challenges is less certain. Climate change will have notable impacts upon nutrition and food safety in developed countries, but further research is necessary to accurately quantify these impacts. Uncertainty about future impacts, coupled with evidence that climate change may lead to more variable food quality, emphasizes the need to maintain and strengthen existing structures and policies to regulate food production, monitor food quality and safety, and respond to nutritional and safety issues that arise.

The physical environment, activity and interaction in residential care facilities for older people: a comparative case study.

PubMed

Nordin, Susanna; McKee, Kevin; Wallinder, Maria; von Koch, Lena; Wijk, Helle; Elf, Marie

2017-12-01

The physical environment is of particular importance for supporting activities and interactions among older people living in residential care facilities (RCFs) who spend most of their time inside the facility. More knowledge is needed regarding the complex relationships between older people and environmental aspects in long-term care. The present study aimed to explore how the physical environment influences resident activities and interactions at two RCFs by using a mixed-method approach. Environmental assessments were conducted via the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM), and resident activities, interactions and locations were assessed through an adapted version of the Dementia Care Mapping (DCM). The Observed Emotion Rating Scale (OERS) was used to assess residents' affective states. Field notes and walk-along interviews were also used. Findings indicate that the design of the physical environment influenced the residents' activities and interactions. Private apartments and dining areas showed high environmental quality at both RCFs, whereas the overall layout had lower quality. Safety was highly supported. Despite high environmental quality in general, several factors restricted resident activities. To optimise care for older people, the design process must clearly focus on accessible environments that provide options for residents to use the facility independently. © 2016 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.

The effectiveness of an aged care specific leadership and management program on workforce, work environment, and care quality outcomes: design of a cluster randomised controlled trial

PubMed Central

2013-01-01

Background A plethora of observational evidence exists concerning the impact of management and leadership on workforce, work environment, and care quality. Yet, no randomised controlled trial has been conducted to test the effectiveness of leadership and management interventions in aged care. An innovative aged care clinical leadership program (Clinical Leadership in Aged Care − CLiAC) was developed to improve managers’ leadership capacities to support the delivery of quality care in Australia. This paper describes the study design of the cluster randomised controlled trial testing the effectiveness of the program. Methods Twenty-four residential and community aged care sites were recruited as managers at each site agreed in writing to participate in the study and ensure that leaders allocated to the control arm would not be offered the intervention program. Sites undergoing major managerial or structural changes were excluded. The 24 sites were randomly allocated to receive the CLiAC program (intervention) or usual care (control), stratified by type (residential vs. community, six each for each arm). Treatment allocation was masked to assessors and staff of all participating sites. The objective is to establish the effectiveness of the CLiAC program in improving work environment, workforce retention, as well as care safety and quality, when compared to usual care. The primary outcomes are measures of work environment, care quality and safety, and staff turnover rates. Secondary outcomes include manager leadership capacity, staff absenteeism, intention to leave, stress levels, and job satisfaction. Differences between intervention and control groups will be analysed by researchers blinded to treatment allocation using linear regression of individual results adjusted for stratification and clustering by site (primary analysis), and additionally for baseline values and potential confounders (secondary analysis). Outcomes measured at the site level will be compared by cluster-level analysis. The overall costs and benefits of the program will also be assessed. Discussion The outcomes of the trial have the potential to inform actions to enhance leadership and management capabilities of the aged care workforce, address pressing issues about workforce shortages, and increase the quality of aged care services. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12611001070921) PMID:24160714

Redirecting traditional professional values to support safety: changing organisational culture in health care.

PubMed

Carroll, J S; Quijada, M A

2004-12-01

Professionals in healthcare organisations who seek to enhance safety and quality in an increasingly demanding industry environment often identify culture as a barrier to change. The cultural focus on individual autonomy, for example, seems to conflict with desired norms of teamwork, problem reporting, and learning. We offer a definition and explication of why culture is important to change efforts. A cultural analysis of health care suggests professional values that can be redirected to support change. We offer examples of organisations that drew upon cultural strengths to create new ways of working and gradually shifted the culture.

Redirecting traditional professional values to support safety: changing organisational culture in health care

PubMed Central

Carroll, J; Quijada, M

2004-01-01

Professionals in healthcare organisations who seek to enhance safety and quality in an increasingly demanding industry environment often identify culture as a barrier to change. The cultural focus on individual autonomy, for example, seems to conflict with desired norms of teamwork, problem reporting, and learning. We offer a definition and explication of why culture is important to change efforts. A cultural analysis of health care suggests professional values that can be redirected to support change. We offer examples of organisations that drew upon cultural strengths to create new ways of working and gradually shifted the culture. PMID:15576686

Safety considerations in the design and operation of large wind turbines

NASA Technical Reports Server (NTRS)

Reilly, D. H.

1979-01-01

The engineering and safety techniques used to assure the reliable and safe operation of large wind turbine generators utilizing the Mod 2 Wind Turbine System Program as an example is described. The techniques involve a careful definition of the wind turbine's natural and operating environments, use of proven structural design criteria and analysis techniques, an evaluation of potential failure modes and hazards, and use of a fail safe and redundant component engineering philosophy. The role of an effective quality assurance program, tailored to specific hardware criticality, and the checkout and validation program developed to assure system integrity are described.

Financial analysis for the infusion alliance.

PubMed

Perucca, Roxanne

2010-01-01

Providing high-quality, cost-efficient care is a major strategic initiative of every health care organization. Today's health care environment is transparent; very competitive; and focused upon providing exceptional service, safety, and quality. Establishing an infusion alliance facilitates the achievement of organizational strategic initiatives, that is, increases patient throughput, decreases length of stay, prevents the occurrence of infusion-related complications, enhances customer satisfaction, and provides greater cost-efficiency. This article will discuss how to develop a financial analysis that promotes value and enhances the financial outcomes of an infusion alliance.

Failing to Fix What is Found: Risk Accommodation in the Oil and Gas Industry.

PubMed

Stackhouse, Madelynn R D; Stewart, Robert

2017-01-01

The present program of research synthesizes the findings from three studies in line with two goals. First, the present research explores how the oil and gas industry is performing at risk mitigation in terms of finding and fixing errors when they occur. Second, the present research explores what factors in the work environment relate to a risk-accommodating environment. Study 1 presents a descriptive evaluation of high-consequence incidents at 34 oil and gas companies over a 12-month period (N = 873), especially in terms of those companies' effectiveness at investigating and fixing errors. The analysis found that most investigations were fair in terms of quality (mean = 75.50%), with a smaller proportion that were weak (mean = 11.40%) or strong (mean = 13.24%). Furthermore, most companies took at least one corrective action for high-consequence incidents, but few of these corrective actions were confirmed as having been completed (mean = 13.77%). In fact, most corrective actions were secondary interim administrative controls (e.g., having a safety meeting) rather than fair or strong controls (e.g., training, engineering elimination). Study 2a found that several environmental factors explain the 56.41% variance in safety, including management's disengagement from safety concerns, finding and fixing errors, safety management system effectiveness, training, employee safety, procedures, and a production-over-safety culture. Qualitative results from Study 2b suggest that a compliance-based culture of adhering to liability concerns, out-group blame, and a production-over-safety orientation may all impede safety effectiveness. © 2016 Society for Risk Analysis.

Discharge of swine wastes risks water quality and food safety: Antibiotics and antibiotic resistance genes from swine sources to the receiving environments.

PubMed

He, Liang-Ying; Ying, Guang-Guo; Liu, You-Sheng; Su, Hao-Chang; Chen, Jun; Liu, Shuang-Shuang; Zhao, Jian-Liang

2016-01-01

Swine feedlots are widely considered as a potential hotspot for promoting the dissemination of antibiotic resistance genes (ARGs) in the environment. ARGs could enter the environment via discharge of animal wastes, thus resulting in contamination of soil, water, and food. We investigated the dissemination and diversification of 22 ARGs conferring resistance to sulfonamides, tetracyclines, chloramphenicols, and macrolides as well as the occurrence of 18 corresponding antibiotics from three swine feedlots to the receiving water, soil environments and vegetables. Most ARGs and antibiotics survived the on-farm waste treatment processes in the three swine farms. Elevated diversity of ARGs was observed in the receiving environments including river water and vegetable field soils when compared with respective controls. The variation of ARGs along the vertical soil profiles of vegetable fields indicated enrichment and migration of ARGs. Detection of various ARGs and antibiotic residues in vegetables fertilized by swine wastes could be of great concern to the general public. This research demonstrated the contribution of swine wastes to the occurrence and development of antibiotic resistance determinants in the receiving environments and potential risks to food safety and human health. Copyright © 2016 Elsevier Ltd. All rights reserved.

Measuring Neighborhood Walkable Environments: A Comparison of Three Approaches

PubMed Central

Chiang, Yen-Cheng; Sullivan, William; Larsen, Linda

2017-01-01

Multiple studies have revealed the impact of walkable environments on physical activity. Scholars attach considerable importance to leisure and health-related walking. Recent studies have used Google Street View as an instrument to assess city streets and walkable environments; however, no study has compared the validity of Google Street View assessments of walkable environment attributes to assessments made by local residents and compiled from field visits. In this study, we involved nearby residents and compared the extent to which Google Street View assessments of the walkable environment correlated with assessments from local residents and with field visits. We determined the assessment approaches (local resident or field visit assessments) that exhibited the highest agreement with Google Street View. One city with relatively high-quality walkable environments and one city with relatively low-quality walkable environments were examined, and three neighborhoods from each city were surveyed. Participants in each neighborhood used one of three approaches to assess the walkability of the environment: 15 local residents assessed the environment using a map, 15 participants made a field visit to assess the environment, and 15 participants used Google Street View to assess the environment, yielding a total of 90 valid samples for the two cities. Findings revealed that the three approaches to assessing neighborhood walkability were highly correlated for traffic safety, aesthetics, sidewalk quality, and physical barriers. Compared with assessments from participants making field visits, assessments by local residents were more highly correlated with Google Street View assessments. Google Street View provides a more convenient, low-cost, efficient, and safe approach to assess neighborhood walkability. The results of this study may facilitate future large-scale walkable environment surveys, effectively reduce expenses, and improve survey efficiency. PMID:28587186

Science in a Box: An Educator Guide with NASA Glovebox Activities in Science, Math, and Technology.

ERIC Educational Resources Information Center

National Aeronautics and Space Administration, Washington, DC. Education Dept.

The Space Shuttle and International Space Station provide a unique microgravity environment for research that is a critical part of the National Aeronautics and Space Administration's (NASA) mission to improve the quality of life on Earth and enable the health and safety of space explorers for long duration missions beyond our solar system. This…

The NASA Risk Management Program

NASA Technical Reports Server (NTRS)

Buchbinder, Benjamin

1990-01-01

This paper describes the NASA Risk Management Program established by the Headquarters Office of Safety and Mission Quality (MSQ). Current agency policy is outlined, risk management assistance to the field is described, and examples are given of independent risk assessments conducted by SMQ. The motivation for and the structure of the program is placed in the historical context of pre- and post-Challenger environments.

Guide for Developing High-Quality Emergency Operations Plans for Institutions of Higher Education

ERIC Educational Resources Information Center

Office of Safe and Healthy Students, US Department of Education, 2013

2013-01-01

Our nation's postsecondary institutions are entrusted to provide a safe and healthy learning environment for students, faculty, and staff who live, work, and study on campus. Many of these emergencies occur with little to no warning; therefore, it is critical for institutions of higher education (IHEs) to plan ahead to help ensure the safety and…

Resident Well-Being, Community Connections, and Neighbourhood Perceptions, Pride, and Opportunities among Disadvantage Metropolitan and Regional Communities: Evidence from the Neighbourhood Renewal Project

ERIC Educational Resources Information Center

Renzaho, Andre M. N.; Richardson, Ben; Strugnell, Claudia

2012-01-01

The current study aims investigate the relationship between participants' neighbourhood perceptions and social capital and resident well-being using data from the Neighbourhood Renewal Project (NRP; n = 7855). Resident well-being was positively associated with the quality of the physical environment and safety of the neighbourhood, but negatively…

Food insecurity, diet quality and body mass index of women participating in the Supplemental Nutrition Assistance Program: The role of intrapersonal, home environment, community and social factors.

PubMed

Sanjeevi, Namrata; Freeland-Graves, Jeanne; Hersh, Matthew

2018-06-01

Obesity is a public health problem that disproportionately affects low-income populations. Moreover, participation in Supplemental Nutrition Assistance Program (SNAP) has been associated with obesity among low-income women. The goal of this study was to determine the impact of intrapersonal, home environment, community and social factors on diet quality and body mass index (BMI) of low-income women participating in SNAP. This study also aimed to examine the role of these factors in mediating the relationship between food insecurity and diet quality, and BMI. A total of 152 women receiving SNAP benefits were recruited from low-income neighborhood centers and housing communities, and administered a demographics questionnaire, the United States adult food security scale, food frequency questionnaire, and multi-dimensional home environment scale (MHES). They also were measured for height and weight to calculate BMI. The Dietary Guidelines Adherence Index 2015 was used to measure diet quality. Regression analyses were conducted to determine the MHES subscales that were significant predictors of diet quality and BMI. The Preacher and Hayes mediation model was used to evaluate the mediation of the relationship between food insecurity and diet quality, and BMI by the MHES. Emotional eating resistance and favorable social eating behaviors were positively associated with diet quality; whereas emotional eating resistance, lower availability of unhealthy food at home, neighborhood safety and favorable social eating behaviors were inversely associated with BMI in women participating in SNAP. The MHES significantly mediated the relationship between food insecurity and BMI. These results emphasize the importance of intrapersonal, home environment, community and social factors in mediating the relationship between food insecurity and BMI in low-income women. Copyright © 2018 Elsevier Ltd. All rights reserved.

Examining influences on speaking up among critical care healthcare providers in the United Arab Emirates.

PubMed

Edrees, Hanan H; Ismail, Mohd Nasir Mohd; Kelly, Bernadette; Goeschel, Christine A; Berenholtz, Sean M; Pronovost, Peter J; Al Obaidli, Ali Abdul Kareem; Weaver, Sallie J

2017-11-01

Assess perceived barriers to speaking up and to provide recommendations for reducing barriers to reporting adverse events and near misses. A six-item survey was administered to critical care providers in 19 Intensive Care Units in Abu Dhabi as part of an organizational safety and quality improvement effort. Questions elicited perspectives about influences on reporting, perceived barriers and recommendations for conveying patient safety as an organizational priority. Qualitative thematic analyses were conducted for open-ended questions. A total of 1171 participants were invited to complete the survey and 639 responded (response rate = 54.6%). Compared to other stakeholders (e.g. the media, public), a larger proportion of respondents 'agreed/strongly agreed' that corporate health system leadership and the health regulatory authority encouraged and supported error reporting (83%; 75%), and had the most influence on their decisions to report (81%; 74%). 29.5% of respondents cited fear of repercussion as a barrier, and 21.3% of respondents indicated no barriers to reporting. Barriers included perceptions of a culture of blame and issues with reporting procedures. Recommendations to establish patient safety as an organizational priority included creating supportive environments to discuss errors, hiring staff to advocate for patient safety, and implementing policies to standardize clinical practices and streamline reporting procedures. Influences on reporting perceived by providers in the UAE were similar to those in the US and other countries. These findings highlight the roles of corporate leadership and regulators in developing non-punitive environments where reporting is a valuable and safe activity. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

75 FR 73946 - Worker Safety and Health Program: Safety Conscious Work Environment

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-30

... DEPARTMENT OF ENERGY 10 CFR Part 851 Worker Safety and Health Program: Safety Conscious Work... Nuclear Regulatory Commission's ``Safety-Conscious Work Environment'' guidelines as a model. DOE published.... Second, not only would instituting a ``Safety-Conscious Work Environment'' by regulation be redundant...

Ergonomics solution for crossing collisions based on field assessment of visual environment at urban intersections in Japan.

PubMed

Mori, Midori; Horino, Sadao; Kitajima, Sou; Ueyama, Masaru; Ebara, Takeshi; Itani, Toru

2008-11-01

This paper aims to assess quantitatively the actual visual environment of uncontrolled urban downtown intersections in Japan in relation to frequently occurring crossing collisions and to discuss the safety countermeasures for them. In Field Study 1 dealing with direct visibility, our ultra-wide-angle photograph analysis revealed that most of the right/left-ward visible range at 11 intersections were insufficient to check safety, and the quality of direct visibility was closely associated with causing crossing collisions. The countermeasures to reduce a blind area were determined to be a top priority. In Field Study 2 dealing with indirect visibility, more than half of the 25 traffic convex mirrors had marked shortcomings for preventive safety, and ergonomics guidelines ensuring indirect visibility were proposed for installing traffic convex mirrors. Low-cost/low-technology-oriented countermeasures are highly recommended to obtain clear/sufficient images of crucial information satisfying drivers' requirements on traffic convex mirrors in accordance with those ergonomics guidelines was highly recommended. Crossing collisions could be prevented by improvement of poor direct and indirect visibility.

The regulatory pendulum in transfusion medicine.

PubMed

Farrugia, Albert

2002-10-01

Blood banking and the manufacture of blood products have been relatively outside the influence of regulatory authorities. Several developments contributed to a revision of this environment. The transmission of acquired immunodeficiency syndrome by blood products changed the perception of blood product safety and also spawned litigation and governmental inquiries. The blood banking industry has embraced, with varying degrees of enthusiasm, the principles of systematic quality management and good manufacturing practice, which has created a substantial subindustry and has contributed to a disproportionate focus on product quality. Conventional market forces have also gradually penetrated the traditional blood economies. The public and political focus has resulted in regulatory and policy efforts being concentrated on inappropriate areas. Several of the safety efforts can be arguably described as cost-ineffective while diverting attention and resources from more important issues. An improved integration into mainstream public health policy and incorporation of objectively measured risks into regulatory policy would do much to enhance the quality of the transfusion system. This can be achieved if regulators themselves are overseen through a process that ensures performance and accountability against objective and predefined standards. A further beneficial outcome from this approach could be the harmonization of blood safety and policy measures, the need for which is being felt increasingly worldwide. Copyright 2002, Elsevier Science (USA)

As accessible as a book on a library shelf: the imperative of routine simulation in modern health care.

PubMed

Gordon, James A

2012-01-01

Technology-enhanced patient simulation has emerged as an important new modality for teaching and learning in medicine. In particular, immersive simulation platforms that replicate the clinical environment promise to revolutionize medical education by enabling an enhanced level of safety, standardization, and efficiency across health-care training. Such an experiential approach seems unique in reliably catalyzing a level of emotional engagement that fosters immediate and indelible learning and allows for increasingly reliable levels of performance evaluation-all in a completely risk-free environment. As such, medical simulation is poised to emerge as a critical component of training and certification throughout health care, promising to fundamentally enhance quality and safety across disciplines. To encourage routine simulation-based practice as part of its core quality and safety mission, Massachusetts General Hospital now incorporates simulation resources within its historic medical library (est. 1847), located at the center of the campus. In this new model, learners go to the library not only to read about a patient's illness, but also to take care of their "patient." Such an approach redefines and advances the central role of the library on the campus and ensures that simulation-based practice is centrally available as part of everyday hospital operations. This article describes the reasons for identifying simulation as an institutional priority leading up to the Massachusetts General Hospital Bicentennial Celebration (1811-2011) and for creating a simulation-based learning laboratory within a hospital library.

Current and Future Technologies for Microbiological Decontamination of Cereal Grains.

PubMed

Los, Agata; Ziuzina, Dana; Bourke, Paula

2018-06-01

Cereal grains are the most important staple foods for mankind worldwide. The constantly increasing annual production and yield is matched by demand for cereals, which is expected to increase drastically along with the global population growth. A critical food safety and quality issue is to minimize the microbiological contamination of grains as it affects cereals both quantitatively and qualitatively. Microorganisms present in cereals can affect the safety, quality, and functional properties of grains. Some molds have the potential to produce harmful mycotoxins and pose a serious health risk for consumers. Therefore, it is essential to reduce cereal grain contamination to the minimum to ensure safety both for human and animal consumption. Current production of cereals relies heavily on pesticides input, however, numerous harmful effects on human health and on the environment highlight the need for more sustainable pest management and agricultural methods. This review evaluates microbiological risks, as well as currently used and potential technologies for microbiological decontamination of cereal grains. © 2018 Institute of Food Technologists®.

Environment, Health, and Safety - Construction Subcontractors Documents |

Science.gov Websites

NREL Environment, Health, and Safety - Construction Subcontractors Documents Environment , Health, and Safety - Construction Subcontractors Documents The purpose of this page is to ensure NREL Environment, Health and Safety (EH&S) requirements are understood by construction subcontractors and

Second Insulin Pump Safety Meeting: Summary Report

PubMed Central

Zhang, Yi; Jones, Paul L.; Klonoff, David C.

2010-01-01

Diabetes Technology Society facilitated a second meeting of insulin pump experts at Mills-Peninsula Health Services, San Mateo, California on November 4, 2009, at the request of the Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories. The first such meeting was held in Bethesda, Maryland, on November 12, 2008. The group of physicians, nurses, diabetes educators, and engineers from across the United States discussed safety issues in insulin pump therapy and recommended adjustments to current insulin pump design and use to enhance overall safety. The meeting discussed safety issues in the context of pump operation; software; hardware; physical structure; electrical, biological, and chemical considerations; use; and environment from engineering, medical, nursing, and pump/user perspectives. There was consensus among meeting participants that insulin pump designs have made great progress in improving the quality of life of people with diabetes, but much more remains to be done. PMID:20307411

Linking Environmental Sustainability, Health, and Safety Data in Health Care: A Research Roadmap.

PubMed

Kaplan, Susan B; Forst, Linda

2017-08-01

Limited but growing evidence demonstrates that environmental sustainability in the health-care sector can improve worker and patient health and safety. Yet these connections are not appreciated or understood by decision makers in health-care organizations or oversight agencies. Several studies demonstrate improvements in quality of care, staff satisfaction, and work productivity related to environmental improvements in the health-care sector. A pilot study conducted by the authors found that already-collected data could be used to evaluate impacts of environmental sustainability initiatives on worker and patient health and safety, yet few hospitals do so. Future research should include a policy analysis of laws that could drive efforts to integrate these areas, elucidation of organizational models that promote sharing of environmental and health and safety data, and development of tools and methods to enable systematic linkage and evaluation of these data to expand the evidence base and improve the hospital environment.

West Valley Demonstration Project Annual Site Environmental Report Calendar Year 2011

DOE Office of Scientific and Technical Information (OSTI.GOV)

none,

2012-09-27

The West Valley Demonstration Project (WVDP) Annual Site Environmental Report (ASER) for Calendar Year 2011. The report, prepared for the U.S. Department of Energy West Valley Demonstration Project office (DOE-WVDP), summarizes the environmental protection program at the WVDP for calendar year (CY) 2011. Monitoring and surveillance of the facilities used by the DOE are conducted to verify protection of public health and safety and the environment. The report is a key component of DOE’s effort to keep the public informed of environmental conditions at the WVDP. The quality assurance protocols applied to the environmental monitoring program ensure the validity andmore » accuracy of the monitoring data. In addition to demonstrating compliance with environmental laws, regulations, and directives, evaluation of data collected in 2011 continued to indicate that WVDP activities pose no threat to public health or safety, or to the environment.« less

West Valley Demonstration Project Annual Site Environmental Report Calendar Year 2009

DOE Office of Scientific and Technical Information (OSTI.GOV)

West Valley Environmental Services LLC

2010-09-17

The West Valley Demonstration Project (WVDP) Annual Site Environmental Report (ASER) for Calendar Year 2009. The report, prepared by the U.S. Department of Energy West Valley Demonstration Project office (DOE-WVDP), summarizes the environmental protection program at the WVDP for calendar year (CY) 2009. Monitoring and surveillance of the facilities used by the DOE are conducted to verify protection of public health and safety and the environment. The report is a key component of DOE’s effort to keep the public informed of environmental conditions at the WVDP. The quality assurance protocols applied to the environmental monitoring program by the DOE ensuremore » the validity and accuracy of the monitoring data. In addition to demonstrating compliance with environmental regulations and directives, evaluation of data collected in 2009 continued to indicate that WVDP activities pose no threat to public health or safety, or to the environment.« less

West Valley Demonstration Project Annual Site Environmental Report (ASER) for Calendar Year 2014

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rendall, John D.; Steiner, Alison F.; Pendl, Michael P.

West Valley Demonstration Project (WVDP) Annual Site Environmental Report (ASER) for Calendar Year 2014. The report, prepared for the U.S. Department of Energy West Valley Demonstration Project office (DOE-WVDP), summarizes the environmental protection program at the WVDP for calendar year (CY) 2014. Monitoring and surveillance of the facilities used by the DOE are conducted to verify protection of public health and safety and the environment. The report is a key component of DOE’s effort to keep the public informed of environmental conditions at the WVDP. The quality assurance protocols applied to the environmental monitoring program ensure the validity and accuracymore » of the monitoring data. In addition to demonstrating compliance with environmental laws, regulations, and directives, evaluation of data collected in 2014 continued to indicate that WVDP activities pose no threat to public health or safety, or to the environment.« less

West Valley Demonstration Project Annual Site Environmental Report (ASER) for Calendar Year 2015

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rendall, John D.; Steiner, Alison F.; Pendl, Michael P.

West Valley Demonstration Project (WVDP) Annual Site Environmental Report (ASER) for Calendar Year 2015. The report, prepared for the U.S. Department of Energy West Valley Demonstration Project office (DOE-WVDP), summarizes the environmental protection program at the WVDP for calendar year (CY) 2015. Monitoring and surveillance of the facilities used by the DOE are conducted to verify protection of public health and safety and the environment. The report is a key component of DOE’s effort to keep the public informed of environmental conditions at the WVDP. The quality assurance protocols applied to the environmental monitoring program ensure the validity and accuracymore » of the monitoring data. In addition to demonstrating compliance with environmental laws, regulations, and directives, evaluation of data collected in 2015 continued to indicate that WVDP activities pose no threat to public health or safety, or to the environment.« less

West Valley Demonstration Project Annual Site Environmental Report Calendar Year 2013

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rendall, John D.; Steiner, Alison F.; Pendl, Michael P.

2014-09-16

West Valley Demonstration Project (WVDP) Annual Site Environmental Report (ASER) for Calendar Year 2013. The report, prepared for the U.S. Department of Energy West Valley Demonstration Project office (DOE-WVDP), summarizes the environmental protection program at the WVDP for calendar year (CY) 2013. Monitoring and surveillance of the facilities used by the DOE are conducted to verify protection of public health and safety and the environment. The report is a key component of DOE’s effort to keep the public informed of environmental conditions at the WVDP. The quality assurance protocols applied to the environmental monitoring program ensure the validity and accuracymore » of the monitoring data. In addition to demonstrating compliance with environmental laws, regulations, and directives, evaluation of data collected in 2013 continued to indicate that WVDP activities pose no threat to public health or safety, or to the environment.« less

West Valley Demonstration Project Annual Site Environmental Report (ASER) Calendar Year (2016)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Steiner, Alison F.; Pendl, Michael P.; Steiner, II, Robert E.

West Valley Demonstration Project (WVDP) Annual Site Environmental Report (ASER) for Calendar Year 2016. The report, prepared for the U.S. Department of Energy West Valley Demonstration Project office (DOE-WVDP), summarizes the environmental protection program at the WVDP for calendar year (CY) 2016. Monitoring and surveillance of the facilities used by the DOE are conducted to verify protection of public health and safety and the environment. The report is a key component of DOE’s effort to keep the public informed of environmental conditions at the WVDP. The quality assurance protocols applied to the environmental monitoring program ensure the validity and accuracymore » of the monitoring data. In addition to demonstrating compliance with environmental laws, regulations, and directives, evaluation of data collected in 2016 continued to indicate that WVDP activities pose no threat to public health or safety, or to the environment.« less

Process safety improvement--quality and target zero.

PubMed

Van Scyoc, Karl

2008-11-15

Process safety practitioners have adopted quality management principles in design of process safety management systems with positive effect, yet achieving safety objectives sometimes remain a distant target. Companies regularly apply tools and methods which have roots in quality and productivity improvement. The "plan, do, check, act" improvement loop, statistical analysis of incidents (non-conformities), and performance trending popularized by Dr. Deming are now commonly used in the context of process safety. Significant advancements in HSE performance are reported after applying methods viewed as fundamental for quality management. In pursuit of continual process safety improvement, the paper examines various quality improvement methods, and explores how methods intended for product quality can be additionally applied to continual improvement of process safety. Methods such as Kaizen, Poke yoke, and TRIZ, while long established for quality improvement, are quite unfamiliar in the process safety arena. These methods are discussed for application in improving both process safety leadership and field work team performance. Practical ways to advance process safety, based on the methods, are given.

Protocol for a realist review of workplace learning in postgraduate medical education and training.

PubMed

Wiese, Anel; Kilty, Caroline; Bergin, Colm; Flood, Patrick; Fu, Na; Horgan, Mary; Higgins, Agnes; Maher, Bridget; O'Kane, Grainne; Prihodova, Lucia; Slattery, Dubhfeasa; Bennett, Deirdre

2017-01-19

Postgraduate medical education and training (PGMET) is a complex social process which happens predominantly during the delivery of patient care. The clinical learning environment (CLE), the context for PGMET, shapes the development of the doctors who learn and work within it, ultimately impacting the quality and safety of patient care. Clinical workplaces are complex, dynamic systems in which learning emerges from non-linear interactions within a network of related factors and activities. Those tasked with the design and delivery of postgraduate medical education and training need to understand the relationship between the processes of medical workplace learning and these contextual elements in order to optimise conditions for learning. We propose to conduct a realist synthesis of the literature to address the overarching questions; how, why and in what circumstances do doctors learn in clinical environments? This review is part of a funded projected with the overall aim of producing guidelines and recommendations for the design of high quality clinical learning environments for postgraduate medical education and training. We have chosen realist synthesis as a methodology because of its suitability for researching complexity and producing answers useful to policymakers and practitioners. This realist synthesis will follow the steps and procedures outlined by Wong et al. in the RAMESES Publication Standards for Realist Synthesis and the Realist Synthesis RAMESES Training Materials. The core research team is a multi-disciplinary group of researchers, clinicians and health professions educators. The wider research group includes experts in organisational behaviour and human resources management as well as the key stakeholders; doctors in training, patient representatives and providers of PGMET. This study will draw from the published literature and programme, and substantive, theories of workplace learning, to describe context, mechanism and outcome configurations for PGMET. This information will be useful to policymakers and practitioners in PGMET, who will be able to apply our findings within their own contexts. Improving the quality of clinical learning environments can improve the performance, humanism and wellbeing of learners and improve the quality and safety of patient care. The review is not registered with the PROSPERO International Prospective Register of Systematic Reviews as the review objectives relate solely to education outcomes.

A new leadership role for pharmacists: a prescription for change.

PubMed

Burgess, L Hayley; Cohen, Michael R; Denham, Charles R

2010-03-01

Pharmacists can play an important role as leaders to reduce patient safety risks, optimize the safe function of medication management systems, and align pharmacy services with national initiatives that measure and reward quality performance. The objective of this article is to determine the actions that pharmacists can take to create a visible and sustainable safe medication management structure and system in the health care environment. An evidence-based literature search was performed to determine what actions successful pharmacist leaders have taken to improve patient safety. There is a growing number of quality and patient safety standards, as well as measures that focus specifically on medication use and education. Health care organizations must be made aware of the valuable resources that pharmacists provide and of the complexity of medication management. There are steps that pharmacist leaders can take to achieve these goals. The 10 steps that pharmacist leaders can take to create a visible and sustainable safe medication management structure and system are the following: 1. Identify and mitigate medication management risks and hazards to reduce preventable patient harm. 2. Establish pharmacy leadership structures and systems to ensure organizational awareness of medication safety gaps. 3. Support an organizational culture of safe medication use. 4. Ensure evidence-based medication regimens for all patients. 5. Have daily check-in calls/meetings, with the primary focus on significant safety or quality issues. 6. Establish a medication safety committee. 7. Perform medication safety walk-rounds to evaluate medication processes, and request front-line staff ’s input about medication safe practices. 8. Ensure that pharmacy staff engage in teamwork, skill building, and communication training. 9. Engage in readiness planning for implementation of health information technology (HIT). 10. Include medication history-taking and reviews upon entry into the organization; medication counseling and training during the discharge process; and follow-up after the transition to home.

[The significance of glucose positive coliform bacteria and potentially pathogenic bacteria as an indicator of epidemiological safety of tap water].

PubMed

Zhuravlev, P V; Aleshnya, V V; Panasovets, O P; Morozova, A A; Artemova, T Z; Talaeva, Yu G; Zagaynova, A V

2013-01-01

Due to intensive anthropogenic pollution of water environment generally accepted indicators of epidemic security of water bodies--common bacteria (CB) and thermotolerant coliform bacteria (TCB) do not always permit to obtain an objective characterization of bacterial contamination of tap water. From the point of view of authors the integral index--glucose positive coliform bacteria most adequately reflect the sanitary-hygienic and epidemiological situation of water bodies. In monitoring for bacterial quality of tap water it is advisable to determine glucose positive coliform bacteria, that will provide the relevance of estimation of the epidemiological safety of water use. According to the method developed by the authors the calculation of the index of population risk of acute intestinal infections (AHI) occurrence in dependence on the quality of tap water in Azov and Tsimlyansk towns.

Organizational culture and a safety-conscious work environment: The mediating role of employee communication satisfaction.

PubMed

Silla, Inmaculada; Navajas, Joaquin; Koves, G Kenneth

2017-06-01

A safety-conscious work environment allows high-reliability organizations to be proactive regarding safety and enables employees to feel free to report any concern without fear of retaliation. Currently, research on the antecedents to safety-conscious work environments is scarce. Structural equation modeling was applied to test the mediating role of employee communication satisfaction in the relationship between constructive culture and a safety-conscious work environment in several nuclear power plants. Employee communication satisfaction partially mediated the positive relationships between a constructive culture and a safety-conscious work environment. Constructive cultures in which cooperation, supportive relationships, individual growth and high performance are encouraged facilitate the establishment of a safety-conscious work environment. This influence is partially explained by increased employee communication satisfaction. Constructive cultures should be encouraged within organizations. In addition, managers should promote communication policies and practices that support a safety-conscious work environment. Copyright © 2017 Elsevier Ltd and National Safety Council. All rights reserved.

Investigating nurses' quality of life and work-life balance statuses in Singapore.

PubMed

Kowitlawkul, Y; Yap, S F; Makabe, S; Chan, S; Takagai, J; Tam, W W S; Nurumal, M S

2018-04-06

To investigate the key determinants of nurses' quality of life and work-life balance statuses in a tertiary hospital in Singapore. Nurses' quality of life can directly and indirectly impact patients' safety and quality of care. Therefore, identifying key factors that influence nurses' quality of life is essential in the healthcare delivery system. A descriptive quantitative study design was adopted, and validated questionnaires were used. Data were collected in a period of 3 months (March to May 2014) at a 600-bed tertiary hospital in Singapore. One thousand and forty nurses participated in the study. Social support and sense of coherence were found to be significant predictors for high quality of life in all domains. Most nurses in this study spent more time on work than their private lives. However, there was no significant difference in job satisfaction among the four groups of nurses' proportions of percentages of actual time spent on work and private life. Cultivating social support from family, friends/colleagues and supervisors can help an individual cope with stress and enhance a nurse's quality of life. Even though nurses who spent more time at work were still satisfied with their job, they might need to be aware of their physical health and work environment. Nursing policy related to nurses' physical health and environment should be established. Health promotion programmes such as physical exercise and mindfulness interventions should be conducted to promote nurses' well-being and healthy workplace environments to enhance nurses' quality of life. © 2018 International Council of Nurses.

A Review on the Rising Prevalence of International Standards: Threats or Opportunities for the Agri-Food Produce Sector in Developing Countries, with a Focus on Examples from the MENA Region.

PubMed

Faour-Klingbeil, Dima; Todd, Ewen C D

2018-03-03

Food safety standards are a necessity to protect consumers' health in today's growing global food trade. A number of studies have suggested safety standards can interrupt trade, bringing financial and technical burdens on small as well as large agri-food producers in developing countries. Other examples have shown that economical extension, key intermediaries, and funded initiatives have substantially enhanced the capacities of growers in some countries of the Middle East and North Africa (MENA) region to meet the food safety and quality requirements, and improve their access to international markets. These endeavors often compensate for the weak regulatory framework, but do not offer a sustainable solution. There is a big gap in the food safety level and control systems between countries in the MENA region and those in the developed nations. This certainly has implications for the safety of fresh produce and agricultural practices, which hinders any progress in their international food trade. To overcome the barriers of legal and private standards, food safety should be a national priority for sustainable agricultural development in the MENA countries. Local governments have a primary role in adopting the vision for developing and facilitating the implementation of their national Good Agricultural Practices (GAP) standards that are consistent with the international requirements and adapted to local policies and environment. Together, the public and private sector's support are instrumental to deliver the skills and infrastructure needed for leveraging the safety and quality level of the agri-food chain.

A Review on the Rising Prevalence of International Standards: Threats or Opportunities for the Agri-Food Produce Sector in Developing Countries, with a Focus on Examples from the MENA Region

PubMed Central

Faour-Klingbeil, Dima

2018-01-01

Food safety standards are a necessity to protect consumers’ health in today’s growing global food trade. A number of studies have suggested safety standards can interrupt trade, bringing financial and technical burdens on small as well as large agri-food producers in developing countries. Other examples have shown that economical extension, key intermediaries, and funded initiatives have substantially enhanced the capacities of growers in some countries of the Middle East and North Africa (MENA) region to meet the food safety and quality requirements, and improve their access to international markets. These endeavors often compensate for the weak regulatory framework, but do not offer a sustainable solution. There is a big gap in the food safety level and control systems between countries in the MENA region and those in the developed nations. This certainly has implications for the safety of fresh produce and agricultural practices, which hinders any progress in their international food trade. To overcome the barriers of legal and private standards, food safety should be a national priority for sustainable agricultural development in the MENA countries. Local governments have a primary role in adopting the vision for developing and facilitating the implementation of their national Good Agricultural Practices (GAP) standards that are consistent with the international requirements and adapted to local policies and environment. Together, the public and private sector’s support are instrumental to deliver the skills and infrastructure needed for leveraging the safety and quality level of the agri-food chain. PMID:29510498

Perceptions of work environment priorities: Are there any differences by company size? An ecological study.

PubMed

Nordlöf, Hasse; Wijk, Katarina; Westergren, Karl-Erik

2015-01-01

Earlier studies suggest that the quality of handling occupational health and safety (OHS) activities differs between companies of different sizes. Company size is a proxy variable for other variables affecting OHS performance. The objective of this study was to investigate if there is an association between company size and perceptions of work environment prioritizations. Data from 106 small- and medium-sized Swedish manufacturing companies was collected. One manager and one safety delegate at each company rated different aspects of their companies' work environment prioritizations with a 43-item questionnaire. Ratings were aggregated to a summary statistic for each company before analysis. No significant differences in perceptions of priority were found to be associated with company sizes. This is in contrast to earlier studies of objective differences. The respondents in small companies, however, showed significantly greater consensus in their ratings. Company size does not appear to be associated with perceptions of work environment prioritizations. Company size is an important proxy variable to study in order to understand what factors enable and obstruct safe and healthy workplaces. The work presented here should be viewed as an initial exploration to serve as direction for future academic work.

[Consumption of psychoactive substances by caregivers].

PubMed

Gauthier, Françoise

2012-11-01

Prescribed medication, self-medication or doping the use of psychoactive substances by caregivers is varied. Doping behaviour in the care environment is under-estimated and trivialised. It is often difficult to spot at an early stage and yet this consumption is not without consequences on the quality and safety of work. Gérard-Marchant general hospital in Toulouse integrates this issue into its professional risk management policy.

Enabling Medical Device Interoperability for the Integrated Clinical Environment

DTIC Science & Technology

2013-08-01

include the unique device identifier (UDI) as specified by the FDA , a logical timestamp as described above, and the data. 17 Existing adverse event...failure or malfunction that led to an adverse effect during a medical procedure. User: clinical and legal experts, IT-experts, biomed experts...diagnosis, treatment, research, safety and quality improvements, equipment management, and adverse event detection and reporting . The Medical

Assessing watershed-wildfire risks on National Forest System lands in the Rocky Mountain Region of the United States

Treesearch

Matthew P. Thompson; Joe Scott; Paul G. Langowski; Julie W. Gilbertson-Day; Jessica R. Haas; Elise M. Bowne

2013-01-01

Wildfires can cause significant negative impacts to water quality with resultant consequences for the environment and human health and safety, as well as incurring substantial rehabilitation and water treatment costs. In this paper we will illustrate how state-of-the-art wildfire simulation modeling and geospatial risk assessment methods can be brought to bear to...

The influence of farmland pollution on the quality and safety of agricultural products

NASA Astrophysics Data System (ADS)

Ma, Z. L.; Li, L. Y.; Ye, C.; Lin, X. Y.; B, C.; Wei

2018-02-01

The quality and safety of agricultural products is not only a major livelihood issues for people’s health, but also the main barriers to international trade of agricultural products nowadays. The soil is the foundation to the production of agricultural products and the guarantee of agricultural development. The farmland soil quality is directly related to the quality and safety of agricultural products. Our country’s soil has been polluted by a series of pollution, Such as the excessive discharge of industrial wastes, the encroachment of household waste, and the unreasonable use of pesticides and fertilizers. Soil degradation is a serious threat to the quality and safety of agricultural products, so eliminating soil degradation is the fundamental way out for quality and safety of agricultural products. By analyzing problems of the quality and safety of agricultural products in our country, and exploring the farmland soil influence on the quality and safety of agricultural products. This article provides a reference for improving the control level of quality and safety of agricultural products and the farmland soil quality.

Modifying physician behavior to improve cost-efficiency in safety-net ambulatory settings.

PubMed

Borkowski, Nancy; Gumus, Gulcin; Deckard, Gloria J

2013-01-01

Change interventions in one form or another are viewed as important tools to reduce variation in medical services, reduce costs, and improve quality of care. With the current focus on efficient resource use, the successful design and implementation of change strategies are of utmost importance for health care managers. We present a case study in which macro and micro level change strategies were used to modify primary care physicians' practice patterns of prescribing diagnostic services in a safety-net's ambulatory clinics. The findings suggest that health care managers using evidence-based strategies can create a practice environment that reduces barriers and facilitates change.

Donor human milk banking and the emergence of milk sharing.

PubMed

Landers, Susan; Hartmann, Ben T

2013-02-01

Donor human milk has emerged as the preferred substrate to feed extremely preterm infants, when mother's own milk is unavailable. This article summarizes the clinical data demonstrating the safety, efficacy, and cost-effectiveness of feeding donor human milk to premature babies. It describes the current state of milk banking in North America, as well as other parts of the world, and the differing criteria for donor selection, current pasteurization techniques, and quality control measures. A risk assessment methodology is proposed, which would allow milk banks globally to assess the safety of their process and respond appropriately to differing risk environments. Copyright © 2013. Published by Elsevier Inc.

Developing future clinical leaders for quality improvement: experience from a London children's hospital.

PubMed

Runnacles, Jane; Moult, Beki; Lachman, Peter

2013-11-01

Medical training does not necessarily prepare graduates for the real world of healthcare in which continual improvement is required. Doctors in postgraduate training (DrPGT) rarely have the opportunity to develop skills to implement changes where they work. Paradoxically they are often best placed to identify safety and quality concerns and can innovate across organisational boundaries. In order to address this, educational programmes require a supportive educational environment and should include experiential learning on a safety and quality project, alongside teaching of quality improvement (QI) knowledge and systems theory. Enabling Doctors in Quality Improvement and Patient Safety (EQuIP) has been designed for DrPGT at a London children's hospital. The aim is to prepare trainees for the future of continual improvement to ensure safe and effective services are developed through effective clinical microsystems. This paper describes the rationale and design of EQuIP with evaluation built in the evolving programme. EQuIP supports DrPGTs through a QI project within their department, aligned to the Great Ormond Street NHS Foundation Trust's objectives. This changes the way DrPGTs view healthcare as they become quality champions for their department. A three-level approach to the programme is described. The innovation involves a peer-designed programme while being work-based, delivering organisational strategies. Results of the preprogramme and postprogramme evaluations demonstrate an improvement in knowledge, skills and attitudes. Benefits to both the DrPGTs and the organisation are emphasised and key factors to achieve success and barriers identified by the participants. The design and evaluation of EQuIP may inform similar educational programmes in other organisations. This capacity building is crucial to ensure that future clinical leaders have the skills and motivation to improve the effectiveness of clinical microsystems.

TU-EF-BRD-04: Summing It Up: The Future of Quality and Safety Research

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ford, E.

Research related to quality and safety has been a staple of medical physics academic activities for a long time. From very early on, medical physicists have developed new radiation measurement equipment and analysis techniques, created ever increasingly accurate dose calculation models, and have vastly improved imaging, planning, and delivery techniques. These and other areas of interest have improved the quality and safety of radiotherapy for our patients. With the advent of TG-100, quality and safety is an area that will garner even more research interest in the future. As medical physicists pursue quality and safety research in greater numbers, itmore » is worthwhile to consider what actually constitutes research on quality and safety. For example, should the development of algorithms for real-time EPID-based in-vivo dosimetry be defined as “quality and safety” research? How about the clinical implementation of such as system? Surely the application of failure modes and effects analysis to a clinical process would be considered quality and safety research, but is this type of research that should be included in the medical physics peer-reviewed literature? The answers to such questions are of critical importance to set researchers in a direction that will provide the greatest benefit to our field and the patients we serve. The purpose of this symposium is to consider what constitutes research in the arena of quality and safety and differentiate it from other research directions. The key distinction here is developing the tool itself (e.g. algorithms for EPID dosimetry) vs. studying the impact of the tool with some quantitative metric. Only the latter would I call quality and safety research. Issues of ‘basic’ versus ‘applied’ quality and safety research will be covered as well as how the research results should be structured to provide increasing levels of support that a quality and safety intervention is effective and sustainable. Examples from existing peer-reviewed research will be used to highlight the main points. Historical, medical physicists have leveraged many areas of applied physics, engineering and biology to improve radiotherapy. Research on quality and safety is another area where physicists can have an impact. The key to further progress is to clearly define what constitutes quality and safety research for those interested in doing such research and the reviewers of that research. Learning Objectives: List several tools of quality and safety with references to peer-reviewed literature. Describe effects of mental workload on performance. Outline research in quality and safety indicators and technique analysis. Understand what quality and safety research needs to be going forward. Understand the links between cooperative group trials and quality and safety research.« less

TU-EF-BRD-01: Topics in Quality and Safety Research and Level of Evidence

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pawlicki, T.

Research related to quality and safety has been a staple of medical physics academic activities for a long time. From very early on, medical physicists have developed new radiation measurement equipment and analysis techniques, created ever increasingly accurate dose calculation models, and have vastly improved imaging, planning, and delivery techniques. These and other areas of interest have improved the quality and safety of radiotherapy for our patients. With the advent of TG-100, quality and safety is an area that will garner even more research interest in the future. As medical physicists pursue quality and safety research in greater numbers, itmore » is worthwhile to consider what actually constitutes research on quality and safety. For example, should the development of algorithms for real-time EPID-based in-vivo dosimetry be defined as “quality and safety” research? How about the clinical implementation of such as system? Surely the application of failure modes and effects analysis to a clinical process would be considered quality and safety research, but is this type of research that should be included in the medical physics peer-reviewed literature? The answers to such questions are of critical importance to set researchers in a direction that will provide the greatest benefit to our field and the patients we serve. The purpose of this symposium is to consider what constitutes research in the arena of quality and safety and differentiate it from other research directions. The key distinction here is developing the tool itself (e.g. algorithms for EPID dosimetry) vs. studying the impact of the tool with some quantitative metric. Only the latter would I call quality and safety research. Issues of ‘basic’ versus ‘applied’ quality and safety research will be covered as well as how the research results should be structured to provide increasing levels of support that a quality and safety intervention is effective and sustainable. Examples from existing peer-reviewed research will be used to highlight the main points. Historical, medical physicists have leveraged many areas of applied physics, engineering and biology to improve radiotherapy. Research on quality and safety is another area where physicists can have an impact. The key to further progress is to clearly define what constitutes quality and safety research for those interested in doing such research and the reviewers of that research. Learning Objectives: List several tools of quality and safety with references to peer-reviewed literature. Describe effects of mental workload on performance. Outline research in quality and safety indicators and technique analysis. Understand what quality and safety research needs to be going forward. Understand the links between cooperative group trials and quality and safety research.« less

Facilitated Nurse Medication-Related Event Reporting to Improve Medication Management Quality and Safety in Intensive Care Units.

PubMed

Xu, Jie; Reale, Carrie; Slagle, Jason M; Anders, Shilo; Shotwell, Matthew S; Dresselhaus, Timothy; Weinger, Matthew B

Medication safety presents an ongoing challenge for nurses working in complex, fast-paced, intensive care unit (ICU) environments. Studying ICU nurse's medication management-especially medication-related events (MREs)-provides an approach to analyze and improve medication safety and quality. The goal of this study was to explore the utility of facilitated MRE reporting in identifying system deficiencies and the relationship between MREs and nurses' work in the ICUs. We conducted 124 structured 4-hour observations of nurses in three different ICUs. Each observation included measurement of nurse's moment-to-moment activity and self-reports of workload and negative mood. The observer then obtained MRE reports from the nurse using a structured tool. The MREs were analyzed by three experts. MREs were reported in 35% of observations. The 60 total MREs included four medication errors and seven adverse drug events. Of the 49 remaining MREs, 65% were associated with negative patient impact. Task/process deficiencies were the most common contributory factor for MREs. MRE occurrence was correlated with increased total task volume. MREs also correlated with increased workload, especially during night shifts. Most of these MREs would not be captured by traditional event reporting systems. Facilitated MRE reporting provides a robust information source about potential breakdowns in medication management safety and opportunities for system improvement.

Work environments for employee creativity.

PubMed

Dul, Jan; Ceylan, Canan

2011-01-01

Innovative organisations need creative employees who generate new ideas for product or process innovation. This paper presents a conceptual framework for the effect of personal, social-organisational and physical factors on employee creativity. Based on this framework, an instrument to analyse the extent to which the work environment enhances creativity is developed. This instrument was applied to a sample of 409 employees and support was found for the hypothesis that a creative work environment enhances creative performance. This paper illustrates how the instrument can be used in companies to select and implement improvements. STATEMENT OF RELEVANCE: The ergonomics discipline addresses the work environment mainly for improving health and safety and sometimes productivity and quality. This paper opens a new area for ergonomics: designing work environments for enhancing employee creativity in order to strengthen an organisation's capability for product and process innovation and, consequently, its competitiveness.

Building organizational capacity for a healthy work environment through role-based professional practice.

PubMed

Cornett, Patricia A; O'Rourke, Maria W

2009-01-01

The professional practice of registered nurses (RNs) and their professional role competence are key variables that have an impact on quality and patient safety. Organizations in which RNs practice must have the capacity to fully support the professional role of those RNs in exercising their legitimate power derived through nurse licensing laws and professional standards and ethics. The interplay of individual RN practice and organizational practice, and measurement thereof, are the essence of organizational capacity. Two models are discussed that tie together the attributes of healthy workplace environments and provide the structure to guide and sustain organizational capacity.

Evaluation of Safety, Quality and Productivity in Construction

NASA Astrophysics Data System (ADS)

Usmen, M. A.; Vilnitis, M.

2015-11-01

This paper examines the success indicators of construction projects, safety, quality and productivity, in terms of their implications and impacts during and after construction. First safety is considered during construction with a focus on hazard identification and the prevention of occupational accidents and injuries on worksites. The legislation mandating safety programs, training and compliance with safety standards is presented and discussed. Consideration of safety at the design stage is emphasized. Building safety and the roles of building codes in prevention of structural failures are also covered in the paper together with factors affecting building failures and methods for their prevention. Quality is introduced in the paper from the perspective of modern total quality management. Concepts of quality management, quality control, quality assurance and Six Sigma and how they relate to building quality and structural integrity are discussed with examples. Finally, productivity concepts are presented with emphasis on effective project management to minimize loss of productivity, complimented by lean construction and lean Six Sigma principles. The paper concludes by synthesizing the relationships between safety, quality and productivity.

Impact of critical care environment on burnout, perceived quality of care and safety attitude of the nursing team.

PubMed

Guirardello, Edinêis de Brito

2017-06-05

assess the perception of the nursing team about the environment of practice in critical care services and its relation with the safety attitude, perceived quality of care and burnout level. cross-sectional study involving 114 nursing professionals from the intensive care unit of a teaching hospital. The following instruments were used: Nursing Work Index-Revised, Maslach Burnout Inventory and the Safety Attitude Questionnaire. the professionals who perceived greater autonomy, good relationships with the medical team and better control over the work environment presented lower levels of burnout, assessed the quality of care as good and reported a positive perception on the safety attitude for the domain job satisfaction. the findings evidenced that environments favorable to these professionals' practice result in lower levels of burnout, a better perceived quality of care and attitudes favorable to patient safety. avaliar a percepção da equipe de enfermagem sobre o ambiente da prática em unidades de cuidados críticos e sua relação com atitude de segurança, percepção da qualidade do cuidado e nível de burnout. estudo transversal com a participação de 114 profissionais de enfermagem da unidade de terapia intensiva de um hospital de ensino. Foram utilizados os instrumentos: Nursing Work Index-Revised, Inventário de Burnout de Maslach e o Questionário de Atitudes de Segurança. os profissionais que perceberam maior autonomia, boas relações com a equipe médica e melhor controle sobre o ambiente de trabalho, apresentaram menores níveis de burnout, avaliaram como boa a qualidade do cuidado e relataram uma percepção positiva da atitude de segurança para o domínio satisfação no trabalho. os achados evidenciaram que ambientes favoráveis à prática desses profissionais resultam em menores níveis de burnout, melhor percepção da qualidade do cuidado e atitudes favoráveis à segurança do paciente. evaluar la percepción del equipo de enfermería sobre el ambiente de la práctica en unidades de cuidados críticos y su relación con actitud de seguridad, percepción de la calidad del cuidado y nivel de burnout. estudio trasversal con la participación de 114 profesionales de enfermería de la unidad de terapia intensiva de un hospital de enseñanza. Fueron utilizados los instrumentos: Nursing Work Index-Revised, Inventario de Burnout de Maslach y el Cuestionario de Actitudes de Seguridad. los profesionales que percibieron mayor autonomía, buenas relaciones con el equipo médico y mejor control sobre el ambiente de trabajo presentaron menores niveles de burnout, evaluaron como buena la calidad del cuidado y relataron percepción positiva de la actitud de seguridad para el dominio satisfacción en el trabajo. los hallazgos evidenciaron que ambientes favorables a la práctica de esos profesionales resultan en menores niveles de burnout, mejor percepción de la calidad del cuidado y actitudes favorables a la seguridad del paciente.

[Study thought of pharmaceutical preparations quality standards by dynamic quality control technology].

PubMed

Yu, Dan-Hong; Mao, Chen-Mei; Lv, Cheng-Zhe; Jin, Hui-Zhen; Yao, Xin; Jia, Xiao-Bin

2014-07-01

Pharmaceutical preparations, particularly as a "secret recipe" of traditional Chinese medicine in medical institutions, are the product of China's medical and health industry, and they are also an important means of competing of different medical institutions. Although pharmaceutical preparations have advantages and characteristics than institutes for drug and pharmaceutical companies, the quality standards of pharmaceutical preparations in medical institutions has not reached the desired level over the years. As we all know, the quality of pharmaceutical preparations is important to ensure the efficacy, especially under the environment of people pay more sttention on drug safety and effectiveness and contry increase emphasis on the stste of pharmaceutical preparations. In view of this, we will improve the grade, stability, and clinical efficacy of pharmaceutical preparations by the advanced equipment, testing instruments and the process dynamic quality control technology. Finally, we hope we can provide new ideas for the quality control of pharmaceutical preparations.

A national stakeholder consensus study of challenges and priorities for clinical learning environments in postgraduate medical education.

PubMed

Kilty, Caroline; Wiese, Anel; Bergin, Colm; Flood, Patrick; Fu, Na; Horgan, Mary; Higgins, Agnes; Maher, Bridget; O'Kane, Grainne; Prihodova, Lucia; Slattery, Dubhfeasa; Stoyanov, Slavi; Bennett, Deirdre

2017-11-22

High quality clinical learning environments (CLE) are critical to postgraduate medical education (PGME). The understaffed and overcrowded environments in which many residents work present a significant challenge to learning. The purpose of this study was to develop a national expert group consensus amongst stakeholders in PGME to; (i) identify important barriers and facilitators of learning in CLEs and (ii) indicate priority areas for improvement. Our objective was to provide information to focus efforts to provide high quality CLEs. Group Concept Mapping (GCM) is an integrated mixed methods approach to generating expert group consensus. A multi-disciplinary group of experts were invited to participate in the GCM process via an online platform. Multi-dimensional scaling and hierarchical cluster analysis were used to analyse participant inputs in regard to barriers, facilitators and priorities. Participants identified facilitators and barriers in ten domains within clinical learning environments. Domains rated most important were those which related to residents' connection to and engagement with more senior doctors. Organisation and conditions of work and Time to learn with senior doctors during patient care were rated as the most difficult areas in which to make improvements. High quality PGME requires that residents engage and connect with senior doctors during patient care, and that they are valued and supported both as learners and service providers. Academic medicine and health service managers must work together to protect these elements of CLEs, which not only shape learning, but impact quality of care and patient safety.

Work environment, overtime and sleep among offshore personnel.

PubMed

Parkes, Katharine R

2017-02-01

Personnel working on North Sea oil/gas installations are exposed to remote and potentially hazardous environments, and to extended work schedules (typically, 14×12h shifts). Moreover, overtime (additional to the standard 84-h week) is not uncommon among offshore personnel. Evidence from onshore research suggests that long work hours and adverse environmental characteristics are associated with sleep impairments, and consequently with health and safety risks, including accidents and injuries. However, little is known about the extent to which long hours and a demanding work environment combine synergistically in relation to sleep. The present study sought to address this issue, using survey data collected from offshore day-shift personnel (N=551). The multivariate analysis examined the additive and interactive effects of overtime and measures of the psychosocial/physical work environment (job demands, job control, supervisor support, and physical stressors) as predictors of sleep outcomes during offshore work weeks. Control variables, including age and sleep during leave weeks, were also included in the analysis model. Sleep duration and quality were significantly impaired among those who worked overtime (54% of the participants) relative to those who worked only 12-h shifts. A linear relationship was found between long overtime hours and short sleep duration; personnel who worked >33h/week overtime reported <6h/day sleep. Significant interactions were also found; sleep duration was negatively related to job demands, and positively related to supervisor support, only among personnel who worked overtime. Poor sleep quality was predicted by the additive effects of overtime, low support and an adverse physical environment. These findings highlight the need to further examine the potential health and safety consequences of impaired sleep associated with high overtime rates offshore, and to identify the extent to which adverse effects of overtime can be mitigated by favourable physical and psychosocial work environment characteristics. Copyright © 2015 Elsevier Ltd. All rights reserved.

MEASUREMENT EQUIVALENCE OF NEIGHBORHOOD QUALITY MEASURES FOR EUROPEAN AMERICAN AND MEXICAN AMERICAN FAMILIES

PubMed Central

Kim, Su Yeong; Nair, Rajni; Knight, George P.; Roosa, Mark W.; Updegraff, Kimberly A.

2009-01-01

The factorial and construct equivalence of subscales assessing parents’ and children’s perceptions of the quality of their neighborhood was examined in Mexican American and European American families. All subscales (dangerous people in the neighborhood, sense of safety in the neighborhood, quality of the physical environment) demonstrated adequate partial factorial invariance across English- and Spanish-speaking Mexican American and European American families. Reports by children about dangerous people in the neighborhood was the closest to achieving strict factorial invariance, and the only one of the four dimensions to achieve invariance in the validity analyses across Mexican American and European American families. The implications of using these self-report neighborhood quality measures in studies of multiple cultural or language groups are discussed. PMID:19183709

Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety.

PubMed

McFadden, Kathleen L; Stock, Gregory N; Gowen, Charles R

2014-10-01

Successful amelioration of medical errors represents a significant problem in the health care industry. There is a need for greater understanding of the factors that lead to improved process quality and patient safety outcomes in hospitals. We present a research model that shows how transformational leadership, safety climate, and continuous quality improvement (CQI) initiatives are related to objective quality and patient safety outcome measures. The proposed framework is tested using structural equation modeling, based on data collected for 204 hospitals, and supplemented with objective outcome data from the Centers for Medicare and Medicaid Services. The results provide empirical evidence that a safety climate, which is connected to the chief executive officer's transformational leadership style, is related to CQI initiatives, which are linked to improved process quality. A unique finding of this study is that, although CQI initiatives are positively associated with improved process quality, they are also associated with higher hospital-acquired condition rates, a measure of patient safety. Likewise, safety climate is directly related to improved patient safety outcomes. The notion that patient safety climate and CQI initiatives are not interchangeable or universally beneficial is an important contribution to the literature. The results confirm the importance of using CQI to effectively enhance process quality in hospitals, and patient safety climate to improve patient safety outcomes. The overall pattern of findings suggests that simultaneous implementation of CQI initiatives and patient safety climate produces greater combined benefits.

Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety.

PubMed

McFadden, Kathleen L; Stock, Gregory N; Gowen, Charles R

2015-01-01

Successful amelioration of medical errors represents a significant problem in the health care industry. There is a need for greater understanding of the factors that lead to improved process quality and patient safety outcomes in hospitals. We present a research model that shows how transformational leadership, safety climate, and continuous quality improvement (CQI) initiatives are related to objective quality and patient safety outcome measures. The proposed framework is tested using structural equation modeling, based on data collected for 204 hospitals, and supplemented with objective outcome data from the Centers for Medicare and Medicaid Services. The results provide empirical evidence that a safety climate, which is connected to the chief executive officer's transformational leadership style, is related to CQI initiatives, which are linked to improved process quality. A unique finding of this study is that, although CQI initiatives are positively associated with improved process quality, they are also associated with higher hospital-acquired condition rates, a measure of patient safety. Likewise, safety climate is directly related to improved patient safety outcomes. The notion that patient safety climate and CQI initiatives are not interchangeable or universally beneficial is an important contribution to the literature. The results confirm the importance of using CQI to effectively enhance process quality in hospitals, and patient safety climate to improve patient safety outcomes. The overall pattern of findings suggests that simultaneous implementation of CQI initiatives and patient safety climate produces greater combined benefits.

48 CFR 970.5223-1 - Integration of environment, safety, and health into work planning and execution.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Integration of environment, safety, and health into work planning and execution. As prescribed in 970.2303-3(b), insert the following clause: Integration of Environment, Safety, and Health Into Work Planning and... danger to the environment or health and safety of employees or the public, the Contracting Officer may...

30 CFR 250.107 - What must I do to protect health, safety, property, and the environment?

Code of Federal Regulations, 2011 CFR

2011-07-01

..., property, and the environment? (a) You must protect health, safety, property, and the environment by: (1... would have a significant effect on safety, health, or the environment; (2) If it is economically... 30 Mineral Resources 2 2011-07-01 2011-07-01 false What must I do to protect health, safety...

48 CFR 970.5223-1 - Integration of environment, safety, and health into work planning and execution.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Integration of environment, safety, and health into work planning and execution. As prescribed in 970.2303-3(b), insert the following clause: Integration of Environment, Safety, and Health Into Work Planning and... danger to the environment or health and safety of employees or the public, the Contracting Officer may...

48 CFR 970.5223-1 - Integration of environment, safety, and health into work planning and execution.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Integration of environment, safety, and health into work planning and execution. As prescribed in 970.2303-3(b), insert the following clause: Integration of Environment, Safety, and Health Into Work Planning and... danger to the environment or health and safety of employees or the public, the Contracting Officer may...

30 CFR 250.107 - What must I do to protect health, safety, property, and the environment?

Code of Federal Regulations, 2012 CFR

2012-07-01

... the environment? (a) You must protect health, safety, property, and the environment by: (1) Performing... would have a significant effect on safety, health, or the environment; (2) If it is economically... 30 Mineral Resources 2 2012-07-01 2012-07-01 false What must I do to protect health, safety...

48 CFR 970.5223-1 - Integration of environment, safety, and health into work planning and execution.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Integration of environment, safety, and health into work planning and execution. As prescribed in 970.2303-3(b), insert the following clause: Integration of Environment, Safety, and Health Into Work Planning and... danger to the environment or health and safety of employees or the public, the Contracting Officer may...

30 CFR 250.107 - What must I do to protect health, safety, property, and the environment?

Code of Federal Regulations, 2014 CFR

2014-07-01

... the environment? (a) You must protect health, safety, property, and the environment by: (1) Performing... would have a significant effect on safety, health, or the environment; (2) If it is economically... 30 Mineral Resources 2 2014-07-01 2014-07-01 false What must I do to protect health, safety...

30 CFR 250.107 - What must I do to protect health, safety, property, and the environment?

Code of Federal Regulations, 2013 CFR

2013-07-01

... the environment? (a) You must protect health, safety, property, and the environment by: (1) Performing... would have a significant effect on safety, health, or the environment; (2) If it is economically... 30 Mineral Resources 2 2013-07-01 2013-07-01 false What must I do to protect health, safety...

TU-EF-BRD-03: Mental Workload and Performance

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mazur, L.

Research related to quality and safety has been a staple of medical physics academic activities for a long time. From very early on, medical physicists have developed new radiation measurement equipment and analysis techniques, created ever increasingly accurate dose calculation models, and have vastly improved imaging, planning, and delivery techniques. These and other areas of interest have improved the quality and safety of radiotherapy for our patients. With the advent of TG-100, quality and safety is an area that will garner even more research interest in the future. As medical physicists pursue quality and safety research in greater numbers, itmore » is worthwhile to consider what actually constitutes research on quality and safety. For example, should the development of algorithms for real-time EPID-based in-vivo dosimetry be defined as “quality and safety” research? How about the clinical implementation of such as system? Surely the application of failure modes and effects analysis to a clinical process would be considered quality and safety research, but is this type of research that should be included in the medical physics peer-reviewed literature? The answers to such questions are of critical importance to set researchers in a direction that will provide the greatest benefit to our field and the patients we serve. The purpose of this symposium is to consider what constitutes research in the arena of quality and safety and differentiate it from other research directions. The key distinction here is developing the tool itself (e.g. algorithms for EPID dosimetry) vs. studying the impact of the tool with some quantitative metric. Only the latter would I call quality and safety research. Issues of ‘basic’ versus ‘applied’ quality and safety research will be covered as well as how the research results should be structured to provide increasing levels of support that a quality and safety intervention is effective and sustainable. Examples from existing peer-reviewed research will be used to highlight the main points. Historical, medical physicists have leveraged many areas of applied physics, engineering and biology to improve radiotherapy. Research on quality and safety is another area where physicists can have an impact. The key to further progress is to clearly define what constitutes quality and safety research for those interested in doing such research and the reviewers of that research. Learning Objectives: List several tools of quality and safety with references to peer-reviewed literature. Describe effects of mental workload on performance. Outline research in quality and safety indicators and technique analysis. Understand what quality and safety research needs to be going forward. Understand the links between cooperative group trials and quality and safety research.« less

The Veterans Affairs National Quality Scholars program: a model for interprofessional education in quality and safety.

PubMed

Patrician, Patricia A; Dolansky, Mary A; Pair, Vincent; Bates, Mekeshia; Moore, Shirley M; Splaine, Mark; Gilman, Stuart C

2013-01-01

The Quality and Safety Education for Nurses (QSEN) project is enhancing the emphasis on quality care and patient safety content in nursing schools. A partnership between QSEN and the Veterans Affairs National Quality Scholars program resulted in a unique experiential, interdisciplinary fellowship for both nurses and physicians. This article introduces the Veterans Affairs National Quality Scholars program and provides examples of learning activities and fellows' accomplishments. Interprofessional quality and safety education at the doctoral and postdoctoral levels is germane to improving the quality of health care.

Laminar-airflow equipment certification: what the pharmacist needs to know.

PubMed

Bryan, D; Marback, R C

1984-07-01

The basic information pharmacy practitioners need to determine the suitability and applicability of laminar-airflow equipment test standards and procedures is presented. The operative guideline for any laminar-flow clean bench (LFCB) certification is the cleanroom and work station requirements for controlled environments as defined by the federal government under Federal Standard 209b (FS 209b). FS 209b outlines the tests, test procedures, and acceptable performance ranges for all LFCB equipment. National Sanitation Foundation Standard Number 49 (NSF 49) is used in the certification of biological-safety cabinets (BSCs). NSF 49 covers those aspects of safety, maintenance, performance, and testing that are unique BSCs. To monitor certification properly, practitioners should be familiar with these standards and the air-velocity profile, high-efficiency particulate air filter performance, noise output, light, and electrical test procedures. A review of the requisite knowledge, experience, and reputation of certifying agents is presented, along with an outline of all the necessary procedures, equipment, and documentation to be used in the process. A thorough test report should be issued upon unit certification. As pharmacy practitioners are responsible for all other aspects of quality assurance, they should also be capable of auditing these certifications to ensure the aseptic quality of products compounded in the laminar-airflow environment.

Battery-free radio frequency identification (RFID) sensors for food quality and safety

PubMed Central

Potyrailo, Radislav A.; Nagraj, Nandini; Tang, Zhexiong; Mondello, Frank J.; Surman, Cheryl; Morris, William

2012-01-01

The market demands for new sensors for food quality and safety stimulate the development of new sensing technologies that can provide an unobtrusive sensor form factor, battery-free operation, and minimal sensor cost. Intelligent labeling of food products to indicate and report their freshness and other conditions is one of important possible applications of such new sensors. We have applied passive (battery-free) radio frequency identification (RFID) sensors for highly sensitive and selective detection of food freshness and bacterial growth. In these sensors, the electric field generated in the RFID sensor antenna extends out from the plane of the RFID sensor and is affected by the ambient environment providing the opportunity for sensing. This environment may be in the form of a food sample within the electric field of the sensing region or a sensing film deposited onto the sensor antenna. Examples of applications include monitoring of freshness of milk, freshness of fish, and bacterial growth in a solution. Unlike other food freshness monitoring approaches that require a thin film battery for operation of an RFID sensor and fabrication of custom-made sensors, our developed passive RFID sensing approach combines advantages of both battery-free and cost-effective sensor design and offers response selectivity that is impossible to achieve with other individual sensors. PMID:22881825

Battery-free radio frequency identification (RFID) sensors for food quality and safety.

PubMed

Potyrailo, Radislav A; Nagraj, Nandini; Tang, Zhexiong; Mondello, Frank J; Surman, Cheryl; Morris, William

2012-09-05

Market demands for new sensors for food quality and safety stimulate the development of new sensing technologies that can provide an unobtrusive sensor form, battery-free operation, and minimal sensor cost. Intelligent labeling of food products to indicate and report their freshness and other conditions is one important possible application of such new sensors. This study applied passive (battery-free) radio frequency identification (RFID) sensors for the highly sensitive and selective detection of food freshness and bacterial growth. In these sensors, the electric field generated in the RFID sensor antenna extends from the plane of the RFID sensor and is affected by the ambient environment, providing the opportunity for sensing. This environment may be in the form of a food sample within the electric field of the sensing region or a sensing film deposited onto the sensor antenna. Examples of applications include monitoring of milk freshness, fish freshness, and bacterial growth in a solution. Unlike other food freshness monitoring approaches that require a thin film battery for operation of an RFID sensor and fabrication of custom-made sensors, the passive RFID sensing approach developed here combines the advantages of both battery-free and cost-effective sensor design and offers response selectivity that is impossible to achieve with other individual sensors.

A hospital-based child protection programme evaluation instrument: a modified Delphi study.

PubMed

Wilson, Denise; Koziol-McLain, Jane; Garrett, Nick; Sharma, Pritika

2010-08-01

Refine instrument for auditing hospital-based child abuse and neglect violence intervention programmes prior to field-testing. A modified Delphi study to identify and rate items and domains indicative of an effective and quality child abuse and neglect intervention programme. Experts participated in four Delphi rounds: two surveys, a one-day workshop and the opportunity to comment on the penultimate instrument. New Zealand. Twenty-four experts in the field of care and protection of children. Items with panel agreement >or=85% and mean importance rating >or=4.0 (scale from 1 (not important) to 5 (very important)). There was high-level consensus on items across Rounds 1 and 2 (89% and 85%, respectively). In Round 3 an additional domain (safety and security) was agreed upon and cultural issues, alert systems for children at risk, and collaboration among primary care, community, non-government and government agencies were discussed. The final instrument included nine domains ('policies and procedures', 'safety and security', 'collaboration', 'cultural environment', 'training of providers', 'intervention services', 'documentation' 'evaluation' and 'physical environment') and 64 items. The refined instrument represents the hallmarks of an ideal child abuse and neglect programme given current knowledge and experience. The instrument enables rigorous evaluations of hospital-based child abuse and neglect intervention programmes for quality improvement and benchmarking with other programmes.

Study of the Continuous Improvement Trend for Health, Safety and Environmental Indicators, after Establishment of Integrated Management System (IMS) in a Pharmaceutical Industry in Iran.

PubMed

Mariouryad, Pegah; Golbabaei, Farideh; Nasiri, Parvin; Mohammadfam, Iraj; Marioryad, Hossein

2015-10-01

Nowadays, organizations try to improve their services and consequently adopt management systems and standards which have become key parts in various industries. One of these management systems which have been noticed in the recent years is Integrated Management System that is the combination of quality, health, safety and environment management systems. This study was conducted with the aim of evaluating the improvement trend after establishment of integrated management system for health, safety and environment indicators, in a pharmaceutical industry in Iran. First, during several inspections in different parts of the industry, indicators that should have been noted were listed and then these indicators were organized in 3 domains of health, safety and environment in the form of a questionnaire that followed Likert method of scaling. Also, the weight of each index was resulted from averaging out of 30 managers and the viewpoints of the related experts in the field. Moreover, by checking the documents and evidence of different years (5 contemplation years of this study), the score of each indicator was determined by multiplying the weight and score of the indices and were finally analysed. Over 5 years, scores of health scope indicators, increased from 161.99 to 202.23. Score in the first year after applying the integrated management system establishment was 172.37 in safety part and in the final year increased to 197.57. The changes of environmental scope rates, from the beginning of the program up to the last year increased from 49.24 to 64.27. Integrated management systems help organizations to improve programs to achieve their objectives. Although in this study all trends of health, safety and environmental indicator changes were positive, but at the same time showed to be slow. So, one can suggest that the result of an annual evaluation should be applied in planning future activities for the years ahead.

Study of the Continuous Improvement Trend for Health, Safety and Environmental Indicators, after Establishment of Integrated Management System (IMS) in a Pharmaceutical Industry in Iran

PubMed Central

Mariouryad, Pegah; Golbabaei, Farideh; Nasiri, Parvin; Mohammadfam, Iraj

2015-01-01

Background Nowadays, organizations try to improve their services and consequently adopt management systems and standards which have become key parts in various industries. One of these management systems which have been noticed in the recent years is Integrated Management System that is the combination of quality, health, safety and environment management systems. Aim This study was conducted with the aim of evaluating the improvement trend after establishment of integrated management system for health, safety and environment indicators, in a pharmaceutical industry in Iran. Materials and Methods First, during several inspections in different parts of the industry, indicators that should have been noted were listed and then these indicators were organized in 3 domains of health, safety and environment in the form of a questionnaire that followed Likert method of scaling. Also, the weight of each index was resulted from averaging out of 30 managers and the viewpoints of the related experts in the field. Moreover, by checking the documents and evidence of different years (5 contemplation years of this study), the score of each indicator was determined by multiplying the weight and score of the indices and were finally analysed. Results Over 5 years, scores of health scope indicators, increased from 161.99 to 202.23. Score in the first year after applying the integrated management system establishment was 172.37 in safety part and in the final year increased to 197.57. The changes of environmental scope rates, from the beginning of the program up to the last year increased from 49.24 to 64.27. Conclusion Integrated management systems help organizations to improve programs to achieve their objectives. Although in this study all trends of health, safety and environmental indicator changes were positive, but at the same time showed to be slow. So, one can suggest that the result of an annual evaluation should be applied in planning future activities for the years ahead. PMID:26557547

Overview of medical errors and adverse events

PubMed Central

2012-01-01

Safety is a global concept that encompasses efficiency, security of care, reactivity of caregivers, and satisfaction of patients and relatives. Patient safety has emerged as a major target for healthcare improvement. Quality assurance is a complex task, and patients in the intensive care unit (ICU) are more likely than other hospitalized patients to experience medical errors, due to the complexity of their conditions, need for urgent interventions, and considerable workload fluctuation. Medication errors are the most common medical errors and can induce adverse events. Two approaches are available for evaluating and improving quality-of-care: the room-for-improvement model, in which problems are identified, plans are made to resolve them, and the results of the plans are measured; and the monitoring model, in which quality indicators are defined as relevant to potential problems and then monitored periodically. Indicators that reflect structures, processes, or outcomes have been developed by medical societies. Surveillance of these indicators is organized at the hospital or national level. Using a combination of methods improves the results. Errors are caused by combinations of human factors and system factors, and information must be obtained on how people make errors in the ICU environment. Preventive strategies are more likely to be effective if they rely on a system-based approach, in which organizational flaws are remedied, rather than a human-based approach of encouraging people not to make errors. The development of a safety culture in the ICU is crucial to effective prevention and should occur before the evaluation of safety programs, which are more likely to be effective when they involve bundles of measures. PMID:22339769

From the school of nursing quality and safety officer: nursing students' use of safety reporting tools and their perception of safety issues in clinical settings.

PubMed

Cooper, Elizabeth

2013-01-01

Improved patient safety and quality are priority goals for nurses and schools of nursing. This article describes the innovative new role of quality and safety officer (QSO) developed by one university in response to the Quality and Safety Education for Nurses challenge to increase quality and safety education for prelicensure nursing students. The article also describes the results of a study conducted by the QSO, obtaining information from prelicensure nursing students about the use of safety tools and identifying the students' perceptions of safety issues, communication, and safety reporting in the clinical setting. Responses of 145 prelicensure nursing students suggest that it is difficult to get all errors and near-miss events reported. Barriers for nursing students are similar to the barriers nurses and physicians identify in reporting errors and near-miss events. The survey reveals that safety for the patient is the primary concern of the student nurse. Copyright © 2013 Elsevier Inc. All rights reserved.

Exploring the Influence of Nurse Work Environment and Patient Safety Culture on Attitudes Toward Incident Reporting.

PubMed

Yoo, Moon Sook; Kim, Kyoung Ja

2017-09-01

The aim of this study was to explore the influence of nurse work environments and patient safety culture on attitudes toward incident reporting. Patient safety culture had been known as a factor of incident reporting by nurses. Positive work environment could be an important influencing factor for the safety behavior of nurses. A cross-sectional survey design was used. The structured questionnaire was administered to 191 nurses working at a tertiary university hospital in South Korea. Nurses' perception of work environment and patient safety culture were positively correlated with attitudes toward incident reporting. A regression model with clinical career, work area and nurse work environment, and patient safety culture against attitudes toward incident reporting was statistically significant. The model explained approximately 50.7% of attitudes toward incident reporting. Improving nurses' attitudes toward incident reporting can be achieved with a broad approach that includes improvements in work environment and patient safety culture.

49 CFR 190.239 - Safety orders.

Code of Federal Regulations, 2011 CFR

2011-10-01

... pipeline integrity risk to public safety, property, or the environment, the Associate Administrator may... existence of a condition that poses a pipeline integrity risk to public safety, property, or the environment... public safety, property, or the environment. (5) Post-hearing action. Following a hearing under this...

77 FR 26280 - Patient Safety Organizations: Voluntary Relinquishment From CareRise LLC

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-03

... Organizations: Voluntary Relinquishment From CareRise LLC AGENCY: Agency for Healthcare Research and Quality... relinquishment from CareRise LLC of its status as a Patient Safety Organization (PSO). The Patient Safety and... safety and the quality of health care delivery. HHS issued the Patient Safety and Quality Improvement...

Fundamentally updating fundamentals.

PubMed

Armstrong, Gail; Barton, Amy

2013-01-01

Recent educational research indicates that the six competencies of the Quality and Safety Education for Nurses initiative are best introduced in early prelicensure clinical courses. Content specific to quality and safety has traditionally been covered in senior level courses. This article illustrates an effective approach to using quality and safety as an organizing framework for any prelicensure fundamentals of nursing course. Providing prelicensure students a strong foundation in quality and safety in an introductory clinical course facilitates early adoption of quality and safety competencies as core practice values. Copyright © 2013 Elsevier Inc. All rights reserved.

Committee Opinion No. 683: Behavior That Undermines a Culture of Safety.

PubMed

2017-01-01

A key element of an organizational safety culture is maintaining an environment of professionalism that encourages communication and promotes high-quality care. Behavior that undermines a culture of safety, including disruptive or intimidating behavior, has a negative effect on the quality and safety of patient care. Intimidating behavior and disruptive behavior are unprofessional and should not be tolerated. Confronting disruptive individuals is difficult. Co-workers often are reluctant to report disruptive behavior because of fear of retaliation and the stigma associated with "blowing the whistle" on a colleague. Additionally, negative behavior of revenue-generating physicians may be overlooked because of concern about the perceived consequences of confronting them. The Joint Commission requires that hospitals establish a code of conduct that "defines acceptable behavior and behavior that undermines a culture of safety." Clear standards of behavior that acknowledge the consequences of disruptive and intimidating behavior must be established and communicated. Institutions and practices should develop a multifaceted approach to address disruptive behavior. Confidential reporting systems and assistance programs for physicians who exhibit disruptive behavior should be established. A concerted effort should be made within each organization to educate staff (ie, medical, nursing, and ancillary staff) about the potential negative effects of disruptive and inappropriate behavior. A clearly delineated hospital-wide policy and procedure relating to disruptive behavior should be developed and enforced by hospital administration. To preserve professional standing, physicians should understand how to respond to and mitigate the effect of complaints or reports.

Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction.

PubMed

Gausvik, Christian; Lautar, Ashley; Miller, Lisa; Pallerla, Harini; Schlaudecker, Jeffrey

2015-01-01

Efficient, accurate, and timely communication is required for quality health care and is strongly linked to health care staff job satisfaction. Developing ways to improve communication is key to increasing quality of care, and interdisciplinary care teams allow for improved communication among health care professionals. This study examines the patient- and family-centered use of structured interdisciplinary bedside rounds (SIBR) on an acute care for the elderly (ACE) unit in a 555-bed metropolitan community hospital. This mixed methods study surveyed 24 nurses, therapists, patient care assistants, and social workers to measure perceptions of teamwork, communication, understanding of the plan for the day, safety, efficiency, and job satisfaction. A similar survey was administered to a control group of 38 of the same staff categories on different units in the same hospital. The control group units utilized traditional physician-centric rounding. Significant differences were found in each category between the SIBR staff on the ACE unit and the control staff. Nurse job satisfaction is an important marker of retention and recruitment, and improved communication may be an important aspect of increasing this satisfaction. Furthermore, improved communication is key to maintaining a safe hospital environment with quality patient care. Interdisciplinary team rounds that take place at the bedside improve both nursing satisfaction and related communication markers of quality and safety, and may help to achieve higher nurse retention and safer patient care. These results point to the interconnectedness and dual benefit to both job satisfaction and patient quality of care that can come from enhancements to team communication.

Bronson Methodist Hospital: journey to excellence in quality and safety.

PubMed

Knapp, Cheryl

2006-10-01

Bronson Healthcare Group, a 343-bed not-for-profit health care system serving all of southwest Michigan and northern Indiana, has as its flagship Bronson Methodist Hospital, the recipient of the 2005 Malcolm Baldrige National Quality Award. The Baldrige criteria were used to formalize Bronson's approach to performance excellence. The strategic plan is condensed and communicated via a "Plan for Excellence" focused on three strategies: clinical excellence, customer and service excellence, and corporate effectiveness. Initiatives include clinical scene investigation (a system for reporting and investigating sentinel and atypical events), a strategy for educating staff in the Situation-Background-Assessment-Recommendations (SBAR) communication technique, and mandatory influenza immunization for health care staff (safety), patient health literacy needs and a health information center (patient centeredness); methods to reduce bloodstream and ventilator-acquired pneumonia infections (effectiveness); a physician portal for access to forms, test results, and patient information (efficiency); restaurant-style pagers for patients and families while waiting (timeliness); and community outreach (equity). Bronson's journey to excellence continues with more accountability for hand-off communication and teamwork, enhancing a non-punitive environment for patient safety reporting, and further incorporating patient and family involvement.

Disclosure of adverse events and errors in surgical care: challenges and strategies for improvement.

PubMed

Lipira, Lauren E; Gallagher, Thomas H

2014-07-01

The disclosure of adverse events to patients, including those caused by medical errors, is a critical part of patient-centered healthcare and a fundamental component of patient safety and quality improvement. Disclosure benefits patients, providers, and healthcare institutions. However, the act of disclosure can be difficult for physicians. Surgeons struggle with disclosure in unique ways compared with other specialties, and disclosure in the surgical setting has specific challenges. The frequency of surgical adverse events along with a dysfunctional tort system, the team structure of surgical staff, and obstacles created inadvertently by existing surgical patient safety initiatives may contribute to an environment not conducive to disclosure. Fortunately, there are multiple strategies to address these barriers. Participation in communication and resolution programs, integration of Just Culture principles, surgical team disclosure planning, refinement of informed consent and morbidity and mortality processes, surgery-specific professional standards, and understanding the complexities of disclosing other clinicians' errors all have the potential to help surgeons provide patients with complete, satisfactory disclosures. Improvement in the regularity and quality of disclosures after surgical adverse events and errors will be key as the field of patient safety continues to advance.

Integrating team training strategies into obstetrical emergency simulation training.

PubMed

Daniel, Linda T; Simpson, Ellen K

2009-01-01

Successful management of obstetrical emergencies such as shoulder dystocia requires the coordinated efforts of a multidisciplinary team of professionals. Simulation education provides an opportunity to learn and master simple as well as complex technical skills needed in emergent situations. Team training has been shown to improve the quality of communication among team members and consequently has an enormous impact on human performance. In the healthcare environment, especially obstetrics where the stakes are high, integrating team training into simulation education can advance efforts to create and sustain a culture of safety. With over 7,100 deliveries annually, our 1,100-bed, two-hospital regional healthcare system embarked on this journey to advance the culture of safety.

Does compliance make a facility safe?

PubMed

Pearson, Susan

2013-04-01

'Every defect is a treasure, if the company can uncover its cause and work to prevent it across the corporation' - Kiichiro Toyoda, founder, Toyota. This quote, as true in healthcare as it in the manufacturing sphere, set the tone for discussion at a recent Dublin conference, which examined the thorny issue of whether compliance is really enough to ensure safety. Focusing especially on water safety, the event aimed to promote collaboration and knowledge sharing between Irish and UK healthcare professionals, including technical services managers, infection control staff, quality and risk personnel, support service managers, hospital directors, and CEOs. Susan Pearson BSc, a freelance journalist and communications consultant specialising in medicine and the environment, reports.

Implementing a patient safety and quality program across two merged pediatric institutions.

PubMed

Abramson, Erika; Hyman, Daniel; Osorio, S Nena; Kaushal, Rainu

2009-01-01

Academic centers are among the health care organizations that have used consolidation as a strategy to improve efficiency and reduce costs. In 1997, the New York Hospital and The Presbyterian Hospital underwent a full-asset merger to become New York City's largest medical center, known as the New York-Presbyterian Hospital (NYPH). In 2006, recognition of the challenges of the Children's Service Line at NYPH led to the formation of a Patient Safety and Quality Program to deliver consistently safe and effective health care. Each campus has a children's quality council, an interdisciplinary group that discusses and prioritizes safety and quality issues. The quality councils from each campus report directly to a bicampus children's quality steering committee formed to ensure that similar safety practices and standards are implemented across both children's hospitals. A safety subcommittee, which primarily coordinates and follows up on leadership safety walk rounds, and a significant-events subcommittee, which reviews morbidities and mortalities, report to each hospital's quality council. The bicampus pediatric quality and safety program is organized around five broad themes: improving the culture of safety, reducing the frequency of health care-acquired infections, reducing harm in the health care setting, using information technology to improve the quality and safety of care provided to patients and families, and measuring the effectiveness of care in key areas. Two sample initiatives--building family engagement and prevention of adverse medication events--illustrate the program's successes and challenges. Developing a pediatric safety and quality program across two campuses has been challenging but has led to important improvements at both organizations.

The Armstrong Institute: An Academic Institute for Patient Safety and Quality Improvement, Research, Training, and Practice.

PubMed

Pronovost, Peter J; Holzmueller, Christine G; Molello, Nancy E; Paine, Lori; Winner, Laura; Marsteller, Jill A; Berenholtz, Sean M; Aboumatar, Hanan J; Demski, Renee; Armstrong, C Michael

2015-10-01

Academic medical centers (AMCs) could advance the science of health care delivery, improve patient safety and quality improvement, and enhance value, but many centers have fragmented efforts with little accountability. Johns Hopkins Medicine, the AMC under which the Johns Hopkins University School of Medicine and the Johns Hopkins Health System are organized, experienced similar challenges, with operational patient safety and quality leadership separate from safety and quality-related research efforts. To unite efforts and establish accountability, the Armstrong Institute for Patient Safety and Quality was created in 2011.The authors describe the development, purpose, governance, function, and challenges of the institute to help other AMCs replicate it and accelerate safety and quality improvement. The purpose is to partner with patients, their loved ones, and all interested parties to end preventable harm, continuously improve patient outcomes and experience, and eliminate waste in health care. A governance structure was created, with care mapped into seven categories, to oversee the quality and safety of all patients treated at a Johns Hopkins Medicine entity. The governance has a Patient Safety and Quality Board Committee that sets strategic goals, and the institute communicates these goals throughout the health system and supports personnel in meeting these goals. The institute is organized into 13 functional councils reflecting their behaviors and purpose. The institute works daily to build the capacity of clinicians trained in safety and quality through established programs, advance improvement science, and implement and evaluate interventions to improve the quality of care and safety of patients.

Perspectives on quality mental health care from Brazilian and Cape Verdean outpatients: implications for effective patient-centered policies and models of care.

PubMed

De Jesus, Maria; Earl, Tara R

2014-01-01

Mental health providers are increasingly coming into contact with large and growing multi-racial/ethnic and immigrant patient populations in the United States. Knowledge of patient perspectives on what constitutes quality mental health care is necessary for these providers. The aim of this study was to identify indicators of quality of mental health care that matter most to two underrepresented immigrant patient groups of Portuguese background: Brazilians and Cape Verdeans. A qualitative design was adopted using focus group discussions. Six focus groups of patients (n=24 Brazilians; n=24 Cape Verdeans) who received outpatient mental health treatment through public safety net clinics in the northeast region of the United States were conducted. The Consensual Qualitative Research analytic method allowed us to identify three quality of care domains: provider performance, aspects of mental health care environment, and effectiveness of mental health care treatment. Provider performance was associated with five categories: relational, communication, linguistic, cultural, and technical competencies. Aspects of mental health care environment were linked to two categories: psychosocial and physical environment. Effectiveness of mental health care treatment was related to two categories: therapeutic relationship and treatment outcomes. Study findings provide useful data for the development of more culturally appropriate and effective patient-centered models and policies in mental health care.

Perspectives on quality mental health care from Brazilian and Cape Verdean outpatients: Implications for effective patient-centered policies and models of care

PubMed Central

De Jesus, Maria; Earl, Tara R.

2014-01-01

Mental health providers are increasingly coming into contact with large and growing multi-racial/ethnic and immigrant patient populations in the United States. Knowledge of patient perspectives on what constitutes quality mental health care is necessary for these providers. The aim of this study was to identify indicators of quality of mental health care that matter most to two underrepresented immigrant patient groups of Portuguese background: Brazilians and Cape Verdeans. A qualitative design was adopted using focus group discussions. Six focus groups of patients (n=24 Brazilians; n=24 Cape Verdeans) who received outpatient mental health treatment through public safety net clinics in the northeast region of the United States were conducted. The Consensual Qualitative Research analytic method allowed us to identify three quality of care domains: provider performance, aspects of mental health care environment, and effectiveness of mental health care treatment. Provider performance was associated with five categories: relational, communication, linguistic, cultural, and technical competencies. Aspects of mental health care environment were linked to two categories: psychosocial and physical environment. Effectiveness of mental health care treatment was related to two categories: therapeutic relationship and treatment outcomes. Study findings provide useful data for the development of more culturally appropriate and effective patient-centered models and policies in mental health care. PMID:24461570

[Quality management and safety culture in medicine: context and concepts].

PubMed

Wischet, Werner; Eitzinger, Claudia

2009-01-01

The publication of the IOM report "To err is human: building a safer health system" in 1999 put spotlight on the primacy of the principle of primum non nocere and made patient safety a central topic of quality management. A key conclusion of the report was the need for a well-developed safety culture. While concepts of quality management have evolved along the lines of ISO and Total Quality Management over the last decades patient safety still has not got the same amount of attention (PubMed). Evidence from other safety-critical areas but also from the field of medicine itself suggests that an efficient culture of safety is a conditio sine qua non for the sustainable improvement of patient safety. Considering these arguments the present paper aims at emphasizing the importance of an efficient culture of safety for patient safety and quality management in healthcare. In addition, key instruments of safety culture as well as their limitations will be presented.

Quality of Life Among Thai Workers in Textile Dyeing Factories

PubMed Central

Kittipichai, Wirin; Arsa, Rattanaporn; Jirapongsuwan, Ann; Singhakant, Chatchawal

2015-01-01

The purpose of a cross-sectional study was to investigate factors influencing the quality of life among Thai workers in textile dyeing factories. Samples included 205 Thai workers from five textile dyeing factories located in the suburban area of Bangkok in Thailand. Data were collected with a self-administered questionnaire. Scales of the questionnaire had reliability coefficients ranging from 0.70–0.91. The results revealed that the overall quality of life among workers was most likely between good and moderate levels, and the percentage-mean score was 74.77. The seven factors associated with the overall quality of life were co-worker relationships, safety at work in the dimension of accident prevention, job characteristics, supervisory relationships, welfares, marital status, and physical environment. Furthermore, co-worker relationships, accident prevention, and marital status were three considerable predictors accounted for 23% of the variance in the overall quality of life among workers in textile dyeing factories. PMID:25948458

Do changes to the local street environment alter behaviour and quality of life of older adults? The 'DIY Streets' intervention.

PubMed

Ward Thompson, Catharine; Curl, Angela; Aspinall, Peter; Alves, Susana; Zuin, Affonso

2014-07-01

The burden of ill-health due to inactivity has recently been highlighted. Better studies on environments that support physical activity are called for, including longitudinal studies of environmental interventions. A programme of residential street improvements in the UK (Sustrans 'DIY Streets') allowed a rare opportunity for a prospective, longitudinal study of the effect of such changes on older adults' activities, health and quality of life. Pre-post, cross-sectional surveys were carried out in locations across England, Wales and Scotland; participants were aged 65+ living in intervention or comparison streets. A questionnaire covered health and quality of life, frequency of outdoor trips, time outdoors in different activities and a 38-item scale on neighbourhood open space. A cohort study explored changes in self-report activity and well-being postintervention. Activity levels were also measured by accelerometer and accompanying diary records. The cross-sectional surveys showed outdoor activity predicted by having a clean, nuisance-free local park, attractive, barrier-free routes to it and other natural environments nearby. Being able to park one's car outside the house also predicted time outdoors. The environmental changes had an impact on perceptions of street walkability and safety at night, but not on overall activity levels, health or quality of life. Participants' moderate-to-vigorous activity levels rarely met UK health recommendations. Our study contributes to methodology in a longitudinal, pre-post design and points to factors in the built environment that support active ageing. We include an example of knowledge exchange guidance on age-friendly built environments for policy-makers and planners. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Do changes to the local street environment alter behaviour and quality of life of older adults? The ‘DIY Streets’ intervention

PubMed Central

Ward Thompson, Catharine; Curl, Angela; Aspinall, Peter; Alves, Susana; Zuin, Affonso

2014-01-01

Background The burden of ill-health due to inactivity has recently been highlighted. Better studies on environments that support physical activity are called for, including longitudinal studies of environmental interventions. A programme of residential street improvements in the UK (Sustrans ‘DIY Streets’) allowed a rare opportunity for a prospective, longitudinal study of the effect of such changes on older adults’ activities, health and quality of life. Methods Pre–post, cross-sectional surveys were carried out in locations across England, Wales and Scotland; participants were aged 65+ living in intervention or comparison streets. A questionnaire covered health and quality of life, frequency of outdoor trips, time outdoors in different activities and a 38-item scale on neighbourhood open space. A cohort study explored changes in self-report activity and well-being postintervention. Activity levels were also measured by accelerometer and accompanying diary records. Results The cross-sectional surveys showed outdoor activity predicted by having a clean, nuisance-free local park, attractive, barrier-free routes to it and other natural environments nearby. Being able to park one's car outside the house also predicted time outdoors. The environmental changes had an impact on perceptions of street walkability and safety at night, but not on overall activity levels, health or quality of life. Participants’ moderate-to-vigorous activity levels rarely met UK health recommendations. Conclusions Our study contributes to methodology in a longitudinal, pre–post design and points to factors in the built environment that support active ageing. We include an example of knowledge exchange guidance on age-friendly built environments for policy-makers and planners. PMID:23242959

Assessment of Environmental Determinants of Physical Activity: a Study of Built Environment Indicators in Brno, Czech Republic.

PubMed

Brázdová, Zuzana Derflerová; Klimusová, Helena; Hruška, Dalibor; Prokopová, Alice; Burjanek, Aleš; Wulff, Krauff Rainer Schwanhaeuser

2015-11-01

Research on physical activity in relation to obesity gradually becomes more focused on environmental determinants, which can potentially influence people's health choices. The present article addresses the topic of physical activity from a wider sociological perspective. Our pilot study was designed with the objective of testing the applicability of a method included in the EC 6th Framework Programme EURO-PREVOB, in the Czech context. The method examines specific determinants of the built environment that can have an impact on physical activity at the population level. In addition, the study aims to analyze possible differences in built environment indicators and their relation to the physical activity of people living in neighbourhoods with areas of varying socioeconomic status. The field study was carried out in the city of Brno, Czech Republic, in 5 neighbourhood quintiles, i.e. areas divided according to the socioeconomic status of local residents. In each quintile, we evaluated the quality of the built environment according to the quality, aesthetics and safety of segregated cycle facilities, playgrounds/playing areas, public open spaces, marked road crossings and pavements as well as signs of incivilities and devastation. Between the five quintiles, significant differences were found in the quality of parks and playgrounds/playing areas, pavements, marking of pedestrian crossings, and in general aesthetics, i.e. signs of incivilities and devastation of the built environment. No differences were found in the quality and use of cycle facilities. The method we used for the evaluation of the built environment proved highly applicable in Czech populated areas. Monitoring of built environment indicators in the Czech Republic should provide a basis for health maps, showing potential associations between the prevalence of high-incidence, non-infectious diseases and various social determinants of physical activity. This information might help in achieving an improvement in these determinants at a community level and promoting an increase in physical activity at the population level. Copyright© by the National Institute of Public Health, Prague 2015.

How can we keep patients with dementia safe in our acute hospitals? A review of challenges and solutions

PubMed Central

George, Jim; Long, Susannah; Vincent, Charles

2013-01-01

Maintaining patient safety in acute hospitals is a global health challenge. Traditionally, patient safety measures have been concentrated on critical care and surgical patients. In this review the medical literature was reviewed over the last ten years on aspects of patient safety specifically related to patients with dementia. Patients with dementia do badly in hospital with frequent adverse events resulting in the geriatric syndromes of falls, delirium and loss of function with increased length of stay and increased mortality. Contributory factors include inadequate assessment and treatment, inappropriate intervention, discrimination, low staff levels and lack of staff training. Unfortunately there is no one simple solution to this problem, but what is needed is a multifactorial, multilevel approach at the seven levels of care – patient, task, staff, team, environment, organisation and institution. Improving safety and quality of care for patients with dementia in acute hospitals will benefit all patients and is an urgent priority for the NHS. PMID:23759885

Occupational safety and health objectives of Healthy People 2010: a systematic approach for occupational health nurses--Part II.

PubMed

Olszewski, Kimberly; Parks, Carol; Chikotas, Noreen E

2007-03-01

Occupational safety and health objectives 20.6 through 20.11 focus on reducing work-related assaults, lead exposure, skin diseases and disorders, needlestick injuries, and work-related, noise-induced hearing loss and promoting worksite stress reduction programs. Using the intervention strategies provided, occupational health nurses can play a key role in reducing workplace-related injury, disease, disability, and death. variety of resources pertaining to occupational health and safety from the federal, national, health care, nursing, and environmental realms can assist occupational health nurses in developing and implementing programs appropriate for their workplaces. Through the Healthy People 2010 occupational health and safety objectives, occupational health nurses have the opportunity to develop and implement workplace policies and programs promoting not only a safe and healthy work environment but also improved health and disease prevention. Occupational health nurses can implement strategies to increase quality and years of life and eliminate health disparities in the American work force.

Teamwork and communication: an effective approach to patient safety.

PubMed

Mujumdar, Sandhya; Santos, Diana

2014-01-01

Teamwork and communication failures are leading causes of patient safety incidents in health care. Though health care providers must work in teams, they are not well-trained in teamwork and communication skills. Health care faces the problems of differences in communication styles, communication failures and poor teamwork. There is enough evidence in the literature to show that communication failure is detrimental to patient safety. It is estimated that 80% of serious medical errors worldwide take place because of miscommunication between medical providers. NUH recognizes that effective communication and teamwork are essential in the delivery of high quality safe patient care, especially in a complex organization. NUH is a good example, where there is a rich mix of nationalities and races, in staff and in patients, and there is a rapidly expanding care environment. NUH had to overcome these challenges by adopting a multi-pronged approach. The trials and tribulations of NUH in this journey were worthwhile as the patient safety climate survey scores improved over the years.

Perceptions of work environment priorities: Are there any differences by company size? An ecological study

PubMed Central

Nordlöf, Hasse; Wijk, Katarina; Westergren, Karl-Erik

2015-01-01

BACKGROUND: Earlier studies suggest that the quality of handling occupational health and safety (OHS) activities differs between companies of different sizes. Company size is a proxy variable for other variables affecting OHS performance. OBJECTIVE: The objective of this study was to investigate if there is an association between company size and perceptions of work environment prioritizations. METHODS: Data from 106 small- and medium-sized Swedish manufacturing companies was collected. One manager and one safety delegate at each company rated different aspects of their companies’ work environment prioritizations with a 43-item questionnaire. Ratings were aggregated to a summary statistic for each company before analysis. RESULTS: No significant differences in perceptions of priority were found to be associated with company sizes. This is in contrast to earlier studies of objective differences. The respondents in small companies, however, showed significantly greater consensus in their ratings. CONCLUSIONS: Company size does not appear to be associated with perceptions of work environment prioritizations. Company size is an important proxy variable to study in order to understand what factors enable and obstruct safe and healthy workplaces. The work presented here should be viewed as an initial exploration to serve as direction for future academic work. PMID:26409368

Relationships between work outcomes, work attitudes and work environments of health support workers in Ontario long-term care and home and community care settings.

PubMed

Berta, Whitney; Laporte, Audrey; Perreira, Tyrone; Ginsburg, Liane; Dass, Adrian Rohit; Deber, Raisa; Baumann, Andrea; Cranley, Lisa; Bourgeault, Ivy; Lum, Janet; Gamble, Brenda; Pilkington, Kathryn; Haroun, Vinita; Neves, Paula

2018-03-22

Our overarching study objective is to further our understanding of the work psychology of Health Support Workers (HSWs) in long-term care and home and community care settings in Ontario, Canada. Specifically, we seek novel insights about the relationships among aspects of these workers' work environments, their work attitudes, and work outcomes in the interests of informing the development of human resource programs to enhance elder care. We conducted a path analysis of data collected via a survey administered to a convenience sample of Ontario HSWs engaged in the delivery of elder care over July-August 2015. HSWs' work outcomes, including intent to stay, organizational citizenship behaviors, and performance, are directly and significantly related to their work attitudes, including job satisfaction, work engagement, and affective organizational commitment. These in turn are related to how HSWs perceive their work environments including their quality of work life (QWL), their perceptions of supervisor support, and their perceptions of workplace safety. HSWs' work environments are within the power of managers to modify. Our analysis suggests that QWL, perceptions of supervisor support, and perceptions of workplace safety present particularly promising means by which to influence HSWs' work attitudes and work outcomes. Furthermore, even modest changes to some aspects of the work environment stand to precipitate a cascade of positive effects on work outcomes through work attitudes.

An Efficient and QoS Supported Multichannel MAC Protocol for Vehicular Ad Hoc Networks

PubMed Central

Tan, Guozhen; Yu, Chao

2017-01-01

Vehicular Ad Hoc Networks (VANETs) employ multichannel to provide a variety of safety and non-safety (transport efficiency and infotainment) applications, based on the IEEE 802.11p and IEEE 1609.4 protocols. Different types of applications require different levels Quality-of-Service (QoS) support. Recently, transport efficiency and infotainment applications (e.g., electronic map download and Internet access) have received more and more attention, and this kind of applications is expected to become a big market driver in a near future. In this paper, we propose an Efficient and QoS supported Multichannel Medium Access Control (EQM-MAC) protocol for VANETs in a highway environment. The EQM-MAC protocol utilizes the service channel resources for non-safety message transmissions during the whole synchronization interval, and it dynamically adjusts minimum contention window size for different non-safety services according to the traffic conditions. Theoretical model analysis and extensive simulation results show that the EQM-MAC protocol can support QoS services, while ensuring the high saturation throughput and low transmission delay for non-safety applications. PMID:28991217

Expanding leadership capacity: educational levels for nurse leaders.

PubMed

Yoder-Wise, Patricia S; Scott, Elaine S; Sullivan, Dori Taylor

2013-06-01

A master's degree in nursing administration prepares the nurse to lead nursing and interprofessional teams, to create new and innovative approaches to improve care processes and outcomes, as well as traditional management responsibilities related to budgets, human resources, quality and safety, and a healthy work environment. Are we not at a critical juncture in our profession when we should challenge the profession to require a master's degree education for all levels of nursing administration?

[Establishment and application of "multi-dimensional structure and process dynamic quality control technology system" in preparation products of traditional Chinese medicine (I)].

PubMed

Gu, Jun-Fei; Feng, Liang; Zhang, Ming-Hua; Wu, Chan; Jia, Xiao-Bin

2013-11-01

Safety is an important component of the quality control of traditional Chinese medicine (TCM) preparation products, as well as an important guarantee for clinical application. Currently, the quality control of TCMs in Chinese Pharmacopoeia mostly focuses on indicative compounds for TCM efficacy. TCM preparations are associated with multiple links, from raw materials to products, and each procedure may have impacts on the safety of preparation. We make a summary and analysis on the factors impacting safety during the preparation of TCM products, and then expound the important role of the "multi-dimensional structure and process dynamic quality control technology system" in the quality safety of TCM preparations. Because the product quality of TCM preparation is closely related to the safety, the control over safety-related material basis is an important component of the product quality control of TCM preparations. The implementation of the quality control over the dynamic process of TCM preparations from raw materials to products, and the improvement of the TCM quality safety control at the microcosmic level help lay a firm foundation for the development of the modernization process of TCM preparations.

10 CFR Appendix A to Subpart B of... - General Statement of Safety Basis Policy

Code of Federal Regulations, 2012 CFR

2012-01-01

... with DOE Policy 450.2A, “Identifying, Implementing and Complying with Environment, Safety and Health..., safety, and health into work planning and execution (48 CFR 970.5223-1, Integration of Environment...) Using the method in DOE-STD-1120-98, Integration of Environment, Safety, and Health into Facility...

10 CFR Appendix A to Subpart B of... - General Statement of Safety Basis Policy

Code of Federal Regulations, 2014 CFR

2014-01-01

... with DOE Policy 450.2A, “Identifying, Implementing and Complying with Environment, Safety and Health..., safety, and health into work planning and execution (48 CFR 970.5223-1, Integration of Environment...) Using the method in DOE-STD-1120-98, Integration of Environment, Safety, and Health into Facility...

10 CFR Appendix A to Subpart B of... - General Statement of Safety Basis Policy

Code of Federal Regulations, 2013 CFR

2013-01-01

... with DOE Policy 450.2A, “Identifying, Implementing and Complying with Environment, Safety and Health..., safety, and health into work planning and execution (48 CFR 970.5223-1, Integration of Environment...) Using the method in DOE-STD-1120-98, Integration of Environment, Safety, and Health into Facility...

eLearning techniques supporting problem based learning in clinical simulation.

PubMed

Docherty, Charles; Hoy, Derek; Topp, Helena; Trinder, Kathryn

2005-08-01

This paper details the results of the first phase of a project using eLearning to support students' learning within a simulated environment. The locus was a purpose built clinical simulation laboratory (CSL) where the School's philosophy of problem based learning (PBL) was challenged through lecturers using traditional teaching methods. a student-centred, problem based approach to the acquisition of clinical skills that used high quality learning objects embedded within web pages, substituting for lecturers providing instruction and demonstration. This encouraged student nurses to explore, analyse and make decisions within the safety of a clinical simulation. Learning was facilitated through network communications and reflection on video performances of self and others. Evaluations were positive, students demonstrating increased satisfaction with PBL, improved performance in exams, and increased self-efficacy in the performance of nursing activities. These results indicate that eLearning techniques can help students acquire clinical skills in the safety of a simulated environment within the context of a problem based learning curriculum.

NASA Case Sensitive Review and Audit Approach

NASA Astrophysics Data System (ADS)

Lee, Arthur R.; Bacus, Thomas H.; Bowersox, Alexandra M.; Newman, J. Steven

2005-12-01

As an Agency involved in high-risk endeavors NASA continually reassesses its commitment to engineering excellence and compliance to requirements. As a component of NASA's continual process improvement, the Office of Safety and Mission Assurance (OSMA) established the Review and Assessment Division (RAD) [1] to conduct independent audits to verify compliance with Agency requirements that impact safe and reliable operations. In implementing its responsibilities, RAD benchmarked various approaches for conducting audits, focusing on organizations that, like NASA, operate in high-risk environments - where seemingly inconsequential departures from safety, reliability, and quality requirements can have catastrophic impact to the public, NASA personnel, high-value equipment, and the environment. The approach used by the U.S. Navy Submarine Program [2] was considered the most fruitful framework for the invigorated OSMA audit processes. Additionally, the results of benchmarking activity revealed that not all audits are conducted using just one approach or even with the same objectives. This led to the concept of discrete, unique "audit cases."

Climate resilient crops for improving global food security and safety.

PubMed

Dhankher, Om Parkash; Foyer, Christine H

2018-05-01

Food security and the protection of the environment are urgent issues for global society, particularly with the uncertainties of climate change. Changing climate is predicted to have a wide range of negative impacts on plant physiology metabolism, soil fertility and carbon sequestration, microbial activity and diversity that will limit plant growth and productivity, and ultimately food production. Ensuring global food security and food safety will require an intensive research effort across the food chain, starting with crop production and the nutritional quality of the food products. Much uncertainty remains concerning the resilience of plants, soils, and associated microbes to climate change. Intensive efforts are currently underway to improve crop yields with lower input requirements and enhance the sustainability of yield through improved biotic and abiotic stress tolerance traits. In addition, significant efforts are focused on gaining a better understanding of the root/soil interface and associated microbiomes, as well as enhancing soil properties. © 2018 The Authors Plant, Cell & Environment Published by John Wiley & Sons Ltd.

The use of information technology to enhance patient safety and nursing efficiency.

PubMed

Lee, Tso-Ying; Sun, Gi-Tseng; Kou, Li-Tseng; Yeh, Mei-Ling

2017-10-23

Issues in patient safety and nursing efficiency have long been of concern. Advancing the role of nursing informatics is seen as the best way to address this. The aim of this study was to determine if the use, outcomes and satisfaction with a nursing information system (NIS) improved patient safety and the quality of nursing care in a hospital in Taiwan. This study adopts a quasi-experimental design. Nurses and patients were surveyed by questionnaire and data retrieval before and after the implementation of NIS in terms of blood drawing, nursing process, drug administration, bar code scanning, shift handover, and information and communication integration. Physiologic values were easier to read and interpret; it took less time to complete electronic records (3.7 vs. 9.1 min); the number of errors in drug administration was reduced (0.08% vs. 0.39%); bar codes reduced the number of errors in blood drawing (0 vs. 10) and transportation of specimens (0 vs. 0.42%); satisfaction with electronic shift handover increased significantly; there was a reduction in nursing turnover (14.9% vs. 16%); patient satisfaction increased significantly (3.46 vs. 3.34). Introduction of NIS improved patient safety and nursing efficiency and increased nurse and patient satisfaction. Medical organizations must continually improve the nursing information system if they are to provide patients with high quality service in a competitive environment.

78 FR 6819 - Patient Safety Organizations: Voluntary Relinquishment From the BREF PSO

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-31

..., Center for Quality Improvement and Patient Safety, AHRQ, 540 Gaither Road, Rockville, MD 20850; Telephone... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety... (AHRQ), HHS. ACTION: Notice of delisting. SUMMARY: The Patient Safety and Quality Improvement Act of...

Radioactive waste management in a hospital.

PubMed

Khan, Shoukat; Syed, At; Ahmad, Reyaz; Rather, Tanveer A; Ajaz, M; Jan, Fa

2010-01-01

Most of the tertiary care hospitals use radioisotopes for diagnostic and therapeutic applications. Safe disposal of the radioactive waste is a vital component of the overall management of the hospital waste. An important objective in radioactive waste management is to ensure that the radiation exposure to an individual (Public, Radiation worker, Patient) and the environment does not exceed the prescribed safe limits. Disposal of Radioactive waste in public domain is undertaken in accordance with the Atomic Energy (Safe disposal of radioactive waste) rules of 1987 promulgated by the Indian Central Government Atomic Energy Act 1962. Any prospective plan of a hospital that intends using radioisotopes for diagnostic and therapeutic procedures needs to have sufficient infrastructural and manpower resources to keep its ambient radiation levels within specified safe limits. Regular monitoring of hospital area and radiation workers is mandatory to assess the quality of radiation safety. Records should be maintained to identify the quality and quantity of radioactive waste generated and the mode of its disposal. Radiation Safety officer plays a key role in the waste disposal operations.

Systematic and progressive implementation of the centers of excellence for rheumatoid arthritis: a methodological proposal.

PubMed

Santos-Moreno, Pedro; Caballero-Uribe, Carlo V; Massardo, Maria Loreto; Maldonado, Claudio Galarza; Soriano, Enrique R; Pineda, Carlos; Cardiel, Mario; Benavides, Juan Alberto; Beltrán, Paula Andrea

2017-12-01

The implementation of excellence centers in specific diseases has been gaining recognition in the field of health; specifically in rheumatoid arthritis, where the prognosis of the disease is related to an early diagnosis and a timely intervention, it is necessary that the provision of health services is developed in an environment of quality, opportunity, and safety with the highest standards of care. A methodology that allows this implementation in such a way that is achievable by the most of the care centers is a priority to achieve a better attention to populations with this disease. In this paper, we propose a systematic and progressive methodology that will help all the institutions to develop successful models without faltering in the process. The expected impact on public health is defined by a better effective coverage of high-quality treatments, obtaining better health outcomes with safety and accessibility that reduces the budgetary impact for the health systems of our countries.

Advanced medical imaging protocol workflow-a flexible electronic solution to optimize process efficiency, care quality and patient safety in the National VA Enterprise.

PubMed

Medverd, Jonathan R; Cross, Nathan M; Font, Frank; Casertano, Andrew

2013-08-01

Radiologists routinely make decisions with only limited information when assigning protocol instructions for the performance of advanced medical imaging examinations. Opportunity exists to simultaneously improve the safety, quality and efficiency of this workflow through the application of an electronic solution leveraging health system resources to provide concise, tailored information and decision support in real-time. Such a system has been developed using an open source, open standards design for use within the Veterans Health Administration. The Radiology Protocol Tool Recorder (RAPTOR) project identified key process attributes as well as inherent weaknesses of paper processes and electronic emulators of paper processes to guide the development of its optimized electronic solution. The design provides a kernel that can be expanded to create an integrated radiology environment. RAPTOR has implications relevant to the greater health care community, and serves as a case model for modernization of legacy government health information systems.

Quality management and perceptions of teamwork and safety climate in European hospitals.

PubMed

Kristensen, Solvejg; Hammer, Antje; Bartels, Paul; Suñol, Rosa; Groene, Oliver; Thompson, Caroline A; Arah, Onyebuchi A; Kutaj-Wasikowska, Halina; Michel, Philippe; Wagner, Cordula

2015-12-01

This study aimed to investigate the associations of quality management systems with teamwork and safety climate, and to describe and compare differences in perceptions of teamwork climate and safety climate among clinical leaders and frontline clinicians. We used a multi-method, cross-sectional approach to collect survey data of quality management systems and perceived teamwork and safety climate. Our data analyses included descriptive and multilevel regression methods. Data on implementation of quality management system from seven European countries were evaluated including patient safety culture surveys from 3622 clinical leaders and 4903 frontline clinicians. Perceived teamwork and safety climate. Teamwork climate was reported as positive by 67% of clinical leaders and 43% of frontline clinicians. Safety climate was perceived as positive by 54% of clinical leaders and 32% of frontline clinicians. We found positive associations between implementation of quality management systems and teamwork and safety climate. Our findings, which should be placed in a broader clinical quality improvement context, point to the importance of quality management systems as a supportive structural feature for promoting teamwork and safety climate. To gain a deeper understanding of this association, further qualitative and quantitative studies using longitudinally collected data are recommended. The study also confirms that more clinical leaders than frontline clinicians have a positive perception of teamwork and safety climate. Such differences should be accounted for in daily clinical practice and when tailoring initiatives to improve teamwork and safety climate. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Quality of Life for Diverse Older Adults in Assisted Living: The Centrality of Control.

PubMed

Koehn, Sharon D; Mahmood, Atiya N; Stott-Eveneshen, Sarah

This pilot project asked: How do ethnically diverse older adult residents of assisted living (AL) facilities in British Columbia (BC) experience quality of life? And, what role, if any, do organizational and physical environmental features play in influencing how quality of life is experienced? The study was conducted at three AL sites in BC: two ethnoculturally targeted and one nontargeted. Environmental audits at each site captured descriptive data on policies, fees, rules, staffing, meals, and activities, and the built environment of the AL building and neighborhood. Using a framework that understands the quality of life of older adults to be contingent on their capability to pursue 5 conceptual attributes-attachment, role, enjoyment, security, and control-we conducted 3 focus groups with residents (1 per site) and 6 interviews with staff (2 per site). Attributes were linked to the environmental features captured in the audits. All dimensions of the environment, especially organizational, influence tenants' capability to attain the attributes of quality of life, most importantly control. Although many tenants accept the trade-off between increased safety and diminished control that accompanies a move into AL, more could be done to minimize that loss. Social workers can advocate for the necessary multi-sectoral changes.

Aligning the 3Rs with new paradigms in the safety assessment of chemicals.

PubMed

Burden, Natalie; Mahony, Catherine; Müller, Boris P; Terry, Claire; Westmoreland, Carl; Kimber, Ian

2015-04-01

There are currently several factors driving a move away from the reliance on in vivo toxicity testing for the purposes of chemical safety assessment. Progress has started to be made in the development and validation of non-animal methods. However, recent advances in the biosciences provide exciting opportunities to accelerate this process and to ensure that the alternative paradigms for hazard identification and risk assessment deliver lasting 3Rs benefits, whilst improving the quality and relevance of safety assessment. The NC3Rs, a UK-based scientific organisation which supports the development and application of novel 3Rs techniques and approaches, held a workshop recently which brought together over 20 international experts in the field of chemical safety assessment. The aim of this workshop was to review the current scientific, technical and regulatory landscapes, and to identify key opportunities towards reaching these goals. Here, we consider areas where further strategic investment will need to be focused if significant impact on 3Rs is to be matched with improved safety science, and why the timing is right for the field to work together towards an environment where we no longer rely on whole animal data for the accurate safety assessment of chemicals.

Current food safety management systems in fish-exporting companies require further improvements to adequately cope with contextual pressure: case study.

PubMed

Onjong, Hillary Adawo; Wangoh, John; Njage, Patrick Murigu Kamau

2014-10-01

Fish-processing plants still face food safety (FS) challenges worldwide despite the existence of several quality assurance standards and food safety management systems/s (FSMSs). This study assessed performance of FSMS in fish exporting sector considering pressure from the context in which they operate. A FSMS diagnostic tool with checklist was used to assess the context, FSMS, and FS output in 9 Kenyan fish exporting companies. Majority (67%) companies operated at moderate- to high-risk context but with an average performance in control and assurance activities. This situation could be insufficient to deal with ambiguity, uncertainty, and vulnerability issues in the context characteristics. Contextual risk posed by product characteristics (nature of raw materials) and chain environment characteristics was high. Risk posed by the chain environment characteristics, low power in supplier relationships, and low degree of authority in customer relationships was high. Lack of authority in relationship with suppliers would lead to high raw material risk situation. Even though cooling facilities, a key control activity, was at an advanced level, there was inadequate packaging intervention equipment which coupled with inadequate physical intervention equipment could lead to further weakened FSMS performance. For the fish companies to improve their FSMS to higher level and enhance predictability, they should base their FSMS on scientific information sources, historical results, and own experimental trials in their preventive, intervention, and monitoring systems. Specific suggestions are derived for improvements toward higher FSMS activity levels or lower risk levels in context characteristics. Weak areas in performance of control and assurance activities in export fish-processing sector already implementing current quality assurance guidelines and standards were studied taking into consideration contextual pressure wherein the companies operate. Important mitigation measures toward improved contextual risk, core assurance, and control activities irrespective of applied food safety management systems in fish industries were suggested. © 2014 Institute of Food Technologists®

Integrating patient safety into the clinical microsystem

PubMed Central

Mohr, J; Batalden, P; Barach, P

2004-01-01

Healthcare institutions continue to face challenges in providing safe patient care in increasingly complex organisational and regulatory environments while striving to maintain financial viability. The clinical microsystem provides a conceptual and practical framework for approaching organisational learning and delivery of care. Tensions exist between the conceptual theory and the daily practical applications of providing safe and effective care within healthcare systems. Healthcare organisations are often complex, disorganised, and opaque systems to their users and their patients. This disorganisation may lead to patient discomfort and harm as well as much waste. Healthcare organisations are in some sense conglomerates of smaller systems, not coherent monolithic organisations. The microsystem unit allows organisational leaders to embed quality and safety into a microsystem's developmental journey. Leaders can set the stage for making safety a priority for the organisation while allowing individual microsystems to create innovative strategies for improvement. PMID:15576690

From Board to Bedside: How the Application of Financial Structures to Safety and Quality Can Drive Accountability in a Large Health Care System.

PubMed

Austin, J Matthew; Demski, Renee; Callender, Tiffany; Lee, K H Ken; Hoffman, Ann; Allen, Lisa; Radke, Deborah A; Kim, Yungjin; Werthman, Ronald J; Peterson, Ronald R; Pronovost, Peter J

2017-04-01

As the health care system in the United States places greater emphasis on the public reporting of quality and safety data and its use to determine payment, provider organizations must implement structures that ensure discipline and rigor regarding these data. An academic health system, as part of a performance management system, applied four key components of a financial reporting structure to support the goal of top-to-bottom accountability for improving quality and safety. The four components implemented by Johns Hopkins Medicine were governance, accountability, reporting of consolidated quality performance statements, and auditing. Governance is provided by the health system's Patient Safety and Quality Board Committee, which reviews goals and strategy for patient safety and quality, reviews quarterly performance for each entity, and holds organizational leaders accountable for performance. An accountability plan includes escalating levels of review corresponding to the number of months an entity misses the defined performance target for a measure. A consolidated quality statement helps inform the Patient Safety and Quality Board Committee and leadership on key quality and safety issues. An audit evaluates the efficiency and effectiveness of processes for data collection, validation, and storage, as to ensure the accuracy and completeness of quality measure reporting. If hospitals and health systems truly want to prioritize improvements in safety and quality, they will need to create a performance management system that ensures data validity and supports performance accountability. Without valid data, it is difficult to know whether a performance gap is due to data quality or clinical quality. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Control of the Environment in the Operating Room.

PubMed

Katz, Jonathan D

2017-10-01

There is a direct relationship between the quality of the environment of a workplace and the productivity and efficiency of the work accomplished. Components such as temperature, humidity, ventilation, drafts, lighting, and noise each contribute to the quality of the overall environment and the sense of well-being of those who work there.The modern operating room is a unique workplace with specific, and frequently conflicting, environmental requirements for each of the inhabitants. Even minor disturbances in the internal environment of the operating room can have serious ramifications on the comfort, effectiveness, and safety of each of the inhabitants. A cool, well-ventilated, and dry climate is optimal for many members of the surgical team. Any significant deviation from these objectives raises the risk of decreased efficiency and productivity and adverse surgical outcomes. A warmer, more humid, and quieter environment is necessary for the patient. If these requirements are not met, the risk of surgical morbidity and mortality is increased. An important task for the surgical team is to find the correct balance between these 2 opposed requirements. Several of the components of the operating room environment, especially room temperature and airflow patterns, are easily manipulated by the members of the surgical team. In the following discussion, we will examine these elements to better understand the clinical ramifications of adjustments and accommodations that are frequently made to meet the requirements of both the surgical staff and the patient.

Determinants of business sustainability: an ergonomics perspective.

PubMed

Genaidy, Ash M; Sequeira, Reynold; Rinder, Magda M; A-Rehim, Amal D

2009-03-01

There is a need to integrate both macro- and micro-ergonomic approaches for the effective implementation of interventions designed to improve the root causes of problems such as work safety, quality and productivity in the enterprise system. The objective of this study was to explore from an ergonomics perspective the concept of business sustainability through optimising the worker-work environment interface. The specific aims were: (a) to assess the working conditions of a production department work process with the goal to jointly optimise work safety, quality and quantity; (b) to evaluate the enterprise-wide work process at the system level as a social entity in an attempt to trace the root causes of ergonomic issues impacting employees throughout the work process. The Work Compatibility Model was deployed to examine the experiences of workers (that is, effort, perceived risk/benefit, performance and satisfaction/dissatisfaction or psychological impact) and their associations with the complex domains of the work environment (task content, physical and non-physical work environment and conditions for learning/growth/development). This was followed by assessment of the enterprise system through detailed interviews with department managers and lead workers. A system diagnostic instrument was also constructed from information derived from the published literature to evaluate the enterprise system performance. The investigation of the production department indicated that the stress and musculoskeletal pain experienced by workers (particularly on the day shift) were derived from sources elsewhere in the work process. The enterprise system evaluation and detailed interviews allowed the research team to chart the feed-forward and feedback stress propagation loops in the work system. System improvement strategies were extracted on the basis of tacit/explicit knowledge obtained from department managers and lead workers. In certain situations concerning workplace human performance issues, a combined macro-micro ergonomic methodology is essential to solve the productivity, quality and safety issues impacting employees along the trajectory or path of the enterprise-wide work process. In this study, the symptoms associated with human performance issues in one production department work process had root causes originating in the customer service department work process. In fact, the issues found in the customer service department caused performance problems elsewhere in the enterprise-wide work process such as the traffic department. Sustainable enterprise solutions for workplace human performance require the integration of macro- and micro-ergonomic approaches.

Finding safety: a pilot study of managed alcohol program participants' perceptions of housing and quality of life.

PubMed

Pauly, Bernadette Bernie; Gray, Erin; Perkin, Kathleen; Chow, Clifton; Vallance, Kate; Krysowaty, Bonnie; Stockwell, Timothy

2016-05-09

There is a higher prevalence of alcohol use and severe alcohol dependence among homeless populations. The combination of alcohol use and lack of housing contributes to increased vulnerability to the harms of substance use including stigma, injury, illness, and death. Managed alcohol programs (MAPs) administer prescribed doses of alcohol at regular intervals to people with severe and chronic alcohol dependence and homelessness. As a pilot for a larger national study of MAPs, we conducted an in-depth evaluation of one program in Ontario, Canada. In this paper, we report on housing and quality of life outcomes and experiences of the MAP participants and staff. We conducted a pilot study using mixed methods. The sample consisted of 38 people enrolled in or eligible for entry into a MAP who completed a structured quantitative survey that included measures related to their housing and quality of life. All of the participants self-identified as Indigenous. In addition, we conducted 11 in-depth qualitative interviews with seven MAP residents and four program staff and analyzed the interviews using constant comparative analysis. The qualitative analysis was informed by Rhodes' risk environment framework. When compared to controls, MAP participants were more likely to retain their housing and experienced increased safety and improved quality of life compared to life on the streets, in jails, shelters, or hospitals. They described the MAP as a safe place characterized by caring, respect, trust and a nonjudgmental approach with a sense of family and home as well as opportunities to reconnect with family members. The MAP was, as described by participants, a safer environment and a home with feelings of family and a sense of community that countered stigma, loss, and dislocation with potential for healing and recovery. The MAP environment characterized by caring, respect, trust, a sense of home, "feeling like family", and the opportunities for family and cultural reconnections is consistent with First Nations principles for healing and recovery and principles of harm reduction.

‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care

PubMed Central

Ball, Jane E; Murrells, Trevor; Rafferty, Anne Marie; Morrow, Elizabeth; Griffiths, Peter

2014-01-01

Background There is strong evidence to show that lower nurse staffing levels in hospitals are associated with worse patient outcomes. One hypothesised mechanism is the omission of necessary nursing care caused by time pressure—‘missed care’. Aim To examine the nature and prevalence of care left undone by nurses in English National Health Service hospitals and to assess whether the number of missed care episodes is associated with nurse staffing levels and nurse ratings of the quality of nursing care and patient safety environment. Methods Cross-sectional survey of 2917 registered nurses working in 401 general medical/surgical wards in 46 general acute National Health Service hospitals in England. Results Most nurses (86%) reported that one or more care activity had been left undone due to lack of time on their last shift. Most frequently left undone were: comforting or talking with patients (66%), educating patients (52%) and developing/updating nursing care plans (47%). The number of patients per registered nurse was significantly associated with the incidence of ‘missed care’ (p<0.001). A mean of 7.8 activities per shift were left undone on wards that are rated as ‘failing’ on patient safety, compared with 2.4 where patient safety was rated as ‘excellent’ (p <0. 001). Conclusions Nurses working in English hospitals report that care is frequently left undone. Care not being delivered may be the reason low nurse staffing levels adversely affects quality and safety. Hospitals could use a nurse-rated assessment of ‘missed care’ as an early warning measure to identify wards with inadequate nurse staffing. PMID:23898215

Evaluation of the built environment: staff and family satisfaction pre- and post-occupancy of the Children's Hospital.

PubMed

Kotzer, Anne Marie; Zacharakis, Susan Koch; Raynolds, Mary; Buenning, Fred

2011-01-01

To evaluate and compare the impact of an existing and newly built hospital environment on family and staff satisfaction related to light, noise, temperature, aesthetics, and amenities, as well as safety, security, and privacy. The United States is engaged in an unprecedented healthcare building boom driven by the need to replace aging facilities, understand the impact of the built environment on quality and safety, incorporate rapidly emerging technologies, and enhance patient- and family-centered care. More importantly, there is heightened attention to creating optimal physical environments to achieve the best possible outcomes for patients, families, and staff. Using a pre-post descriptive survey design, all nursing, social work, therapy staff, and families on selected inpatient units were invited to participate. A demographic form and Family and Staff Satisfaction Surveys were developed and administered pre- and post-occupancy of the new facility. Pre/post mean scores for staff satisfaction improved on all survey subscales with statistically significant improvement (p < .05) in most areas. The most improvement was seen with layout of the patient room, natural light, storage and writing surfaces, and comfort and appeal. Family satisfaction demonstrated statistically significant improvement on all subscales (p ≤ .01), especially for natural light, quiet space, parking, and the child's room as a healing environment. Families and staff reported greater satisfaction with the newly built hospital environment compared to the old facility. Study results will help guide future architectural design decisions, attract and retain staff at a world-class facility, and create the most effective healing environments.

Regulatory challenges to global harmonization and expanded access to concentrates: how will regulators balance the increasing cost of new safety requirements with the desire to increase the availability of affordable product?

PubMed

Farrugia, A

2004-10-01

The provision of concentrates of the deficient coagulation factors is an essential component of the provision of comprehensive haemophilia care. Their safety, quality and efficacy need to be assured independently of the measures dictated by the market and the individual manufacturers. Over the past 20 years, this assurance has become the role of regulatory authorities, which in the developed world have generated a framework that assesses haemophilia products as medicines in the highest category of risk relative to other therapeutic agents. Systems of official regulation mandating standards and other measures are now coupled with voluntary standards adopted by industry bodies as additional features of a comprehensive nexus of arrangements contributing to product quality and risk minimization. Currently, the regulation of products for haemophilia in less developed economies relies on reference to decisions in the first-world authorities. This may not always result in optimal outcomes as most of the haemophilia care in the developing world is through local plasma and cryoprecipitate, which are not subject to the oversight of mainstream regulators. Furthermore, the emergence of companies based outside the developed world and seeking to supply the emerging economies of the developing world with haemophilia concentrates has necessitated new strategies for regulation that are independent of the established frameworks. Overall, the principles used by mainstream agencies may be applied in all environments seeking to assure the quality of haemophilia care. Applied properly, they can contribute to maintaining the delivery of a form of therapy that is nowadays amongst the safest in therapeutic practice. A rigid interpretation can seriously impede access to treatment, and therefore the development of independent expertise and appropriate strategies in assuring product safety and quality in the developing world is essential if patient safety and access to products can be assured.

Effective interventions on service quality improvement in a physiotherapy clinic.

PubMed

Gharibi, Farid; Tabrizi, JafarSadegh; Eteraf Oskouei, MirAli; AsghariJafarabadi, Mohammad

2014-01-01

Service quality is considered as a main domain of quality associ-ated with non-clinical aspect of healthcare. This study aimed to survey and im-proves service quality of delivered care in the Physiotherapy Clinic affiliated with the Tabriz University of Medical Sciences, Tabriz, Iran. A quasi experimental interventional study was conducted in the Physiotherapy Clinic, 2010-2011. Data were collected using a validated and reli-able researcher made questionnaire with participation of 324 patients and their coadjutors. The study questionnaire consisted of 7 questions about demographic factors and 38 questions for eleven aspects of service quality. Data were then analyzed using paired samples t-test by SPSS16. In the pre intervention phase, six aspects of service quality including choice of provider, safety, prevention and early detection, dignity, autonomy and availability achieved non-acceptable scores. Following interventions, all aspects of the service quality improved and also total service quality score improved from 8.58 to 9.83 (P<0.001). Service quality can be improved by problem implementation of appropriate interventions. The acquired results can be used in health system fields to create respectful environments for healthcare customers.

48 CFR 970.5223-1 - Integration of environment, safety, and health into work planning and execution.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Integration of environment... Integration of environment, safety, and health into work planning and execution. As prescribed in 970.2303-3(b), insert the following clause: Integration of Environment, Safety, and Health Into Work Planning and...

30 CFR 250.107 - What must I do to protect health, safety, property, and the environment?

Code of Federal Regulations, 2010 CFR

2010-07-01

..., property, and the environment? 250.107 Section 250.107 Mineral Resources MINERALS MANAGEMENT SERVICE... Performance Standards § 250.107 What must I do to protect health, safety, property, and the environment? (a) You must protect health, safety, property, and the environment by: (1) Performing all operations in a...

The Relationship Between Professional Burnout and Quality and Safety in Healthcare: A Meta-Analysis.

PubMed

Salyers, Michelle P; Bonfils, Kelsey A; Luther, Lauren; Firmin, Ruth L; White, Dominique A; Adams, Erin L; Rollins, Angela L

2017-04-01

Healthcare provider burnout is considered a factor in quality of care, yet little is known about the consistency and magnitude of this relationship. This meta-analysis examined relationships between provider burnout (emotional exhaustion, depersonalization, and reduced personal accomplishment) and the quality (perceived quality, patient satisfaction) and safety of healthcare. Publications were identified through targeted literature searches in Ovid MEDLINE, PsycINFO, Web of Science, CINAHL, and ProQuest Dissertations & Theses through March of 2015. Two coders extracted data to calculate effect sizes and potential moderators. We calculated Pearson's r for all independent relationships between burnout and quality measures, using a random effects model. Data were assessed for potential impact of study rigor, outliers, and publication bias. Eighty-two studies including 210,669 healthcare providers were included. Statistically significant negative relationships emerged between burnout and quality (r = -0.26, 95 % CI [-0.29, -0.23]) and safety (r = -0.23, 95 % CI [-0.28, -0.17]). In both cases, the negative relationship implied that greater burnout among healthcare providers was associated with poorer-quality healthcare and reduced safety for patients. Moderators for the quality relationship included dimension of burnout, unit of analysis, and quality data source. Moderators for the relationship between burnout and safety were safety indicator type, population, and country. Rigor of the study was not a significant moderator. This is the first study to systematically, quantitatively analyze the links between healthcare provider burnout and healthcare quality and safety across disciplines. Provider burnout shows consistent negative relationships with perceived quality (including patient satisfaction), quality indicators, and perceptions of safety. Though the effects are small to medium, the findings highlight the importance of effective burnout interventions for healthcare providers. Moderator analyses suggest contextual factors to consider for future study.

Integrative Review of the Intersection of Green Space and Neighborhood Violence.

PubMed

Mancus, Gibran C; Campbell, Jacquelyn

2018-03-01

To systematically analyze evidence about the impact of green space on the perception and actual safety of residents of urban neighborhoods. Systematic review of green space and violence based on Broome review criteria. One landmark study prompted the initial hand search and identification of search terms. Twenty-three quantitative, five qualitative, and two mixed-methods studies were found in the urban planning, public health, medical, and psychological literature that met the following criteria: analyzed green space and violence as factors in the perception of safety as an outcome measure, including action taken by being outside for recreation, exercise, or self-report in the survey. Findings were inconsistent regarding the direct relationship between perception of safety and green space when using recreation and exercise as a proxy for perception of safety. Findings regarding perception of safety in surveys were limited but indicated a positive correlation with green space. There is sufficient evidence to conclude that the perception of safety is supported by quality, accessibility, and aesthetic dimensions of neighborhood green space, and the perception of safety is often unrelated to actual crime rates. The science for understanding mechanisms between green space and violence as part of environmental health has been insufficiently developed and requires further study. Environmental health, including green space, is central to health promotion, and understanding is key to preventing the epidemic of violence. This article provides a summary of research related to green space, violence in communities, perception of safety, and violent crime in those communities. It identifies gaps in our knowledge where future research is needed. Nurses have the opportunity to lead the development, implementation, and evaluation of evidence-based interventions and policies addressing the inequality of quality and quantity of green space in the built and natural environment and related co-benefits. © 2018 Sigma Theta Tau International.

Labelling Of Textile Products From The Perspective Of Quality, Maintenance, Safety And Environment

NASA Astrophysics Data System (ADS)

Draxlerová, Mária; Rusko, Miroslav; Kuracina, Marcel

2015-06-01

Fundamental right of all consumers is the availability of necessary information to protect their own health. Information should be obtained from the marks referred to the product which they come into contact with. Marks are integral parts of everyone's life. We can see various types of marks at home, in stores and everywhere around us. Symbols indicate to the consumer the importance assigned to them in an opinion system (labelling scheme).

[Proposal for the formation of an intravenous therapy team].

PubMed

Carrero Caballero, M C

2006-12-01

At the present time, the medical profession is succeeding not only in helping the sick live longer but to have a higher quality of life, if possible inside their family environment. This requires a serious study regarding this situation. Many patients can receive intravenous treatment in outpatient clinics whenever these have a trustworthy system to administer intravenous pharmaceuticals, a system which provides safety and comfort to the patient and ease to the professionals which administer it.

Shift work and employee fatigue: implications for occupational health nursing.

PubMed

Yumang-Ross, Doreen J; Burns, Candace

2014-06-01

Long work hours and irregular shifts are part of the nation's 24-hour society and contribute to employee fatigue. Factors affecting employee fatigue are circadian rhythm, sleep quality and quantity, individual health, the environment, and work tasks. Employee fatigue contributes to accidents and injuries, and affects occupational performance, safety, and health. These findings should be used by occupational health nurses to address fatigue management and develop comprehensive fatigue management programs. Copyright 2014, SLACK Incorporated.

43 CFR 3162.5 - Environment and safety.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Environment and safety. 3162.5 Section 3162.5 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND... for Operating Rights Owners and Operators § 3162.5 Environment and safety. ...

43 CFR 3162.5 - Environment and safety.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Environment and safety. 3162.5 Section 3162.5 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND... for Operating Rights Owners and Operators § 3162.5 Environment and safety. ...

43 CFR 3162.5 - Environment and safety.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Environment and safety. 3162.5 Section 3162.5 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND... for Operating Rights Owners and Operators § 3162.5 Environment and safety. ...

43 CFR 3162.5 - Environment and safety.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Environment and safety. 3162.5 Section 3162.5 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND... for Operating Rights Owners and Operators § 3162.5 Environment and safety. ...

Open wide: looking into the safety culture of dental school clinics.

PubMed

Ramoni, Rachel; Walji, Muhammad F; Tavares, Anamaria; White, Joel; Tokede, Oluwabunmi; Vaderhobli, Ram; Kalenderian, Elsbeth

2014-05-01

Although dentists perform highly technical procedures in complex environments, patient safety has not received the same focus in dentistry as in medicine. Cultivating a robust patient safety culture is foundational to minimizing patient harm, but little is known about how dental teams view patient safety or the patient safety culture within their practice. As a step toward rectifying that omission, the goals of this study were to benchmark the patient safety culture in three U.S. dental schools, identifying areas for improvement. The extensively validated Medical Office Survey on Patient Safety Culture (MOSOPS), developed by the Agency for Healthcare Research and Quality, was administered to dental faculty, dental hygienists, dental students, and staff at the three schools. Forty-seven percent of the 328 invited individuals completed the survey. The "Teamwork" category received the highest marks and "Patient Care Tracking and Follow-Up" and "Leadership Support for Patient Safety" the lowest. Only 48 percent of the respondents rated systems and processes in place to prevent/catch patient problems as good/excellent. All patient safety dimensions received lower marks than in medical practices. These findings and the inherent risk associated with dental procedures lead to the conclusion that dentistry in general, and academic dental clinics in particular, stands to benefit from an increased focus on patient safety. This first published use of the MOSOPS in a dental clinic setting highlights both clinical and educational priorities for improving the safety of care in dental school clinics.

Sci-Fri AM: Quality, Safety, and Professional Issues 01: CPQR Technical Quality Control Suite Development including Quality Control Workload Results

DOE Office of Scientific and Technical Information (OSTI.GOV)

Malkoske, Kyle; Nielsen, Michelle; Brown, Erika

A close partnership between the Canadian Partnership for Quality Radiotherapy (CPQR) and the Canadian Organization of Medical Physicist’s (COMP) Quality Assurance and Radiation Safety Advisory Committee (QARSAC) has resulted in the development of a suite of Technical Quality Control (TQC) Guidelines for radiation treatment equipment, that outline specific performance objectives and criteria that equipment should meet in order to assure an acceptable level of radiation treatment quality. The framework includes consolidation of existing guidelines and/or literature by expert reviewers, structured stages of public review, external field-testing and ratification by COMP. The adopted framework for the development and maintenance of themore » TQCs ensures the guidelines incorporate input from the medical physics community during development, measures the workload required to perform the QC tests outlined in each TQC, and remain relevant (i.e. “living documents”) through subsequent planned reviews and updates. This presentation will show the Multi-Leaf Linear Accelerator document as an example of how feedback and cross-national work to achieve a robust guidance document. During field-testing, each technology was tested at multiple centres in a variety of clinic environments. As part of the defined feedback, workload data was captured. This lead to average time associated with testing as defined in each TQC document. As a result, for a medium-sized centre comprising 6 linear accelerators and a comprehensive brachytherapy program, we evaluate the physics workload to 1.5 full-time equivalent physicist per year to complete all QC tests listed in this suite.« less

Combining clinical microsystems and an experiential quality improvement curriculum to improve residency education in internal medicine.

PubMed

Tess, Anjala V; Yang, Julius J; Smith, C Christopher; Fawcett, Caitlin M; Bates, Carol K; Reynolds, Eileen E

2009-03-01

Beth Israel Deaconess Medical Center's internal medicine residency program was admitted to the new Education Innovation Project accreditation pathway of the Accreditation Council of Graduate Medical Education to begin in July 2006. The authors restructured the inpatient medical service to create clinical microsystems in which residents practice throughout residency. Program leadership then mandated an active curriculum in quality improvement based in those microsystems. To provide the experience to every graduating resident, a core faculty in patient safety was trained in the basics of quality improvement. The authors hypothesized that such changes would increase the number of residents participating in quality improvement projects, improve house officer engagement in quality improvement work, enhance the culture of safety the residents perceive in their training environment, improve work flow on the general medicine ward rotations, and improve the overall educational experience for the residents on ward rotations.The authors describe the first 18 months of the intervention (July 2006 to January 2008). The authors assessed attitudes and the educational experience with surveys and evaluation forms. After the intervention, the authors documented residents' participation in projects that overlapped with hospital priorities. More residents reported roles in designing and implementing quality improvement changes. Residents also noted greater satisfaction with the quality of care they deliver. Fewer residents agreed or strongly agreed that the new admitting system interfered with communication. Ongoing residency program assessment showed an improved perception of workload, and educational ratings of rotations improved. The changes required few resources and can be transported to other settings.

Culture and behaviour in the English National Health Service: overview of lessons from a large multimethod study

PubMed Central

Dixon-Woods, Mary; Baker, Richard; Charles, Kathryn; Dawson, Jeremy; Jerzembek, Gabi; Martin, Graham; McCarthy, Imelda; McKee, Lorna; Minion, Joel; Ozieranski, Piotr; Willars, Janet; Wilkie, Patricia; West, Michael

2014-01-01

Background Problems of quality and safety persist in health systems worldwide. We conducted a large research programme to examine culture and behaviour in the English National Health Service (NHS). Methods Mixed-methods study involving collection and triangulation of data from multiple sources, including interviews, surveys, ethnographic case studies, board minutes and publicly available datasets. We narratively synthesised data across the studies to produce a holistic picture and in this paper present a high-level summary. Results We found an almost universal desire to provide the best quality of care. We identified many ‘bright spots’ of excellent caring and practice and high-quality innovation across the NHS, but also considerable inconsistency. Consistent achievement of high-quality care was challenged by unclear goals, overlapping priorities that distracted attention, and compliance-oriented bureaucratised management. The institutional and regulatory environment was populated by multiple external bodies serving different but overlapping functions. Some organisations found it difficult to obtain valid insights into the quality of the care they provided. Poor organisational and information systems sometimes left staff struggling to deliver care effectively and disempowered them from initiating improvement. Good staff support and management were also highly variable, though they were fundamental to culture and were directly related to patient experience, safety and quality of care. Conclusions Our results highlight the importance of clear, challenging goals for high-quality care. Organisations need to put the patient at the centre of all they do, get smart intelligence, focus on improving organisational systems, and nurture caring cultures by ensuring that staff feel valued, respected, engaged and supported. PMID:24019507

Acessibility in collective housing for the elderly: a case study in Portugal.

PubMed

Paiva, Marie Monique Bruère; Villarouco, Vilma

2012-01-01

Physical spaces need to be adjusted to suit the changes of a physical, cognitive and emotional order occasioned by the natural aging of people. Ergonomics of the built environment contributes to improving the interaction of the user and physical environment, with a view to their comfort and safety. By thinking through the influence that environments have on the quality of life of the elderly, this article presents an assessment of accessibility in private units--bedrooms and bathrooms--of a Long-Stay Institution for the Elderly (ILPI in Portuguese) in Portugal. The analysis of the physical and spatial conditioning factors by means of the Ergonomics Methodology for the Built Environment (EMBE), proposed by VILLAROUCO (2008), gave evidence of the need for interventions to suitably adapt physical infrastructure, with the objective of promoting the physical well-being of the elderly, and thus, enhancing the autonomy and independence of a wider range of users.

Implementation of Programmatic Quality and the Impact on Safety

NASA Technical Reports Server (NTRS)

Huls, Dale Thomas; Meehan, Kevin

2005-01-01

The purpose of this paper is to discuss the implementation of a programmatic quality assurance discipline within the International Space Station Program and the resulting impact on safety. NASA culture has continued to stress safety at the expense of quality when both are extremely important and both can equally influence the success or failure of a Program or Mission. Although safety was heavily criticized in the media after Colimbiaa, strong case can be made that it was the failure of quality processes and quality assurance in all processes that eventually led to the Columbia accident. Consequently, it is possible to have good quality processes without safety, but it is impossible to have good safety processes without quality. The ISS Program quality assurance function was analyzed as representative of the long-term manned missions that are consistent with the President s Vision for Space Exploration. Background topics are as follows: The quality assurance organizational structure within the ISS Program and the interrelationships between various internal and external organizations. ISS Program quality roles and responsibilities with respect to internal Program Offices and other external organizations such as the Shuttle Program, JSC Directorates, NASA Headquarters, NASA Contractors, other NASA Centers, and International Partner/participants will be addressed. A detailed analysis of implemented quality assurance responsibilities and functions with respect to NASA Headquarters, the JSC S&MA Directorate, and the ISS Program will be presented. Discussions topics are as follows: A comparison of quality and safety resources in terms of staffing, training, experience, and certifications. A benchmark assessment of the lessons learned from the Columbia Accident Investigation (CAB) Report (and follow-up reports and assessments), NASA Benchmarking, and traditional quality assurance activities against ISS quality procedures and practices. The lack of a coherent operational and sustaining quality assurance strategy for long-term manned space flight. An analysis of the ISS waiver processes and the Problem Reporting and Corrective Action (PRACA) process implemented as quality functions. Impact of current ISS Program procedures and practices with regards to operational safety and risk A discussion regarding a "defense-in-depth" approach to quality functions will be provided to address the issue of "integration vs independence" with respect to the roles of Programs, NASA Centers, and NASA Headquarters. Generic recommendations are offered to address the inadequacies identified in the implementation of ISS quality assurance. A reassessment by the NASA community regarding the importance of a "quality culture" as a component within a larger "safety culture" will generate a more effective and value-added functionality that will ultimately enhance safety.

Translating Health Care–Associated Urinary Tract Infection Prevention Research into Practice via the Bladder Bundle

PubMed Central

Saint, Sanjay; Olmsted, Russell N.; Fakih, Mohamad G.; Kowalski, Christine P.; Watson, Sam R.; Sales, Anne E.; Krein, Sarah L.

2009-01-01

Article-at-a-Glance Background: Catheter-associated urinary tract infection (CAUTI), a frequent health care–associated infection (HAI), is a costly and common condition resulting in patient discomfort, activity restriction, and hospital discharge delays. The Centers for Medicare & Medicaid Services (CMS) no longer reimburses hospitals for the extra cost of caring for patients who develop CAUTI. The Michigan Health and Hospital Association (MHA) Keystone Center for Patient Safety & Quality has initiated a statewide initiative, MHA Keystone HAI, to help ameliorate the burden of disease associated with indwelling catheterization. In addition, a long-term research project is being conducted to evaluate the current initiative and to identify practical strategies to ensure the effective use of proven infection prevention and patient safety practices. Overview of the Bladder Bundle Initiative in Michigan: The bladder bundle as conceived by MHA Keystone HAI focuses on preventing CAUTI by optimizing the use of urinary catheters with a specific emphasis on continual assessment and catheter removal as soon as possible, especially for patients without a clear indication. Collaboration Between Researchers and State wide Patient Safety Organizations: A synergistic collaboration between patient safety researchers and a statewide patient safety organization is aimed at identifying effective strategies to move evidence from peer-reviewed literature to the bedside. Practical strategies that facilitate implementation of the bundle will be developed and tested using mixed quantitative and qualitative methods. Discussion: Simply disseminating scientific evidence is often ineffective in changing clinical practice. Therefore, learning how to implement these findings is critically important to promoting high-quality care and a safe health care environment. PMID:19769204

Exploring Environmental Variation in Residential Care Facilities for Older People.

PubMed

Nordin, Susanna; McKee, Kevin; Wijk, Helle; Elf, Marie

2017-01-01

The aim of this study was to explore variation in environmental quality in Swedish residential care facilities (RCFs) using the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM). Well-designed physical environments can positively impact on health and well-being among older persons with frail health living in RCFs and are essential for supporting person-centered care. However, the evidence base for informing the design of RCFs is weak, partly due to a lack of valid and reliable instruments that could provide important information on the environmental quality. Twenty RCFs were purposively sampled from several regions, varying in their building design, year of construction, size, and geographic location. The RCFs were assessed using S-SCEAM and the data were analyzed to examine variation in environmental quality between and within facilities. There was substantial variation in the quality of the physical environment between and within RCFs, reflected in S-SCEAM scores related to specific facility locations and with regard to domains reflecting residents' needs. In general, private apartments and dining areas had high S-SCEAM scores, while gardens had lower scores. Scores on the safety domain were high in the majority of RCFs, whereas scores for cognitive support and privacy were relatively low. Despite high building standard requirements, the substantial variations regarding environmental quality between and within RCFs indicate the potential for improvements to support the needs of older persons. We conclude that S-SCEAM is a sensitive and unique instrument representing a valuable contribution to evidence-based design that can support person-centered care.

[Hygiene and security management in medical biology laboratory].

PubMed

Vinner, E; Odou, M F; Fovet, B; Ghnassia, J C

2013-06-01

Risk management in Medical Biology Laboratory (MBL) which includes hygiene and waste management, is an integrated process to the whole MBL organisation. It is composed of three stages: risks factors identification, grading and prioritization, and their evaluation in the system. From the legislation and NF EN ISO 15189 standard's requirements viewpoint, prevention and protection actions to implement are described, at premises level, but also at work station environment's one (human resources and equipments) towards biological, chemical, linked to gas, to ionizing or non ionizing radiations and fire riks, in order not to compromise patients safety, employees safety, and quality results. Then, although NF EN 15189 standard only enacts requirements in terms of prevention, curative actions after established blood or chemical exposure accident are defined.

The influence of handling qualities on safety and survivability

NASA Technical Reports Server (NTRS)

Anderson, S. B.

1977-01-01

The relationship of handling qualities to safety and survivability of military aircraft is examined which includes the following: (1) a brief discussion of the philosophy used in the military specifications for treatment of degraded handling qualities, (2) an examination of several example handling qualities problem areas which influence safety and survivability; and (3) a movie illustrating the potential dangers of inadequate handling qualities features.

Space Station Environmental Health System water quality monitoring

NASA Technical Reports Server (NTRS)

Vincze, Johanna E.; Sauer, Richard L.

1990-01-01

One of the unique aspects of the Space Station is that it will be a totally encapsulated environment and the air and water supplies will be reclaimed for reuse. The Environmental Health System, a subsystem of CHeCS (Crew Health Care System), must monitor the air and water on board the Space Station Freedom to verify that the quality is adequate for crew safety. Specifically, the Water Quality Subsystem will analyze the potable and hygiene water supplies regularly for organic, inorganic, particulate, and microbial contamination. The equipment selected to perform these analyses will be commercially available instruments which will be converted for use on board the Space Station Freedom. Therefore, the commercial hardware will be analyzed to identify the gravity dependent functions and modified to eliminate them. The selection, analysis, and conversion of the off-the-shelf equipment for monitoring the Space Station reclaimed water creates a challenging project for the Water Quality engineers and scientists.

Klickitat Cogeneration Project : Final Environmental Assessment.

DOE Office of Scientific and Technical Information (OSTI.GOV)

United States. Bonneville Power Administration; Klickitat Energy Partners

1994-09-01

To meet BPA`s contractual obligation to supply electrical power to its customers, BPA proposes to acquire power generated by Klickitat Cogeneration Project. BPA has prepared an environmental assessment evaluating the proposed project. Based on the EA analysis, BPA`s proposed action is not a major Federal action significantly affecting the quality of the human environment within the meaning of the National Environmental Policy Act of 1969 for the following reasons: (1)it will not have a significant impact land use, upland vegetation, wetlands, water quality, geology, soils, public health and safety, visual quality, historical and cultural resources, recreation and socioeconomics, and (2)more » impacts to fisheries, wildlife resources, air quality, and noise will be temporary, minor, or sufficiently offset by mitigation. Therefore, the preparation of an environmental impact statement is not required and BPA is issuing this FONSI (Finding of No Significant Impact).« less

Preventing Harm in the ICU-Building a Culture of Safety and Engaging Patients and Families.

PubMed

Thornton, Kevin C; Schwarz, Jennifer J; Gross, A Kendall; Anderson, Wendy G; Liu, Kathleen D; Romig, Mark C; Schell-Chaple, Hildy; Pronovost, Peter J; Sapirstein, Adam; Gropper, Michael A; Lipshutz, Angela K M

2017-09-01

Preventing harm remains a persistent challenge in the ICU despite evidence-based practices known to reduce the prevalence of adverse events. This review seeks to describe the critical role of safety culture and patient and family engagement in successful quality improvement initiatives in the ICU. We review the evidence supporting the impact of safety culture and provide practical guidance for those wishing to implement initiatives aimed at improving safety culture and more effectively integrate patients and families in such efforts. Literature review using PubMed including evaluation of key studies assessing large-scale quality improvement efforts in the ICU, impact of safety culture on patient outcomes, methodologies for quality improvement commonly used in healthcare, and patient and family engagement. Print and web-based resources from leading patient safety organizations were also searched. Our group completed a review of original studies, review articles, book chapters, and recommendations from leading patient safety organizations. Our group determined by consensus which resources would best inform this review. A strong safety culture is associated with reduced adverse events, lower mortality rates, and lower costs. Quality improvement efforts have been shown to be more effective and sustainable when paired with a strong safety culture. Different methodologies exist for quality improvement in the ICU; a thoughtful approach to implementation that engages frontline providers and administrative leadership is essential for success. Efforts to substantively include patients and families in the processes of quality improvement work in the ICU should be expanded. Efforts to establish a culture of safety and meaningfully engage patients and families should form the foundation for all safety interventions in the ICU. This review describes an approach that integrates components of several proven quality improvement methodologies to enhance safety culture in the ICU and highlights opportunities to include patients and families.

John M. Eisenberg Patient Safety and Quality Awards.

PubMed

2009-12-01

The Joint Commission Journal on Quality and Patient Safety is honored to publish articles on the recipients of the annual John M. Eisenberg Patient Safety and Quality Awards. This year, a new category was created: individual achievement at the international level.

Patient Safety Reporting Systems: Sustained Quality Improvement Using a Multidisciplinary Team and “Good Catch” Awards

PubMed Central

Herzer, Kurt R.; Mirrer, Meredith; Xie, Yanjun; Steppan, Jochen; Li, Matthew; Jung, Clinton; Cover, Renee; Doyle, Peter A.; Mark, Lynette J.

2014-01-01

Background Since 1999, hospitals have made substantial commitments to healthcare quality and patient safety through individual initiatives of executive leadership involvement in quality, investments in safety culture, education and training for medical students and residents in quality and safety, the creation of patient safety committees, and implementation of patient safety reporting systems. Cohesive quality and safety approaches have become comprehensive programs to identify and mitigate hazards that could harm patients. This article moves to the next level with an intense refocusing of attention on one of the individual components of a comprehensive program--the patient safety reporting system—with a goal of maximized usefulness of the reports and long-term sustainability of quality improvements arising from them. Methods A six-phase framework was developed to deal with patient safety hazards: identify, report, analyze, mitigate, reward, and follow up. Unique features of this process included a multidisciplinary team to review reports, mitigate hazards, educate and empower providers, recognize the identifying/reporting individuals or groups with “Good Catch” awards, and follow up to determine if quality improvements were sustained over time. Results To date, 29 patient safety hazards have gone through this process with “Good Catch” awards being granted at our institution. These awards were presented at various times over the past 4 years since the process began in 2008. Follow-up revealed that 86% of the associated quality improvements have been sustained over time since the awards were given. We present the details of two of these “Good Catch” awards: vials of heparin with an unusually high concentration of the drug that posed a potential overdose hazard and a rapid infusion device that resisted practitioner control. Conclusion A multidisciplinary team's analysis and mitigation of hazards identified in a patient safety reporting system, positive recognition with a “Good Catch” award, education of practitioners, and long-term follow-up resulted in an outcome of sustained quality improvement initiatives. PMID:22946251

Continuing professional education in Eritrea taught by local obstetrics and gynaecology residents: Effects on work environment and patient outcomes.

PubMed

Marzolf, Susan; Zekarias, Berhane; Tedla, Kifleyesus; Woldeyesus, Dawit Estifanos; Sereke, Dawit; Yohannes, Abraham; Asrat, Kibreab; Weaver, Marcia R

2015-01-01

Education and training can improve the quality of health care. We evaluated a course taught by Obstetrics/Gynaecology residents on the work environment and maternal/neonatal outcomes at Orotta Maternity Hospital. Participants were given a Standardised Safety Attitudes Questionnaire (SAQ) to measure work environment before and after training. Maternal/neonatal outcomes were extracted from hospital logbooks. Neonatal quality indicators were: adverse score index, weighted score index and severity score index. SAQ response rate was 77.6% (45/58) pre-training and 95.6% (43/45) post-training. Mean total SAQ score increased from 3.07 to 3.32 out of 5 points (p < 0.05). Changes in relative risk (RR) were not statistically significant for maternal [maternal death ratio of RR (RRR) =1.08, 95% CI: 0.20-5.84 and blood transfusion RRR = 0.90, 95% CI: 0.74 -1.09] or neonatal outcomes (intrapartum death RRR = 1.24, 95% CI: 0.57-2.75, neonatal death RRR = 0.93, 95% CI: 0.26-3.24, neonatal transfer RRR = 1.02, 95% CI: 0.81-1.27, and Apgar < 7 at 5 minutes RRR = 1.20, 95% CI: 0.83-1.73). Neonatal quality indicators did not change significantly. Utilising residents to teach staff-developed training within a hospital setting was feasible and may improve the work environment. Impact on maternal/neonatal outcomes is not evident but continued follow-up is important.

[Study on influence of different storage environments and packaging materials on quality of Citri Reticulatae Pericarpium].

PubMed

Luo, Jiao-Yang; Zhou, Wen-Ju; Li, Kun-Lun; Zhao, Ming; Yang, Mei-Hua

2018-03-01

Traditional Chinese herbs are readily contaminated by mold that produced mycotoxins which are closly related to the herbs' external factors and external environments during the storage process. In this study, Citri Reticulatae Pericarpium was used as example, and the characteristics of traits, water content, active components (naringin, hesperidin, sinensetin, naringin, tangeretin) and the accumulation of aflatoxins (AFs) were selected as the evaluation indexes. Citri Reticulatae Pericarpium was stored under different environments and packaging materials for 12 months, and then the quality changes and mildew of Citri Reticulatae Pericarpium were examined. The results showed that the color of Citri Reticulatae Pericarpium was deepened after storage, but without mildew phenomenon. Besides, the sample storage in kraft paper and woven bags had varying degrees of moth phenomenon after 12 months storage, and the water content exceeded the limit of Chinese Pharmacopoeia. In addition, the contents of the five active constituents obviously decreased, especially for hesperidin, which did not meet the pharmacopoeia standard after storage. AFs were not detected in any of the tested samples. According to the results, we conclude that low temperature and humidity environment is more suitable for the storage of Citri Reticulatae Pericarpium, and that packaging materials should be further investigated. This study is of great significance for preventing the mold to contaminate the traditional Chinese medicine and ensuring the quality, effectiveness and safety of TCMs. Copyright© by the Chinese Pharmaceutical Association.

Environmental Change in the Agro-Pastoral Transitional Zone, Northern China: Patterns, Drivers, and Implications.

PubMed

Jiang, Chong; Wang, Fei

2016-01-28

Chengde city is located in the agro-pastoral transitional zone in northern China near the capital city of Beijing, which has experienced large-scale ecological construction in the past three decades. This study quantitatively assessed the environmental changes in Chengde through observation records of water resources, water environment, atmospheric environment, and vegetation activity and investigated the possible causes. From the late 1950s to 2002, the streamflow presented a downward trend induced by climate variability and human activities, with contribution ratios of 33.2% and 66.8%, respectively. During 2001-2012, the days of levels I and II air quality presented clear upward trends. Moreover, the air pollutant concentration was relatively low compared with that in the adjacent areas, which means the air quality has improved more than that in the neighboring areas. The water quality, which deteriorated during 1993-2000, began to improve in 2002. The air and water quality changes were closely related to pollutant emissions induced by anthropogenic activities. During 1982-2012, the vegetation in the southeastern and central regions presented restoration trends, whereas that in the northwestern area showed degradation trends. The pixels with obvious degradation trends correlated significantly with annual mean temperature and annual precipitation. Ecological engineering also played a positive role in vegetation restoration. This analysis can be beneficial to environment managers in the active response and adaptation to the possible effects of future climate change, population growth, and industrial development and can be used to ensure sustainable development and environmental safety.

Quality and safety in medical care: what does the future hold?

PubMed

Liang, Bryan A; Mackey, Tim

2011-11-01

The rapid changes in health care policy, embracing quality and safety mandates, have culminated in programs and initiatives under the Patient Protection and Affordable Care Act. To review the context of, and anticipated quality and patient safety mandates for, delivery systems, incentives under health care reform, and models for future accountability for outcomes of care. Assessment of the provisions of Patient Protection and Affordable Care Act, other reform efforts, and reform initiatives focusing on future quality and safety provisions for health care providers. Health care reform and other efforts focus on consumerism in the context of price. Quality and safety efforts will be structured using financial incentives, best-practices research, and new delivery models that focus on reaching benchmarks while reducing costs. In addition, patient experience will be a key component of reimbursement, and a move toward "retail" approaches directed at the individual patient may supplant traditional "wholesale" efforts at attracting employers. Quality and safety have always been of prime importance in medicine. However, in the future, under health care reform and associated initiatives, a shift in the paradigm of medicine will integrate quality and safety measurement with financial incentives and a new emphasis on consumerism.

Nurses' sleep quality, work environment and quality of care in the Spanish National Health System: observational study among different shifts

PubMed Central

Gómez-García, Teresa; Ruzafa-Martínez, María; Fuentelsaz-Gallego, Carmen; Madrid, Juan Antonio; Rol, Maria Angeles; Martínez-Madrid, María José; Moreno-Casbas, Teresa

2016-01-01

Objective The main objective of this study was to determine the relationship between the characteristics of nurses' work environments in hospitals in the Spanish National Health System (SNHS) with nurse reported quality of care, and how care was provided by using different shifts schemes. The study also examined the relationship between job satisfaction, burnout, sleep quality and daytime drowsiness of nurses and shift work. Methods This was a multicentre, observational, descriptive, cross-sectional study, centred on a self-administered questionnaire. The study was conducted in seven SNHS hospitals of different sizes. We recruited 635 registered nurses who worked on day, night and rotational shifts on surgical, medical and critical care units. Their average age was 41.1 years, their average work experience was 16.4 years and 90% worked full time. A descriptive and bivariate analysis was carried out to study the relationship between work environment, quality and safety care, and sleep quality of nurses working different shift patterns. Results 65.4% (410) of nurses worked on a rotating shift. The Practice Environment Scale of the Nursing Work Index classification ranked 20% (95) as favourable, showing differences in nurse manager ability, leadership and support between shifts (p=0.003). 46.6% (286) were sure that patients could manage their self-care after discharge, but there were differences between shifts (p=0.035). 33.1% (201) agreed with information being lost in the shift change, showing differences between shifts (p=0.002). The Pittsburgh Sleep Quality Index reflected an average of 6.8 (SD 3.39), with differences between shifts (p=0.017). Conclusions Nursing requires shift work, and the results showed that the rotating shift was the most common. Rotating shift nurses reported worse perception in organisational and work environmental factors. Rotating and night shift nurses were less confident about patients' competence of self-care after discharge. The most common nursing care omissions reported were related to nursing care plans. For the Global Sleep Quality score, difference were found between day and night shift workers. PMID:27496241

A systematic review of Human Factors and Ergonomics (HFE)-based healthcare system redesign for quality of care and patient safety

PubMed Central

Xie, Anping; Carayon, Pascale

2014-01-01

Healthcare systems need to be redesigned to provide care that is safe, effective and efficient, and meets the multiple needs of patients. This systematic review examines how Human Factors and Ergonomics (HFE) is applied to redesign healthcare work systems and processes and improve quality and safety of care. We identified twelve projects representing 23 studies and addressing different physical, cognitive and organizational HFE issues in a variety of healthcare systems and care settings. Some evidence exists for the effectiveness of HFE-based healthcare system redesign in improving process and outcome measures of quality and safety of care. We assessed risk of bias in 16 studies reporting the impact of HFE-based healthcare system redesign and found varying quality across studies. Future research should further assess the impact of HFE on quality and safety of care, and clearly define the mechanisms by which HFE-based system redesign can improve quality and safety of care. Practitioner Summary Existing evidence shows that HFE-based healthcare system redesign has the potential to improve quality of care and patient safety. Healthcare organizations need to recognize the importance of HFE-based healthcare system redesign to quality of care and patient safety, and invest resources to integrate HFE in healthcare improvement activities. PMID:25323570

Fundamentals of quality and safety in diagnostic radiology.

PubMed

Bruno, Michael A; Nagy, Paul

2014-12-01

The most fundamental aspects of quality and safety in radiology are reviewed, including a brief history of the quality and safety movement as applied to radiology, the overarching considerations of organizational culture, team building, choosing appropriate goals and metrics, and the radiologist's quality "tool kit." Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Quality and Safety as a Core Leadership Competency.

PubMed

Bleich, Michael R

2018-05-01

A leader's toolbox of competencies comprises knowledge, skills, and abilities in clinical care, finance, human resource management, and more. As essential as these are, a strong command of quality and safety competencies is sovereign in leading and managing, ensuring an optimal patient experience. Four core areas of quality and safety competencies are presented: systems science, knowledge workers, implementation science and big data, and quality safety tools and techniques. J Contin Educ Nurs. 2018;49(5):200-202. Copyright 2018, SLACK Incorporated.

Implementation Science: New Approaches to Integrating Quality and Safety Education for Nurses Competencies in Nursing Education.

PubMed

Dolansky, Mary A; Schexnayder, Julie; Patrician, Patricia A; Sales, Anne

Although quality and safety competencies were developed and disseminated nearly a decade ago by the Quality and Safety Education for Nurses (QSEN) project, the uptake in schools of nursing has been slow. The use of implementation science methods may be useful to accelerate quality and safety competency integration in nursing education. The article includes a definition and description of implementation science methods and practical implementation strategies for nurse educators to consider when integrating the QSEN competencies into nursing curriculum.

The cultural environment behind successful maternal death and morbidity reviews.

PubMed

Lewis, G

2014-09-01

This paper discusses some of the background principles which, through wide experience of instituting reviews of maternal deaths or near-misses around the world, appear common to their successful introduction. A supportive culture at personal, institutional and national level underpinned by the fostering of professionalism and the development of an ethos of safety against a wider supportive environment is needed. Reviews undertaken at a local level are as beneficial as those at a regional or population level and should be encouraged as a routine part of the quality improvement agenda for each and every healthcare facility. © 2014 The Authors BJOG An International Journal of Obsetrics and Gynaecology © 2014 RCOG.

Microbiological performance of dairy processing plants is influenced by scale of production and the implemented food safety management system: a case study.

PubMed

Opiyo, Beatrice Atieno; Wangoh, John; Njage, Patrick Murigu Kamau

2013-06-01

The effects of existing food safety management systems and size of the production facility on microbiological quality in the dairy industry in Kenya were studied. A microbial assessment scheme was used to evaluate 14 dairies in Nairobi and its environs, and their performance was compared based on their size and on whether they were implementing hazard analysis critical control point (HACCP) systems and International Organization for Standardization (ISO) 22000 recommendations. Environmental samples from critical sampling locations, i.e., workers' hands and food contact surfaces, and from end products were analyzed for microbial quality, including hygiene indicators and pathogens. Microbial safety level profiles (MSLPs) were constructed from the microbiological data to obtain an overview of contamination. The maximum MSLP score for environmental samples was 18 (six microbiological parameters, each with a maximum MSLP score of 3) and that for end products was 15 (five microbiological parameters). Three dairies (two large scale and one medium scale; 21% of total) achieved the maximum MSLP scores of 18 for environmental samples and 15 for the end product. Escherichia coli was detected on food contact surfaces in three dairies, all of which were small scale dairies, and the microorganism was also present in end product samples from two of these dairies, an indication of cross-contamination. Microbial quality was poorest in small scale dairies. Most operations in these dairies were manual, with minimal system documentation. Noncompliance with hygienic practices such as hand washing and cleaning and disinfection procedures, which is common in small dairies, directly affects the microbial quality of the end products. Dairies implementing HACCP systems or ISO 22000 recommendations achieved maximum MSLP scores and hence produced safer products.

Quality, risk management and patient safety: the challenge of effective integration.

PubMed

França, Margarida

2008-01-01

Nowadays we observe the development of three waves of intervention and change within healthcare services: quality management, risk management and patient safety. The Patient Safety movement has been launched at international level as a consequence of the Institute of Medicine's report--To Err is Human, and today patient safety constitutes one basic dimension of health quality subjected to the direct intervention of supranational entities (WHO, EU) and Member States' Governments. The objective of this paper is to raise awareness about the value of quality improvement (QI) methodologies and tools to sustainable healthcare quality outcomes.

Safety climate and attitude toward medication error reporting after hospital accreditation in South Korea.

PubMed

Lee, Eunjoo

2016-09-01

This study compared registered nurses' perceptions of safety climate and attitude toward medication error reporting before and after completing a hospital accreditation program. Medication errors are the most prevalent adverse events threatening patient safety; reducing underreporting of medication errors significantly improves patient safety. Safety climate in hospitals may affect medication error reporting. This study employed a longitudinal, descriptive design. Data were collected using questionnaires. A tertiary acute hospital in South Korea undergoing a hospital accreditation program. Nurses, pre- and post-accreditation (217 and 373); response rate: 58% and 87%, respectively. Hospital accreditation program. Perceived safety climate and attitude toward medication error reporting. The level of safety climate and attitude toward medication error reporting increased significantly following accreditation; however, measures of institutional leadership and management did not improve significantly. Participants' perception of safety climate was positively correlated with their attitude toward medication error reporting; this correlation strengthened following completion of the program. Improving hospitals' safety climate increased nurses' medication error reporting; interventions that help hospital administration and managers to provide more supportive leadership may facilitate safety climate improvement. Hospitals and their units should develop more friendly and intimate working environments that remove nurses' fear of penalties. Administration and managers should support nurses who report their own errors. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Undergraduate medical students' perceptions and intentions regarding patient safety during clinical clerkship.

PubMed

Lee, Hoo-Yeon; Hahm, Myung-Il; Lee, Sang Gyu

2018-04-04

The purpose of this study was to examine undergraduate medical students' perceptions and intentions regarding patient safety during clinical clerkships. Cross-sectional study administered in face-to-face interviews using modified the Medical Student Safety Attitudes and Professionalism Survey (MSSAPS) from three colleges of medicine in Korea. We assessed medical students' perceptions of the cultures ('safety', 'teamwork', and 'error disclosure'), 'behavioural intentions' concerning patient safety issues and 'overall patient safety'. Confirmatory factor analysis and Spearman's correlation analyses was performed. In total, 194(91.9%) of the 211 third-year undergraduate students participated. 78% of medical students reported that the quality of care received by patients was impacted by teamwork during clinical rotations. Regarding error disclosure, positive scores ranged from 10% to 74%. Except for one question asking whether the disclosure of medical errors was an important component of patient safety (74%), the percentages of positive scores for all the other questions were below 20%. 41.2% of medical students have intention to disclose it when they saw a medical error committed by another team member. Many students had difficulty speaking up about medical errors. Error disclosure guidelines and educational efforts aimed at developing sophisticated communication skills are needed. This study may serve as a reference for other institutions planning patient safety education in their curricula. Assessing student perceptions of safety culture can provide clerkship directors and clinical service chiefs with information that enhances the educational environment and promotes patient safety.

Ecological analysis of college women's physical activity and health-related quality of life.

PubMed

Zhang, Tao; Dunn, Jacqueline; Morrow, James; Greenleaf, Christy

2018-03-01

Despite significant health benefits of regular physical activity, over 60 percent of college women do not meet recommended physical activity guidelines to promote their health and health-related quality of life (HRQoL), a comprehensive construct including physical and psychosocial health functioning. The major purpose of this study was to examine the influences of individual (e.g., self-efficacy, enjoyment), social (e.g., family and friend support), and physical environmental factors (e.g., crime safety) on college women's physical activity and HRQoL. Participants were 235 (Mean age = 21.0 years) college women from a public research university located in the southwest region of the United States. They completed validated surveys assessing their perceptions of physical activity, HRQoL, and social ecological factors during the spring semester of 2012. The findings of three multiple linear regressions, entering individual factors first, followed by social and physical environmental factors, revealed that self-efficacy and crime safety were significantly related to physical activity. For HRQoL-physical functioning, significant factors were self-efficacy, enjoyment, and crime safety. Enjoyment was the only factor related to HRQoL-psychosocial functioning. These findings indicated that physical activity professionals need to foster safe environments, enhance self-efficacy, and provide enjoyable activities to promote college women's physical activity and HRQoL.

How to teach evidence-based medicine to urologists

PubMed Central

Hajebrahimi, Sakineh; Mostafaie, Ali

2011-01-01

The goal of this article is to help develop, disseminate, and evaluate resources that can be used to practice and teach EBM for urology residents and continuing education of urologists to reduce the gap between research and clinical practice. Urology departments should build capacity for residents to shape the future of quality and safety in healthcare through translating evidence into practice. Cutting edge approaches require knowing how to teach Evidence-based urology, to make Bio-statistics easy to understanding and how to lead improvement at every level. The authors shared their experience about ‘what works’ in a surgical department to building an Evidence-based environment and high quality of cares. PMID:22279316

Evaluating alternative service contracts for medical equipment.

PubMed

De Vivo, L; Derrico, P; Tomaiuolo, D; Capussotto, C; Reali, A

2004-01-01

Managing medical equipments is a formidable task that has to be pursued maximizing the benefits within a highly regulated and cost-constrained environment. Clinical engineers are uniquely equipped to determine which policies are the most efficacious and cost effective for a health care institution to ensure that medical devices meet appropriate standards of safety, quality and performance. Part of this support is a strategy for preventive and corrective maintenance. This paper describes an alternative scheme of OEM (Original Equipment Manufacturer) service contract for medical equipment that combines manufacturers' technical support and in-house maintenance. An efficient and efficacious organization can reduce the high cost of medical equipment maintenance while raising reliability and quality. Methodology and results are discussed.

Improving Health Care Workers for Seasonal Influenza Vaccination at University Health System: A Paradigm for Closing the Quality Chasm

PubMed Central

Patterson, Jan E.; Cadena, Jose; Prigmore, Teresa; Bowling, Jason; Ayala, Beth Ann; Kirkman, Leni; Parekh, Amruta; Scepanski, Theresa

2011-01-01

Significant gaps in quality and patient safety in the US health-care system have been identified and were reported in the past decade by the Institute of Medicine. Despite recognition of these gaps in “knowing versus doing,” change in health care is slow and difficult. The quality improvement and clinical safety movement is increasing among US medical centers. Our health science center implemented the UT System Clinical Safety and Effectiveness course, providing project-based teaching of quality-improvement tools and principles of patient safety. A quality-improvement project that increased healthcare workers' influenza vaccination rate by 17.8% from that in 2008 to a rate of 76.6% in 2009 serves as a paradigm of how physicians can lead quality-improvement project teams to narrow the quality chasm (1). Local efforts to narrow the chasm are discussed in the present paper, including inter-professional education in quality improvement and clinical safety. PMID:21686222

Health and safety in the dental clinic - Hygiene regulations for use of elemental mercury in the protection of rights, safety and well-being of the patients, workers and the environment.

PubMed

Ngim, Chunhan; Ngim, Allister Daquan

2013-12-01

The rules governing the use of metallic mercury, a toxic and hazardous chemical, is in most jurisdictions identical to widely accepted standards and practices for handling the same chemical in industry for the protection of humans and their work environment. There cannot be exceptions solely for the practitioner dentists and their patients. Any workplace must be safe for both workers and visitors. The latter being dental patients waiting in the dentist's work environment. We reviewed the literature for toxic health effects of elemental mercury upon humans and present information about the Minimata Convention convened by the United Nations Environment Programme. A study conducted among dentists in Singapore and their personal work environment almost 30 years ago contributed to the workplace standard for elemental mercury, which was reduced, and is still currently enforced as a global standard. We recommend that dentists, with a large alternative battery of restorative materials today, make selection of a restorative material a more seriously considered choice, and not to make use of amalgam without the proper use of personal protective equipment for themselves (members of the dental operating team) and their patients, (amalgam traps and judicious monitoring of their workplace air quality). Mercury is ubiquitous in our presence due to human activities; any reduction in the dentists' workplace contributes to a global reduction. © 2013 Published by Elsevier (Singapore) Pte Ltd.

Obstetric Safety and Quality.

PubMed

Pettker, Christian M; Grobman, William A

2015-07-01

Obstetric safety and quality is an emerging and important topic not only as a result of the pressures of patient and regulatory expectations, but also because of the genuine interest of caregivers to reduce harm, improve outcomes, and optimize care. Although each seeks to improve care by using scientific approaches beyond human physiology and pathophysiology, patient safety methodologies seek to avoid preventable adverse events, whereas health care quality projects aim to achieve the best possible outcomes. It is well-documented that an increasingly complex medical system controlled by human workers is a circumstance subject to recurrent failure. A safety culture encourages a proactive approach to mitigate failure before, during, and after it occurs. This article highlights the key concepts in health care safety and quality and reviews the background of the quality improvement sciences with particular emphasis on obstetric outcomes and quality measures.

75 FR 54351 - Statement of Organization, Functions, and Delegations of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-07

... helping staff create a safe, healthful workplace environment, by assisting in the prevention of work... Health and Safety (CAJP), and insert the following: Office of Safety, Health, and Environment (CAJP). The mission of the Office of Safety, Health, and Environment (OSHE) of the Centers for Disease Control and...

30 CFR 250.806 - Safety and pollution prevention equipment quality assurance requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Safety and pollution prevention equipment... Gas Production Safety Systems § 250.806 Safety and pollution prevention equipment quality assurance... install only certified safety and pollution prevention equipment (SPPE) in wells located on the OCS. SPPE...

Quality and Safety Education for Nurses (QSEN): The Key is Systems Thinking.

PubMed

Dolansky, Mary A; Moore, Shirley M

2013-09-30

Over a decade has passed since the Institute of Medicine's reports on the need to improve the American healthcare system, and yet only slight improvement in quality and safety has been reported. The Quality and Safety Education for Nurses (QSEN) initiative was developed to integrate quality and safety competencies into nursing education. The current challenge is for nurses to move beyond the application of QSEN competencies to individual patients and families and incorporate systems thinking in quality and safety education and healthcare delivery. This article provides a history of QSEN and proposes a framework in which systems thinking is a critical aspect in the application of the QSEN competencies. We provide examples of how using this framework expands nursing focus from individual care to care of the system and propose ways to teach and measure systems thinking. The conclusion calls for movement from personal effort and individual care to a focus on care of the system that will accelerate improvement of healthcare quality and safety.

Agile Methods for Open Source Safety-Critical Software

PubMed Central

Enquobahrie, Andinet; Ibanez, Luis; Cheng, Patrick; Yaniv, Ziv; Cleary, Kevin; Kokoori, Shylaja; Muffih, Benjamin; Heidenreich, John

2011-01-01

The introduction of software technology in a life-dependent environment requires the development team to execute a process that ensures a high level of software reliability and correctness. Despite their popularity, agile methods are generally assumed to be inappropriate as a process family in these environments due to their lack of emphasis on documentation, traceability, and other formal techniques. Agile methods, notably Scrum, favor empirical process control, or small constant adjustments in a tight feedback loop. This paper challenges the assumption that agile methods are inappropriate for safety-critical software development. Agile methods are flexible enough to encourage the right amount of ceremony; therefore if safety-critical systems require greater emphasis on activities like formal specification and requirements management, then an agile process will include these as necessary activities. Furthermore, agile methods focus more on continuous process management and code-level quality than classic software engineering process models. We present our experiences on the image-guided surgical toolkit (IGSTK) project as a backdrop. IGSTK is an open source software project employing agile practices since 2004. We started with the assumption that a lighter process is better, focused on evolving code, and only adding process elements as the need arose. IGSTK has been adopted by teaching hospitals and research labs, and used for clinical trials. Agile methods have matured since the academic community suggested they are not suitable for safety-critical systems almost a decade ago, we present our experiences as a case study for renewing the discussion. PMID:21799545

Agile Methods for Open Source Safety-Critical Software.

PubMed

Gary, Kevin; Enquobahrie, Andinet; Ibanez, Luis; Cheng, Patrick; Yaniv, Ziv; Cleary, Kevin; Kokoori, Shylaja; Muffih, Benjamin; Heidenreich, John

2011-08-01

The introduction of software technology in a life-dependent environment requires the development team to execute a process that ensures a high level of software reliability and correctness. Despite their popularity, agile methods are generally assumed to be inappropriate as a process family in these environments due to their lack of emphasis on documentation, traceability, and other formal techniques. Agile methods, notably Scrum, favor empirical process control, or small constant adjustments in a tight feedback loop. This paper challenges the assumption that agile methods are inappropriate for safety-critical software development. Agile methods are flexible enough to encourage the rightamount of ceremony; therefore if safety-critical systems require greater emphasis on activities like formal specification and requirements management, then an agile process will include these as necessary activities. Furthermore, agile methods focus more on continuous process management and code-level quality than classic software engineering process models. We present our experiences on the image-guided surgical toolkit (IGSTK) project as a backdrop. IGSTK is an open source software project employing agile practices since 2004. We started with the assumption that a lighter process is better, focused on evolving code, and only adding process elements as the need arose. IGSTK has been adopted by teaching hospitals and research labs, and used for clinical trials. Agile methods have matured since the academic community suggested they are not suitable for safety-critical systems almost a decade ago, we present our experiences as a case study for renewing the discussion.

A Wireless Sensor Network-Based Ubiquitous Paprika Growth Management System

PubMed Central

Hwang, Jeonghwan; Shin, Changsun; Yoe, Hyun

2010-01-01

Wireless Sensor Network (WSN) technology can facilitate advances in productivity, safety and human quality of life through its applications in various industries. In particular, the application of WSN technology to the agricultural area, which is labor-intensive compared to other industries, and in addition is typically lacking in IT technology applications, adds value and can increase the agricultural productivity. This study attempts to establish a ubiquitous agricultural environment and improve the productivity of farms that grow paprika by suggesting a ‘Ubiquitous Paprika Greenhouse Management System’ using WSN technology. The proposed system can collect and monitor information related to the growth environment of crops outside and inside paprika greenhouses by installing WSN sensors and monitoring images captured by CCTV cameras. In addition, the system provides a paprika greenhouse environment control facility for manual and automatic control from a distance, improves the convenience and productivity of users, and facilitates an optimized environment to grow paprika based on the growth environment data acquired by operating the system. PMID:22163543

A status review of photovoltaic power conversion equipment reliability, safety, and quality assurance protocols

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hacke, Peter; Lokanath, Sumanth; Williams, Paul

Data indicate that the inverter is the element of the photovoltaic plant that has the highest number of service calls and the greatest operation and maintenance cost burden. This paper describes the projects and relevant background needed in developing design qualification standards that would serve to establish a minimum level of reliability, along with a review of photovoltaic inverter quality and safety standards, most of which are in their infancy. We compare stresses and levels for accelerated testing of inverters proposed in the standard drafts, and those proposed by manufacturers and purchasers of inverters. We also review bases for themore » methods, stress types, and stress levels for durability testing of key inverter components. Many of the test protocols appear to need more comprehensive inclusion of stress factors existing in the natural environment such as wind driven rain, dust, and grid disturbances. Further understanding of how temperature, humidity ingress, and voltage bias affect the inverters and their components is also required. We provide data indicating inconsistent quality of the inverters and the durability of components leading to greater cost for the photovoltaic plant operator. Accordingly, the recommendation for data collection within quality standards for obtaining cost of ownership metrics is made. Design validation testing using realistic operation, environmental, and connection conditions, including under end-use field conditions with feedback for continuous improvement is recommended for inclusion within a quality standard.« less

A status review of photovoltaic power conversion equipment reliability, safety, and quality assurance protocols

DOE PAGES

Hacke, Peter; Lokanath, Sumanth; Williams, Paul; ...

2017-10-10

Data indicate that the inverter is the element of the photovoltaic plant that has the highest number of service calls and the greatest operation and maintenance cost burden. This paper describes the projects and relevant background needed in developing design qualification standards that would serve to establish a minimum level of reliability, along with a review of photovoltaic inverter quality and safety standards, most of which are in their infancy. We compare stresses and levels for accelerated testing of inverters proposed in the standard drafts, and those proposed by manufacturers and purchasers of inverters. We also review bases for themore » methods, stress types, and stress levels for durability testing of key inverter components. Many of the test protocols appear to need more comprehensive inclusion of stress factors existing in the natural environment such as wind driven rain, dust, and grid disturbances. Further understanding of how temperature, humidity ingress, and voltage bias affect the inverters and their components is also required. We provide data indicating inconsistent quality of the inverters and the durability of components leading to greater cost for the photovoltaic plant operator. Accordingly, the recommendation for data collection within quality standards for obtaining cost of ownership metrics is made. Design validation testing using realistic operation, environmental, and connection conditions, including under end-use field conditions with feedback for continuous improvement is recommended for inclusion within a quality standard.« less

Effectiveness of maritime safety control in different navigation zones using a spatial sequential DEA model: Yangtze River case.

PubMed

Wu, Bing; Wang, Yang; Zhang, Jinfen; Savan, Emanuel Emil; Yan, Xinping

2015-08-01

This paper aims to analyze the effectiveness of maritime safety control from the perspective of safety level along the Yangtze River with special considerations for navigational environments. The influencing variables of maritime safety are reviewed, including ship condition, maritime regulatory system, human reliability and navigational environment. Because the former three variables are generally assumed to be of the same level of safety, this paper focuses on studying the impact of navigational environments on the level of safety in different waterways. An improved data envelopment analysis (DEA) model is proposed by treating the navigational environment factors as inputs and ship accident data as outputs. Moreover, because the traditional DEA model cannot provide an overall ranking of different decision making units (DMUs), the spatial sequential frontiers and grey relational analysis are incorporated into the DEA model to facilitate a refined assessment. Based on the empirical study results, the proposed model is able to solve the problem of information missing in the prior models and evaluate the level of safety with a better accuracy. The results of the proposed DEA model are further compared with an evidential reasoning (ER) method, which has been widely used for level of safety evaluations. A sensitivity analysis is also conducted to better understand the relationship between the variation of navigational environments and level of safety. The sensitivity analysis shows that the level of safety varies in terms of traffic flow. It indicates that appropriate traffic control measures should be adopted for different waterways to improve their safety. This paper presents a practical method of conducting maritime level of safety assessments under dynamic navigational environment. Copyright © 2015 Elsevier Ltd. All rights reserved.

Is there a relationship between high-quality performance in major teaching hospitals and residents' knowledge of quality and patient safety?

PubMed

Pingleton, Susan K; Horak, Bernard J; Davis, David A; Goldmann, Donald A; Keroack, Mark A; Dickler, Robert M

2009-11-01

The relationship of the quality of teaching hospitals' clinical performance to resident education in quality and patient safety is unclear. The authors studied residents' knowledge of these areas in major teaching hospitals with higher- and lower-quality performance rankings. They assessed the presence of formal and informal quality curricula to determine whether programmatic differences exist. The authors used qualitative research methodology with purposeful sampling. They gathered data from individual structured interviews with residents and key educational and quality leaders in six medical schools and teaching hospitals, which represented a range of quality performance rankings, geographic regions, and public or private status. No relationship emerged between a hospital's quality status, residents' curriculum, and the residents' understanding of quality. Residents' definitions of quality and safety and their knowledge of the practice-based learning and systems-based practice competencies were indistinguishable between hospitals. Residents in all programs had extensive patient safety knowledge acquired through an informal curriculum in the hospital setting. A formal curriculum existed in only two programs, both of them ambulatory settings. Residents' learning about quality and patient safety is extensive, largely through a positive informal curriculum in the teaching hospital and, less frequently, via a formal curriculum. No relationship was found between the quality performance of the teaching hospital and the residents' curriculum or understanding of quality or safety. Residents seem to learn through an informal curriculum provided by hospital initiatives and resources, and thus these data suggest the importance of major teaching hospitals in quality education.

[Out of hospital emergencies towards a safety culture].

PubMed

Cano-del Pozo, M I; Obón-Azuara, B; Valderrama-Rodríguez, M; Revilla-López, C; Brosed-Yuste, C; Fajardo-Trasobares, E; Garcés-Baquero, P; Mateo-Clavería, J; Molina-Estrada, I; Perona-Flores, N; Salcedo-de Dios, S; Tomé-Rey, A

2014-01-01

The aim of this study is to measure the degree of safety culture (CS) among healthcare professional workers of an out-of-hospital Emergency Medical Service. Most patient safety studies have been conducted in relation to the hospital rather than pre-hospital Emergency Medical Services. The objective is to analyze the dimensions with lower scores in order to plan futures strategies. A descriptive study using the AHRQ (Agency for Healthcare Research and Quality) questionnaire. The questionnaire was delivered to all healthcare professionals workers of 061 Advanced Life Support Units of Aragón, during the month of August 2013. The response rate was 55%. Main strengths detected: an adequate number of staff (96%), good working conditions (89%), tasks supported from immediate superior (77%), teamwork climate (74%), and non-punitive environment to report adverse events (68%). Areas for improvement: insufficient training in patient safety (53%) and lack of feedback of incidents reported (50%). The opportunities for improvement identified focus on the training of professionals in order to ensure safer care, while extending the safety culture. Also, the implementation of a system of notification and registration of adverse events in the service is deemed necessary. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

Modelizing home safety as experienced by people with mental illness.

PubMed

Désormeaux-Moreau, Marjorie; Larivière, Nadine; Aubin, Ginette

2018-05-01

As more individuals with mental disorders now live in the community and as the custodial care housing model has shifted to supported housing, home safety has become a rising issue, however, not well documented. To describe the phenomenon of home safety for people with a mental disorder as well as its contributing factors. A descriptive qualitative design was used. Individual interviews were conducted with persons with a mental disorder (n = 8), while focus groups were conducted with relatives, health and social service providers and community stakeholders (n = 21). The data were analyzed with the grounded theory analysis as described by Paillé (1994). Findings suggest that home safety implies risk and protective factors, which are associated with (1) the person's characteristics; (2) the quality of the home environment; (3) the nature of the activities in which the individual engages. These dimensions are interrelated so that home incidents arise from a dynamic interaction between risk and protective factors. Home incidents therefore occur when the interaction between these dimensions is altered. Considering this situation, Occupational Therapists are well positioned to play a leading role and act as key contributors in the area of home safety in people with mental disorders.

Leading organisational learning in health care.

PubMed

Carroll, J S; Edmondson, A C

2002-03-01

As healthcare organisations seek to enhance safety and quality in a changing environment, organisational learning practices can help to improve existing skills and knowledge and provide opportunities to discover better ways of working together. Leadership at executive, middle management, and local levels is needed to create a sense of shared purpose. This shared vision should help to build effective relationships, facilitate connections between action and reflection, and strengthen the desirable elements of the healthcare culture while modifying outdated assumptions, procedures, and structures.

MODIS. Volume 1: MODIS level 1A software baseline requirements

NASA Technical Reports Server (NTRS)

Masuoka, Edward; Fleig, Albert; Ardanuy, Philip; Goff, Thomas; Carpenter, Lloyd; Solomon, Carl; Storey, James

1994-01-01

This document describes the level 1A software requirements for the moderate resolution imaging spectroradiometer (MODIS) instrument. This includes internal and external requirements. Internal requirements include functional, operational, and data processing as well as performance, quality, safety, and security engineering requirements. External requirements include those imposed by data archive and distribution systems (DADS); scheduling, control, monitoring, and accounting (SCMA); product management (PM) system; MODIS log; and product generation system (PGS). Implementation constraints and requirements for adapting the software to the physical environment are also included.

Managing work-related stress in the district nursing workplace.

PubMed

Burke, Michelle

2013-11-01

This article aims to highlight the issue of work-related stress within the district nursing workplace. It will acknowledge how the management of work-related stress has previously been discussed within nursing literature and will consider the emerging relationship between staff working conditions, staff wellbeing and quality of patient care. It will reintroduce the Health and Safety Executive's (HSE's) Management Standards approach to tackling work-related stress, which provides management support to reduce environmental work stressors and encourage enabling work environments and a positive workplace culture.

A novel program to improve patient safety by integrating peer review into the emergency medicine residency curriculum.

PubMed

Strayer, Reuben J; Shy, Bradley D; Shearer, Peter L

2014-12-01

Evaluating the quality of care as part of a quality improvement process is required in many clinical environments by accrediting bodies. It produces metrics used to evaluate department and individual provider performance, provides outcomes-based feedback to clinicians, and identifies ways to reduce error. To improve patient safety and train our residents to perform peer review, we expanded our quality assurance program from a narrow, administrative process carried out by a small number of attendings to an educationally focused activity of much greater scope incorporating all residents on a monthly basis. We developed an explicit system by which residents analyze sets of high-risk cases and record their impressions onto structured databases, which are reviewed by faculty. At monthly meetings, results from the month's case reviews are presented, learning points discussed, and corrective actions are proposed. By integrating Clinical Quality Review (CQR) as a core, continuous component of the residency curriculum, we increased the number of cases reviewed more than 10-fold and implemented a variety of clinical process improvements. An anonymous survey conducted after 2 years of resident-led CQR indicated that residents value their exposure to the peer review process and feel it benefits them as clinicians, but also that the program requires a significant investment of time that can be burdensome. Copyright © 2014 Elsevier Inc. All rights reserved.

The Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH): an observational instrument for assessing the physical environment of institutional settings for persons with dementia.

PubMed

Sloane, Philip D; Mitchell, C Madeline; Weisman, Gerald; Zimmerman, Sheryl; Foley, Kristie M Long; Lynn, Mary; Calkins, Margaret; Lawton, M Powell; Teresi, Jeanne; Grant, Leslie; Lindeman, David; Montgomery, Rhonda

2002-03-01

To develop an observational instrument that describes the ability of physical environments of institutional settings to address therapeutic goals for persons with dementia. A National Institute on Aging workgroup identified and subsequently revised items that evaluated exit control, maintenance, cleanliness, safety, orientation/cueing, privacy, unit autonomy, outdoor access, lighting, noise, visual/tactile stimulation, space/seating, and familiarity/homelikeness. The final instrument contains 84 discrete items and one global rating. A summary scale, the Special Care Unit Environmental Quality Scale (SCUEQS), consists of 18 items. Lighting items were validated using portable light meters. Concurrent criterion validation compared SCUEQS scores with the Professional Environmental Assessment Protocol (PEAP). Interrater kappa statistics for 74% of items were above.60. For another 10% of items, kappas could not be calculated due to empty cells, but interrater agreement was above 80%. The SCUEQS demonstrated an interrater reliability of.93, a test--retest reliability of.88, and an internal consistency of.81--.83. Light meter ratings correlated significantly with the Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH) lighting items (r =.29--.38, p =.01--.04), and the SCUEQS correlated significantly with global PEAP ratings (r =.52, p <.01). The TESS-NH efficiently assesses discrete elements of the physical environment and has strong reliability and validity. The SCUEQS provides a quantitative measure of environmental quality in institutional settings.

Work environment and occupational risk assessment for small animal Portuguese veterinary activities.

PubMed

Macedo, Angela C; Mota, Vânia T; Tavares, João M; Machado, Osvaldo L; Malcata, Francisco X; Cristo, Marinela P; Mayan, Olga N

2018-03-01

The professional work of small animal veterinary staff encompasses a wide diversity of demanding tasks. This has prompted a number of studies covering physical, chemical, biological, ergonomic, or psychological hazards, as well as their health effects upon veterinary workers. However, such results were obtained from self-reported surveys (via paper or online). This study reports the identification of potential hazards and provides a risk assessment of 15 veterinary clinics based on data from walk-through surveys, interviews with workers, and quantification of indoor air quality parameters including concentration of volatile organic compounds (total, isoflurane, and glutaraldehyde). The risk arising from X-ray exposure was unacceptable in seven clinics; X-ray examination should be discontinued in the absence of isolated radiation rooms, poor safety practices, and lack of personal protective equipment. Ergonomic-related hazards and work practices should be revised as soon as possible, considering that improper postures, as well as moving and lifting heavy animals are major causes of musculoskeletal disorders. The risk levels were, in general, small or medium (acceptable) with regard to exposure to physical hazards (such as bites, scratches, cuts, and burns) and biological hazards. It was observed that the indoor air quality parameters including temperature, respirable particulate matter and total volatile organic compounds do not indicate a comfortable workplace environment, requiring clinics' attention to keep the safe environment. The veterinarians and nurses were exposed to isoflurane (above 2 ppm) during surgery if an extractor system for waste gas was used instead of a scavenging system. Finally, veterinary workers did not possess any type of training on occupational safety and health issues, even though they recognized its importance.

The impact of information technology and organizational focus on the visibility of patient care errors.

PubMed

Walston, Stephen L; Mwachofi, Ari; Aldosari, Bakheet; Al-Omar, Badran A; Yousef, Asmaa Al; Sheikh, Asiya

2010-01-01

INVESTIGATED: The implementation of information systems and the creation of an open culture, characterized by emphasis on patient safety and problem solving, are 2 means suggested to improve health care quality. This study examines the effects of use of information technology and focus on patient safety and problem solving on the visibility of patient care errors. A survey of nurses in Saudi Arabia is analyzed by means of factor analysis and multiregression analysis to examine nurses' use of information technology and culture in controlling errors. Our research suggests that greater use of information technology to control patient care errors may reduce the prevalence of such errors while an increased focus on patient safety and problem solving facilitates an open environment where errors can be more openly discussed and addressed. The use of technology appears to have a role in decreasing errors. Yet, an organization that focuses on problem solving and patient safety can open lines of communication and create a culture in which errors can be discussed and resolved.

Engaging staff to improve quality and safety in an austere medical environment: a case-control study in two Sierra Leonean hospitals.

PubMed

Rosen, Michael A; Chima, Adaora M; Sampson, John B; Jackson, Eric V; Koka, Rahul; Marx, Megan K; Kamara, Thaim B; Ogbuagu, Onyebuchi U; Lee, Benjamin H

2015-08-01

Inadequate observance of basic processes in patient care such as patient monitoring and documentation practices are potential impediments to the timely diagnoses and management of patients. These gaps exist in low resource settings such as Sierra Leone and can be attributed to a myriad of factors such as workforce and technology deficiencies. In the study site, only 12.4% of four critical vital signs were documented in the pre-intervention period. Implement a failure mode and effects analysis (FMEA) to improve documentation of four patient vital signs: temperature, blood pressure, pulse rate and respiratory rate. FMEA was implemented among a subpopulation of health workers who are involved in monitoring and documenting patient vital signs. Pre- and post-FMEA monitoring and documentation practice were compared with a control site. Participants identified a four-step process to monitoring and documenting vital signs, three categories of failure modes and four potential solutions. Based on 2100 patient days of documentation compliance data from 147 patients between July and November 2012, staff members at the study site were 1.79 times more likely to document all four patient vital signs in the post-implementation period (95% CI [1.35, 2.38]). FMEA is a feasible and effective strategy for improving quality and safety in an austere medical environment. Documentation compliance improved at the intervention facility. To evaluate the scalability and sustainability of this approach, programs targeting the development of these types of process improvement skills in local staff should be evaluated. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Application safety evaluation of the radio frequency identification tag under magnetic resonance imaging.

PubMed

Fei, Xiaolu; Li, Shanshan; Gao, Shan; Wei, Lan; Wang, Lihong

2014-09-04

Radio Frequency Identification(RFID) has been widely used in healthcare facilities, but it has been paid little attention whether RFID applications are safe enough under healthcare environment. The purpose of this study is to assess the effects of RFID tags on Magnetic Resonance (MR) imaging in a typical electromagnetic environment in hospitals, and to evaluate the safety of their applications. A Magphan phantom was used to simulate the imaging objects, while active RFID tags were placed at different distances (0, 4, 8, 10 cm) from the phantom border. The phantom was scanned by using three typical sequences including spin-echo (SE) sequence, gradient-echo (GRE) sequence and inversion-recovery (IR) sequence. The quality of the image was quantitatively evaluated by using signal-to-noise ratio (SNR), uniformity, high-contrast resolution, and geometric distortion. RFID tags were read by an RFID reader to calculate their usable rate. RFID tags can be read properly after being placed in high magnetic field for up to 30 minutes. SNR: There were no differences between the group with RFID tags and the group without RFID tags using SE and IR sequence, but it was lower when using GRE sequence.Uniformity: There was a significant difference between the group with RFID tags and the group without RFID tags using SE and GRE sequence. Geometric distortion and high-contrast resolution: There were no obvious differences found. Active RFID tags can affect MR imaging quality, especially using the GRE sequence. Increasing the distance from the RFID tags to the imaging objects can reduce that influence. When the distance was longer than 8 cm, MR imaging quality were almost unaffected. However, the Gradient Echo related sequence is not recommended when patients wear a RFID wristband.

Toward an integrated knowledge environment to support modern oncology.

PubMed

Blake, Patrick M; Decker, David A; Glennon, Timothy M; Liang, Yong Michael; Losko, Sascha; Navin, Nicholas; Suh, K Stephen

2011-01-01

Around the world, teams of researchers continue to develop a wide range of systems to capture, store, and analyze data including treatment, patient outcomes, tumor registries, next-generation sequencing, single-nucleotide polymorphism, copy number, gene expression, drug chemistry, drug safety, and toxicity. Scientists mine, curate, and manually annotate growing mountains of data to produce high-quality databases, while clinical information is aggregated in distant systems. Databases are currently scattered, and relationships between variables coded in disparate datasets are frequently invisible. The challenge is to evolve oncology informatics from a "systems" orientation of standalone platforms and silos into an "integrated knowledge environments" that will connect "knowable" research data with patient clinical information. The aim of this article is to review progress toward an integrated knowledge environment to support modern oncology with a focus on supporting scientific discovery and improving cancer care.

[Weight parameters of water quality impact and risk grade determination of water environmental sensitive spots in Jiashan].

PubMed

Xie, Rong-Rong; Pang, Yong; Zhang, Qian; Chen, Ke; Sun, Ming-Yuan

2012-07-01

For the safety of the water environment in Jiashan county in Zhejiang Province, one-dimensional hydrodynamic and water quality models are established based on three large-scale monitoring of hydrology and water quality in Jiashan county, three water environmental sensitive spots including Hongqitang dam Chijia hydrological station and Luxie pond are selected to investigate weight parameters of water quality impact and risk grade determination. Results indicate as follows (1) Internal pollution impact in Jiashan areas was greater than the external, the average weight parameters of internal chemical oxygen demand (COD) pollution is 55.3%, internal ammonia nitrogen (NH(4+)-N) is 67.4%, internal total phosphor (TP) is 63.1%. Non-point pollution impact in Jiashan areas was greater than point pollution impact, the average weight parameters of non-point COD pollutions is 53.7%, non-point NH(4+)-N is 65.9%, non-point TP is 57.8%. (2) The risk of Hongqitang dam and Chijia hydrological station are in the middle risk. The risk of Luxie pond is also in the middle risk in August, and in April and December the risk of Luxie pond is low. The strategic decision will be suggested to guarantee water environment security and social and economic security in the study.

Empowering certified nurse's aides to improve quality of work life through a team communication program.

PubMed

Howe, Erin E

2014-01-01

The purpose of this pilot study was to explore the impact of a certified nurse's aide (CNA)-led interdisciplinary teamwork and communication intervention on perceived quality of work environment and six-month job intentions. CNAs are frequently excluded from team communication and decision-making, which often leads to job dissatisfaction with high levels of staff turnover. Using a mixed quantitative and qualitative approach with pre- post-program design, the intervention utilized the strategy of debriefing from the national patient safety initiative, TeamSTEPPS. Inherent in the program design, entitled Long Term Care (LTC) Team Talk, was the involvement of the CNAs in the development of the intervention as an empowering process on two wings of a transitional care unit in a long-term care facility in upstate NY. CNAs' perceptions of work environment quality were measured using a Quality of Work Life (QWL) instrument. Additionally, job turnover intent within six months was assessed. Results indicated improved scores on nearly all QWL subscales anticipated to be impacted, and enhanced perceived empowerment of the CNAs on each wing albeit through somewhat different experiential processes. The program is highly portable and can potentially be implemented in a variety of long-term care settings. Copyright © 2014 Mosby, Inc. All rights reserved.

77 FR 4731 - Review and Submittal of a Tribe's Facility License Information

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-31

... conducted in a manner which adequately protects the environment and public health and safety.'' 25 U.S.C... conducted in a manner that adequately protects the environment and the public health and safety, as required... that adequately protects the environment and the public health and safety. The proposed rule maintains...

38 CFR 17.155 - Minimum standards of safety and quality for automotive adaptive equipment.

Code of Federal Regulations, 2012 CFR

2012-07-01

... safety and quality for automotive adaptive equipment. 17.155 Section 17.155 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Automotive Equipment and Driver Training § 17.155 Minimum standards of safety and quality for automotive adaptive equipment. (a) The Under Secretary for...

38 CFR 17.155 - Minimum standards of safety and quality for automotive adaptive equipment.

Code of Federal Regulations, 2014 CFR

2014-07-01

... safety and quality for automotive adaptive equipment. 17.155 Section 17.155 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Automotive Equipment and Driver Training § 17.155 Minimum standards of safety and quality for automotive adaptive equipment. (a) The Under Secretary for...

38 CFR 17.155 - Minimum standards of safety and quality for automotive adaptive equipment.

Code of Federal Regulations, 2011 CFR

2011-07-01

... safety and quality for automotive adaptive equipment. 17.155 Section 17.155 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Automotive Equipment and Driver Training § 17.155 Minimum standards of safety and quality for automotive adaptive equipment. (a) The Under Secretary for...

38 CFR 17.155 - Minimum standards of safety and quality for automotive adaptive equipment.

Code of Federal Regulations, 2013 CFR

2013-07-01

... safety and quality for automotive adaptive equipment. 17.155 Section 17.155 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Automotive Equipment and Driver Training § 17.155 Minimum standards of safety and quality for automotive adaptive equipment. (a) The Under Secretary for...

Safety, reliability, maintainability and quality provisions for the Space Shuttle program

NASA Technical Reports Server (NTRS)

1990-01-01

This publication establishes common safety, reliability, maintainability and quality provisions for the Space Shuttle Program. NASA Centers shall use this publication both as the basis for negotiating safety, reliability, maintainability and quality requirements with Shuttle Program contractors and as the guideline for conduct of program safety, reliability, maintainability and quality activities at the Centers. Centers shall assure that applicable provisions of the publication are imposed in lower tier contracts. Centers shall give due regard to other Space Shuttle Program planning in order to provide an integrated total Space Shuttle Program activity. In the implementation of safety, reliability, maintainability and quality activities, consideration shall be given to hardware complexity, supplier experience, state of hardware development, unit cost, and hardware use. The approach and methods for contractor implementation shall be described in the contractors safety, reliability, maintainability and quality plans. This publication incorporates provisions of NASA documents: NHB 1700.1 'NASA Safety Manual, Vol. 1'; NHB 5300.4(IA), 'Reliability Program Provisions for Aeronautical and Space System Contractors'; and NHB 5300.4(1B), 'Quality Program Provisions for Aeronautical and Space System Contractors'. It has been tailored from the above documents based on experience in other programs. It is intended that this publication be reviewed and revised, as appropriate, to reflect new experience and to assure continuing viability.

The Effect of Line Maintenance Activity on Airline Safety Quality

NASA Technical Reports Server (NTRS)

Rhoades, Dawna L.; Reynolds, Rosemarie; Waguespack, Blaise, Jr.; Williams, Michael

2005-01-01

One of the arguments against deregulation of the airline industry has been the possibility that financially troubled carriers would be tempted to lower line maintenance spending, thus lowering maintenance quality and decreasing the overall safety of the carrier. Given the financial crisis triggered by the events of 9/11: it appears to be a good time to revisit this issue. This paper examines the quality of airline line maintenance activity and examines the impact of maintenance spending on maintenance quality and overall safety. Findings indicate that increased maintenance spending is associated with increased line maintenance activity and increased overall safety quality for the major U.S. carriers.

Roadmap to an effective quality improvement and patient safety program implementation in a rural hospital setting.

PubMed

Ingabire, Willy; Reine, Petera M; Hedt-Gauthier, Bethany L; Hirschhorn, Lisa R; Kirk, Catherine M; Nahimana, Evrard; Nepomscene Uwiringiyemungu, Jean; Ndayisaba, Aphrodis; Manzi, Anatole

2015-12-01

Implementation lessons: (1) implementation of an effective quality improvement and patient safety program in a rural hospital setting requires collaboration between hospital leadership, Ministry of Health and other stakeholders. (2) Building Quality Improvement (QI) capacity to develop engaged QI teams supported by mentoring can improve quality and patient safety. Copyright © 2015 Elsevier Inc. All rights reserved.

Cross-sectional and longitudinal associations of neighbourhood social environment and smoking behaviour: the multiethnic study of atherosclerosis.

PubMed

Mayne, Stephanie L; Auchincloss, Amy H; Moore, Kari A; Michael, Yvonne L; Tabb, Loni Philip; Echeverria, Sandra E; Diez Roux, Ana V

2017-04-01

Social features of neighbourhood environments may influence smoking by creating a stressful environment or by buffering stress through social cohesion. However, the association of the overall neighbourhood social environment (NSE) with smoking, and the association of specific neighbourhood social factors with change in smoking behaviour over time, has rarely been examined. This study included 5856 adults aged 45-84 years from the Multi-Ethnic Study of Atherosclerosis (2000-2012, average follow-up: 7.8 years). Outcomes included current smoking status and smoking intensity (average number of cigarettes smoked per day among baseline smokers). NSE was assessed as a composite score composed of aesthetic quality, safety and social cohesion scales (derived from neighbourhood surveys). Generalised linear mixed models evaluated the association of baseline NSE (composite score and individual scales) with current smoking (modified Poisson models) and smoking intensity (negative binomial models) cross-sectionally and longitudinally. Each SD increase in baseline NSE composite score was associated with 13% lower prevalence of smoking at baseline (adjusted prevalence ratio (aPR) 0.87 (95% CI 0.78 to 0.98). Neighbourhood safety and aesthetic quality were similarly associated with lower smoking prevalence (aPR 0.87 (0.78 to 0.97) and aPR 0.87 (0.77 to 0.99), respectively) but the association with social cohesion was weaker or null. No significant associations were observed for smoking intensity among baseline smokers. Baseline NSE was not associated with changes in smoking risk or intensity over time. Results suggest that neighbourhood social context influences whether older adults smoke, but does not promote smoking cessation or reduction over time. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Role of a quality management system in improving patient safety - laboratory aspects.

PubMed

Allen, Lynn C

2013-09-01

The aim of this study is to describe how implementation of a quality management system (QMS) based on ISO 15189 enhances patient safety. A literature review showed that several European hospitals implemented a QMS based on ISO 9001 and assessed the impact on patient safety. An Internet search showed that problems affecting patient safety have occurred in a number of laboratories across Canada. The requirements of a QMS based on ISO 15189 are outlined, and the impact of the implementation of each requirement on patient safety is summarized. The Quality Management Program - Laboratory Services in Ontario is briefly described, and the experience of Ontario laboratories with Ontario Laboratory Accreditation, based on ISO 15189, is outlined. Several hospitals that implemented ISO 9001 reported either a positive impact or no impact on patient safety. Patient safety problems in Canadian laboratories are described. Implementation of each requirement of the QMS can be seen to have a positive effect on patient safety. Average laboratory conformance on Ontario Laboratory Accreditation is very high, and laboratories must address and resolve any nonconformities. Other standards, practices, and quality requirements may also contribute to patient safety. Implementation of a QMS based on ISO 15189 provides a solid foundation for quality in the laboratory and enhances patient safety. It helps to prevent patient safety issues; when such issues do occur, effective processes are in place for investigation and resolution. Patient safety problems in Canadian laboratories might have been prevented had effective QMSs been in place. Ontario Laboratory Accreditation has had a positive impact on quality in Ontario laboratories. Copyright © 2013 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

The impact of fire suppression tasks on firefighter hydration: a critical review with consideration of the utility of reported hydration measures.

PubMed

Walker, Adam; Pope, Rodney; Orr, Robin Marc

2016-01-01

Firefighting is a highly stressful occupation with unique physical challenges, apparel and environments that increase the potential for dehydration. Dehydration leaves the firefighter at risk of harm to their health, safety and performance. The purpose of this review was to critically analyse the current literature investigating the impact of fighting 'live' fires on firefighter hydration. A systematic search was performed of four electronic databases for relevant published studies investigating the impact of live fire suppression on firefighter hydration. Study eligibility was assessed using strict inclusion and exclusion criteria. The included studies were critically appraised using the Downs and Black protocol and graded according to the Kennelly grading system. Ten studies met the eligibility criteria for this review. The average score for methodological quality was 55 %, ranging from 50 % ('fair' quality) to 61 % ('good' quality) with a 'substantial agreement' between raters ( k  = .772). Wildfire suppression was considered in five studies and structural fire suppression in five studies. Results varied across the studies, reflecting variations in outcome measures, hydration protocols and interventions. Three studies reported significant indicators of dehydration resulting from structural fire suppression, while two studies found mixed results, with some measures indicating dehydration and other measures an unchanged hydration status. Three studies found non-significant changes in hydration resulting from wildfire firefighting and two studies found significant improvements in markers of hydration. Ad libitum fluid intake was a common factor across the studies finding no, or less severe, dehydration. The evidence confirms that structural and wildfire firefighting can cause dehydration. Ad libitum drinking may be sufficient to maintain hydration in many wildfire environments but possibly not during intense, longer duration, hot structural fire operations. Future high quality research better quantifying the effects of these influences on the degree of dehydration is required to inform policies and procedures that ensure firefighter health and safety.

40 CFR 243.201 - Safety.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Safety. 243.201 Section 243.201 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE STORAGE... Procedures § 243.201 Safety. ...

40 CFR 243.201 - Safety.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Safety. 243.201 Section 243.201 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE STORAGE... Procedures § 243.201 Safety. ...

Patient safety reporting systems: sustained quality improvement using a multidisciplinary team and "good catch" awards.

PubMed

Herzer, Kurt R; Mirrer, Meredith; Xie, Yanjun; Steppan, Jochen; Li, Matthew; Jung, Clinton; Cover, Renee; Doyle, Peter A; Mark, Lynette J

2012-08-01

Since 1999, hospitals have made substantial commitments to health care quality and patient safety through individual initiatives of executive leadership involvement in quality, investments in safety culture, education and training for medical students and residents in quality and safety, the creation of patient safety committees, and implementation of patient safety reporting systems. At the Weinberg Surgical Suite at The Johns Hopkins Hospital (Baltimore), a 16-operating-room inpatient/outpatient cancer center, a patient safety reporting process was developed to maximize the usefulness of the reports and the long-term sustainability of quality improvements arising from them. A six-phase framework was created incorporating UHC's Patient Safety Net (PSN): Identify, report, analyze, mitigate, reward, and follow up. Unique features of this process included a multidisciplinary team to review reports, mitigate hazards, educate and empower providers, recognize the identifying/reporting individuals or groups with "Good Catch" awards, and follow up to determine if quality improvements were sustained over time. Good Catch awards have been given in recognition of 29 patient safety hazards identified since 2008; in each of these cases, an initiative was developed to mitigate the original hazard. Twenty-five (86%) of the associated quality improvements have been sustained. Two Good Catch award-winning projects--vials of heparin with an unusually high concentration of the drug that posed a potential overdose hazard and a rapid infusion device that resisted practitioner control--are described in detail. A multidisciplinary team's analysis and mitigation of hazards identified in a patient safety reporting process entailed positive recognition with a Good Catch award, education of practitioners, and long-term follow-up.

Microbial indicators, pathogens and methods for their monitoring in water environment.

PubMed

Saxena, Gaurav; Bharagava, Ram Naresh; Kaithwas, Gaurav; Raj, Abhay

2015-06-01

Water is critical for life, but many people do not have access to clean and safe drinking water and die because of waterborne diseases. The analysis of drinking water for the presence of indicator microorganisms is key to determining microbiological quality and public health safety. However, drinking water-related illness outbreaks are still occurring worldwide. Moreover, different indicator microorganisms are being used in different countries as a tool for the microbiological examination of drinking water. Therefore, it becomes very important to understand the potentials and limitations of indicator microorganisms before implementing the guidelines and regulations designed by various regulatory agencies. This review provides updated information on traditional and alternative indicator microorganisms with merits and demerits in view of their role in managing the waterborne health risks as well as conventional and molecular methods proposed for monitoring of indicator and pathogenic microorganisms in the water environment. Further, the World Health Organization (WHO) water safety plan is emphasized in order to develop the better approaches designed to meet the requirements of safe drinking water supply for all mankind, which is one of the major challenges of the 21st century.

RN assessments of excellent quality of care and patient safety are associated with significantly lower odds of 30-day inpatient mortality: A national cross-sectional study of acute-care hospitals.

PubMed

Smeds-Alenius, Lisa; Tishelman, Carol; Lindqvist, Rikard; Runesdotter, Sara; McHugh, Matthew D

2016-09-01

Quality and safety in health care has been increasingly in focus during the past 10-15 years. Stakeholders actively discuss ways to measure safety and quality of care to improve the health care system as a whole. Defining and measuring quality and safety, however, is complicated. One underutilized resource worthy of further exploration is the use of registered nurses (RNs) as informants of overall quality of care and patient safety. However, research is still scarce or lacking regarding RN assessments of patient safety and quality of care and their relationship to objective patient outcomes. To investigate relationships between RN assessed quality of care and patient safety and 30-day inpatient mortality post-surgery in acute-care hospitals. This is a national cross-sectional study. A survey (n=>10,000 RNs); hospital organizational data (n=67); hospital discharge registry data (n>200,000 surgical patients). RN data derives from a national sample of RNs working directly with inpatient care in surgical/medical wards in acute-care hospitals in Sweden in 2010. Patient data are from the same hospitals in 2009-2010. Adjusted multivariate logistic regression models were used to estimate relationships between RN assessments and 30-day inpatient mortality. Patients cared for in hospitals where a high proportion of RNs reported excellent quality of care (the highest third of hospitals) had 23% lower odds of 30-day inpatient mortality compared to patients cared for in hospitals in the lowest third (OR 0.77, CI 0.65-0.91). Similarly, patients in hospitals where a high proportion of RNs reported excellent patient safety (highest third) had is 26% lower odds of death (OR 0.74, CI 0.60-0.91). RN assessed excellent patient safety and quality of care are related to significant reductions in odds of 30-day inpatient mortality, suggesting that positive RN reports of quality and safety can be valid indicators of these key variables. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Calendar year 1993 groundwater quality report for the Chestnut Ridge Hydrogeologic Regime, Y-12 Plant, Oak Ridge, Tennessee. 1993 groundwater quality data and calculated rate of contaminant migration, Part 1

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1994-02-01

This annual groundwater report contains groundwater quality data obtained during the 1993 calendar year (CY) at several hazardous and non-hazardous waste-management facilities associated with the US Department of Energy (DOE) Y-12 Plant located on the DOE Oak Ridge Reservation (ORR) southeast of Oak Ridge, Tennessee. These sites are located south of the Y-12 Plant in the Chestnut Ridge Hydrogeologic Regime (Chestnut Ridge Regime), which is one of three regimes defined for the purposes of groundwater quality monitoring at the Y-12 Plant. The Environmental Management Department of the Y-12 Plant Health, Safety, Environment, and Accountability Organization manages the groundwater monitoring activitiesmore » in each regime as part of the Y-12 Plant Groundwater Protection Program (GWPP). The annual groundwater report for the Chestnut Ridge Regime is completed in two-parts; Part 1 (this report) containing the groundwater quality data and Part 2 containing a detailed evaluation of the data. The primary purpose of this report is to serve as a reference for the groundwater quality data obtained each year under the lead of the Y-12 Plant GWPP. However, because it contains information needed to comply with Resource Conservation and Recovery Act (RCRA) interim status assessment monitoring and reporting requirements, this report is submitted to the Tennessee Department of Health and Environment (TDEC) by the RCRA reporting deadline.« less

78 FR 6819 - Patient Safety Organizations: Voluntary Relinquishment From The Connecticut Hospital Association...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-31

..., Center for Quality Improvement and Patient Safety, AHRQ, 540 Gaither Road, Rockville, MD 20850; Telephone... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From The Connecticut Hospital Association Federal Patient Safety...

The quality and safety culture in general hospitals: patients', physicians' and nurses' evaluation of its effect on patient satisfaction.

PubMed

Kagan, Ilya; Porat, Nurit; Barnoy, Sivia

2018-06-21

To explore the disparities between patients' and health care workers' perception of the quality and safety culture and to explore the relationship between patient perceptions, and engagement in, and satisfaction with their care and treatment. A cross-sectional study was conducted in medical-surgical wards of four Israeli general hospitals. Data were collected using a self-administered questionnaire. Fourteen medical-surgical wards of the four hospitals where data were collected. The sample comprised of 390 physicians and nurses and 726 inpatients admitted for at least 3 days. A self-administered questionnaire that covered the following topics: (i) quality and safety culture, (ii) patient engagement, (iii) patient satisfaction, (iv) an assessment of the care quality and safety in the ward and (v) sociodemographic data. The questionnaire was translated into Arabic and Russian. Sixty nine items were directed to the staff and 71 to patients. Patients evaluated the quality and safety culture significantly higher than did the health care workers. Significant correlations were found between patients' engagement in and satisfaction with their care and their quality and safety assessments. Their evaluation of this culture was the only predictor of their satisfaction and engagement. Arabic-speaking patients rated four variables, including patients' satisfaction with their care, lower than did Hebrew and Russian speakers. Patients have sufficient experience and understanding to form an opinion of the quality and safety of their care. The lower evaluation of the quality and safety culture expressed by health care workers might stem from their more realistic expectations.

ASAS Centennial Paper: Developments and future outlook for preharvest food safety.

PubMed

Oliver, S P; Patel, D A; Callaway, T R; Torrence, M E

2009-01-01

The last century of food animal agriculture is a remarkable triumph of scientific research. Knowledge derived through research has resulted in the development and use of new technologies that have increased the efficiency of food production and created a huge animal production and food manufacturing industry capable of feeding the US population while also providing significant quantities of high-quality food for export to other countries. Although the US food supply is among the safest in the world, the US Center for Disease Prevention and Control estimates that 76 million people get sick, more than 300,000 are hospitalized, and 5,000 die each year from foodborne illness. Consequently, preventing foodborne illness and death remains a major public health concern. Challenges to providing a safe, abundant, and nutritious food supply are complex because all aspects of food production, from farm to fork, must be considered. Given the national and international demand and expectations for food safety as well as the formidable challenges of producing and maintaining a safe food supply, food safety research and educational programs have taken on a new urgency. Remarkable progress has been made during the last century. Wisdom from a century of animal agriculture research now includes the realization that on-farm pathogens are intricately associated with animal health and well-being, the production of high-quality food, and profitability. In this review, some of the developments that have occurred over the last few decades are summarized, including types, sources, and concentrations of disease-causing pathogens encountered in food-producing animal environments and their association with food safety; current and future methods to control or reduce foodborne pathogens on the farm; and present and future preharvest food safety research directions. Future scientific breakthroughs will no doubt have a profound impact on animal agriculture and the production of high-quality food, but we will also be faced with moral, ethical, and societal dilemmas that must be reconciled. A strong, science-based approach that addresses all the complex issues involved in continuing to improve food safety and public health is necessary to prevent foodborne illnesses. Not only must research be conducted to solve complex food safety issues, but results of that research must also be communicated effectively to producers and consumers.

Radioactive Waste Management in A Hospital

PubMed Central

Khan, Shoukat; Syed, AT; Ahmad, Reyaz; Rather, Tanveer A.; Ajaz, M; Jan, FA

2010-01-01

Most of the tertiary care hospitals use radioisotopes for diagnostic and therapeutic applications. Safe disposal of the radioactive waste is a vital component of the overall management of the hospital waste. An important objective in radioactive waste management is to ensure that the radiation exposure to an individual (Public, Radiation worker, Patient) and the environment does not exceed the prescribed safe limits. Disposal of Radioactive waste in public domain is undertaken in accordance with the Atomic Energy (Safe disposal of radioactive waste) rules of 1987 promulgated by the Indian Central Government Atomic Energy Act 1962. Any prospective plan of a hospital that intends using radioisotopes for diagnostic and therapeutic procedures needs to have sufficient infrastructural and manpower resources to keep its ambient radiation levels within specified safe limits. Regular monitoring of hospital area and radiation workers is mandatory to assess the quality of radiation safety. Records should be maintained to identify the quality and quantity of radioactive waste generated and the mode of its disposal. Radiation Safety officer plays a key role in the waste disposal operations. PMID:21475524

Unveiling factors that contribute to functional aging among health care shiftworkers in São Paulo, Brazil.

PubMed

Fischer, Frida Marina; Bellusci, Silvia M; Teixeira, Liliane R; Borges, Flávio N S; Ferreira, Regiane M; Gonçalves, Mariana B L; Martins, Samantha E; Christoffolete, Marcelo A

2002-01-01

The aims of this study were to evaluate aging factors associated with work stressors, work ability, and the quality of living conditions, among health care personnel. A cross-sectional study was conducted among 176 health care shiftworkers. Two health survey questionnaires (Tuomi et al., 1997, Scandinavian Journal of Work, Environment and Health, 17(Suppl 1), 67-74; and Tepas, 1996, unpublished instrument) were completed and ergonomic work analyses (Rohmert & Landau, 1983, A new technique for job analysis, London and New York: Taylor & Francis) were carried out at the emergency wards. Main concerns about exposure at the workplace were changes in equipment and technology, transportation, and changes in employer policies. Main concerns about off-the-job conditions were personal safety, increases in the cost of living, food safety, and water and air quality. 81.7% scored adequate (> 36.5 points) in the Work Ability Index, and considered themselves having adequate current work ability to cope with physical, mental, and social demands. The most frequently reported diseases were musculoskeletal disorders and minor emotional problems.

[Diagnostic and therapeutic activity moderation. Quaternary and genetic prevention].

PubMed

Gérvas, Juan

2006-03-01

Medical activities have more positive than negative outcomes. Because this balance, medicine has a great social recognition. But with new technology and more aggressive diagnostic and therapeutic interventions, there is a decreasing gap in between benefits and harms. Risk increases because more interventions, and because placing patients in more technology environments. As a consecuence, patient safety decreases. Quantity becomes as important as quality, and the place of care is crucial for patient safety. Medical activities should be of , performed in the low level of care possible. Then, quaternary prevention (to avoid unnecessary use and risk of medical interventions) should be a continuous parallel clinical activity. I consider four examples of needed quaternary prevention, with Spanish data: 1) cardiovascular prevention (where there is an inverse use of resources, as patients who need more receive less); 2) use of new antidepressants (which has provoke an artificial epidemic of

Exploring performance obstacles of intensive care nurses.

PubMed

Gurses, Ayse P; Carayon, Pascale

2009-05-01

High nursing workload, poor patient safety, and poor nursing quality of working life (QWL) are major issues in intensive care units (ICUs). Characteristics of the ICU and performance obstacles may contribute to these issues. The goal of this study was to comprehensively identify the performance obstacles perceived by ICU nurses. We used a qualitative research design and conducted semi-structured interviews with 15 ICU nurses of a medical-surgical ICU. Based on this qualitative study and a previously reported quantitative study, we identified seven main types of performance obstacles experienced by ICU nurses. Obstacles related to the physical environment (e.g., noise, amount of space), family relations (e.g., distractions caused by family, lack of time to spend with family), and equipment (e.g., unavailability, misplacement) were the most frequently experienced performance obstacles. The qualitative interview data provided rich information regarding the factors contributing to the performance obstacles. Overall, ICU nurses experience a variety of performance obstacles in their work on a daily basis. Future research is needed to understand the impact of performance obstacles on nursing workload, nursing QWL, and quality and safety of care.

Good manufacturing practice and viral safety.

PubMed

Kerner, B

1995-07-01

The concept of virus inactivation during the manufacture of blood products raises questions about possible recontamination of the product by the environment. A strict regime of good manufacturing practice (GMP) is mandatory. The guidelines originally issued by the World Health Organization (WHO), and now law in most countries, are an excellent basis for the operation of a production plant. The following elements of GMP require special concern: (i) All functions shall be defined in a clear organization chart. (ii) Personnel shall be appropriately trained for the job and to perfect hygiene. (iii) Buildings and facilities, as well as supply systems, shall exclude the possibility of recontamination of already virus-inactivated materials. (iv) Equipment shall be easy to clean and fully sterilizable. (v) Production shall follow appropriate written procedures. (vi) The Quality Control Organization shall monitor the process by in-process controls and review the records for possible deviations. All GMP issues are coordinated by a Quality Assurance Organization that also reviews the overall performance of the operation. The maintenance of viral safety of the products basically depends upon the full commitment of all bodies involved to proper and non-negotiable GMP.

Barriers to the implementation of management systems: lessons from the past.

PubMed

Gardner, D

2000-01-01

There is a substantial body of evidence, both empirical and anecdotal, concerning factors associated with the success and failure of management systems. Given the increasing interest in management systems for occupational health and safety, quality, and the environment, it is worth looking at some of these factors in order to learn from them and plan for the future. One of the most comprehensive sources of information about factors that can make a management system succeed or fail lies in the material written about systems that improve the quality of products and services. Such systems were extremely widespread during the 1970s and 1980s but are now much less often cited or studied by Australian organisations. One of the reasons underlying the present relative lack of emphasis is that such programs, both here and overseas, experienced a failure rate of between 85% and 95%. While it may seem unlikely that occupational health and safety (OHS) and environmental management systems will experience similar failure rates, it is still worthwhile to look at what went wrong with other systems and to learn from these experiences.

Wireless remote monitoring of toxic gases in shipbuilding.

PubMed

Pérez-Garrido, Carlos; González-Castaño, Francisco J; Chaves-Díeguez, David; Rodríguez-Hernández, Pedro S

2014-02-14

Large-scale wireless sensor networks have not achieved market impact, so far. Nevertheless, this technology may be applied successfully to small-scale niche markets. Shipyards are hazardous working environments with many potential risks to worker safety. Toxic gases generated in soldering processes in enclosed spaces (e.g., cargo holds) are one such risk. The dynamic environment of a ship under construction makes it very difficult to plan gas detection fixed infrastructures connected to external monitoring stations via wired links. While portable devices with gas level indicators exist, they require workers to monitor measurements, often in situations where they are focused on other tasks for relatively long periods. In this work, we present a wireless multihop remote gas monitoring system for shipyard environments that has been tested in a real ship under construction. Using this system, we validate IEEE 802.15.4/Zigbee wireless networks as a suitable technology to connect gas detectors to control stations outside the ships. These networks have the added benefit that they reconfigure themselves dynamically in case of network failure or redeployment, for example when a relay is moved to a new location. Performance measurements include round trip time (which determines the alert response time for safety teams) and link quality indicator and packet error rate (which determine communication robustness).

Wireless Remote Monitoring of Toxic Gases in Shipbuilding

PubMed Central

Pérez-Garrido, Carlos; González-Castaño, Francisco J.; Chaves-Diéguez, David; Rodríguez-Hernández, Pedro S.

2014-01-01

Large-scale wireless sensor networks have not achieved market impact, so far. Nevertheless, this technology may be applied successfully to small-scale niche markets. Shipyards are hazardous working environments with many potential risks to worker safety. Toxic gases generated in soldering processes in enclosed spaces (e.g., cargo holds) are one such risk. The dynamic environment of a ship under construction makes it very difficult to plan gas detection fixed infrastructures connected to external monitoring stations via wired links. While portable devices with gas level indicators exist, they require workers to monitor measurements, often in situations where they are focused on other tasks for relatively long periods. In this work, we present a wireless multihop remote gas monitoring system for shipyard environments that has been tested in a real ship under construction. Using this system, we validate IEEE 802.15.4/Zigbee wireless networks as a suitable technology to connect gas detectors to control stations outside the ships. These networks have the added benefit that they reconfigure themselves dynamically in case of network failure or redeployment, for example when a relay is moved to a new location. Performance measurements include round trip time (which determines the alert response time for safety teams) and link quality indicator and packet error rate (which determine communication robustness). PMID:24534919

Design and evaluation of a seat orientation controller during uneven terrain driving.

PubMed

Candiotti, Jorge; Wang, Hongwu; Chung, Cheng-Shiu; Kamaraj, Deepan C; Grindle, Garrett G; Shino, Motoki; Cooper, Rory A

2016-03-01

Electric powered wheelchairs (EPWs) are essential devices for people with disabilities as aids for mobility and quality of life improvement. However, the design of currently available common EPWs is still limited and makes it challenging for the users to drive in both indoor and outdoor environments such as uneven surfaces, steep hills, or cross slopes, making EPWs susceptible to loss of stability and at risk for falls. An alternative wheel-legged robotic wheelchair, "MEBot", was designed to improve the safety and mobility of EPW users in both indoor and outdoor environments. MEBot is able to elevate its six wheels using pneumatic actuators, as well to detect changes in the seat angle using a gyroscope and accelerometer. This capability enables MEBot to provide sensing for a dynamic self-leveling seat application that can maintain the center of mass within the boundaries of the wheelchair, thereby, improving EPW safety. To verify the effectiveness of the application, MEBot was tested on a motion platform with six degrees of freedom to simulate different slopes that could be experienced by the EPW in outdoor environments. The results demonstrate the robustness of the application to maintain the wheelchair seat in a horizontal reference against changes in the ground angle. Published by Elsevier Ltd.

A novel downlink scheduling strategy for traffic communication system based on TD-LTE technology.

PubMed

Chen, Ting; Zhao, Xiangmo; Gao, Tao; Zhang, Licheng

2016-01-01

There are many existing classical scheduling algorithms which can obtain better system throughput and user equality, however, they are not designed for traffic transportation environment, which cannot consider whether the transmission performance of various information flows could meet comprehensive requirements of traffic safety and delay tolerance. This paper proposes a novel downlink scheduling strategy for traffic communication system based on TD-LTE technology, which can perform two classification mappings for various information flows in the eNodeB: firstly, associate every information flow packet with traffic safety importance weight according to its relevance to the traffic safety; secondly, associate every traffic information flow with service type importance weight according to its quality of service (QoS) requirements. Once the connection is established, at every scheduling moment, scheduler would decide the scheduling order of all buffers' head of line packets periodically according to the instant value of scheduling importance weight function, which calculated by the proposed algorithm. From different scenario simulations, it can be verified that the proposed algorithm can provide superior differentiated transmission service and reliable QoS guarantee to information flows with different traffic safety levels and service types, which is more suitable for traffic transportation environment compared with the existing popularity PF algorithm. With the limited wireless resource, information flow closed related to traffic safety will always obtain priority scheduling right timely, which can help the passengers' journey more safe. Moreover, the proposed algorithm cannot only obtain good flow throughput and user fairness which are almost equal to those of the PF algorithm without significant differences, but also provide better realtime transmission guarantee to realtime information flow.

Performance standards of the nerve conduction study technologist.

PubMed

Neal, Peggy J; Katirji, Bashar

2008-06-01

The primary performance standard of the nerve conduction study technologist is to perform nerve conduction studies (NCS) on patients with trauma or diseases of the peripheral nervous system. However, to be in compliance with various healthcare/medical accreditation agencies, such as Occupational Safety and Health Administration (OSHA), Centers for Disease Control and Prevention (CDC), or The Joint Commission [formerly known as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)], there are many other important performance objectives that must be met as well. It is the responsibility of the NCS technologist to meet these standards on a daily basis. Once these standards become an expected responsibility of the NCS technologist's position, the patient undergoing a nerve conduction study should be assured of a high quality test performed in an optimal safety environment.

Overcrowding and diversion in the emergency department: the health care safety net unravels.

PubMed

Velianoff, George D

2002-03-01

Emergency department overcrowding and diversion of patients are serious problems that are symptomatic of larger health care system issues. Downsizing, government regulations, managed care, increased numbers of uninsured, and reimbursement decreases are issues that have created the overcrowding and diversion issues. The Emergency Medical Treatment and Active Labor Act (EMTALA), poor operations and hospital processes, unavailable inpatient beds and closures, consolidations and workforce shortages are also contributors to the overcrowding and diversion issues. Options and solutions are proposed to alleviate the problem, however, greater collaboration, changed work environments, and reimbursement structures need to be developed and instituted. The safety net of the US health system is unraveling, and without intervention, the emergency department will not be able to provide services to the public at any level of quality and efficiency.

Preventive medicine oversight of splash pads on military installations.

PubMed

Hardcastle, Lisa Raysby; Perry, Matthew; Browne, Ashley

2015-01-01

Over the past several years, an increasing number of military installations have installed splash pads that provide fun, recreational water entertainment for Soldiers and their families. The addition of splash pads brings added responsibilities for medical treatment facility preventive medicine oversight and installation facilities maintenance to ensure a safe and healthy environment. Currently, there are no consistent standards or detailed guidance for military installations to follow when installing and maintaining splash pads. The central issues associated with splash pads on military installations are water quality and risk for waterborne illnesses, responsibility for safety and health oversight, and federal energy and water sustainability mandates. This article examines the importance of implementing a standard for design and oversight to ensure the health and safety of Soldiers and their families.

Health, safety, and environmental risk assessment of steel production complex in central Iran using TOPSIS.

PubMed

Jozi, S A; Majd, N Moradi

2014-10-01

This research was carried out with the aim of presenting an environmental management plan for steel production complex (SPC) in central Iran. Following precise identification of the plant activities as well as the study area, possible sources of environmental pollution and adverse impacts on the air quality, water, soil, biological environment, socioeconomic and cultural environment, and health and safety of the employees were determined considering the work processes of the steel complex. Afterwards, noise, wastewater, and air pollution sources were measured. Subsequently, factors polluting the steel complex were identified by TOPSIS and then prioritized using Excel Software. Based on the obtained results, the operation of the furnaces in hot rolling process with the score 1, effluent derived from hot rolling process with the score 0.565, nonprincipal disposal and dumping of waste at the plant enclosure with the score 0.335, walking beam process with the score 1.483 respectively allocated themselves the highest priority in terms of air, water, soil and noise pollution. In terms of habitats, land cover and socioeconomic and cultural environment, closeness to the forest area and the existence of four groups of wildlife with the score 1.106 and proximity of villages and residential areas to the plant with the score 3.771 respectively enjoyed the highest priorities while impressibility and occupational accidents with the score 2.725 and cutting and welding operations with score 2.134 had the highest priority among health and safety criteria. Finally, strategies for the control of pollution sources were identified and Training, Monitoring and environmental management plan of the SPC was prepared.

Waste management to improve food safety and security for health advancement.

PubMed

Lin, Angela Yu-Chen; Huang, Susana Tzy-Ying; Wahlqvist, Mark L

2009-01-01

Economic growth inevitably influences the food chain. Growing demand with changes in lifestyle and health consciousness encourage use of packaged and pre-prepared foods. The needs of environmental protection from waste generated are largely overlooked, and a lack of knowledge about the impact on the environment and its health effects constitute food security/safety problems. Food production and waste generation directly affect resource (i.e., energy and water) consumption and often contaminate the environment. More pressure on food production has inculcated the use of pesticides, herbicides, antibiotics and chemical fertilizers which add to current global pollution. At least half of food grown is discarded before and after it reaches consumers. It is estimated that one third to half of landfill waste comes from the food sector. This landfill releases green house gases (GHG) as well as leachate which worsen soil and water quality and safety. Pharmaceutical and chemical contaminations from residential, industrial and agricultural sources make their way into nearby water and soil and can eventually affect our food systems. Phthalates, PFOA, BPA, commonly used in plastics and personal care products, are found in unacceptable concentrations in Taiwanese waters. They, too, contribute to food contamination and long-term health risk. Existing waste management strategies warrant more stringent norms for waste reduction at source. Awareness through education could reduce food waste and its consequences. This review encompasses impacts of food production systems on the environment, pollution which results from food waste, costs and economic advantages in food waste management, and health consequences of waste.

48 CFR 952.223-71 - Integration of environment, safety, and health into work planning and execution.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Integration of environment, safety, and health into work planning and execution. 952.223-71 Section 952.223-71 Federal Acquisition... Provisions and Clauses 952.223-71 Integration of environment, safety, and health into work planning and...

A Lane-Level LBS System for Vehicle Network with High-Precision BDS/GPS Positioning

PubMed Central

Guo, Chi; Guo, Wenfei; Cao, Guangyi; Dong, Hongbo

2015-01-01

In recent years, research on vehicle network location service has begun to focus on its intelligence and precision. The accuracy of space-time information has become a core factor for vehicle network systems in a mobile environment. However, difficulties persist in vehicle satellite positioning since deficiencies in the provision of high-quality space-time references greatly limit the development and application of vehicle networks. In this paper, we propose a high-precision-based vehicle network location service to solve this problem. The major components of this study include the following: (1) application of wide-area precise positioning technology to the vehicle network system. An adaptive correction message broadcast protocol is designed to satisfy the requirements for large-scale target precise positioning in the mobile Internet environment; (2) development of a concurrence service system with a flexible virtual expansion architecture to guarantee reliable data interaction between vehicles and the background; (3) verification of the positioning precision and service quality in the urban environment. Based on this high-precision positioning service platform, a lane-level location service is designed to solve a typical traffic safety problem. PMID:25755665

Improving the health care work environment: implications for research, practice, and policy.

PubMed

Harrison, Michael I; Henriksen, Kerm; Hughes, Ronda G

2007-11-01

Despite the gains to date, we need better understanding of practices for implementing and sustaining improvements in health care work environments and further study of organizational conditions affecting implementation of improvements. Limiting work hours, improving schedules, and providing sleep hygiene training will help combat clinician fatigue. Hospital crowding can be reduced through systemwide improvement of patient flow and capacity management, coupled with management support, measurement, and reporting on crowding. Long-term solutions to nurse staffing shortfalls include process redesign to enhance efficiency. Improvement of organizational climate, human resource management, and interoccupational relations will also contribute to staff retention. Evidence-based enhancements to patient rooms and other physical features in hospitals contribute directly to safety and quality and also affect staff performance. POLICY: Landrigan and his colleagues call for external restrictions on residents' work shifts. Clarke examines prospects for mandated nursing-staff ratios. Public reporting on staffing, crowding, and other risks may incent change. Reporting and pay for performance require standardized measures of targeted conditions. Organizations promoting care quality can help spread safe work practices; they can also support collaborative learning and other strategies that may enhance implementation of improvements in work environments.

42 CFR 418.58 - Condition of participation: Quality assessment and performance improvement.

Code of Federal Regulations, 2011 CFR

2011-10-01

... collected to do the following: (i) Monitor the effectiveness and safety of services and quality of care. (ii..., patient safety, and quality of care. (2) Performance improvement activities must track adverse patient... care and patient safety, and that all improvement actions are evaluated for effectiveness. (3) That one...

Line-scan Raman imaging and spectroscopy platform for surface and subsurface evaluation of food safety and quality

USDA-ARS?s Scientific Manuscript database

Both surface and subsurface food inspection is important since interesting safety and quality attributes can be at different sample locations. This paper presents a multipurpose line-scan Raman platform for food safety and quality research, which can be configured for Raman chemical imaging (RCI) mo...

Impact of Performance Obstacles on Intensive Care Nurses‘ Workload, Perceived Quality and Safety of Care, and Quality of Working Life

PubMed Central

Gurses, Ayse P; Carayon, Pascale; Wall, Melanie

2009-01-01

Objectives To study the impact of performance obstacles on intensive care nurses‘ workload, quality and safety of care, and quality of working life (QWL). Performance obstacles are factors that hinder nurses‘ capacity to perform their job and that are closely associated with their immediate work system. Data Sources/Study Setting Data were collected from 265 nurses in 17 intensive care units (ICUs) between February and August 2004 via a structured questionnaire, yielding a response rate of 80 percent. Study Design A cross-sectional study design was used. Data were analyzed by correlation analyses and structural equation modeling. Principal Findings Performance obstacles were found to affect perceived quality and safety of care and QWL of ICU nurses. Workload mediated the impact of performance obstacles with the exception of equipment-related issues on perceived quality and safety of care as well as QWL. Conclusions Performance obstacles in ICUs are a major determinant of nursing workload, perceived quality and safety of care, and QWL. In general, performance obstacles increase nursing workload, which in turn negatively affect perceived quality and safety of care and QWL. Redesigning the ICU work system to reduce performance obstacles may improve nurses‘ work. PMID:19207589

Nursing practice environment, job outcomes and safety climate: a structural equation modelling analysis.

PubMed

Dos Santos Alves, Daniela Fernanda; da Silva, Dirceu; de Brito Guirardello, Edinêis

2017-01-01

To assess correlations between the characteristics of the nursing practice environment, job outcomes and safety climate. The nursing practice environment is critical to the well-being of professionals and to patient safety, as highlighted by national and international studies; however, there is a lack of evidence regarding this theme in paediatric units. A cross-sectional study, in two paediatric hospitals in Brazil, was conducted from December 2013 to February 2014. For data collection, we used the Nursing Work Index - Revised, Safety Attitudes Questionnaire - Short Form 2006 and the Maslach Burnout Inventory, and for analysis Spearman's correlation coefficient and structural equation modelling were used. Two hundred and sixty-seven professional nurses participated in the study. Autonomy, control over the work environment and the relationship between nursing and medical staff are factors associated with job outcomes and safety climate and can be considered their predictors. Professional nurses with greater autonomy, good working relationships and control over their work environment have lower levels of emotional exhaustion, higher job satisfaction, less intention of leaving the job and the safety climate is positive. Initiatives to improve the professional practice environment can improve the safety of paediatric patients and the well-being of professional nurses. © 2016 John Wiley & Sons Ltd.

Quality organization and risk in anaesthesia: the French perspective.

PubMed

Marty, Jean; Samain, Emmanuel

2017-04-01

Ensuring the quality and safety of anaesthesia in the face of budgetary restrictions and changing demographics is challenging. In France, the environment is regulated by the legislation, and it is often necessary to find solutions that seize opportunities to break with the traditional organization. Postoperative mortality remains excessively high. The move towards ambulatory care is being adequately integrated into all the stages of patient management in the context of a single therapeutic plan that is mutually agreed upon by all caregivers. The French National Health Authority, which provides certification for healthcare establishments, encourages this 'seamless' approach between private practice and the hospital setting, based on teamwork and interdisciplinary consultation. By daring to break with traditional organizational structures, and by taking account of human factors and staged strategies, it is possible to deliver appropriate care, with a level of quality and safety that meets users' demands. The management of a patient undergoing surgery with anaesthesia is a seamless spectrum from the patient's home to the hospital and back to home. Decision-making must be multidisciplinary. Increased use of ambulatory care, breaks with traditional organizational structures, and efforts to reduce postoperative mortality represents opportunities to improve overall system performance. Demographic and economic constraints are potential threats to be identified.

The evolution of modern agriculture and its future with biotechnology.

PubMed

Harlander, Susan K

2002-06-01

Since the dawn of agriculture, humans have been manipulating crops to enhance their quality and yield. Via conventional breeding, seed producers have developed the modern corn hybrids and wheat commonly grown today. Newer techniques, such as radiation breeding, enhanced the seed producers' ability to develop new traits in crops. Then in the 1980's-1990's, scientists began applying genetic engineering techniques to improve crop quality and yield. In contrast to earlier breeding methods, these techniques raised questions about their safety to consumers and the environment. This paper provides an overview of the kinds of genetically modified crops developed and marketed to date and the value they provide farmers and consumers. The safety assessment process required for these crops is contrasted with the lack of a formal process required for traditionally bred crops. While European consumers have expressed concern about foods and animal feeds containing ingredients from genetically modified crops, Americans have largely been unconcerned or unaware of the presence of genetically modified foods on the market. This difference in attitude is reflected in Europe's decision to label foods containing genetically modified ingredients while no such labeling is required in the U.S. In the future, genetic modification will produce a variety of new products with enhanced nutritional or quality attributes.

Associations between the Quality of the Residential Built Environment and Pregnancy Outcomes among Women in North Carolina

PubMed Central

Messer, Lynne C.; Kroeger, Gretchen L.

2011-01-01

Background: The built environment, a key component of environmental health, may be an important contributor to health disparities, particularly for reproductive health outcomes. Objective: In this study we investigated the relationship between seven indices of residential built environment quality and adverse reproductive outcomes for the City of Durham, North Carolina (USA). Methods: We surveyed approximately 17,000 residential tax parcels in central Durham, assessing > 50 individual variables on each. These data, collected using direct observation, were combined with tax assessor, public safety, and U.S. Census data to construct seven indices representing important domains of the residential built environment: housing damage, property disorder, security measures, tenure (owner or renter occupied), vacancy, crime count, and nuisance count. Fixed-slope random-intercept multilevel models estimated the association between the residential built environment and five adverse birth outcomes. Models were adjusted for maternal characteristics and clustered at the primary adjacency community unit, defined as the index block, plus all adjacent blocks that share any portion of a line segment (block boundary) or vertex. Results: Five built environment indices (housing damage, property disorder, tenure, vacancy, and nuisance count) were associated with each of the five outcomes in the unadjusted context: preterm birth, small for gestational age (SGA), low birth weight (LBW), continuous birth weight, and birth weight percentile for gestational age (BWPGA; sex-specific birth weight distributions for infants delivered at each gestational age using National Center for Health Statistics referent births for 2000–2004). However, some estimates were attenuated after adjustment. In models adjusted for individual-level covariates, housing damage remained statistically significantly associated with SGA, birth weight, and BWPGA. Conclusion: This work suggests a real and meaningful relationship between the quality of the residential built environment and birth outcomes, which we argue are a good measure of general community health. PMID:22138639

Nurses' perceptions of their professional practice environment: a cross-sectional study.

PubMed

Cao, Yingjuan; DiGiacomo, Michelle; Salamonson, Yenna; Li, Ye; Huai, Baosha; Davidson, Patricia M

2015-12-01

To describe nurses' perceptions concerning their professional practice environment in mainland China and identify factors associated with these views. Globally, the environments in which nurses work influence the quality of nursing practice and health care. A cross-sectional descriptive survey using both paper- and online-based delivery modes was used. A convenience sampling method was used. The survey questionnaire was composed of sociodemographic items and the 38-item Chinese version of Professional Practice Environment survey. The content of the paper-based questionnaire was identical to the online survey. Pearson's chi-square test was conducted to compare the demographic characteristics of these two data sets. Descriptive statistics analysis included frequency, percentage, mean and standard deviation. Multiple linear regression analysis using the Backwards method was applied to identify independent predictors of each subscale of the 38-item Chinese version of Professional Practice Environment. A total of 573 questionnaires were analysed. The mean score of each subscale of the 38-item Chinese version of Professional Practice Environment in this study ranged from 2·66-3·05. All subscales except work motivation (3·05, standard deviation: 0·44) scored less than 3·0. Areas rated as most in need of improvement included control over practice, interpersonal interaction, supportive leadership and handling conflict, and staff relationships with physicians and autonomy. This study has identified nurses' perspectives regarding their workplaces in contemporary China. These data have provided an important baseline for developing and implementing culturally appropriate strategies to improve the working environment of Chinese nurses. A supportive and enabling work environment promotes professional development and the safety and quality of health care. Addressing these factors is important in optimising work place environments. © 2015 John Wiley & Sons Ltd.

Documenting quality improvement and patient safety efforts: the quality portfolio. A statement from the academic hospitalist taskforce.

PubMed

Taylor, Benjamin B; Parekh, Vikas; Estrada, Carlos A; Schleyer, Anneliese; Sharpe, Bradley

2014-01-01

Physicians increasingly investigate, work, and teach to improve the quality of care and safety of care delivery. The Society of General Internal Medicine Academic Hospitalist Task Force sought to develop a practical tool, the quality portfolio, to systematically document quality and safety achievements. The quality portfolio was vetted with internal and external stakeholders including national leaders in academic medicine. The portfolio was refined for implementation to include an outlined framework, detailed instructions for use and an example to guide users. The portfolio has eight categories including: (1) a faculty narrative, (2) leadership and administrative activities, (3) project activities, (4) education and curricula, (5) research and scholarship, (6) honors, awards, and recognition, (7) training and certification, and (8) an appendix. The authors offer this comprehensive, yet practical tool as a method to document quality and safety activities. It is relevant for physicians across disciplines and institutions and may be useful as a standalone document or as an adjunct to traditional promotion documents. As the Next Accreditation System is implemented, academic medical centers will require faculty who can teach and implement the systems-based practice requirements. The quality portfolio is a method to document quality improvement and safety activities.

Criterion for Estimation of Ecological Safety of Objects of Urban Transport Construction

NASA Astrophysics Data System (ADS)

Bakaeva, N. V.; Chernyaeva, I. V.

2017-11-01

A new approach to assess the ecological safety of the urban environment including urban transport facilities is being considered. The chemical and acoustic pollution of the environment from the impact of the urban transport construction objects is analyzed. The description of the sustainable state concept and ecological balance of the urban environment is given. A criterion for assessing environmental safety based on a comprehensive indicator of the city’s biosphere compatibility was proposed. The scale of environmental safety assessments is constructed.

Psychosocial safety climate: a multilevel theory of work stress in the health and community service sector.

PubMed

Dollard, M F; McTernan, W

2011-12-01

Work stress is widely thought to be a significant problem in the health and community services sector. We reviewed evidence from a range of different data sources that confirms this belief. High levels of psychosocial risk factors, psychological health problems and workers compensation claims for stress are found in the sector. We propose a multilevel theoretical model of work stress to account for the results. Psychosocial safety climate (PSC) refers to a climate for psychological health and safety. It reflects the balance of concern by management about psychological health v. productivity. By extending the health erosion and motivational paths of the Job Demands-Resources model we propose that PSC within work organisations predicts work conditions and in turn psychological health and engagement. Over and above this, however, we expect that the external environment of the sector particularly government policies, driven by economic rationalist ideology, is increasing work pressure and exhaustion. These conditions are likely to lead to a reduced quality of service, errors and mistakes.

Taking ownership of safety. What are the active ingredients of safety coaching and how do they impact safety outcomes in critical offshore working environments?

PubMed

Krauesslar, Victoria; Avery, Rachel E; Passmore, Jonathan

2015-01-01

Safety coaching interventions have become a common feature in the safety critical offshore working environments of the North Sea. Whilst the beneficial impact of coaching as an organizational tool has been evidenced, there remains a question specifically over the use of safety coaching and its impact on behavioural change and producing safe working practices. A series of 24 semi-structured interviews were conducted with three groups of experts in the offshore industry: safety coaches, offshore managers and HSE directors. Using a thematic analysis approach, several significant themes were identified across the three expert groups including connecting with and creating safety ownership in the individual, personal significance and humanisation, ingraining safety and assessing and measuring a safety coach's competence. Results suggest clear utility of safety coaching when applied by safety coaches with appropriate coach training and understanding of safety issues in an offshore environment. The current work has found that the use of safety coaching in the safety critical offshore oil and gas industry is a powerful tool in managing and promoting a culture of safety and care.

48 CFR 952.223-71 - Integration of environment, safety, and health into work planning and execution.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Provisions and Clauses 952.223-71 Integration of environment, safety, and health into work planning and..., safety, and health into work planning and execution. 952.223-71 Section 952.223-71 Federal Acquisition... safety and health standards applicable to the work conditions of contractor and subcontractor employees...

48 CFR 952.223-71 - Integration of environment, safety, and health into work planning and execution.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Provisions and Clauses 952.223-71 Integration of environment, safety, and health into work planning and..., safety, and health into work planning and execution. 952.223-71 Section 952.223-71 Federal Acquisition... safety and health standards applicable to the work conditions of contractor and subcontractor employees...

48 CFR 952.223-71 - Integration of environment, safety, and health into work planning and execution.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Provisions and Clauses 952.223-71 Integration of environment, safety, and health into work planning and..., safety, and health into work planning and execution. 952.223-71 Section 952.223-71 Federal Acquisition... safety and health standards applicable to the work conditions of contractor and subcontractor employees...

48 CFR 952.223-71 - Integration of environment, safety, and health into work planning and execution.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Provisions and Clauses 952.223-71 Integration of environment, safety, and health into work planning and..., safety, and health into work planning and execution. 952.223-71 Section 952.223-71 Federal Acquisition... safety and health standards applicable to the work conditions of contractor and subcontractor employees...

ESH&Q Joule: Greg Gilbert | News

Science.gov Websites

Accelerator Division Accelerator Physics Center Office of the Chief Safety Officer Environment, Safety, Health Plan II Policies Manuals Manuals Engineering Manual Environment, Safety and Health Manual (FESHM) Fermi . "Having been at the lab for a while, I've seen safety initiatives come and go," Greg said

Pharmaceutical process chemistry: evolution of a contemporary data-rich laboratory environment.

PubMed

Caron, Stéphane; Thomson, Nicholas M

2015-03-20

Over the past 20 years, the industrial laboratory environment has gone through a major transformation in the industrial process chemistry setting. In order to discover and develop robust and efficient syntheses and processes for a pharmaceutical portfolio with growing synthetic complexity and increased regulatory expectations, the round-bottom flask and other conventional equipment familiar to a traditional organic chemistry laboratory are being replaced. The new process chemistry laboratory fosters multidisciplinary collaborations by providing a suite of tools capable of delivering deeper process understanding through mechanistic insights and detailed kinetics translating to greater predictability at scale. This transformation is essential to the field of organic synthesis in order to promote excellence in quality, safety, speed, and cost efficiency in synthesis.

Environmental Change in the Agro-Pastoral Transitional Zone, Northern China: Patterns, Drivers, and Implications

PubMed Central

Jiang, Chong; Wang, Fei

2016-01-01

Chengde city is located in the agro–pastoral transitional zone in northern China near the capital city of Beijing, which has experienced large-scale ecological construction in the past three decades. This study quantitatively assessed the environmental changes in Chengde through observation records of water resources, water environment, atmospheric environment, and vegetation activity and investigated the possible causes. From the late 1950s to 2002, the streamflow presented a downward trend induced by climate variability and human activities, with contribution ratios of 33.2% and 66.8%, respectively. During 2001–2012, the days of levels I and II air quality presented clear upward trends. Moreover, the air pollutant concentration was relatively low compared with that in the adjacent areas, which means the air quality has improved more than that in the neighboring areas. The water quality, which deteriorated during 1993–2000, began to improve in 2002. The air and water quality changes were closely related to pollutant emissions induced by anthropogenic activities. During 1982–2012, the vegetation in the southeastern and central regions presented restoration trends, whereas that in the northwestern area showed degradation trends. The pixels with obvious degradation trends correlated significantly with annual mean temperature and annual precipitation. Ecological engineering also played a positive role in vegetation restoration. This analysis can be beneficial to environment managers in the active response and adaptation to the possible effects of future climate change, population growth, and industrial development and can be used to ensure sustainable development and environmental safety. PMID:26828508

Positioning Continuing Education: Boundaries and Intersections between the Domains Continuing Education, Knowledge Translation, Patient Safety and Quality Improvement

ERIC Educational Resources Information Center

Kitto, Simon; Bell, Mary; Peller, Jennifer; Sargeant, Joan; Etchells, Edward; Reeves, Scott; Silver, Ivan

2013-01-01

Public and professional concern about health care quality, safety and efficiency is growing. Continuing education, knowledge translation, patient safety and quality improvement have made concerted efforts to address these issues. However, a coordinated and integrated effort across these domains is lacking. This article explores and discusses the…

APSIC Guidelines for environmental cleaning and decontamination.

PubMed

Ling, Moi Lin; Apisarnthanarak, Anucha; Thu, Le Thi Anh; Villanueva, Victoria; Pandjaitan, Costy; Yusof, Mohamad Yasim

2015-01-01

This document is an executive summary of APSIC Guidelines for Environmental Cleaning and Decontamination. It describes best practices in routine cleaning and decontamination in healthcare facilities as well as in specific settings e.g. management of patients with isolation precautions, food preparation areas, construction and renovation, and following a flood. It recommends the implementation of environmental hygiene program to keep the environment safe for patients, staff and visitors visiting a healthcare facility. Objective assessment of cleanliness and quality is an essential component of this program as a method for identifying quality improvement opportunities. Recommendations for safe handling of linen and bedding; as well as occupational health and safety issues are included in the guidelines. A training program is vital to ensure consistent adherence to best practices.

Quality of Life in Rural Communities: Residents Living Near to Tembeling, Pahang and Muar Rivers, Malaysia.

PubMed

Idris, Khairuddin; Mohamed Shaffril, Hayrol Azril; Md Yassin, Sulaiman; Abu Samah, Asnarulkhadi; Hamzah, Azimi; Abu Samah, Bahaman

2016-01-01

The main aim of this study is to identify the quality of life (QoL) among communities residing near the Tembeling, Pahang and Muar Rivers in Malaysia. This quantitative study used a constructed questionnaire as main tool to collect data on the QoL of river communities. A total of 240 villagers were selected as respondents. The results indicated that the dimensions of settlement, safety, involvement and social relationships, as well as education scored highest, while dimensions of physical environment, financial and job security yielded moderate scores. Dimensions of infrastructure facilities yielded a low mean score. Recommendations are provided, in the hope that our results may be useful for strategies that could enhance QoL of these river communities.

Practical strategies for increasing efficiency and effectiveness in critical care education.

PubMed

Joyce, Maurice F; Berg, Sheri; Bittner, Edward A

2017-02-04

Technological advances and evolving demands in medical care have led to challenges in ensuring adequate training for providers of critical care. Reliance on the traditional experience-based training model alone is insufficient for ensuring quality and safety in patient care. This article provides a brief overview of the existing educational practice within the critical care environment. Challenges to education within common daily activities of critical care practice are reviewed. Some practical evidence-based educational approaches are then described which can be incorporated into the daily practice of critical care without disrupting workflow or compromising the quality of patient care. It is hoped that such approaches for improving the efficiency and efficacy of critical care education will be integrated into training programs.

Digital pathology in clinical use: where are we now and what is holding us back?

PubMed

Griffin, Jon; Treanor, Darren

2017-01-01

Whole slide imaging is being used increasingly in research applications and in frozen section, consultation and external quality assurance practice. Digital pathology, when integrated with other digital tools such as barcoding, specimen tracking and digital dictation, can be integrated into the histopathology workflow, from specimen accession to report sign-out. These elements can bring about improvements in the safety, quality and efficiency of a histopathology department. The present paper reviews the evidence for these benefits. We then discuss the challenges of implementing a fully digital pathology workflow, including the regulatory environment, validation of whole slide imaging and the evidence for the design of a digital pathology workstation. © 2016 John Wiley & Sons Ltd.

Web Information Systems for Monitoring and Control of Indoor Air Quality at Subway Stations

NASA Astrophysics Data System (ADS)

Choi, Gi Heung; Choi, Gi Sang; Jang, Joo Hyoung

In crowded subway stations indoor air quality (IAQ) is a key factor for ensuring the safety, health and comfort of passengers. In this study, a framework for web-based information system in VDN environment for monitoring and control of IAQ in subway stations is suggested. Since physical variables that describing IAQ need to be closely monitored and controlled in multiple locations in subway stations, concept of distributed monitoring and control network using wireless media needs to be implemented. Connecting remote wireless sensor network and device (LonWorks) networks to the IP network based on the concept of VDN can provide a powerful, integrated, distributed monitoring and control performance, making a web-based information system possible.

Virtual reality and medicine--from the cockpit to the operating room: are we there yet?

PubMed

Saied, Nahel

2005-01-01

Teaching medicine to medical students, physicians in training and nurses is a challenging task that has remained unchanged for decades. The airline industry has achieved a great deal of safety and quality in a technically challenging environment. Many believe that their outstanding achievement is due to team training and crew resource management using simulators and dedicated training programs. Many experts in the medical profession believe that adopting the same strategies in teaching medical students and trainees could achieve significant reductions in medical errors and improve the quality of patient care. This article explores the role of teaching medicine using virtual reality in a multitude of medical specialties and outlines the use of simulation training at Saint Louis University.

[Exploration of the Association Between Workplace Bullying and Attitudes Toward Patient Safety in Female Nurses].

PubMed

Lin, Yuh-Hsuan; Hsiao, Shu-Tai Sheen; Lin, Chiou-Fen; Yang, Chyn-Yng; Chung, Min-Huey

2018-02-01

Workplace bullying is known to have a significant and detrimental effect on the physical and psychological outcomes of its victims. The reactions of victims to bullying may decrease clinical care outcomes and patient safety. To explore the relationship between workplace bullying and the attitudes of female nurses toward the safety of their patients. This cross-sectional survey study used convenience sampling. Participants included female nurses from a regional teaching hospital. The research tool was a three-part, structured questionnaire that included a basic personal information datasheet, negative behavior scale, and patient safety attitude scale. The researcher distributed 420 questionnaires and collected 329 valid samples (valid return rate: 78.3%). Data were analyzed using SPSS software version 22.0. The analysis found that 29.8% of the participants had suffered from various degrees of workplace bullying. The mean score for patient safety attitudes was 3.58 (standard deviation = 0.55). Workplace bullying and patient safety attitudes were negatively correlated (p < .1), and being a recipient of workplace bullying was identified as a significant predictor of attitudes toward patient safety. Based on the results, we suggest that supervisors should take the initiative to care for their nursing staffs and to provide them with training in conflict-oriented skills. Organization managers should set up relevant committee-notification mechanisms that construct the safe working environment necessary to reduce workplace bullying and to enhance the patient safety attitudes of nurses, which will indirectly improve the quality of patient care.

[Quality of care and safety indicators in anticoagulated patients with non-valvular auricular fibrillation and deep venous thromboembolic disease].

PubMed

Ignacio, E; Mira, J J; Campos, F J; López de Sá, E; Lorenzo, A; Caballero, F

To identify and prioritise indicators to assess the quality of care and safety of patients with non-valvular auricular fibrillation (NVAF) and deep vein thrombosis (DVT) treated with anticoagulants. Using the consensus conference technique, a group of professionals and clinical experts, the determining factors of the NVAF and DVT care process were identified, in order to define the quality and safety criteria. A proposal was made for indicators of quality and safety that were prioritised, taking into account a series of pre-established attributes. The selected indicators were classified into indicators of context, safety, action, and outcomes of the intervention in the patient. A set of 114 health care and safety quality indicators were identified, of which 35 were prioritised: 15 for NVAF and 20 for DVT. About half (49%) of the indicators (40% for NVAF and 55% for DVT) applied to patient safety, and 26% (33% for NVAF and 20% for DVT) to the outcomes of interventions in the patient. The present work presents a set of agreed indicators by a group of expert professionals that can contribute to the improvement of the quality of care of patients with NVAF and DVT treated with anticoagulants. Copyright © 2018 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

A systematic review of human factors and ergonomics (HFE)-based healthcare system redesign for quality of care and patient safety.

PubMed

Xie, Anping; Carayon, Pascale

2015-01-01

Healthcare systems need to be redesigned to provide care that is safe, effective and efficient, and meets the multiple needs of patients. This systematic review examines how human factors and ergonomics (HFE) is applied to redesign healthcare work systems and processes and improve quality and safety of care. We identified 12 projects representing 23 studies and addressing different physical, cognitive and organisational HFE issues in a variety of healthcare systems and care settings. Some evidence exists for the effectiveness of HFE-based healthcare system redesign in improving process and outcome measures of quality and safety of care. We assessed risk of bias in 16 studies reporting the impact of HFE-based healthcare system redesign and found varying quality across studies. Future research should further assess the impact of HFE on quality and safety of care, and clearly define the mechanisms by which HFE-based system redesign can improve quality and safety of care.

Safety in construction--a comprehensive description of the characteristics of high safety standards in construction work, from the combined perspective of supervisors and experienced workers.

PubMed

Törner, Marianne; Pousette, Anders

2009-01-01

The often applied engineering approach to safety management in the construction industry needs to be supplemented by organizational measures and measures based on how people conceive and react to their social environment. This requires in-depth knowledge of the broad preconditions for high safety standards in construction. The aim of the study was to comprehensively describe the preconditions and components of high safety standards in the construction industry from the perspective of both experienced construction workers and first-line managers. Five worker safety representatives and 19 first-line managers were interviewed, all strategically selected from within a large Swedish construction project. Phenomenographic methodology was used for data acquisition and analysis and to categorize the information. Nine informants verified the results. The study identified four main categories of work safety preconditions and components: (1) Project characteristics and nature of the work, which set the limits of safety management; (2) Organization and structures, with the subcategories planning, work roles, procedures, and resources; (3) Collective values, norms, and behaviors, with the subcategories climate and culture, and interaction and cooperation; and (4) Individual competence and attitudes, with the subcategories knowledge, ability and experience, and individual attitudes. The results comprehensively describe high safety standards in construction, incorporating organizational, group, individual, and technical aspects. High-quality interaction between different organizational functions and hierarchical levels stood out as important aspects of safety. The results are discussed in relation to previous research into safety and into the social-psychological preconditions for other desired outcomes in occupational settings. The results can guide construction companies in planning and executing construction projects to a high safety standard.

Laser safety programs in general surgery.

PubMed

Lanzafame, R J

1994-06-01

General surgery represents a speciality where, while any procedure can be performed with lasers, there are no procedures for which the laser is the sine quo non. The general surgeon may perform a variety of procedures with a multitude of laser wavelengths and technologies. Laser safety in general surgery requires a multidisciplinary approach. Effective laser safety requires the oversight of the hospital's "laser usage committee" and "laser safety officer" while providing a workable framework for daily laser use in a variety of clinical scenarios simultaneously. This framework must be user-friendly rather than oppressive. This presentation will describe laser safety at the Rochester General Hospital, a tertiary care, community-based teaching hospital. The safety program incorporates the following components: input to physician credentialing and training, education and in-servicing of nursing and technical personnel, equipment purchase and maintenance, quality assurance, and safety monitoring. The University of Rochester general surgery residency training program mandates laser training during the PGY-2 year. This program stresses the safe use of lasers and provides the basis for graded hands-on experience during the surgical residency. The greatest challenge for laser safety in general surgery centers on the burgeoning field of minimally invasive surgery. Safety assurance must be balanced so as to maintain a safe operating-room environment while ensuring patient safety and the ability to permit the surgery to proceed efficiently. Safety measures for laparoscopic procedures must be sensitive to the needs of the surgical team while not providing confusing signals for the "gallery" observers. This task is critical for the safe operation of lasers in general surgery. Effective laser safety in general surgery requires constant vigilance tempered with sensitivity to the needs of the surgeon and the patient as laser technology and its applications continue to evolve.

Design of agricultural product quality safety retrospective supervision system of Jiangsu province

NASA Astrophysics Data System (ADS)

Wang, Kun

2017-08-01

In store and supermarkets to consumers can trace back agricultural products through the electronic province card to query their origin, planting, processing, packaging, testing and other important information and found that the problems. Quality and safety issues can identify the responsibility of the problem. This paper designs a retroactive supervision system for the quality and safety of agricultural products in Jiangsu Province. Based on the analysis of agricultural production and business process, the goal of Jiangsu agricultural product quality safety traceability system construction is established, and the specific functional requirements and non-functioning requirements of the retroactive system are analyzed, and the target is specified for the specific construction of the retroactive system. The design of the quality and safety traceability system in Jiangsu province contains the design of the overall design, the trace code design and the system function module.

Understanding the role of sleep quality and sleep duration in commercial driving safety.

PubMed

Lemke, Michael K; Apostolopoulos, Yorghos; Hege, Adam; Sönmez, Sevil; Wideman, Laurie

2016-12-01

Long-haul truck drivers in the United States suffer disproportionately high injury rates. Sleep is a critical factor in these outcomes, contributing to fatigue and degrading multiple aspects of safety-relevant performance. Both sleep duration and sleep quality are often compromised among truck drivers; however, much of the efforts to combat fatigue focus on sleep duration rather than sleep quality. Thus, the current study has two objectives: (1) to determine the degree to which sleep impacts safety-relevant performance among long-haul truck drivers; and (2) to evaluate workday and non-workday sleep quality and duration as predictors of drivers' safety-relevant performance. A non-experimental, descriptive, cross-sectional design was employed to collect survey and biometric data from 260 long-haul truck drivers. The Trucker Sleep Disorders Survey was developed to assess sleep duration and quality, the impact of sleep on job performance and accident risk, and other relevant work organization characteristics. Descriptive statistics assessed work organization variables, sleep duration and quality, and frequency of engaging in safety-relevant performance while sleepy. Linear regression analyses were conducted to evaluate relationships between sleep duration, sleep quality, and work organization variables with safety composite variables. Drivers reported long work hours, with over 70% of drivers working more than 11h daily. Drivers also reported a large number of miles driven per week, with an average of 2,812.61 miles per week, and frequent violations of hours-of-service rules, with 43.8% of drivers "sometimes to always" violating the "14-h rule." Sleep duration was longer, and sleep quality was better, on non-workdays compared on workdays. Drivers frequently operated motor vehicles while sleepy, and sleepiness impacted several aspects of safety-relevant performance. Sleep quality was better associated with driving while sleepy and with job performance and concentration than sleep duration. Sleep duration was better associated with accidents and accident risk than sleep quality. Sleep quality appears to be better associated with safety-relevant performance among long-haul truck drivers than sleep duration. Comprehensive and multilevel efforts are needed to meaningfully address sleep quality among drivers. Copyright © 2016 Elsevier Ltd. All rights reserved.

DoD Veterinary Service Activity Role in DoD Food Safety.

DTIC Science & Technology

1998-01-01

medical research and development; zoonotic disease prevention and control; and food safety and quality assurance. The latter mission is not all encompassing...within DoD. This paper reviews the division of responsibilities, within DoD, for food safety and quality assurance. The complexity of the division...and the problem it causes joint operations planners are explored. A proposal for integrating overall strategic responsibility for food safety and quality assurance into the DoD Veterinary Service Activity is developed.

Leadership in Surgery for Public Sector Hospitals in Jamaica: Strategies for the Operating Room

PubMed Central

Cawich, Shamir O; Harding, Hyacinth E; Crandon, Ivor W; McGaw, Clarence D; Barnett, Alan T; Tennant, Ingrid; Evans, Necia R; Martin, Allie C; Simpson, Lindberg K; Johnson, Peter

2013-01-01

The barriers to health care delivery in developing nations are many: underfunding, limited support services, scarce resources, suboptimal health care worker attitudes, and deficient health care policies are some of the challenges. The literature contains little information about health care leadership in developing nations. This discursive paper examines the impact of leadership on the delivery of operating room (OR) services in public sector hospitals in Jamaica. Delivery of OR services in Jamaica is hindered by many unique cultural, financial, political, and environmental barriers. We identify six leadership goals adapted to this environment to achieve change. Effective leadership must adapt to the environment. Delivery of OR services in Jamaica may be improved by addressing leadership training, workplace safety, interpersonal communication, and work environment and by revising existing policies. Additionally, there should be regular practice audits and quality control surveys. PMID:24355903

PS-CARA: Context-Aware Resource Allocation Scheme for Mobile Public Safety Networks.

PubMed

Kaleem, Zeeshan; Khaliq, Muhammad Zubair; Khan, Ajmal; Ahmad, Ishtiaq; Duong, Trung Q

2018-05-08

The fifth-generation (5G) communications systems are expecting to support users with diverse quality-of-service (QoS) requirements. Beside these requirements, the task with utmost importance is to support the emergency communication services during natural or man-made disasters. Most of the conventional base stations are not properly functional during a disaster situation, so deployment of emergency base stations such as mobile personal cell (mPC) is crucial. An mPC having moving capability can move in the disaster area to provide emergency communication services. However, mPC deployment causes severe co-channel interference to the users in its vicinity. The problem in the existing resource allocation schemes is its support for static environment, that does not fit well for mPC. So, a resource allocation scheme for mPC users is desired that can dynamically allocate resources based on users’ location and its connection establishment priority. In this paper, we propose a public safety users priority-based context-aware resource allocation (PS-CARA) scheme for users sum-rate maximization in disaster environment. Simulations results demonstrate that the proposed PS-CARA scheme can increase the user average and edge rate around 10.3% and 32.8% , respectively because of context information availability and by prioritizing the public safety users. The simulation results ensure that call blocking probability is also reduced considerably under the PS-CARA scheme.

PS-CARA: Context-Aware Resource Allocation Scheme for Mobile Public Safety Networks

PubMed Central

Khaliq, Muhammad Zubair; Khan, Ajmal; Ahmad, Ishtiaq

2018-01-01

The fifth-generation (5G) communications systems are expecting to support users with diverse quality-of-service (QoS) requirements. Beside these requirements, the task with utmost importance is to support the emergency communication services during natural or man-made disasters. Most of the conventional base stations are not properly functional during a disaster situation, so deployment of emergency base stations such as mobile personal cell (mPC) is crucial. An mPC having moving capability can move in the disaster area to provide emergency communication services. However, mPC deployment causes severe co-channel interference to the users in its vicinity. The problem in the existing resource allocation schemes is its support for static environment, that does not fit well for mPC. So, a resource allocation scheme for mPC users is desired that can dynamically allocate resources based on users’ location and its connection establishment priority. In this paper, we propose a public safety users priority-based context-aware resource allocation (PS-CARA) scheme for users sum-rate maximization in disaster environment. Simulations results demonstrate that the proposed PS-CARA scheme can increase the user average and edge rate around 10.3% and 32.8% , respectively because of context information availability and by prioritizing the public safety users. The simulation results ensure that call blocking probability is also reduced considerably under the PS-CARA scheme. PMID:29738499

Making time for learning-oriented leadership in multidisciplinary hospital management groups.

PubMed

Singer, Sara J; Hayes, Jennifer E; Gray, Garry C; Kiang, Mathew V

2015-01-01

Although the clinical requirements of health care delivery imply the need for interdisciplinary management teams to work together to promote frontline learning, such interdisciplinary, learning-oriented leadership is atypical. We designed this study to identify behaviors enabling groups of diverse managers to perform as learning-oriented leadership teams on behalf of quality and safety. We randomly selected 12 of 24 intact groups of hospital managers from one hospital to participate in a Safety Leadership Team Training program. We collected primary data from March 2008 to February 2010 including pre- and post-staff surveys, multiple interviews, observations, and archival data from management groups. We examined the level and trend in frontline perceptions of managers' learning-oriented leadership following the intervention and ability of management groups to achieve objectives on targeted improvement projects. Among the 12 intervention groups, we identified higher- and lower-performing intervention groups and behaviors that enabled higher performers to work together more successfully. Management groups that achieved more of their performance goals and whose staff perceived more and greater improvement in their learning-oriented leadership after participation in Safety Leadership Team Training invested in structures that created learning capacity and conscientiously practiced prescribed learning-oriented management and problem-solving behaviors. They made the time to do these things because they envisioned the benefits of learning, valued the opportunity to learn, and maintained an environment of mutual respect and psychological safety within their group. Learning in management groups requires vision of what learning can accomplish; will to explore, practice, and build learning capacity; and mutual respect that sustains a learning environment.

40 CFR 240.209 - Safety.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Safety. 240.209 Section 240.209 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures § 240.209 Safety. ...

40 CFR 240.209 - Safety.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Safety. 240.209 Section 240.209 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures § 240.209 Safety. ...

The Safety Analysis of Shipborne Ammunition in Fire Environment

NASA Astrophysics Data System (ADS)

Ren, Junpeng; Wang, Xudong; Yue, Pengfei

2017-12-01

The safety of Ammunition has always been the focus of national military science and technology issues. And fire is one of the major safety threats to the ship’s ammunition storage environment, In this paper, Mk-82 shipborne aviation bomb has been taken as the study object, simulated the whole process of fire by using the FDS (Fire Detection System) software. According to the simulation results of FDS, ANSYS software was used to simulate the temperature field of Mk-82 carrier-based aviation bomb under fire environment, and the safety of aviation bomb in fire environment was analyzed. The result shows that the aviation bombs under the fire environment can occur the combustion or explosion after 70s constant cook-off, and it was a huge threat to the ship security.

Requirements for modeling airborne microbial contamination in space stations

NASA Astrophysics Data System (ADS)

Van Houdt, Rob; Kokkonen, Eero; Lehtimäki, Matti; Pasanen, Pertti; Leys, Natalie; Kulmala, Ilpo

2018-03-01

Exposure to bioaerosols is one of the facets that affect indoor air quality, especially for people living in densely populated or confined habitats, and is associated to a wide range of health effects. Good indoor air quality is thus vital and a prerequisite for fully confined environments such as space habitats. Bioaerosols and microbial contamination in these confined space stations can have significant health impacts, considering the unique prevailing conditions and constraints of such habitats. Therefore, biocontamination in space stations is strictly monitored and controlled to ensure crew and mission safety. However, efficient bioaerosol control measures rely on solid understanding and knowledge on how these bioaerosols are created and dispersed, and which factors affect the survivability of the associated microorganisms. Here we review the current knowledge gained from relevant studies in this wide and multidisciplinary area of bioaerosol dispersion modeling and biological indoor air quality control, specifically taking into account the specific space conditions.

Perceptions of Physical Inspections as a Tool to Protect Housing Quality and Promote Health Equity.

PubMed

Holtzen, Holly; Klein, Elizabeth G; Keller, Brittney; Hood, Nancy

2016-01-01

Physical inspections that assess how well affordable housing properties meet quality and safety standards help to ensure that low-income tenants live in a healthy built environment. This study was part of a larger Health Impact Assessment (HIA) conducted between January 2012 and November 2013 to inform policymakers about the potential health consequences of a proposed policy decision to align the physical inspections required by housing funding agencies, which would result in a reduction of the frequency of physical inspections. Key informant interviews (n=18) of property managers and tenants were used to explore the inspection process, identification of housing quality issues, and potential effects on the health of affordable housing tenants and the impact on property management practices. Results indicate that physical inspection frequency may be an important trigger for property managers and tenants to adhere to proper maintenance schedules.

Current Assessments of Quality and Safety Competencies in Registered Professional Nurses: An Examination of Nurse Leader Perceptions

ERIC Educational Resources Information Center

Smith, Elaine Lois

2012-01-01

Quality and safety in healthcare is a national concern. It has been proposed that nurses and other clinicians need to develop a new set of competencies in order to make significant improvements in the quality and safety of patient care. These new competencies include: patient-centered care; teamwork and collaboration; evidence-based practice;…

A Comparison of Urban and Rural Kindergarten Teachers' Perceptions of School Safety for Young Children: Implications for Quality Teacher Education

ERIC Educational Resources Information Center

Wong, Yau-ho Paul

2017-01-01

Although a quality preschool supports young children's health and safety, "quality" has been defined diversely enough that its delivery has been varied among kindergarten teachers. The current study was the first to examine and compare perceptions of school safety between urban and rural kindergarten teachers. Sixty-seven Hong Kong…

Evaluating the Effectiveness of Two Teaching Strategies to Improve Nursing Students' Knowledge, Skills, and Attitudes About Quality Improvement and Patient Safety.

PubMed

Maxwell, Karen L; Wright, Vivian H

The purpose of this study was to evaluate two teaching strategies with regard to quality and safety education for nurses content on quality improvement and safety. Two groups (total of 64 students) participated in online learning or online learning in conjunction with a flipped classroom. A pretest/posttest control group design was used. The use of online modules in conjunction with the flipped classroom had a greater effect on increasing nursing students' knowledge of quality improvement than the use of online modules only. There was no statistically significant difference between the groups for safety.

Towards a sociology of healthcare safety and quality.

PubMed

Allen, Davina; Braithwaite, Jeffrey; Sandall, Jane; Waring, Justin

2016-02-01

The contributions to this collection address technologies, practices, experiences and the organisation of quality and safety across a wide range of healthcare contexts. Spanning three continents, from hospital to community, maternity to mental health, they shine a light into the boardrooms, back offices and front-lines of healthcare, offering sociological insights from the perspectives of managers, clinicians and patients. We review these articles and consider how they contribute to some of the dilemmas that confront mainstream approaches to quality and safety and then look ahead to outline future lines of sociological inquiry to progress the theory and practice of quality and safety. © 2015 Foundation for the Sociology of Health & Illness.

An integrated organisation-wide data quality management and information governance framework: theoretical underpinnings.

PubMed

Liaw, Siaw-Teng; Pearce, Christopher; Liyanage, Harshana; Liaw, Gladys S S; de Lusignan, Simon

2014-01-01

Increasing investment in eHealth aims to improve cost effectiveness and safety of care. Data extraction and aggregation can create new data products to improve professional practice and provide feedback to improve the quality of source data. A previous systematic review concluded that locally relevant clinical indicators and use of clinical record systems could support clinical governance. We aimed to extend and update the review with a theoretical framework. We searched PubMed, Medline, Web of Science, ABI Inform (Proquest) and Business Source Premier (EBSCO) using the terms curation, information ecosystem, data quality management (DQM), data governance, information governance (IG) and data stewardship. We focused on and analysed the scope of DQM and IG processes, theoretical frameworks, and determinants of the processing, quality assurance, presentation and sharing of data across the enterprise. There are good theoretical reasons for integrated governance, but there is variable alignment of DQM, IG and health system objectives across the health enterprise. Ethical constraints exist that require health information ecosystems to process data in ways that are aligned with improving health and system efficiency and ensuring patient safety. Despite an increasingly 'big-data' environment, DQM and IG in health services are still fragmented across the data production cycle. We extend current work on DQM and IG with a theoretical framework for integrated IG across the data cycle. The dimensions of this theory-based framework would require testing with qualitative and quantitative studies to examine the applicability and utility, along with an evaluation of its impact on data quality across the health enterprise.

A multicenter trial of aviation-style training for surgical teams.

PubMed

Catchpole, Ken R; Dale, Trevor J; Hirst, D Guy; Smith, J Phillip; Giddings, Tony A E B

2010-09-01

This study measured the effect of aviation-style team training on 3 surgical teams from different specialties. It focused on team working and communication, particularly briefing, time-out, and debriefing, and sought to understand how improvements in team skills could be implemented in a broad range of naturalistic surgical environments to improve safety, quality, and efficiency. Surgical teams performing maxillofacial, vascular, and neurosurgery were studied during 112 operations: 51 before and 61 after intervention. Human factors experts delivered the training of up to 2 days in the classroom followed by 6 days of coaching in theater for each team. Trained observers measured teamwork using the Oxford NOTECHS and the frequency of preoperative briefings, pre-incision time-outs, and postoperative debriefings. The Safety Attitudes Questionnaire and ethnographic observations were used to provide contextual details. There were significantly more time-outs (chi = 18.17, P < 0.001), briefings (chi = 8.62, P = 0.004), and debriefings (chi = 8.58, P = 0.004) after the intervention. The NOTECHS scores showed an interaction between site and intervention (F2,106 = 7.57, P = 0.001). The Safety Attitudes Questionnaire and ethnographic observations helped understand these differences. Aviation-style teamwork training can increase compliance and team performance, but this was influenced by the attitude and collaboration of key individuals, and the effect was reduced by significant latent failures. This study demonstrates the need to improve organizational and personal management factors in the National Health Service if training in patient safety is to be effective and sustained. It also shows the influence of working conditions on clinical studies of quality improvement.

The Impact of Environment and Occupation on the Health and Safety of Active Duty Air Force Members - Database Development and De-Identification

DTIC Science & Technology

2015-04-01

et al. Work , obesity , and occupational safety and health . Am J Public Health . 2007; 97(3):428-436. 7. Grunberg L, Moore S, Anderson-Connolly R...AFRL-SA-WP-SR-2015-0005 The Impact of Environment and Occupation on the Health and Safety of Active Duty Air Force Members – Database...TITLE AND SUBTITLE The Impact of Environment and Occupation on the Health and Safety of Active Duty Air Force Members – Database Development and De

Psychometric Evaluation of an Instrument for Measuring Organizational Climate for Quality: Evidence From a National Sample of Infection Preventionists.

PubMed

Pogorzelska-Maziarz, Monika; Nembhard, Ingrid M; Schnall, Rebecca; Nelson, Shanelle; Stone, Patricia W

2016-09-01

In recent years, there has been increased interest in measuring the climate for infection prevention; however, reliable and valid instruments are lacking. This study tested the psychometric properties of the Leading a Culture of Quality for Infection Prevention (LCQ-IP) instrument measuring the infection prevention climate in a sample of 972 infection preventionists from acute care hospitals. An exploratory principal component analysis showed that the instrument had structural validity and captured 4 factors related to the climate for infection prevention: Psychological Safety, Prioritization of Quality, Supportive Work Environment, and Improvement Orientation. LCQ-IP exhibited excellent internal consistency, with a Cronbach α of .926. Criterion validity was supported with overall LCQ-IP scores, increasing with the number of evidence-based prevention policies in place (P = .047). This psychometrically sound instrument may be helpful to researchers and providers in assessing climate for quality related to infection prevention. © The Author(s) 2015.

42 CFR 416.43 - Conditions for coverage-Quality assessment and performance improvement.

Code of Federal Regulations, 2013 CFR

2013-10-01

... outcomes, patient safety, and quality of care. (2) Performance improvement activities must track adverse... improves patient safety by using quality indicators or performance measures associated with improved health... incorporate quality indicator data, including patient care and other relevant data regarding services...

42 CFR 416.43 - Conditions for coverage-Quality assessment and performance improvement.

Code of Federal Regulations, 2012 CFR

2012-10-01

... outcomes, patient safety, and quality of care. (2) Performance improvement activities must track adverse... improves patient safety by using quality indicators or performance measures associated with improved health... incorporate quality indicator data, including patient care and other relevant data regarding services...

42 CFR 416.43 - Conditions for coverage-Quality assessment and performance improvement.

Code of Federal Regulations, 2014 CFR

2014-10-01

... outcomes, patient safety, and quality of care. (2) Performance improvement activities must track adverse... improves patient safety by using quality indicators or performance measures associated with improved health... incorporate quality indicator data, including patient care and other relevant data regarding services...

Nurses' sleep quality, work environment and quality of care in the Spanish National Health System: observational study among different shifts.

PubMed

Gómez-García, Teresa; Ruzafa-Martínez, María; Fuentelsaz-Gallego, Carmen; Madrid, Juan Antonio; Rol, Maria Angeles; Martínez-Madrid, María José; Moreno-Casbas, Teresa

2016-08-05

The main objective of this study was to determine the relationship between the characteristics of nurses' work environments in hospitals in the Spanish National Health System (SNHS) with nurse reported quality of care, and how care was provided by using different shifts schemes. The study also examined the relationship between job satisfaction, burnout, sleep quality and daytime drowsiness of nurses and shift work. This was a multicentre, observational, descriptive, cross-sectional study, centred on a self-administered questionnaire. The study was conducted in seven SNHS hospitals of different sizes. We recruited 635 registered nurses who worked on day, night and rotational shifts on surgical, medical and critical care units. Their average age was 41.1 years, their average work experience was 16.4 years and 90% worked full time. A descriptive and bivariate analysis was carried out to study the relationship between work environment, quality and safety care, and sleep quality of nurses working different shift patterns. 65.4% (410) of nurses worked on a rotating shift. The Practice Environment Scale of the Nursing Work Index classification ranked 20% (95) as favourable, showing differences in nurse manager ability, leadership and support between shifts (p=0.003). 46.6% (286) were sure that patients could manage their self-care after discharge, but there were differences between shifts (p=0.035). 33.1% (201) agreed with information being lost in the shift change, showing differences between shifts (p=0.002). The Pittsburgh Sleep Quality Index reflected an average of 6.8 (SD 3.39), with differences between shifts (p=0.017). Nursing requires shift work, and the results showed that the rotating shift was the most common. Rotating shift nurses reported worse perception in organisational and work environmental factors. Rotating and night shift nurses were less confident about patients' competence of self-care after discharge. The most common nursing care omissions reported were related to nursing care plans. For the Global Sleep Quality score, difference were found between day and night shift workers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The relationship between nurse practice environment, nurse work characteristics, burnout and job outcome and quality of nursing care: a cross-sectional survey.

PubMed

Van Bogaert, Peter; Kowalski, Christoph; Weeks, Susan Mace; Van Heusden, Danny; Clarke, Sean P

2013-12-01

To explore the mechanisms through which nurse practice environment dimensions are associated with job outcomes and nurse-assessed quality of care. Mediating variables tested included nurse work characteristics of workload, social capital, decision latitude, as well as burnout dimensions of emotional exhaustion, depersonalization, and personal accomplishment. Acute care hospitals face daily challenges to their efforts to achieve nurse workforce stability, safety, and quality of care. A body of knowledge shows a favourably rated nurse practice environment as an important condition for better nurse and patient outcome variables; however, further research initiatives are imperative for a clear understanding to support and guide the practice community. Cross-sectional survey. Grounded on previous empirical findings, a structural equation model designed with valid measurement instruments was tested. The study population was registered acute care nurses (N=1201) in two independent hospitals and one hospital group with six hospitals in Belgium. Nurse practice environment dimensions predicted job outcome variables and nurse ratings of quality of care. Analyses were consistent with features of nurses' work characteristics including perceived workload, decision latitude, and social capital, as well as three dimension of burnout playing mediating roles between nurse practice environment and outcomes. A revised model adjusted using various fit measures explained 52% and 47% of job outcomes and nurse-assessed quality of care, respectively. The study refines understanding of the relationship between aspects of nursing practice in order to achieve favourable nursing outcomes and offers important concepts for managers to track in their daily work. The findings of this study indicate that it is important for clinicians and leaders to consider how nurses are involved in decision-making about care processes and tracking outcomes of care and whether they are able to work with physicians, superiors, peers, and subordinates in a trusting environment based on shared values. The involvement of nurse managers at the unit level is especially critical because of associations with nurse work characteristics such as decision latitude and social capital and outcome variables. Further practice and research initiatives to support nurses' involvement in decision-making process and interdisciplinary teamwork are recommended. Copyright © 2013 Elsevier Ltd. All rights reserved.

Argonne News Brief: First Sensors for Chicago’s “City Fitness Tracker”

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

This week in Chicago, the Array of Things team installed its first 50 nodes on city streets to kick off the groundbreaking urban sensing project. Array of Things is designed as a “fitness tracker” for the city, collecting new streams of data on Chicago’s environment, infrastructure, and activity. This hyper-local, open data can help researchers, city officials, and software developers study and address critical city challenges, such as preventing urban flooding, improving traffic safety and air quality, and assessing the nature and impact of climate change.

The role of the chief nursing officer in leading the practice: lessons from the Benner tradition.

PubMed

Cathcart, Eloise Balasco

2008-01-01

There is a real danger that measurable tasks and procedures can be misconstrued for nursing practice in contemporary healthcare organizations focused on the measurement of quality, safety, and productivity. This study uses the work of Patricia Benner to address the complex nature of nursing practice and discusses why the chief nursing officer must create an environment within the organization for the practice to be fully lived out if he or she is to be successful as the leader of the discipline.

Effective Processing of the Iron Ores

NASA Astrophysics Data System (ADS)

Kuskov, Vadim; Kuskova, Yana; Udovitsky, Vladimir

2017-11-01

Effective technology for a complex wasteless processing of the iron ores has been designed and includes three main components (plats): comminution plant, briquette plant, pigment plant. The comminution is done per energy effective technology. Using of briquetting for ores clotting enables the costs cut and brings to a higher level of environmental safety of the process. Briquette formation can be done as a regular pressing, as an extrusion. Developed technology allows to produce high quality competitively products for metallurgy industry and red iron oxide pigments. The whole production line impacts the environment in a minimal manner.

Occidental Geothermal, Inc. , Oxy geothermal power plant No. 1. Final environmental impact report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1981-12-01

The project-specific environmental analysis covers the following: geology, soils, water resources, biology, air quality, noise, waste management, health, safety, transportation, energy and material resources, cultural resources, socioeconomics, public services, land use, and aesthetics. Other topics covered are: the cumulative envionmental analysis; unavoidable significant adverse environmental effects; irreversible environmental changes and irretrievable commitments of energy and materials; the relationship between local short-term uses of man's environment and the maintenance and enhancement of long-term productivity; growth-inducing impacts; and alternatives to the proposed action. (MHR)

Improving patient safety and healthcare quality: examples of good practice.

PubMed

Tingle, John

2017-07-27

John Tingle, Reader in Health Law at Nottingham Trent University, discusses a recent report by the Care Quality Commission that showcases eight NHS trusts that have improved their patient safety and healthcare quality.

Implementing Software Safety in the NASA Environment

NASA Technical Reports Server (NTRS)

Wetherholt, Martha S.; Radley, Charles F.

1994-01-01

Until recently, NASA did not consider allowing computers total control of flight systems. Human operators, via hardware, have constituted the ultimate safety control. In an attempt to reduce costs, NASA has come to rely more and more heavily on computers and software to control space missions. (For example. software is now planned to control most of the operational functions of the International Space Station.) Thus the need for systematic software safety programs has become crucial for mission success. Concurrent engineering principles dictate that safety should be designed into software up front, not tested into the software after the fact. 'Cost of Quality' studies have statistics and metrics to prove the value of building quality and safety into the development cycle. Unfortunately, most software engineers are not familiar with designing for safety, and most safety engineers are not software experts. Software written to specifications which have not been safety analyzed is a major source of computer related accidents. Safer software is achieved step by step throughout the system and software life cycle. It is a process that includes requirements definition, hazard analyses, formal software inspections, safety analyses, testing, and maintenance. The greatest emphasis is placed on clearly and completely defining system and software requirements, including safety and reliability requirements. Unfortunately, development and review of requirements are the weakest link in the process. While some of the more academic methods, e.g. mathematical models, may help bring about safer software, this paper proposes the use of currently approved software methodologies, and sound software and assurance practices to show how, to a large degree, safety can be designed into software from the start. NASA's approach today is to first conduct a preliminary system hazard analysis (PHA) during the concept and planning phase of a project. This determines the overall hazard potential of the system to be built. Shortly thereafter, as the system requirements are being defined, the second iteration of hazard analyses takes place, the systems hazard analysis (SHA). During the systems requirements phase, decisions are made as to what functions of the system will be the responsibility of software. This is the most critical time to affect the safety of the software. From this point, software safety analyses as well as software engineering practices are the main focus for assuring safe software. While many of the steps proposed in this paper seem like just sound engineering practices, they are the best technical and most cost effective means to assure safe software within a safe system.

FY 1991 safety program status report

NASA Technical Reports Server (NTRS)

1991-01-01

In FY 1991, the NASA Safety Division continued efforts to enhance the quality and productivity of its safety oversight function. Recent initiatives set forth in areas such as training, risk management, safety assurance, operational safety, and safety information systems have matured into viable programs contributing to the safety and success of activities throughout the Agency. Efforts continued to develop a centralized intra-agency safety training program with establishment of the NASA Safety Training Center at the Johnson Space Center (JSC). The objective is to provide quality training for NASA employees and contractors on a broad range of safety-related topics. Courses developed by the Training Center will be presented at various NASA locations to minimize travel and reach the greatest number of people at the least cost. In FY 1991, as part of the ongoing efforts to enhance the total quality of NASA's safety work force, the Safety Training Center initiated development of a Certified Safety Professional review course. This course provides a comprehensive review of the skills and knowledge that well-rounded safety professionals must possess to qualify for professional certification. FY 1992 will see the course presented to NASA and contractor employees at all installations via the NASA Video Teleconference System.

[Centennial retrospective on the evolution and development of the nursing practice environment in Taiwan].

PubMed

Lin, Shou-Ju; Huang, Lain-Hua

2014-08-01

The practice environment for nurses has seen tremendous change over the past century due to the dedication and trailblazing work of nursing pioneers. This article describes how the nursing practice environment in Taiwan has evolved over this period. References used include nursing narratives, hospital accreditation standards, standard operating procedures, workplace safety standards, and worksite-related values and expectations. The efforts of the professional nursing community to realize a positive practice environment are further discussed. Over this century of change, the only thing that has remained unchanged is the commitment of nurses to "treat patients as one's own family". In the current as well as the previous periods of manpower shortages in nursing, the nursing community has managed to turn crisis into opportunity by using the situation to enhance pay and benefits. Nursing professionalism is widely respected and recognized throughout Taiwan society. The rapidly changing needs of the 21st century in aspects such as the advancement of high technology, the rapid growth of the elderly population, and the fast rate of social change seriously impact the development of the nursing profession. How to effectively apply high technology, simplify workflows, provide high quality and humanistic nursing care, build safe and quality workplaces, attract bright nursing students, and provide healthcare for the entire population will remain the responsibilities of nursing for generations to come.

Human factors systems approach to healthcare quality and patient safety

PubMed Central

Carayon, Pascale; Wetterneck, Tosha B.; Rivera-Rodriguez, A. Joy; Hundt, Ann Schoofs; Hoonakker, Peter; Holden, Richard; Gurses, Ayse P.

2013-01-01

Human factors systems approaches are critical for improving healthcare quality and patient safety. The SEIPS (Systems Engineering Initiative for Patient Safety) model of work system and patient safety is a human factors systems approach that has been successfully applied in healthcare research and practice. Several research and practical applications of the SEIPS model are described. Important implications of the SEIPS model for healthcare system and process redesign are highlighted. Principles for redesigning healthcare systems using the SEIPS model are described. Balancing the work system and encouraging the active and adaptive role of workers are key principles for improving healthcare quality and patient safety. PMID:23845724

Measuring patient safety in a UK dental hospital: development of a dental clinical effectiveness dashboard.

PubMed

Pemberton, M N; Ashley, M P; Shaw, A; Dickson, S; Saksena, A

2014-10-01

Patient safety is an important marker of quality for any healthcare organisation. In 2008, the British Government white paper entitled High quality care for all, resulting from a review led by Lord Darzi, identified patient safety as a key component of quality and discussed how it might be measured, analysed and acted upon. National and local clinically curated metrics were suggested, which could be displayed via a 'clinical dashboard'. This paper explains the development of a clinical effectiveness dashboard focused on patient safety in an English dental hospital and how it has helped us identify relevant patient safety issues in secondary dental care.

Improving Safety, Quality and Efficiency through the Management of Emerging Processes: The TenarisDalmine Experience

ERIC Educational Resources Information Center

Bonometti, Patrizia

2012-01-01

Purpose: The aim of this contribution is to describe a new complexity-science-based approach for improving safety, quality and efficiency and the way it was implemented by TenarisDalmine. Design/methodology/approach: This methodology is called "a safety-building community". It consists of a safety-behaviour social self-construction…

Exploring the Influence of Nursing Work Environment and Patient Safety Culture on Missed Nursing Care in Korea.

PubMed

Kim, Kyoung-Ja; Yoo, Moon Sook; Seo, Eun Ji

2018-04-20

This study aimed to explore the influence of nurse work environment and patient safety culture in hospital on instances of missed nursing care in South Korea. A cross-sectional design was used, in which a structured questionnaire was administered to 186 nurses working at a tertiary university hospital. Data were analyzed using descriptive statistics, t-test or ANOVA, Pearson correlation and multiple regression analysis. Missed nursing care was found to be correlated with clinical career, nursing work environment and patient safety culture. The regression model explained approximately 30.3 % of missed nursing care. Meanwhile, staffing and resource adequacy (β = -.31, p = .001), nurse manager ability, leadership and support of nurses (β = -.26, p = .004), clinical career (β = -.21, p = .004), and perception on patient safety culture within unit (β = -.19, p = .041) were determined to be influencing factors on missed nursing care. This study has significance as it suggested that missed nursing care is affected by work environment factors within unit. This means that missed nursing care is a unit outcome affected by nurse work environment factors and patient safety culture. Therefore, missed nursing care can be managed through the implementation of interventions that promote a positive nursing work environment and patient safety culture. Copyright © 2018. Published by Elsevier B.V.

Total Quality Management and the System Safety Secretary

NASA Technical Reports Server (NTRS)

Elliott, Suzan E.

1993-01-01

The system safety secretary is a valuable member of the system safety team. As downsizing occurs to meet economic constraints, the Total Quality Management (TQM) approach is frequently adopted as a formula for success and, in some cases, for survival.

Integrated management system: The integration of ISO 9001, ISO 14001, OHSAS 18001 and ISO 31000

NASA Astrophysics Data System (ADS)

Muzaimi, Hafizzudin; Chew, Boon Cheong; Hamid, Syaiful Rizal

2017-03-01

The implementation of integrated management system (IMS) for better quality management has become a preference for many organizations. This can be seen as many organizations used the combination of quality ISO 9001, an environment ISO 14001 and occupational health and safety management system OHSAS 18001 as a core for the IMS that largely implemented. Besides, the linked between quality management with risk management system need to be identified as the management system that enhance the effectiveness of IMS. Therefore, the risk management system ISO 31000 also presented as a part of integration. In nowadays competitive environment, the increasing pressure and needs from customer or stakeholders make it compulsory for the organization to propose the new system and standards. This paper presents and discusses about the benefit of integration, the management system components that can be converged and the implementation approach. A series of interview was conducted through in-depth interviews with 8 experts in this field, while data collected were analyzed qualitatively. The results consist of 16 factors of IMS implementation that have been identified and the use of PDCA approach for an effective implementation of IMS. As a conclusion, the paper proposes the integration of four management systems (ISO 9001, ISO 14001, OHSAS 18001 and ISO 31000) and on how the IMS can be used to structure the process of management for quality management towards sustainability practices in the organization.

Using Modified-ISS Model to Evaluate Medication Administration Safety During Bar Code Medication Administration Implementation in Taiwan Regional Teaching Hospital.

PubMed

Ma, Pei-Luen; Jheng, Yan-Wun; Jheng, Bi-Wei; Hou, I-Ching

2017-01-01

Bar code medication administration (BCMA) could reduce medical errors and promote patient safety. This research uses modified information systems success model (M-ISS model) to evaluate nurses' acceptance to BCMA. The result showed moderate correlation between medication administration safety (MAS) to system quality, information quality, service quality, user satisfaction, and limited satisfaction.

40 CFR 258.10 - Airport safety.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Airport safety. 258.10 Section 258.10 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES CRITERIA FOR MUNICIPAL SOLID WASTE LANDFILLS Location Restrictions § 258.10 Airport safety. (a) Owners or operators of new...

40 CFR 258.10 - Airport safety.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Airport safety. 258.10 Section 258.10 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES CRITERIA FOR MUNICIPAL SOLID WASTE LANDFILLS Location Restrictions § 258.10 Airport safety. (a) Owners or operators of new...

Quality and Safety in Health Care, Part XXI: PSOs and the Vascular Quality Initiative.

PubMed

Harolds, Jay A

2017-04-01

Congress provided for the formation of patient safety organizations (PSOs) so that physicians and other providers would come forward to improve the safety and quality of health care. Important legal safeguards for the providers and patients were put in place for PSOs. The Society for Vascular Surgery (SVS) PSO operates the Vascular Quality Initiative. The latter gathers information from certain commonly done vascular procedures. First, information is collected so a risk adjustment determination of each individual patient can be done. Then the details of every procedure are recorded for later analysis of the processes of the patient's care. In addition, outcome analysis from all procedures is carried out. This registry is an important source of data for research improving health care safety and quality.

The safe home project.

PubMed

Arphorn, Sara; Jiraniratisai, Sopaphan; Rungtakul, Rungsri; Phutta, Nikom

2011-12-01

The Thai Health Promotion Foundation supported the Improvement of Quality of Life of Informal Workers project in Ban Luang District, Amphur Photaram, Ratchaburi Province. There were many informal workers in Ban Luang District. Sweet-crispy fish producers in Ban Luang were the largest group among the sweet-crispy fish producers in Thailand. This project was aimed at improving living and working conditions of informal workers, with a focus on the sweet-crispy fish group. Good practices of improved living and working conditions were used to help informal workers build safe, healthy and productive work environments. These informal workers often worked in substandard conditions and were exposed to various hazards in the working area. These hazards included risk of exposure to hot work environment, ergonomics-related injuries, chemical hazards, electrical hazards etc. Ergonomics problems were commonly in the sweet-crispy fish group. Unnatural postures such as prolonged sitting were performed dominantly. One hundred and fifty informal workers participated in this project. Occupational health volunteers were selected to encourage occupational health and safety in four groups of informal workers in 2009. The occupational health volunteers trained in 2008 were farmers, beauty salon workers and doll makers. The occupational health and safety knowledge is extended to a new informal worker group: sweet-crispy fish producer, in 2009. The occupational health and safety training for sweet-crispy fish group is conducted by occupational health volunteers. The occupational health volunteers increased their skills and knowledge assist in to make safe home and safe community through participatory oriented training. The improvement of living and working condition is conducted by using a modified WISH, Work Improvement for Safe Home, checklist. The plans of improvement were recorded. The informal workers showed improvement mostly on material handling and storage. The safe uses and safe storage of chemicals were introduced among farmers. The awareness of healthcare using personal protective equipments is increased in all groups especially in farmers. Safe home by local occupational health volunteer is proposed to be one effective measure for improvement of quality of life.

Surveillance of Salmonella enteritidis in layer houses: a retrospective comparison of the Food and Drug Administration's egg safety rule (2010-2011) and the California Egg Quality Assurance Program (2007-2011).

PubMed

Pitesky, Maurice; Charlton, Bruce; Bland, Mark; Rolfe, Dan

2013-03-01

Between July 2007 and December 2011, 2660 environmental drag swab samples were collected in total from California layer flocks on behalf of the California Egg Quality Assurance Program (CEQAP), the egg safety rule (21 CFR Parts 16 and 118) of the Food and Drug Administration (FDA), or both. The samples were processed by the California Animal Health and Food Safety Lab, and positive or negative results for Salmonella enterica serovar Enteritidis (SE) were recorded. This study retrospectively compares the differences between the FDA and CEQAP programs with respect to their SE environmental sampling surveillance results. To accomplish this comparison, two different CEQAP (new and old) data sets representing different SE environmental surveillance approaches in the life of the flock were compared against each other and against the FDA's SE environmental testing plan. Significant differences were noted between the CEQAP and FDA programs with respect to the prevalence of SE in the farm environment. Analyses of the prevalence of SE at different stages in the flock's life cycle (chick papers, preproduction, midproduction, postmolt, and premarket) found the highest prevalence of SE in premarket (11.9%), followed by postmolt (3.5%) and midproduction (3.4%), and there was a tie between chick papers and preproduction (2.1%). To assess the main effects of the presence of SE in the farm environment, backwards binary logistic regression was used. Of six independent variables examined (age of flock, year, season, owner, CEQAP membership, and analysis of pooled samples vs. individual swabs), only age of flock, owner, and year were determined to be significant factors in the final model. Although CEQAP membership and pooling vs. individuals swabs were not included in the final model, Pearson chi-square tests did show significantly higher odds of SE for non-CEQAP member farms and higher odds of SE in pooled samples vs. individual swabs.

A Discussion of Patient Safety Programs in the United States Air Force Ground Medical Expeditionary Environment and an Analysis of Potential Solutions for Increasing Their Effectiveness

DTIC Science & Technology

2017-05-01

and 4N to work Patient Safety together, and it has worked out fine in our environment .” • “It is my opinion that there needs to be a permanent full...GROUND MEDICAL EXPEDITIONARY ENVIRONMENT AND AN ANALYSIS OF POTENTIAL SOLUTIONS FOR INCREASING THEIR EFFECTIVENESS By: James Lee...DISCUSSION OF PATIENT SAFETY PROGRAMS IN THE UNITED STATES AIR FORCE GROUND MEDICAL EXPEDITIONARY ENVIRONMENT AND AN ANALYSIS OF POTENTIAL SOLUTIONS FOR

Toxicants exposures as novel zoonoses: reflections on sustainable development, food safety and veterinary public health.

PubMed

Frazzoli, C; Mantovani, A

2010-12-01

The modern concept of zoonosis considers any detriment to the health and/or quality of human life resulting from relationships with (other) vertebrate or edible or toxic invertebrate animals. Whereas exposure to toxicants through foods of animal origin (a.o.) is a well-established issue, hereby we discuss it as novel zoonoses, from the standpoints of health implications as well as similarities and differences with classical zoonoses caused by biological agents. Novel toxicant-related zoonoses are linked with new issues in food safety, such as the environment-feed-food chain. In fact, the potential effect of the combined and repeated exposure to dietary toxicants is generally long-term and not readily discernible. Endocrine disrupting chemicals in staple foods of a.o. are discussed as a telling example of a food safety issue summing up critical points covered by the definition of sustainable development, also implicating health risks for generations to come. We suggest some critical points to implement the veterinary public health action in sustainable food safety, such as enhancement of Hazard Analysis and Critical Control Points systems for toxicological risk management. © 2010 Blackwell Verlag GmbH.

Incentivizing primary care providers to innovate: building medical homes in the post-Katrina New Orleans safety net.

PubMed

Rittenhouse, Diane R; Schmidt, Laura A; Wu, Kevin J; Wiley, James

2014-02-01

To evaluate safety-net clinics' responses to a novel community-wide Patient-Centered Medical Home (PCMH) financial incentive program in post-Katrina New Orleans. Between June 2008 and June 2010, we studied 50 primary care clinics in New Orleans receiving federal funds to expand services and improve care delivery. Multiwave, longitudinal, observational study of a local safety-net primary care system. Clinic-level data from a semiannual survey of clinic leaders (89.3 percent response rate), augmented by administrative records. Overall, 62 percent of the clinics responded to financial incentives by achieving PCMH recognition from the National Committee on Quality Assurance (NCQA). Higher patient volume, higher baseline PCMH scores, and type of ownership were significant predictors of achieving NCQA recognition. The steepest increase in adoption of PCMH processes occurred among clinics achieving the highest, Level 3, NCQA recognition. Following NCQA recognition, 88.9 percent stabilized or increased their use of PCMH processes, although several specific PCMH processes had very low rates of adoption overall. Findings demonstrate that widespread PCMH implementation is possible in a safety-net environment when external financial incentives are aligned with the goal of practice innovation. © Health Research and Educational Trust.

[Implementation of "5S" methodology in laboratory safety and its effect on employee satisfaction].

PubMed

Dogan, Yavuz; Ozkutuk, Aydan; Dogan, Ozlem

2014-04-01

Health institutions use the accreditation process to achieve improvement across the organization and management of the health care system. An ISO 15189 quality and efficiency standard is the recommended standard for medical laboratories qualification. The "safety and accommodation conditions" of this standard covers the requirement to improve working conditions and maintain the necessary safety precautions. The most inevitable precaution for ensuring a safe environment is the creation of a clean and orderly environment to maintain a potentially safe surroundings. In this context, the 5S application which is a superior improvement tool that has been used by the industry, includes some advantages such as encouraging employees to participate in and to help increase the productivity. The main target of this study was to implement 5S methods in a clinical laboratory of a university hospital for evaluating its effect on employees' satisfaction, and correction of non-compliance in terms of the working environment. To start with, first, 5S education was given to management and employees. Secondly, a 5S team was formed and then the main steps of 5S (Seiri: Sort, Seiton: Set in order, Seiso: Shine, Seiketsu: Standardize, and Shitsuke: Systematize) were implemented for a duration of 3 months. A five-point likert scale questionnaire was used in order to determine and assess the impact of 5S on employees' satisfaction considering the areas such as facilitating the job, the job satisfaction, setting up a safe environment, and the effect of participation in management. Questionnaire form was given to 114 employees who actively worked during the 5S implementation period, and the data obtained from 63 (52.3%) participants (16 male, 47 female) were evaluated. The reliability of the questionnaire's Cronbach's alpha value was determined as 0.858 (p< 0.001). After the implementation of 5S it was observed and determined that facilitating the job and setting up a safe environment created a statistically significant effect on employees, and some sufficient satisfaction was observed. In addition, the non-conformity score, which was identified in the laboratory during the previous years, was significantly reduced at a rate of 69.7% after the implementation of 5S. 5S practices have successfully contributed to the establishment and to the sustainability of laboratory safety systems in the first public ISO 15189 accredited public clinical laboratory in Turkey. It is concluded that 5S methods can be used as an effective improvement tool in order to maintain a safe environment, to facilitate the job, and to encourage employees to participate in the management process.

42 CFR 482.21 - Condition of participation: Quality assessment and performance improvement program.

Code of Federal Regulations, 2013 CFR

2013-10-01

... quality improvement and patient safety, including the reduction of medical errors, is defined, implemented... address priorities for improved quality of care and patient safety; and that all improvement actions are... incorporate quality indicator data including patient care data, and other relevant data, for example...

42 CFR 482.21 - Condition of participation: Quality assessment and performance improvement program.

Code of Federal Regulations, 2014 CFR

2014-10-01

... quality improvement and patient safety, including the reduction of medical errors, is defined, implemented... address priorities for improved quality of care and patient safety; and that all improvement actions are... incorporate quality indicator data including patient care data, and other relevant data, for example...

42 CFR 482.21 - Condition of participation: Quality assessment and performance improvement program.

Code of Federal Regulations, 2012 CFR

2012-10-01

... quality improvement and patient safety, including the reduction of medical errors, is defined, implemented... address priorities for improved quality of care and patient safety; and that all improvement actions are... incorporate quality indicator data including patient care data, and other relevant data, for example...

Layoffs and tradeoffs: production, quality, and safety demands under the threat of job loss.

PubMed

Probst, Tahira M

2002-07-01

Employees often face a conflict between production targets, quality assurance, and adherence to safety policies. In a time when layoffs are on the rise, it is important to understand the effects of employee job insecurity on these potentially competing demands. A laboratory experiment manipulated the threat of layoffs in a simulated organization and assessed its effect on employee productivity, product quality, and adherence to safety policies. Results suggest that student participants faced with the threat of layoffs were more productive, yet violated more safety rules and produced lower quality outputs, than participants in the control condition. Implications for organizations contemplating layoffs and directions for future research are discussed.

[Child health environment in the context of relocating of camp site families to social housing].

PubMed

Burgos, Soledad; Sigala, Fiorenza; Argueta, Luzmila; Iglesias, Verónica

2015-01-01

Housing interventions aimed at overcoming poverty can lead to changes in the health status of children by modifying risk factors in their physical and social environment the aim was to identify children's environmental health factors to change with the relocation of families from slums to public housing. A cross-sectional study was conducted in children ages 2-8 years old of families relocated to public housing (n=115) who were compared to children residing in slums (n=88) in Santiago, Chile. Family socioeconomic characteristics, indoor environment and neighborhoods were collected. It was included respiratory symptoms, accidents and maternal-child care of children. χ2, Fisher and Mann-Whitney test were used to compare groups. There were differences in households related to pets keeping, presence of humidity/molds in homes, types of fuels, and perceived safety problems in neighborhoods (p<0.05). The families from slums reported higher tenancy of pets (73.8% v/s 32.2%%), humidity/molds in homes (43.,2% v/s 18.3%), use of wood for heating (39.8% v/s 0.0%), compared with families of public housing. Residents of public housing perceived more safety problems in neighborhood, and children have more asthma related symptoms and have lower diversity of accidents in home. Among the factors studied, indoor air quality and safety in neighborhoods could be linked to changes from the relocation of families. This reinforces the need to deepen the positive and negative influences of residential mobility of these groups focused on child welfare perspective. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Environmental factors influencing older adults' walking for transportation: a study using walk-along interviews.

PubMed

Van Cauwenberg, Jelle; Van Holle, Veerle; Simons, Dorien; Deridder, Riet; Clarys, Peter; Goubert, Liesbet; Nasar, Jack; Salmon, Jo; De Bourdeaudhuij, Ilse; Deforche, Benedicte

2012-07-10

Current knowledge on the relationship between the physical environment and walking for transportation among older adults (≥ 65 years) is limited. Qualitative research can provide valuable information and inform further research. However, qualitative studies are scarce and fail to include neighborhood outings necessary to study participants' experiences and perceptions while interacting with and interpreting the local social and physical environment. The current study sought to uncover the perceived environmental influences on Flemish older adults' walking for transportation. To get detailed and context-sensitive environmental information, it used walk-along interviews. Purposeful convenience sampling was used to recruit 57 older adults residing in urban or semi-urban areas. Walk-along interviews to and from a destination (e.g. a shop) located within a 15 minutes' walk from the participants' home were conducted. Content analysis was performed using NVivo 9 software (QSR International). An inductive approach was used to derive categories and subcategories from the data. Data were categorized in the following categories and subcategories: access to facilities (shops & services, public transit, connectivity), walking facilities (sidewalk quality, crossings, legibility, benches), traffic safety (busy traffic, behavior of other road users), familiarity, safety from crime (physical factors, other persons), social contacts, aesthetics (buildings, natural elements, noise & smell, openness, decay) and weather. The findings indicate that to promote walking for transportation a neighborhood should provide good access to shops and services, well-maintained walking facilities, aesthetically appealing places, streets with little traffic and places for social interaction. In addition, the neighborhood environment should evoke feelings of familiarity and safety from crime. Future quantitative studies should investigate if (changes in) these environmental factors relate to (changes in) older adults' walking for transportation.