EHR Safety: The Way Forward to Safe and Effective Systems

PubMed Central

Walker, James M.; Carayon, Pascale; Leveson, Nancy; Paulus, Ronald A.; Tooker, John; Chin, Homer; Bothe, Albert; Stewart, Walter F.

2008-01-01

Diverse stakeholders—clinicians, researchers, business leaders, policy makers, and the public—have good reason to believe that the effective use of electronic health care records (EHRs) is essential to meaningful advances in health care quality and patient safety. However, several reports have documented the potential of EHRs to contribute to health care system flaws and patient harm. As organizations (including small hospitals and physician practices) with limited resources for care-process transformation, human-factors engineering, software safety, and project management begin to use EHRs, the chance of EHR-associated harm may increase. The authors propose a coordinated set of steps to advance the practice and theory of safe EHR design, implementation, and continuous improvement. These include setting EHR implementation in the context of health care process improvement, building safety into the specification and design of EHRs, safety testing and reporting, and rapid communication of EHR-related safety flaws and incidents. PMID:18308981

The electronic security partnership of safety/security and information systems departments.

PubMed

Yow, J Art

2012-01-01

The ever-changing world of security electronics is reviewed in this article. The author focuses on its usage in a hospital setting and the need for safety/security and information systems departments to work together to protect and get full value from IP systems.

Towards a Usability and Error "Safety Net": A Multi-Phased Multi-Method Approach to Ensuring System Usability and Safety.

PubMed

Kushniruk, Andre; Senathirajah, Yalini; Borycki, Elizabeth

2017-01-01

The usability and safety of health information systems have become major issues in the design and implementation of useful healthcare IT. In this paper we describe a multi-phased multi-method approach to integrating usability engineering methods into system testing to ensure both usability and safety of healthcare IT upon widespread deployment. The approach involves usability testing followed by clinical simulation (conducted in-situ) and "near-live" recording of user interactions with systems. At key stages in this process, usability problems are identified and rectified forming a usability and technology-induced error "safety net" that catches different types of usability and safety problems prior to releasing systems widely in healthcare settings.

A sensor monitoring system for telemedicine, safety and security applications

NASA Astrophysics Data System (ADS)

Vlissidis, Nikolaos; Leonidas, Filippos; Giovanis, Christos; Marinos, Dimitrios; Aidinis, Konstantinos; Vassilopoulos, Christos; Pagiatakis, Gerasimos; Schmitt, Nikolaus; Pistner, Thomas; Klaue, Jirka

2017-02-01

A sensor system capable of medical, safety and security monitoring in avionic and other environments (e.g. homes) is examined. For application inside an aircraft cabin, the system relies on an optical cellular network that connects each seat to a server and uses a set of database applications to process data related to passengers' health, safety and security status. Health monitoring typically encompasses electrocardiogram, pulse oximetry and blood pressure, body temperature and respiration rate while safety and security monitoring is related to the standard flight attendance duties, such as cabin preparation for take-off, landing, flight in regions of turbulence, etc. In contrast to previous related works, this article focuses on the system's modules (medical and safety sensors and associated hardware), the database applications used for the overall control of the monitoring function and the potential use of the system for security applications. Further tests involving medical, safety and security sensing performed in an real A340 mock-up set-up are also described and reference is made to the possible use of the sensing system in alternative environments and applications, such as health monitoring within other means of transport (e.g. trains or small passenger sea vessels) as well as for remotely located home users, over a wired Ethernet network or the Internet.

NASA System Safety Handbook. Volume 2: System Safety Concepts, Guidelines, and Implementation Examples

NASA Technical Reports Server (NTRS)

Dezfuli, Homayoon; Benjamin, Allan; Everett, Christopher; Feather, Martin; Rutledge, Peter; Sen, Dev; Youngblood, Robert

2015-01-01

This is the second of two volumes that collectively comprise the NASA System Safety Handbook. Volume 1 (NASASP-210-580) was prepared for the purpose of presenting the overall framework for System Safety and for providing the general concepts needed to implement the framework. Volume 2 provides guidance for implementing these concepts as an integral part of systems engineering and risk management. This guidance addresses the following functional areas: 1.The development of objectives that collectively define adequate safety for a system, and the safety requirements derived from these objectives that are levied on the system. 2.The conduct of system safety activities, performed to meet the safety requirements, with specific emphasis on the conduct of integrated safety analysis (ISA) as a fundamental means by which systems engineering and risk management decisions are risk-informed. 3.The development of a risk-informed safety case (RISC) at major milestone reviews to argue that the systems safety objectives are satisfied (and therefore that the system is adequately safe). 4.The evaluation of the RISC (including supporting evidence) using a defined set of evaluation criteria, to assess the veracity of the claims made therein in order to support risk acceptance decisions.

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

Soubies, B.; Henry, J.Y.; Le Meur, M.

1300 MWe pressurised water reactors (PWRs), like the 1400 MWe reactors, operate with microprocessor-based safety systems. This is particularly the case for the Digital Integrated Protection System (SPIN), which trips the reactor in an emergency and sets in action the safeguard functions. The softwares used in these systems must therefore be highly dependable in the execution of their functions. In the case of SPIN, three players are working at different levels to achieve this goal: the protection system manufacturer, Merlin Gerin; the designer of the nuclear steam supply system, Framatome; the operator of the nuclear power plants, Electricite de Francemore » (EDF), which is also responsible for the safety of its installations. Regulatory licenses are issued by the French safety authority, the Nuclear Installations Safety Directorate (French abbreviation DSIN), subsequent to a successful examination of the technical provisions adopted by the operator. This examination is carried out by the IPSN and the standing group on nuclear reactors. This communication sets out: the methods used by the manufacturer to develop SPIN software for the 1400 MWe PWRs (N4 series); the approach adopted by the IPSN to evaluate the safety software of the protection system for the N4 series of reactors.« less

The safety helmet detection technology and its application to the surveillance system.

PubMed

Wen, Che-Yen

2004-07-01

The Automatic Teller Machine (ATM) plays an important role in the modem economy. It provides a fast and convenient way to process transactions between banks and their customers. Unfortunately, it also provides a convenient way for criminals to get illegal money or use stolen ATM cards to extract money from their victims' accounts. For safety reasons, each ATM has a surveillance system to record customer's face information. However, when criminals use an ATM to withdraw money illegally, they usually hide their faces with something (in Taiwan, criminals usually use safety helmets to block their faces) to avoid the surveillance system recording their face information, which decreases the efficiency of the surveillance system. In this paper, we propose a circle/circular arc detection method based upon the modified Hough transform, and apply it to the detection of safety helmets for the surveillance system of ATMs. Since the safety helmet location will be within the set of the obtainable circles/circular arcs (if any exist), we use geometric features to verify if any safety helmet exists in the set. The proposed method can be used to help the surveillance systems record a customer's face information more precisely. If customers wear safety helmets to block their faces, the system can send a message to remind them to take off their helmets. Besides this, the method can be applied to the surveillance systems of banks by providing an early warning safeguard when any "customer" or "intruder" uses a safety helmet to avoid his/her face information from being recorded by the surveillance system. This will make the surveillance system more useful. Real images are used to analyze the performance of the proposed method.

A system review of the Virginia Alcohol Safety Action Program.

DOT National Transportation Integrated Search

1980-01-01

In March 1979, the Virginia General Assembly gave the Virginia Department of Transportation Safety (VDTS) the power and responsibility to make binding policy and set standards for the local Virginia Alcohol Safety Action Projects across the state. In...

Towards integrated hygiene and food safety management systems: the Hygieneomic approach.

PubMed

Armstrong, G D

1999-09-15

Integrated hygiene and food safety management systems in food production can give rise to exceptional improvements in food safety performance, but require high level commitment and full functional involvement. A new approach, named hygieneomics, has been developed to assist management in their introduction of hygiene and food safety systems. For an effective introduction, the management systems must be designed to fit with the current generational state of an organisation. There are, broadly speaking, four generational states of an organisation in their approach to food safety. They comprise: (i) rules setting; (ii) ensuring compliance; (iii) individual commitment; (iv) interdependent action. In order to set up an effective integrated hygiene and food safety management system a number of key managerial requirements are necessary. The most important ones are: (a) management systems must integrate the activities of key functions from research and development through to supply chain and all functions need to be involved; (b) there is a critical role for the senior executive, in communicating policy and standards; (c) responsibilities must be clearly defined, and it should be clear that food safety is a line management responsibility not to be delegated to technical or quality personnel; (d) a thorough and effective multi-level audit approach is necessary; (e) key activities in the system are HACCP and risk management, but it is stressed that these are ongoing management activities, not once-off paper generating exercises; and (f) executive management board level review is necessary of audit results, measurements, status and business benefits.

An exploration of Australian hospital pharmacists' attitudes to patient safety.

PubMed

Lalor, Daniel J; Chen, Timothy F; Walpola, Ramesh; George, Rachel A; Ashcroft, Darren M; Fois, Romano A

2015-02-01

To explore the attitudes of Australian hospital pharmacists towards patient safety in their work settings. A safety climate questionnaire was administered to all 2347 active members of the Society of Hospital Pharmacists of Australia in 2010. Part of the survey elicited free-text comments about patient safety, error and incident reporting. The comments were subjected to thematic analysis to determine the attitudes held by respondents in relation to patient safety and its quality management in their work settings. Two hundred and ten (210) of 643 survey respondents provided comments on safety and quality issues related to their work settings. The responses contained a number of dominant themes including issues of workforce and working conditions, incident reporting systems, the response when errors occur, the presence or absence of a blame culture, hospital management support for safety initiatives, openness about errors and the value of teamwork. A number of pharmacists described the development of a mature patient-safety culture - one that is open about reporting errors and active in reducing their occurrence. Others described work settings in which a culture of blame persists, stifling error reporting and ultimately compromising patient safety. Australian hospital pharmacists hold a variety of attitudes that reflect diverse workplace cultures towards patient safety, error and incident reporting. This study has provided an insight into these attitudes and the actions that are needed to improve the patient-safety culture within Australian hospital pharmacy work settings. © 2014 Royal Pharmaceutical Society.

Selecting indicators for patient safety at the health system level in OECD countries.

PubMed

McLoughlin, Vivienne; Millar, John; Mattke, Soeren; Franca, Margarida; Jonsson, Pia Maria; Somekh, David; Bates, David

2006-09-01

Concerns about patient safety have arisen with growing documentation of the extent and nature of harm. Yet there are no robust and meaningful data that can be used internationally to assess the extent of the problem and considerable methodological difficulties. This article describes a project undertaken as part of the Organization for Economic Cooperation and Development (OECD) Quality Indicator Project, which aimed at developing an initial set of patient safety indicators. Patient safety indicators from OECD countries were identified and then rated against three principal criteria: importance to patient safety, scientific soundness, and potential feasibility. Although some countries are developing multi-source monitoring systems, these are not yet mature enough for international exchange. This project reviewed routine data collections as a starting point. Of an initial set of 59 candidate indicators identified, 21 were selected which cover known areas of harm to patients. This project is an important initial step towards defining a usable set of patient safety indicators that will allow comparisons to be made internationally and will support mutual learning and quality improvement in health care. Measures of harm should be complemented over time with measures of effective improvement factors.

A system review of the Virginia Alcohol Safety Action Program : executive summary.

DOT National Transportation Integrated Search

1980-01-01

In March 1979, the Virginia General Assembly gave the Virginia Department of Transportation Safety (VDTS) the power and responsibility to make binding policy and set standards for the local Virginia Alcohol Safety Action Projects across the state. In...

Preparing Florida for deployment of SafetyAnalyst for all roads.

DOT National Transportation Integrated Search

2012-05-01

SafetyAnalyst is an advanced software system designed to provide the state and local highway agencies with a comprehensive set of tools to enhance their programming of site-specific highway safety improvements. As one of the 27 states that sponsored ...

Study on development and application of platform with students' safety based on SOA

NASA Astrophysics Data System (ADS)

Jiang, Derong

2011-10-01

Students' safety management is a very important work, which is responsible for the entire school student security problems, student safety primarily prevent, only advance predict various of the imminent problems, to better protect their safety. The system mainly used on the development request the student safety management, safety evaluation, safety education, and etc, which are for daily management work completed for students in the security digital management. Development of the system can reduce the safety management for department working pressure, meanwhile, can reduce the labor force to use, accelerate query speed, strengthens the management, as well as the national various departments about the information step, making each management standardized. Therefore, developing a set of suitability and the populace, compatibly good system is very necessary.

Patient Safety: Moving the Bar in Prison Health Care Standards

PubMed Central

Greifinger, Robert B.; Mellow, Jeff

2010-01-01

Improvements in community health care quality through error reduction have been slow to transfer to correctional settings. We convened a panel of correctional experts, which recommended 60 patient safety standards focusing on such issues as creating safety cultures at organizational, supervisory, and staff levels through changes to policy and training and by ensuring staff competency, reducing medication errors, encouraging the seamless transfer of information between and within practice settings, and developing mechanisms to detect errors or near misses and to shift the emphasis from blaming staff to fixing systems. To our knowledge, this is the first published set of standards focusing on patient safety in prisons, adapted from the emerging literature on quality improvement in the community. PMID:20864714

Evaluation of the comfort and convenience of safety belt systems in 1980 and 1981 model vehicles

DOT National Transportation Integrated Search

1981-03-01

An analysis was conducted of both user and vehicle characteristics that influence the user perceptions of safety belt system comfort and convenience. A research design was developed involving various passenger cars, vans, and pickups, and a set of dr...

Blame the Patient, Blame the Doctor or Blame the System? A Meta-Synthesis of Qualitative Studies of Patient Safety in Primary Care

PubMed Central

Daker-White, Gavin; Hays, Rebecca; McSharry, Jennifer; Giles, Sally; Cheraghi-Sohi, Sudeh; Rhodes, Penny; Sanders, Caroline

2015-01-01

Objective Studies of patient safety in health care have traditionally focused on hospital medicine. However, recent years have seen more research located in primary care settings which have different features compared to secondary care. This study set out to synthesize published qualitative research concerning patient safety in primary care in order to build a conceptual model. Method Meta-ethnography, an interpretive synthesis method whereby third order interpretations are produced that best describe the groups of findings contained in the reports of primary studies. Results Forty-eight studies were included as 5 discrete subsets where the findings were translated into one another: patients’ perspectives of safety, staff perspectives of safety, medication safety, systems or organisational issues and the primary/secondary care interface. The studies were focused predominantly on issues seen to either improve or compromise patient safety. These issues related to the characteristics or behaviour of patients, staff or clinical systems and interactions between staff, patients and staff, or people and systems. Electronic health records, protocols and guidelines could be seen to both degrade and improve patient safety in different circumstances. A conceptual reading of the studies pointed to patient safety as a subjective feeling or judgement grounded in moral views and with potentially hidden psychological consequences affecting care processes and relationships. The main threats to safety appeared to derive from ‘grand’ systems issues, for example involving service accessibility, resources or working hours which may not be amenable to effective intervention by individual practices or health workers, especially in the context of a public health system. Conclusion Overall, the findings underline the human elements in patient safety primary health care. The key to patient safety lies in effective face-to-face communication between patients and health care staff or between the different staff involved in the care of an individual patient. Electronic systems can compromise safety when they override the opportunities for face-to-face communication. The circumstances under which guidelines or protocols are seen to either compromise or improve patient safety needs further investigation. PMID:26244494

[Expert investigation on food safety standard system framework construction in China].

PubMed

He, Xiang; Yan, Weixing; Fan, Yongxiang; Zeng, Biao; Peng, Zhen; Sun, Zhenqiu

2013-09-01

Through investigating food safety standard framework among food safety experts, to summarize the basic elements and principles of food safety standard system, and provide policy advices for food safety standards framework. A survey was carried out among 415 experts from government, professional institutions and the food industry/enterprises using the National Food Safety Standard System Construction Consultation Questionnaire designed in the name of the Secretariat of National Food Safety Standard Committee. Experts have different advices in each group about the principles of food product standards, food additive product standards, food related product standards, hygienic practice, test methods. According to the results, the best solution not only may reflect experts awareness of the work of food safety standards situation, but also provide advices for setting and revision of food safety standards for the next. Through experts investigation, the framework and guiding principles of food safety standard had been built.

Care or Scare: The Safety of Youth in Congregate Care in New York City

ERIC Educational Resources Information Center

Freundlich, Madelyn; Avery, Rosemary J.; Padgett, Deborah

2007-01-01

Objective: This qualitative study examined stakeholders' perceptions of the safety of youth ages 12 and older living in congregate care facilities within the New York City foster care system. The study explored the youth's physical safety, the safety of their personal belongings, the physical conditions of congregate care settings, and the…

Safety Control and Safety Education at Technical Institutes

NASA Astrophysics Data System (ADS)

Iino, Hiroshi

The importance of safety education for students at technical institutes is emphasized on three grounds including safety of all working members and students in their education, research and other activities. The Kanazawa Institute of Technology re-organized the safety organization into a line structure and improved safety minds of all their members and now has a chemical materials control system and a set of compulsory safety education programs for their students, although many problems still remain.

Safety Verification of the Small Aircraft Transportation System Concept of Operations

NASA Technical Reports Server (NTRS)

Carreno, Victor; Munoz, Cesar

2005-01-01

A critical factor in the adoption of any new aeronautical technology or concept of operation is safety. Traditionally, safety is accomplished through a rigorous process that involves human factors, low and high fidelity simulations, and flight experiments. As this process is usually performed on final products or functional prototypes, concept modifications resulting from this process are very expensive to implement. This paper describe an approach to system safety that can take place at early stages of a concept design. It is based on a set of mathematical techniques and tools known as formal methods. In contrast to testing and simulation, formal methods provide the capability of exhaustive state exploration analysis. We present the safety analysis and verification performed for the Small Aircraft Transportation System (SATS) Concept of Operations (ConOps). The concept of operations is modeled using discrete and hybrid mathematical models. These models are then analyzed using formal methods. The objective of the analysis is to show, in a mathematical framework, that the concept of operation complies with a set of safety requirements. It is also shown that the ConOps has some desirable characteristic such as liveness and absence of dead-lock. The analysis and verification is performed in the Prototype Verification System (PVS), which is a computer based specification language and a theorem proving assistant.

Archetypes for Organisational Safety

NASA Technical Reports Server (NTRS)

Marais, Karen; Leveson, Nancy G.

2003-01-01

We propose a framework using system dynamics to model the dynamic behavior of organizations in accident analysis. Most current accident analysis techniques are event-based and do not adequately capture the dynamic complexity and non-linear interactions that characterize accidents in complex systems. In this paper we propose a set of system safety archetypes that model common safety culture flaws in organizations, i.e., the dynamic behaviour of organizations that often leads to accidents. As accident analysis and investigation tools, the archetypes can be used to develop dynamic models that describe the systemic and organizational factors contributing to the accident. The archetypes help clarify why safety-related decisions do not always result in the desired behavior, and how independent decisions in different parts of the organization can combine to impact safety.

Health IT for Patient Safety and Improving the Safety of Health IT.

PubMed

Magrabi, Farah; Ong, Mei-Sing; Coiera, Enrico

2016-01-01

Alongside their benefits health IT applications can pose new risks to patient safety. Problems with IT have been linked to many different types of clinical errors including prescribing and administration of medications; as well as wrong-patient, wrong-site errors, and delays in procedures. There is also growing concern about the risks of data breach and cyber-security. IT-related clinical errors have their origins in processes undertaken to design, build, implement and use software systems in a broader sociotechnical context. Safety can be improved with greater standardization of clinical software and by improving the quality of processes at different points in the technology life cycle, spanning design, build, implementation and use in clinical settings. Oversight processes can be set up at a regional or national level to ensure that clinical software systems meet specific standards. Certification and regulation are two mechanisms to improve oversight. In the absence of clear standards, guidelines are useful to promote safe design and implementation practices. Processes to identify and mitigate hazards can be formalised via a safety management system. Minimizing new patient safety risks is critical to realizing the benefits of IT.

Fuzzy-logic-based network for complex systems risk assessment: application to ship performance analysis.

PubMed

Abou, Seraphin C

2012-03-01

In this paper, a new interpretation of intuitionistic fuzzy sets in the advanced framework of the Dempster-Shafer theory of evidence is extended to monitor safety-critical systems' performance. Not only is the proposed approach more effective, but it also takes into account the fuzzy rules that deal with imperfect knowledge/information and, therefore, is different from the classical Takagi-Sugeno fuzzy system, which assumes that the rule (the knowledge) is perfect. We provide an analytical solution to the practical and important problem of the conceptual probabilistic approach for formal ship safety assessment using the fuzzy set theory that involves uncertainties associated with the reliability input data. Thus, the overall safety of the ship engine is investigated as an object of risk analysis using the fuzzy mapping structure, which considers uncertainty and partial truth in the input-output mapping. The proposed method integrates direct evidence of the frame of discernment and is demonstrated through references to examples where fuzzy set models are informative. These simple applications illustrate how to assess the conflict of sensor information fusion for a sufficient cooling power system of vessels under extreme operation conditions. It was found that propulsion engine safety systems are not only a function of many environmental and operation profiles but are also dynamic and complex. Copyright © 2011 Elsevier Ltd. All rights reserved.

Application of the SEIPS Model to Analyze Medication Safety in a Crisis Residential Center.

PubMed

Steele, Maria L; Talley, Brenda; Frith, Karen H

2018-02-01

Medication safety and error reduction has been studied in acute and long-term care settings, but little research is found in the literature regarding mental health settings. Because mental health settings are complex, medication administration is vulnerable to a variety of errors from transcription to administration. The purpose of this study was to analyze critical factors related to a mental health work system structure and processes that threaten safe medication administration practices. The Systems Engineering Initiative for Patient Safety (SEIPS) model provides a framework to analyze factors affecting medication safety. The model approach analyzes the work system concepts of technology, tasks, persons, environment, and organization to guide the collection of data. In the study, the Lean methodology tools were used to identify vulnerabilities in the system that could be targeted later for improvement activities. The project director completed face-to-face interviews, asked nurses to record disruptions in a log, and administered a questionnaire to nursing staff. The project director also conducted medication chart reviews and recorded medication errors using a standardized taxonomy for errors that allowed categorization of the prevalent types of medication errors. Results of the study revealed disruptions during the medication process, pharmacology training needs, and documentation processes as the primary opportunities for improvement. The project engaged nurses to identify sustainable quality improvement strategies to improve patient safety. The mental health setting carries challenges for safe medication administration practices. Through analysis of the structure, process, and outcomes of medication administration, opportunities for quality improvement and sustainable interventions were identified, including minimizing the number of distractions during medication administration, training nurses on psychotropic medications, and improving the documentation system. A task force was created to analyze the descriptive data and to establish objectives aimed at improving efficiency of the work system and care process involved in medication administration at the end of the project. Copyright © 2017 Elsevier Inc. All rights reserved.

Ex-ante assessment of the safety effects of intelligent transport systems.

PubMed

Kulmala, Risto

2010-07-01

There is a need to develop a comprehensive framework for the safety assessment of Intelligent Transport Systems (ITS). This framework should: (1) cover all three dimensions of road safety-exposure, crash risk and consequence, (2) cover, in addition to the engineering effect, also the effects due to behavioural adaptation and (3) be compatible with the other aspects of state of the art road safety theories. A framework based on nine ITS safety mechanisms is proposed and discussed with regard to the requirements set to the framework. In order to illustrate the application of the framework in practice, the paper presents a method based on the framework and the results from applying that method for twelve intelligent vehicle systems in Europe. The framework is also compared to two recent frameworks applied in the safety assessment of intelligent vehicle safety systems. Copyright 2010 Elsevier Ltd. All rights reserved.

Microbiological Food Safety Surveillance in China

PubMed Central

Pei, Xiaoyan; Li, Ning; Guo, Yunchang; Liu, Xiumei; Yan, Lin; Li, Ying; Yang, Shuran; Hu, Jing; Zhu, Jianghui; Yang, Dajin

2015-01-01

Microbiological food safety surveillance is a system that collects data regarding food contamination by foodborne pathogens, parasites, viruses, and other harmful microbiological factors. It helps to understand the spectrum of food safety, timely detect food safety hazards, and provide relevant data for food safety supervision, risk assessment, and standards-setting. The study discusses the microbiological surveillance of food safety in China, and introduces the policies and history of the national microbiological surveillance system. In addition, the function and duties of different organizations and institutions are provided in this work, as well as the generation and content of the surveillance plan, quality control, database, and achievement of the microbiological surveillance of food safety in China. PMID:26343705

Does user-centred design affect the efficiency, usability and safety of CPOE order sets?

PubMed Central

Chan, Julie; Shojania, Kaveh G; Easty, Anthony C

2011-01-01

Background Application of user-centred design principles to Computerized provider order entry (CPOE) systems may improve task efficiency, usability or safety, but there is limited evaluative research of its impact on CPOE systems. Objective We evaluated the task efficiency, usability, and safety of three order set formats: our hospital's planned CPOE order sets (CPOE Test), computer order sets based on user-centred design principles (User Centred Design), and existing pre-printed paper order sets (Paper). Participants 27staff physicians, residents and medical students. Setting Sunnybrook Health Sciences Centre, an academic hospital in Toronto, Canada. Methods Participants completed four simulated order set tasks with three order set formats (two CPOE Test tasks, one User Centred Design, and one Paper). Order of presentation of order set formats and tasks was randomized. Users received individual training for the CPOE Test format only. Main Measures Completion time (efficiency), requests for assistance (usability), and errors in the submitted orders (safety). Results 27 study participants completed 108 order sets. Mean task times were: User Centred Design format 273 s, Paper format 293 s (p=0.73 compared to UCD format), and CPOE Test format 637 s (p<0.0001 compared to UCD format). Users requested assistance in 31% of the CPOE Test format tasks, whereas no assistance was needed for the other formats (p<0.01). There were no significant differences in number of errors between formats. Conclusions The User Centred Design format was more efficient and usable than the CPOE Test format even though training was provided for the latter. We conclude that application of user-centred design principles can enhance task efficiency and usability, increasing the likelihood of successful implementation. PMID:21486886

Racial/ethnic differences in obesity and comorbidities between safety-net- and non safety-net integrated health systems

PubMed Central

Balasubramanian, Bijal A.; Garcia, Michael P.; Corley, Douglas A.; Doubeni, Chyke A.; Haas, Jennifer S.; Kamineni, Aruna; Quinn, Virginia P.; Wernli, Karen; Zheng, Yingye; Skinner, Celette Sugg

2017-01-01

Abstract Previous research shows that patients in integrated health systems experience fewer racial disparities compared with more traditional healthcare systems. Little is known about patterns of racial/ethnic disparities between safety-net and non safety-net integrated health systems. We evaluated racial/ethnic differences in body mass index (BMI) and the Charlson comorbidity index from 3 non safety-net- and 1 safety-net integrated health systems in a cross-sectional study. Multinomial logistic regression modeled comorbidity and BMI on race/ethnicity and health care system type adjusting for age, sex, insurance, and zip-code-level income The study included 1.38 million patients. Higher proportions of safety-net versus non safety-net patients had comorbidity score of 3+ (11.1% vs. 5.0%) and BMI ≥35 (27.7% vs. 15.8%). In both types of systems, blacks and Hispanics were more likely than whites to have higher BMIs. Whites were more likely than blacks or Hispanics to have higher comorbidity scores in a safety net system, but less likely to have higher scores in the non safety-nets. The odds of comorbidity score 3+ and BMI 35+ in blacks relative to whites were significantly lower in safety-net than in non safety-net settings. Racial/ethnic differences were present within both safety-net and non safety-net integrated health systems, but patterns differed. Understanding patterns of racial/ethnic differences in health outcomes in safety-net and non safety-net integrated health systems is important to tailor interventions to eliminate racial/ethnic disparities in health and health care. PMID:28296752

Perinatal safety: from concept to nursing practice.

PubMed

Lyndon, Audrey; Kennedy, Holly Powell

2010-01-01

Communication and teamwork problems are leading causes of documented preventable adverse outcomes in perinatal care. An essential component of perinatal safety is the organizational culture in which clinicians work. Clinicians' individual and collective authority to question the plan of care and take action to change the direction of a clinical situation in the patient's best interest can be viewed as their "agency for safety." However, collective agency for safety and commitment to support nurses in their role of advocacy is missing in many perinatal care settings. This article draws from Organizational Accident Theory, High Reliability Theory, and Symbolic Interactionism to describe the nurse's role in maintaining safety during labor and birth in acute care settings and suggests actions for supporting the perinatal nurse at individual, group, and systems levels to achieve maximum safety in perinatal care.

Two-lane rural highways safety performance functions.

DOT National Transportation Integrated Search

2016-05-01

This report documents findings from a comprehensive set of safety performance functions developed for the entire : state two-lane rural highway system in Washington. The findings indicate that random parameter models and : heterogeneous negative bino...

77 FR 42736 - Common Formats for Patient Safety Data Collection and Event Reporting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-20

... Safety Databases (NPSD). Since the initial release of the Common Formats in August 2008, AHRQ has.... The inventory includes many systems from the private sector, including prominent academic settings...

Formalizing Probabilistic Safety Claims

NASA Technical Reports Server (NTRS)

Herencia-Zapana, Heber; Hagen, George E.; Narkawicz, Anthony J.

2011-01-01

A safety claim for a system is a statement that the system, which is subject to hazardous conditions, satisfies a given set of properties. Following work by John Rushby and Bev Littlewood, this paper presents a mathematical framework that can be used to state and formally prove probabilistic safety claims. It also enables hazardous conditions, their uncertainties, and their interactions to be integrated into the safety claim. This framework provides a formal description of the probabilistic composition of an arbitrary number of hazardous conditions and their effects on system behavior. An example is given of a probabilistic safety claim for a conflict detection algorithm for aircraft in a 2D airspace. The motivation for developing this mathematical framework is that it can be used in an automated theorem prover to formally verify safety claims.

Risk management in the North sea offshore industry: History, status and challenges

NASA Astrophysics Data System (ADS)

Smith, E. J.

1995-10-01

There have been major changes in the UK and Norwegian offshore safety regimes in the last decade. On the basis of accumulated experience (including some major accidents), there has been a move away from a rigid, prescriptive approach to setting safety standards; it is now recognised that a more flexible, "goal-setting" approach is more suited to achieving cost-effective solutions to offshore safety. In order to adapt to this approach, offshore operators are increasingly using Quantitative Risk Assessment (QRA) techniques as part of their risk management programmes. Structured risk assessment can be used at all stages of a project life-cycle. In the design stages (concept and detailed design), these techniques are valuable tools in ensuring that money is wisely spent on safety-related systems. In the operational stage, QRA can aid the development of procedures. High quality Safety Management Systems (SMSs), covering issues such as training, inspection, and emergency planning, are crucial to maintain "asdesigned" levels of safety and reliability. Audits of SMSs should be carried out all through the operational phase to ensure that risky conditions do not accumulate.

Does user-centred design affect the efficiency, usability and safety of CPOE order sets?

PubMed

Chan, Julie; Shojania, Kaveh G; Easty, Anthony C; Etchells, Edward E

2011-05-01

Application of user-centred design principles to Computerized provider order entry (CPOE) systems may improve task efficiency, usability or safety, but there is limited evaluative research of its impact on CPOE systems. We evaluated the task efficiency, usability, and safety of three order set formats: our hospital's planned CPOE order sets (CPOE Test), computer order sets based on user-centred design principles (User Centred Design), and existing pre-printed paper order sets (Paper). 27 staff physicians, residents and medical students. Sunnybrook Health Sciences Centre, an academic hospital in Toronto, Canada. Methods Participants completed four simulated order set tasks with three order set formats (two CPOE Test tasks, one User Centred Design, and one Paper). Order of presentation of order set formats and tasks was randomized. Users received individual training for the CPOE Test format only. Completion time (efficiency), requests for assistance (usability), and errors in the submitted orders (safety). 27 study participants completed 108 order sets. Mean task times were: User Centred Design format 273 s, Paper format 293 s (p=0.73 compared to UCD format), and CPOE Test format 637 s (p<0.0001 compared to UCD format). Users requested assistance in 31% of the CPOE Test format tasks, whereas no assistance was needed for the other formats (p<0.01). There were no significant differences in number of errors between formats. The User Centred Design format was more efficient and usable than the CPOE Test format even though training was provided for the latter. We conclude that application of user-centred design principles can enhance task efficiency and usability, increasing the likelihood of successful implementation.

A system to improve medication safety in the setting of acute kidney injury: initial provider response.

PubMed

McCoy, Allison B; McCoy, Allison Beck; Peterson, Josh F; Gadd, Cynthia S; Gadd, Cindy; Danciu, Ioana; Waitman, Lemuel R

2008-11-06

Clinical decision support systems can decrease common errors related to inappropriate or excessive dosing for nephrotoxic or renally cleared drugs. We developed a comprehensive medication safety intervention with varying levels of workflow intrusiveness within computerized provider order entry to continuously monitor for and alert providers about early-onset acute kidney injury. Initial provider response to the interventions shows potential success in improving medication safety and suggests future enhancements to increase effectiveness.

Utilization of the Seniors Falls Investigation Methodology to identify system-wide causes of falls in community-dwelling seniors.

PubMed

Zecevic, Aleksandra A; Salmoni, Alan W; Lewko, John H; Vandervoort, Anthoney A; Speechley, Mark

2009-10-01

As a highly heterogeneous group, seniors live in complex environments influenced by multiple physical and social structures that affect their safety. Until now, the major approach to falls research has been person centered. However, in industrial settings, the individuals involved in an accident are seen as the inheritors of system defects. The objective of the present study was to investigate safety deficiencies that contributed to falls in community-dwelling seniors using a systems approach. The investigations were conducted using the Seniors Falls Investigation Methodology (SFIM), an adapted version of a method used to examine transportation accidents, such as airplane crashes. Fifteen seniors, who experienced a fall or near fall, participated in multiple case studies. A cross-case synthesis was used to summarize findings and identify common patterns of causes and safety deficiencies. Falls and near falls are a result of latent unsafe conditions, and unsafe acts and decisions combined in a diverse set of circumstances. If not identified and removed, these unsafe conditions can cause falls for other seniors. This study provided compelling evidence that causes of falling are systemic and develop over time. It demonstrated that the systems approach is needed to expand the focus from the individual to multilayered organizational and supervisory causes. The SFIM demonstrated capability to identify causes of falls that will allow better prevention and management programs, hence advancing seniors' safety. SFIM shows great potential for implementation in organized settings, such as hospitals and long-term care homes.

Federal Motor Carrier Safety Administration’s advanced system testing utilizing a data acquisition system on the highways (FAST DASH) safety technology evaluation project #3 : novel convex mirrors.

DOT National Transportation Integrated Search

2016-11-01

An independent evaluation of a set of novel prototype mirrors was conducted to determine whether the mirrors perform as well as traditional production mirrors across the basic functions of field of view (FOV), image distortion, and distance estimatio...

Perinatal Safety: From Concept to Nursing Practice

PubMed Central

Kennedy, Holly Powell

2010-01-01

Communication and teamwork problems are leading causes of documented preventable adverse outcomes in perinatal care. An essential component of perinatal safety is the organizational culture in which clinicians work. Clinicians’ individual and collective authority to question the plan of care and take action to change the direction of a clinical situation in the patient’s best interest can be viewed as their “agency for safety.” However, collective agency for safety and commitment to support nurses in their advocacy role is missing in many perinatal care settings. This paper draws from Organizational Accident Theory, High Reliability Theory, and Symbolic Interactionism to describe the nurse’s role in maintaining safety during labor and birth in acute care settings, and suggests actions for supporting the perinatal nurse at individual, group, and systems levels to achieve maximum safety in perinatal care. PMID:20147827

Software safety - A user's practical perspective

NASA Technical Reports Server (NTRS)

Dunn, William R.; Corliss, Lloyd D.

1990-01-01

Software safety assurance philosophy and practices at the NASA Ames are discussed. It is shown that, to be safe, software must be error-free. Software developments on two digital flight control systems and two ground facility systems are examined, including the overall system and software organization and function, the software-safety issues, and their resolution. The effectiveness of safety assurance methods is discussed, including conventional life-cycle practices, verification and validation testing, software safety analysis, and formal design methods. It is concluded (1) that a practical software safety technology does not yet exist, (2) that it is unlikely that a set of general-purpose analytical techniques can be developed for proving that software is safe, and (3) that successful software safety-assurance practices will have to take into account the detailed design processes employed and show that the software will execute correctly under all possible conditions.

A Legislative Reform for the Food Safety System of China: A Regulatory Paradigm Shift and Collaborative Governance.

PubMed

Han, Yonghong

2015-01-01

After describing the historical development of China's food safety system from the perspectives of legislation and administration, this article discusses progress in its food law (The Draft Amendments to Food Safety Law). As a further legislative reform for China's food safety system, the Draft Amendments to the Food Safety Law contain innovative institutional designs and manifest a regulatory paradigm shift from government-centered governance to collaborative governance. However, the Draft Amendments face challenges in their implementation. This article argues that developing collaborative governance for food safety in China can be a solution to these challenges. Based on theoretical and empirical studies of collaborative governance, this article proposes that the institutional design of collaborative governance should focus on providing obligations for administrative agencies in the process of food safety rule-making and standard-setting, increasing the independence of nongovernmental organizations, and building two-way electronic platforms for public participation.

Vaccine safety monitoring systems in developing countries: an example of the Vietnam model.

PubMed

Ali, Mohammad; Rath, Barbara; Thiem, Vu Dinh

2015-01-01

Only few health intervention programs have been as successful as vaccination programs with respect to preventing morbidity and mortality in developing countries. However, the success of a vaccination program is threatened by rumors and misunderstanding about the risks of vaccines. It is short-sighted to plan the introduction of vaccines into developing countries unless effective vaccine safety monitoring systems are in place. Such systems that track adverse events following immunization (AEFI) is currently lacking in most developing countries. Therefore, any rumor may affect the entire vaccination program. Public health authorities should implement the safety monitoring system of vaccines, and disseminate safety issues in a proactive mode. Effective safety surveillance systems should allow for the conduct of both traditional and alternative epidemiologic studies through the use of prospective data sets. The vaccine safety data link implemented in Vietnam in mid-2002 indicates that it is feasible to establish a vaccine safety monitoring system for the communication of vaccine safety in developing countries. The data link provided the investigators an opportunity to evaluate AEFI related to measles vaccine. Implementing such vaccine safety monitoring system is useful in all developing countries. The system should be able to make objective and clear communication regarding safety issues of vaccines, and the data should be reported to the public on a regular basis for maintaining their confidence in vaccination programs.

Assessing the safety effects of cooperative intelligent transport systems: A bowtie analysis approach.

PubMed

Ehlers, Ute Christine; Ryeng, Eirin Olaussen; McCormack, Edward; Khan, Faisal; Ehlers, Sören

2017-02-01

The safety effects of cooperative intelligent transport systems (C-ITS) are mostly unknown and associated with uncertainties, because these systems represent emerging technology. This study proposes a bowtie analysis as a conceptual framework for evaluating the safety effect of cooperative intelligent transport systems. These seek to prevent road traffic accidents or mitigate their consequences. Under the assumption of the potential occurrence of a particular single vehicle accident, three case studies demonstrate the application of the bowtie analysis approach in road traffic safety. The approach utilizes exemplary expert estimates and knowledge from literature on the probability of the occurrence of accident risk factors and of the success of safety measures. Fuzzy set theory is applied to handle uncertainty in expert knowledge. Based on this approach, a useful tool is developed to estimate the effects of safety-related cooperative intelligent transport systems in terms of the expected change in accident occurrence and consequence probability. Copyright © 2016 Elsevier Ltd. All rights reserved.

The 12th International Conference on Computer Safety, Reliability and Security

DTIC Science & Technology

1993-10-29

then used [10]. The adequacy of the proposed methodology is shown through the design and the validation of a simple control system: a train set example...satisfying the safety condition. 4 Conclusions In this paper we have presented a methodology which can be used for the design of safety-critical systems...has a Burner but no Detector (or the Detector is permanently non -active). The PA: G1 for this design is shown in Fig 3a. The probability matrices are

Sociotechnical attributes of safe and unsafe work systems.

PubMed

Kleiner, Brian M; Hettinger, Lawrence J; DeJoy, David M; Huang, Yuang-Hsiang; Love, Peter E D

2015-01-01

Theoretical and practical approaches to safety based on sociotechnical systems principles place heavy emphasis on the intersections between social-organisational and technical-work process factors. Within this perspective, work system design emphasises factors such as the joint optimisation of social and technical processes, a focus on reliable human-system performance and safety metrics as design and analysis criteria, the maintenance of a realistic and consistent set of safety objectives and policies, and regular access to the expertise and input of workers. We discuss three current approaches to the analysis and design of complex sociotechnical systems: human-systems integration, macroergonomics and safety climate. Each approach emphasises key sociotechnical systems themes, and each prescribes a more holistic perspective on work systems than do traditional theories and methods. We contrast these perspectives with historical precedents such as system safety and traditional human factors and ergonomics, and describe potential future directions for their application in research and practice. The identification of factors that can reliably distinguish between safe and unsafe work systems is an important concern for ergonomists and other safety professionals. This paper presents a variety of sociotechnical systems perspectives on intersections between social--organisational and technology--work process factors as they impact work system analysis, design and operation.

Safety incidents involving confused and forgetful older patients in a specialised care setting--analysis of the safety incidents reported to the HaiPro reporting system.

PubMed

Kinnunen-Luovi, Kaisa; Saarnio, Reetta; Isola, Arja

2014-09-01

To describe the safety incidents involving confused and forgetful older patients in a specialised care setting entered in the HaiPro reporting system. About 10% of patients experience a safety incident during hospitalisation, which causes or could cause them harm. The possibility of a safety incident during hospitalisation increases significantly with age. A mild or moderate memory disorder and acute confusion are often present in the safety incidents originating with an older patient. The design of the study was action research with this study using findings from one of the first-phase studies, which included qualitative and quantitative analysed data. Data were collected from the reporting system for safety incidents (HaiPro) in a university hospital in Finland. There were 672 reported safety incidents from four acute medical wards during the years 2009-2011, which were scrutinised. Seventy-five of them were linked to a confused patient and were analysed. The majority of the safety incidents analysed involved patient-related accidents. In addition to challenging behaviour, contributing factors included ward routines, shortage of nursing staff, environmental factors and staff knowledge and skills. Nurses tried to secure the patient safety in many different ways, but the modes of actions were insufficient. Nursing staff need evidence-based information on how to assess the cognitive status of a confused patient and how to encounter such patients. The number of nursing staff and ward routines should be examined critically and put in proportion to the care intensity demands caused by the patient's confused state. The findings can be used as a starting point in the prevention of safety incidents and in improving the care of older patients. © 2013 John Wiley & Sons Ltd.

RPP-PRT-58489, Revision 1, One Systems Consistent Safety Analysis Methodologies Report. 24590-WTP-RPT-MGT-15-014

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

Gupta, Mukesh; Niemi, Belinda; Paik, Ingle

2015-09-02

In 2012, One System Nuclear Safety performed a comparison of the safety bases for the Tank Farms Operations Contractor (TOC) and Hanford Tank Waste Treatment and Immobilization Plant (WTP) (RPP-RPT-53222 / 24590-WTP-RPT-MGT-12-018, “One System Report of Comparative Evaluation of Safety Bases for Hanford Waste Treatment and Immobilization Plant Project and Tank Operations Contract”), and identified 25 recommendations that required further evaluation for consensus disposition. This report documents ten NSSC approved consistent methodologies and guides and the results of the additional evaluation process using a new set of evaluation criteria developed for the evaluation of the new methodologies.

The HSE management system in practice-implementation

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

Primrose, M.J.; Bentley, P.D.; Sykes, R.M.

1996-11-01

This paper sets out the necessary strategic issues that must be dealt with when setting up a management system for HSE. It touches on the setting of objectives using a form of risk matrix and the establishment of corporate risk tolerability levels. Such issue management is vital but can be seen as yet another corporate HQ initiative. It must therefore be linked, and made relevant to those in middle management tasked with implementing the system and also to those at risk {open_quote}at the sharp end{close_quote} of the business. Setting acceptance criteria is aimed at demonstrating a necessary and sufficient levelmore » of control or coverage for those hazards considered as being within the objective setting of the Safety or HSE Case. Critical risk areas addressed via the Safety Case, within Shell companies at least, must show how this coverage is extended to critical health and environmental issues. Methods of achieving this are various ranging from specific Case deliverables (like the Hazard Register and Accountability Matrices) through to the incorporation of topics from the hazard analysis in toolbox talks and meetings. Risk analysis techniques are increasingly seen as complementary rather than separate with environmental assessments, health risk assessment sand safety risk analyses taking place together and results being considered jointly. The paper ends with some views on the way ahead regarding the linking of risk decisions to target setting at the workplace and views on how Case information may be retrieved and used on a daily basis.« less

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.

Market-based control mechanisms for patient safety

PubMed Central

Coiera, E; Braithwaite, J

2009-01-01

A new model is proposed for enhancing patient safety using market-based control (MBC), inspired by successful approaches to environmental governance. Emissions trading, enshrined in the Kyoto protocol, set a carbon price and created a carbon market—is it possible to set a patient safety price and let the marketplace find ways of reducing clinically adverse events? To “cap and trade,” a regulator would need to establish system-wide and organisation-specific targets, based on the cost of adverse events, create a safety market for trading safety credits and then police the market. Organisations are given a clear policy signal to reduce adverse event rates, are told by how much, but are free to find mechanisms best suited to their local needs. The market would inevitably generate novel ways of creating safety credits, and accountability becomes hard to evade when adverse events are explicitly measured and accounted for in an organisation’s bottom line. PMID:19342522

The power of collaboration with patient safety programs: building safe passage for patients, nurses, and clinical staff.

PubMed

Kerfoot, Karlene M; Rapala, Kathryn; Ebright, Patricia; Rogers, Suzanne M

2006-12-01

Patient safety is a relatively new field, with many opinions and few effectively proven approaches. One factor is clear: optimal patient safety outcomes cannot be achieved in isolation. Although it is well recognized that multidisciplinary collaboration in the healthcare setting is necessary to effect patient safety, collaboration with resources external to healthcare-academia and industry in particular-will not only aid but also quicken the patient safety efforts. The authors outline a healthcare system's use of all available resources to build a patient safety program.

33 CFR 161.1 - Purpose and Intent.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 161.1 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) PORTS... certain sections of the Ports and Waterways Safety Act (PWSA) setting up a national system of Vessel Traffic Services that will enhance navigation, vessel safety, and marine environmental protection, and...

REgulatory Management: Communication About Technology-Based Innovations Can Be Improved

DTIC Science & Technology

2001-02-01

locations and was built to accommodate a variety of users’ computing environments. • FDA’s Center for Food Safety and Applied Nutrition’s Voluntary...transportation communities. Food Safety Initiative Ensuring the safety of the nation’s food supply is the responsibility of an interlocking monitoring system...that watches over food production and distribution at every level of government—local, state, and national. Given the complex set of food safety laws

Learning Patient Safety in Academic Settings: A Comparative Study of Finnish and British Nursing Students' Perceptions.

PubMed

Tella, Susanna; Smith, Nancy-Jane; Partanen, Pirjo; Turunen, Hannele

2015-06-01

Globalization of health care demands nursing education programs that equip students with evidence-based patient safety competences in the global context. Nursing students' entrance into clinical placements requires professional readiness. Thus, evidence-based learning activities about patient safety must be provided in academic settings prior to students' clinical placements. To explore and compare Finnish and British nursing students' perceptions of learning about patient safety in academic settings to inform nursing educators about designing future education curriculum. A purpose-designed instrument, Patient Safety in Nursing Education Questionnaire (PaSNEQ) was used to examine the perceptions of Finnish (n = 195) and British (n = 158) nursing students prior to their final year of registration. Data were collected in two Finnish and two English nursing schools in 2012. Logistic regressions were used to analyze the differences. British students reported more inclusion (p < .001) of "gaining knowledge," "training skills," and "highlighting affirmative attitudes and motivation" related to patient safety in their programs. Both student groups considered patient safety education to be more valuable for their own learning than what their programs had provided. Training patient safety skills in the academic settings were the strongest predictors for differences (odds ratio [OR] = 34.69, 95% confidence interval [CI] 7.39-162.83), along with work experience in the healthcare sector (OR = 3.02, 95% CI 1.39-6.58). To prepare nursing students for practical work, training related to clear communication, reporting errors, systems-based approaches, interprofessional teamwork, and use of simulation in academic settings requires comprehensive attention, especially in Finland. Overall, designing patient safety-affirming nursing curricula in collaboration with students may enhance their positive experiences on teaching and learning about patient safety. An international collaboration between educators could help to develop and harmonize patient safety education and to better prepare nurses for practice in the global context. © 2015 Sigma Theta Tau International.

Patient portal readiness among postpartum patients in a safety net setting.

PubMed

Wieland, Daryl; Gibeau, Anne; Dewey, Caitlin; Roshto, Melanie; Frankel, Hilary

2017-07-05

Maternity patients interact with the healthcare system over an approximately ten-month interval, requiring multiple visits, acquiring pregnancy-specific education, and sharing health information among providers. Many features of a web-based patient portal could help pregnant women manage their interactions with the healthcare system; however, it is unclear whether pregnant women in safety-net settings have the resources, skills or interest required for portal adoption. In this study of postpartum patients in a safety net hospital, we aimed to: (1) determine if patients have the technical resources and skills to access a portal, (2) gain insight into their interest in health information, and (3) identify the perceived utility of portal features and potential barriers to adoption. We developed a structured questionnaire to collect demographics from postpartum patients and measure use of technology and the internet, self-reported literacy, interest in health information, awareness of portal functions, and perceived barriers to use. The questionnaire was administered in person to women in an inpatient setting. Of the 100 participants surveyed, 95% reported routine internet use and 56% used it to search for health information. Most participants had never heard of a patient portal, yet 92% believed that the portal functions were important. The two most appealing functions were to check results and manage appointments. Most participants in this study have the required resources such as a device and familiarity with the internet to access a patient portal including an interest in interacting with a healthcare institution via electronic means. Pregnancy is a critical episode of care where active engagement with the healthcare system can influence outcomes. Healthcare systems and portal developers should consider ways to tailor a portal to address the specific health needs of a maternity population including those in a safety net setting.

Applied Strategies for Improving Patient Safety: A Comprehensive Process To Improve Care in Rural and Frontier Communities

ERIC Educational Resources Information Center

Westfall, John M.; Fernald, Douglas H.; Staton, Elizabeth W.; VanVorst, Rebecca; West, David; Pace, Wilson D.

2004-01-01

Medical errors and patient safety have gained increasing attention throughout all areas of medical care. Understanding patient safety in rural settings is crucial for improving care in rural communities. To describe a system to decrease medical errors and improve care in rural and frontier primary care offices. Applied Strategies for Improving…

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

Hazard Analysis and Safety Requirements for Small Drone Operations: To What Extent Do Popular Drones Embed Safety?

PubMed

Plioutsias, Anastasios; Karanikas, Nektarios; Chatzimihailidou, Maria Mikela

2018-03-01

Currently, published risk analyses for drones refer mainly to commercial systems, use data from civil aviation, and are based on probabilistic approaches without suggesting an inclusive list of hazards and respective requirements. Within this context, this article presents: (1) a set of safety requirements generated from the application of the systems theoretic process analysis (STPA) technique on a generic small drone system; (2) a gap analysis between the set of safety requirements and the ones met by 19 popular drone models; (3) the extent of the differences between those models, their manufacturers, and the countries of origin; and (4) the association of drone prices with the extent they meet the requirements derived by STPA. The application of STPA resulted in 70 safety requirements distributed across the authority, manufacturer, end user, or drone automation levels. A gap analysis showed high dissimilarities regarding the extent to which the 19 drones meet the same safety requirements. Statistical results suggested a positive correlation between drone prices and the extent that the 19 drones studied herein met the safety requirements generated by STPA, and significant differences were identified among the manufacturers. This work complements the existing risk assessment frameworks for small drones, and contributes to the establishment of a commonly endorsed international risk analysis framework. Such a framework will support the development of a holistic and methodologically justified standardization scheme for small drone flights. © 2017 Society for Risk Analysis.

SAFEGUARD: An Assured Safety Net Technology for UAS

NASA Technical Reports Server (NTRS)

Dill, Evan T.; Young, Steven D.; Hayhurst, Kelly J.

2016-01-01

As demands increase to use unmanned aircraft systems (UAS) for a broad spectrum of commercial applications, regulatory authorities are examining how to safely integrate them without loss of safety or major disruption to existing airspace operations. This work addresses the development of the Safeguard system as an assured safety net technology for UAS. The Safeguard system monitors and enforces conformance to a set of rules defined prior to flight (e.g., geospatial stay-out or stay-in regions, speed limits, altitude limits). Safeguard operates independently of the UAS autopilot and is strategically designed in a way that can be realized by a small set of verifiable functions to simplify compliance with regulatory standards for commercial aircraft. A framework is described that decouples the system from any other devices on the UAS as well as introduces complementary positioning source(s) for applications that require integrity and availability beyond what the Global Positioning System (GPS) can provide. Additionally, the high level logic embedded within the software is presented, as well as the steps being taken toward verification and validation (V&V) of proper functionality. Next, an initial prototype implementation of the described system is disclosed. Lastly, future work including development, testing, and system V&V is summarized.

Validation of Safety-Critical Systems for Aircraft Loss-of-Control Prevention and Recovery

NASA Technical Reports Server (NTRS)

Belcastro, Christine M.

2012-01-01

Validation of technologies developed for loss of control (LOC) prevention and recovery poses significant challenges. Aircraft LOC can result from a wide spectrum of hazards, often occurring in combination, which cannot be fully replicated during evaluation. Technologies developed for LOC prevention and recovery must therefore be effective under a wide variety of hazardous and uncertain conditions, and the validation framework must provide some measure of assurance that the new vehicle safety technologies do no harm (i.e., that they themselves do not introduce new safety risks). This paper summarizes a proposed validation framework for safety-critical systems, provides an overview of validation methods and tools developed by NASA to date within the Vehicle Systems Safety Project, and develops a preliminary set of test scenarios for the validation of technologies for LOC prevention and recovery

[Patient safety and a culture of responsibility in ambulatory care: strategies for improving practice].

PubMed

Lichte, Thomas; Klement, Andreas; Herrmann, Markus

2009-01-01

The development of a medical safety culture is spreading beyond the hospital into the ambulatory setting. Patient safety defined as "absence of unwanted events" (primum non nocere) can serve as a starting point for the advancement of our ambulatory medical care system. Error analyses conducted in GP and specialist practices will identify gaps and traps in the system and provide ideas for the development and implementation of new safety strategies in ambulatory patient care. In the light of the structures and processes of GP medical care aspects of patient safety will be correlated to the outcome quality and examples will be discussed. Possible strategies for the improvement of patient safety in GP practice will be presented from the perspective of both patient- and practice individuality.

Sociotechnical attributes of safe and unsafe work systems

PubMed Central

Kleiner, Brian M.; Hettinger, Lawrence J.; DeJoy, David M.; Huang, Yuang-Hsiang; Love, Peter E.D.

2015-01-01

Theoretical and practical approaches to safety based on sociotechnical systems principles place heavy emphasis on the intersections between social–organisational and technical–work process factors. Within this perspective, work system design emphasises factors such as the joint optimisation of social and technical processes, a focus on reliable human–system performance and safety metrics as design and analysis criteria, the maintenance of a realistic and consistent set of safety objectives and policies, and regular access to the expertise and input of workers. We discuss three current approaches to the analysis and design of complex sociotechnical systems: human–systems integration, macroergonomics and safety climate. Each approach emphasises key sociotechnical systems themes, and each prescribes a more holistic perspective on work systems than do traditional theories and methods. We contrast these perspectives with historical precedents such as system safety and traditional human factors and ergonomics, and describe potential future directions for their application in research and practice. Practitioner Summary: The identification of factors that can reliably distinguish between safe and unsafe work systems is an important concern for ergonomists and other safety professionals. This paper presents a variety of sociotechnical systems perspectives on intersections between social–organisational and technology–work process factors as they impact work system analysis, design and operation. PMID:25909756

Development and implementation of an HSE management system in E and P companies

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

Bentley, P.D.; Mundhenk, D.L.; Jones, M.G.

1995-01-01

This paper describes the experience to date with safety management systems (SMS's) and describes their implementation after the Piper Alpha disaster and Lord Cullen's report. It also shows the gradual expansion of these systems toward fully integrated health, safety, and environment (HSE) management systems. The authors' company policy, which was clearly stated before publication of Lord Cullen's report, is that work should not start until the appropriate controls are in place. Work based on this policy and on objective-setting SMS's within Shell Intl. Petroleum Mij. (SIPM) E and P coordination started in earnest soon after the publication of the reportmore » in Nov. 1990 and has continued without interruption since that time. Objective-setting systems may be defined as systems where the company management sets its own objectives or goals on the basis of functional rather than prescriptive requirements and then goes on to demonstrate how such goals have been, or are being, met. The paper ends with a projection of what may be expected in the future.« less

Safety Outreach and Incident Response Stakeholder Strategy

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

Rosewater, David Martin; Conover, David

2016-06-01

The objective of this document is to set out a strategy to reach all stakeholders that can impact the timely deployment of safe stationary energy storage systems in the built environment with information on ESS technology and safety that is relevant to their role in deployment of the technology.

Setting Priorities for NIOSH Research

ERIC Educational Resources Information Center

Gallagher, Richard E.

1975-01-01

The National Institute for Occupational Safety and Health (NIOSH) is attempting to develop total programs of occupational safety and health protection. It has established research criteria and a priority system for evaluating the order of investigating suspect substances or agents based upon the expected gain of the health benefit. (Author/MW)

NASA Requirements for Ground-Based Pressure Vessels and Pressurized Systems (PVS). Revision C

NASA Technical Reports Server (NTRS)

Greulich, Owen Rudolf

2017-01-01

The purpose of this document is to ensure the structural integrity of PVS through implementation of a minimum set of requirements for ground-based PVS in accordance with this document, NASA Policy Directive (NPD) 8710.5, NASA Safety Policy for Pressure Vessels and Pressurized Systems, NASA Procedural Requirements (NPR) 8715.3, NASA General Safety Program Requirements, applicable Federal Regulations, and national consensus codes and standards (NCS).

The system of technical diagnostics of the industrial safety information network

NASA Astrophysics Data System (ADS)

Repp, P. V.

2017-01-01

This research is devoted to problems of safety of the industrial information network. Basic sub-networks, ensuring reliable operation of the elements of the industrial Automatic Process Control System, were identified. The core tasks of technical diagnostics of industrial information safety were presented. The structure of the technical diagnostics system of the information safety was proposed. It includes two parts: a generator of cyber-attacks and the virtual model of the enterprise information network. The virtual model was obtained by scanning a real enterprise network. A new classification of cyber-attacks was proposed. This classification enables one to design an efficient generator of cyber-attacks sets for testing the virtual modes of the industrial information network. The numerical method of the Monte Carlo (with LPτ - sequences of Sobol), and Markov chain was considered as the design method for the cyber-attacks generation algorithm. The proposed system also includes a diagnostic analyzer, performing expert functions. As an integrative quantitative indicator of the network reliability the stability factor (Kstab) was selected. This factor is determined by the weight of sets of cyber-attacks, identifying the vulnerability of the network. The weight depends on the frequency and complexity of cyber-attacks, the degree of damage, complexity of remediation. The proposed Kstab is an effective integral quantitative measure of the information network reliability.

Assessing the Relative Influence and Efficacy of Public and Private Food Safety Regulation Regimes: Comparing Codex and Global G.A.P. Standards.

PubMed

Halabi, Sam F; Lin, Ching-Fu

An extensive global system of private food regulation is under construction, one that exceeds conventional regulation thought of as being driven by public authorities like FDA and USDA in the U.S. or the Food Standards Agency in the UK. Agrifood and grocer organizations, in concert with some farming groups, have been the primary designers of this new food regulatory regime. These groups have established alliances that compete with national regulators in complex ways. This article analyzes the relationship between public and private sources of food safety regulation by examining standards adopted by the Codex Alimentarius Commission, a food safety organization jointly run by the Food and Agricultural Organization and the World Health Organization and GlobalG.A.P., a farm assurance program created in the late 1990s by supermarket chains and their major suppliers which has now expanded into a global certifying coalition. While Codex standards are adopted, often as written, by national food safety regulators who are principal drivers of the standard setting process, customers for agricultural products in many countries now demand evidence of GlobalG.A.P. certification as a prerequisite for doing business This article tests not only the durability and strength of private sector standard setting in the food safety system, but also the desirability of that system as an alternative to formal, governmental processes embodied, for our purposes, in the standards adopted by Codex. In many cases, official standards and GlobalG.A.P. standards clash in ways that implicate not only food safety but the flow of agricultural products in the global trading system. The article analyzes current weaknesses in both regimes and possibilities for change that will better reconcile the two competing systems.

Ending on a positive: Examining the role of safety leadership decisions, behaviours and actions in a safety critical situation.

PubMed

Donovan, Sarah-Louise; Salmon, Paul M; Horberry, Timothy; Lenné, Michael G

2018-01-01

Safety leadership is an important factor in supporting safe performance in the workplace. The present case study examined the role of safety leadership during the Bingham Canyon Mine high-wall failure, a significant mining incident in which no fatalities or injuries were incurred. The Critical Decision Method (CDM) was used in conjunction with a self-reporting approach to examine safety leadership in terms of decisions, behaviours and actions that contributed to the incidents' safe outcome. Mapping the analysis onto Rasmussen's Risk Management Framework (Rasmussen, 1997), the findings demonstrate clear links between safety leadership decisions, and emergent behaviours and actions across the work system. Communication and engagement based decisions featured most prominently, and were linked to different leadership practices across the work system. Further, a core sub-set of CDM decision elements were linked to the open flow and exchange of information across the work system, which was critical to supporting the safe outcome. The findings provide practical implications for the development of safety leadership capability to support safety within the mining industry. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Safety culture in the context of work intensification--development in Germany over the last 10 years].

PubMed

Lauterberg, Jörg

2009-01-01

This article tries to review the development of patient safety culture in the German healthcare system over the last decade. Since the use of standardized questionnaires and other instruments to measure safety culture in Germany has only just begun there are no representative and longitudinal data. Therefore a set of indicators and clues is chosen to characterise the safety culture development on the micro-, meso- and macro-level of the healthcare system in four areas. Is patient safety an issue of the healthcare debates and especially of research? Have dedicated structures and processes been implemented to support clinical risk management? What are the objective outcomes of healthcare and treatment in regard to patient safety? In summary, there are a lot of signs that patient safety issues in Germany are gaining more and more importance on all levels of the healthcare system. To date there have been single evidence-based studies only indicating a causal or close temporal relationship between patient safety outcomes and the increasing efforts of hospitals, outpatient and long-term care facilities.

U.S. Food System Working Conditions as an Issue of Food Safety.

PubMed

Clayton, Megan L; Smith, Katherine C; Pollack, Keshia M; Neff, Roni A; Rutkow, Lainie

2017-02-01

Food workers' health and hygiene are common pathways to foodborne disease outbreaks. Improving food system jobs is important to food safety because working conditions impact workers' health, hygiene, and safe food handling. Stakeholders from key industries have advanced working conditions as an issue of public safety in the United States. Yet, for the food industry, stakeholder engagement with this topic is seemingly limited. To understand this lack of action, we interviewed key informants from organizations recognized for their agenda-setting role on food-worker issues. Findings suggest that participants recognize the work standards/food safety connection, yet perceived barriers limit adoption of a food safety frame, including more pressing priorities (e.g., occupational safety); poor fit with organizational strategies and mission; and questionable utility, including potential negative consequences. Using these findings, we consider how public health advocates may connect food working conditions to food and public safety and elevate it to the public policy agenda.

Safety status system for operating room devices.

PubMed

Guédon, Annetje C P; Wauben, Linda S G L; Overvelde, Marlies; Blok, Joleen H; van der Elst, Maarten; Dankelman, Jenny; van den Dobbelsteen, John J

2014-01-01

Since the increase of the number of technological aids in the operating room (OR), equipment-related incidents have come to be a common kind of adverse events. This underlines the importance of adequate equipment management to improve the safety in the OR. A system was developed to monitor the safety status (periodic maintenance and registered malfunctions) of OR devices and to facilitate the notification of malfunctions. The objective was to assess whether the system is suitable for use in an busy OR setting and to analyse its effect on the notification of malfunctions. The system checks automatically the safety status of OR devices through constant communication with the technical facility management system, informs the OR staff real-time and facilitates notification of malfunctions. The system was tested for a pilot period of six months in four ORs of a Dutch teaching hospital and 17 users were interviewed on the usability of the system. The users provided positive feedback on the usability. For 86.6% of total time, the localisation of OR devices was accurate. 62 malfunctions of OR devices were reported, an increase of 12 notifications compared to the previous year. The safety status system was suitable for an OR complex, both from a usability and technical point of view, and an increase of reported malfunctions was observed. The system eases monitoring the safety status of equipment and is a promising tool to improve the safety related to OR devices.

Defining Desirable Central Nervous System Drug Space through the Alignment of Molecular Properties, in Vitro ADME, and Safety Attributes

PubMed Central

2010-01-01

As part of our effort to increase survival of drug candidates and to move our medicinal chemistry design to higher probability space for success in the Neuroscience therapeutic area, we embarked on a detailed study of the property space for a collection of central nervous system (CNS) molecules. We carried out a thorough analysis of properties for 119 marketed CNS drugs and a set of 108 Pfizer CNS candidates. In particular, we focused on understanding the relationships between physicochemical properties, in vitro ADME (absorption, distribution, metabolism, and elimination) attributes, primary pharmacology binding efficiencies, and in vitro safety data for these two sets of compounds. This scholarship provides guidance for the design of CNS molecules in a property space with increased probability of success and may lead to the identification of druglike candidates with favorable safety profiles that can successfully test hypotheses in the clinic. PMID:22778836

Innovation and Transformation in California’s Safety-net Healthcare Settings: An Inside Perspective

PubMed Central

Lyles, Courtney R.; Aulakh, Veenu; Jameson, Wendy; Schillinger, Dean; Yee, Hal; Sarkar, Urmimala

2016-01-01

Background Health reform requires safety-net settings to transform care delivery, but how they will innovate in order to achieve this transformation is unknown. Methods We conducted two series of key informant interviews (N= 28) in 2012 with leadership from both California’s public hospital systems and community health centers. Interviews focused on how innovation was conceptualized and solicited examples of successful innovations. Results In contrast to disruptive innovation, interviewees often defined innovation as improving implementation, making incremental changes, and promoting integration. Many leaders gave examples of existing innovative practices such as patient-centered approaches to meeting their diverse patient needs. Participants expressed challenges to adapting quickly, but a desire to partner together. Conclusions Safety-net systems have already begun implementing innovative practices supporting their key priority areas. However, more support is needed, specifically to accelerate the change needed to succeed under health reform. PMID:24170938

Comprehensive target populations for current active safety systems using national crash databases.

PubMed

Kusano, Kristofer D; Gabler, Hampton C

2014-01-01

The objective of active safety systems is to prevent or mitigate collisions. A critical component in the design of active safety systems is the identification of the target population for a proposed system. The target population for an active safety system is that set of crashes that a proposed system could prevent or mitigate. Target crashes have scenarios in which the sensors and algorithms would likely activate. For example, the rear-end crash scenario, where the front of one vehicle contacts another vehicle traveling in the same direction and in the same lane as the striking vehicle, is one scenario for which forward collision warning (FCW) would be most effective in mitigating or preventing. This article presents a novel set of precrash scenarios based on coded variables from NHTSA's nationally representative crash databases in the United States. Using 4 databases (National Automotive Sampling System-General Estimates System [NASS-GES], NASS Crashworthiness Data System [NASS-CDS], Fatality Analysis Reporting System [FARS], and National Motor Vehicle Crash Causation Survey [NMVCCS]) the scenarios developed in this study can be used to quantify the number of police-reported crashes, seriously injured occupants, and fatalities that are applicable to proposed active safety systems. In this article, we use the precrash scenarios to identify the target populations for FCW, pedestrian crash avoidance systems (PCAS), lane departure warning (LDW), and vehicle-to-vehicle (V2V) or vehicle-to-infrastructure (V2I) systems. Crash scenarios were derived using precrash variables (critical event, accident type, precrash movement) present in all 4 data sources. This study found that these active safety systems could potentially mitigate approximately 1 in 5 of all severity and serious injury crashes in the United States and 26 percent of fatal crashes. Annually, this corresponds to 1.2 million all severity, 14,353 serious injury (MAIS 3+), and 7412 fatal crashes. In addition, we provide the source code for the crash scenarios as an appendix (see online supplement) to this article so that researchers can use the crash scenarios in future research.

Intelligent transportation systems benefits, costs, and lessons learned : 2014 update report.

DOT National Transportation Integrated Search

2014-06-01

Intelligent transportation systems (ITS) provide a proven set of strategies for advancing transportation safety, mobility, and environmental sustainability by integrating communication and information technology applications into the management and o...

Safety assessment guidance in the International Atomic Energy Agency RADWASS Program

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

Vovk, I.F.; Seitz, R.R.

1995-12-31

The IAEA RADWASS programme is aimed at establishing a coherent and comprehensive set of principles and standards for the safe management of waste and formulating the guidelines necessary for their application. A large portion of this programme has been devoted to safety assessments for various waste management activities. Five Safety Guides are planned to be developed to provide general guidance to enable operators and regulators to develop necessary framework for safety assessment process in accordance with international recommendations. They cover predisposal, near surface disposal, geological disposal, uranium/thorium mining and milling waste, and decommissioning and environmental restoration. The Guide on safetymore » assessment for near surface disposal is at the most advanced stage of preparation. This draft Safety Guide contains guidance on description of the disposal system, development of a conceptual model, identification and description of relevant scenarios and pathways, consequence analysis, presentation of results and confidence building. The set of RADWASS publications is currently undergoing in-depth review to ensure a harmonized approach throughout the Safety Series.« less

Could changes in the wheelchair delivery system improve safety?

PubMed Central

Kirby, R L; Coughlan, S G; Christie, M

1995-01-01

Despite emerging evidence about the high incidence and severity of wheelchair-related injuries, regulations governing wheelchair safety are almost nonexistent in Canada. The authors believe that, to improve wheelchair safety, a concerted effort by government, manufacturers, purchasing groups, users and clinicians is needed. Health Canada's Health Protection Branch should treat wheelchairs as medical devices (as defined in the Food and Drugs Act 1985) and improve its injury-reporting network. Manufacturers should give a higher priority to safety in wheelchair design, improve their educational materials and formalize postmarketing surveillance. Purchasing groups should try to ensure that they do not stifle innovation in wheelchair design by setting unrealistic reimbursement ceilings and should use their market power more effectively. Users should obtain their wheelchairs in specialized settings, heed safety warnings and make more effective use of litigation when such action is warranted. Clinicians should ensure that patients are equipped with the most appropriate wheelchair for their needs, that they are given adequate training in safe wheelchair use and that they understand the dangers involved. Rapid changes in wheelchair technology and emerging evidence about the high incidence and severity of injuries related to wheelchair use suggest that such changes are needed in the wheelchair delivery system. PMID:7489551

Patient safety competencies in undergraduate nursing students: a rapid evidence assessment.

PubMed

Bianchi, Monica; Bressan, Valentina; Cadorin, Lucia; Pagnucci, Nicola; Tolotti, Angela; Valcarenghi, Dario; Watson, Roger; Bagnasco, Annamaria; Sasso, Loredana

2016-12-01

To identify patient safety competencies, and determine the clinical learning environments that facilitate the development of patient safety competencies in nursing students. Patient safety in nursing education is of key importance for health professional environments, settings and care systems. To be effective, safe nursing practice requires a good integration between increasing knowledge and the different clinical practice settings. Nurse educators have the responsibility to develop effective learning processes and ensure patient safety. Rapid Evidence Assessment. MEDLINE, CINAHL, SCOPUS and ERIC were searched, yielding 500 citations published between 1 January 2004-30 September 2014. Following the Rapid Evidence Assessment process, 17 studies were included in this review. Hawker's (2002) quality assessment tool was used to assess the quality of the selected studies. Undergraduate nursing students need to develop competencies to ensure patient safety. The quality of the pedagogical atmosphere in the clinical setting has an important impact on the students' overall level of competence. Active student engagement in clinical processes stimulates their critical reasoning, improves interpersonal communication and facilitates adequate supervision and feedback. Few studies describe the nursing students' patient safety competencies and exactly what they need to learn. In addition, studies describe only briefly which clinical learning environments facilitate the development of patient safety competencies in nursing students. Further research is needed to identify additional pedagogical strategies and the specific characteristics of the clinical learning environments that encourage the development of nursing students' patient safety competencies. © 2016 John Wiley & Sons Ltd.

Dimensions of patient safety culture in family practice.

PubMed

Palacios-Derflingher, Luz; O'Beirne, Maeve; Sterling, Pam; Zwicker, Karen; Harding, Brianne K; Casebeer, Ann

2010-01-01

Safety culture has been shown to affect patient safety in healthcare. While the United States and United Kingdom have studied the dimensions that reflect patient safety culture in family practice settings, to date, this has not been done in Canada. Differences in the healthcare systems between these countries and Canada may affect the dimensions found to be relevant here. Thus, it is important to identify and compare the dimensions from the United States and the United Kingdom in a Canadian context. The objectives of this study were to explore the dimensions of patient safety culture that relate to family practice in Canada and to determine if differences and similarities exist between dimensions found in Canada and those found in previous studies undertaken in the United States and the United Kingdom. A qualitative study was undertaken applying thematic analysis using focus groups with family practice offices and supplementary key stakeholders. Analysis of the data indicated that most of the dimensions from the United States and United Kingdom are appropriate in our Canadian context. Exceptions included owner/managing partner/leadership support for patient safety, job satisfaction and overall perceptions of patient safety and quality. Two unique dimensions were identified in the Canadian context: disclosure and accepting responsibility for errors. Based on this early work, it is important to consider differences in care settings when understanding dimensions of patient safety culture. We suggest that additional research in family practice settings is critical to further understand the influence of context on patient safety culture.

Aviation Safety Reporting System: Process and Procedures

NASA Technical Reports Server (NTRS)

Connell, Linda J.

1997-01-01

The Aviation Safety Reporting System (ASRS) was established in 1976 under an agreement between the Federal Aviation Administration (FAA) and the National Aeronautics and Space Administration (NASA). This cooperative safety program invites pilots, air traffic controllers, flight attendants, maintenance personnel, and others to voluntarily report to NASA any aviation incident or safety hazard. The FAA provides most of the program funding. NASA administers the program, sets its policies in consultation with the FAA and aviation community, and receives the reports submitted to the program. The FAA offers those who use the ASRS program two important reporting guarantees: confidentiality and limited immunity. Reports sent to ASRS are held in strict confidence. More than 350,000 reports have been submitted since the program's beginning without a single reporter's identity being revealed. ASRS removes all personal names and other potentially identifying information before entering reports into its database. This system is a very successful, proof-of-concept for gathering safety data in order to provide timely information about safety issues. The ASRS information is crucial to aviation safety efforts both nationally and internationally. It can be utilized as the first step in safety by providing the direction and content to informed policies, procedures, and research, especially human factors. The ASRS process and procedures will be presented as one model of safety reporting feedback systems.

Implementation of an integrated computerized prescriber order-entry system for chemotherapy in a multisite safety-net health system.

PubMed

Chung, Clement; Patel, Shital; Lee, Rosetta; Fu, Lily; Reilly, Sean; Ho, Tuyet; Lionetti, Jason; George, Michael D; Taylor, Pam

2018-03-15

The development of a computerized prescriber order-entry (CPOE) system for chemotherapy in a multisite safety-net health system and the challenges to its successful implementation are described. Before CPOE for chemotherapy was first implemented and embedded in the electronic medical record system of Harris Health System (HHS), pharmacy personnel relied on regimen-specific preprinted order sets. However, due to differences in practice styles and workflow logistics, the paper orders across the 3 facilities were mostly site specific, with varying clinical content. Many of these order sets had not been approved by the oncology subcommittee. In addition, disparities in clinical knowledge and lack of communication contributed to inconsistencies in order set development. Led by medical directors from medical oncology departments at the 3 facilities, pharmacy administrators, and information technology representatives, HHS committed resources to supporting the adoption and use of a CPOE system for chemotherapy. Five practical lessons of broad applicability have been learned: engagement of interprofessional stakeholders, optimization of workflow before CPOE implementation, requirement of verification tool for CPOE, consolidation of protocols, and commitment to ongoing training and support. Evaluation of the CPOE system demonstrated a systemwide reduction in medication errors by 75% ( p < 0.05). Satisfaction with the CPOE system varied among sites and was unchanged institutionwide 6 months after the CPOE implementation. The development and implementation of CPOE for chemotherapy at a multisite safety-net health system created opportunities to optimize patient care and reduce variations through interprofessional collaborations. Initial evaluation suggested that CPOE reduced the medication-order error rate and improved user satisfaction in 1 of 3 facilities. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

How Effective Are Incident-Reporting Systems for Improving Patient Safety? A Systematic Literature Review

PubMed Central

Stavropoulou, Charitini; Doherty, Carole; Tosey, Paul

2015-01-01

Context Incident-reporting systems (IRSs) are used to gather information about patient safety incidents. Despite the financial burden they imply, however, little is known about their effectiveness. This article systematically reviews the effectiveness of IRSs as a method of improving patient safety through organizational learning. Methods Our systematic literature review identified 2 groups of studies: (1) those comparing the effectiveness of IRSs with other methods of error reporting and (2) those examining the effectiveness of IRSs on settings, structures, and outcomes in regard to improving patient safety. We used thematic analysis to compare the effectiveness of IRSs with other methods and to synthesize what was effective, where, and why. Then, to assess the evidence concerning the ability of IRSs to facilitate organizational learning, we analyzed studies using the concepts of single-loop and double-loop learning. Findings In total, we identified 43 studies, 8 that compared IRSs with other methods and 35 that explored the effectiveness of IRSs on settings, structures, and outcomes. We did not find strong evidence that IRSs performed better than other methods. We did find some evidence of single-loop learning, that is, changes to clinical settings or processes as a consequence of learning from IRSs, but little evidence of either improvements in outcomes or changes in the latent managerial factors involved in error production. In addition, there was insubstantial evidence of IRSs enabling double-loop learning, that is, a cultural change or a change in mind-set. Conclusions The results indicate that IRSs could be more effective if the criteria for what counts as an incident were explicit, they were owned and led by clinical teams rather than centralized hospital departments, and they were embedded within organizations as part of wider safety programs. PMID:26626987

Cold Vacuum Drying (CVD) Set Point Determination

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

PHILIPP, B.L.

2000-03-21

The Safety Class Instrumentation and Control (SCIC) system provides active detection and response to process anomalies that, if unmitigated, would result in a safety event. Specifically, actuation of the SCIC system includes two portions. The portion which isolates the MCO and initiates the safety-class helium (SCHe) purge, and the portion which detects and stops excessive heat input to the MCO on high tempered water MCO inlet temperature. For the MCO isolation and purge, the SCIC receives signals from MCO pressure (both positive pressure and vacuum), helium flow rate, bay high temperature switches, seismic trips and time under vacuum trips.

A systematic review of patient tracking systems for use in the pediatric emergency department.

PubMed

Dobson, Ian; Doan, Quynh; Hung, Geoffrey

2013-01-01

Patient safety is of great importance in the pediatric emergency department (PED). The combination of acutely and critically ill patients and high patient volumes creates a need for systems to support physicians in making accurate and timely diagnoses. Electronic patient tracking systems can potentially improve PED safety by reducing overcrowding and enhancing security. To enhance our understanding of current electronic tracking technologies, how they are implemented in a clinical setting, and resulting effect on patient care outcomes including patient safety. Nine databases were searched. Two independent reviewers identified articles that contained reference to patient tracking technologies in pediatrics or emergency medicine. Quantitative studies were assessed independently for methodological strength by two reviewers using an external assessment tool. Of 2292 initial articles, 22 were deemed relevant. Seventeen were qualitative, and the remaining five quantitative articles were assessed as being methodologically weak. Existing patient tracking systems in the ED included: infant monitoring/abduction prevention; barcode identification; radiofrequency identification (RFID)- or infrared (IR)-based patient tracking. Twenty articles supported the use of tracking technology to enhance patient safety or improve efficiency. One article failed to support the use of IR patient sensors due to study design flaws. Support exists for the use of barcode-, IR-, and RFID-based patient tracking systems to improve ED patient safety and efficiency. A lack of methodologically strong studies indicates a need for further evidence-based support for the implementation of patient tracking technology in a clinical or research setting. Copyright © 2013 Elsevier Inc. All rights reserved.

The relationship between employees' perceptions of safety and organizational culture.

PubMed

O'Toole, Michael

2002-01-01

With limited resources to help reduce occupational injuries, companies struggle with how to best focus these resources to achieve the greatest reduction in injuries for the optimal cost. Safety culture has been identified as a critical factor that sets the tone for importance of safety within an organization. An employee safety perception survey was conducted, and injury data were collected over a 45-month period from a large ready-mix concrete producer located in the southwest region of the United States. The results of this preliminary study suggest that the reductions in injuries experienced at the company locations was strongly impacted by the positive employee perceptions on several key factors. Management's commitment to safety was the factor with the greatest positive perception by employees taking the survey. This study was set up as a pilot project and did not unitize an experimental design. That weakness reduces the strength of these findings but adds to the importance of expanding the pilot project with an appropriate experimental design. Management leadership has been identified, along with several other factors, to influence employee perceptions of the safety management system. Those perceptions, in turn, appear to influence employee decisions that relate to at-risk behaviors and decisions on the job. The results suggest that employee perceptions of the safety system are related to management's commitment to safety, which, in turn, appear to be related to injury rates. Management should focus on how to best leverage these key factors to more positively impact injury rates within their companies.

Effects and Satisfaction of Medical Device Safety Information Reporting System Using Electronic Medical Record.

PubMed

Jang, Hye Jung; Choi, Young Deuk; Kim, Nam Hyun

2017-04-01

This paper describes an evaluation study on the effectiveness of developing an in-hospital medical device safety information reporting system for managing safety information, including adverse incident data related to medical devices, following the enactment of the Medical Device Act in Korea. Medical device safety information reports were analyzed for 190 cases that took place prior to the application of a medical device safety information reporting system and during a period when the reporting system was used. Also, questionnaires were used to measure the effectiveness of the medical device safety information reporting system. The analysis was based on the questionnaire responses of 15 reporters who submitted reports in both the pre- and post-reporting system periods. Sixty-two reports were submitted in paper form, but after the system was set up, this number more than doubled to 128 reports in electronic form. In terms of itemized reporting, a total of 45 items were reported. Before the system was used, 23 items had been reported, but this increased to 32 items after the system was put to use. All survey variables of satisfaction received a mean of over 3 points, while positive attitude , potential benefits , and positive benefits all exceeded 4 points, each receiving 4.20, 4.20, and 4.13, respectively. Among the variables, time-consuming and decision-making had the lowest mean values, each receiving 3.53. Satisfaction was found to be high for system quality and user satisfaction , but relatively low for time-consuming and decision-making . We were able to verify that effective reporting and monitoring of adverse incidents and the safety of medical devices can be implemented through the establishment of an in-hospital medical device safety information reporting system that can enhance patient safety and medical device risk management.

An on-line monitoring system for navigation equipment

NASA Astrophysics Data System (ADS)

Wang, Bo; Yang, Ping; Liu, Jing; Yang, Zhengbo; Liang, Fei

2017-10-01

Civil air navigation equipment is the most important infrastructure of Civil Aviation, which is closely related to flight safety. In addition to regular flight inspection, navigation equipment's patrol measuring, maintenance measuring, running measuring under special weather conditions are the important means of ensuring aviation flight safety. According to the safety maintenance requirements of Civil Aviation Air Traffic Control navigation equipment, this paper developed one on-line monitoring system with independent intellectual property rights for navigation equipment, the system breakthroughs the key technologies of measuring navigation equipment on-line including Instrument Landing System (ILS) and VHF Omni-directional Range (VOR), which also meets the requirements of navigation equipment ground measurement set by the ICAO DOC 8071, it provides technical means of the ground on-line measurement for navigation equipment, improves the safety of navigation equipment operation, and reduces the impact of measuring navigation equipment on airport operation.

Near-misses are an opportunity to improve patient safety: adapting strategies of high reliability organizations to healthcare.

PubMed

Van Spall, Harriette; Kassam, Alisha; Tollefson, Travis T

2015-08-01

Near-miss investigations in high reliability organizations (HROs) aim to mitigate risk and improve system safety. Healthcare settings have a higher rate of near-misses and subsequent adverse events than most high-risk industries, but near-misses are not systematically reported or analyzed. In this review, we will describe the strategies for near-miss analysis that have facilitated a culture of safety and continuous quality improvement in HROs. Near-miss analysis is routine and systematic in HROs such as aviation. Strategies implemented in aviation include the Commercial Aviation Safety Team, which undertakes systematic analyses of near-misses, so that findings can be incorporated into Standard Operating Procedures (SOPs). Other strategies resulting from incident analyses include Crew Resource Management (CRM) for enhanced communication, situational awareness training, adoption of checklists during operations, and built-in redundancy within systems. Health care organizations should consider near-misses as opportunities for quality improvement. The systematic reporting and analysis of near-misses, commonplace in HROs, can be adapted to health care settings to prevent adverse events and improve clinical outcomes.

A systematic review of patient safety in mental health: a protocol based on the inpatient setting.

PubMed

D'Lima, Danielle; Archer, Stephanie; Thibaut, Bethan Ines; Ramtale, Sonny Christian; Dewa, Lindsay H; Darzi, Ara

2016-11-29

Despite the growing international interest in patient safety as a discipline, there has been a lack of exploration of its application to mental health. It cannot be assumed that findings based upon physical health in acute care hospitals can be applied to mental health patients, disorders and settings. To the authors' knowledge, there has only been one review of the literature that focuses on patient safety research in mental health settings, conducted in Canada in 2008. We have identified a need to update this review and develop the methodology in order to strengthen the findings and disseminate internationally for advancement in the field. This systematic review will explore the existing research base on patient safety in mental health within the inpatient setting. To conduct this systematic review, a thorough search across multiple databases will be undertaken, based upon four search facets ("mental health", "patient safety", "research" and "inpatient setting"). The search strategy has been developed based upon the Canadian review accompanied with input from the National Reporting and Learning System (NRLS) taxonomy of patient safety incidents and the Diagnostic and Statistical Manual of Mental Disorders (fifth edition). The screening process will involve perspectives from at least two researchers at all stages with a third researcher invited to review when discrepancies require resolution. Initial inclusion and exclusion criteria have been developed and will be refined iteratively throughout the process. Quality assessment and data extraction of included articles will be conducted by at least two researchers. A data extraction form will be developed, piloted and iterated as necessary in accordance with the research question. Extracted information will be analysed thematically. We believe that this systematic review will make a significant contribution to the advancement of patient safety in mental health inpatient settings. The findings will enable the development and implementation of interventions to improve the quality of care experienced by patients and support the identification of future research priorities. PROSPERO CRD42016034057.

Safety assessment and detection methods of genetically modified organisms.

PubMed

Xu, Rong; Zheng, Zhe; Jiao, Guanglian

2014-01-01

Genetically modified organisms (GMOs), are gaining importance in agriculture as well as the production of food and feed. Along with the development of GMOs, health and food safety concerns have been raised. These concerns for these new GMOs make it necessary to set up strict system on food safety assessment of GMOs. The food safety assessment of GMOs, current development status of safety and precise transgenic technologies and GMOs detection have been discussed in this review. The recent patents about GMOs and their detection methods are also reviewed. This review can provide elementary introduction on how to assess and detect GMOs.

Capturing Safety Requirements to Enable Effective Task Allocation Between Humans and Automaton in Increasingly Autonomous Systems

NASA Technical Reports Server (NTRS)

Neogi, Natasha A.

2016-01-01

There is a current drive towards enabling the deployment of increasingly autonomous systems in the National Airspace System (NAS). However, shifting the traditional roles and responsibilities between humans and automation for safety critical tasks must be managed carefully, otherwise the current emergent safety properties of the NAS may be disrupted. In this paper, a verification activity to assess the emergent safety properties of a clearly defined, safety critical, operational scenario that possesses tasks that can be fluidly allocated between human and automated agents is conducted. Task allocation role sets were proposed for a human-automation team performing a contingency maneuver in a reduced crew context. A safety critical contingency procedure (engine out on takeoff) was modeled in the Soar cognitive architecture, then translated into the Hybrid Input Output formalism. Verification activities were then performed to determine whether or not the safety properties held over the increasingly autonomous system. The verification activities lead to the development of several key insights regarding the implicit assumptions on agent capability. It subsequently illustrated the usefulness of task annotations associated with specialized requirements (e.g., communication, timing etc.), and demonstrated the feasibility of this approach.

An Interoperability Platform Enabling Reuse of Electronic Health Records for Signal Verification Studies

PubMed Central

Yuksel, Mustafa; Gonul, Suat; Laleci Erturkmen, Gokce Banu; Sinaci, Ali Anil; Invernizzi, Paolo; Facchinetti, Sara; Migliavacca, Andrea; Bergvall, Tomas; Depraetere, Kristof; De Roo, Jos

2016-01-01

Depending mostly on voluntarily sent spontaneous reports, pharmacovigilance studies are hampered by low quantity and quality of patient data. Our objective is to improve postmarket safety studies by enabling safety analysts to seamlessly access a wide range of EHR sources for collecting deidentified medical data sets of selected patient populations and tracing the reported incidents back to original EHRs. We have developed an ontological framework where EHR sources and target clinical research systems can continue using their own local data models, interfaces, and terminology systems, while structural interoperability and Semantic Interoperability are handled through rule-based reasoning on formal representations of different models and terminology systems maintained in the SALUS Semantic Resource Set. SALUS Common Information Model at the core of this set acts as the common mediator. We demonstrate the capabilities of our framework through one of the SALUS safety analysis tools, namely, the Case Series Characterization Tool, which have been deployed on top of regional EHR Data Warehouse of the Lombardy Region containing about 1 billion records from 16 million patients and validated by several pharmacovigilance researchers with real-life cases. The results confirm significant improvements in signal detection and evaluation compared to traditional methods with the missing background information. PMID:27123451

Performance Measurement and Target-Setting in California's Safety Net Health Systems.

PubMed

Hemmat, Shirin; Schillinger, Dean; Lyles, Courtney; Ackerman, Sara; Gourley, Gato; Vittinghoff, Eric; Handley, Margaret; Sarkar, Urmimala

Health policies encourage implementing quality measurement with performance targets. The 2010-2015 California Medicaid waiver mandated quality measurement and reporting. In 2013, California safety net hospitals participating in the waiver set a voluntary performance target (the 90th percentile for Medicare preferred provider organization plans) for mammography screening and cholesterol control in diabetes. They did not reach the target, and the difference-in-differences analysis suggested that there was no difference for mammography ( P = .39) and low-density lipoprotein control ( P = .11) performance compared to measures for which no statewide quality improvement initiative existed. California's Medicaid waiver was associated with improved performance on a number of metrics, but this performance was not attributable to target setting on specific health conditions. Performance may have improved because of secular trends or systems improvements related to waiver funding. Relying on condition-specific targets to measure performance may underestimate improvements and disadvantage certain health systems. Achieving ambitious targets likely requires sustained fiscal, management, and workforce investments.

Range Safety for an Autonomous Flight Safety System

NASA Technical Reports Server (NTRS)

Lanzi, Raymond J.; Simpson, James C.

2010-01-01

The Range Safety Algorithm software encapsulates the various constructs and algorithms required to accomplish Time Space Position Information (TSPI) data management from multiple tracking sources, autonomous mission mode detection and management, and flight-termination mission rule evaluation. The software evaluates various user-configurable rule sets that govern the qualification of TSPI data sources, provides a prelaunch autonomous hold-launch function, performs the flight-monitoring-and-termination functions, and performs end-of-mission safing

Rodent Bone Marrow Micronucleus Assay. Test Substance: Solvent Yellow 33 2-(2-Quinolyl)-1,3-indandione

DTIC Science & Technology

2011-01-18

Observations, and Micronucleus Scoring Data Table 10: Summary of Micronucleus Assay Results Appendix I: Software Systems Attachment A: Material Safety ...compliance with U.S. Food and Drug Administration regulations set forth in 21 CFR, Part 58, and with the Organization for Economic Co-Operation and...Solubility: Insoluble in water pH: 7 Storage Conditions: Room Temperature Safety Precautions: Standard Toxikon Laboratory Safety Precautions, Bovine

Safety Sufficiency for NextGen: Assessment of Selected Existing Safety Methods, Tools, Processes, and Regulations

NASA Technical Reports Server (NTRS)

Xu, Xidong; Ulrey, Mike L.; Brown, John A.; Mast, James; Lapis, Mary B.

2013-01-01

NextGen is a complex socio-technical system and, in many ways, it is expected to be more complex than the current system. It is vital to assess the safety impact of the NextGen elements (technologies, systems, and procedures) in a rigorous and systematic way and to ensure that they do not compromise safety. In this study, the NextGen elements in the form of Operational Improvements (OIs), Enablers, Research Activities, Development Activities, and Policy Issues were identified. The overall hazard situation in NextGen was outlined; a high-level hazard analysis was conducted with respect to multiple elements in a representative NextGen OI known as OI-0349 (Automation Support for Separation Management); and the hazards resulting from the highly dynamic complexity involved in an OI-0349 scenario were illustrated. A selected but representative set of the existing safety methods, tools, processes, and regulations was then reviewed and analyzed regarding whether they are sufficient to assess safety in the elements of that OI and ensure that safety will not be compromised and whether they might incur intolerably high costs.

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.

A Review of Safety and Design Requirements of the Artificial Pancreas.

PubMed

Blauw, Helga; Keith-Hynes, Patrick; Koops, Robin; DeVries, J Hans

2016-11-01

As clinical studies with artificial pancreas systems for automated blood glucose control in patients with type 1 diabetes move to unsupervised real-life settings, product development will be a focus of companies over the coming years. Directions or requirements regarding safety in the design of an artificial pancreas are, however, lacking. This review aims to provide an overview and discussion of safety and design requirements of the artificial pancreas. We performed a structured literature search based on three search components-type 1 diabetes, artificial pancreas, and safety or design-and extended the discussion with our own experiences in developing artificial pancreas systems. The main hazards of the artificial pancreas are over- and under-dosing of insulin and, in case of a bi-hormonal system, of glucagon or other hormones. For each component of an artificial pancreas and for the complete system we identified safety issues related to these hazards and proposed control measures. Prerequisites that enable the control algorithms to provide safe closed-loop control are accurate and reliable input of glucose values, assured hormone delivery and an efficient user interface. In addition, the system configuration has important implications for safety, as close cooperation and data exchange between the different components is essential.

A set-theoretic model reference adaptive control architecture for disturbance rejection and uncertainty suppression with strict performance guarantees

NASA Astrophysics Data System (ADS)

Arabi, Ehsan; Gruenwald, Benjamin C.; Yucelen, Tansel; Nguyen, Nhan T.

2018-05-01

Research in adaptive control algorithms for safety-critical applications is primarily motivated by the fact that these algorithms have the capability to suppress the effects of adverse conditions resulting from exogenous disturbances, imperfect dynamical system modelling, degraded modes of operation, and changes in system dynamics. Although government and industry agree on the potential of these algorithms in providing safety and reducing vehicle development costs, a major issue is the inability to achieve a-priori, user-defined performance guarantees with adaptive control algorithms. In this paper, a new model reference adaptive control architecture for uncertain dynamical systems is presented to address disturbance rejection and uncertainty suppression. The proposed framework is predicated on a set-theoretic adaptive controller construction using generalised restricted potential functions.The key feature of this framework allows the system error bound between the state of an uncertain dynamical system and the state of a reference model, which captures a desired closed-loop system performance, to be less than a-priori, user-defined worst-case performance bound, and hence, it has the capability to enforce strict performance guarantees. Examples are provided to demonstrate the efficacy of the proposed set-theoretic model reference adaptive control architecture.

Binding Procurement

NASA Technical Reports Server (NTRS)

Rao, Gopalakrishna M.; Vaidyanathan, Hari

2007-01-01

This viewgraph presentation reviews the use of the binding procurement process in purchasing Aerospace Flight Battery Systems. NASA Engineering and Safety Center (NESC) requested NASA Aerospace Flight Battery Systems Working Group to develop a set of guideline requirements document for Binding Procurement Contracts.

Information Extraction for System-Software Safety Analysis: Calendar Year 2007 Year-End Report

NASA Technical Reports Server (NTRS)

Malin, Jane T.

2008-01-01

This annual report describes work to integrate a set of tools to support early model-based analysis of failures and hazards due to system-software interactions. The tools perform and assist analysts in the following tasks: 1) extract model parts from text for architecture and safety/hazard models; 2) combine the parts with library information to develop the models for visualization and analysis; 3) perform graph analysis on the models to identify possible paths from hazard sources to vulnerable entities and functions, in nominal and anomalous system-software configurations; 4) perform discrete-time-based simulation on the models to investigate scenarios where these paths may play a role in failures and mishaps; and 5) identify resulting candidate scenarios for software integration testing. This paper describes new challenges in a NASA abort system case, and enhancements made to develop the integrated tool set.

Development and Assessment of a Medication Safety Measurement Program in a Long-Term Care Pharmacy.

PubMed

Hertig, John B; Hultgren, Kyle E; Parks, Scott; Rondinelli, Rick

2016-02-01

Medication errors continue to be a major issue in the health care system, including in long-term care facilities. While many hospitals and health systems have developed methods to identify, track, and prevent these errors, long-term care facilities historically have not invested in these error-prevention strategies. The objective of this study was two-fold: 1) to develop a set of medication-safety process measures for dispensing in a long-term care pharmacy, and 2) to analyze the data from those measures to determine the relative safety of the process. The study was conducted at In Touch Pharmaceuticals in Valparaiso, Indiana. To assess the safety of the medication-use system, each step was documented using a comprehensive flowchart (process flow map) tool. Once completed and validated, the flowchart was used to complete a "failure modes and effects analysis" (FMEA) identifying ways a process may fail. Operational gaps found during FMEA were used to identify points of measurement. The research identified a set of eight measures as potential areas of failure; data were then collected on each one of these. More than 133,000 medication doses (opportunities for errors) were included in the study during the research time frame (April 1, 2014, and ended on June 4, 2014). Overall, there was an approximate order-entry error rate of 15.26%, with intravenous errors at 0.37%. A total of 21 errors migrated through the entire medication-use system. These 21 errors in 133,000 opportunities resulted in a final check error rate of 0.015%. A comprehensive medication-safety measurement program was designed and assessed. This study demonstrated the ability to detect medication errors in a long-term pharmacy setting, thereby making process improvements measureable. Future, larger, multi-site studies should be completed to test this measurement program.

A Framework to Guide the Assessment of Human-Machine Systems.

PubMed

Stowers, Kimberly; Oglesby, James; Sonesh, Shirley; Leyva, Kevin; Iwig, Chelsea; Salas, Eduardo

2017-03-01

We have developed a framework for guiding measurement in human-machine systems. The assessment of safety and performance in human-machine systems often relies on direct measurement, such as tracking reaction time and accidents. However, safety and performance emerge from the combination of several variables. The assessment of precursors to safety and performance are thus an important part of predicting and improving outcomes in human-machine systems. As part of an in-depth literature analysis involving peer-reviewed, empirical articles, we located and classified variables important to human-machine systems, giving a snapshot of the state of science on human-machine system safety and performance. Using this information, we created a framework of safety and performance in human-machine systems. This framework details several inputs and processes that collectively influence safety and performance. Inputs are divided according to human, machine, and environmental inputs. Processes are divided into attitudes, behaviors, and cognitive variables. Each class of inputs influences the processes and, subsequently, outcomes that emerge in human-machine systems. This framework offers a useful starting point for understanding the current state of the science and measuring many of the complex variables relating to safety and performance in human-machine systems. This framework can be applied to the design, development, and implementation of automated machines in spaceflight, military, and health care settings. We present a hypothetical example in our write-up of how it can be used to aid in project success.

Development of national standards related to the integrated safety and security of high-rise buildings

NASA Astrophysics Data System (ADS)

Voskresenskaya, Elena; Vorona-Slivinskaya, Lubov

2018-03-01

The article considers the issues of developing national standards for high-rise construction. The system of standards should provide industrial, operational, economic and terrorist safety of high-rise buildings and facilities. Modern standards of high-rise construction should set the rules for designing engineering systems of high-rise buildings, which will ensure the integrated security of buildings, increase their energy efficiency and reduce the consumption of resources in construction and operation.

Next level of board accountability in health care quality.

PubMed

Pronovost, Peter J; Armstrong, C Michael; Demski, Renee; Peterson, Ronald R; Rothman, Paul B

2018-03-19

Purpose The purpose of this paper is to offer six principles that health system leaders can apply to establish a governance and management system for the quality of care and patient safety. Design/methodology/approach Leaders of a large academic health system set a goal of high reliability and formed a quality board committee in 2011 to oversee quality and patient safety everywhere care was delivered. Leaders of the health system and every entity, including inpatient hospitals, home care companies, and ambulatory services staff the committee. The committee works with the management for each entity to set and achieve quality goals. Through this work, the six principles emerged to address management structures and processes. Findings The principles are: ensure there is oversight for quality everywhere care is delivered under the health system; create a framework to organize and report the work; identify care areas where quality is ambiguous or underdeveloped (i.e. islands of quality) and work to ensure there is reporting and accountability for quality measures; create a consolidated quality statement similar to a financial statement; ensure the integrity of the data used to measure and report quality and safety performance; and transparently report performance and create an explicit accountability model. Originality/value This governance and management system for quality and safety functions similar to a finance system, with quality performance documented and reported, data integrity monitored, and accountability for performance from board to bedside. To the authors' knowledge, this is the first description of how a board has taken this type of systematic approach to oversee the quality of care.

Aviation Weather Information Requirements Study

NASA Technical Reports Server (NTRS)

Keel, Byron M.; Stancil, Charles E.; Eckert, Clifford A.; Brown, Susan M.; Gimmestad, Gary G.; Richards, Mark A.; Schaffner, Philip R. (Technical Monitor)

2000-01-01

The Aviation Safety Program (AvSP) has as its goal an improvement in aviation safety by a factor of 5 over the next 10 years and a factor of 10 over the next 20 years. Since weather has a big impact on aviation safety and is associated with 30% of all aviation accidents, Weather Accident Prevention (WxAP) is a major element under this program. The Aviation Weather Information (AWIN) Distribution and Presentation project is one of three projects under this element. This report contains the findings of a study conducted by the Georgia Tech Research Institute (GTRI) under the Enhanced Weather Products effort, which is a task under AWIN. The study examines current aviation weather products and there application. The study goes on to identify deficiencies in the current system and to define requirements for aviation weather products that would lead to an increase in safety. The study also provides an overview the current set of sensors applied to the collection of aviation weather information. New, modified, or fused sensor systems are identified which could be applied in improving the current set of weather products and in addressing the deficiencies defined in the report. In addition, the study addresses and recommends possible sensors for inclusion in an electronic pilot reporting (EPIREP) system.

NASIS data base management system - IBM 360/370 OS MVT implementation. 5: Retrieval command system reference manual

NASA Technical Reports Server (NTRS)

1973-01-01

The retrieval command subsystem reference manual for the NASA Aerospace Safety Information System (NASIS) is presented. The output oriented classification of retrieval commands provides the user with the ability to review a set of data items for verification or inspection as a typewriter or CRT terminal and to print a set of data on a remote printer. Predefined and user-definable data formatting are available for both output media.

Good practice statements on safe laboratory testing: A mixed methods study by the LINNEAUS collaboration on patient safety in primary care.

PubMed

Bowie, Paul; Forrest, Eleanor; Price, Julie; Verstappen, Wim; Cunningham, David; Halley, Lyn; Grant, Suzanne; Kelly, Moya; Mckay, John

2015-09-01

The systems-based management of laboratory test ordering and results handling is a known source of error in primary care settings worldwide. The consequences are wide-ranging for patients (e.g. avoidable harm or poor care experience), general practitioners (e.g. delayed clinical decision making and potential medico-legal implications) and the primary care organization (e.g. increased allocation of resources to problem-solve and dealing with complaints). Guidance is required to assist care teams to minimize associated risks and improve patient safety. To identify, develop and build expert consensus on 'good practice' guidance statements to inform the implementation of safe systems for ordering laboratory tests and managing results in European primary care settings. Mixed methods studies were undertaken in the UK and Ireland, and the findings were triangulated to develop 'good practice' statements. Expert consensus was then sought on the findings at the wider European level via a Delphi group meeting during 2013. We based consensus on 10 safety domains and developed 77 related 'good practice' statements (≥ 80% agreement levels) judged to be essential to creating safety and minimizing risks in laboratory test ordering and subsequent results handling systems in international primary care. Guidance was developed for improving patient safety in this important area of primary care practice. We need to consider how this guidance can be made accessible to frontline care teams, utilized by clinical educators and improvement advisers, implemented by decision makers and evaluated to determine acceptability, feasibility and impacts on patient safety.

[Attitudes towards patient safety culture in a hospital setting and related variables].

PubMed

Mir-Abellán, Ramon; Falcó-Pegueroles, Anna; de la Puente-Martorell, María Luisa

To describe attitudes towards patient safety culture among workers in a hospital setting and determine the influence of socio-demographic and professional variables. The Hospital Survey on Patient Safety Culture was distributed among a sample of professionals and nursing assistants. A dimension was considered a strength if positive responses exceeded 75% and an opportunity for improvement if more than 50% of responses were negative. 59% (n=123) of respondents rated safety between 7 and 8. 53% (n=103) stated that they had not used the notification system to report any incidents in the previous twelve months. The strength identified was "teamwork in the unit/service" and the opportunity for improvement was "staffing". A more positive attitude was observed in outpatient services and among nursing professionals and part-time staff. This study has allowed us to determine the rating of the hospital in patient safety culture. This is vital for developing improvement strategies. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Evaluating transportation systems management & operations (TSM&O) benefits to alternative intersection treatments : [summary].

DOT National Transportation Integrated Search

2015-12-01

The Florida Department of Transportation (FDOT) has set a goal to optimize existing : infrastructure to improve safety, capacity, and reliability while reducing congestion and delays. : FDOT is pursuing this goal through Transportation Systems Manage...

Using Contemporary Leadership Skills in Medication Safety Programs.

PubMed

Hertig, John B; Hultgren, Kyle E; Weber, Robert J

2016-04-01

The discipline of studying medication errors and implementing medication safety programs in hospitals dates to the 1970s. These initial programs to prevent errors focused only on pharmacy operation changes - and not the broad medication use system. In the late 1990s, research showed that faulty systems, and not faulty people, are responsible for errors and require a multidisciplinary approach. The 2013 ASHP Statement on the Role of the Medication Safety Leader recommended that medication safety leaders be integrated team members rather than a single point of contact. Successful medication safety programs must employ a new approach - one that embraces the skills of all health care team members and positions many leaders to improve safety. This approach requires a new set of leadership skills based on contemporary management principles, including followership, team-building, tracking and assessing progress, storytelling and communication, and cultivating innovation, all of which promote transformational change. The application of these skills in developing or changing a medication safety program is reviewed in this article.

Using Contemporary Leadership Skills in Medication Safety Programs

PubMed Central

Hertig, John B.; Hultgren, Kyle E.; Weber, Robert J.

2016-01-01

The discipline of studying medication errors and implementing medication safety programs in hospitals dates to the 1970s. These initial programs to prevent errors focused only on pharmacy operation changes – and not the broad medication use system. In the late 1990s, research showed that faulty systems, and not faulty people, are responsible for errors and require a multidisciplinary approach. The 2013 ASHP Statement on the Role of the Medication Safety Leader recommended that medication safety leaders be integrated team members rather than a single point of contact. Successful medication safety programs must employ a new approach – one that embraces the skills of all health care team members and positions many leaders to improve safety. This approach requires a new set of leadership skills based on contemporary management principles, including followership, team-building, tracking and assessing progress, storytelling and communication, and cultivating innovation, all of which promote transformational change. The application of these skills in developing or changing a medication safety program is reviewed in this article. PMID:27303083

The aspects of safety in future care settings.

PubMed

Pharow, Peter; Blobel, Bernd G M E; Savastano, Mario

2007-01-01

Communication and cooperation processes in the growing healthcare and welfare domain require a well-defined set of security services provided by a standards-based interoperable security infrastructure. Any communication and collaboration procedures require a verifiable purpose. Without such a purpose for communicating with each other, there's no need to communicate at all. But security is not the only aspect that needs to carefully be investigated. More and more, aspects of safety, privacy, and quality get importance while discussing about future-proof health information systems and health networks--regardless whether local, regional and national ones or even pan-European networks. The patient needs to be moved into the center of each care process. During the course of the current paradigm change from an organization centered via a process-related to a person-centered healthcare and welfare system approach, different new technologies need to be applied in order to meet the new challenges arising from both legal and technical circumstances. International organizations like WHO, UNESCO and the European Parliament increasingly aim at enhancing the safety aspect in future care settings, and so do many projects and studies. Beside typical information and communication devices, extended use of modern IT technology in healthcare and welfare includes large medical devices like, e.g., CT, X-ray and MR but also very tiny devices like sensors worn or implemented in a person's clothing. Safety gets on top of the nations priority list for several reasons. The paper aims at identifying some of these reasons along with possible solutions on how to increase patient's awareness, confidence, and acceptance in future care settings.

Prediction of Safety Stock Using Fuzzy Time Series (FTS) and Technology of Radio Frequency Identification (RFID) for Stock Control at Vendor Managed Inventory (VMI)

NASA Astrophysics Data System (ADS)

Mashuri, Chamdan; Suryono; Suseno, Jatmiko Endro

2018-02-01

This research was conducted by prediction of safety stock using Fuzzy Time Series (FTS) and technology of Radio Frequency Identification (RFID) for stock control at Vendor Managed Inventory (VMI). Well-controlled stock influenced company revenue and minimized cost. It discussed about information system of safety stock prediction developed through programming language of PHP. Input data consisted of demand got from automatic, online and real time acquisition using technology of RFID, then, sent to server and stored at online database. Furthermore, data of acquisition result was predicted by using algorithm of FTS applying universe of discourse defining and fuzzy sets determination. Fuzzy set result was continued to division process of universe of discourse in order to be to final step. Prediction result was displayed at information system dashboard developed. By using 60 data from demand data, prediction score was 450.331 and safety stock was 135.535. Prediction result was done by error deviation validation using Mean Square Percent Error of 15%. It proved that FTS was good enough in predicting demand and safety stock for stock control. For deeper analysis, researchers used data of demand and universe of discourse U varying at FTS to get various result based on test data used.

Inherent Safety Characteristics of Advanced Fast Reactors

NASA Astrophysics Data System (ADS)

Bochkarev, A. S.; Korsun, A. S.; Kharitonov, V. S.; Alekseev, P. N.

2017-01-01

The study presents SFR transient performance for ULOF events initiated by pump trip and pump seizure with simultaneous failure of all shutdown systems in both cases. The most severe cases leading to the pin cladding rupture and possible sodium boiling are demonstrated. The impact of various features on SFR inherent safety performance for ULOF events was analysed. The decrease in hydraulic resistance of primary loop and increase in primary pump coast down time were investigated. Performing analysis resulted in a set of recommendations to varying parameters for the purpose of enhancing the inherent safety performance of SFR. In order to prevent the safety barrier rupture for ULOF events the set of thermal hydraulic criteria defining the ULOF transient processes dynamics and requirements to these criteria were recommended based on achieved results: primary sodium flow dip under the natural circulation asymptotic level and natural circulation rise time.

Patient safety risks associated with telecare: a systematic review and narrative synthesis of the literature.

PubMed

Guise, Veslemøy; Anderson, Janet; Wiig, Siri

2014-11-25

Patient safety risk in the homecare context and patient safety risk related to telecare are both emerging research areas. Patient safety issues associated with the use of telecare in homecare services are therefore not clearly understood. It is unclear what the patient safety risks are, how patient safety issues have been investigated, and what research is still needed to provide a comprehensive picture of risks, challenges and potential harm to patients due to the implementation and use of telecare services in the home. Furthermore, it is unclear how training for telecare users has addressed patient safety issues. A systematic review of the literature was conducted to identify patient safety risks associated with telecare use in homecare services and to investigate whether and how these patient safety risks have been addressed in telecare training. Six electronic databases were searched in addition to hand searches of key items, reference tracking and citation tracking. Strict inclusion and exclusion criteria were set. All included items were assessed according to set quality criteria and subjected to a narrative synthesis to organise and synthesize the findings. A human factors systems framework of patient safety was used to frame and analyse the results. 22 items were included in the review. 11 types of patient safety risks associated with telecare use in homecare services emerged. These are in the main related to the nature of homecare tasks and practices, and person-centred characteristics and capabilities, and to a lesser extent, problems with the technology and devices, organisational issues, and environmental factors. Training initiatives related to safe telecare use are not described in the literature. There is a need to better identify and describe patient safety risks related to telecare services to improve understandings of how to avoid and minimize potential harm to patients. This process can be aided by reframing known telecare implementation challenges and user experiences of telecare with the help of a human factors systems approach to patient safety.

Management Commitment to Safety, Teamwork, and Hospital Worker Injuries.

PubMed

McGonagle, Alyssa K; Essenmacher, Lynnette; Hamblin, Lydia; Luborsky, Mark; Upfal, Mark; Arnetz, Judith

2016-01-01

Although many studies link teamwork in health care settings to patient safety, evidence linking teamwork to hospital worker safety is lacking. This study addresses this gap by providing evidence linking teamwork perceptions in hospital workers to worker injuries, and further, finds a linkage between manager commitment to safety and teamwork. Organizational records of worker injuries and survey responses regarding management commitment to safety and teamwork from 446 hospital workers within 42 work units in a multi-site hospital system were examined. Results underscored the particular importance of teamwork on worker injuries as well as the importance of management commitment to safety as relating to teamwork. To improve worker safety, organizational leaders and unit managers should work to maintain environments wherein teamwork can thrive.

Management Commitment to Safety, Teamwork, and Hospital Worker Injuries

PubMed Central

McGonagle, Alyssa K.; Essenmacher, Lynnette; Hamblin, Lydia; Luborsky, Mark; Upfal, Mark; Arnetz, Judith

2016-01-01

Although many studies link teamwork in health care settings to patient safety, evidence linking teamwork to hospital worker safety is lacking. This study addresses this gap by providing evidence linking teamwork perceptions in hospital workers to worker injuries, and further, finds a linkage between manager commitment to safety and teamwork. Organizational records of worker injuries and survey responses regarding management commitment to safety and teamwork from 446 hospital workers within 42 work units in a multi-site hospital system were examined. Results underscored the particular importance of teamwork on worker injuries as well as the importance of management commitment to safety as relating to teamwork. To improve worker safety, organizational leaders and unit managers should work to maintain environments wherein teamwork can thrive. PMID:27867448

Leadership for safety: industrial experience.

PubMed

Flin, R; Yule, S

2004-12-01

The importance of leadership for effective safety management has been the focus of research attention in industry for a number of years, especially in energy and manufacturing sectors. In contrast, very little research into leadership and safety has been carried out in medical settings. A selective review of the industrial safety literature for leadership research with possible application in health care was undertaken. Emerging findings show the importance of participative, transformational styles for safety performance at all levels of management. Transactional styles with attention to monitoring and reinforcement of workers' safety behaviours have been shown to be effective at the supervisory level. Middle managers need to be involved in safety and foster open communication, while ensuring compliance with safety systems. They should allow supervisors a degree of autonomy for safety initiatives. Senior managers have a prime influence on the organisation's safety culture. They need to continuously demonstrate a visible commitment to safety, best indicated by the time they devote to safety matters.

Software development for safety-critical medical applications

NASA Technical Reports Server (NTRS)

Knight, John C.

1992-01-01

There are many computer-based medical applications in which safety and not reliability is the overriding concern. Reduced, altered, or no functionality of such systems is acceptable as long as no harm is done. A precise, formal definition of what software safety means is essential, however, before any attempt can be made to achieve it. Without this definition, it is not possible to determine whether a specific software entity is safe. A set of definitions pertaining to software safety will be presented and a case study involving an experimental medical device will be described. Some new techniques aimed at improving software safety will also be discussed.

Surgical checklists: a systematic review of impacts and implementation

PubMed Central

Treadwell, Jonathan R; Lucas, Scott; Tsou, Amy Y

2014-01-01

Background Surgical complications represent a significant cause of morbidity and mortality with the rate of major complications after inpatient surgery estimated at 3–17% in industrialised countries. The purpose of this review was to summarise experience with surgical checklist use and efficacy for improving patient safety. Methods A search of four databases (MEDLINE, CINAHL, EMBASE and the Cochrane Database of Controlled Trials) was conducted from 1 January 2000 to 26 October 2012. Articles describing actual use of the WHO checklist, the Surgical Patient Safety System (SURPASS) checklist, a wrong-site surgery checklist or an anaesthesia equipment checklist were eligible for inclusion (this manuscript summarises all but the anaesthesia equipment checklists, which are described in the Agency for Healthcare Research and Quality publication). Results We included a total of 33 studies. We report a variety of outcomes including avoidance of adverse events, facilitators and barriers to implementation. Checklists have been adopted in a wide variety of settings and represent a promising strategy for improving the culture of patient safety and perioperative care in a wide variety of settings. Surgical checklists were associated with increased detection of potential safety hazards, decreased surgical complications and improved communication among operating staff. Strategies for successful checklist implementation included enlisting institutional leaders as local champions, incorporating staff feedback for checklist adaptation and avoiding redundancies with existing systems for collecting information. Conclusions Surgical checklists represent a relatively simple and promising strategy for addressing surgical patient safety worldwide. Further studies are needed to evaluate to what degree checklists improve clinical outcomes and whether improvements may be more pronounced in particular settings. PMID:23922403

Industry Initiated Core Safety Attributes for Human Spaceflight for the 7th IAASS Conference

NASA Technical Reports Server (NTRS)

Mango, Edward J.

2014-01-01

Now that the NASA Commercial Crew Program (CCP) is beginning its full certification contract for crew transportation to the International Space Station (ISS), is it time for industry to embrace a minimum set of core safety attributes? Those attributes can then be evolved into an industry-led set of basic safety standards and requirements. After 50 years of human space travel sponsored by governments, there are two basic conditions that now exist within the international space industry. The first, there is enough of a space-faring history to encourage the space industry to design, develop and operate human spaceflight systems without government contracts for anything other than services. Second, industry is capable of defining and enforcing a set of industry-based safety attributes and standards for human spaceflight to low-Earth orbit (LEO). This paper will explore both of these basic conditions with a focus on the safety attributes and standards. In the United States, the Federal Aviation Administration (FAA) is now starting to dialogue with industry about the basic safety principles and attributes needed for potential future regulatory oversight. This process is not yet formalized and will take a number of years once approval is given to move forward. Therefore, throughout the next few years, it is an excellent time and opportunity for industry to collaborate together and develop the core set of attributes and standards. As industry engages and embraces a common set of safety attributes, then government agencies, like the FAA and NASA can use that industry-based product to strengthen their efforts on a safe commercial spaceflight foundation for the future. As the commercial space industry takes the lead role in establishing core safety attributes, and then enforcing those attributes, the entire planet can move away from governmental control of design and development and let industry expand safe and successful space operations in LEO. At that point the governmental agencies can focus on oversight of the industries' defined standards and enforcement for common welfare of the space-faring populous and overall public safety.

Five major NASA health and safety issues

NASA Astrophysics Data System (ADS)

Gavert, Raymond B.

2000-01-01

The goal has been set to establish NASA as number one in safety in the nation. This includes Systems and Mission Safety as well as Occupational Safety for all NASA employees and contractors on and off the job. There are five major health and safety issues important in the pursuit of being number one and they are: (1) Radiation (2) Hearing (3) Habitability/Toxicology (4) Extravehicular Activity (EVA) (5) Stress. The issues have features of accumulated injury since NASA's future missions involve long time human presence in space i.e., International Space Station operations and Mars missions. The objective of this paper is to discuss these five issues in terms of controlling risks and enhancing health and safety. Safety metrics are discussed in terms of the overall goal of NASA to be number one in safety. .

Development of a generalized perturbation theory method for sensitivity analysis using continuous-energy Monte Carlo methods

DOE PAGES

Perfetti, Christopher M.; Rearden, Bradley T.

2016-03-01

The sensitivity and uncertainty analysis tools of the ORNL SCALE nuclear modeling and simulation code system that have been developed over the last decade have proven indispensable for numerous application and design studies for nuclear criticality safety and reactor physics. SCALE contains tools for analyzing the uncertainty in the eigenvalue of critical systems, but cannot quantify uncertainty in important neutronic parameters such as multigroup cross sections, fuel fission rates, activation rates, and neutron fluence rates with realistic three-dimensional Monte Carlo simulations. A more complete understanding of the sources of uncertainty in these design-limiting parameters could lead to improvements in processmore » optimization, reactor safety, and help inform regulators when setting operational safety margins. A novel approach for calculating eigenvalue sensitivity coefficients, known as the CLUTCH method, was recently explored as academic research and has been found to accurately and rapidly calculate sensitivity coefficients in criticality safety applications. The work presented here describes a new method, known as the GEAR-MC method, which extends the CLUTCH theory for calculating eigenvalue sensitivity coefficients to enable sensitivity coefficient calculations and uncertainty analysis for a generalized set of neutronic responses using high-fidelity continuous-energy Monte Carlo calculations. Here, several criticality safety systems were examined to demonstrate proof of principle for the GEAR-MC method, and GEAR-MC was seen to produce response sensitivity coefficients that agreed well with reference direct perturbation sensitivity coefficients.« less

Emotions at work: what is the link to patient and staff safety? Implications for nurse managers in the NHS.

PubMed

Smith, Pam; Pearson, Pauline H; Ross, Fiona

2009-03-01

This paper sets the discussion of emotions at work within the modern NHS and the current prioritisation of creating a safety culture within the service. The paper focuses on the work of students, frontline nurses and their managers drawing on recent studies of patient safety in the curriculum, and governance and incentives in the care of patients with complex long term conditions. The primary research featured in the paper combined a case study design with focus groups, interviews and observation. In the patient safety research the importance of physical and emotional safety emerged as a key finding both for users and professionals. In the governance and incentives research, risk emerged as a key concern for managers, frontline workers and users. The recognition of emotions and the importance of emotional labour at an individual and organizational level managed by emotionally intelligent leaders played an important role in promoting worker and patient safety and reducing workplace risk. Nurse managers need to be aware of the emotional complexities of their organizations in order to set up systems to support the emotional wellbeing of professionals and users which in turn ensures safety and reduces risk.

Specific features of medicines safety and pharmacovigilance in Africa

PubMed Central

Pal, Shanthi N.; Olsson, Sten; Dodoo, Alexander; Bencheikh, Rachida Soulayami

2012-01-01

The thalidomide tragedy in the late 1950s and early 1960s served as a wakeup call and raised questions about the safety of medicinal products. The developed countries rose to the challenge putting in place systems to ensure the safety of medicines. However, this was not the case for low-resource settings because of prevailing factors inherent in them. This paper reviews some of these features and the current status of pharmacovigilance in Africa. The health systems in most of the 54 countries of Africa are essentially weak, lacking in basic infrastructure, personnel, equipment and facilities. The recent mass deployment of medicines to address diseases of public health significance in Africa poses additional challenges to the health system with notable safety concerns. Other safety issues of note include substandard and counterfeit medicines, medication errors and quality of medicinal products. The first national pharmacovigilance centres established in Africa with membership of the World Health Organization (WHO) international drug monitoring programme were in Morocco and South Africa in 1992. Of the 104 full member countries in the programme, there are now 24 African countries with a further nine countries as associate members. The pharmacovigilance systems operational in African countries are based essentially on spontaneous reporting facilitated by the introduction of the new tool Vigiflow. The individual case safety reports committed to the WHO global database (Vigibase) attest to the growth of pharmacovigilance in Africa with the number of reports rising from 2695 in 2000 to over 25,000 in 2010. There is need to engage the various identified challenges of the weak pharmacovigilance systems in the African setting and to focus efforts on how to provide resources, infrastructure and expertise. Raising the level of awareness among healthcare providers, developing training curricula for healthcare professionals, provisions for paediatric and geriatric pharmacovigilance, engaging the pharmaceutical industries as well as those for herbal remedies are of primary concern. PMID:25083223

75 FR 81667 - Biweekly Notice; Applications and Amendments to Facility Operating Licenses Involving No...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-28

...-Filing system does not support unlisted software, and the NRC Meta System Help Desk will not be able to... Setpoint Methodology for LSSS [Limiting Safety System Setting] Functions,'' which included the instrument... System Instrumentation,'' Function 3, Condensate Storage Tank Level--Low. The supporting TS Bases will...

[Quality control in herbal supplements].

PubMed

Oelker, Luisa

2005-01-01

Quality and safety of food and herbal supplements are the result of a whole of different elements as good manufacturing practice and process control. The process control must be active and able to individuate and correct all possible hazards. The main and most utilized instrument is the hazard analysis critical control point (HACCP) system the correct application of which can guarantee the safety of the product. Herbal supplements need, in addition to standard quality control, a set of checks to assure the harmlessness and safety of the plants used.

Safety and fitness electronic records system (SAFER) : draft master test plan

DOT National Transportation Integrated Search

1995-12-31

The purpose of this plan is to establish a formal set of guidelines and activities to be : adhered to and performed by JHU/APL and the developer to ensure that the SAFER System has been tested successfully and is fully compliant with the SAFER System...

Building clinical and organizational resilience to reconcile safety threats, tensions and trade-offs: insights from theory and evidence.

PubMed

Jeffs, Lianne; Tregunno, Deborah; MacMillan, Kathleen; Espin, Sherry

2009-01-01

Healthcare delivery settings are complex adaptive and tightly coupled, interrelated systems. Within the larger healthcare system, a key subsystem is the "clinical microsystem" level. It is at this level that clinicians are faced with high levels of uncertainty in their daily work - uncertainty that impacts the quality and safety of care that patients receive. The first aim of this paper is to enhance healthcare leaders' understanding of what is currently known about safety threats and strategies to manage the inherent tensions and trade-offs that occur in everyday practice. The second aim is to inform strategies that build clinical and organizational resilience through a multi-level framework derived from the collective theoretical and empirical work. Together, this information can strengthen safety practices throughout healthcare organizations.

Safe design of healthcare facilities

PubMed Central

Reiling, J

2006-01-01

The physical environment has a significant impact on health and safety; however, hospitals have not been designed with the explicit goal of enhancing patient safety through facility design. In April 2002, St Joseph's Community Hospital of West Bend, a member of SynergyHealth, brought together leaders in healthcare and systems engineering to develop a set of safety‐driven facility design recommendations and principles that would guide the design of a new hospital facility focused on patient safety. By introducing safety‐driven innovations into the facility design process, environmental designers and healthcare leaders will be able to make significant contributions to patient safety. PMID:17142606

A bicycle safety index for evaluating urban street facilities.

PubMed

Asadi-Shekari, Zohreh; Moeinaddini, Mehdi; Zaly Shah, Muhammad

2015-01-01

The objectives of this research are to conceptualize the Bicycle Safety Index (BSI) that considers all parts of the street and to propose a universal guideline with microscale details. A point system method comparing existing safety facilities to a defined standard is proposed to estimate the BSI. Two streets in Singapore and Malaysia are chosen to examine this model. The majority of previous measurements to evaluate street conditions for cyclists usually cannot cover all parts of streets, including segments and intersections. Previous models also did not consider all safety indicators and cycling facilities at a microlevel in particular. This study introduces a new concept of a practical BSI to complete previous studies using its practical, easy-to-follow, point system-based outputs. This practical model can be used in different urban settings to estimate the level of safety for cycling and suggest some improvements based on the standards.

Preliminary Assessment of Operational Hazards and Safety Requirements for Airborne Trajectory Management (ABTM) Roadmap Applications

NASA Technical Reports Server (NTRS)

Cotton, William B.; Hilb, Robert; Koczo, Stefan, Jr.; Wing, David J.

2016-01-01

A set of five developmental steps building from the NASA TASAR (Traffic Aware Strategic Aircrew Requests) concept are described, each providing incrementally more efficiency and capacity benefits to airspace system users and service providers, culminating in a Full Airborne Trajectory Management capability. For each of these steps, the incremental Operational Hazards and Safety Requirements are identified for later use in future formal safety assessments intended to lead to certification and operational approval of the equipment and the associated procedures. Two established safety assessment methodologies that are compliant with the FAA's Safety Management System were used leading to Failure Effects Classifications (FEC) for each of the steps. The most likely FEC for the first three steps, Basic TASAR, Digital TASAR, and 4D TASAR, is "No effect". For step four, Strategic Airborne Trajectory Management, the likely FEC is "Minor". For Full Airborne Trajectory Management (Step 5), the most likely FEC is "Major".

Behavior-based safety on construction sites: a case study.

PubMed

Choudhry, Rafiq M

2014-09-01

This work presents the results of a case study and describes an important area within the field of construction safety management, namely behavior-based safety (BBS). This paper adopts and develops a management approach for safety improvements in construction site environments. A rigorous behavioral safety system and its intervention program was implemented and deployed on target construction sites. After taking a few weeks of safety behavior measurements, the project management team implemented the designed intervention and measurements were taken. Goal-setting sessions were arranged on-site with workers' participation to set realistic and attainable targets of performance. Safety performance measurements continued and the levels of performance and the targets were presented on feedback charts. Supervisors were asked to give workers recognition and praise when they acted safely or improved critical behaviors. Observers were requested to have discussions with workers, visit the site, distribute training materials to workers, and provide feedback to crews and display charts. They were required to talk to operatives in the presence of line managers. It was necessary to develop awareness and understanding of what was being measured. In the process, operatives learned how to act safely when conducting site tasks using the designed checklists. Current weekly scores were discussed in the weekly safety meetings and other operational site meetings with emphasis on how to achieve set targets. The reliability of the safety performance measures taken by the company's observers was monitored. A clear increase in safety performance level was achieved across all categories: personal protective equipment; housekeeping; access to heights; plant and equipment, and scaffolding. The research reveals that scores of safety performance at one project improved from 86% (at the end of 3rd week) to 92.9% during the 9th week. The results of intervention demonstrated large decreases in unsafe behaviors and significant increases in safe behaviors. The results of this case study showed that an approach based on goal setting, feedback, and an effective measure of safety behavior if properly applied by committed management, can improve safety performance significantly in construction site environments. The results proved that the BBS management technique can be applied to any country's culture, showing that it would be a good approach for improving the safety of front-line workers and that it has industry wide application for ongoing construction projects. Copyright © 2014 Elsevier Ltd. All rights reserved.

Case study: the Argentina Road Safety Project: lessons learned for the decade of action for road safety, 2011-2020.

PubMed

Raffo, Veronica; Bliss, Tony; Shotten, Marc; Sleet, David; Blanchard, Claire

2013-12-01

This case study of the Argentina Road Safety Project demonstrates how the application of World Bank road safety project guidelines focused on institution building can accelerate knowledge transfer, scale up investment and improve the focus on results. The case study highlights road safety as a development priority and outlines World Bank initiatives addressing the implementation of the World Report on Road Traffic Injury's recommendations and the subsequent launch of the Decade of Action for Road Safety, from 2011-2020. The case study emphasizes the vital role played by the lead agency in ensuring sustainable road safety improvements and promoting the shift to a 'Safe System' approach, which necessitated the strengthening of all elements of the road safety management system. It summarizes road safety performance and institutional initiatives in Argentina leading up to the preparation and implementation of the project. We describe the project's development objectives, financing arrangements, specific components and investment staging. Finally, we discuss its innovative features and lessons learned, and present a set of supplementary guidelines, both to assist multilateral development banks and their clients with future road safety initiatives, and to encourage better linkages between the health and transportation sectors supporting them.

An Autonomous Flight Safety System

NASA Technical Reports Server (NTRS)

Bull, James B.; Lanzi, Raymond J.

2007-01-01

The Autonomous Flight Safety System (AFSS) being developed by NASA s Goddard Space Flight Center s Wallops Flight Facility and Kennedy Space Center has completed two successful developmental flights and is preparing for a third. AFSS has been demonstrated to be a viable architecture for implementation of a completely vehicle based system capable of protecting life and property in event of an errant vehicle by terminating the flight or initiating other actions. It is capable of replacing current human-in-the-loop systems or acting in parallel with them. AFSS is configured prior to flight in accordance with a specific rule set agreed upon by the range safety authority and the user to protect the public and assure mission success. This paper discusses the motivation for the project, describes the method of development, and presents an overview of the evolving architecture and the current status.

BWR station blackout: A RISMC analysis using RAVEN and RELAP5-3D

DOE PAGES

Mandelli, D.; Smith, C.; Riley, T.; ...

2016-01-01

The existing fleet of nuclear power plants is in the process of extending its lifetime and increasing the power generated from these plants via power uprates and improved operations. In order to evaluate the impact of these factors on the safety of the plant, the Risk-Informed Safety Margin Characterization (RISMC) project aims to provide insights to decision makers through a series of simulations of the plant dynamics for different initial conditions and accident scenarios. This paper presents a case study in order to show the capabilities of the RISMC methodology to assess impact of power uprate of a Boiling Watermore » Reactor system during a Station Black-Out accident scenario. We employ a system simulator code, RELAP5-3D, coupled with RAVEN which perform the stochastic analysis. Furthermore, our analysis is performed by: 1) sampling values from a set of parameters from the uncertainty space of interest, 2) simulating the system behavior for that specific set of parameter values and 3) analyzing the outcomes from the set of simulation runs.« less

Advancing pharmacovigilance through academic-legal collaboration: the case of gadolinium-based contrast agents and nephrogenic systemic fibrosis-a Research on Adverse Drug Events and Reports (RADAR) report.

PubMed

Edwards, B J; Laumann, A E; Nardone, B; Miller, F H; Restaino, J; Raisch, D W; McKoy, J M; Hammel, J A; Bhatt, K; Bauer, K; Samaras, A T; Fisher, M J; Bull, C; Saddleton, E; Belknap, S M; Thomsen, H S; Kanal, E; Cowper, S E; Abu Alfa, A K; West, D P

2014-10-01

To compare and contrast three databases, that is, The International Centre for Nephrogenic Systemic Fibrosis Registry (ICNSFR), the Food and Drug Administration Adverse Event Reporting System (FAERS) and a legal data set, through pharmacovigilance and to evaluate international nephrogenic systemic fibrosis (NSF) safety efforts. The Research on Adverse Drug events And Reports methodology was used for assessment-the FAERS (through June 2009), ICNSFR and the legal data set (January 2002 to December 2010). Safety information was obtained from the European Medicines Agency, the Danish Medicine Agency and the Food and Drug Administration. The FAERS encompassed the largest number (n = 1395) of NSF reports. The ICNSFR contained the most complete (n = 335, 100%) histopathological data. A total of 382 individual biopsy-proven, product-specific NSF cases were analysed from the legal data set. 76.2% (291/382) identified exposure to gadodiamide, of which 67.7% (197/291) were unconfounded. Additionally, 40.1% (153/382) of cases involved gadopentetate dimeglumine, of which 48.4% (74/153) were unconfounded, while gadoversetamide was identified in 7.3% (28/382) of which 28.6% (8/28) were unconfounded. Some cases involved gadobenate dimeglumine or gadoteridol, 5.8% (22/382), all of which were confounded. The mean number of exposures to gadolinium-based contrast agents (GBCAs) was gadodiamide (3), gadopentetate dimeglumine (5) and gadoversetamide (2). Of the 279 unconfounded cases, all involved a linear-structured GBCA. 205 (73.5%) were a non-ionic GBCA while 74 (26.5%) were an ionic GBCA. Clinical and legal databases exhibit unique characteristics that prove complementary in safety evaluations. Use of the legal data set allowed the identification of the most commonly implicated GBCA. This article is the first to demonstrate explicitly the utility of a legal data set to pharmacovigilance research.

49 CFR 232.213 - Extended haul trains.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF TRANSPORTATION BRAKE SYSTEM SAFETY STANDARDS FOR FREIGHT AND OTHER NON-PASSENGER TRAINS AND... extended haul trains will originate and a description of the trains that will be operated as extended haul.... (5) The train shall have no more than one pick-up and one set-out en route, except for the set-out of...

Impact of Passive Safety on FHR Instrumentation Systems Design and Classification

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

Holcomb, David Eugene

2015-01-01

Fluoride salt-cooled high-temperature reactors (FHRs) will rely more extensively on passive safety than earlier reactor classes. 10CFR50 Appendix A, General Design Criteria for Nuclear Power Plants, establishes minimum design requirements to provide reasonable assurance of adequate safety. 10CFR50.69, Risk-Informed Categorization and Treatment of Structures, Systems and Components for Nuclear Power Reactors, provides guidance on how the safety significance of systems, structures, and components (SSCs) should be reflected in their regulatory treatment. The Nuclear Energy Institute (NEI) has provided 10 CFR 50.69 SSC Categorization Guideline (NEI-00-04) that factors in probabilistic risk assessment (PRA) model insights, as well as deterministic insights, throughmore » an integrated decision-making panel. Employing the PRA to inform deterministic requirements enables an appropriately balanced, technically sound categorization to be established. No FHR currently has an adequate PRA or set of design basis accidents to enable establishing the safety classification of its SSCs. While all SSCs used to comply with the general design criteria (GDCs) will be safety related, the intent is to limit the instrumentation risk significance through effective design and reliance on inherent passive safety characteristics. For example, FHRs have no safety-significant temperature threshold phenomena, thus enabling the primary and reserve reactivity control systems required by GDC 26 to be passively, thermally triggered at temperatures well below those for which core or primary coolant boundary damage would occur. Moreover, the passive thermal triggering of the primary and reserve shutdown systems may relegate the control rod drive motors to the control system, substantially decreasing the amount of safety-significant wiring needed. Similarly, FHR decay heat removal systems are intended to be running continuously to minimize the amount of safety-significant instrumentation needed to initiate operation of systems and components important to safety as required in GDC 20. This paper provides an overview of the design process employed to develop a pre-conceptual FHR instrumentation architecture intended to lower plant capital and operational costs by minimizing reliance on expensive, safety related, safety-significant instrumentation through the use of inherent passive features of FHRs.« less

An airport occupational health and safety management system from the OHSAS 18001 perspective.

PubMed

Dejanović, Dejana; Heleta, Milenko

2016-09-01

Occupational health and safety represents a set of technical, medical, legal, psychological, pedagogical and other measures with the aim to detect and eliminate hazards that threaten the lives and health of employees. These measures should be applied in a systematic way. Therefore, the aim of this study is to review occupational health and safety legislation in Serbia and the requirements that airports should fulfill for Occupational Health and Safety Assessment Series certification. Analyzing the specificity of airport activities and injuries as their outcomes, the article also proposes preventive measures for the health and safety of employees. Furthermore, the airport activities which are the most important from the standpoint of risks are defined, as the goals for occupational health and safety performance improvement.

Medication safety programs in primary care: a scoping review.

PubMed

Khalil, Hanan; Shahid, Monica; Roughead, Libby

2017-10-01

Medication safety plays an essential role in all healthcare organizations; improving this area is paramount to quality and safety of any wider healthcare program. While several medication safety programs in the hospital setting have been described and the associated impact on patient safety evaluated, no systematic reviews have described the impact of medication safety programs in the primary care setting. A preliminary search of the literature demonstrated that no systematic reviews, meta-analysis or scoping reviews have reported on medication safety programs in primary care; instead they have focused on specific interventions such as medication reconciliation or computerized physician order entry. This scoping review sought to map the current medication safety programs used in primary care. The current scoping review sought to examine the characteristics of medication safety programs in the primary care setting and to map evidence on the outcome measures used to assess the effectiveness of medication safety programs in improving patient safety. The current review considered participants of any age and any condition using care obtained from any primary care services. We considered studies that focussed on the characteristics of medication safety programs and the outcome measures used to measure the effectiveness of these programs on patient safety in the primary care setting. The context of this review was primary care settings, primary healthcare organizations, general practitioner clinics, outpatient clinics and any other clinics that do not classify patients as inpatients. We considered all quantitative studied published in English. A three-step search strategy was utilized in this review. Data were extracted from the included studies to address the review question. The data extracted included type of medication safety program, author, country of origin, aims and purpose of the study, study population, method, comparator, context, main findings and outcome measures. The objectives, inclusion criteria and methods for this scoping review were specified in advance and documented in a protocol that was previously published. This scoping review included nine studies published over an eight-year period that investigated or described the effects of medication safety programs in primary care settings. We classified each of the nine included studies into three main sections according to whether they included an organizational, professional or patient component. The organizational component is aimed at changing the structure of the organization to implement the intervention, the professional component is aimed at the healthcare professionals involved in implementing the interventions, and the patient component is aimed at counseling and education of the patient. All of the included studies had different types of medication safety programs. The programs ranged from complex interventions including pharmacists and teams of healthcare professionals to educational packages for patients and computerized system interventions. The outcome measures described in the included studies were medication error incidence, adverse events and number of drug-related problems. Multi-faceted medication safety programs are likely to vary in characteristics. They include educational training, quality improvement tools, informatics, patient education and feedback provision. The most likely outcome measure for these programs is the incidence of medication errors and reported adverse events or drug-related problems.

46 CFR 393.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Act, as set forth in Chapter 551 of Title 46, United States Code. (d) Corridor Sponsor. An entity that... emissions, energy savings, improved safety, system resiliency, and/or reduced infrastructure costs. Routes...

Nurse working conditions and patient safety outcomes.

PubMed

Stone, Patricia W; Mooney-Kane, Cathy; Larson, Elaine L; Horan, Teresa; Glance, Laurent G; Zwanziger, Jack; Dick, Andrew W

2007-06-01

System approaches, such as improving working conditions, have been advocated to improve patient safety. However, the independent effect of many working condition variables on patient outcomes is unknown. To examine effects of a comprehensive set of working conditions on elderly patient safety outcomes in intensive care units. Observational study, with patient outcome data collected using the National Nosocomial Infection Surveillance system protocols and Medicare files. Several measures of health status and fixed setting characteristics were used to capture distinct dimensions of patient severity of illness and risk for disease. Working condition variables included organizational climate measured by nurse survey; objective measures of staffing, overtime, and wages (derived from payroll data); and hospital profitability and magnet accreditation. The sample comprised 15,846 patients in 51 adult intensive care units in 31 hospitals depending on the outcome analyzed; 1095 nurses were surveyed. Central line associated bloodstream infections (CLBSI), ventilator-associated pneumonia, catheter-associated urinary tract infections, 30-day mortality, and decubiti. Units with higher staffing had lower incidence of CLBSI, ventilator-associated pneumonia, 30-day mortality, and decubiti (P

Perceptions of health care professionals on the safety and security at Odi District Hospital, Gauteng, South Africa

PubMed Central

Okeke, Sunday O.

2017-01-01

Background For optimum delivery of service, an establishment needs to ensure a safe and secure environment. In 2011, the South African government promulgated the National Core Standards for Health Establishments for safety and security for all employees in all establishments. Little is known about whether these standards are being complied to. Aim and setting: To assess the perceptions of health care professionals (HCPs) on safety and security at Odi District Hospital. Methodology A sample of 181 out of a total of 341 HCPs was drawn through a systematic sampling method from each HCP category. Data were collected through a self-administered questionnaire. The SPSS® statistical software version 22 was used for data analysis. The level of statistical significance was set at < 0.05. Results There were more female respondents than male respondents (136; 75.10%). The dominant age group was 28–47 years (114; 57.46%). Perceptions on security personnel, their efficiency and the security system were significantly affirmed (p = 0.0001). The hospital infrastructure, surroundings and plan in emergencies were perceived to be safe (p < 0.0001). The hospital lighting system was perceived as inadequate (p = 0.0041). Only 36 (20.2%) HCPs perceived that hospital authorities were concerned about employees’ safety (p < 0.0001). Conclusion HCPs had positive perceptions regarding the hospital’s security system. Except for the negative perceptions of the lighting system and the perceived lack of hospital authorities’ concern for staff safety, perceptions of the HCPs on the hospital working environment were positive. The hospital authorities need to establish the basis of negative perceptions and enforce remedial measures to redress them. PMID:29113444

Sociotechnical systems as a framework for regulatory system design and evaluation: Using Work Domain Analysis to examine a new regulatory system.

PubMed

Carden, Tony; Goode, Natassia; Read, Gemma J M; Salmon, Paul M

2017-03-15

Like most work systems, the domain of adventure activities has seen a series of serious incidents and subsequent calls to improve regulation. Safety regulation systems aim to promote safety and reduce accidents. However, there is scant evidence they have led to improved safety outcomes. In fact there is some evidence that the poor integration of regulatory system components has led to adverse safety outcomes in some contexts. Despite this, there is an absence of methods for evaluating regulatory and compliance systems. This article argues that sociotechnical systems theory and methods provide a suitable framework for evaluating regulatory systems. This is demonstrated through an analysis of a recently introduced set of adventure activity regulations. Work Domain Analysis (WDA) was used to describe the regulatory system in terms of its functional purposes, values and priority measures, purpose-related functions, object-related processes and cognitive objects. This allowed judgement to be made on the nature of the new regulatory system and on the constraints that may impact its efficacy following implementation. Importantly, the analysis suggests that the new system's functional purpose of ensuring safe activities is not fully supported in terms of the functions and objects available to fulfil them. Potential improvements to the design of the system are discussed along with the implications for regulatory system design and evaluation across the safety critical domains generally. Copyright © 2017 Elsevier Ltd. All rights reserved.

Vortex Advisory System Safety Analysis : Volume 1. Analytical Model

DOT National Transportation Integrated Search

1978-09-01

The Vortex Advisory System (VAS) is based on wind criterion--when the wind near the runway end is outside of the criterion, all interarrival Instrument Flight Rules (IFR) aircraft separations can be set at 3 nautical miles. Five years of wind data ha...

Trust, temporality and systems: how do patients understand patient safety in primary care? A qualitative study.

PubMed

Rhodes, Penny; Campbell, Stephen; Sanders, Caroline

2016-04-01

Patient safety research has tended to focus on hospital settings, although most clinical encounters occur in primary care, and to emphasize practitioner errors, rather than patients' own understandings of safety. To explore patients' understandings of safety in primary care. Qualitative interviews were conducted with patients recruited from general practices in northwest England. Participants were asked basic socio-demographic information; thereafter, topics were largely introduced by interviewees themselves. Transcripts were coded and analysed using NVivo10 (qualitative data software), following a process of constant comparison. Thirty-eight people (14 men, 24 women) from 19 general practices in rural, small town and city locations were interviewed. Many of their concerns (about access, length of consultation, relationship continuity) have been discussed in terms of quality, but, in the interviews, were raised as matters of safety. Three broad themes were identified: (i) trust and psycho-social aspects of professional-patient relationships; (ii) choice, continuity, access, and the temporal underpinnings of safety; and (iii) organizational and systems-level tensions constraining safety. Conceptualizations of safety included common reliance on a bureaucratic framework of accreditation, accountability, procedural rules and regulation, but were also individual and context-dependent. For patients, safety is not just a property of systems, but personal and contingent and is realized in the interaction between doctor and patient. However, it is the systems approach that has dominated safety thinking, and patients' individualistic and relational conceptualizations are poorly accommodated within current service organization. © 2015 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Piloted Well Clear Performance Evaluation of Detect and Avoid Systems with Suggestive Guidance

NASA Technical Reports Server (NTRS)

Mueller, Eric; Santiago, Confesor; Watza, Spencer

2016-01-01

Regulations to establish operational and performance requirements for unmanned aircraft systems (UAS) are being developed by a consortium of government, industry and academic institutions (RTCA, 2013). Those requirements will apply to the new detect-and-avoid (DAA) systems and other equipment necessary to integrate UAS with the United States (U.S) National Airspace System (NAS) and will be determined according to their contribution to the overall safety case. That safety case requires demonstration that DAA-equipped UAS collectively operating in the NAS meet an airspace safety threshold (AST). Several key gaps must be closed in order to link equipment requirements to an airspace safety case. Foremost among these is calculation of the systems risk ratio, the degree to which a particular system mitigates violation of an aircraft separation standard (FAA, 2013). The risk ratio of a DAA system, in combination with risk ratios of other collision mitigation mechanisms, will determine the overall safety of the airspace measured in terms of the number of collisions per flight hour. It is not known what the effectiveness is of a pilot-in-the-loop DAA system or even what parameters of the DAA system most improve the pilots ability to maintain separation. The relationship between the DAA system design and the overall effectiveness of the DAA system that includes the pilot, expressed as a risk ratio, must be determined before DAA operational and performance requirements can be finalized. Much research has been devoted to integrating UAS into non-segregated airspace (Dalamagkidis, 2009, Ostwald, 2007, Gillian, 2012, Hesselink, 2011, Santiago, 2015, Rorie 2015 and 2016). Several traffic displays intended for use as part of a DAA system have gone through human-in-the-loop simulation and flight-testing. Most of these evaluations were part of development programs to produce a deployable system, so it is unclear how to generalize particular aspects of those designs to general requirements for future traffic displays (Calhoun, 2014). Other displays have undergone testing to collect data that may generalize to new displays, but have not been evaluated in the context of the development of an overall safety case for UAS equipped with DAA systems in the NAS (Bell, 2012). Other research efforts focus on DAA surveillance performance and separation standards. Together with this work, they are expected to facilitate validation of the airspace safety case (Park, 2014 and Johnson, 2015). The contribution of the present work is to quantify the effectiveness of the pilot-automation system to remain well clear as a function of display features and surveillance sensor error. This quantification will help enable selection of a minimum set of DAA design features that meets the AST, a set that may not be unique for all UAS platforms. A second objective is to collect and analyze pilot performance parameters that will improve the modeling of overall DAA system performance in non-human-in-the-loop simulations. Simulating the DAA-equipped UAS in such batch experiments will allow investigation of a much larger number of encounters than is possible in human simulations. This capability is necessary to demonstrate that a particular set of DAA requirements meets the AST under all foreseeable operational conditions.

[The Spanish National Health System patient safety strategy, results for the period 2005-2007].

PubMed

Terol, E; Agra, Y; Fernández-Maíllo, M M; Casal, J; Sierra, E; Bandrés, B; García, M J; del Peso, P

2008-12-01

In 2005 the Spanish National Health System (SNHS) implemented a strategy aimed at improving patient safety in Spanish healthcare centres. Promote and develop knowledge of patient safety and a patient safety culture among health professionals and patients; design and implement adverse event information and reporting systems for learning purposes; introduce recommended safe practices in SNHS centres; promote patient safety research and public and patient involvement in patient safety policies. An Institutional Technical Committee was created with representatives from all the Spanish regions. All national organizations involved in healthcare quality and patient safety took part in the project. The strategy follows the WHO World Alliance for Patient Safety and Council of Europe recommendations. Budget allocated in the period 2005-2007: approximately EUR35 million. Around 5,000 health professionals were educated in PS concepts. Several studies were conducted on: adverse events in Hospitals and Primary Care, as well as studies to obtain information on health professionals' perceptions on safety, the use of medications and the situation regarding hospital-acquired infections. All the regions have introduced safe clinical practices related with the strategy. The strategy has been implemented in all the Spanish regions. Awareness was raised among health professionals and the public. A network of alliances has been set up with the regions, universities, schools, agencies and other organizations supporting the strategy.

Are automatic systems the future of motorcycle safety? A novel methodology to prioritize potential safety solutions based on their projected effectiveness.

PubMed

Gil, Gustavo; Savino, Giovanni; Piantini, Simone; Baldanzini, Niccolò; Happee, Riender; Pierini, Marco

2017-11-17

Motorcycle riders are involved in significantly more crashes per kilometer driven than passenger car drivers. Nonetheless, the development and implementation of motorcycle safety systems lags far behind that of passenger cars. This research addresses the identification of the most effective motorcycle safety solutions in the context of different countries. A knowledge-based system of motorcycle safety (KBMS) was developed to assess the potential for various safety solutions to mitigate or avoid motorcycle crashes. First, a set of 26 common crash scenarios was identified from the analysis of multiple crash databases. Second, the relative effectiveness of 10 safety solutions was assessed for the 26 crash scenarios by a panel of experts. Third, relevant information about crashes was used to weigh the importance of each crash scenario in the region studied. The KBMS method was applied with an Italian database, with a total of more than 1 million motorcycle crashes in the period 2000-2012. When applied to the Italian context, the KBMS suggested that automatic systems designed to compensate for riders' or drivers' errors of commission or omission are the potentially most effective safety solution. The KBMS method showed an effective way to compare the potential of various safety solutions, through a scored list with the expected effectiveness of each safety solution for the region to which the crash data belong. A comparison of our results with a previous study that attempted a systematic prioritization of safety systems for motorcycles (PISa project) showed an encouraging agreement. Current results revealed that automatic systems have the greatest potential to improve motorcycle safety. Accumulating and encoding expertise in crash analysis from a range of disciplines into a scalable and reusable analytical tool, as proposed with the use of KBMS, has the potential to guide research and development of effective safety systems. As the expert assessment of the crash scenarios is decoupled from the regional crash database, the expert assessment may be reutilized, thereby allowing rapid reanalysis when new crash data become available. In addition, the KBMS methodology has potential application to injury forecasting, driver/rider training strategies, and redesign of existing road infrastructure.

Leadership for safety: industrial experience

PubMed Central

Flin, R; Yule, S

2004-01-01

The importance of leadership for effective safety management has been the focus of research attention in industry for a number of years, especially in energy and manufacturing sectors. In contrast, very little research into leadership and safety has been carried out in medical settings. A selective review of the industrial safety literature for leadership research with possible application in health care was undertaken. Emerging findings show the importance of participative, transformational styles for safety performance at all levels of management. Transactional styles with attention to monitoring and reinforcement of workers' safety behaviours have been shown to be effective at the supervisory level. Middle managers need to be involved in safety and foster open communication, while ensuring compliance with safety systems. They should allow supervisors a degree of autonomy for safety initiatives. Senior managers have a prime influence on the organisation's safety culture. They need to continuously demonstrate a visible commitment to safety, best indicated by the time they devote to safety matters. PMID:15576692

Profiling Systems Using the Defining Characteristics of Systems of Systems (SoS)

DTIC Science & Technology

2010-02-01

system exhaust and emissions system gas engine heating and air conditioning system fuel system regenerative braking system safety system...overcome the limitations of these fuzzy scales, measurement scales are often divided into a relatively small number of disjoint categories so that the...precision is not justified. This lack of precision can typically be addressed by breaking the measurement scale into a set of categories , the use of

GammaKnife surgery: safety and the identity of users.

PubMed

Dinka, David; Nyce, James M; Timpka, Toomas

2005-01-01

In this study we investigated safety-related usability issues of an advanced medical technology, a radiosurgery system. We were interested in which criteria are important for users when a system's usability and safety is to be improved. The data collection was based on interviews and observations at three different sites where the Leksell GammaKnife is used. The analysis was qualitative. The main finding was that the user's identity or professional background has a significant impact both on how he or she views his or her role in the clinical setting, and on how he or she defines what improvements are necessary and general safety issues. In fact, the opinion even of users experienced in safety-related problems was highly influenced by how they related to the technology and its development. None of the users actually considered Leksell GammaKnife as lacking in safety, instead, their assessment was directed towards potential future system improvements. Our findings suggest that the importance of user identity or professional background cannot be neglected during the development of advanced technology. They also suggest that the user feedback should always be related to user background and identity in order to understand how important different issues are for particular users.

The role of the emergency medical dispatch centre (EMDC) and prehospital emergency care safety: results from an incident report (IR) system.

PubMed

Mortaro, Alberto; Pascu, Diana; Zerman, Tamara; Vallaperta, Enrico; Schönsberg, Alberto; Tardivo, Stefano; Pancheri, Serena; Romano, Gabriele; Moretti, Francesca

2015-07-01

The role of the emergency medical dispatch centre (EMDC) is essential to ensure coordinated and safe prehospital care. The aim of this study was to implement an incident report (IR) system in prehospital emergency care management with a view to detecting errors occurring in this setting and guiding the implementation of safety improvement initiatives. An ad hoc IR form for the prehospital setting was developed and implemented within the EMDC of Verona. The form included six phases (from the emergency call to hospital admission) with the relevant list of potential error modes (30 items). This descriptive observational study considered the results from 268 consecutive days between February and November 2010. During the study period, 161 error modes were detected. The majority of these errors occurred in the resource allocation and timing phase (34.2%) and in the dispatch phase (31.0%). Most of the errors were due to human factors (77.6%), and almost half of them were classified as either moderate (27.9%) or severe (19.9%). These results guided the implementation of specific corrective actions, such as the adoption of a more efficient Medical Priority Dispatch System and the development of educational initiatives targeted at both EMDC staff and the population. Despite the intrinsic limits of IR methodology, results suggest how the implementation of an IR system dedicated to the emergency prehospital setting can act as a major driver for the development of a "learning organization" and improve both efficacy and safety of first aid care.

A Collection Scheme for Tracing Information of Pig Safety Production

NASA Astrophysics Data System (ADS)

Luo, Qingyao; Xiong, Benhai; Yang, Liang

This study takes one main production pattern of smallhold pig farming in Tianjin as a study prototype, deeply analyzes characters of informations about tracing inputs including vaccines,feeds,veterinary drugs and supervision test in pig farming, proposesinputs metadata, criteria for integrating inputs event and interface norms for data transmision, developes and completes identification of 2D ear tags and traceability information collection system of pig safety production based on mobile PDA. The system has implemented functions including setting and invalidate of 2D ear tags, collection of tracing inputs and supervision in the mobile PDA and finally integration of tracing events (the epidemic event,feed event,drug event and supervision event) on the traceability data center (server). The PDA information collection system has been applied for demonstration in Tianjin, the collection is simple, convenient and feasible. It could meet with requirements of traceability information system of pig safety production

75 FR 58014 - Pipeline Safety: Information Collection Activity; Request for Comments

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-23

... detection systems must comply with the standards set out in American Petroleum Institute (API) publication API 1130. API 1130 requires operators to record and retain certain information regarding the operation and testing of CPM systems. Compliance with API 1130, including its recordkeeping requirements...

Safety studies on vacuum insulated liquid helium cryostats

NASA Astrophysics Data System (ADS)

Weber, C.; Henriques, A.; Zoller, C.; Grohmann, S.

2017-12-01

The loss of insulating vacuum is often considered as a reasonable foreseeable accident for the dimensioning of cryogenic safety relief devices (SRD). The cryogenic safety test facility PICARD was designed at KIT to investigate such events. In the course of first experiments, discharge instabilities of the spring loaded safety relief valve (SRV) occurred, the so-called chattering and pumping effects. These instabilities reduce the relief flow capacity, which leads to impermissible over-pressures in the system. The analysis of the process dynamics showed first indications for a smaller heat flux than the commonly assumed 4W/cm2. This results in an oversized discharge area for the reduced relief flow rate, which corresponds to the lower heat flux. This paper presents further experimental investigations on the venting of the insulating vacuum with atmospheric air under variation of the set pressure (p set) of the SRV. Based on dynamic process analysis, the results are discussed with focus on effective heat fluxes and operating characteristics of the spring-loaded SRV.

Assessment of Oropharyngeal and Laryngeal Cancer Treatment Delay in a Private and Safety Net Hospital System.

PubMed

Perlow, Haley K; Ramey, Stephen J; Silver, Ben; Kwon, Deukwoo; Chinea, Felix M; Samuels, Stuart E; Samuels, Michael A; Elsayyad, Nagy; Yechieli, Raphael

2018-04-01

Objective To examine the impact of treatment setting and demographic factors on oropharyngeal and laryngeal cancer time to treatment initiation (TTI). Study Design Retrospective case series. Setting Safety net hospital and adjacent private academic hospital. Subjects and Methods Demographic, staging, and treatment details were retrospectively collected for 239 patients treated from January 1, 2014, to June 30, 2016. TTI was defined as days between diagnostic biopsy and initiation of curative treatment (defined as first day of radiotherapy [RT], surgery, or chemotherapy). Results On multivariable analysis, safety net hospital treatment (vs private academic hospital treatment), initial diagnosis at outside hospital, and oropharyngeal cancer (vs laryngeal cancer) were all associated with increased TTI. Surgical treatment, severe comorbidity, and both N1 and N2 status were associated with decreased TTI. Conclusion Safety net hospital treatment was associated with increased TTI. No differences in TTI were found when language spoken and socioeconomic status were examined in the overall cohort.

Specific features of goal setting in road traffic safety

NASA Astrophysics Data System (ADS)

Kolesov, V. I.; Danilov, O. F.; Petrov, A. I.

2017-10-01

Road traffic safety (RTS) management is inherently a branch of cybernetics and therefore requires clear formalization of the task. The paper aims at identification of the specific features of goal setting in RTS management under the system approach. The paper presents the results of cybernetic modeling of the cause-to-effect mechanism of a road traffic accident (RTA); in here, the mechanism itself is viewed as a complex system. A designed management goal function is focused on minimizing the difficulty in achieving the target goal. Optimization of the target goal has been performed using the Lagrange principle. The created working algorithms have passed the soft testing. The key role of the obtained solution in the tactical and strategic RTS management is considered. The dynamics of the management effectiveness indicator has been analyzed based on the ten-year statistics for Russia.

GN&C Engineering Best Practices for Human-Rated Spacecraft Systems

NASA Technical Reports Server (NTRS)

Dennehy, Cornelius J.; Lebsock, Kenneth; West, John

2007-01-01

The NASA Engineering and Safety Center (NESC) recently completed an in-depth assessment to identify a comprehensive set of engineering considerations for the Design, Development, Test and Evaluation (DDT&E) of safe and reliable human-rated spacecraft systems. Reliability subject matter experts, discipline experts, and systems engineering experts were brought together to synthesize the current "best practices" both at the spacecraft system and subsystems levels. The objective of this paper is to summarize, for the larger Community of Practice, the initial set of Guidance, Navigation and Control (GN&C) engineering Best Practices as identified by this NESC assessment process.

GN&C Engineering Best Practices for Human-Rated Spacecraft System

NASA Technical Reports Server (NTRS)

Dennehy, Cornelius J.; Lebsock, Kenneth; West, John

2008-01-01

The NASA Engineering and Safety Center (NESC) recently completed an in-depth assessment to identify a comprehensive set of engineering considerations for the Design, Development, Test and Evaluation (DDT&E) of safe and reliable human-rated spacecraft systems. Reliability subject matter experts, discipline experts, and systems engineering experts were brought together to synthesize the current "best practices" both at the spacecraft system and subsystems levels. The objective of this paper is to summarize, for the larger Community of Practice, the initial set of Guidance, Navigation and Control (GN&C) engineering Best Practices as identified by this NESC assessment process.

GN&C Engineering Best Practices For Human-Rated Spacecraft Systems

NASA Technical Reports Server (NTRS)

Dennehy, Cornelius J.; Lebsock, Kenneth; West, John

2007-01-01

The NASA Engineering and Safety Center (NESC) recently completed an in-depth assessment to identify a comprehensive set of engineering considerations for the Design, Development, Test and Evaluation (DDT&E) of safe and reliable human-rated spacecraft systems. Reliability subject matter experts, discipline experts, and systems engineering experts were brought together to synthesize the current "best practices" both at the spacecraft system and subsystems levels. The objective of this paper is to summarize, for the larger Community of Practice, the initial set of Guidance, Navigation and Control (GN&C) engineering Best Practices as identified by this NESC assessment process.

Measurement tools and process indicators of patient safety culture in primary care. A mixed methods study by the LINNEAUS collaboration on patient safety in primary care.

PubMed

Parker, Dianne; Wensing, Michel; Esmail, Aneez; Valderas, Jose M

2015-09-01

There is little guidance available to healthcare practitioners about what tools they might use to assess the patient safety culture. To identify useful tools for assessing patient safety culture in primary care organizations in Europe; to identify those aspects of performance that should be assessed when investigating the relationship between safety culture and performance in primary care. Two consensus-based studies were carried out, in which subject matter experts and primary healthcare professionals from several EU states rated (a) the applicability to their healthcare system of several existing safety culture assessment tools and (b) the appropriateness and usefulness of a range of potential indicators of a positive patient safety culture to primary care settings. The safety culture tools were field-tested in four countries to ascertain any challenges and issues arising when used in primary care. The two existing tools that received the most favourable ratings were the Manchester patient safety framework (MaPsAF primary care version) and the Agency for healthcare research and quality survey (medical office version). Several potential safety culture process indicators were identified. The one that emerged as offering the best combination of appropriateness and usefulness related to the collection of data on adverse patient events. Two tools, one quantitative and one qualitative, were identified as applicable and useful in assessing patient safety culture in primary care settings in Europe. Safety culture indicators in primary care should focus on the processes rather than the outcomes of care.

Measurement tools and process indicators of patient safety culture in primary care. A mixed methods study by the LINNEAUS collaboration on patient safety in primary care

PubMed Central

Parker, Dianne; Wensing, Michel; Esmail, Aneez; Valderas, Jose M

2015-01-01

ABSTRACT Background: There is little guidance available to healthcare practitioners about what tools they might use to assess the patient safety culture. Objective: To identify useful tools for assessing patient safety culture in primary care organizations in Europe; to identify those aspects of performance that should be assessed when investigating the relationship between safety culture and performance in primary care. Methods: Two consensus-based studies were carried out, in which subject matter experts and primary healthcare professionals from several EU states rated (a) the applicability to their healthcare system of several existing safety culture assessment tools and (b) the appropriateness and usefulness of a range of potential indicators of a positive patient safety culture to primary care settings. The safety culture tools were field-tested in four countries to ascertain any challenges and issues arising when used in primary care. Results: The two existing tools that received the most favourable ratings were the Manchester patient safety framework (MaPsAF primary care version) and the Agency for healthcare research and quality survey (medical office version). Several potential safety culture process indicators were identified. The one that emerged as offering the best combination of appropriateness and usefulness related to the collection of data on adverse patient events. Conclusion: Two tools, one quantitative and one qualitative, were identified as applicable and useful in assessing patient safety culture in primary care settings in Europe. Safety culture indicators in primary care should focus on the processes rather than the outcomes of care. PMID:26339832

Effective vaccine safety systems in all countries: a challenge for more equitable access to immunization.

PubMed

Amarasinghe, Ananda; Black, Steve; Bonhoeffer, Jan; Carvalho, Sandra M Deotti; Dodoo, Alexander; Eskola, Juhani; Larson, Heidi; Shin, Sunheang; Olsson, Sten; Balakrishnan, Madhava Ram; Bellah, Ahmed; Lambach, Philipp; Maure, Christine; Wood, David; Zuber, Patrick; Akanmori, Bartholomew; Bravo, Pamela; Pombo, María; Langar, Houda; Pfeifer, Dina; Guichard, Stéphane; Diorditsa, Sergey; Hossain, Md Shafiqul; Sato, Yoshikuni

2013-04-18

Serious vaccine-associated adverse events are rare. To further minimize their occurrence and to provide adequate care to those affected, careful monitoring of immunization programs and case management is required. Unfounded vaccine safety concerns have the potential of seriously derailing effective immunization activities. To address these issues, vaccine pharmacovigilance systems have been developed in many industrialized countries. As new vaccine products become available to prevent new diseases in various parts of the world, the demand for effective pharmacovigilance systems in low- and middle-income countries (LMIC) is increasing. To help establish such systems in all countries, WHO developed the Global Vaccine Safety Blueprint in 2011. This strategic plan is based on an in-depth analysis of the vaccine safety landscape that involved many stakeholders. This analysis reviewed existing systems and international vaccine safety activities and assessed the financial resources required to operate them. The Blueprint sets three main strategic goals to optimize the safety of vaccines through effective use of pharmacovigilance principles and methods: to ensure minimal vaccine safety capacity in all countries; to provide enhanced capacity for specific circumstances; and to establish a global support network to assist national authorities with capacity building and crisis management. In early 2012, the Global Vaccine Safety Initiative (GVSI) was launched to bring together and explore synergies among on-going vaccine safety activities. The Global Vaccine Action Plan has identified the Blueprint as its vaccine safety strategy. There is an enormous opportunity to raise awareness for vaccine safety in LMIC and to garner support from a large number of stakeholders for the GVSI between now and 2020. Synergies and resource mobilization opportunities presented by the Decade of Vaccines can enhance monitoring and response to vaccine safety issues, thereby leading to more equitable delivery of vaccines worldwide. Copyright © 2012 Elsevier Ltd. All rights reserved.

Accident analysis and control options in support of the sludge water system safety analysis

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

HEY, B.E.

A hazards analysis was initiated for the SWS in July 2001 (SNF-8626, K Basin Sludge and Water System Preliminary Hazard Analysis) and updated in December 2001 (SNF-10020 Rev. 0, Hazard Evaluation for KE Sludge and Water System - Project A16) based on conceptual design information for the Sludge Retrieval System (SRS) and 60% design information for the cask and container. SNF-10020 was again revised in September 2002 to incorporate new hazards identified from final design information and from a What-if/Checklist evaluation of operational steps. The process hazards, controls, and qualitative consequence and frequency estimates taken from these efforts have beenmore » incorporated into Revision 5 of HNF-3960, K Basins Hazards Analysis. The hazards identification process documented in the above referenced reports utilized standard industrial safety techniques (AIChE 1992, Guidelines for Hazard Evaluation Procedures) to systematically guide several interdisciplinary teams through the system using a pre-established set of process parameters (e.g., flow, temperature, pressure) and guide words (e.g., high, low, more, less). The teams generally included representation from the U.S. Department of Energy (DOE), K Basins Nuclear Safety, T Plant Nuclear Safety, K Basin Industrial Safety, fire protection, project engineering, operations, and facility engineering.« less

A risk-based decision support framework for selection of appropriate safety measure system for underground coal mines.

PubMed

Samantra, Chitrasen; Datta, Saurav; Mahapatra, Siba Sankar

2017-03-01

In the context of underground coal mining industry, the increased economic issues regarding implementation of additional safety measure systems, along with growing public awareness to ensure high level of workers safety, have put great pressure on the managers towards finding the best solution to ensure safe as well as economically viable alternative selection. Risk-based decision support system plays an important role in finding such solutions amongst candidate alternatives with respect to multiple decision criteria. Therefore, in this paper, a unified risk-based decision-making methodology has been proposed for selecting an appropriate safety measure system in relation to an underground coal mining industry with respect to multiple risk criteria such as financial risk, operating risk, and maintenance risk. The proposed methodology uses interval-valued fuzzy set theory for modelling vagueness and subjectivity in the estimates of fuzzy risk ratings for making appropriate decision. The methodology is based on the aggregative fuzzy risk analysis and multi-criteria decision making. The selection decisions are made within the context of understanding the total integrated risk that is likely to incur while adapting the particular safety system alternative. Effectiveness of the proposed methodology has been validated through a real-time case study. The result in the context of final priority ranking is seemed fairly consistent.

Applications for radio-frequency identification technology in the perioperative setting.

PubMed

Zhao, Tiyu; Zhang, Xiaoxiang; Zeng, Lili; Xia, Shuyan; Hinton, Antentor Othrell; Li, Xiuyun

2014-06-01

We implemented a two-year project to develop a security-gated management system for the perioperative setting using radio-frequency identification (RFID) technology to enhance the management efficiency of the OR. We installed RFID readers beside the entrances to the OR and changing areas to receive and process signals from the RFID tags that we sewed into surgical scrub attire and shoes. The system also required integrating automatic access control panels, computerized lockers, light-emitting diode (LED) information screens, wireless networks, and an information system. By doing this, we are able to control the flow of personnel and materials more effectively, reduce OR costs, optimize the registration and attire-changing process for personnel, and improve management efficiency. We also anticipate this system will improve patient safety by reducing the risk of surgical site infection. Application of security-gated management systems is an important and effective way to help ensure a clean, convenient, and safe management process to manage costs in the perioperative area and promote patient safety. Copyright © 2014 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Policies governing the use of lithium batteries in the Navy

NASA Technical Reports Server (NTRS)

Bis, R. F.; Barnes, J. A.

1983-01-01

Lithium batteries offer many advantages for Navy systems but may also exhibit undesirable hazardous behavior. Safety problems have been traced to a variety of chemical and physical causes. The Navy has established a central safety office with responsibility for all lithium battery use. Before an item is approved for Navy use, it must pass both a design review and a set of end item tests. These reviews focus on complete systems which include a battery inside the end item. After system approval, specific regulations govern the transportation, storage, and disposal of the unit containing lithium batteries. Each of these areas is discussed in detail.

ESSAA: Embedded system safety analysis assistant

NASA Technical Reports Server (NTRS)

Wallace, Peter; Holzer, Joseph; Guarro, Sergio; Hyatt, Larry

1987-01-01

The Embedded System Safety Analysis Assistant (ESSAA) is a knowledge-based tool that can assist in identifying disaster scenarios. Imbedded software issues hazardous control commands to the surrounding hardware. ESSAA is intended to work from outputs to inputs, as a complement to simulation and verification methods. Rather than treating the software in isolation, it examines the context in which the software is to be deployed. Given a specified disasterous outcome, ESSAA works from a qualitative, abstract model of the complete system to infer sets of environmental conditions and/or failures that could cause a disasterous outcome. The scenarios can then be examined in depth for plausibility using existing techniques.

The Use of Cell Phones to Address Safety Skills for Students with a Moderate ID in Community-Based Settings

ERIC Educational Resources Information Center

Bassette, Laura A.; Taber-Doughty, Teresa; Gama, Roberto I.; Alberto, Paul; Yakubova, Gulnoza; Cihak, David

2018-01-01

The purpose of this study was to examine the impact of a video modeling (VM) intervention in conjunction with a system of least prompts (SLP) to teach safety skills using cell phones to students with a moderate intellectual disability. A multiple-probe design across three participants was used to assess student acquisition in taking and sending a…

NASA Aviation Safety Reporting System

NASA Technical Reports Server (NTRS)

1980-01-01

Problems in briefing of relief by air traffic controllers are discussed, including problems that arise when duty positions are changed by controllers. Altimeter reading and setting errors as factors in aviation safety are discussed, including problems associated with altitude-including instruments. A sample of reports from pilots and controllers is included, covering the topics of ATIS broadcasts an clearance readback problems. A selection of Alert Bulletins, with their responses, is included.

Analysis of the medication-use process in North American hospital systems: underlining key points for adoption to improve patient safety in French hospitals.

PubMed

Brouard, Agnes; Fagon, Jean Yves; Daniels, Charles E

2011-01-01

This project was designed to underline any actions relative to medication error prevention and patient safety improvement setting up in North American hospitals which could be implemented in French Parisian hospitals. A literature research and analysis of medication-use process in the North American hospitals and a validation survey of hospital pharmacist managers in the San Diego area was performed to assess main points of hospital medication-use process. Literature analysis, survey analysis of respondents highlighted main differences between the two countries at three levels: nationwide, hospital level and pharmaceutical service level. According to this, proposal development to optimize medication-use process in the French system includes the following topics: implementation of an expanded use of information technology and robotics; increase pharmaceutical human resources allowing expansion of clinical pharmacy activities; focus on high-risk medications and high-risk patient populations; develop a collective sense of responsibility for medication error prevention in hospital settings, involving medical, pharmaceutical and administrative teams. Along with a strong emphasis that should be put on the identified topics to improve the quality and safety of hospital care in France, consideration of patient safety as a priority at a nationwide level needs to be reinforced.

Motorcycles that See: Multifocal Stereo Vision Sensor for Advanced Safety Systems in Tilting Vehicles

PubMed Central

2018-01-01

Advanced driver assistance systems, ADAS, have shown the possibility to anticipate crash accidents and effectively assist road users in critical traffic situations. This is not the case for motorcyclists, in fact ADAS for motorcycles are still barely developed. Our aim was to study a camera-based sensor for the application of preventive safety in tilting vehicles. We identified two road conflict situations for which automotive remote sensors installed in a tilting vehicle are likely to fail in the identification of critical obstacles. Accordingly, we set two experiments conducted in real traffic conditions to test our stereo vision sensor. Our promising results support the application of this type of sensors for advanced motorcycle safety applications. PMID:29351267

Wireless Roadside Inspection Proof of Concept Test Final Report

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

Capps, Gary J; Franzese, Oscar; Knee, Helmut E

2009-03-01

The U.S. Department of Transportation (DOT) FMCSA commissioned the Wireless Roadside Inspection (WRI) Program to validate technologies and methodologies that can improve safety through inspections using wireless technologies that convey real-time identification of commercial vehicles, drivers, and carriers, as well as information about the condition of the vehicles and their drivers. It is hypothesized that these inspections will: -- Increase safety -- Decrease the number of unsafe commercial vehicles on the road; -- Increase efficiency -- Speed up the inspection process, enabling more inspections to occur, at least on par with the number of weight inspections; -- Improve effectiveness --more » Reduce the probability of drivers bypassing CMV inspection stations and increase the likelihood that fleets will attempt to meet the safety regulations; and -- Benefit industry -- Reduce fleet costs, provide good return-on-investment, minimize wait times, and level the playing field. The WRI Program is defined in three phases which are: Phase 1: Proof of Concept Test (POC) Testing of commercially available off-the-shelf (COTS) or near-COTS technology to validate the wireless inspection concept. Phase 2: Pilot Test Safety technology maturation and back office system integration Phase 3: Field Operational Test Multi-vehicle testing over a multi-state instrumented corridor This report focuses on Phase 1 efforts that were initiated in March, 2006. Technical efforts dealt with the ability of a Universal Wireless Inspection System (UWIS) to collect driver, vehicle, and carrier information; format a Safety Data Message Set from this information; and wirelessly transmit a Safety Data Message Set to a roadside receiver unit or mobile enforcement vehicle.« less

Mindful Application of Aviation Practices in Healthcare.

PubMed

Powell-Dunford, Nicole; Brennan, Peter A; Peerally, Mohammad Farhad; Kapur, Narinder; Hynes, Jonny M; Hodkinson, Peter D

2017-12-01

Evidence supports the efficacy of incorporating select recognized aviation practices and procedures into healthcare. Incident analysis, debrief, safety brief, and crew resource management (CRM) have all been assessed for implementation within the UK healthcare system, a world leader in aviation-based patient safety initiatives. Mindful application, in which aviation practices are specifically tailored to the unique healthcare setting, show promise in terms of acceptance and long-term sustainment. In order to establish British healthcare applications of aviation practices, a PubMed search of UK authored manuscripts published between 2005-2016 was undertaken using search terms 'aviation,' 'healthcare,' 'checklist,' and 'CRM.' A convenience sample of UK-authored aviation medical conference presentations and UK-authored patient safety manuscripts were also reviewed. A total of 11 of 94 papers with UK academic affiliations published between 2005-2016 and relevant to aviation modeled healthcare delivery were found. The debrief process, incident analysis, and CRM are the primary practices incorporated into UK healthcare, with success dependent on cultural acceptance and mindful application. CRM training has gained significant acceptance in UK healthcare environments. Aviation modeled incident analysis, debrief, safety brief, and CRM training are increasingly undertaken within the UK healthcare system. Nuanced application, in which the unique aspects of the healthcare setting are addressed as part of a comprehensive safety approach, shows promise for long-term success. The patient safety brief and aviation modeled incident analysis are in earlier phases of implementation, and warrant further analysis.Powell-Dunford N, Brennan PA, Peerally MF, Kapur N, Hynes JM, Hodkinson PD. Mindful application of aviation practices in healthcare. Aerosp Med Hum Perform. 2017; 88(12):1107-1116.

Intelligent MONitoring System for antiviral pharmacotherapy in patients with chronic hepatitis C (SiMON-VC).

PubMed

Margusino-Framiñán, Luis; Cid-Silva, Purificación; Mena-de-Cea, Álvaro; Sanclaudio-Luhía, Ana Isabel; Castro-Castro, José Antonio; Vázquez-González, Guillermo; Martín-Herranz, Isabel

2017-01-01

Two out of six strategic axes of pharmaceutical care in our hospital are quality and safety of care, and the incorporation of information technologies. Based on this, an information system was developed in the outpatient setting for pharmaceutical care of patients with chronic hepatitis C, SiMON-VC, which would improve the quality and safety of their pharmacotherapy. The objective of this paper is to describe requirements, structure and features of Si- MON-VC. Requirements demanded were that the information system would enter automatically all critical data from electronic clinical records at each of the visits to the Outpatient Pharmacy Unit, allowing the generation of events and alerts, documenting the pharmaceutical care provided, and allowing the use of data for research purposes. In order to meet these requirements, 5 sections were structured for each patient in SiMON-VC: Main Record, Events, Notes, Monitoring Graphs and Tables, and Follow-up. Each section presents a number of tabs with those coded data needed to monitor patients in the outpatient unit. The system automatically generates alerts for assisted prescription validation, efficacy and safety of using antivirals for the treatment of this disease. It features a completely versatile Indicator Control Panel, where temporary monitoring standards and alerts can be set. It allows the generation of reports, and their export to the electronic clinical record. It also allows data to be exported to the usual operating systems, through Big Data and Business Intelligence. Summing up, we can state that SiMON-VC improves the quality of pharmaceutical care provided in the outpatient pharmacy unit to patients with chronic hepatitis C, increasing the safety of antiviral therapy. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Participatory design of a preliminary safety checklist for general practice

PubMed Central

Bowie, Paul; Ferguson, Julie; MacLeod, Marion; Kennedy, Susan; de Wet, Carl; McNab, Duncan; Kelly, Moya; McKay, John; Atkinson, Sarah

2015-01-01

Background The use of checklists to minimise errors is well established in high reliability, safety-critical industries. In health care there is growing interest in checklists to standardise checking processes and ensure task completion, and so provide further systemic defences against error and patient harm. However, in UK general practice there is limited experience of safety checklist use. Aim To identify workplace hazards that impact on safety, health and wellbeing, and performance, and codesign a standardised checklist process. Design and setting Application of mixed methods to identify system hazards in Scottish general practices and develop a safety checklist based on human factors design principles. Method A multiprofessional ‘expert’ group (n = 7) and experienced front-line GPs, nurses, and practice managers (n = 18) identified system hazards and developed and validated a preliminary checklist using a combination of literature review, documentation review, consensus building workshops using a mini-Delphi process, and completion of content validity index exercise. Results A prototype safety checklist was developed and validated consisting of six safety domains (for example, medicines management), 22 sub-categories (for example, emergency drug supplies) and 78 related items (for example, stock balancing, secure drug storage, and cold chain temperature recording). Conclusion Hazards in the general practice work system were prioritised that can potentially impact on the safety, health and wellbeing of patients, GP team members, and practice performance, and a necessary safety checklist prototype was designed. However, checklist efficacy in improving safety processes and outcomes is dependent on user commitment, and support from leaders and promotional champions. Although further usability development and testing is necessary, the concept should be of interest in the UK and internationally. PMID:25918338

U.S. Food safety and Inspection Service testing for Salmonella in selected raw meat and poultry products in the United States, 1998 through 2003: an establishment-level analysis.

PubMed

Eblen, Denise R; Barlow, Kristina E; Naugle, Alecia Larew

2006-11-01

The U.S. Food Safety and Inspection Service (FSIS) pathogen reduction-hazard analysis critical control point systems final rule, published in 1996, established Salmonella performance standards for broiler chicken, cow and bull, market hog, and steer and heifer carcasses and for ground beef, chicken, and turkey meat. In 1998, the FSIS began testing to verify that establishments are meeting performance standards. Samples are collected in sets in which the number of samples is defined but varies according to product class. A sample set fails when the number of positive Salmonella samples exceeds the maximum number of positive samples allowed under the performance standard. Salmonella sample sets collected at 1,584 establishments from 1998 through 2003 were examined to identify factors associated with failure of one or more sets. Overall, 1,282 (80.9%) of establishments never had failed sets. In establishments that did experience set failure(s), generally the failed sets were collected early in the establishment testing history, with the exception of broiler establishments where failure(s) occurred both early and late in the course of testing. Small establishments were more likely to have experienced a set failure than were large or very small establishments, and broiler establishments were more likely to have failed than were ground beef, market hog, or steer-heifer establishments. Agency response to failed Salmonella sample sets in the form of in-depth verification reviews and related establishment-initiated corrective actions have likely contributed to declines in the number of establishments that failed sets. A focus on food safety measures in small establishments and broiler processing establishments should further reduce the number of sample sets that fail to meet the Salmonella performance standard.

Design, implementation and evaluation of an independent real-time safety layer for medical robotic systems using a force-torque-acceleration (FTA) sensor.

PubMed

Richter, Lars; Bruder, Ralf

2013-05-01

Most medical robotic systems require direct interaction or contact with the robot. Force-Torque (FT) sensors can easily be mounted to the robot to control the contact pressure. However, evaluation is often done in software, which leads to latencies. To overcome that, we developed an independent safety system, named FTA sensor, which is based on an FT sensor and an accelerometer. An embedded system (ES) runs a real-time monitoring system for continuously checking of the readings. In case of a collision or error, it instantaneously stops the robot via the robot's external emergency stop. We found that the ES implementing the FTA sensor has a maximum latency of [Formula: see text] ms to trigger the robot's emergency stop. For the standard settings in the application of robotized transcranial magnetic stimulation, the robot will stop after at most 4 mm. Therefore, it works as an independent safety layer preventing patient and/or operator from serious harm.

A review of the National pharmacovigilance system in Malta - implementing and operating a pharmacovigilance management system.

PubMed

Tanti, Amy; Micallef, Benjamin; Serracino-Inglott, Anthony; Borg, John-Joseph

2017-01-01

Regulatory authorities have a legal mandate to implement and maintain a Pharmacovigilance System designed to monitor the safety of authorised medicinal products and detect any change to their risk-benefit balance. Areas covered: This review maps the implementation of pharmacovigilance activities in Malta since accession in the EU in mid 2004 and discusses the challenges the Maltese Regulator encountered while setting up adequate and effective systems to fulfil its legal mandate. Areas reviewed are those around ADR reporting, promotion and safety communications including rapid alerts and recalls, direct healthcare professional communications, risk minimisation measures and safety circulars and quality systems. Expert opinion: Within a ten year period, 3 EU directives on pharmacovigilance were implemented by our agency. Despite limitations to resources, based on a prioritised implementation, the legislation provisions are now fully operational with a good level of sustainability. Lessons learnt from this process are discussed in this review. The coming years will involve strengthening and consolidation of existing processes.

A centralized storage system for the delivery of subcutaneous infusions.

PubMed

Stuart, Peter; Lee, Jane; Arnold, Gill; Davis, Melanie

Symptom control is an important part of maintaining a palliative patient's comfort and dignity, particularly in the end stages of their illness. Within the discipline of palliative care, the use of continuous subcutaneous syringe drivers is an important way of administering drugs at the end stages of a patient's illness to maintain symptom control. This study identified that ward staff had difficulty in obtaining the correct equipment, such as administration sets and Luer-lock syringes, leading to significant delays in patients being given drugs, affecting patient care and, when unable to obtain the correct equipment, the incorrect equipment was used. It was also identified that there was no consistent approach to the use or maintenance of syringe drivers, with a clear risk to patient safety. The study aim was to identify whether the introduction of a centralized storage system of set boxes containing all the relevant equipment would resolve these issues and improve patient care and safety. The audit showed that a centralized storage system enhanced practice by ensuring that there was a standardized approach to the initiation and care of syringe drivers, including equipment when used in the palliative care setting. The system also provided easy access to the correct equipment, reducing in the delay of commencing treatment, as well as the risk of any adverse events.

Safety Characteristics in System Application of Software for Human Rated Exploration Missions for the 8th IAASS Conference

NASA Technical Reports Server (NTRS)

Mango, Edward J.

2016-01-01

NASA and its industry and international partners are embarking on a bold and inspiring development effort to design and build an exploration class space system. The space system is made up of the Orion system, the Space Launch System (SLS) and the Ground Systems Development and Operations (GSDO) system. All are highly coupled together and dependent on each other for the combined safety of the space system. A key area of system safety focus needs to be in the ground and flight application software system (GFAS). In the development, certification and operations of GFAS, there are a series of safety characteristics that define the approach to ensure mission success. This paper will explore and examine the safety characteristics of the GFAS development. The GFAS system integrates the flight software packages of the Orion and SLS with the ground systems and launch countdown sequencers through the 'agile' software development process. A unique approach is needed to develop the GFAS project capabilities within this agile process. NASA has defined the software development process through a set of standards. The standards were written during the infancy of the so-called industry 'agile development' movement and must be tailored to adapt to the highly integrated environment of human exploration systems. Safety of the space systems and the eventual crew on board is paramount during the preparation of the exploration flight systems. A series of software safety characteristics have been incorporated into the development and certification efforts to ensure readiness for use and compatibility with the space systems. Three underlining factors in the exploration architecture require the GFAS system to be unique in its approach to ensure safety for the space systems, both the flight as well as the ground systems. The first are the missions themselves, which are exploration in nature, and go far beyond the comfort of low Earth orbit operations. The second is the current exploration system will launch only one mission per year even less during its developmental phases. Finally, the third is the partnered approach through the use of many different prime contractors, including commercial and international partners, to design and build the exploration systems. These three factors make the challenges to meet the mission preparations and the safety expectations extremely difficult to implement. As NASA leads a team of partners in the exploration beyond earth's influence, it is a safety imperative that the application software used to test, checkout, prepare and launch the exploration systems put safety of the hardware and mission first. Software safety characteristics are built into the design and development process to enable the human rated systems to begin their missions safely and successfully. Exploration missions beyond Earth are inherently risky, however, with solid safety approaches in both hardware and software, the boldness of these missions can be realized for all on the home planet.

Testing Electronic Algorithms to Create Disease Registries in a Safety Net System

PubMed Central

Hanratty, Rebecca; Estacio, Raymond O.; Dickinson, L. Miriam; Chandramouli, Vijayalaxmi; Steiner, John F.; Havranek, Edward P.

2008-01-01

Electronic disease registries are a critical feature of the chronic disease management programs that are used to improve the care of individuals with chronic illnesses. These registries have been developed primarily in managed care settings; use in safety net institutions—organizations whose mission is to serve the uninsured and underserved—has not been described. We sought to assess the feasibility of developing disease registries from electronic data in a safety net institution, focusing on hypertension because of its importance in minority populations. We compared diagnoses obtained from algorithms utilizing electronic data, including laboratory and pharmacy records, against diagnoses derived from chart review. We found good concordance between diagnoses identified from electronic data and those identified by chart review, suggesting that registries of patients with chronic diseases can be developed outside the setting of closed panel managed care organizations. PMID:18469416

Implementation and Evaluation of the Safety Net Specialty Care Program in the Denver Metropolitan Area

PubMed Central

Fort, Meredith P; Namba, Lynnette M; Dutcher, Sarah; Copeland, Tracy; Bermingham, Neysa; Fellenz, Chris; Lantz, Deborah; Reusch, John J; Bayliss, Elizabeth A

2017-01-01

Objectives: In response to limited access to specialty care in safety-net settings, an integrated delivery system and three safety-net organizations in the Denver, CO, metropolitan area launched a unique program in 2013. The program offers safety-net providers the option to electronically consult with specialists. Uninsured patients may be seen by specialists in office visits for a defined set of services. This article describes the program, identifies aspects that have worked well and areas that need improvement, and offers lessons learned. Methods: We quantified electronic consultations (e-consults) between safety-net clinicians and specialists, and face-to-face specialist visits between May 2013 and December 2014. We reviewed and categorized all e-consults from November and December 2014. In 2015, we interviewed 21 safety-net clinicians and staff, 12 specialists, and 10 patients, and conducted a thematic analysis to determine factors facilitating and limiting optimal program use. Results: In the first 20 months of the program, safety-net clinicians at 23 clinics made 602 e-consults to specialists, and 81 patients received face-to-face specialist visits. Of 204 primary care clinicians, 103 made e-consults; 65 specialists participated in the program. Aspects facilitating program use were referral case managers’ involvement and the use of clear, concise questions in e-consults. Key recommendations for process improvement were to promote an understanding of the different health care contexts, support provider-to-provider communication, facilitate hand-offs between settings, and clarify program scope. Conclusion: Participants perceived the program as responsive to their needs, yet opportunities exist for continued uptake and expansion. Communitywide efforts to assess and address needs remain important. PMID:28241908

Qualitative evaluation of the Safety and Improvement in Primary Care (SIPC) pilot collaborative in Scotland: perceptions and experiences of participating care teams

PubMed Central

Bowie, Paul; Halley, Lyn; Blamey, Avril; Gillies, Jill; Houston, Neil

2016-01-01

Objectives To explore general practitioner (GP) team perceptions and experiences of participating in a large-scale safety and improvement pilot programme to develop and test a range of interventions that were largely new to this setting. Design Qualitative study using semistructured interviews. Data were analysed thematically. Subjects and setting Purposive sample of multiprofessional study participants from 11 GP teams based in 3 Scottish National Health Service (NHS) Boards. Results 27 participants were interviewed. 3 themes were generated: (1) programme experiences and benefits, for example, a majority of participants referred to gaining new theoretical and experiential safety knowledge (such as how unreliable evidence-based care can be) and skills (such as how to search electronic records for undetected risks) related to the programme interventions; (2) improvements to patient care systems, for example, improvements in care systems reliability using care bundles were reported by many, but this was an evolving process strongly dependent on closer working arrangements between clinical and administrative staff; (3) the utility of the programme improvement interventions, for example, mixed views and experiences of participating in the safety climate survey and meeting to reflect on the feedback report provided were apparent. Initial theories on the utilisation and potential impact of some interventions were refined based on evidence. Conclusions The pilot was positively received with many practices reporting improvements in safety systems, team working and communications with colleagues and patients. Barriers and facilitators were identified related to how interventions were used as the programme evolved, while other challenges around spreading implementation beyond this pilot were highlighted. PMID:26826149

Industrial Hygiene Issues

NASA Technical Reports Server (NTRS)

Brisbin, Steven G.

1999-01-01

This breakout session is a traditional conference instrument used by the NASA industrial hygiene personnel as a method to convene personnel across the Agency with common interests. This particular session focused on two key topics, training systems and automation of industrial hygiene data. During the FY 98 NASA Occupational Health Benchmarking study, the training system under development by the U.S. Environmental Protection Agency (EPA) was deemed to represent a "best business practice." The EPA has invested extensively in the development of computer based training covering a broad range of safety, health and environmental topics. Currently, five compact disks have been developed covering the topics listed: Safety, Health and Environmental Management Training for Field Inspection Activities; EPA Basic Radiation Training Safety Course; The OSHA 600 Collateral Duty Safety and Health Course; and Key program topics in environmental compliance, health and safety. Mr. Chris Johnson presented an overview of the EPA compact disk-based training system and answered questions on its deployment and use across the EPA. This training system has also recently been broadly distributed across other Federal Agencies. The EPA training system is considered "public domain" and, as such, is available to NASA at no cost in its current form. Copies of the five CD set of training programs were distributed to each NASA Center represented in the breakout session. Mr. Brisbin requested that each NASA Center review the training materials and determine whether there is interest in using the materials as it is or requesting that EPA tailor the training modules to suit NASA's training program needs. The Safety, Health and Medical Services organization at Ames Research Center has completed automation of several key program areas. Mr. Patrick Hogan, Safety Program Manager for Ames Research Center, presented a demonstration of the automated systems, which are described by the following: (1) Safety, Health and Environmental Training. This system includes an assessment of training needs for every NASA Center organization, course descriptions, schedules and automated course scheduling, and presentation of training program metrics; (2) Safety and Health Inspection Information. This system documents the findings from each facility inspection, tracks abatement status on those findings and presents metrics on each department for senior management review; (3) Safety Performance Evaluation Profile. The survey system used by NASA to evaluate employee and supervisory perceptions of safety programs is automated in this system; and (4) Documentation Tracking System. Electronic archive and retrieval of all correspondence and technical reports generated by the Safety, Health and Medical Services Office are provided by this system.

Risk management in mental health: applying lessons from commercial aviation.

PubMed

Hatcher, Simon

2010-02-01

Risk management in mental health focuses on risks in patients and fails to predict rare but catastrophic events such as suicide. Commercial aviation has a similar task in preventing rare but catastrophic accidents. This article describes the systems in place in commercial aviation that allows that industry to prevent disasters and contrasts this with the situation in mental health. In mental health we should learn from commercial aviation by having: national policies to promote patient safety; a national body responsible for implementing this policy which maintains a database of safety occurrences, sets targets and investigates adverse outcomes; legislation in place which encourages clinicians to report safety occurrences; and a common method and language for investigating safety occurrences.

Nature of Blame in Patient Safety Incident Reports: Mixed Methods Analysis of a National Database.

PubMed

Cooper, Jennifer; Edwards, Adrian; Williams, Huw; Sheikh, Aziz; Parry, Gareth; Hibbert, Peter; Butlin, Amy; Donaldson, Liam; Carson-Stevens, Andrew

2017-09-01

A culture of blame and fear of retribution are recognized barriers to reporting patient safety incidents. The extent of blame attribution in safety incident reports, which may reflect the underlying safety culture of health care systems, is unknown. This study set out to explore the nature of blame in family practice safety incident reports. We characterized a random sample of family practice patient safety incident reports from the England and Wales National Reporting and Learning System. Reports were analyzed according to prespecified classification systems to describe the incident type, contributory factors, outcomes, and severity of harm. We developed a taxonomy of blame attribution, and we then used descriptive statistical analyses to identify the proportions of blame types and to explore associations between incident characteristics and one type of blame. Health care professionals making family practice incident reports attributed blame to a person in 45% of cases (n = 975 of 2,148; 95% CI, 43%-47%). In 36% of cases, those who reported the incidents attributed fault to another person, whereas 2% of those reporting acknowledged personal responsibility. Blame was commonly associated with incidents where a complaint was anticipated. The high frequency of blame in these safety, incident reports may reflect a health care culture that leads to blame and retribution, rather than to identifying areas for learning and improvement, and a failure to appreciate the contribution of system factors in others' behavior. Successful improvement in patient safety through the analysis of incident reports is unlikely without achieving a blame-free culture. © 2017 Annals of Family Medicine, Inc.

Nature of Blame in Patient Safety Incident Reports: Mixed Methods Analysis of a National Database

PubMed Central

Cooper, Jennifer; Edwards, Adrian; Williams, Huw; Sheikh, Aziz; Parry, Gareth; Hibbert, Peter; Butlin, Amy; Donaldson, Liam; Carson-Stevens, Andrew

2017-01-01

PURPOSE A culture of blame and fear of retribution are recognized barriers to reporting patient safety incidents. The extent of blame attribution in safety incident reports, which may reflect the underlying safety culture of health care systems, is unknown. This study set out to explore the nature of blame in family practice safety incident reports. METHODS We characterized a random sample of family practice patient safety incident reports from the England and Wales National Reporting and Learning System. Reports were analyzed according to prespecified classification systems to describe the incident type, contributory factors, outcomes, and severity of harm. We developed a taxonomy of blame attribution, and we then used descriptive statistical analyses to identify the proportions of blame types and to explore associations between incident characteristics and one type of blame. RESULTS Health care professionals making family practice incident reports attributed blame to a person in 45% of cases (n = 975 of 2,148; 95% CI, 43%–47%). In 36% of cases, those who reported the incidents attributed fault to another person, whereas 2% of those reporting acknowledged personal responsibility. Blame was commonly associated with incidents where a complaint was anticipated. CONCLUSIONS The high frequency of blame in these safety, incident reports may reflect a health care culture that leads to blame and retribution, rather than to identifying areas for learning and improvement, and a failure to appreciate the contribution of system factors in others’ behavior. Successful improvement in patient safety through the analysis of incident reports is unlikely without achieving a blame-free culture. PMID:28893816

Application research of rail transit safety protection based on laser detection

NASA Astrophysics Data System (ADS)

Wang, Zhifei

2016-10-01

Platform screen door can not only prevent the passengers fell or jumped the track danger, to passengers bring comfortable waiting environment, but also has the function of environmental protection and energy saving. But platform screen door and train the full-length gap region is insecure in the system design of a hidden, such as passengers for some reason (grab the train) in the interstitial region retention, is sandwiched between the intercity safety door and the door, and such as the region lacks security detection and alarm system, once the passengers in the gap region retention (caught), bring more serious threat to the safety of passengers and traffic safety. This paper from the point of view of the design presents the physical, infrared, laser three safety protection device setting schemes. Domestic intelligence of between rail transit shield door and train security clearance processing used is screen door system standard configuration, the obstacle detection function for avoid passengers stranded in the clearance has strong prevention function. Laser detection research and development projects can access to prevent shield door and train gap clamp safety measures. Rail safety protection method are studied applying laser detection technique. According to the laser reflection equation of foreign body, the characteristics of laser detection of foreign bodies are given in theory. By using statistical analysis method, the workflow of laser detection system is established. On this basis, protection methods is proposed. Finally the simulation and test results show that the laser detection technology in the rail traffic safety protection reliability and stability, And the future laser detection technology in is discussed the development of rail transit.

Medication safety.

PubMed

Keohane, Carol A; Bates, David W

2008-03-01

Patient safety is a state of mind, not a technology. The technologies used in the medical setting represent tools that must be properly designed, used well, and assessed on an on-going basis. Moreover, in all settings, building a culture of safety is pivotal for improving safety, and many nontechnologic approaches, such as medication reconciliation and teaching patients about their medications, are also essential. This article addresses the topic of medication safety and examines specific strategies being used to decrease the incidence of medication errors across various clinical settings.

Validation of a physically based catchment model for application in post-closure radiological safety assessments of deep geological repositories for solid radioactive wastes.

PubMed

Thorne, M C; Degnan, P; Ewen, J; Parkin, G

2000-12-01

The physically based river catchment modelling system SHETRAN incorporates components representing water flow, sediment transport and radionuclide transport both in solution and bound to sediments. The system has been applied to simulate hypothetical future catchments in the context of post-closure radiological safety assessments of a potential site for a deep geological disposal facility for intermediate and certain low-level radioactive wastes at Sellafield, west Cumbria. In order to have confidence in the application of SHETRAN for this purpose, various blind validation studies have been undertaken. In earlier studies, the validation was undertaken against uncertainty bounds in model output predictions set by the modelling team on the basis of how well they expected the model to perform. However, validation can also be carried out with bounds set on the basis of how well the model is required to perform in order to constitute a useful assessment tool. Herein, such an assessment-based validation exercise is reported. This exercise related to a field plot experiment conducted at Calder Hollow, west Cumbria, in which the migration of strontium and lanthanum in subsurface Quaternary deposits was studied on a length scale of a few metres. Blind predictions of tracer migration were compared with experimental results using bounds set by a small group of assessment experts independent of the modelling team. Overall, the SHETRAN system performed well, failing only two out of seven of the imposed tests. Furthermore, of the five tests that were not failed, three were positively passed even when a pessimistic view was taken as to how measurement errors should be taken into account. It is concluded that the SHETRAN system, which is still being developed further, is a powerful tool for application in post-closure radiological safety assessments.

Safety design considerations for lithium batteries in CF applications

NASA Astrophysics Data System (ADS)

Moroz, W. J.

1981-02-01

Lithium-sulphur dioxide (Li-SO2) primary cells are being introduced as power supplies into Canadian Forces applications where advantage can be taken of their high energy density characteristics and low temperature capabilities. For safety reasons the high energy capabilities of these cells must be protected against the possibility of accidental abuse. DREO has investigated and identified a number of operational problem areas associated with Li-SO2 systems. Safety design considerations are proposed for three CF applications; the PRC 515 Radio Set/Radar Transponder SST-181X applications and the AN/PRQ-501 Personal Locater Beacon.

Benchmarking road safety performance: Identifying a meaningful reference (best-in-class).

PubMed

Chen, Faan; Wu, Jiaorong; Chen, Xiaohong; Wang, Jianjun; Wang, Di

2016-01-01

For road safety improvement, comparing and benchmarking performance are widely advocated as the emerging and preferred approaches. However, there is currently no universally agreed upon approach for the process of road safety benchmarking, and performing the practice successfully is by no means easy. This is especially true for the two core activities of which: (1) developing a set of road safety performance indicators (SPIs) and combining them into a composite index; and (2) identifying a meaningful reference (best-in-class), one which has already obtained outstanding road safety practices. To this end, a scientific technique that can combine the multi-dimensional safety performance indicators (SPIs) into an overall index, and subsequently can identify the 'best-in-class' is urgently required. In this paper, the Entropy-embedded RSR (Rank-sum ratio), an innovative, scientific and systematic methodology is investigated with the aim of conducting the above two core tasks in an integrative and concise procedure, more specifically in a 'one-stop' way. Using a combination of results from other methods (e.g. the SUNflower approach) and other measures (e.g. Human Development Index) as a relevant reference, a given set of European countries are robustly ranked and grouped into several classes based on the composite Road Safety Index. Within each class the 'best-in-class' is then identified. By benchmarking road safety performance, the results serve to promote best practice, encourage the adoption of successful road safety strategies and measures and, more importantly, inspire the kind of political leadership needed to create a road transport system that maximizes safety. Copyright © 2015 Elsevier Ltd. All rights reserved.

Patient safety climate (PSC) perceptions of frontline staff in acute care hospitals: examining the role of ease of reporting, unit norms of openness, and participative leadership.

PubMed

Zaheer, Shahram; Ginsburg, Liane; Chuang, You-Ta; Grace, Sherry L

2015-01-01

Increased awareness regarding the importance of patient safety issues has led to the proliferation of theoretical conceptualizations, frameworks, and articles that apply safety experiences from high-reliability industries to medical settings. However, empirical research on patient safety and patient safety climate in medical settings still lags far behind the theoretical literature on these topics. The broader organizational literature suggests that ease of reporting, unit norms of openness, and participative leadership might be important variables for improving patient safety. The aim of this empirical study is to examine in detail how these three variables influence frontline staff perceptions of patient safety climate within health care organizations. A cross-sectional study design was used. Data were collected using a questionnaire composed of previously validated scales. The results of the study show that ease of reporting, unit norms of openness, and participative leadership are positively related to staff perceptions of patient safety climate. Health care management needs to involve frontline staff during the development and implementation stages of an error reporting system to ensure staff perceive error reporting to be easy and efficient. Senior and supervisory leaders at health care organizations must be provided with learning opportunities to improve their participative leadership skills so they can better integrate frontline staff ideas and concerns while making safety-related decisions. Finally, health care management must ensure that frontline staff are able to freely communicate safety concerns without fear of being punished or ridiculed by others.

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

77 FR 40647 - Biweekly Notice; Applications and Amendments to Facility Operating Licenses and Combined Licenses...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-10

... operation of the shared unit's diesel generator (emergency power) and to assure long term operation of the... actuation system limiting safety system settings, and emergency diesel generator surveillance start voltage... specification for the Vogtle Electric Generating Plant, Units 1 and 2, associated with the ``Steam Generator (SG...

Aviation Safety Risk Modeling: Lessons Learned From Multiple Knowledge Elicitation Sessions

NASA Technical Reports Server (NTRS)

Luxhoj, J. T.; Ancel, E.; Green, L. L.; Shih, A. T.; Jones, S. M.; Reveley, M. S.

2014-01-01

Aviation safety risk modeling has elements of both art and science. In a complex domain, such as the National Airspace System (NAS), it is essential that knowledge elicitation (KE) sessions with domain experts be performed to facilitate the making of plausible inferences about the possible impacts of future technologies and procedures. This study discusses lessons learned throughout the multiple KE sessions held with domain experts to construct probabilistic safety risk models for a Loss of Control Accident Framework (LOCAF), FLightdeck Automation Problems (FLAP), and Runway Incursion (RI) mishap scenarios. The intent of these safety risk models is to support a portfolio analysis of NASA's Aviation Safety Program (AvSP). These models use the flexible, probabilistic approach of Bayesian Belief Networks (BBNs) and influence diagrams to model the complex interactions of aviation system risk factors. Each KE session had a different set of experts with diverse expertise, such as pilot, air traffic controller, certification, and/or human factors knowledge that was elicited to construct a composite, systems-level risk model. There were numerous "lessons learned" from these KE sessions that deal with behavioral aggregation, conditional probability modeling, object-oriented construction, interpretation of the safety risk results, and model verification/validation that are presented in this paper.

Foundational Security Principles for Medical Application Platforms* (Extended Abstract)

PubMed Central

Vasserman, Eugene Y.; Hatcliff, John

2014-01-01

We describe a preliminary set of security requirements for safe and secure next-generation medical systems, consisting of dynamically composable units, tied together through a real-time safety-critical middleware. We note that this requirement set is not the same for individual (stand-alone) devices or for electronic health record systems, and we must take care to define system-level requirements rather than security goals for components. The requirements themselves build on each other such that it is difficult or impossible to eliminate any one of the requirements and still achieve high-level security goals. PMID:25599096

Engine performance with a hydrogenated safety fuel

NASA Technical Reports Server (NTRS)

Schey, Oscar W; Young, Alfred W

1933-01-01

This report presents the results of an investigation to determine the engine performance obtained with a hydrogenated safety fuel developed to eliminate fire hazard. The tests were made on a single-cylinder universal test engine at compression ratios of 5.0, 5.5, and 6.0. Most of the tests were made with a fuel-injection system, although one set of runs was made with a carburetor when using gasoline to establish comparative performance. The tests show that the b.m.e.p. obtained with safety fuel when using a fuel-injection system is slightly higher than that obtained with gasoline when using a carburetor, although the fuel consumption with safety fuel is higher. When the fuel-injection system is used with each fuel and with normal engine temperatures the b.m.e.p. with safety fuel is from 2 to 4 percent lower than with gasoline and the fuel consumption about 25 to 30 percent higher. However, a few tests at an engine coolant temperature of 250 F have shown a specific fuel consumption approximating that obtained with gasoline with only a slight reduction in power. The idling of the test engine was satisfactory with the safety fuel. Starting was difficult with a cold engine but could be readily accomplished when the jacket water was hot. It is believed that the use of the safety fuel would practically eliminate crash fires.

Random safety auditing, root cause analysis, failure mode and effects analysis.

PubMed

Ursprung, Robert; Gray, James

2010-03-01

Improving quality and safety in health care is a major concern for health care providers, the general public, and policy makers. Errors and quality issues are leading causes of morbidity and mortality across the health care industry. There is evidence that patients in the neonatal intensive care unit (NICU) are at high risk for serious medical errors. To facilitate compliance with safe practices, many institutions have established quality-assurance monitoring procedures. Three techniques that have been found useful in the health care setting are failure mode and effects analysis, root cause analysis, and random safety auditing. When used together, these techniques are effective tools for system analysis and redesign focused on providing safe delivery of care in the complex NICU system. Copyright 2010 Elsevier Inc. All rights reserved.

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.

Design of 3D simulation engine for oilfield safety training

NASA Astrophysics Data System (ADS)

Li, Hua-Ming; Kang, Bao-Sheng

2015-03-01

Aiming at the demand for rapid custom development of 3D simulation system for oilfield safety training, this paper designs and implements a 3D simulation engine based on script-driven method, multi-layer structure, pre-defined entity objects and high-level tools such as scene editor, script editor, program loader. A scripting language been defined to control the system's progress, events and operating results. Training teacher can use this engine to edit 3D virtual scenes, set the properties of entity objects, define the logic script of task, and produce a 3D simulation training system without any skills of programming. Through expanding entity class, this engine can be quickly applied to other virtual training areas.

A web-based incident reporting system and multidisciplinary collaborative projects for patient safety in a Japanese hospital

PubMed Central

Nakajima, K; Kurata, Y; Takeda, H

2005-01-01



Problem: When patient safety programs were mandated for Japanese health care institutions, a safety culture, a tool for collecting incident reports, an organizational arrangement for multidisciplinary collaboration, and interventional methods for improvement had to be established. Design: Observational study of effects of new patient safety programs. Setting: Osaka University Hospital, a large government-run teaching hospital. Strategy for change: A voluntary and anonymous web-based incident reporting system was introduced. For the new organizational structure a clinical risk management committee, a department of clinical quality management, and area clinical risk managers were established with their respective roles clearly defined to advance the plan-do-study-act cycle and to integrate efforts. For preventive action, alert procedures, staff education, ward rounds by peers, a system oriented approach for reducing errors, and various feedback channels were introduced. Effects of change: Continuous incident reporting by all hospital staff has been observed since the introduction of the new system. Several error inducing situations have been improved: wrong choice of drug in computer prescribing, maladministration of drugs due to a look-alike appearance or confusion about the manipulation of a medical device, and poor after hours service of the blood transfusion unit. Staff participation in educational seminars has been dramatically improved. Ward rounds have detected problematic procedures which needed to be dealt with. Lessons learnt: Patient safety programs based on a web-based incident reporting system, responsible persons, staff education, and a variety of feedback procedures can help promote a safety culture, multidisciplinary collaboration, and strong managerial leadership resulting in system oriented improvement. PMID:15805458

Major food safety episodes in Taiwan: implications for the necessity of international collaboration on safety assessment and management.

PubMed

Li, Jih-Heng; Yu, Wen-Jing; Lai, Yuan-Hui; Ko, Ying-Chin

2012-07-01

The major food safety episodes that occurred in Taiwan during the past decade are briefly reviewed in this paper. Among the nine major episodes surveyed, with the exception of a U.S. beef (associated with Creutzfeldt-Jakob disease)-related incident, all the others were associated with chemical toxicants. The general public, which has a layperson attitude of zero tolerance toward food safety, may panic over these food-safety-associated incidents. However, the health effects and impacts of most incidents, with the exception of the melamine incident, were essentially not fully evaluated. The mass media play an important role in determining whether a food safety concern becomes a major incident. A well-coordinated and harmonized system for domestic and international collaboration to set up standards and regulations is critical, as observed in the incidents of pork with ractopamine, Chinese hairy crab with nitrofuran antibiotics, and U.S. wheat with malathion. In the future, it can be anticipated that food safety issues will draw more attention from the general public. For unknown new toxicants or illicit adulteration of food, the establishment of a more proactive safety assessment system to monitor potential threats and provide real-time information exchange is imperative. Copyright © 2012. Published by Elsevier B.V.

Identification of features of electronic prescribing systems to support quality and safety in primary care using a modified Delphi process.

PubMed

Sweidan, Michelle; Williamson, Margaret; Reeve, James F; Harvey, Ken; O'Neill, Jennifer A; Schattner, Peter; Snowdon, Teri

2010-04-15

Electronic prescribing is increasingly being used in primary care and in hospitals. Studies on the effects of e-prescribing systems have found evidence for both benefit and harm. The aim of this study was to identify features of e-prescribing software systems that support patient safety and quality of care and that are useful to the clinician and the patient, with a focus on improving the quality use of medicines. Software features were identified by a literature review, key informants and an expert group. A modified Delphi process was used with a 12-member multidisciplinary expert group to reach consensus on the expected impact of the features in four domains: patient safety, quality of care, usefulness to the clinician and usefulness to the patient. The setting was electronic prescribing in general practice in Australia. A list of 114 software features was developed. Most of the features relate to the recording and use of patient data, the medication selection process, prescribing decision support, monitoring drug therapy and clinical reports. The expert group rated 78 of the features (68%) as likely to have a high positive impact in at least one domain, 36 features (32%) as medium impact, and none as low or negative impact. Twenty seven features were rated as high positive impact across 3 or 4 domains including patient safety and quality of care. Ten features were considered "aspirational" because of a lack of agreed standards and/or suitable knowledge bases. This study defines features of e-prescribing software systems that are expected to support safety and quality, especially in relation to prescribing and use of medicines in general practice. The features could be used to develop software standards, and could be adapted if necessary for use in other settings and countries.

Identification of features of electronic prescribing systems to support quality and safety in primary care using a modified Delphi process

PubMed Central

2010-01-01

Background Electronic prescribing is increasingly being used in primary care and in hospitals. Studies on the effects of e-prescribing systems have found evidence for both benefit and harm. The aim of this study was to identify features of e-prescribing software systems that support patient safety and quality of care and that are useful to the clinician and the patient, with a focus on improving the quality use of medicines. Methods Software features were identified by a literature review, key informants and an expert group. A modified Delphi process was used with a 12-member multidisciplinary expert group to reach consensus on the expected impact of the features in four domains: patient safety, quality of care, usefulness to the clinician and usefulness to the patient. The setting was electronic prescribing in general practice in Australia. Results A list of 114 software features was developed. Most of the features relate to the recording and use of patient data, the medication selection process, prescribing decision support, monitoring drug therapy and clinical reports. The expert group rated 78 of the features (68%) as likely to have a high positive impact in at least one domain, 36 features (32%) as medium impact, and none as low or negative impact. Twenty seven features were rated as high positive impact across 3 or 4 domains including patient safety and quality of care. Ten features were considered "aspirational" because of a lack of agreed standards and/or suitable knowledge bases. Conclusions This study defines features of e-prescribing software systems that are expected to support safety and quality, especially in relation to prescribing and use of medicines in general practice. The features could be used to develop software standards, and could be adapted if necessary for use in other settings and countries. PMID:20398294

Lessons learned from measuring safety culture: an Australian case study.

PubMed

Allen, Suellen; Chiarella, Mary; Homer, Caroline S E

2010-10-01

adverse events in maternity care are relatively common but often avoidable. International patient safety strategies advocate measuring safety culture as a strategy to improve patient safety. Evidence suggests it is necessary to fully understand the safety culture of an organisation to make improvements to patient safety. this paper reports a case study examining the safety culture in one maternity service in Australia and considers the benefits of using surveys and interviews to understand safety culture as an approach to identify possible strategies to improve patient safety in this setting. the study took place in one maternity service in two public hospitals in NSW, Australia. Concurrently, both hospitals were undergoing an organisational restructure which was part of a major health reform agenda. The priorities of the reform included improving the quality of care and patient safety; and, creating a more efficient health system by reducing administration inefficiencies and duplication. a descriptive case study using three approaches: the safety culture was identified to warrant improvement across all six safety culture domains. There was reduced infrastructure and capacity to support incident management activities required to improve safety, which was influenced by instability from the organisational restructure. There was a perceived lack of leadership at all levels to drive safety and quality and improving the safety culture was neither a key priority nor was it valued by the organisation. the safety culture was complex as was undertaking this study. We were unable to achieve a desired 60% response rate highlighting the limitations of using safety culture surveys in isolation as a strategy to improve safety culture. Qualitative interviews provided greater insight into the factors influencing the safety culture. The findings of this study provide evidence of the benefits of including qualitative methods with quantitative surveys when examining safety culture. Undertaking research in this way requires local engagement, commitment and capacity from the study site. The absence of these factors is likely to limit the practicality of this approach in the clinical setting. the use of safety culture surveys as the only method of assessing safety culture is of limited value in identifying strategies to potentially improve the safety culture. Copyright © 2010 Elsevier Ltd. All rights reserved.

Discrete Abstractions of Hybrid Systems: Verification of Safety and Application to User-Interface Design

NASA Technical Reports Server (NTRS)

Oishi, Meeko; Tomlin, Claire; Degani, Asaf

2003-01-01

Human interaction with complex hybrid systems involves the user, the automation's discrete mode logic, and the underlying continuous dynamics of the physical system. Often the user-interface of such systems displays a reduced set of information about the entire system. In safety-critical systems, how can we identify user-interface designs which do not have adequate information, or which may confuse the user? Here we describe a methodology, based on hybrid system analysis, to verify that a user-interface contains information necessary to safely complete a desired procedure or task. Verification within a hybrid framework allows us to account for the continuous dynamics underlying the simple, discrete representations displayed to the user. We provide two examples: a car traveling through a yellow light at an intersection and an aircraft autopilot in a landing/go-around maneuver. The examples demonstrate the general nature of this methodology, which is applicable to hybrid systems (not fully automated) which have operational constraints we can pose in terms of safety. This methodology differs from existing work in hybrid system verification in that we directly account for the user's interactions with the system.

Air traffic surveillance and control using hybrid estimation and protocol-based conflict resolution

NASA Astrophysics Data System (ADS)

Hwang, Inseok

The continued growth of air travel and recent advances in new technologies for navigation, surveillance, and communication have led to proposals by the Federal Aviation Administration (FAA) to provide reliable and efficient tools to aid Air Traffic Control (ATC) in performing their tasks. In this dissertation, we address four problems frequently encountered in air traffic surveillance and control; multiple target tracking and identity management, conflict detection, conflict resolution, and safety verification. We develop a set of algorithms and tools to aid ATC; These algorithms have the provable properties of safety, computational efficiency, and convergence. Firstly, we develop a multiple-maneuvering-target tracking and identity management algorithm which can keep track of maneuvering aircraft in noisy environments and of their identities. Secondly, we propose a hybrid probabilistic conflict detection algorithm between multiple aircraft which uses flight mode estimates as well as aircraft current state estimates. Our algorithm is based on hybrid models of aircraft, which incorporate both continuous dynamics and discrete mode switching. Thirdly, we develop an algorithm for multiple (greater than two) aircraft conflict avoidance that is based on a closed-form analytic solution and thus provides guarantees of safety. Finally, we consider the problem of safety verification of control laws for safety critical systems, with application to air traffic control systems. We approach safety verification through reachability analysis, which is a computationally expensive problem. We develop an over-approximate method for reachable set computation using polytopic approximation methods and dynamic optimization. These algorithms may be used either in a fully autonomous way, or as supporting tools to increase controllers' situational awareness and to reduce their work load.

Third year nursing students' viewpoints about circumstances which threaten safety in the clinical setting.

PubMed

Montgomery, Phyllis; Killam, Laura; Mossey, Sharolyn; Heerschap, Corey

2014-02-01

Evidence emphasizes that learners, educators, clinicians, programs, and organizations share the responsibility for establishing and maintaining safety throughout undergraduate nursing education. Increased knowledge about students' perceptions of threats to safety in the clinical setting may guide educators' efforts to promote the development of safe novice practitioners while preserving patient safety. The purpose of this study was to describe third year nursing students' viewpoints of the circumstances which threaten safety in the clinical setting. Using Q methodology, 34 third year Bachelor of Science in Nursing students sorted 43 theoretical statement cards. Each card identified a statement describing a threat to safety in the clinical setting. These statements were generated through a review of nursing literature and consultation with experts in nursing education. Centroid factor analysis and varimax rotation identified viewpoints regarding circumstances that most threaten safety. Three discrete viewpoints and one consensus perspective constituted students' description of threatened safety. The discrete viewpoints were labeled lack of readiness, misdirected practices, and negation of professional boundaries. There was consensus that it is most unsafe in the clinical setting when novices fail to consolidate an integrated cognitive, behavioral, and ethical identity. This unifying perspective was labeled non-integration. Third year nursing students and their educators are encouraged to be mindful of the need to ensure readiness prior to entry into the clinical setting. In the clinical setting, the learning of prepared students must be guided by competent educators. Finally, both students and their educators must respect professional boundaries to promote safety for students and patients. © 2013.

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.

Fine-Tuning ADAS Algorithm Parameters for Optimizing Traffic ...

EPA Pesticide Factsheets

With the development of the Connected Vehicle technology that facilitates wirelessly communication among vehicles and road-side infrastructure, the Advanced Driver Assistance Systems (ADAS) can be adopted as an effective tool for accelerating traffic safety and mobility optimization at various highway facilities. To this end, the traffic management centers identify the optimal ADAS algorithm parameter set that enables the maximum improvement of the traffic safety and mobility performance, and broadcast the optimal parameter set wirelessly to individual ADAS-equipped vehicles. After adopting the optimal parameter set, the ADAS-equipped drivers become active agents in the traffic stream that work collectively and consistently to prevent traffic conflicts, lower the intensity of traffic disturbances, and suppress the development of traffic oscillations into heavy traffic jams. Successful implementation of this objective requires the analysis capability of capturing the impact of the ADAS on driving behaviors, and measuring traffic safety and mobility performance under the influence of the ADAS. To address this challenge, this research proposes a synthetic methodology that incorporates the ADAS-affected driving behavior modeling and state-of-the-art microscopic traffic flow modeling into a virtually simulated environment. Building on such an environment, the optimal ADAS algorithm parameter set is identified through an optimization programming framework to enable th

Understanding procedural violations using Safety-I and Safety-II: The case of community pharmacies.

PubMed

Jones, Christian E L; Phipps, Denham L; Ashcroft, Darren M

2018-06-01

Procedural violations are known to occur in a range of work settings, and are an important topic of interest with regard to safety management. A Safety-I perspective sees violations as undesirable digressions from standardised procedures, while a Safety-II perspective sees violations as adaptations to a complex work system. This study aimed to apply both perspectives to the examination of violations in community pharmacies. Twenty-four participants (13 pharmacists and 11 pharmacy support staff) were purposively sampled to participate in semi-structured interviews using the critical incident technique. Participants described violations they made during the course of their work. Interviews were digitally recorded, transcribed verbatim and analysed using template analysis. Community pharmacies located in England and Wales. 31 procedural violations were described during the interviews revealing multiple reasons for violations in this setting. Our findings suggest that from a Safety-II perspective, staff violated to adapt to situations and to manage safety. However, participants also violated procedures in order to maintain productivity which was found to increase risk in some, but not all situations. Procedural violations often relied on the context in which staff were working, resulting in the violation being deemed rational to the individual making the violation, yet the behaviour may be difficult to justify from an outside perspective. Combining Safety-I and Safety-II perspectives provided a detailed understanding of the underlying reasons for procedural violations. Our findings identify aspects of practice that could benefit from targeted interventions to help support staff in providing safe patient care.

Comparing safety climate for nurses working in operating theatres, critical care and ward areas in the UK: a mixed methods study

PubMed Central

Tarling, Maggie; Jones, Anne; Murrells, Trevor; McCutcheon, Helen

2017-01-01

Objectives The main aim of the study was to explore the potential sources of variation and understand the meaning of safety climate for nursing practice in acute hospital settings in the UK. Design A sequential mixed methods design included a cross-sectional survey using the Safety Climate Questionnaire (SCQ) and thematic analysis of focus group discussions. Confirmatory factor analysis (CFA) was used to validate the factor structure of the SCQ. Factor scores were compared between nurses working in operating theatres, critical care and ward areas. Results from the survey and the thematic analysis were then compared and synthesised. Setting A London University. Participants 319 registered nurses working in acute hospital settings completed the SCQ and a further 23 nurses participated in focus groups. Results CFA indicated that there was a good model fit on some criteria (χ2=1683.699, df=824, p<0.001; χ2/df=2.04; root mean square error of approximation=0.058) but a less acceptable fit on comparative fit index which is 0.804. There was a statistically significant difference between clinical specialisms in management commitment (F (4,266)=4.66, p=0.001). Nurses working in operating theatres had lower scores compared with ward areas and they also reported negative perceptions about management in their focus group. There was significant variation in scores for communication across clinical specialism (F (4,266)=2.62, p=0.035) but none of the pairwise comparisons achieved statistical significance. Thematic analysis identified themes of human factors, clinical management and protecting patients. The system and the human side of caring was identified as a meta-theme. Conclusions The results suggest that the SCQ has some utility but requires further exploration. The findings indicate that safety in nursing practice is a complex interaction between safety systems and the social and interpersonal aspects of clinical practice. PMID:29084793

Safety analysis report for the use of hazardous production materials in photovoltaic applications at the National Renewable Energy Laboratory. Volume 2, Appendices

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

Crandall, R.S.; Nelson, B.P.; Moskowitz, P.D.

1992-07-01

To ensure the continued safety of SERI`s employees, the community, and the environment, NREL commissioned an internal audit of its photovoltaic operations that used hazardous production materials (HPMS). As a result of this audit, NREL management voluntarily suspended all operations using toxic and/or pyrophoric gases. This suspension affected seven laboratories and ten individual deposition systems. These activities are located in Building 16, which has a permitted occupancy of Group B, Division 2 (B-2). NREL management decided to do the following. (1) Exclude from this SAR all operations which conformed, or could easily be made to conform, to B-2 Occupancy requirements.more » (2) Include in this SAR all operations that could be made to conform to B-2 Occupancy requirements with special administrative and engineering controls. (3) Move all operations that could not practically be made to conform to B-2 occupancy requirements to alternate locations. In addition to the layered set of administrative and engineering controls set forth in this SAR, a semiquantitative risk analysis was performed on 30 various accident scenarios. Twelve presented only routine risks, while 18 presented low risks. Considering the demonstrated safe operating history of NREL in general and these systems specifically, the nature of the risks identified, and the layered set of administrative and engineering controls, it is clear that this facility falls within the DOE Low Hazard Class. Each operation can restart only after it has passed an Operational Readiness Review, comparing it to the requirements of this SAR, while subsequent safety inspections will ensure future compliance. This document contains the appendices to the NREL safety analysis report.« less

SU-F-P-08: Medical Physics Perspective On Radiation Therapy Quality and Safety Considerations in Low Income Settings

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

Van Dyk, J; Meghzifene, A

Purpose: The last few years have seen a significant growth of interest in the global radiation therapy crisis. Various organizations are quantifying the need and providing aid in support of addressing the shortfall existing in many low-to-middle income countries (LMICs). The Lancet Oncology Commission report (Lancet Oncol. Sep;16(10):1153-86, 2015) projects a need of 22,000 new medical physicists in LMICs by 2035 if there is to be equal access globally. With the tremendous demand for new facilities, equipment and personnel, it is very important to recognize quality and safety considerations and to address them directly. Methods: A detailed examination of qualitymore » and safety publications was undertaken. A paper by Dunscombe (Front. Oncol. 2: 129, 2012) reviewed the recommendations of 7 authoritative reports on safety in radiation therapy and found the 12 most cited recommendations, summarized in order of most to least cited: training, staffing, documentation/standard operating procedures, incident learning, communication/questioning, check lists, QC/PM, dosimetric audit, accreditation, minimizing interruptions, prospective risk assessment, and safety culture. However, these authoritative reports were generally based on input from high income contexts. In this work, the recommendations were analyzed with a special emphasis on issues that are significant in LMICs. Results: The review indicated that there are significant challenges in LMICs with training and staffing ranking at the top in terms quality and safety. Conclusion: With the recognized need for expanding global access to radiation therapy, especially in LMICs, and the backing by multiple support organizations, quality and safety considerations must be overtly addressed. While multidimensional, training and staffing are top priorities. The use of outdated systems with poor interconnectivity, coupled with a lack of systematic QA in high patient load settings are additional concerns. Any support provided to lower resourced settings must address the multiple facets associated with these quality and safety indicators.« less

Using ADOPT Algorithm and Operational Data to Discover Precursors to Aviation Adverse Events

NASA Technical Reports Server (NTRS)

Janakiraman, Vijay; Matthews, Bryan; Oza, Nikunj

2018-01-01

The US National Airspace System (NAS) is making its transition to the NextGen system and assuring safety is one of the top priorities in NextGen. At present, safety is managed reactively (correct after occurrence of an unsafe event). While this strategy works for current operations, it may soon become ineffective for future airspace designs and high density operations. There is a need for proactive management of safety risks by identifying hidden and "unknown" risks and evaluating the impacts on future operations. To this end, NASA Ames has developed data mining algorithms that finds anomalies and precursors (high-risk states) to safety issues in the NAS. In this paper, we describe a recently developed algorithm called ADOPT that analyzes large volumes of data and automatically identifies precursors from real world data. Precursors help in detecting safety risks early so that the operator can mitigate the risk in time. In addition, precursors also help identify causal factors and help predict the safety incident. The ADOPT algorithm scales well to large data sets and to multidimensional time series, reduce analyst time significantly, quantify multiple safety risks giving a holistic view of safety among other benefits. This paper details the algorithm and includes several case studies to demonstrate its application to discover the "known" and "unknown" safety precursors in aviation operation.

Patient safety principles in family medicine residency accreditation standards and curriculum objectives

PubMed Central

Kassam, Aliya; Sharma, Nishan; Harvie, Margot; O’Beirne, Maeve; Topps, Maureen

2016-01-01

Abstract Objective To conduct a thematic analysis of the College of Family Physicians of Canada’s (CFPC’s) Red Book accreditation standards and the Triple C Competency-based Curriculum objectives with respect to patient safety principles. Design Thematic content analysis of the CFPC’s Red Book accreditation standards and the Triple C curriculum. Setting Canada. Main outcome measures Coding frequency of the patient safety principles (ie, patient engagement; respectful, transparent relationships; complex systems; a just and trusting culture; responsibility and accountability for actions; and continuous learning and improvement) found in the analyzed CFPC documents. Results Within the analyzed CFPC documents, the most commonly found patient safety principle was patient engagement (n = 51 coding references); the least commonly found patient safety principles were a just and trusting culture (n = 5 coding references) and complex systems (n = 5 coding references). Other patient safety principles that were uncommon included responsibility and accountability for actions (n = 7 coding references) and continuous learning and improvement (n = 12 coding references). Conclusion Explicit inclusion of patient safety content such as the use of patient safety principles is needed for residency training programs across Canada to ensure the full spectrum of care is addressed, from community-based care to acute hospital-based care. This will ensure a patient safety culture can be cultivated from residency and sustained into primary care practice. PMID:27965349

Who is in control of road safety? A STAMP control structure analysis of the road transport system in Queensland, Australia.

PubMed

Salmon, Paul M; Read, Gemma J M; Stevens, Nicholas J

2016-11-01

Despite significant progress, road trauma continues to represent a global safety issue. In Queensland (Qld), Australia, there is currently a focus on preventing the 'fatal five' behaviours underpinning road trauma (drug and drink driving, distraction, seat belt wearing, speeding, and fatigue), along with an emphasis on a shared responsibility for road safety that spans road users, vehicle manufacturers, designers, policy makers etc. The aim of this article is to clarify who shares the responsibility for road safety in Qld and to determine what control measures are enacted to prevent the fatal five behaviours. This is achieved through the presentation of a control structure model that depicts the actors and organisations within the Qld road transport system along with the control and feedback relationships that exist between them. Validated through a Delphi study, the model shows a diverse set of actors and organisations who share the responsibility for road safety that goes beyond those discussed in road safety policies and strategies. The analysis also shows that, compared to other safety critical domains, there are less formal control structures in road transport and that opportunities exist to add new controls and strengthen existing ones. Relationships that influence rather than control are also prominent. Finally, when compared to other safety critical domains, the strength of road safety controls is brought into question. Copyright © 2016 Elsevier Ltd. All rights reserved.

Portable detection system of vegetable oils based on laser induced fluorescence

NASA Astrophysics Data System (ADS)

Zhu, Li; Zhang, Yinchao; Chen, Siying; Chen, He; Guo, Pan; Mu, Taotao

2015-11-01

Food safety, especially edible oils, has attracted more and more attention recently. Many methods and instruments have emerged to detect the edible oils, which include oils classification and adulteration. It is well known than the adulteration is based on classification. Then, in this paper, a portable detection system, based on laser induced fluorescence, is proposed and designed to classify the various edible oils, including (olive, rapeseed, walnut, peanut, linseed, sunflower, corn oils). 532 nm laser modules are used in this equipment. Then, all the components are assembled into a module (100*100*25mm). A total of 700 sets of fluorescence data (100 sets of each type oil) are collected. In order to classify different edible oils, principle components analysis and support vector machine have been employed in the data analysis. The training set consisted of 560 sets of data (80 sets of each oil) and the test set consisted of 140 sets of data (20 sets of each oil). The recognition rate is up to 99%, which demonstrates the reliability of this potable system. With nonintrusive and no sample preparation characteristic, the potable system can be effectively applied for food detection.

"No-Go Considerations" for In Situ Simulation Safety.

PubMed

Bajaj, Komal; Minors, Anjoinette; Walker, Katie; Meguerdichian, Michael; Patterson, Mary

2018-06-01

In situ simulation is the practice of simulation in the actual clinical environment and has demonstrated utility in the assessment of system processes, identification of latent safety threats, and improvement in teamwork and communication. Nonetheless, performing simulated events in a real patient care setting poses potential risks to patient and staff safety. One integral aspect of a comprehensive approach to ensure the safety of in situ simulation includes the identification and establishment of "no-go considerations," that is, key decision-making considerations under which in situ simulations should be canceled, postponed, moved to another area, or rescheduled. These considerations should be modified and adjusted to specific clinical units. This article provides a framework of key essentials in developing no-go considerations.

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

Not Available

Reflecting Secretary O`Leary`s focus on occupational safety and health, the Office of Occupational Safety is pleased to provide you with the latest update to the DOE Interpretations Guide to OSH Standards. This Guide was developed in cooperation with the Occupational Safety and Health Administration, which continued its support during this last revision by facilitating access to the interpretations found on the OSHA Computerized Information System (OCIS). This March 31, 1994 update contains 123 formal interpretation letters written by OSHA. As a result of the unique requests received by the 1-800 Response Line, this update also contains 38 interpretations developed bymore » DOE. This new occupational safety and health information adds still more important guidance to the four volume reference set that you presently have in your possession.« less

Reference set for performance testing of pediatric vaccine safety signal detection methods and systems.

PubMed

Brauchli Pernus, Yolanda; Nan, Cassandra; Verstraeten, Thomas; Pedenko, Mariia; Osokogu, Osemeke U; Weibel, Daniel; Sturkenboom, Miriam; Bonhoeffer, Jan

2016-12-12

Safety signal detection in spontaneous reporting system databases and electronic healthcare records is key to detection of previously unknown adverse events following immunization. Various statistical methods for signal detection in these different datasources have been developed, however none are geared to the pediatric population and none specifically to vaccines. A reference set comprising pediatric vaccine-adverse event pairs is required for reliable performance testing of statistical methods within and across data sources. The study was conducted within the context of the Global Research in Paediatrics (GRiP) project, as part of the seventh framework programme (FP7) of the European Commission. Criteria for the selection of vaccines considered in the reference set were routine and global use in the pediatric population. Adverse events were primarily selected based on importance. Outcome based systematic literature searches were performed for all identified vaccine-adverse event pairs and complemented by expert committee reports, evidence based decision support systems (e.g. Micromedex), and summaries of product characteristics. Classification into positive (PC) and negative control (NC) pairs was performed by two independent reviewers according to a pre-defined algorithm and discussed for consensus in case of disagreement. We selected 13 vaccines and 14 adverse events to be included in the reference set. From a total of 182 vaccine-adverse event pairs, we classified 18 as PC, 113 as NC and 51 as unclassifiable. Most classifications (91) were based on literature review, 45 were based on expert committee reports, and for 46 vaccine-adverse event pairs, an underlying pathomechanism was not plausible classifying the association as NC. A reference set of vaccine-adverse event pairs was developed. We propose its use for comparing signal detection methods and systems in the pediatric population. Published by Elsevier Ltd.

Medication Safety Systems and the Important Role of Pharmacists.

PubMed

Mansur, Jeannell M

2016-03-01

Preventable medication-related adverse events continue to occur in the healthcare setting. While the Institute of Medicine's To Err is Human, published in 2000, highlighted the prevalence of medical and medication-related errors in patient morbidity and mortality, there has not been significant documented progress in addressing system contributors to medication errors. The lack of progress may be related to the myriad of pharmaceutical options now available and the nuances of optimizing drug therapy to achieve desired outcomes and prevent undesirable outcomes. However, on a broader scale, there may be opportunities to focus on the design and performance of the many processes that are part of the medication system. Errors may occur in the storage, prescribing, transcription, preparation and dispensing, or administration and monitoring of medications. Each of these nodes of the medication system, with its many components, is prone to failure, resulting in harm to patients. The pharmacist is uniquely trained to be able to impact medication safety at the individual patient level through medication management skills that are part of the clinical pharmacist's role, but also to analyze the performance of medication processes and to lead redesign efforts to mitigate drug-related outcomes that may cause harm. One population that can benefit from a focus on medication safety through clinical pharmacy services and medication safety programs is the elderly, who are at risk for adverse drug events due to their many co-morbidities and the number of medications often used. This article describes the medication safety systems and provides a blueprint for creating a foundation for medication safety programs within healthcare organizations. The specific role of pharmacists and clinical pharmacy services in medication safety is also discussed here and in other articles in this Theme Issue.

SafeNet: a methodology for integrating general-purpose unsafe devices in safe-robot rehabilitation systems.

PubMed

Vicentini, Federico; Pedrocchi, Nicola; Malosio, Matteo; Molinari Tosatti, Lorenzo

2014-09-01

Robot-assisted neurorehabilitation often involves networked systems of sensors ("sensory rooms") and powerful devices in physical interaction with weak users. Safety is unquestionably a primary concern. Some lightweight robot platforms and devices designed on purpose include safety properties using redundant sensors or intrinsic safety design (e.g. compliance and backdrivability, limited exchange of energy). Nonetheless, the entire "sensory room" shall be required to be fail-safe and safely monitored as a system at large. Yet, sensor capabilities and control algorithms used in functional therapies require, in general, frequent updates or re-configurations, making a safety-grade release of such devices hardly sustainable in cost-effectiveness and development time. As such, promising integrated platforms for human-in-the-loop therapies could not find clinical application and manufacturing support because of lacking in the maintenance of global fail-safe properties. Under the general context of cross-machinery safety standards, the paper presents a methodology called SafeNet for helping in extending the safety rate of Human Robot Interaction (HRI) systems using unsafe components, including sensors and controllers. SafeNet considers, in fact, the robotic system as a device at large and applies the principles of functional safety (as in ISO 13489-1) through a set of architectural procedures and implementation rules. The enabled capability of monitoring a network of unsafe devices through redundant computational nodes, allows the usage of any custom sensors and algorithms, usually planned and assembled at therapy planning-time rather than at platform design-time. A case study is presented with an actual implementation of the proposed methodology. A specific architectural solution is applied to an example of robot-assisted upper-limb rehabilitation with online motion tracking. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

47 CFR 90.676 - Transition administrator for reconfiguration of the 806-824/851-869 MHz band in order to separate...

Code of Federal Regulations, 2010 CFR

2010-10-01

... their systems and ensuring that estimates contain a firm work schedule. The Transition Administrator... available to eligible applicants in the Public Safety or Critical Infrastructure Industry Categories as set...

47 CFR 101.1301 - Scope.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 5 2014-10-01 2014-10-01 false Scope. 101.1301 Section 101.1301 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES FIXED MICROWAVE SERVICES Multiple Address Systems General Provisions § 101.1301 Scope. This subpart sets out the...

47 CFR 101.1301 - Scope.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 5 2013-10-01 2013-10-01 false Scope. 101.1301 Section 101.1301 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES FIXED MICROWAVE SERVICES Multiple Address Systems General Provisions § 101.1301 Scope. This subpart sets out the...

47 CFR 101.1301 - Scope.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 5 2012-10-01 2012-10-01 false Scope. 101.1301 Section 101.1301 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES FIXED MICROWAVE SERVICES Multiple Address Systems General Provisions § 101.1301 Scope. This subpart sets out the...

Hospital safety climate surveys: measurement issues.

PubMed

Jackson, Jeanette; Sarac, Cakil; Flin, Rhona

2010-12-01

Organizational safety culture relates to behavioural norms in the workplace and is usually assessed by safety climate surveys. These can be a diagnostic indicator on the state of safety in a hospital. This review examines recent studies using staff surveys of hospital safety climate, focussing on measurement issues. Four questionnaires (hospital survey on patient safety culture, safety attitudes questionnaire, patient safety climate in healthcare organizations, hospital safety climate scale), with acceptable psychometric properties, are now applied across countries and clinical settings. Comparisons for benchmarking must be made with caution in case of questionnaire modifications. Increasing attention is being paid to the unit and hospital level wherein distinct cultures may be located, as well as to associated measurement and study design issues. Predictive validity of safety climate is tested against safety behaviours/outcomes, with some relationships reported, although effects may be specific to professional groups/units. Few studies test the role of intervening variables that could influence the effect of climate on outcomes. Hospital climate studies are becoming a key component of healthcare safety management systems. Large datasets have established more reliable instruments that allow a more focussed investigation of the role of culture in the improvement and maintenance of staff's safety perceptions within units, as well as within hospitals.

Using health-system-wide data to understand hepatitis B virus prophylaxis and reactivation outcomes in patients receiving rituximab.

PubMed

Schmajuk, Gabriela; Tonner, Chris; Trupin, Laura; Li, Jing; Sarkar, Urmimala; Ludwig, Dana; Shiboski, Stephen; Sirota, Marina; Dudley, R Adams; Murray, Sara; Yazdany, Jinoos

2017-03-01

Hepatitis B virus (HBV) reactivation in the setting of rituximab use is a potentially fatal but preventable safety event. The rate of HBV screening and proportion of patients at risk who receive antiviral prophylaxis in patients initiating rituximab is unknown.We analyzed electronic health record (EHR) data from 2 health systems, a university center and a safety net health system, including diagnosis grouper codes, problem lists, medications, laboratory results, procedures codes, clinical encounter notes, and scanned documents. We identified all patients who received rituximab between 6/1/2012 and 1/1/2016. We calculated the proportion of rituximab users with inadequate screening for HBV according to the Centers for Disease Control guidelines for detecting latent HBV infection before their first rituximab infusion during the study period. We also assessed the proportion of patients with positive hepatitis B screening tests who were prescribed antiviral prophylaxis. Finally, we characterized safety failures and adverse events.We included 926 patients from the university and 132 patients from the safety net health system. Sixty-one percent of patients from the university had adequate screening for HBV compared with 90% from the safety net. Among patients at risk for reactivation based on results of HBV testing, 66% and 92% received antiviral prophylaxis at the university and safety net, respectively.We found wide variations in hepatitis B screening practices among patients receiving rituximab, resulting in unnecessary risks to patients. Interventions should be developed to improve patient safety procedures in this high-risk patient population.

Evolution of a holistic systems approach to planning and managing road safety: the Victorian case study, 1970-2015.

PubMed

Muir, Carlyn; Johnston, Ian R; Howard, Eric

2018-06-01

The Victorian Safe System approach to road safety slowly evolved from a combination of the Swedish Vision Zero philosophy and the Sustainable Safety model developed by the Dutch. The Safe System approach reframes the way in which road safety is viewed and managed. This paper presents a case study of the institutional change required to underpin the transformation to a holistic approach to planning and managing road safety in Victoria, Australia. The adoption and implementation of a Safe System approach require strong institutional leadership and close cooperation among all the key agencies involved, and Victoria was fortunate in that it had a long history of strong interagency mechanisms in place. However, the challenges in the implementation of the Safe System strategy in Victoria are generally neither technical nor scientific; they are predominantly social and political. While many governments purport to develop strategies based on Safe System thinking, on-the-ground action still very much depends on what politicians perceive to be publicly acceptable, and Victoria is no exception. This is a case study of the complexity of institutional change and is presented in the hope that the lessons may prove useful for others seeking to adopt more holistic planning and management of road safety. There is still much work to be done in Victoria, but the institutional cultural shift has taken root. Ongoing efforts must be continued to achieve alert and compliant road users; however, major underpinning benefits will be achieved through focusing on road network safety improvements (achieving forgiving infrastructure, such as wire rope barriers) in conjunction with reviews of posted speed limits (to be set in response to the level of protection offered by the road infrastructure) and by the progressive introduction into the fleet of modern vehicle safety features. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Improvement And Development Of The Motivation System In The Occupational And Industrial Safety Field

NASA Astrophysics Data System (ADS)

Pavlov, Arkhip; Gavrilov, Dmitrij

2017-11-01

This paper discusses one of the main problems in labour and industrial management in the occupational and industrial safety field - motivation to work safely. The problem is complex and should be solved by a set of measures, where the assignment of responsibility to employees for the results of their work is absent, including in the field of labour protection and industrial safety. In accordance with the obligatory management principles, employees' work resolves to the strict implementation of the actions prescribed by the regulations. The responsibility for the negative result rests with the person who enacted or instructs employees. Thus, the employee is practically exempt from responsibility for the final result. One of the possible solutions to this problem is to put an assignment of responsibility on the employees for the results of their activities also in the occupational and industrial safety field. This is illustrated by the experience of other states, particularly of Australia. In conclusion suggestions for improvement and development of the motivation system in the field of occupational and industrial safety.

Automation, decision support, and expert systems in nephrology.

PubMed

Soman, Sandeep; Zasuwa, Gerard; Yee, Jerry

2008-01-01

Increasing data suggest that errors in medicine occur frequently and result in substantial harm to the patient. The Institute of Medicine report described the magnitude of the problem, and public interest in this issue, which was already large, has grown. The traditional approach in medicine has been to identify the persons making the errors and recommend corrective strategies. However, it has become increasingly clear that it is more productive to focus on the systems and processes through which care is provided. If these systems are set up in ways that would both make errors less likely and identify those that do occur and, at the same time, improve efficiency, then safety and productivity would be substantially improved. Clinical decision support systems (CDSSs) are active knowledge systems that use 2 or more items of patient data to generate case specific recommendations. CDSSs are typically designed to integrate a medical knowledge base, patient data, and an inference engine to generate case specific advice. This article describes how automation, templating, and CDSS improve efficiency, patient care, and safety by reducing the frequency and consequences of medical errors in nephrology. We discuss practical applications of these in 3 settings: a computerized anemia-management program (CAMP, Henry Ford Health System, Detroit, MI), vascular access surveillance systems, and monthly capitation notes in the hemodialysis unit.

Optimised layout and roadway support planning with integrated intelligent software

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

Kouniali, S.; Josien, J.P.; Piguet, J.P.

1996-12-01

Experience with knowledge-based systems for Layout planning and roadway support dimensioning is on hand in European coal mining since 1985. The systems SOUT (Support choice and dimensioning, 1989), SOUT 2, PLANANK (planning of bolt-support), Exos (layout planning diagnosis. 1994), Sout 3 (1995) have been developed in close cooperation by CdF{sup 1}. INERIS{sup 2} , EMN{sup 3} (France) and RAG{sup 4}, DMT{sup 5}, TH - Aachen{sup 6} (Germany); ISLSP (Integrated Software for Layout and support planning) development is in progress (completion scheduled for July 1996). This new software technology in combination with conventional programming systems, numerical models and existing databases turnedmore » out to be suited for setting-up an intelligent decision aid for layout and roadway support planning. The system enhances reliability of planning and optimises the safety-to-cost ratio for (1) deformation forecast for roadways in seam and surrounding rocks, consideration of the general position of the roadway in the rock mass (zones of increased pressure, position of operating and mined panels); (2) support dimensioning; (3) yielding arches, rigid arches, porch sets, rigid rings, yielding rings and bolting/shotcreting for drifts; (4) yielding arches, rigid arches and porch sets for roadways in seam; and (5) bolt support for gateroads (assessment of exclusion criteria and calculation of the bolting pattern) bolting of face-end zones (feasibility and safety assessment; stability guarantee).« less

Challenges in Developing Competency-based Training Curriculum for Food Safety Regulators in India

PubMed Central

Thippaiah, Anitha; Allagh, Komal Preet; Murthy, G. V.

2014-01-01

Context: The Food Safety and Standards Act have redefined the roles and responsibilities of food regulatory workforce and calls for highly skilled human resources as it involves complex management procedures. Aims: 1) Identify the competencies needed among the food regulatory workforce in India. 2) Develop a competency-based training curriculum for food safety regulators in the country. 3) Develop training materials for use to train the food regulatory workforce. Settings and Design: The Indian Institute of Public Health, Hyderabad, led the development of training curriculum on food safety with technical assistance from the Royal Society for Public Health, UK and the National Institute of Nutrition, India. The exercise was to facilitate the implementation of new Act by undertaking capacity building through a comprehensive training program. Materials and Methods: A competency-based training needs assessment was conducted before undertaking the development of the training materials. Results: The training program for Food Safety Officers was designed to comprise of five modules to include: Food science and technology, Food safety management systems, Food safety legislation, Enforcement of food safety regulations, and Administrative functions. Each module has a facilitator guide for the tutor and a handbook for the participant. Essentials of Food Hygiene-I (Basic level), II and III (Retail/ Catering/ Manufacturing) were primarily designed for training of food handlers and are part of essential reading for food safety regulators. Conclusion: The Food Safety and Standards Act calls for highly skilled human resources as it involves complex management procedures. Despite having developed a comprehensive competency-based training curriculum by joint efforts by the local, national, and international agencies, implementation remains a challenge in resource-limited setting. PMID:25136155

Improving the governance of patient safety in emergency care: a systematic review of interventions

PubMed Central

Hesselink, Gijs; Berben, Sivera; Beune, Thimpe

2016-01-01

Objectives To systematically review interventions that aim to improve the governance of patient safety within emergency care on effectiveness, reliability, validity and feasibility. Design A systematic review of the literature. Methods PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews and PsychInfo were searched for studies published between January 1990 and July 2014. We included studies evaluating interventions relevant for higher management to oversee and manage patient safety, in prehospital emergency medical service (EMS) organisations and hospital-based emergency departments (EDs). Two reviewers independently selected candidate studies, extracted data and assessed study quality. Studies were categorised according to study quality, setting, sample, intervention characteristics and findings. Results Of the 18 included studies, 13 (72%) were non-experimental. Nine studies (50%) reported data on the reliability and/or validity of the intervention. Eight studies (44%) reported on the feasibility of the intervention. Only 4 studies (22%) reported statistically significant effects. The use of a simulation-based training programme and well-designed incident reporting systems led to a statistically significant improvement of safety knowledge and attitudes by ED staff and an increase of incident reports within EDs, respectively. Conclusions Characteristics of the interventions included in this review (eg, anonymous incident reporting and validation of incident reports by an independent party) could provide useful input for the design of an effective tool to govern patient safety in EMS organisations and EDs. However, executives cannot rely on a robust set of evidence-based and feasible tools to govern patient safety within their emergency care organisation and in the chain of emergency care. Established strategies from other high-risk sectors need to be evaluated in emergency care settings, using an experimental design with valid outcome measures to strengthen the evidence base. PMID:26826151

History, Principles, and Policies of Observation Medicine.

PubMed

Ross, Michael A; Granovsky, Michael

2017-08-01

The history of observation medicine has paralleled the rise of emergency medicine over the past 50 years to meet the needs of patients, emergency departments, hospitals, and the US health care system. Just as emergency departments are the safety net of the health system, observation units are the safety net of emergency departments. The growth of observation medicine has been driven by innovations in health care, an ongoing shift of patients from inpatient to outpatient settings, and changes in health policy. These units have been shown to provide better outcomes than traditional care for selected patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Prospect Theory and Interval-Valued Hesitant Set for Safety Evacuation Model

NASA Astrophysics Data System (ADS)

Kou, Meng; Lu, Na

2018-01-01

The study applies the research results of prospect theory and multi attribute decision making theory, combined with the complexity, uncertainty and multifactor influence of the underground mine fire system and takes the decision makers’ psychological behavior of emotion and intuition into full account to establish the intuitionistic fuzzy multiple attribute decision making method that is based on the prospect theory. The model established by this method can explain the decision maker’s safety evacuation decision behavior in the complex system of underground mine fire due to the uncertainty of the environment, imperfection of the information and human psychological behavior and other factors.

Implementation and Use of Anesthesia Information Management Systems for Non-operating Room Locations.

PubMed

Bouhenguel, Jason T; Preiss, David A; Urman, Richard D

2017-12-01

Non-operating room anesthesia (NORA) encounters comprise a significant fraction of contemporary anesthesia practice. With the implemention of an aneshtesia information management system (AIMS), anesthesia practitioners can better streamline preoperative assessment, intraoperative automated documentation, real-time decision support, and remote surveillance. Despite the large personal and financial commitments involved in adoption and implementation of AIMS and other electronic health records in these settings, the benefits to safety, efficacy, and efficiency are far too great to be ignored. Continued future innovation of AIMS technology only promises to further improve on our NORA experience and improve care quality and safety. Copyright © 2017 Elsevier Inc. All rights reserved.

Region and database management for HANDI 2000 business management system

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

Wilson, D.

The Data Integration 2000 Project will result in an integrated and comprehensive set of functional applications containing core information necessary to support the Project Hanford Management Contract. It is based on the Commercial-Off-The-Shelf product solution with commercially proven business processes. The COTS product solution set, of PassPort and People Soft software, supports finance, supply and chemical management/Material Safety Data Sheet, human resources.

Improving timeliness and efficiency in the referral process for safety net providers: application of the Lean Six Sigma methodology.

PubMed

Deckard, Gloria J; Borkowski, Nancy; Diaz, Deisell; Sanchez, Carlos; Boisette, Serge A

2010-01-01

Designated primary care clinics largely serve low-income and uninsured patients who present a disproportionate number of chronic illnesses and face great difficulty in obtaining the medical care they need, particularly the access to specialty physicians. With limited capacity for providing specialty care, these primary care clinics generally refer patients to safety net hospitals' specialty ambulatory care clinics. A large public safety net health system successfully improved the effectiveness and efficiency of the specialty clinic referral process through application of Lean Six Sigma, an advanced process-improvement methodology and set of tools driven by statistics and engineering concepts.

Individualization through standardization: electronic orders for subcutaneous insulin in the hospital.

PubMed

Kennihan, Mary; Zohra, Tatheer; Devi, Radha; Srinivasan, Chitra; Diaz, Josefina; Howard, Bradley S; Braithwaite, Susan S

2012-01-01

The objective was to design electronic order sets that would promote safe, effective, and individualized order entry for subcutaneous insulin in the hospital, based on a review of best practices. Saint Francis Hospital in Evanston, Illinois, a community teaching hospital, was selected as the pilot site for 6 hospitals in the Health Care System to introduce an electronic medical record. Articles dealing with management of hospital hyperglycemia, medical order entry systems, and patient safety were reviewed selectively. In the published literature on institutional glycemic management programs and insulin order sets, features were identified that improve safety and effectiveness of subcutaneous insulin therapy. Subcutaneous electronic insulin order sets were created, designated in short: "patients eating", "patients not eating", and "patients receiving overnight enteral feedings." Together with an option for free text entry, menus of administration instructions were designed within each order set that were applicable to specific insulin orders and expressed in standardized language, such as "hold if tube feeds stop" or "do not withhold." Two design features are advocated for electronic order sets for subcutaneous insulin that will both standardize care and protect individualization. First, within the order sets, the glycemic management plan should be matched to the carbohydrate exposure of the patients, with juxtaposition of appropriate orders for both glucose monitoring and insulin. Second, in order to convey precautions of insulin use to pharmacy and nursing staff, the prescriber must be able to attach administration instructions to specific insulin orders.

System analysis of vehicle active safety problem

NASA Astrophysics Data System (ADS)

Buznikov, S. E.

2018-02-01

The problem of the road transport safety affects the vital interests of the most of the population and is characterized by a global level of significance. The system analysis of problem of creation of competitive active vehicle safety systems is presented as an interrelated complex of tasks of multi-criterion optimization and dynamic stabilization of the state variables of a controlled object. Solving them requires generation of all possible variants of technical solutions within the software and hardware domains and synthesis of the control, which is close to optimum. For implementing the task of the system analysis the Zwicky “morphological box” method is used. Creation of comprehensive active safety systems involves solution of the problem of preventing typical collisions. For solving it, a structured set of collisions is introduced with its elements being generated also using the Zwicky “morphological box” method. The obstacle speed, the longitudinal acceleration of the controlled object and the unpredictable changes in its movement direction due to certain faults, the road surface condition and the control errors are taken as structure variables that characterize the conditions of collisions. The conditions for preventing typical collisions are presented as inequalities for physical variables that define the state vector of the object and its dynamic limits.

Postmarketing Safety Study Tool: A Web Based, Dynamic, and Interoperable System for Postmarketing Drug Surveillance Studies

PubMed Central

Sinaci, A. Anil; Laleci Erturkmen, Gokce B.; Gonul, Suat; Yuksel, Mustafa; Invernizzi, Paolo; Thakrar, Bharat; Pacaci, Anil; Cinar, H. Alper; Cicekli, Nihan Kesim

2015-01-01

Postmarketing drug surveillance is a crucial aspect of the clinical research activities in pharmacovigilance and pharmacoepidemiology. Successful utilization of available Electronic Health Record (EHR) data can complement and strengthen postmarketing safety studies. In terms of the secondary use of EHRs, access and analysis of patient data across different domains are a critical factor; we address this data interoperability problem between EHR systems and clinical research systems in this paper. We demonstrate that this problem can be solved in an upper level with the use of common data elements in a standardized fashion so that clinical researchers can work with different EHR systems independently of the underlying information model. Postmarketing Safety Study Tool lets the clinical researchers extract data from different EHR systems by designing data collection set schemas through common data elements. The tool interacts with a semantic metadata registry through IHE data element exchange profile. Postmarketing Safety Study Tool and its supporting components have been implemented and deployed on the central data warehouse of the Lombardy region, Italy, which contains anonymized records of about 16 million patients with over 10-year longitudinal data on average. Clinical researchers in Roche validate the tool with real life use cases. PMID:26543873

Adverse Events Associated with Hospitalization or Detected through the RAI-HC Assessment among Canadian Home Care Clients

PubMed Central

Doran, Diane; Hirdes, John P.; Blais, Régis; Baker, G. Ross; Poss, Jeff W.; Li, Xiaoqiang; Dill, Donna; Gruneir, Andrea; Heckman, George; Lacroix, Hélène; Mitchell, Lori; O'Beirne, Maeve; Foebel, Andrea; White, Nancy; Qian, Gan; Nahm, Sang-Myong; Yim, Odilia; Droppo, Lisa; McIsaac, Corrine

2013-01-01

Background: The occurrence of adverse events (AEs) in care settings is a patient safety concern that has significant consequences across healthcare systems. Patient safety problems have been well documented in acute care settings; however, similar data for clients in home care (HC) settings in Canada are limited. The purpose of this Canadian study was to investigate AEs in HC, specifically those associated with hospitalization or detected through the Resident Assessment Instrument for Home Care (RAI-HC). Method: A retrospective cohort design was used. The cohort consisted of HC clients from the provinces of Nova Scotia, Ontario, British Columbia and the Winnipeg Regional Health Authority. Results: The overall incidence rate of AEs associated with hospitalization ranged from 6% to 9%. The incidence rate of AEs determined from the RAI-HC was 4%. Injurious falls, injuries from other than fall and medication-related events were the most frequent AEs associated with hospitalization, whereas new caregiver distress was the most frequent AE identified through the RAI-HC. Conclusion: The incidence of AEs from all sources of data ranged from 4% to 9%. More resources are needed to target strategies for addressing safety risks in HC in a broader context. Tools such as the RAI-HC and its Clinical Assessment Protocols, already available in Canada, could be very useful in the assessment and management of HC clients who are at safety risk. PMID:23968676

Use patterns among early adopters of adaptive cruise control.

PubMed

Xiong, Huimin; Boyle, Linda Ng; Moeckli, Jane; Dow, Benjamin R; Brown, Timothy L

2012-10-01

The objective of this study was to investigate use patterns among early adopters of adaptive cruise control (ACC). Extended use ofACC may influence a driver's behavior in the long-term, which can have unintended safety consequences. The authors examined the use of a motion-based simulator by 24 participants (15 males and 9 females). Cluster analysis was performed on drivers' use of ACC and was based on their gap settings, speed settings, number of warnings issued, and ACC disengaged. The data were then examined on the basis of driving performance measures and drivers' subjective responses to trust in ACC, understanding of system operations, and driving styles. Driving performance measures included minimum time headway, adjusted minimum time to collision, and drivers' reaction time to critical events. Three groups of drivers were observed on the basis of risky behavior, moderately risky behavior, and conservative behavior. Drivers in the conservative group stayed farther behind the lead vehicle than did drivers in the other two groups. Risky drivers responded later to critical events and had more ACC warnings issued. Safety consequences with ACC may be more prevalent in some driver groups than others. The findings suggest that these safety implications are related to trust in automation, driving styles, understanding of system operations, and personalities. Potential applications of this research include enhanced design for next-generation ACC systems and countermeasures to improve safe driving with ACC.

Exploring the Effects of Cultural Variables in the Implementation of Behavior-Based Safety in Two Organizations

ERIC Educational Resources Information Center

Bumstead, Alaina; Boyce, Thomas E.

2005-01-01

The present case study examines how culture can influence behavior-based safety in different organizational settings and how behavior-based safety can impact different organizational cultures. Behavior-based safety processes implemented in two culturally diverse work settings are described. Specifically, despite identical implementation plans,…

Safety in the Chemical Laboratory: An Undergraduate Chemical Laboratory Safety Course.

ERIC Educational Resources Information Center

Nicholls, L. Jewel

1982-01-01

Describes a two-quarter hour college chemistry course focusing on laboratory safety. Includes lists of topics/assignments, problem sets (toxicology, storage, and energy) and videotapes, films, and slide sets used in the course. (JN)

The NASA Aviation Safety Program: Overview

NASA Technical Reports Server (NTRS)

Shin, Jaiwon

2000-01-01

In 1997, the United States set a national goal to reduce the fatal accident rate for aviation by 80% within ten years based on the recommendations by the Presidential Commission on Aviation Safety and Security. Achieving this goal will require the combined efforts of government, industry, and academia in the areas of technology research and development, implementation, and operations. To respond to the national goal, the National Aeronautics and Space Administration (NASA) has developed a program that will focus resources over a five year period on performing research and developing technologies that will enable improvements in many areas of aviation safety. The NASA Aviation Safety Program (AvSP) is organized into six research areas: Aviation System Modeling and Monitoring, System Wide Accident Prevention, Single Aircraft Accident Prevention, Weather Accident Prevention, Accident Mitigation, and Synthetic Vision. Specific project areas include Turbulence Detection and Mitigation, Aviation Weather Information, Weather Information Communications, Propulsion Systems Health Management, Control Upset Management, Human Error Modeling, Maintenance Human Factors, Fire Prevention, and Synthetic Vision Systems for Commercial, Business, and General Aviation aircraft. Research will be performed at all four NASA aeronautics centers and will be closely coordinated with Federal Aviation Administration (FAA) and other government agencies, industry, academia, as well as the aviation user community. This paper provides an overview of the NASA Aviation Safety Program goals, structure, and integration with the rest of the aviation community.

[A set of quality and safety indicators for hospitals of the "Agencia Valenciana de Salud"].

PubMed

Nebot-Marzal, C M; Mira-Solves, J J; Guilabert-Mora, M; Pérez-Jover, V; Pablo-Comeche, D; Quirós-Morató, T; Cuesta Peredo, D

2014-01-01

To prepare a set of quality and safety indicators for Hospitals of the «Agencia Valenciana de Salud». The qualitative technique Metaplan® was applied in order to gather proposals on sustainability and nursing. The catalogue of the «Spanish Society of Quality in Healthcare» was adopted as a starting point for clinical indicators. Using the Delphi technique, 207 professionals were invited to participate in the selecting the most reliable and feasible indicators. Lastly, the resulting proposal was validated with the managers of 12 hospitals, taking into account the variability, objectivity, feasibility, reliability and sensitivity, of the indicators. Participation rates varied between 66.67% and 80.71%. Of the 159 initial indicators, 68 were prioritized and selected (21 economic or management indicators, 22 nursing indicators, and 25 clinical or hospital indicators). Three of them were common to all three categories and two did not match the specified criteria during the validation phase, thus obtaining a final catalogue of 63 indicators. A set of quality and safety indicators for Hospitals was prepared. They are currently being monitored using the hospital information systems. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

The assessment of exploitation process of power for access control system

NASA Astrophysics Data System (ADS)

Wiśnios, Michał; Paś, Jacek

2017-10-01

The safety of public utility facilities is a function not only of effectiveness of the electronic safety systems, used for protection of property and persons, but it also depends on the proper functioning of their power supply systems. The authors of the research paper analysed the power supply systems, which are used in buildings for the access control system that is integrated with the closed-circuit TV. The Access Control System is a set of electronic, electromechanical and electrical devices and the computer software controlling the operation of the above-mentioned elements, which is aimed at identification of people, vehicles allowed to cross the boundary of the reserved area, to prevent from crossing the reserved area and to generate the alarm signal informing about the attempt of crossing by an unauthorised entity. The industrial electricity with appropriate technical parameters is a basis of proper functioning of safety systems. Only the electricity supply to the systems is not equivalent to the operation continuity provision. In practice, redundant power supply systems are used. In the carried out reliability analysis of the power supply system, various power circuits of the system were taken into account. The reliability and operation requirements for this type of system were also included.

Development and psychometric testing of an instrument to measure safety climate perceptions in community pharmacy.

PubMed

Newham, Rosemary; Bennie, Marion; Maxwell, David; Watson, Anne; de Wet, Carl; Bowie, Paul

2014-12-01

A positive and strong safety culture underpins effective learning from patient safety incidents in health care, including the community pharmacy (CP) setting. To build this culture, perceptions of safety climate must be measured with context-specific and reliable instruments. No pre-existing instruments were specifically designed or suitable for CP within Scotland. We therefore aimed to develop a psychometrically sound instrument to measure perceptions of safety climate within Scottish CPs. The first stage, development of a preliminary instrument, comprised three steps: (i) a literature review; (ii) focus group feedback; and (iii) content validation. The second stage, psychometric testing, consisted of three further steps: (iv) a pilot survey; (v) a survey of all CP staff within a single health board in NHS Scotland; and (vi) application of statistical methods, including principal components analysis and calculation of Cronbach's reliability coefficients, to derive the final instrument. The preliminary questionnaire was developed through a process of literature review and feedback. This questionnaire was completed by staff in 50 CPs from the 131 (38%) sampled. 250 completed questionnaires were suitable for analysis. Psychometric evaluation resulted in a 30-item instrument with five positively correlated safety climate factors: leadership, teamwork, safety systems, communication and working conditions. Reliability coefficients were satisfactory for the safety climate factors (α > 0.7) and overall (α = 0.93). The robust nature of the technical design and testing process has resulted in the development of an instrument with sufficient psychometric properties, which can be implemented in the community pharmacy setting in NHS Scotland. © 2014 John Wiley & Sons, Ltd.

Detection of errant laser beams

NASA Astrophysics Data System (ADS)

Taylor, Arthur F. D. S.; Edwards, Stanley A.; Barrett, J. A.; Bandle, Anthony M.

1990-10-01

The new generation of automated laser machine tools poses problems for those responsible for setting safety standards. While traditional safeguarding will frustrate full exploitation of this hybrid technology, wholesale abandonment of effective containment in favour of safety monitoring and control systems is unlikely to be acceptable. Long term, quantitative risk assessment will resolve this dilemma. Short term, guide lines will have to be derived from practical considerations of the laser facility design, materials, primary safety devices and procedures. Earlier risk assessments are reviewed relative to the emerging perspective of high average power laser installations. Aspects of extended beam delivery systems and equipment utilization and maintenance are examined to assess possible interaction with operational safety and in particular the potential to adversely influence errant laser beam occurrances (ELBO). To satisfy international safety standards for a laser enclosure which offers flexibility and is cost effective a detection system is described which continuously surveys the inside of the enclosure. Extensive trials have been carried out with high average power lasers (up to 10kW) where a range of engineering materials has been exposed to a laser beam. It is shown that the ratio of detection and shut down time to the burn through time can be an acceptable risk and thus indicate which materials will prove adequate.

Struggling to invent high-reliability organizations in health care settings: Insights from the field.

PubMed

Dixon, Nancy M; Shofer, Marjorie

2006-08-01

The Mission of the Agency for Healthcare Research and Quality (AHRQ) has been to support and conduct health services research and to disseminate those research findings. Recently the Agency has changed its mission to: "Improving the quality, safety, efficiency and effectiveness of health care for all Americans." For agency personnel working with the topic of patient safety, that change has created a need to develop greater awareness of the current patient safety initiatives underway at leading health care systems in order to determine where AHRQ might best play a role in helping these systems more rapidly adopt new practices to improve patient safety. In order to make that determination, AHRQ conducted a customer needs assessment of leaders in selected health care systems, asking them questions about their current implementation initiatives and their perceived needs for continued implementation of patient safety initiatives. Although not designed or conducted as a research study, the hour-long interviews produced rich insights into the implementation efforts of patient safety initiatives. The senior leaders interviewed in each of the health care systems, described implementing patient safety initiatives on multiple fronts-in some systems as many as 15 initiatives were underway. As the number of initiatives attests, there was no lack of knowledge about what patient safety practices should be implemented (CPOE, rapid response teams, reduction in surgical site infections) rather the major struggle these health care systems faced was the "how to" of implementation. Most initiatives were only newly begun, so these leaders were not yet confident about what they had learned from these efforts or whether they could be sustained over time. These health care systems drew many of the ideas for initiatives from outside of health care, for example, the nuclear power industry or aviation. The executives expressed concern about a number of issues including: how patient safety initiatives should be sequenced, the lack of benchmarking data to measure their systems against and the pressing need for IT standardization. The insights from this customer needs assessment revealed a wealth of implementation knowledge in the field and has led AHRQ to create an opportunity for leading edge health care systems to learn from each other via learning networks.

A procedure for analysis of guyline tension.

Treesearch

Ward W. Carson; Jens E. Jorgensen; Stephen E. Reutebuch; William J. Bramwell

1982-01-01

Most cable logging operations use a spar held in place near the landing by a system of guylines and anchors. Safety and economic considerations require that overloads be avoided and that the spar remain stable. This paper presents a procedure and a computer program to estimate the guyline and anchor loads on a particular system configuration by a specific set of...

Identifying the most significant indicators of the total road safety performance index.

PubMed

Tešić, Milan; Hermans, Elke; Lipovac, Krsto; Pešić, Dalibor

2018-04-01

The review of the national and international literature dealing with the assessment of the road safety level has shown great efforts of the authors who tried to define the methodology for calculating the composite road safety index on a territory (region, state, etc.). The procedure for obtaining a road safety composite index of an area has been largely harmonized. The question that has not been fully resolved yet concerns the selection of indicators. There is a wide range of road safety indicators used to show a road safety situation on a territory. Road safety performance index (RSPI) obtained on the basis of a larger number of safety performance indicators (SPIs) enable decision makers to more precisely define the earlier goal- oriented actions. However, recording a broader comprehensive set of SPIs helps identify the strengths and weaknesses of a country's road safety system. Providing high quality national and international databases that would include comparable SPIs seems to be difficult since a larger number of countries dispose of a small number of identical indicators available for use. Therefore, there is a need for calculating a road safety performance index with a limited number of indicators (RSPI ln n ) which will provide a comparison of a sufficient quality, of as many countries as possible. The application of the Data Envelopment Analysis (DEA) method and correlative analysis has helped to check if the RSPI ln n is likely to be of sufficient quality. A strong correlation between the RSPI ln n and the RSPI has been identified using the proposed methodology. Based on this, the most contributing indicators and methodologies for gradual monitoring of SPIs, have been defined for each country analyzed. The indicator monitoring phases in the analyzed countries have been defined in the following way: Phase 1- the indicators relating to alcohol, speed and protective systems; Phase 2- the indicators relating to roads and Phase 3- the indicators relating to trauma management. This will help achieve the standardization of indicators including data collection procedures and selection of the key list of indicators that need to be monitored. Based on the results, it has been concluded that the use of the most contributing indicators will make it possible to assess the level of road safety on a territory, with an acceptable quality score by focusing on the low-ranked countries. A smaller set of significant indicators defined in this manner can serve for a fast and simple understanding of a road safety situation and assessment of effects of measures undertaken. Also, this universal index approach is applicable in cases when a broader comprehensive set of indicators is analyzed, which provides a more accurate identification of weaker points and rank the countries in a more meaningful way. Copyright © 2018 Elsevier Ltd. All rights reserved.

Supplement : development of improved injury criteria for the assessment of advanced automotive restraint systems : II

DOT National Transportation Integrated Search

2000-03-01

In the Supplemental Notice of Proposed Rulemaking (SNPRM) on advanced air bags, the National Highway Traffic Safety Administration (NHTSA) proposed a comprehensive set of injury criteria for evaluating the potential for injury to the head, neck, ches...

Panel Resource Management (PRM) Implementation and Effects within Safety Review Panel Settings and Dynamics

NASA Technical Reports Server (NTRS)

Taylor, Robert W.; Nash, Sally K.

2007-01-01

While technical training and advanced degree's assure proficiency at specific tasks within engineering disciplines, they fail to address the potential for communication breakdown and decision making errors familiar to multicultural environments where language barriers, intimidating personalities and interdisciplinary misconceptions exist. In an effort to minimize these pitfalls to effective panel review, NASA's lead safety engineers to the ISS Safety Review Panel (SRP), and Payload Safety Review Panel (PSRP) initiated training with their engineers, in conjunction with the panel chairs, and began a Panel Resource Management (PRM) program. The intent of this program focuses on the ability to reduce the barriers inhibiting effective participation from all panel attendees by bolstering participants confidence levels through increased communication skills, situational awareness, debriefing, and a better technical understanding of requirements and systems.

Data management plan for HANDI 2000 business management system

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

Wilson, D.

The Hanford Data Integration 2000 (HANDI 2000) Project will result in an integrated and comprehensive set of functional applications containing core information necessary to support the Project Hanford Management Contract (PHMC). It is based on the Commercial-Off-The-Shelf (COTS) product solution with commercially proven business processes. The COTS product solution set, of PassPort (PP) and PeopleSoft (PS) software, supports finance, supply and chemical management/Material Safety Data Sheet.

Food safety - the roles and responsibilities of different sectors

NASA Astrophysics Data System (ADS)

Karabasil, N.; Bošković, T.; Dimitrijević, M.; Vasilev, D.; Đorđević, V.; Lakićević, B.; Teodorović, V.

2017-09-01

Serbia is a relatively small country but with a long tradition in food production, especially meat and meat products. Serbia, as part of its open negotiation process as a candidate country with the European Union (EU), started to harmonise its legislation with the EU, and has published a set of laws and regulations relating to the hygiene of food production and food safety, the official control of production and the welfare of animals. Therefore, the food safety system in Serbia is based on principles established in the EU. There is a need for cooperation of different sectors (government, food business operators and consumers) in the management of food safety, and every sector has its role and responsibility. This paper aims to provide analytical support for the process of upgrading safety and quality in Serbia’s food sector and explains the roles and responsibilities of different sectors in the food chain.

Safety and health in biomass production, transportation, and storage: a commentary based on the biomass and biofuels session at the 2013 North American Agricultural Safety Summit.

PubMed

Yoder, Aaron M; Schwab, Charles; Gunderson, Paul; Murphy, Dennis

2014-01-01

There is significant interest in biomass production ranging from government agencies to the private sector, both inside and outside of the traditional production agricultural setting. This interest has led to an increase in the development and production of biomass crops. Much of this effort has focused on specific segments of the process, and more specifically on the mechanics of these individual segments. From a review of scientific literature, it is seen that little effort has been put into identifying, classifying and preventing safety hazards in on-farm biomass production systems. This commentary describes the current status of the knowledge pertaining to health and safety factors of biomass production and storage in the US and identifies areas of standards development that the biomass industry needs from the agricultural safety and health community.

Review of Estelle and LOTOS with respect to critical computer applications

NASA Technical Reports Server (NTRS)

Bown, Rodney L.

1991-01-01

Man rated NASA space vehicles seem to represent a set of ultimate critical computer applications. These applications require a high degree of security, integrity, and safety. A variety of formal and/or precise modeling techniques are becoming available for the designer of critical systems. The design phase of the software engineering life cycle includes the modification of non-development components. A review of the Estelle and LOTOS formal description languages is presented. Details of the languages and a set of references are provided. The languages were used to formally describe some of the Open System Interconnect (OSI) protocols.

In situ medical simulation investigation of emergency department procedural sedation with randomized trial of experimental bedside clinical process guidance intervention.

PubMed

Siegel, Nathan A; Kobayashi, Leo; Dunbar-Viveiros, Jennifer A; Devine, Jeffrey; Al-Rasheed, Rakan S; Gardiner, Fenwick G; Olsson, Krister; Lai, Stella; Jones, Mark S; Dannecker, Max; Overly, Frank L; Gosbee, John W; Portelli, David C; Jay, Gregory D

2015-06-01

Patient safety during emergency department procedural sedation (EDPS) can be difficult to study. Investigators sought to delineate and experimentally assess EDPS performance and safety practices of senior-level emergency medicine residents through in situ simulation. Study sessions used 2 pilot-tested EDPS scenarios with critical action checklists, institutional forms, embedded probes, and situational awareness questionnaires. An experimental informatics system was separately developed for bedside EDPS process guidance. Postgraduate year 3 and 4 subjects completed both scenarios in randomized order; only experimental subjects were provided with the experimental system during second scenarios. Twenty-four residents were recruited into a control group (n = 12; 6.2 ± 7.4 live EDPS experience) and experimental group (n = 12; 11.3 ± 8.2 live EDPS experience [P = 0.10]). Critical actions for EDPS medication selection, induction, and adverse event recognition with resuscitation were correctly performed by most subjects. Presedation evaluations, sedation rescue preparation, equipment checks, time-outs, and documentation were frequently missed. Time-outs and postsedation assessments increased during second scenarios in the experimental group. Emergency department procedural sedation safety probe detection did not change across scenarios in either group. Situational awareness scores were 51% ± 7% for control group and 58% ± 12% for experimental group. Subjects using the experimental system completed more time-outs and scored higher Simulation EDPS Safety Composite Scores, although without comprehensive improvements in EDPS practice or safety. Study simulations delineated EDPS and assessed safety behaviors in senior emergency medicine residents, who exhibited the requisite medical knowledge base and procedural skill set but lacked some nontechnical skills that pertain to emergency department microsystem functions and patient safety. The experimental system exhibited limited impact only on in-simulation time-out compliance.

Systems thinking and incivility in nursing practice: An integrative review.

PubMed

Phillips, Janet M; Stalter, Ann M; Winegardner, Sherri; Wiggs, Carol; Jauch, Amy

2018-01-23

There is a critical need for nurses and interprofessional healthcare providers to implement systems thinking (ST) across international borders, addressing incivility and its perilous effects on patient quality and safety. An estimated one million patients die in hospitals worldwide due to avoidable patient-related errors. Establishing safe and civil workplaces using ST is paramount to promoting clear, level-headed thinking from which patient-centered nursing actions can impact health systems. The purpose of the paper is to answer the research question, What ST evidence fosters the effect of workplace civility in practice settings? Whittemore and Knafl's integrative review method guided this study. The quality of articles was determined using Chu et al.'s Mixed Methods Assessment Tool. Thirty-eight studies were reviewed. Themes emerged describing antecedents and consequences of incivility as embedded within complex systems, suggesting improvements for civility and systems/ST in nursing practice. This integrative review provides information about worldwide incivility in nursing practice from a systems perspective. Several models are offered as a means of promoting civility in nursing practice to improve patient quality and safety. Further study is needed regarding incivility and resultant effects on patient quality and safety. © 2018 Wiley Periodicals, Inc.

SCALE Code System

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

Rearden, Bradley T.; Jessee, Matthew Anderson

The SCALE Code System is a widely-used modeling and simulation suite for nuclear safety analysis and design that is developed, maintained, tested, and managed by the Reactor and Nuclear Systems Division (RNSD) of Oak Ridge National Laboratory (ORNL). SCALE provides a comprehensive, verified and validated, user-friendly tool set for criticality safety, reactor and lattice physics, radiation shielding, spent fuel and radioactive source term characterization, and sensitivity and uncertainty analysis. Since 1980, regulators, licensees, and research institutions around the world have used SCALE for safety analysis and design. SCALE provides an integrated framework with dozens of computational modules including three deterministicmore » and three Monte Carlo radiation transport solvers that are selected based on the desired solution strategy. SCALE includes current nuclear data libraries and problem-dependent processing tools for continuous-energy (CE) and multigroup (MG) neutronics and coupled neutron-gamma calculations, as well as activation, depletion, and decay calculations. SCALE includes unique capabilities for automated variance reduction for shielding calculations, as well as sensitivity and uncertainty analysis. SCALE’s graphical user interfaces assist with accurate system modeling, visualization of nuclear data, and convenient access to desired results.« less

SCALE Code System 6.2.1

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

Rearden, Bradley T.; Jessee, Matthew Anderson

The SCALE Code System is a widely-used modeling and simulation suite for nuclear safety analysis and design that is developed, maintained, tested, and managed by the Reactor and Nuclear Systems Division (RNSD) of Oak Ridge National Laboratory (ORNL). SCALE provides a comprehensive, verified and validated, user-friendly tool set for criticality safety, reactor and lattice physics, radiation shielding, spent fuel and radioactive source term characterization, and sensitivity and uncertainty analysis. Since 1980, regulators, licensees, and research institutions around the world have used SCALE for safety analysis and design. SCALE provides an integrated framework with dozens of computational modules including three deterministicmore » and three Monte Carlo radiation transport solvers that are selected based on the desired solution strategy. SCALE includes current nuclear data libraries and problem-dependent processing tools for continuous-energy (CE) and multigroup (MG) neutronics and coupled neutron-gamma calculations, as well as activation, depletion, and decay calculations. SCALE includes unique capabilities for automated variance reduction for shielding calculations, as well as sensitivity and uncertainty analysis. SCALE’s graphical user interfaces assist with accurate system modeling, visualization of nuclear data, and convenient access to desired results.« less

The appropriate and inappropriate use of child restraint seats in Manitoba.

PubMed

Blair, John; Perdios, Angeliki; Babul, Shelina; Young, Kevin; Beckles, Janice; Pike, Ian; Cripton, Peter; Sasges, Debbie; Mulpuri, Krishore; Desapriya, Ediriweera

2008-09-01

The objective of this research was to describe the use and incorrect use of child restraint systems in Manitoba, Canada. In 2004, a team of inspectors made up of Royal Canadian Mounted Police officers and trained car seat technicians from the Manitoba child seat coalition conducted a descriptive survey of types and frequency of child restraint systems' incorrect use. The setting was 10 roadside inspection sites located around the city of Winnipeg, Manitoba. The subjects were parents and primary caregivers of children using child restraint systems. The main outcome measured was the reported appropriate use rate as determined by the compliance to safety standards for correct installation and use of child restraints. A total of 340 child restraint systems were assessed. The overall rate of incorrect use was 70%. The errors present in stage III systems (booster seats) are much lower than the errors present in stage I systems (rear-facing child safety seats) and stage II systems (forward-facing child safety seats). The data presented illustrate that incorrect use of child restraint systems in the province of Manitoba is a large problem and must be dealt with immediately in order to ensure child safety now and in the future. Community-wide information and enhanced enforcement campaigns, consisting of activities such as mass media, information and publicity, child restraint systems displays and special enforcement strategies (check points, dedicated law enforcement officials, alternative penalties) should be used to increase the correct use of child restraint systems. Failure to use child restraint systems properly can contribute to serious injury or death of a child.

The new mission of forensic mental health systems: managing violence as a medical syndrome in an environment that balances treatment and safety.

PubMed

Warburton, Katherine

2014-10-01

The association between violence and mental illness is well-studied, yet remains highly controversial. Currently, there appears to be a trend of increasing violence in state hospital settings, including both civilly and forensically committed populations. In fact, physical aggression is the primary reason for admission to many state hospitals. Given that violence is now often both a reason for admission and a barrier to discharge, there is a case to be made for psychiatric violence to be re-conceptualized dimensionally, as a primary syndrome, not as the byproduct of one. Furthermore, treatment settings need to be enhanced to address the new types of violence exhibited in inpatient environments, and this modification needs to be geared toward balancing safety with treatment.

[Measurement and study report as a part of the control system for human safety and health protection against electromagnetic fields and electromagnetic radiation (0 Hz-300 GHz)].

PubMed

Aniołczyk, Halina

2007-01-01

The National Control System for safety and health protection against electromagnetic fields (EMF) and electromagnetic radiation (EMR) (0 Hz-300 GHz) is constantly analyzed in view of Directive 2004/40/EC. Reports on the effects of investments (at the designing stage or at the stage of looking for their localization) on the environment and measurement and study reports on the objects already existing or being put into operation are important elements of this system. These documents should meet both national and European Union's legislation requirements. The overriding goal of the control system is safety and health protection of humans against electromagnetic fields in the environment and in occupational settings. The author pays a particular attention to provisions made in directives issued by relevant ministers and to Polish standards, which should be documented in measurement and study reports published by the accredited laboratories and relating to the problems of human safety and health protection. Similar requirements are valid for the Reports. Therefore, along with measurement outcomes, the reports should include data on the EMF exposure classification at work-posts and the assessment of occupational risk resulting from EMF exposure or at least thorough data facilitating such a classification.

An error taxonomy system for analysis of haemodialysis incidents.

PubMed

Gu, Xiuzhu; Itoh, Kenji; Suzuki, Satoshi

2014-12-01

This paper describes the development of a haemodialysis error taxonomy system for analysing incidents and predicting the safety status of a dialysis organisation. The error taxonomy system was developed by adapting an error taxonomy system which assumed no specific specialty to haemodialysis situations. Its application was conducted with 1,909 incident reports collected from two dialysis facilities in Japan. Over 70% of haemodialysis incidents were reported as problems or complications related to dialyser, circuit, medication and setting of dialysis condition. Approximately 70% of errors took place immediately before and after the four hours of haemodialysis therapy. Error types most frequently made in the dialysis unit were omission and qualitative errors. Failures or complications classified to staff human factors, communication, task and organisational factors were found in most dialysis incidents. Device/equipment/materials, medicine and clinical documents were most likely to be involved in errors. Haemodialysis nurses were involved in more incidents related to medicine and documents, whereas dialysis technologists made more errors with device/equipment/materials. This error taxonomy system is able to investigate incidents and adverse events occurring in the dialysis setting but is also able to estimate safety-related status of an organisation, such as reporting culture. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Modeling and Hazard Analysis Using STPA

NASA Astrophysics Data System (ADS)

Ishimatsu, Takuto; Leveson, Nancy; Thomas, John; Katahira, Masa; Miyamoto, Yuko; Nakao, Haruka

2010-09-01

A joint research project between MIT and JAXA/JAMSS is investigating the application of a new hazard analysis to the system and software in the HTV. Traditional hazard analysis focuses on component failures but software does not fail in this way. Software most often contributes to accidents by commanding the spacecraft into an unsafe state(e.g., turning off the descent engines prematurely) or by not issuing required commands. That makes the standard hazard analysis techniques of limited usefulness on software-intensive systems, which describes most spacecraft built today. STPA is a new hazard analysis technique based on systems theory rather than reliability theory. It treats safety as a control problem rather than a failure problem. The goal of STPA, which is to create a set of scenarios that can lead to a hazard, is the same as FTA but STPA includes a broader set of potential scenarios including those in which no failures occur but the problems arise due to unsafe and unintended interactions among the system components. STPA also provides more guidance to the analysts that traditional fault tree analysis. Functional control diagrams are used to guide the analysis. In addition, JAXA uses a model-based system engineering development environment(created originally by Leveson and called SpecTRM) which also assists in the hazard analysis. One of the advantages of STPA is that it can be applied early in the system engineering and development process in a safety-driven design process where hazard analysis drives the design decisions rather than waiting until reviews identify problems that are then costly or difficult to fix. It can also be applied in an after-the-fact analysis and hazard assessment, which is what we did in this case study. This paper describes the experimental application of STPA to the JAXA HTV in order to determine the feasibility and usefulness of the new hazard analysis technique. Because the HTV was originally developed using fault tree analysis and following the NASA standards for safety-critical systems, the results of our experimental application of STPA can be compared with these more traditional safety engineering approaches in terms of the problems identified and the resources required to use it.

Fault Detection and Safety in Closed-Loop Artificial Pancreas Systems

PubMed Central

2014-01-01

Continuous subcutaneous insulin infusion pumps and continuous glucose monitors enable individuals with type 1 diabetes to achieve tighter blood glucose control and are critical components in a closed-loop artificial pancreas. Insulin infusion sets can fail and continuous glucose monitor sensor signals can suffer from a variety of anomalies, including signal dropout and pressure-induced sensor attenuations. In addition to hardware-based failures, software and human-induced errors can cause safety-related problems. Techniques for fault detection, safety analyses, and remote monitoring techniques that have been applied in other industries and applications, such as chemical process plants and commercial aircraft, are discussed and placed in the context of a closed-loop artificial pancreas. PMID:25049365

78 FR 7642 - Airworthiness Directives; Piper Aircraft, Inc.

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-04

...., Washington, DC 20590. FOR FURTHER INFORMATION CONTACT: Hector Hernandez, Aerospace Engineer, FAA, Atlanta.... Conclusion We reviewed the relevant data, considered the comments received, and determined that air safety... work-hours x $85 per hour = $608 $1,458 system--per set of cables. $850. Authority for This Rulemaking...

Safety assessment of a home-based telecare system for adults with developmental disabilities in Indiana: a multi-stakeholder perspective.

PubMed

Brewer, Jeffrey L; Taber-Doughty, Teresa; Kubik, Sara

2010-01-01

We investigated the perceptions of people about the safety, security and privacy of a telecare monitoring system for adults with developmental disabilities living in residential settings. The telecare system was used by remote caregivers overnight, when staff were not present in the homes. We surveyed 127 people from different stakeholder groups in the state of Indiana. The people surveyed included those with knowledge or experience of telecare, and those without. The stakeholders were clients, their advocates, service provider administrators and independent case coordinators. The responses in each category for every group were positive except one: only 4 of the 11 telecare case coordinators agreed that the telecare system provided a secure environment. Overall, the telecare system was perceived to be as safe, secure and private as the conventional alternative of having staff in the home.

Drug safety: withdrawn medications are only part of the picture.

PubMed

Rawson, Nigel S B

2016-02-13

In a research article published in BMC Medicine, Onakpoya and colleagues provide a historical review of withdrawals of medications for safety reasons. However, withdrawn medications are only one part of the picture about how regulatory agencies manage drug risks. Moreover, medications introduced before the increased pre-marketing regulations and post-marketing monitoring systems instituted after the thalidomide tragedy have little relevance when considering the present drug safety picture because the circumstances under which they were introduced were completely different. To more fully understand drug safety management and regulatory agency actions, withdrawals should be evaluated within the setting and timeframe in which the medications are approved, which requires information about approvals and safety warnings. Studies are needed that provide a more comprehensive current picture of the identification and evaluation of drug safety risks as well as how regulatory agencies deal with them. Please see related research article: http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0553-2.

NASA System Safety Handbook. Volume 1; System Safety Framework and Concepts for Implementation

NASA Technical Reports Server (NTRS)

Dezfuli, Homayoon; Benjamin, Allan; Everett, Christopher; Smith, Curtis; Stamatelatos, Michael; Youngblood, Robert

2011-01-01

System safety assessment is defined in NPR 8715.3C, NASA General Safety Program Requirements as a disciplined, systematic approach to the analysis of risks resulting from hazards that can affect humans, the environment, and mission assets. Achievement of the highest practicable degree of system safety is one of NASA's highest priorities. Traditionally, system safety assessment at NASA and elsewhere has focused on the application of a set of safety analysis tools to identify safety risks and formulate effective controls.1 Familiar tools used for this purpose include various forms of hazard analyses, failure modes and effects analyses, and probabilistic safety assessment (commonly also referred to as probabilistic risk assessment (PRA)). In the past, it has been assumed that to show that a system is safe, it is sufficient to provide assurance that the process for identifying the hazards has been as comprehensive as possible and that each identified hazard has one or more associated controls. The NASA Aerospace Safety Advisory Panel (ASAP) has made several statements in its annual reports supporting a more holistic approach. In 2006, it recommended that "... a comprehensive risk assessment, communication and acceptance process be implemented to ensure that overall launch risk is considered in an integrated and consistent manner." In 2009, it advocated for "... a process for using a risk-informed design approach to produce a design that is optimally and sufficiently safe." As a rationale for the latter advocacy, it stated that "... the ASAP applauds switching to a performance-based approach because it emphasizes early risk identification to guide designs, thus enabling creative design approaches that might be more efficient, safer, or both." For purposes of this preface, it is worth mentioning three areas where the handbook emphasizes a more holistic type of thinking. First, the handbook takes the position that it is important to not just focus on risk on an individual basis but to consider measures of aggregate safety risk and to ensure wherever possible that there be quantitative measures for evaluating how effective the controls are in reducing these aggregate risks. The term aggregate risk, when used in this handbook, refers to the accumulation of risks from individual scenarios that lead to a shortfall in safety performance at a high level: e.g., an excessively high probability of loss of crew, loss of mission, planetary contamination, etc. Without aggregated quantitative measures such as these, it is not reasonable to expect that safety has been optimized with respect to other technical and programmatic objectives. At the same time, it is fully recognized that not all sources of risk are amenable to precise quantitative analysis and that the use of qualitative approaches and bounding estimates may be appropriate for those risk sources. Second, the handbook stresses the necessity of developing confidence that the controls derived for the purpose of achieving system safety not only handle risks that have been identified and properly characterized but also provide a general, more holistic means for protecting against unidentified or uncharacterized risks. For example, while it is not possible to be assured that all credible causes of risk have been identified, there are defenses that can provide protection against broad categories of risks and thereby increase the chances that individual causes are contained. Third, the handbook strives at all times to treat uncertainties as an integral aspect of risk and as a part of making decisions. The term "uncertainty" here does not refer to an actuarial type of data analysis, but rather to a characterization of our state of knowledge regarding results from logical and physical models that approximate reality. Uncertainty analysis finds how the output parameters of the models are related to plausible variations in the input parameters and in the modeling assumptions. The evaluation of unrtainties represents a method of probabilistic thinking wherein the analyst and decision makers recognize possible outcomes other than the outcome perceived to be "most likely." Without this type of analysis, it is not possible to determine the worth of an analysis product as a basis for making decisions related to safety and mission success. In line with these considerations the handbook does not take a hazard-analysis-centric approach to system safety. Hazard analysis remains a useful tool to facilitate brainstorming but does not substitute for a more holistic approach geared to a comprehensive identification and understanding of individual risk issues and their contributions to aggregate safety risks. The handbook strives to emphasize the importance of identifying the most critical scenarios that contribute to the risk of not meeting the agreed-upon safety objectives and requirements using all appropriate tools (including but not limited to hazard analysis). Thereafter, emphasis shifts to identifying the risk drivers that cause these scenarios to be critical and ensuring that there are controls directed toward preventing or mitigating the risk drivers. To address these and other areas, the handbook advocates a proactive, analytic-deliberative, risk-informed approach to system safety, enabling the integration of system safety activities with systems engineering and risk management processes. It emphasizes how one can systematically provide the necessary evidence to substantiate the claim that a system is safe to within an acceptable risk tolerance, and that safety has been achieved in a cost-effective manner. The methodology discussed in this handbook is part of a systems engineering process and is intended to be integral to the system safety practices being conducted by the NASA safety and mission assurance and systems engineering organizations. The handbook posits that to conclude that a system is adequately safe, it is necessary to consider a set of safety claims that derive from the safety objectives of the organization. The safety claims are developed from a hierarchy of safety objectives and are therefore hierarchical themselves. Assurance that all the claims are true within acceptable risk tolerance limits implies that all of the safety objectives have been satisfied, and therefore that the system is safe. The acceptable risk tolerance limits are provided by the authority who must make the decision whether or not to proceed to the next step in the life cycle. These tolerances are therefore referred to as the decision maker's risk tolerances. In general, the safety claims address two fundamental facets of safety: 1) whether required safety thresholds or goals have been achieved, and 2) whether the safety risk is as low as possible within reasonable impacts on cost, schedule, and performance. The latter facet includes consideration of controls that are collective in nature (i.e., apply generically to broad categories of risks) and thereby provide protection against unidentified or uncharacterized risks.

The ICARE Method

NASA Technical Reports Server (NTRS)

Henke, Luke

2010-01-01

The ICARE method is a flexible, widely applicable method for systems engineers to solve problems and resolve issues in a complete and comprehensive manner. The method can be tailored by diverse users for direct application to their function (e.g. system integrators, design engineers, technical discipline leads, analysts, etc.). The clever acronym, ICARE, instills the attitude of accountability, safety, technical rigor and engagement in the problem resolution: Identify, Communicate, Assess, Report, Execute (ICARE). This method was developed through observation of Space Shuttle Propulsion Systems Engineering and Integration (PSE&I) office personnel approach in an attempt to succinctly describe the actions of an effective systems engineer. Additionally it evolved from an effort to make a broadly-defined checklist for a PSE&I worker to perform their responsibilities in an iterative and recursive manner. The National Aeronautics and Space Administration (NASA) Systems Engineering Handbook states, engineering of NASA systems requires a systematic and disciplined set of processes that are applied recursively and iteratively for the design, development, operation, maintenance, and closeout of systems throughout the life cycle of the programs and projects. ICARE is a method that can be applied within the boundaries and requirements of NASA s systems engineering set of processes to provide an elevated sense of duty and responsibility to crew and vehicle safety. The importance of a disciplined set of processes and a safety-conscious mindset increases with the complexity of the system. Moreover, the larger the system and the larger the workforce, the more important it is to encourage the usage of the ICARE method as widely as possible. According to the NASA Systems Engineering Handbook, elements of a system can include people, hardware, software, facilities, policies and documents; all things required to produce system-level results, qualities, properties, characteristics, functions, behavior and performance. The ICARE method can be used to improve all elements of a system and, consequently, the system-level functional, physical and operational performance. Even though ICARE was specifically designed for a systems engineer, any person whose job is to examine another person, product, or process can use the ICARE method to improve effectiveness, implementation, usefulness, value, capability, efficiency, integration, design, and/or marketability. This paper provides the details of the ICARE method, emphasizing the method s application to systems engineering. In addition, a sample of other, non-systems engineering applications are briefly discussed to demonstrate how ICARE can be tailored to a variety of diverse jobs (from project management to parenting).

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

Space-Based Telemetry and Range Safety Project Ku-Band and Ka-Band Phased Array Antenna

NASA Technical Reports Server (NTRS)

Whiteman, Donald E.; Valencia, Lisa M.; Birr, Richard B.

2005-01-01

The National Aeronautics and Space Administration Space-Based Telemetry and Range Safety study is a multiphase project to increase data rates and flexibility and decrease costs by using space-based communications assets for telemetry during launches and landings. Phase 1 used standard S-band antennas with the Tracking and Data Relay Satellite System to obtain a baseline performance. The selection process and available resources for Phase 2 resulted in a Ku-band phased array antenna system. Several development efforts are under way for a Ka-band phased array antenna system for Phase 3. Each phase includes test flights to demonstrate performance and capabilities. Successful completion of this project will result in a set of communications requirements for the next generation of launch vehicles.

Ku- and Ka-Band Phased Array Antenna for the Space-Based Telemetry and Range Safety Project

NASA Technical Reports Server (NTRS)

Whiteman, Donald E.; Valencia, Lisa M.; Birr, Richard B.

2005-01-01

The National Aeronautics and Space Administration Space-Based Telemetry and Range Safety study is a multiphase project to increase data rates and flexibility and decrease costs by using space-based communications assets for telemetry during launches and landings. Phase 1 used standard S-band antennas with the Tracking and Data Relay Satellite System to obtain a baseline performance. The selection process and available resources for Phase 2 resulted in a Ku-band phased array antenna system. Several development efforts are under way for a Ka-band phased array antenna system for Phase 3. Each phase includes test flights to demonstrate performance and capabilities. Successful completion of this project will result in a set of communications requirements for the next generation of launch vehicles.

Practical Applications of Cosmic Ray Science: Spacecraft, Aircraft, Ground Based Computation and Control Systems and Human Health and Safety

NASA Technical Reports Server (NTRS)

Atwell, William; Koontz, Steve; Normand, Eugene

2012-01-01

In this paper we review the discovery of cosmic ray effects on the performance and reliability of microelectronic systems as well as on human health and safety, as well as the development of the engineering and health science tools used to evaluate and mitigate cosmic ray effects in earth surface, atmospheric flight, and space flight environments. Three twentieth century technological developments, 1) high altitude commercial and military aircraft; 2) manned and unmanned spacecraft; and 3) increasingly complex and sensitive solid state micro-electronics systems, have driven an ongoing evolution of basic cosmic ray science into a set of practical engineering tools (e.g. ground based test methods as well as high energy particle transport and reaction codes) needed to design, test, and verify the safety and reliability of modern complex electronic systems as well as effects on human health and safety. The effects of primary cosmic ray particles, and secondary particle showers produced by nuclear reactions with spacecraft materials, can determine the design and verification processes (as well as the total dollar cost) for manned and unmanned spacecraft avionics systems. Similar considerations apply to commercial and military aircraft operating at high latitudes and altitudes near the atmospheric Pfotzer maximum. Even ground based computational and controls systems can be negatively affected by secondary particle showers at the Earth's surface, especially if the net target area of the sensitive electronic system components is large. Accumulation of both primary cosmic ray and secondary cosmic ray induced particle shower radiation dose is an important health and safety consideration for commercial or military air crews operating at high altitude/latitude and is also one of the most important factors presently limiting manned space flight operations beyond low-Earth orbit (LEO).

Specialty pharmacies and other restricted drug distribution systems: financial and safety considerations for patients and health-system pharmacists.

PubMed

Kirschenbaum, Bonnie E

2009-12-15

To discuss the role of restricted drug distribution systems in the implementation of risk evaluation and mitigation strategies (REMS), health-system pharmacists' concerns associated with the use of specialty pharmacies and other restricted drug distribution systems, reimbursement policies for high-cost specialty drugs, supply chain models for traditional and specialty drugs, and emerging trends in the management of and reimbursement for specialty pharmaceuticals. Restricted drug distribution systems established by pharmaceutical manufacturers, specialty pharmacies, or other specialty suppliers may be a component of REMS, which are required by the Food and Drug Administration for the management of known or potential serious risks from certain drugs. Concerns of health-system pharmacists using specialty suppliers include access to pharmaceuticals, operational challenges, product integrity, financial implications, continuity of care, and patient safety. An ambulatory care patient taking a specialty drug product from home to a hospital outpatient clinic or inpatient setting for administration, a practice known as "brown bagging," raises concerns about product integrity and institutional liability. An institution's finances, tolerance for liability, and ability to skillfully manage the processes involved often determine its choice between an approach that prohibits brown bagging but is costly and one that permits the practice under certain conditions and is less costly. The recent shift from a traditional supply chain model to a specialty pharmacy supply chain model for high-cost pharmaceuticals has the potential to increase pharmaceutical costs for health systems. A dialogue is needed between health-system pharmacists and group purchasing organizations to address the latter's role in mitigating the financial implications of this change and to help clarify the safety issues. Some health plans have shifted part of the cost of expensive drugs to patients by establishing a fourth tier of drugs with a large copayment based on a substantial percentage of the cost of the drug. The number and cost of specialty drugs are expected to increase in the future. New approaches and reimbursement models are emerging to manage the high cost of new pharmaceuticals. Health-system pharmacists can improve drug safety and manage costs by collaborating with group purchasing organizations, establishing policies for brown bagging, and making efforts to reconcile drug therapy provided in different settings through traditional drug channels and specialty pharmacies or other restricted drug distribution systems.

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.

Edible safety requirements and assessment standards for agricultural genetically modified organisms.

PubMed

Deng, Pingjian; Zhou, Xiangyang; Zhou, Peng; Du, Zhong; Hou, Hongli; Yang, Dongyan; Tan, Jianjun; Wu, Xiaojin; Zhang, Jinzhou; Yang, Yongcun; Liu, Jin; Liu, Guihua; Li, Yonghong; Liu, Jianjun; Yu, Lei; Fang, Shisong; Yang, Xiaoke

2008-05-01

This paper describes the background, principles, concepts and methods of framing the technical regulation for edible safety requirement and assessment of agricultural genetically modified organisms (agri-GMOs) for Shenzhen Special Economic Zone in the People's Republic of China. It provides a set of systematic criteria for edible safety requirements and the assessment process for agri-GMOs. First, focusing on the degree of risk and impact of different agri-GMOs, we developed hazard grades for toxicity, allergenicity, anti-nutrition effects, and unintended effects and standards for the impact type of genetic manipulation. Second, for assessing edible safety, we developed indexes and standards for different hazard grades of recipient organisms, for the influence of types of genetic manipulation and hazard grades of agri-GMOs. To evaluate the applicability of these criteria and their congruency with other safety assessment systems for GMOs applied by related organizations all over the world, we selected some agri-GMOs (soybean, maize, potato, capsicum and yeast) as cases to put through our new assessment system, and compared our results with the previous assessments. It turned out that the result of each of the cases was congruent with the original assessment.

Smart Water Conservation System for Irrigated Landscape

DTIC Science & Technology

2016-05-01

purple pipe indicating reuse water) and properly labeled “not for human consumption”; • Do not connect rainwater overflow discharge to sanitary sewer...Report Smart Water Conservation System 75 May 2016 Condensate Capture If redirecting condensate from sanitary sewer, ensure sewer gases are managed...the spring/early summer to determine optimum irrigation safety factor. Irrigate at night or early morning. Set soak and cycle for clay soils. ET

Assessment of Contributions to Patient Safety Knowledge by the Agency for Healthcare Research and Quality-Funded Patient Safety Projects

PubMed Central

Sorbero, Melony E S; Ricci, Karen A; Lovejoy, Susan; Haviland, Amelia M; Smith, Linda; Bradley, Lily A; Hiatt, Liisa; Farley, Donna O

2009-01-01

Objective To characterize the activities of projects funded in Agency for Healthcare Research and Quality (AHRQ)' patient safety portfolio and assess their aggregate potential to contribute to knowledge development. Data Sources Information abstracted from proposals for projects funded in AHRQ' patient safety portfolio, information on safety practices from the AHRQ Evidence Report on Patient Safety Practices, and products produced by the projects. Study Design This represented one part of the process evaluation conducted as part of a longitudinal evaluation based on the Context–Input–Process–Product model. Principal Findings The 234 projects funded through AHRQ' patient safety portfolio examined a wide variety of patient safety issues and extended their work beyond the hospital setting to less studied parts of the health care system. Many of the projects implemented and tested practices for which the patient safety evidence report identified a need for additional evidence. The funded projects also generated a substantial body of new patient safety knowledge through a growing number of journal articles and other products. Conclusions The projects funded in AHRQ' patient safety portfolio have the potential to make substantial contributions to the knowledge base on patient safety. The full value of this new knowledge remains to be confirmed through the synthesis of results. PMID:21456108

Assessment of contributions to patient safety knowledge by the Agency for Healthcare Research and Quality-funded patient safety projects.

PubMed

Sorbero, Melony E S; Ricci, Karen A; Lovejoy, Susan; Haviland, Amelia M; Smith, Linda; Bradley, Lily A; Hiatt, Liisa; Farley, Donna O

2009-04-01

To characterize the activities of projects funded in Agency for Healthcare Research and Quality (AHRQ)'s patient safety portfolio and assess their aggregate potential to contribute to knowledge development. Information abstracted from proposals for projects funded in AHRQ's patient safety portfolio, information on safety practices from the AHRQ Evidence Report on Patient Safety Practices, and products produced by the projects. This represented one part of the process evaluation conducted as part of a longitudinal evaluation based on the Context–Input–Process–Product model. The 234 projects funded through AHRQ's patient safety portfolio examined a wide variety of patient safety issues and extended their work beyond the hospital setting to less studied parts of the health care system. Many of the projects implemented and tested practices for which the patient safety evidence report identified a need for additional evidence. The funded projects also generated a substantial body of new patient safety knowledge through a growing number of journal articles and other products. The projects funded in AHRQ's patient safety portfolio have the potential to make substantial contributions to the knowledge base on patient safety. The full value of this new knowledge remains to be confirmed through the synthesis of results

The use of in-situ simulation to improve safety in the plastic surgery office: a feasibility study.

PubMed

Shapiro, Fred E; Pawlowski, John B; Rosenberg, Noah M; Liu, Xiaoxia; Feinstein, David M; Urman, Richard D

2014-01-01

Simulation-based interventions and education can potentially contribute to safer and more effective systems of care. We utilized in-situ simulation to highlight safety issues, regulatory requirements, and assess perceptions of safety processes by the plastic surgery office staff. A high-fidelity human patient simulator was brought to an office-based plastic surgery setting to enact a half-day full-scale, multidisciplinary medical emergency. Facilitated group debriefings were conducted after each scenario with special consideration of the principles of team training, communication, crisis management, and adherence to evidence-based protocols and regulatory standards. Abbreviated AHRQ Medical Office Safety Culture Survey was completed by the participants before and after the session. The in-situ simulations had a high degree of acceptance and face validity according to the participants. Areas highlighted by the simulation sessions included rapid communication, delegation of tasks, location of emergency materials, scope of practice, and logistics of transport. The participant survey indicated greater awareness of patient safety issues following participation in simulation and debriefing exercises in 3 areas (P < 0.05): the need to change processes if there is a recognized patient safety issue (100% vs 75%), openness to ideas about improving office processes (100% vs 88%), and the need to discuss ways to prevent errors from recurring (88% vs 62%). Issues of safety and regulatory compliance can be assessed in an office-based setting through the short-term (half-day) use of in-situ simulation with facilitated debriefing and the review of audiovisual recordings by trained facilities inspectors.

The Use of In-Situ Simulation to Improve Safety in the Plastic Surgery Office: A Feasibility Study

PubMed Central

Shapiro, Fred E.; Pawlowski, John B.; Rosenberg, Noah M.; Liu, Xiaoxia; Feinstein, David M.; Urman, Richard D.

2014-01-01

Objective: Simulation-based interventions and education can potentially contribute to safer and more effective systems of care. We utilized in-situ simulation to highlight safety issues, regulatory requirements, and assess perceptions of safety processes by the plastic surgery office staff. Methods: A high-fidelity human patient simulator was brought to an office-based plastic surgery setting to enact a half-day full-scale, multidisciplinary medical emergency. Facilitated group debriefings were conducted after each scenario with special consideration of the principles of team training, communication, crisis management, and adherence to evidence-based protocols and regulatory standards. Abbreviated AHRQ Medical Office Safety Culture Survey was completed by the participants before and after the session. Results: The in-situ simulations had a high degree of acceptance and face validity according to the participants. Areas highlighted by the simulation sessions included rapid communication, delegation of tasks, location of emergency materials, scope of practice, and logistics of transport. The participant survey indicated greater awareness of patient safety issues following participation in simulation and debriefing exercises in 3 areas (P < 0.05): the need to change processes if there is a recognized patient safety issue (100% vs 75%), openness to ideas about improving office processes (100% vs 88%), and the need to discuss ways to prevent errors from recurring (88% vs 62%). Conclusions: Issues of safety and regulatory compliance can be assessed in an office-based setting through the short-term (half-day) use of in-situ simulation with facilitated debriefing and the review of audiovisual recordings by trained facilities inspectors. PMID:24501616

Multiple Kernel Learning for Heterogeneous Anomaly Detection: Algorithm and Aviation Safety Case Study

NASA Technical Reports Server (NTRS)

Das, Santanu; Srivastava, Ashok N.; Matthews, Bryan L.; Oza, Nikunj C.

2010-01-01

The world-wide aviation system is one of the most complex dynamical systems ever developed and is generating data at an extremely rapid rate. Most modern commercial aircraft record several hundred flight parameters including information from the guidance, navigation, and control systems, the avionics and propulsion systems, and the pilot inputs into the aircraft. These parameters may be continuous measurements or binary or categorical measurements recorded in one second intervals for the duration of the flight. Currently, most approaches to aviation safety are reactive, meaning that they are designed to react to an aviation safety incident or accident. In this paper, we discuss a novel approach based on the theory of multiple kernel learning to detect potential safety anomalies in very large data bases of discrete and continuous data from world-wide operations of commercial fleets. We pose a general anomaly detection problem which includes both discrete and continuous data streams, where we assume that the discrete streams have a causal influence on the continuous streams. We also assume that atypical sequence of events in the discrete streams can lead to off-nominal system performance. We discuss the application domain, novel algorithms, and also discuss results on real-world data sets. Our algorithm uncovers operationally significant events in high dimensional data streams in the aviation industry which are not detectable using state of the art methods

How important is vehicle safety in the new vehicle purchase process?

PubMed

Koppel, Sjaanie; Charlton, Judith; Fildes, Brian; Fitzharris, Michael

2008-05-01

Whilst there has been a significant increase in the amount of consumer interest in the safety performance of privately owned vehicles, the role that it plays in consumers' purchase decisions is poorly understood. The aims of the current study were to determine: how important vehicle safety is in the new vehicle purchase process; what importance consumers place on safety options/features relative to other convenience and comfort features, and how consumers conceptualise vehicle safety. In addition, the study aimed to investigate the key parameters associated with ranking 'vehicle safety' as the most important consideration in the new vehicle purchase. Participants recruited in Sweden and Spain completed a questionnaire about their new vehicle purchase. The findings from the questionnaire indicated that participants ranked safety-related factors (e.g., EuroNCAP (or other) safety ratings) as more important in the new vehicle purchase process than other vehicle factors (e.g., price, reliability etc.). Similarly, participants ranked safety-related features (e.g., advanced braking systems, front passenger airbags etc.) as more important than non-safety-related features (e.g., route navigation systems, air-conditioning etc.). Consistent with previous research, most participants equated vehicle safety with the presence of specific vehicle safety features or technologies rather than vehicle crash safety/test results or crashworthiness. The key parameters associated with ranking 'vehicle safety' as the most important consideration in the new vehicle purchase were: use of EuroNCAP, gender and education level, age, drivers' concern about crash involvement, first vehicle purchase, annual driving distance, person for whom the vehicle was purchased, and traffic infringement history. The findings from this study are important for policy makers, manufacturers and other stakeholders to assist in setting priorities with regard to the promotion and publicity of vehicle safety features for particular consumer groups (such as younger consumers) in order to increase their knowledge regarding vehicle safety and to encourage them to place highest priority on safety in the new vehicle purchase process.

Predictive Trip Detection for Nuclear Power Plants

NASA Astrophysics Data System (ADS)

Rankin, Drew J.; Jiang, Jin

2016-08-01

This paper investigates the use of a Kalman filter (KF) to predict, within the shutdown system (SDS) of a nuclear power plant (NPP), whether safety parameter measurements have reached a trip set-point. In addition, least squares (LS) estimation compensates for prediction error due to system-model mismatch. The motivation behind predictive shutdown is to reduce the amount of time between the occurrence of a fault or failure and the time of trip detection, referred to as time-to-trip. These reductions in time-to-trip can ultimately lead to increases in safety and productivity margins. The proposed predictive SDS differs from conventional SDSs in that it compares point-predictions of the measurements, rather than sensor measurements, against trip set-points. The predictive SDS is validated through simulation and experiments for the steam generator water level safety parameter. Performance of the proposed predictive SDS is compared against benchmark conventional SDS with respect to time-to-trip. In addition, this paper analyzes: prediction uncertainty, as well as; the conditions under which it is possible to achieve reduced time-to-trip. Simulation results demonstrate that on average the predictive SDS reduces time-to-trip by an amount of time equal to the length of the prediction horizon and that the distribution of times-to-trip is approximately Gaussian. Experimental results reveal that a reduced time-to-trip can be achieved in a real-world system with unknown system-model mismatch and that the predictive SDS can be implemented with a scan time of under 100ms. Thus, this paper is a proof of concept for KF/LS-based predictive trip detection.

Ethics and safety in home care: perspectives on home support workers.

PubMed

Storch, Janet; Curry, Cherie Geering; Stevenson, Lynn; Macdonald, Marilyn; Lang, Ariella

2014-03-01

Home support workers (HSWs) encounter unique safety issues in their provision of home care. These issues raise ethical concerns, affecting the care workers provide to seniors and other recipients. This paper is derived from a subproject of a larger Canada-wide study, Safety at Home: A Pan-Canadian Home Care Safety Study, released in June 2013 by the Canadian Patient Safety Institute. Semi-structured, face-to-face, audiotaped interviews were conducted with providers, clients and informal caregivers in British Columbia, Manitoba and New Brunswick to better understand their perceptions of patient safety in home care. Using the BC data only, we then compared our findings to findings of other BC studies focusing on safety in home care that were conducted over the past decade. Through our interviews and comparative analyses it became clear that HSWs experienced significant inequities in providing home care. Utilizing a model depicting concerns of and for HSWs developed by Craven and colleagues (2012), we were able to illustrate the physical, spatial, interpersonal and temporal concerns set in the context of system design that emphasized the ethical dilemmas of HSWs in home care. Our data suggested the necessity of adding a fifth domain, organizational (system design). In this paper, we issue a call for stronger advocacy for home care and improved collaboration and resource equity between institutional care and community care.

Evaluating the safety impact of adaptive cruise control in traffic oscillations on freeways.

PubMed

Li, Ye; Li, Zhibin; Wang, Hao; Wang, Wei; Xing, Lu

2017-07-01

Adaptive cruise control (ACC) has been considered one of the critical components of automated driving. ACC adjusts vehicle speeds automatically by measuring the status of the ego-vehicle and leading vehicle. Current commercial ACCs are designed to be comfortable and convenient driving systems. Little attention is paid to the safety impacts of ACC, especially in traffic oscillations when crash risks are the highest. The primary objective of this study was to evaluate the impacts of ACC parameter settings on rear-end collisions on freeways. First, the occurrence of a rear-end collision in a stop-and-go wave was analyzed. A car-following model in an integrated ACC was developed for a simulation analysis. The time-to-collision based factors were calculated as surrogate safety measures of the collision risk. We also evaluated different market penetration rates considering that the application of ACC will be a gradual process. The results showed that the safety impacts of ACC were largely affected by the parameters. Smaller time delays and larger time gaps improved safety performance, but inappropriate parameter settings increased the collision risks and caused traffic disturbances. A higher reduction of the collision risk was achieved as the ACC vehicle penetration rate increased, especially in the initial stage with penetration rates of less than 30%. This study also showed that in the initial stage, the combination of ACC and a variable speed limit achieved better safety improvements on congested freeways than each single technique. Copyright © 2017 Elsevier Ltd. All rights reserved.

Development of a check sheet for collecting information necessary for occupational safety and health activities and building relevant systems in overseas business places.

PubMed

Kajiki, Shigeyuki; Kobayashi, Yuichi; Uehara, Masamichi; Nakanishi, Shigemoto; Mori, Koji

2016-06-07

This study aimed to develop an information gathering check sheet to efficiently collect information necessary for Japanese companies to build global occupational safety and health management systems in overseas business places. The study group consisted of 2 researchers with occupational physician careers in a foreign-affiliated company in Japan and 3 supervising occupational physicians who were engaged in occupational safety and health activities in overseas business places. After investigating information and sources of information necessary for implementing occupational safety and health activities and building relevant systems, we conducted information acquisition using an information gathering check sheet in the field, by visiting 10 regions in 5 countries (first phase). The accuracy of the information acquired and the appropriateness of the information sources were then verified in study group meetings to improve the information gathering check sheet. Next, the improved information gathering check sheet was used in another setting (3 regions in 1 country) to confirm its efficacy (second phase), and the information gathering check sheet was thereby completed. The information gathering check sheet was composed of 9 major items (basic information on the local business place, safety and health overview, safety and health systems, safety and health staff, planning/implementation/evaluation/improvement, safety and health activities, laws and administrative organs, local medical care systems and public health, and medical support for resident personnel) and 61 medium items. We relied on the following eight information sources: the internet, company (local business place and head office in Japan), embassy/consulate, ISO certification body, university or other educational institutions, and medical institutions (aimed at Japanese people or at local workers). Through multiple study group meetings and a two-phased field survey (13 regions in 6 countries), an information gathering check sheet was completed. We confirmed the possibility that this check sheet would enable the user to obtain necessary information when expanding safety and health activities in a country or region that is new to the user. It is necessary in the future to evaluate safety and health systems and activities using this information gathering check sheet in a local business place in any country in which a Japanese business will be established, and to verify the efficacy of the check sheet by conducting model programs to test specific approaches.

Unmanned aircraft systems integration into the national airspace

NASA Astrophysics Data System (ADS)

Wolf, H. G.

This paper examines the Federal Aviation Administration (FAA) Regulation Roadmap as set forth in the FAA Modernization and Reform Act of 2012 as well as the evolutionary process of relative legal framework. The paper will also explore the role of industry stakeholders and semi-governmental, advisory groups such as the RTCA SC-203 to show the involvement of non-governmental organizations. Leveraging the author's involvement with RTCA on the Safety Work Group of Special Committee 203, two processes within the context of safety will be explained and problems identified.

[Relations between health information systems and patient safety].

PubMed

Nøhr, Christian

2012-11-05

Health information systems have the potential to reduce medical errors, and indeed many studies have shown a significant reduction. However, if the systems are not designed and implemented properly, there is evidence that suggest that new types of errors will arise--i.e., technology-induced errors. Health information systems will need to undergo a more rigorous evaluation. Usability evaluation and simulation test with humans in the loop can help to detect and prevent technology-induced errors before they are deployed in real health-care settings.

The associations between work-life balance behaviours, teamwork climate and safety climate: cross-sectional survey introducing the work-life climate scale, psychometric properties, benchmarking data and future directions.

PubMed

Sexton, J Bryan; Schwartz, Stephanie P; Chadwick, Whitney A; Rehder, Kyle J; Bae, Jonathan; Bokovoy, Joanna; Doram, Keith; Sotile, Wayne; Adair, Kathryn C; Profit, Jochen

2017-08-01

Improving the resiliency of healthcare workers is a national imperative, driven in part by healthcare workers having minimal exposure to the skills and culture to achieve work-life balance (WLB). Regardless of current policies, healthcare workers feel compelled to work more and take less time to recover from work. Satisfaction with WLB has been measured, as has work-life conflict, but how frequently healthcare workers engage in specific WLB behaviours is rarely assessed. Measurement of behaviours may have advantages over measurement of perceptions; behaviours more accurately reflect WLB and can be targeted by leaders for improvement. 1. To describe a novel survey scale for evaluating work-life climate based on specific behavioural frequencies in healthcare workers.2. To evaluate the scale's psychometric properties and provide benchmarking data from a large healthcare system.3. To investigate associations between work-life climate, teamwork climate and safety climate. Cross-sectional survey study of US healthcare workers within a large healthcare system. 7923 of 9199 eligible healthcare workers across 325 work settings within 16 hospitals completed the survey in 2009 (86% response rate). The overall work-life climate scale internal consistency was Cronbach α=0.790. t-Tests of top versus bottom quartile work settings revealed that positive work-life climate was associated with better teamwork climate, safety climate and increased participation in safety leadership WalkRounds with feedback (p<0.001). Univariate analysis of variance demonstrated differences that varied significantly in WLB between healthcare worker role, hospitals and work setting. The work-life climate scale exhibits strong psychometric properties, elicits results that vary widely by work setting, discriminates between positive and negative workplace norms, and aligns well with other culture constructs that have been found to correlate with clinical outcomes. 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/.

Openness to experience, work experience and patient safety.

PubMed

Chang, Hao-Yuan; Friesner, Daniel; Lee, I-Chen; Chu, Tsung-Lan; Chen, Hui-Ling; Wu, Wan-Er; Teng, Ching-I

2016-11-01

The purpose of this study is to examine how the interaction between nurse openness and work experience is related to patient safety. No study has yet examined the interactions between these, and how openness and work experience jointly impact patient safety. This study adopts a cross-sectional design, using self-reported work experience, perceived time pressure and measures of patient safety, and was conducted in a major medical centre. The sample consisted of 421 full-time nurses from all available units in the centre. Proportionate random sampling was used. Patient safety was measured using the self-reported frequency of common adverse events. Openness was self-rated using items identified in the relevant literature. Nurse openness is positively related to the patient safety construct (B = 0.08, P = 0.03). Moreover, work experience reduces the relation between openness and patient safety (B = -0.12, P < 0.01). The relationship between openness, work experience and patient safety suggests a new means of improving patient care in a health system setting. Nurse managers may enhance patient safety by assessing nurse openness and assigning highly open nurses to duties that make maximum use of that trait. © 2016 John Wiley & Sons Ltd.

Critical Incident Stress Management (CISM) in complex systems: cultural adaptation and safety impacts in healthcare.

PubMed

Müller-Leonhardt, Alice; Mitchell, Shannon G; Vogt, Joachim; Schürmann, Tim

2014-07-01

In complex systems, such as hospitals or air traffic control operations, critical incidents (CIs) are unavoidable. These incidents can not only become critical for victims but also for professionals working at the "sharp end" who may have to deal with critical incident stress (CIS) reactions that may be severe and impede emotional, physical, cognitive and social functioning. These CIS reactions may occur not only under exceptional conditions but also during every-day work and become an important safety issue. In contrast to air traffic management (ATM) operations in Europe, which have readily adopted critical incident stress management (CISM), most hospitals have not yet implemented comprehensive peer support programs. This survey was conducted in 2010 at the only European general hospital setting which implemented CISM program since 2004. The aim of the article is to describe possible contribution of CISM in hospital settings framed from the perspective of organizational safety and individual health for healthcare professionals. Findings affirm that daily work related incidents also can become critical for healthcare professionals. Program efficiency appears to be influenced by the professional culture, as well as organizational structure and policies. Overall, findings demonstrate that the adaptation of the CISM program in general hospitals takes time but, once established, it may serve as a mechanism for changing professional culture, thereby permitting the framing of even small incidents or near misses as an opportunity to provide valuable feedback to the system. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Development of Project Orion Ground Safety Requirements

NASA Technical Reports Server (NTRS)

Kirkpatrick, Paul; Condzella, Bill; Williams, Jeff

2011-01-01

In spite of a very compressed schedule, Project Orion's AFT safety team was able to pull together a comprehensive set of ground safety requirements using existing requirements and subject matter experts. These requirements will serve as the basis for the design of GSE and ground operations. Using the above lessons as a roadmap, new Projects can produce the same results. A rigorous set of ground safety requirements is required to assure ground support equipment (GSE) and associated flight hardware ground operations are conducted safety

48 CFR 1323.506 - Suspension of payments, termination of contract and debarment and suspension actions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Regulations System DEPARTMENT OF COMMERCE SOCIOECONOMIC PROGRAMS ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Drug-Free Workplace 1323.506... suspend a contractor for Drug-Free Workplace violations, is set forth in CAM 1301.70. This authority may...

48 CFR 1323.506 - Suspension of payments, termination of contract and debarment and suspension actions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Regulations System DEPARTMENT OF COMMERCE SOCIOECONOMIC PROGRAMS ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Drug-Free Workplace 1323.506... suspend a contractor for Drug-Free Workplace violations, is set forth in CAM 1301.70. This authority may...

48 CFR 1323.506 - Suspension of payments, termination of contract and debarment and suspension actions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Regulations System DEPARTMENT OF COMMERCE SOCIOECONOMIC PROGRAMS ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Drug-Free Workplace 1323.506... suspend a contractor for Drug-Free Workplace violations, is set forth in CAM 1301.70. This authority may...

48 CFR 1323.506 - Suspension of payments, termination of contract and debarment and suspension actions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Regulations System DEPARTMENT OF COMMERCE SOCIOECONOMIC PROGRAMS ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Drug-Free Workplace 1323.506... suspend a contractor for Drug-Free Workplace violations, is set forth in CAM 1301.70. This authority may...

48 CFR 1323.506 - Suspension of payments, termination of contract and debarment and suspension actions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Regulations System DEPARTMENT OF COMMERCE SOCIOECONOMIC PROGRAMS ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Drug-Free Workplace 1323.506... suspend a contractor for Drug-Free Workplace violations, is set forth in CAM 1301.70. This authority may...

76 FR 28131 - Federal Motor Vehicle Safety Standards; Motorcycle Helmets

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-13

..., this final rule sets a quasi-static load application rate for the helmet retention system; revises the... Analysis and Conclusion e. Quasi-Static Retention Test f. Helmet Conditioning Tolerances g. Other... it as a quasi-static test, instead of a static test. Specifying the application rate will aid...

Pharmaceutical Technology Clerkship: A Professional Elective Course at the University of Kentucky

ERIC Educational Resources Information Center

Im, Sophann; DeLuca, Patrick P.

1978-01-01

Three objectives are described: (1) teach methods for applying the principles of pharmaceutical technology to institutional services involving drug safety, efficacy, and administration; (2) develop student skills in drug-delivery systems within hospitals; and (3) encourage technology application within a clinical setting for better patient care.…

Reducing work zone crashes by using vehicle's flashers as a warning sign : final report

DOT National Transportation Integrated Search

2009-01-01

Rural two-lane highways constitute a large percentage of the highway system in Kansas. Preserving, expending, : and enhancing these highways require the set-up of a large number of one-lane, two-way work zones where traffic : safety has been a severe...

Antecedents of willingness to report medical treatment errors in health care organizations: a multilevel theoretical framework.

PubMed

Naveh, Eitan; Katz-Navon, Tal

2014-01-01

To avoid errors and improve patient safety and quality of care, health care organizations need to identify the sources of failures and facilitate implementation of corrective actions. Hence, health care organizations try to collect reports and data about errors by investing enormous resources in reporting systems. However, despite health care organizations' declared goal of increasing the voluntary reporting of errors and although the Patient Safety and Quality Improvement Act of 2005 (S.544, Public Law 109-41) legalizes efforts to secure reporters from specific liabilities, the problem of underreporting of adverse events by staff members remains. The purpose of the paper is to develop a theory-based model and a set of propositions to understand the antecedents of staff members' willingness to report errors based on a literature synthesis. The model aims to explore a complex system of considerations employees use when deciding whether to report their errors or be silent about them. The model integrates the influences of three types of organizational climates (psychological safety, psychological contracts, and safety climate) and individual perceptions of the applicability of the organization's procedures and proposes their mutual influence on willingness to report errors and, as a consequence, patient safety. The model suggests that managers should try to control and influence both the way employees perceive procedure applicability and organizational context-i.e., psychological safety, no-blame contracts, and safety climate-to increase reporting and improve patient safety.

Researching safety culture: deliberative dialogue with a restorative lens.

PubMed

Lorenzini, Elisiane; Oelke, Nelly D; Marck, Patricia Beryl; Dall'agnol, Clarice Maria

2017-10-01

Safety culture is a key component of patient safety. Many patient safety strategies in health care have been adapted from high-reliability organizations (HRO) such as aviation. However, to date, attempts to transform the cultures of health care settings through HRO approaches have had mixed results. We propose a methodological approach for safety culture research, which integrates the theory and practice of restoration science with the principles and methods of deliberative dialogue to support active engagement in critical reflection and collective debate. Our aim is to describe how these two innovative approaches in health services research can be used together to provide a comprehensive effective method to study and implement change in safety culture. Restorative research in health care integrates socio-ecological theory of complex adaptive systems concepts with collaborative, place-sensitive study of local practice contexts. Deliberative dialogue brings together all stakeholders to collectively develop solutions on an issue to facilitate change. Together these approaches can be used to actively engage people in the study of safety culture to gain a better understanding of its elements. More importantly, we argue that the synergistic use of these approaches offers enhanced potential to move health care professionals towards actionable strategies to improve patient safety within today's complex health care systems. © 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.

DOE interpretations Guide to OSH standards. Update to the Guide

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

Not Available

1994-03-31

Reflecting Secretary O`Leary`s focus on occupational safety and health, the Office of Occupational Safety is pleased to provide you with the latest update to the DOE Interpretations Guide to OSH Standards. This Guide was developed in cooperation with the Occupational Safety and Health Administration, which continued its support during this last revision by facilitating access to the interpretations found on the OSHA Computerized Information System (OCIS). This March 31, 1994 update contains 123 formal interpretation letters written OSHA. As a result of the unique requests received by the 1-800 Response Line, this update also contains 38 interpretations developed by DOE.more » This new occupational safety and health information adds still more important guidance to the four volume reference set that you presently have in your possession.« less

DOE interpretations Guide to OSH standards. Update to the Guide

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

Not Available

1994-03-31

Reflecting Secretary O`Leary`s focus on occupational safety and health, the Office of Occupational Safety is pleased to provide you with the latest update to the DOE Interpretations Guide to OSH Standards. This Guide was developed in cooperation with the Occupational Safety and Health Administration, which continued it`s support during this last revision by facilitating access to the interpretations found on the OSHA Computerized Information System (OCIS). This March 31, 1994 update contains 123 formal in letter written by OSHA. As a result of the unique requests received by the 1-800 Response Line, this update also contains 38 interpretations developed bymore » DOE. This new occupational safety and health information adds still more important guidance to the four volume reference set that you presently have in your possession.« less

Identifying primary care patient safety research priorities in the UK: a James Lind Alliance Priority Setting Partnership

PubMed Central

Stocks, Susan Jill; Alam, Rahul; Taylor, Sian; Rolfe, Carly; Glover, Steven William; Whitcombe, Joanne; Campbell, Stephen M

2018-01-01

Objectives To identify the top 10 unanswered research questions for primary care patient safety research. Design A modified nominal group technique. Setting UK. Participants Anyone with experience of primary care including: patients, carers and healthcare professionals. 341 patients and 86 healthcare professionals submitted questions. Main outcomes A top 10, and top 30, future research questions for primary care patient safety. Results 443 research questions were submitted by 341 patients and 86 healthcare professionals, through a national survey. After checking for relevance and rephrasing, a total of 173 questions were collated into themes. The themes were largely focused on communication, team and system working, interfaces across primary and secondary care, medication, self-management support and technology. The questions were then prioritised through a national survey, the top 30 questions were taken forward to the final prioritisation workshop. The top 10 research questions focused on the most vulnerable in society, holistic whole-person care, safer communication and coordination between care providers, work intensity, continuity of care, suicide risk, complex care at home and confidentiality. Conclusions This study was the first national prioritisation exercise to identify patient and healthcare professional priorities for primary care patient safety research. The research priorities identified a range of important gaps in the existing evidence to inform everyday practice to address primary care patient safety. PMID:29490970

Translating Health Services Research into Practice in the Safety Net.

PubMed

Moore, Susan L; Fischer, Ilana; Havranek, Edward P

2016-02-01

To summarize research relating to health services research translation in the safety net through analysis of the literature and case study of a safety net system. Literature review and key informant interviews at an integrated safety net hospital. This paper describes the results of a comprehensive literature review of translational science literature as applied to health care paired with qualitative analysis of five key informant interviews conducted with senior-level management at Denver Health and Hospital Authority. Results from the literature suggest that implementing innovation may be more difficult in the safety net due to multiple factors, including financial and organizational constraints. Results from key informant interviews confirmed the reality of financial barriers to innovation implementation but also implied that factors, including institutional respect for data, organizational attitudes, and leadership support, could compensate for disadvantages. Translating research into practice is of critical importance to safety net providers, which are under increased pressure to improve patient care and satisfaction. Results suggest that translational research done in the safety net can better illuminate the special challenges of this setting; more such research is needed. © Health Research and Educational Trust.

The practice of pre-marketing safety assessment in drug development.

PubMed

Chuang-Stein, Christy; Xia, H Amy

2013-01-01

The last 15 years have seen a substantial increase in efforts devoted to safety assessment by statisticians in the pharmaceutical industry. While some of these efforts were driven by regulations and public demand for safer products, much of the motivation came from the realization that there is a strong need for a systematic approach to safety planning, evaluation, and reporting at the program level throughout the drug development life cycle. An efficient process can help us identify safety signals early and afford us the opportunity to develop effective risk minimization plan early in the development cycle. This awareness has led many pharmaceutical sponsors to set up internal systems and structures to effectively conduct safety assessment at all levels (patient, study, and program). In addition to process, tools have emerged that are designed to enhance data review and pattern recognition. In this paper, we describe advancements in the practice of safety assessment during the premarketing phase of drug development. In particular, we share examples of safety assessment practice at our respective companies, some of which are based on recommendations from industry-initiated working groups on best practice in recent years.

National Partnership for Maternal Safety: Consensus Bundle on Severe Hypertension During Pregnancy and the Postpartum Period.

PubMed

Bernstein, Peter S; Martin, James N; Barton, John R; Shields, Laurence E; Druzin, Maurice L; Scavone, Barbara M; Frost, Jennifer; Morton, Christine H; Ruhl, Catherine; Slager, Joan; Tsigas, Eleni Z; Jaffer, Sara; Menard, M Kathryn

2017-08-01

Complications arising from hypertensive disorders of pregnancy are among the leading causes of preventable severe maternal morbidity and mortality. Timely and appropriate treatment has the potential to significantly reduce hypertension-related complications. To assist health care providers in achieving this goal, this patient safety bundle provides guidance to coordinate and standardize the care provided to women with severe hypertension during pregnancy and the postpartum period. This is one of several patient safety bundles developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. These safety bundles outline critical clinical practices that should be implemented in every maternity care setting. Similar to other bundles that have been developed and promoted by the Partnership, the hypertension safety bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. This commentary provides information to assist with bundle implementation.

Safety, Tolerability and Pharmacokinetics of Single Doses of Oxytocin Administered via an Inhaled Route in Healthy Females: Randomized, Single-blind, Phase 1 Study.

PubMed

Fernando, Disala; Siederer, Sarah; Singh, Sunita; Schneider, Ian; Gupta, Ashutosh; Powell, Marcy; Richards, Duncan; McIntosh, Michelle P; Lambert, Peter; Fowles, Susan

2017-08-01

The utility of intramuscular (IM) oxytocin for the prevention of postpartum hemorrhage in resource-poor settings is limited by the requirement for temperature-controlled storage and skilled staff to administer the injection. We evaluated the safety, tolerability and pharmacokinetics (PK) of a heat-stable, inhaled (IH) oxytocin formulation. This phase 1, randomized, single-center, single-blind, dose-escalation, fixed-sequence study (NCT02542813) was conducted in healthy, premenopausal, non-pregnant, non-lactating women aged 18-45years. Subjects initially received IM oxytocin 10 international units (IU) on day 1, IH placebo on day 2, and IH oxytocin 50μg on day 3. Subjects were then randomized 4:1 using validated GSK internal software to IH placebo or ascending doses of IH oxytocin (200, 400, 600μg). PK was assessed by comparing systemic exposure (maximum observed plasma concentration, area under the concentration-time curve, and plasma concentrations at 10 and 30min post dose) for IH versus IM oxytocin. Adverse events (AEs), spirometry, laboratory tests, vital signs, electrocardiograms, physical examinations, and cardiac telemetry were assessed. Subjects were recruited between September 14, 2015 and October 12, 2015. Of the 16 subjects randomized following initial dosing, 15 (IH placebo n=3; IH oxytocin n=12) completed the study. IH (all doses) and IM oxytocin PK profiles were comparable in shape. However, systemic exposure with IH oxytocin 400μg most closely matched IM oxytocin 10IU. Systemic exposure was approximately dose proportional for IH oxytocin. No serious AEs were reported. No clinically significant findings were observed for any safety parameters. These data suggest that similar oxytocin systemic exposure can be achieved with IM and IH administration routes, and no safety concerns were identified with either route. The inhalation route may offer the opportunity to increase access to oxytocin for women giving birth in resource-poor settings. Copyright © 2017. Published by Elsevier B.V.

Safety Early Warning Research for Highway Construction Based on Case-Based Reasoning and Variable Fuzzy Sets

PubMed Central

Liu, Yan; Xu, Zhen-Jun

2013-01-01

As a high-risk subindustry involved in construction projects, highway construction safety has experienced major developments in the past 20 years, mainly due to the lack of safe early warnings in Chinese construction projects. By combining the current state of early warning technology with the requirements of the State Administration of Work Safety and using case-based reasoning (CBR), this paper expounds on the concept and flow of highway construction safety early warnings based on CBR. The present study provides solutions to three key issues, index selection, accident cause association analysis, and warning degree forecasting implementation, through the use of association rule mining, support vector machine classifiers, and variable fuzzy qualitative and quantitative change criterion modes, which fully cover the needs of safe early warning systems. Using a detailed description of the principles and advantages of each method and by proving the methods' effectiveness and ability to act together in safe early warning applications, effective means and intelligent technology for a safe highway construction early warning system are established. PMID:24191134

Safety early warning research for highway construction based on case-based reasoning and variable fuzzy sets.

PubMed

Liu, Yan; Yi, Ting-Hua; Xu, Zhen-Jun

2013-01-01

As a high-risk subindustry involved in construction projects, highway construction safety has experienced major developments in the past 20 years, mainly due to the lack of safe early warnings in Chinese construction projects. By combining the current state of early warning technology with the requirements of the State Administration of Work Safety and using case-based reasoning (CBR), this paper expounds on the concept and flow of highway construction safety early warnings based on CBR. The present study provides solutions to three key issues, index selection, accident cause association analysis, and warning degree forecasting implementation, through the use of association rule mining, support vector machine classifiers, and variable fuzzy qualitative and quantitative change criterion modes, which fully cover the needs of safe early warning systems. Using a detailed description of the principles and advantages of each method and by proving the methods' effectiveness and ability to act together in safe early warning applications, effective means and intelligent technology for a safe highway construction early warning system are established.

Food safety management systems performance in African food processing companies: a review of deficiencies and possible improvement strategies.

PubMed

Kussaga, Jamal B; Jacxsens, Liesbeth; Tiisekwa, Bendantunguka Pm; Luning, Pieternel A

2014-08-01

This study seeks to provide insight into current deficiencies in food safety management systems (FSMS) in African food-processing companies and to identify possible strategies for improvement so as to contribute to African countries' efforts to provide safe food to both local and international markets. This study found that most African food products had high microbiological and chemical contamination levels exceeding the set (legal) limits. Relative to industrialized countries, the study identified various deficiencies at government, sector/branch, retail and company levels which affect performance of FSMS in Africa. For instance, very few companies (except exporting and large companies) have implemented HACCP and ISO 22000:2005. Various measures were proposed to be taken at government (e.g. construction of risk-based legislative frameworks, strengthening of food safety authorities, recommend use of ISO 22000:2005, and consumers' food safety training), branch/sector (e.g. sector-specific guidelines and third-party certification), retail (develop stringent certification standards and impose product specifications) and company levels (improving hygiene, strict raw material control, production process efficacy, and enhancing monitoring systems, assurance activities and supportive administrative structures). By working on those four levels, FSMS of African food-processing companies could be better designed and tailored towards their production processes and specific needs to ensure food safety. © 2014 Society of Chemical Industry.

Evaluation of safety climate and employee injury rates in healthcare.

PubMed

Cook, Jacqueline M; Slade, Martin D; Cantley, Linda F; Sakr, Carine J

2016-09-01

Safety climates that support safety-related behaviour are associated with fewer work-related injuries, and prior research in industry suggests that safety knowledge and motivation are strongly related to safety performance behaviours; this relationship is not well studied in healthcare settings. We performed analyses of survey results from a Veterans Health Administration (VHA) Safety Barometer employee perception survey, conducted among VHA employees in 2012. The employee perception survey assessed 6 safety programme categories, including management participation, supervisor participation, employee participation, safety support activities, safety support climate and organisational climate. We examined the relationship between safety climate from the survey results on VHA employee injury and illness rates. Among VHA facilities in the VA New England Healthcare System, work-related injury rate was significantly and inversely related to overall employee perception of safety climate, and all 6 safety programme categories, including employee perception of employee participation, management participation, organisational climate, supervisor participation, safety support activities and safety support climate. Positive employee perceptions of safety climate in VHA facilities are associated with lower work-related injury and illness rates. Employee perception of employee participation, management participation, organisational climate, supervisor participation, safety support activities and safety support climate were all associated with lower work-related injury rates. Future implications include fostering a robust safety climate for patients and healthcare workers to reduce healthcare worker injuries. 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/

Optimal Control of Hybrid Systems in Air Traffic Applications

NASA Astrophysics Data System (ADS)

Kamgarpour, Maryam

Growing concerns over the scalability of air traffic operations, air transportation fuel emissions and prices, as well as the advent of communication and sensing technologies motivate improvements to the air traffic management system. To address such improvements, in this thesis a hybrid dynamical model as an abstraction of the air traffic system is considered. Wind and hazardous weather impacts are included using a stochastic model. This thesis focuses on the design of algorithms for verification and control of hybrid and stochastic dynamical systems and the application of these algorithms to air traffic management problems. In the deterministic setting, a numerically efficient algorithm for optimal control of hybrid systems is proposed based on extensions of classical optimal control techniques. This algorithm is applied to optimize the trajectory of an Airbus 320 aircraft in the presence of wind and storms. In the stochastic setting, the verification problem of reaching a target set while avoiding obstacles (reach-avoid) is formulated as a two-player game to account for external agents' influence on system dynamics. The solution approach is applied to air traffic conflict prediction in the presence of stochastic wind. Due to the uncertainty in forecasts of the hazardous weather, and hence the unsafe regions of airspace for aircraft flight, the reach-avoid framework is extended to account for stochastic target and safe sets. This methodology is used to maximize the probability of the safety of aircraft paths through hazardous weather. Finally, the problem of modeling and optimization of arrival air traffic and runway configuration in dense airspace subject to stochastic weather data is addressed. This problem is formulated as a hybrid optimal control problem and is solved with a hierarchical approach that decouples safety and performance. As illustrated with this problem, the large scale of air traffic operations motivates future work on the efficient implementation of the proposed algorithms.

An examination of public school safety measures across geographic settings.

PubMed

Shelton, Andrea J; Owens, Emiel W; Song, Holim

2009-01-01

Violence at a school can have a negative impact on the health of students, teachers, administrators, and others associated with the school and surrounding community. The use of weapons in school buildings or on school grounds accounts for the majority of violent deaths, particularly among males. This national trend suggests the need for a more concerted effort to improve safety and prevent violence. This article reports the use of 13 safety measures in US public schools in 4 geographic regions (Northeast, Midwest, South, and West) and 3 community settings (urban, suburban, and rural). Data representing 16,000 schools reported in the Educational Longitudinal Survey of 2002-2004 were analyzed. Data were self-reported by school administrators. Of the various safety measures assessed, fire alarms and extinguishers were consistently reported regardless of the geographic region or community setting of the school. Other than measures for fire safety, schools throughout the country routinely used exterior light and student lockers as safety measures. There was a significant difference by geographic region and community setting in the use of safety measures that required specific personnel, namely a security guard and an adult to direct a guest to sign in. Recognizing the patterns of violence at public high schools, administrators working with students, other school personnel, and community partners may consider more combinations of the safety measures within their institutions together with local resources and services to improve safety and reduce violence.

Assessing the utility of TAM, TPB, and UTAUT for advanced driver assistance systems.

PubMed

Rahman, Md Mahmudur; Lesch, Mary F; Horrey, William J; Strawderman, Lesley

2017-11-01

Advanced Driver Assistance Systems (ADAS) are intended to enhance driver performance and improve transportation safety. The potential benefits of these technologies, such as reduction in number of crashes, enhancing driver comfort or convenience, decreasing environmental impact, etc., have been acknowledged by transportation safety researchers and federal transportation agencies. Although these systems afford safety advantages, they may also challenge the traditional role of drivers in operating vehicles. Driver acceptance, therefore, is essential for the implementation of these systems into the transportation system. Recognizing the need for research into the factors affecting driver acceptance, this study assessed the utility of the Technology Acceptance Model (TAM), the Theory of Planned Behavior (TPB), and the Unified Theory of Acceptance and Use of Technology (UTAUT) for modelling driver acceptance in terms of Behavioral Intention to use an ADAS. Each of these models propose a set of factors that influence acceptance of a technology. Data collection was done using two approaches: a driving simulator approach and an online survey approach. In both approaches, participants interacted with either a fatigue monitoring system or an adaptive cruise control system combined with a lane-keeping system. Based on their experience, participants responded to several survey questions to indicate their attitude toward using the ADAS and their perception of its usefulness, usability, etc. A sample of 430 surveys were collected for this study. Results found that all the models (TAM, TPB, and UTAUT) can explain driver acceptance with their proposed sets of factors, each explaining 71% or more of the variability in Behavioral Intention. Among the models, TAM was found to perform the best in modelling driver acceptance followed by TPB. The findings of this study confirm that these models can be applied to ADAS technologies and that they provide a basis for understanding driver acceptance. Copyright © 2017 Elsevier Ltd. All rights reserved.

Safeguard: Progress and Test Results for a Reliable Independent On-Board Safety Net for UAS

NASA Technical Reports Server (NTRS)

Young, Steven D.; Dill, Evan T.; Hayhurst, Kelly J.; Gilabert, Russell V.

2017-01-01

As demands increase to use unmanned aircraft systems (UAS) for a broad spectrum of commercial applications, regulatory authorities are examining how to safely integrate them without compromising safety or disrupting traditional airspace operations. For small UAS, several operational rules have been established; e.g., do not operate beyond visual line-of-sight, do not fly within five miles of a commercial airport, do not fly above 400 feet above ground level. Enforcing these rules is challenging for UAS, as evidenced by the number of incident reports received by the Federal Aviation Administration (FAA). This paper reviews the development of an onboard system - Safeguard - designed to monitor and enforce conformance to a set of operational rules defined prior to flight (e.g., geospatial stay-out or stay-in regions, speed limits, and altitude constraints). Unlike typical geofencing or geo-limitation functions, Safeguard operates independently of the off-the-shelf UAS autopilot and is designed in a way that can be realized by a small set of verifiable functions to simplify compliance with existing standards for safety-critical systems (e.g. for spacecraft and manned commercial transportation aircraft systems). A framework is described that decouples the system from any other devices on the UAS as well as introduces complementary positioning source(s) for applications that require integrity and availability beyond what can be provided by the Global Positioning System (GPS). This paper summarizes the progress and test results for Safeguard research and development since presentation of the design concept at the 35th Digital Avionics Systems Conference (DASC '16). Significant accomplishments include completion of software verification and validation in accordance with NASA standards for spacecraft systems (to Class B), development of improved hardware prototypes, development of a simulation platform that allows for hardware-in-the-loop testing and fast-time Monte Carlo evaluations, and flight testing on multiple air vehicles. Integration testing with NASA's UAS Traffic Management (UTM) service-oriented architecture was also demonstrated.

Suborbital Safety Technical Committee- Summary of Proposed Standards & Guidelines

NASA Astrophysics Data System (ADS)

Quinn, Andy; Atencia Yepez, Amaya; Klicker, Michael; Howard, Diane; Verstraeten, Joram; Other Suborbital Safety TC Members

2013-09-01

There are currently no international safety standards and guidelines to assist designers, operators and authorities in the suborbital domain. There is a launch licensing regime in the United States (US) to assist the forerunners of the suborbital domain however this does not provide a safety approval for the vehicle against set standards or does not have an acceptable level of safety to achieve in terms of design or operation. In Europe a certification framework may be implemented however this (or any regulatory framework) is not in place as yet. This paper summarises the 5 tasks thus far completed by the International Association for the Advancement of Space Safety (IAASS) Suborbital Safety Technical Committee (SS TC) in terms of deriving standards and guidelines for the suborbital domain. The SS TC comprises members from the suborbital industry (US and European vehicle designers), safety experts, legal experts, medical/training experts, prospective spaceport operators and members from the US and European authorities (though these members cannot directly steer the standards and guidelines - they can merely review them for interest and comment on non-policy aspects). The SS TC has been divided into three working groups (WG): Regulatory WG, Technical WG and Operations WG. The 5 tasks that are summarised in this paper include: Regulatory WG - (Task 1) Clarify and promote regulatory framework for suborbital flights (including discussions on Space Law 'v' Air Law for suborbital domain); Technical WG - (Task 1) Defining & Alignment (globally) of Safety Criteria for Suborbital domain using industry best practices, (Task 2) Software/complex hardware certification for suborbital flights; Operations WG - (Task 1) Flight Crew and Spaceflight Participant Medical and Training Standards & Guidelines for suborbital flight, (Task 2) Spaceport Safety Management System. This paper also details the next set of standards and guidelines that will be derived by the SS TC. The paper concludes that these and future IAASS suborbital safety standards and guidelines are needed now and should beconsidered by the industry players before the first commercial flights expected late 2013/early 2014.

The SAFER guides: empowering organizations to improve the safety and effectiveness of electronic health records.

PubMed

Sittig, Dean F; Ash, Joan S; Singh, Hardeep

2014-05-01

Electronic health records (EHRs) have potential to improve quality and safety of healthcare. However, EHR users have experienced safety concerns from EHR design and usability features that are not optimally adapted for the complex work flow of real-world practice. Few strategies exist to address unintended consequences from implementation of EHRs and other health information technologies. We propose that organizations equipped with EHRs should consider the strategy of "proactive risk assessment" of their EHR-enabled healthcare system to identify and address EHR-related safety concerns. In this paper, we describe the conceptual underpinning of an EHR-related self-assessment strategy to provide institutions a foundation upon which they could build their safety efforts. With support from the Office of the National Coordinator for Health Information Technology (ONC), we used a rigorous, iterative process to develop a set of 9 self-assessment tools to optimize the safety and safe use of EHRs. These tools, referred to as the Safety Assurance Factors for EHR Resilience (SAFER) guides, could be used to self-assess safety and effectiveness of EHR implementations, identify specific areas of vulnerability, and create solutions and culture change to mitigate risks. A variety of audiences could conduct these assessments, including frontline clinicians or care teams in different practices, or clinical, quality, or administrative leaders within larger institutions. The guides use a multifaceted systems-based approach to assess risk and empower organizations to work with internal or external stakeholders (eg, EHR developers) on optimizing EHR functionality and using EHRs to drive improvements in the quality and safety of healthcare.

Evaluating Alerting and Guidance Performance of a UAS Detect-And-Avoid System

NASA Technical Reports Server (NTRS)

Lee, Seung Man; Park, Chunki; Thipphavong, David P.; Isaacson, Douglas R.; Santiago, Confesor

2016-01-01

A key challenge to the routine, safe operation of unmanned aircraft systems (UAS) is the development of detect-and-avoid (DAA) systems to aid the UAS pilot in remaining "well clear" of nearby aircraft. The goal of this study is to investigate the effect of alerting criteria and pilot response delay on the safety and performance of UAS DAA systems in the context of routine civil UAS operations in the National Airspace System (NAS). A NAS-wide fast-time simulation study was conducted to assess UAS DAA system performance with a large number of encounters and a broad set of DAA alerting and guidance system parameters. Three attributes of the DAA system were controlled as independent variables in the study to conduct trade-off analyses: UAS trajectory prediction method (dead-reckoning vs. intent-based), alerting time threshold (related to predicted time to LoWC), and alerting distance threshold (related to predicted Horizontal Miss Distance, or HMD). A set of metrics, such as the percentage of true positive, false positive, and missed alerts, based on signal detection theory and analysis methods utilizing the Receiver Operating Characteristic (ROC) curves were proposed to evaluate the safety and performance of DAA alerting and guidance systems and aid development of DAA system performance standards. The effect of pilot response delay on the performance of DAA systems was evaluated using a DAA alerting and guidance model and a pilot model developed to support this study. A total of 18 fast-time simulations were conducted with nine different DAA alerting threshold settings and two different trajectory prediction methods, using recorded radar traffic from current Visual Flight Rules (VFR) operations, and supplemented with DAA-equipped UAS traffic based on mission profiles modeling future UAS operations. Results indicate DAA alerting distance threshold has a greater effect on DAA system performance than DAA alerting time threshold or ownship trajectory prediction method. Further analysis on the alert lead time (time in advance of predicted loss of well clear at which a DAA alert is first issued) indicated a strong positive correlation between alert lead time and DAA system performance (i.e. the ability of the UAS pilot to maneuver the unmanned aircraft to remain well clear). While bigger distance thresholds had beneficial effects on alert lead time and missed alert rate, it also generated a higher rate of false alerts. In the design and development of DAA alerting and guidance systems, therefore, the positive and negative effects of false alerts and missed alerts should be carefully considered to achieve acceptable alerting system performance by balancing false and missed alerts. The results and methodology presented in this study are expected to help stakeholders, policymakers and standards committees define the appropriate setting of DAA system parameter thresholds for UAS that ensure safety while minimizing operational impacts to the NAS and equipage requirements for its users before DAA operational performance standards can be finalized.

Extracellular control of intracellular drug release for enhanced safety of anti-cancer chemotherapy

NASA Astrophysics Data System (ADS)

Zhu, Qian; Qi, Haixia; Long, Ziyan; Liu, Shang; Huang, Zhen; Zhang, Junfeng; Wang, Chunming; Dong, Lei

2016-06-01

The difficulty of controlling drug release at an intracellular level remains a key challenge for maximising drug safety and efficacy. We demonstrate herein a new, efficient and convenient approach to extracellularly control the intracellular release of doxorubicin (DOX), by designing a delivery system that harnesses the interactions between the system and a particular set of cellular machinery. By simply adding a small-molecule chemical into the cell medium, we could lower the release rate of DOX in the cytosol, and thereby increase its accumulation in the nuclei while decreasing its presence at mitochondria. Delivery of DOX with this system effectively prevented DOX-induced mitochondria damage that is the main mechanism of its toxicity, while exerting the maximum efficacy of this anti-cancer chemotherapeutic agent. The present study sheds light on the design of drug delivery systems for extracellular control of intracellular drug delivery, with immediate therapeutic implications.

The 6 "ws" of rapid response systems: best practices for improving development, implementation, and evaluation.

PubMed

Lazzara, Elizabeth H; Benishek, Lauren E; Sonesh, Shirley C; Patzer, Brady; Robinson, Patricia; Wallace, Ruth; Salas, Eduardo

2014-01-01

Delays in care have been cited as one of the primary contributors of preventable mortality; thus, quality patient safety is often contingent upon the delivery of timely clinical care. Rapid response systems (RRSs) have been touted as one mechanism to improve the ability of suitable staff to respond to deteriorating patients quickly and appropriately. Rapid response systems are defined as highly skilled individual(s) who mobilize quickly to provide medical care in response to clinical deterioration. While there is mounting evidence that RRSs are a valid strategy for managing obstetric emergencies, reducing adverse events, and improving patient safety, there remains limited insight into the practices underlying the development and execution of these systems. Therefore, the purpose of this article was to synthesize the literature and answer the primary questions necessary for successfully developing, implementing, and evaluating RRSs within inpatient settings-the Who, What, When, Where, Why, and How of RRSs.

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

Punnoose, Ratish J.; Armstrong, Robert C.; Wong, Matthew H.

Formal methods have come into wide use because of their effectiveness in verifying "safety and security" requirements of digital systems; a set of requirements for which testing is mostly ineffective. Formal methods are routinely used in the design and verification of high-consequence digital systems in industry. This report outlines our work in assessing the capabilities of commercial and open source formal tools and the ways in which they can be leveraged in digital design workflows.

Allocations for HANDI 2000 business management system

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

Wilson, D.

The Data Integration 2000 Project will result in an integrated and comprehensive set of functional applications containing core information necessary to support the Project Hanford Management Contract. It is based on the Commercial-Off-The-Shelf product solution with commercially proven business processes. The COTS product solution set, of PassPort and People Soft software, supports finance, supply and chemical management/Material Safety Data Sheet, human resources. Allocations at Fluor Daniel Hanford are burdens added to base costs using a predetermined rate.

Otolaryngology in Low-Resource Settings: Practical and Ethical Considerations.

PubMed

Cordes, Susan R; Robbins, Kevin Thomas; Woodson, Gayle

2018-06-01

Providing otolaryngology care in low-resource settings requires careful preparation to ensure good outcomes. The level of care that can be provided is dictated by available resources and the supplementary equipment, supplies, and personnel brought in. Other challenges include personal health and safety risks as well as cultural and language differences. Studying outcomes will inform future missions. Educating and developing ongoing partnerships with local physicians can lead to sustained improvements in the local health care system. Copyright © 2018 Elsevier Inc. All rights reserved.

SafetyAnalyst : software tools for safety management of specific highway sites

DOT National Transportation Integrated Search

2010-07-01

SafetyAnalyst provides a set of software tools for use by state and local highway agencies for highway safety management. SafetyAnalyst can be used by highway agencies to improve their programming of site-specific highway safety improvements. SafetyA...

Minimally Invasive Implantable Fetal Micropacemaker: Mechanical Testing and Technical Refinements

PubMed Central

Zhou, Li; Vest, Adriana N.; Peck, Raymond A.; Sredl, Jonathan P.; Huang, Xuechen; Bar-Cohen, Yaniv; Silka, Michael J.; Pruetz, Jay D.; Chmait, Ramen H.; Loeb, Gerald E.

2016-01-01

This paper discusses the technical and safety requirements for cardiac pacing of a human fetus with heart failure and hydrops fetalis secondary to complete heart block. Engineering strategies to meet specific technical requirements were integrated into a systematic design and implementation consisting of a novel fetal micropacemaker, a percutaneous implantation system, and a sterile package that enables device storage and recharging maintenance in a clinical setting. We further analyzed observed problems on myocardial fixation and pacing lead fatigue previously reported in earlier preclinical trials. This paper describes the technical refinements of the implantable fetal micropacemaker to overcome these challenges. The mechanical performance has been extensively tested to verify the improvement of reliability and safety margins of the implantation system. PMID:27021067

Complexity analysis of the Next Gen Air Traffic Management System: trajectory based operations.

PubMed

Lyons, Rhonda

2012-01-01

According to Federal Aviation Administration traffic predictions currently our Air Traffic Management (ATM) system is operating at 150 percent capacity; forecasting that within the next two decades, the traffic with increase to a staggering 250 percent [17]. This will require a major redesign of our system. Today's ATM system is complex. It is designed to safely, economically, and efficiently provide air traffic services through the cost-effective provision of facilities and seamless services in collaboration with multiple agents however, contrary the vision, the system is loosely integrated and is suffering tremendously from antiquated equipment and saturated airways. The new Next Generation (Next Gen) ATM system is designed to transform the current system into an agile, robust and responsive set of operations that are designed to safely manage the growing needs of the projected increasingly complex, diverse set of air transportation system users and massive projected worldwide traffic rates. This new revolutionary technology-centric system is dynamically complex and is much more sophisticated than it's soon to be predecessor. ATM system failures could yield large scale catastrophic consequences as it is a safety critical system. This work will attempt to describe complexity and the complex nature of the NextGen ATM system and Trajectory Based Operational. Complex human factors interactions within Next Gen will be analyzed using a proposed dual experimental approach designed to identify hazards, gaps and elicit emergent hazards that would not be visible if conducted in isolation. Suggestions will be made along with a proposal for future human factors research in the TBO safety critical Next Gen environment.

SafetyAnalyst

DOT National Transportation Integrated Search

2009-01-01

This booklet provides an overview of SafetyAnalyst. SafetyAnalyst is a set of software tools under development to help State and local highway agencies advance their programming of site-specific safety improvements. SafetyAnalyst will incorporate sta...

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.

Discussion on runoff purification technology of highway bridge deck based on water quality safety

NASA Astrophysics Data System (ADS)

Tan, Sheng-guang; Liu, Xue-xin; Zou, Guo-ping; Xiong, Xin-zhu; Tao, Shuang-cheng

2018-06-01

Aiming at the actual problems existing, including a poor purification effect of highway bridge runoff collection and treatment system across sensitive water and necessary manual emergency operation, three kinds of technology, three pools system of bridge runoff purification, the integral pool of bridge runoff purification and ecological planting tank, are put forward by optimizing the structure of purification unit and system setting. At the same time, we come up with an emergency strategy for hazardous material leakage basing on automatic identification and remote control of traffic accidents. On the basis of combining these with the optimized pool structure, sensitive water safety can be guaranteed and water pollution, from directly discharging of bridge runoff, can be decreased. For making up for the shortages of green highway construction technology, the technique has important reference value.

The safety attitudes of people who use multi-purpose recreation facilities as a physical activity setting.

PubMed

Finch, Caroline F; Otago, Leonie; White, Peta; Donaldson, Alex; Mahoney, Mary

2011-06-01

Multi-purpose recreation facilities (MPRFs) are a popular setting for physical activity and it is therefore important that they are safe for all patrons. However, the attitudes of MPRF users towards safety are a potential barrier to the success of injury prevention programmes implemented within MPRFs. This article reports a survey of the safety attitudes of over 700 users of four indoor MPRFs. Factor analysis of 12 five-point Likert scale statements showed that the attitudes clustered around three major dimensions - the importance of safety, the benefits of safety and the perceptions of injury risk. Together, these three dimensions accounted for 49% of the variability in the attitudes. More than 85% of respondents agreed/strongly agreed that: safety was an important aspect of physical activity participation; being injured affected enjoyment of physical activity; people should adopt appropriate safety measures for all physical activity; and individuals were responsible for their own safety. The MPRF users, particularly women and older people, were generally safety conscious, believed in adopting safety measures, and were willing to take responsibility for their own safety. Facility managers can be confident that if they provide evidence-based injury prevention interventions in these settings, then users will respond appropriately and adopt the promoted behaviours.

Periprocedural safety of aneurysm embolization with the Medina Coil System: the early human experience.

PubMed

Turk, Aquilla S; Maia, Orlando; Ferreira, Christian Candido; Freitas, Diogo; Mocco, J; Hanel, Ricardo

2016-02-01

Intracranial saccular aneurysms, if untreated, carry a high risk of morbidity and mortality from intracranial bleeding. Embolization coils are the most common treatment. We describe the periprocedural safety and performance of the initial human experience with the next generation Medina Coil System. The Medina Coil System is a layered three-dimensional coil made from a radiopaque, shape set core wire, and shape memory alloy outer coil filaments. Nine aneurysms in five patients were selected for treatment with the Medina Coil System. Nine aneurysms in five patients, ranging from 5 to 17 mm in size in various locations, were treated with the Medina Coil System. No procedural or periprocedural complications were encountered. Procedure times, number of coils used to treat the aneurysm, and use of adjunctive devices were much less than anticipated if conventional coil technology had been used. The Medina Coil System is a next generation coil that combines all of the familiar and expected procedural safety and technique concepts associated with conventional coils. We found improved circumferential aneurysm filling, which may lead to improved long term outcomes, with fewer devices and faster operating times. 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/

South Carolina Industrial Arts Safety Guide. Student Section.

ERIC Educational Resources Information Center

South Carolina State Dept. of Education, Columbia.

This student section of a South Carolina industrial arts safety guide includes guidelines for developing a student safety program and three sections of shop safety practices. Safety program format, safety committees, safety inspection, and student accident investigation are discussed in the section on developing a student safety program. Set forth…

An Investigation of Health and Safety Measures in a Hydroelectric Power Plant.

PubMed

Acakpovi, Amevi; Dzamikumah, Lucky

2016-12-01

Occupational risk management is known as a catalyst in generating superior returns for all stakeholders on a sustainable basis. A number of companies in Ghana implemented health and safety measures adopted from international companies to ensure the safety of their employees. However, there exist great threats to employees' safety in these companies. The purpose of this paper is to investigate the level of compliance of Occupational Health and Safety management systems and standards set by international and local legislation in power producing companies in Ghana. The methodology is conducted by administering questionnaires and in-depth interviews as measuring instruments. A random sampling technique was applied to 60 respondents; only 50 respondents returned their responses. The questionnaire was developed from a literature review and contained questions and items relevant to the initial research problem. A factor analysis was also carried out to investigate the influence of some variables on safety in general. Results showed that the significant factors that influence the safety of employees at the hydroelectric power plant stations are: lack of training and supervision, non-observance of safe work procedures, lack of management commitment, and lack of periodical check on machine operations. The study pointed out the safety loopholes and therefore helped improve the health and safety measures of employees in the selected company by providing effective recommendations. The implementation of the proposed recommendations in this paper, would lead to the prevention of work-related injuries and illnesses of employees as well as property damage and incidents in hydroelectric power plants. The recommendations may equally be considered as benchmark for the Safety and Health Management System with international standards.

Using modeling and rehearsal to teach fire safety to children with autism.

PubMed

Garcia, David; Dukes, Charles; Brady, Michael P; Scott, Jack; Wilson, Cynthia L

2016-09-01

We evaluated the efficacy of an instructional procedure to teach young children with autism to evacuate settings and notify an adult during a fire alarm. A multiple baseline design across children showed that an intervention that included modeling, rehearsal, and praise was effective in teaching fire safety skills. Safety skills generalized to novel settings and maintained during a 5-week follow-up in both training and generalization settings. © 2016 Society for the Experimental Analysis of Behavior.

Brake reactions of distracted drivers to pedestrian Forward Collision Warning systems.

PubMed

Lubbe, Nils

2017-06-01

Forward Collision Warning (FCW) can be effective in directing driver attention towards a conflict and thereby aid in preventing or mitigating collisions. FCW systems aiming at pedestrian protection have been introduced onto the market, yet an assessment of their safety benefits depends on the accurate modeling of driver reactions when the system is activated. This study contributes by quantifying brake reaction time and brake behavior (deceleration levels and jerk) to compare the effectiveness of an audio-visual warning only, an added haptic brake pulse warning, and an added Head-Up Display in reducing the frequency of collisions with pedestrians. Further, this study provides a detailed data set suited for the design of assessment methods for car-to-pedestrian FCW systems. Brake response characteristics were measured for heavily distracted drivers who were subjected to a single FCW event in a high-fidelity driving simulator. The drivers maintained a self-regulated speed of 30km/h in an urban area, with gaze direction diverted from the forward roadway by a secondary task. Collision rates and brake reaction times differed significantly across FCW settings. Brake pulse warnings resulted in the lowest number of collisions and the shortest brake reaction times (mean 0.8s, SD 0.29s). Brake jerk and deceleration were independent of warning type. Ninety percent of drivers exceeded a maximum deceleration of 3.6m/s 2 and a jerk of 5.3m/s 3 . Brake pulse warning was the most effective FCW interface for preventing collisions. In addition, this study presents the data required for driver modeling for car-to-pedestrian FCW similar to Euro NCAP's 2015 car-to-car FCW assessment. Practical applications: Vehicle manufacturers should consider the introduction of brake pulse warnings to their FCW systems. Euro NCAP could introduce an assessment that quantifies the safety benefits of pedestrian FCW systems and thereby aid the proliferation of effective systems. Copyright © 2017 National Safety Council and Elsevier Ltd. All rights reserved.

Seniors managing multiple medications: using mixed methods to view the home care safety lens.

PubMed

Lang, Ariella; Macdonald, Marilyn; Marck, Patricia; Toon, Lynn; Griffin, Melissa; Easty, Tony; Fraser, Kimberly; MacKinnon, Neil; Mitchell, Jonathan; Lang, Eddy; Goodwin, Sharon

2015-12-12

Patient safety is a national and international priority with medication safety earmarked as both a prevalent and high-risk area of concern. To date, medication safety research has focused overwhelmingly on institutional based care provided by paid healthcare professionals, which often has little applicability to the home care setting. This critical gap in our current understanding of medication safety in the home care sector is particularly evident with the elderly who often manage more than one chronic illness and a complex palette of medications, along with other care needs. This study addresses the medication management issues faced by seniors with chronic illnesses, their family, caregivers, and paid providers within Canadian publicly funded home care programs in Alberta (AB), Ontario (ON), Quebec (QC) and Nova Scotia (NS). Informed by a socio-ecological perspective, this study utilized Interpretive Description (ID) methodology and participatory photographic methods to capture and analyze a range of visual and textual data. Three successive phases of data collection and analysis were conducted in a concurrent, iterative fashion in eight urban and/or rural households in each province. A total of 94 participants (i.e., seniors receiving home care services, their family/caregivers, and paid providers) were interviewed individually. In addition, 69 providers took part in focus groups. Analysis was iterative and concurrent with data collection in that each interview was compared with subsequent interviews for converging as well as diverging patterns. Six patterns were identified that provide a rich portrayal of the complexity of medication management safety in home care: vulnerabilities that impact the safe management and storage of medication, sustaining adequate supports, degrees of shared accountability for care, systems of variable effectiveness, poly-literacy required to navigate the system, and systemic challenges to maintaining medication safety in the home. There is a need for policy makers, health system leaders, care providers, researchers, and educators to work with home care clients and caregivers on three key messages for improvement: adapt care delivery models to the home care landscape; develop a palette of user-centered tools to support medication safety in the home; and strengthen health systems integration.

A study of leading indicators for occupational health and safety management systems in healthcare.

PubMed

Almost, Joan M; VanDenKerkhof, Elizabeth G; Strahlendorf, Peter; Caicco Tett, Louise; Noonan, Joanna; Hayes, Thomas; Van Hulle, Henrietta; Adam, Ryan; Holden, Jeremy; Kent-Hillis, Tracy; McDonald, Mike; Paré, Geneviève C; Lachhar, Karanjit; Silva E Silva, Vanessa

2018-04-23

In Ontario, Canada, approximately $2.5 billion is spent yearly on occupational injuries in the healthcare sector. The healthcare sector has been ranked second highest for lost-time injury rates among 16 Ontario sectors since 2009 with female healthcare workers ranked the highest among all occupations for lost-time claims. There is a great deal of focus in Ontario's occupational health and safety system on compliance and fines, however despite this increased focus, the injury statistics are not significantly improving. One of the keys to changing this trend is the development of a culture of healthy and safe workplaces including the effective utilization of leading indicators within Occupational Health and Safety Management Systems (OHSMSs). In contrast to lagging indicators, which focus on outcomes retrospectively, a leading indicator is associated with proactive activities and consists of selected OHSMSs program elements. Using leading indicators to measure health and safety has been common practice in high-risk industries; however, this shift has not occurred in healthcare. The aim of this project is to conduct a longitudinal study implementing six elements of the Ontario Safety Association for Community and Healthcare (OSACH) system identified as leading indicators and evaluating the effectiveness of this intervention on improving selected health and safety workplace indicators. A quasi-experimental longitudinal research design will be used within two Ontario acute care hospitals. The first phase of the study will focus on assessing current OHSMSs using the leading indicators, determining potential facilitators and barriers to changing current OHSMSs, and identifying the leading indicators that could be added or changed to the existing OHSMS in place. Phase I will conclude with the development of an intervention designed to support optimizing current OHSMSs in participating hospitals based on identified gaps. Phase II will pilot test and evaluate the tailored intervention. By implementing specific elements to test leading indicators, this project will examine a novel approach to strengthening the occupational health and safety system. Results will guide healthcare organizations in setting priorities for their OHSMSs and thereby improve health and safety outcomes.

Safety Hazards in Child Care Settings. CPSC Staff Study.

ERIC Educational Resources Information Center

Consumer Product Safety Commission, Washington, DC.

Each year, thousands of children in child care settings are injured seriously enough to need emergency medical treatment. This national study identified potential safety hazards in 220 licensed child care settings in October and November 1998. Eight product areas were examined: cribs, soft bedding, playground surfacing, playground surface…

Patient safety in thoracic surgery and European Society of Thoracic Surgeons checklist.

PubMed

Novoa, Nuria M

2015-04-01

Improving patient safety seems to be a new interesting clinical subject but, in fact, it is no new. It has to do with one of the oldest ethical principles of our profession: curing and not harming. The important research that has been done in a short period of time has brought in new insight to this complex area that is fast developing. The creation of safety managing systems will allow coordinating efforts from very different, although complementary, areas to create real safety culture and safety climate in every organization. In the surgical settings, teamwork is basic to provide good quality of care. Safety leaders in every team have an important role in establishing priorities, summarizing proposals, coordinating efforts, launching new initiatives and transmitting that safety efforts are worth taken. Preparedness and anticipation are key points for avoiding most of the diverse types of patient harm that can occur. As has been published, a great number of errors can be avoided simply using crosscheck based on specialized checklist that reviews every important detail of the procedure. This strategy has been demonstrated very useful at other high risk industries such as aviation, nuclear or food management. The Safe Surgery Saves Lives program launched in 2002 by the WHO has taught us that improvement is possible using a simple checklist. More complex and detail checklist can be more adequate for more complex procedures and settings. The proposed ESTS checklist reviews different areas of possible error in deeper detail allowing the finest adjustment of the patient before the skin incision. It has been recently released to the general thoracic community and monitors its use and usefulness has to be warrantied.

The Mediterranean Decision Support System for Marine Safety dedicated to oil slicks predictions

NASA Astrophysics Data System (ADS)

Zodiatis, G.; De Dominicis, M.; Perivoliotis, L.; Radhakrishnan, H.; Georgoudis, E.; Sotillo, M.; Lardner, R. W.; Krokos, G.; Bruciaferri, D.; Clementi, E.; Guarnieri, A.; Ribotti, A.; Drago, A.; Bourma, E.; Padorno, E.; Daniel, P.; Gonzalez, G.; Chazot, C.; Gouriou, V.; Kremer, X.; Sofianos, S.; Tintore, J.; Garreau, P.; Pinardi, N.; Coppini, G.; Lecci, R.; Pisano, A.; Sorgente, R.; Fazioli, L.; Soloviev, D.; Stylianou, S.; Nikolaidis, A.; Panayidou, X.; Karaolia, A.; Gauci, A.; Marcati, A.; Caiazzo, L.; Mancini, M.

2016-11-01

In the Mediterranean sea the risk from oil spill pollution is high due to the heavy traffic of merchant vessels for transporting oil and gas, especially after the recent enlargement of the Suez canal and to the increasing coastal and offshore installations related to the oil industry in general. The basic response to major oil spills includes different measures and equipment. However, in order to strengthen the maritime safety related to oil spill pollution in the Mediterranean and to assist the response agencies, a multi-model oil spill prediction service has been set up, known as MEDESS-4MS (Mediterranean Decision Support System for Marine Safety). The concept behind the MEDESS-4MS service is the integration of the existing national ocean forecasting systems in the region with the Copernicus Marine Environmental Monitoring Service (CMEMS) and their interconnection, through a dedicated network data repository, facilitating access to all these data and to the data from the oil spill monitoring platforms, including the satellite data ones, with the well established oil spill models in the region. The MEDESS-4MS offer a range of service scenarios, multi-model data access and interactive capabilities to suite the needs of REMPEC (Regional Marine Pollution Emergency Response Centre for the Mediterranean Sea) and EMSA-CSN (European Maritime Safety Agency-CleanseaNet).

The Triangle Model for evaluating the effect of health information technology on healthcare quality and safety

PubMed Central

Kern, Lisa M; Abramson, Erika; Kaushal, Rainu

2011-01-01

With the proliferation of relatively mature health information technology (IT) systems with large numbers of users, it becomes increasingly important to evaluate the effect of these systems on the quality and safety of healthcare. Previous research on the effectiveness of health IT has had mixed results, which may be in part attributable to the evaluation frameworks used. The authors propose a model for evaluation, the Triangle Model, developed for designing studies of quality and safety outcomes of health IT. This model identifies structure-level predictors, including characteristics of: (1) the technology itself; (2) the provider using the technology; (3) the organizational setting; and (4) the patient population. In addition, the model outlines process predictors, including (1) usage of the technology, (2) organizational support for and customization of the technology, and (3) organizational policies and procedures about quality and safety. The Triangle Model specifies the variables to be measured, but is flexible enough to accommodate both qualitative and quantitative approaches to capturing them. The authors illustrate this model, which integrates perspectives from both health services research and biomedical informatics, with examples from evaluations of electronic prescribing, but it is also applicable to a variety of types of health IT systems. PMID:21857023

Compact mobile-reader system for two-way wireless communication, tracking and status monitoring for transport safety and security

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

Tsai, Han-Chung; Liu, Yung Y.; Lee, Hok L.

A system for monitoring a plurality radio frequency identification tags is described. The system uses at least one set of radio frequency identification tags. Each tag is attached to a container and includes several sensors for detecting physical conditions of said container. The system includes at least one autonomous intermediate reader in wireless communication with the frequency identification tags. The intermediate reader includes external wireless communication system, intermediate reader logic controller, and a self-contained rechargeable power supply. The system uses a central status reporting system in communication the intermediate reader.

Are We There yet? Screening Processes for Intellectual and Developmental Disabilities in Jail Settings

ERIC Educational Resources Information Center

Scheyett, Anna; Vaughn, Jennie; Taylor, Melissa; Parish, Susan

2009-01-01

Early identification of intellectual and developmental disabilities in persons in the criminal justice system is essential to protect their rights during arrest and trial, ensure safety when incarcerated, and maximize the opportunities to receive services while incarcerated and postrelease. Using telephone interviews of jail administrators (N =…

Understanding Teamwork in Trauma Resuscitation through Analysis of Team Errors

ERIC Educational Resources Information Center

Sarcevic, Aleksandra

2009-01-01

An analysis of human errors in complex work settings can lead to important insights into the workspace design. This type of analysis is particularly relevant to safety-critical, socio-technical systems that are highly dynamic, stressful and time-constrained, and where failures can result in catastrophic societal, economic or environmental…

78 FR 63845 - Special Conditions: Embraer S.A., Model EMB-550 Airplanes; Isolation or Airplane Electronic...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-25

... the individual sending the comment (or signing the comment for an association, business, labor union... rudder, controlled by the pilot or copilot sidestick. The digital systems architecture for the Embraer... architecture is used for a diverse set of functions, including: Flight-safety related control and navigation...

Use of bispectral index system (BIS) to Monitor Enteral Conscious (moderate) sedation during general dental procedures.

PubMed

Donaldson, Mark; Goodchild, Jason H

2009-12-01

Although dental board regulations for the provision of in-office enteral conscious (oral) sedation vary widely with respect to training and pharmacologic strategies, they agree on the use of drugs that are inherently safe, the use of pulse oximetry and the availability of emergency equipment, including pharmacologic antagonists. Patient safety is of greatest concern and is best addressed by appropriate selection of patients, adequate training of personnel and appropriate monitoring of patients. Readings from bispectral index system (BIS) monitors, which use electroencephalographic signals, correlate accurately with depth of sedation during nondissociative general anesthesia of adults and children in the operating room setting. The usefulness of such monitoring as an adjunct to other forms of monitoring of in-office enteral sedation in the dental setting may represent the next important application of this tool, adding a further level of safety for the patient and another level of predictability for the practitioner. This paper reviews the current evidence supporting this new technique, presenting data from 20 procedures in which BIS monitoring during in-office enteral sedation was employed in a community dental practice.

Patient Safety Movement: History and Future Directions.

PubMed

Lark, Meghan E; Kirkpatrick, Kay; Chung, Kevin C

2018-02-01

Despite progress within the past 15 years, improving patient safety in health care remains an important public health issue. The history of safety policies, research, and development has revealed that this issue is more complex than initially perceived and is pertinent to all health care settings. Solutions, therefore, must be approached at the systems level and supplemented with a change in safety culture, especially in higher risk fields such as surgery. To do so, health care agents at all levels have started to prioritize the improvement of nontechnical skills such as teamwork, communication, and accountability, as reflected by the development of various checklists and safety campaigns. This progress may be sustained by adopting teamwork training programs that have proven successful in other high-risk industries, such as crew resource management in aviation. These techniques can be readily implemented among surgical teams; however, successful application depends heavily on the strong leadership and vigilance of individual surgeons. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

The STARTEC Decision Support Tool for Better Tradeoffs between Food Safety, Quality, Nutrition, and Costs in Production of Advanced Ready-to-Eat Foods.

PubMed

Skjerdal, Taran; Gefferth, Andras; Spajic, Miroslav; Estanga, Edurne Gaston; de Cecare, Alessandra; Vitali, Silvia; Pasquali, Frederique; Bovo, Federica; Manfreda, Gerardo; Mancusi, Rocco; Trevisiani, Marcello; Tessema, Girum Tadesse; Fagereng, Tone; Moen, Lena Haugland; Lyshaug, Lars; Koidis, Anastasios; Delgado-Pando, Gonzalo; Stratakos, Alexandros Ch; Boeri, Marco; From, Cecilie; Syed, Hyat; Muccioli, Mirko; Mulazzani, Roberto; Halbert, Catherine

2017-01-01

A prototype decision support IT-tool for the food industry was developed in the STARTEC project. Typical processes and decision steps were mapped using real life production scenarios of participating food companies manufacturing complex ready-to-eat foods. Companies looked for a more integrated approach when making food safety decisions that would align with existing HACCP systems. The tool was designed with shelf life assessments and data on safety, quality, and costs, using a pasta salad meal as a case product. The process flow chart was used as starting point, with simulation options at each process step. Key parameters like pH, water activity, costs of ingredients and salaries, and default models for calculations of Listeria monocytogenes , quality scores, and vitamin C, were placed in an interactive database. Customization of the models and settings was possible on the user-interface. The simulation module outputs were provided as detailed curves or categorized as "good"; "sufficient"; or "corrective action needed" based on threshold limit values set by the user. Possible corrective actions were suggested by the system. The tool was tested and approved by end-users based on selected ready-to-eat food products. Compared to other decision support tools, the STARTEC-tool is product-specific and multidisciplinary and includes interpretation and targeted recommendations for end-users.

The STARTEC Decision Support Tool for Better Tradeoffs between Food Safety, Quality, Nutrition, and Costs in Production of Advanced Ready-to-Eat Foods

PubMed Central

Gefferth, Andras; Spajic, Miroslav; Estanga, Edurne Gaston; Vitali, Silvia; Pasquali, Frederique; Bovo, Federica; Manfreda, Gerardo; Mancusi, Rocco; Tessema, Girum Tadesse; Fagereng, Tone; Moen, Lena Haugland; Lyshaug, Lars; Koidis, Anastasios; Delgado-Pando, Gonzalo; Stratakos, Alexandros Ch.; Boeri, Marco; From, Cecilie; Syed, Hyat; Muccioli, Mirko; Mulazzani, Roberto; Halbert, Catherine

2017-01-01

A prototype decision support IT-tool for the food industry was developed in the STARTEC project. Typical processes and decision steps were mapped using real life production scenarios of participating food companies manufacturing complex ready-to-eat foods. Companies looked for a more integrated approach when making food safety decisions that would align with existing HACCP systems. The tool was designed with shelf life assessments and data on safety, quality, and costs, using a pasta salad meal as a case product. The process flow chart was used as starting point, with simulation options at each process step. Key parameters like pH, water activity, costs of ingredients and salaries, and default models for calculations of Listeria monocytogenes, quality scores, and vitamin C, were placed in an interactive database. Customization of the models and settings was possible on the user-interface. The simulation module outputs were provided as detailed curves or categorized as “good”; “sufficient”; or “corrective action needed” based on threshold limit values set by the user. Possible corrective actions were suggested by the system. The tool was tested and approved by end-users based on selected ready-to-eat food products. Compared to other decision support tools, the STARTEC-tool is product-specific and multidisciplinary and includes interpretation and targeted recommendations for end-users. PMID:29457031

U.S. Food Safety and Inspection Service testing for Salmonella in selected raw meat and poultry products in the United States, 1998 through 2003: analysis of set results.

PubMed

Naugle, Alecia Larew; Barlow, Kristina E; Eblen, Denise R; Teter, Vanessa; Umholtz, Robert

2006-11-01

The U.S. Food Safety and Inspection Service (FSIS) tests sets of samples of selected raw meat and poultry products for Salmonella to ensure that federally inspected establishments meet performance standards defined in the pathogen reduction-hazard analysis and critical control point system (PR-HACCP) final rule. In the present report, sample set results are described and associations between set failure and set and establishment characteristics are identified for 4,607 sample sets collected from 1998 through 2003. Sample sets were obtained from seven product classes: broiler chicken carcasses (n = 1,010), cow and bull carcasses (n = 240), market hog carcasses (n = 560), steer and heifer carcasses (n = 123), ground beef (n = 2,527), ground chicken (n = 31), and ground turkey (n = 116). Of these 4,607 sample sets, 92% (4,255) were collected as part of random testing efforts (A sets), and 93% (4,166) passed. However, the percentage of positive samples relative to the maximum number of positive results allowable in a set increased over time for broilers but decreased or stayed the same for the other product classes. Three factors associated with set failure were identified: establishment size, product class, and year. Set failures were more likely early in the testing program (relative to 2003). Small and very small establishments were more likely to fail than large ones. Set failure was less likely in ground beef than in other product classes. Despite an overall decline in set failures through 2003, these results highlight the need for continued vigilance to reduce Salmonella contamination in broiler chicken and continued implementation of programs designed to assist small and very small establishments with PR-HACCP compliance issues.

Safety assessment for In-service Pressure Bending Pipe Containing Incomplete Penetration Defects

NASA Astrophysics Data System (ADS)

Wang, M.; Tang, P.; Xia, J. F.; Ling, Z. W.; Cai, G. Y.

2017-12-01

Incomplete penetration defect is a common defect in the welded joint of pressure pipes. While the safety classification of pressure pipe containing incomplete penetration defects, according to periodical inspection regulations in present, is more conservative. For reducing the repair of incomplete penetration defect, a scientific and applicable safety assessment method for pressure pipe is needed. In this paper, the stress analysis model of the pipe system was established for the in-service pressure bending pipe containing incomplete penetration defects. The local finite element model was set up to analyze the stress distribution of defect location and the stress linearization. And then, the applicability of two assessment methods, simplified assessment and U factor assessment method, to the assessment of incomplete penetration defects located at pressure bending pipe were analyzed. The results can provide some technical supports for the safety assessment of complex pipelines in the future.

Screening Electronic Health Record-Related Patient Safety Reports Using Machine Learning.

PubMed

Marella, William M; Sparnon, Erin; Finley, Edward

2017-03-01

The objective of this study was to develop a semiautomated approach to screening cases that describe hazards associated with the electronic health record (EHR) from a mandatory, population-based patient safety reporting system. Potentially relevant cases were identified through a query of the Pennsylvania Patient Safety Reporting System. A random sample of cases were manually screened for relevance and divided into training, testing, and validation data sets to develop a machine learning model. This model was used to automate screening of remaining potentially relevant cases. Of the 4 algorithms tested, a naive Bayes kernel performed best, with an area under the receiver operating characteristic curve of 0.927 ± 0.023, accuracy of 0.855 ± 0.033, and F score of 0.877 ± 0.027. The machine learning model and text mining approach described here are useful tools for identifying and analyzing adverse event and near-miss reports. Although reporting systems are beginning to incorporate structured fields on health information technology and the EHR, these methods can identify related events that reporters classify in other ways. These methods can facilitate analysis of legacy safety reports by retrieving health information technology-related and EHR-related events from databases without fields and controlled values focused on this subject and distinguishing them from reports in which the EHR is mentioned only in passing. Machine learning and text mining are useful additions to the patient safety toolkit and can be used to semiautomate screening and analysis of unstructured text in safety reports from frontline staff.

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.

Evaluation of the impacts of cooperative adaptive cruise control on reducing rear-end collision risks on freeways.

PubMed

Li, Ye; Wang, Hao; Wang, Wei; Xing, Lu; Liu, Shanwen; Wei, Xueyan

2017-01-01

Although plenty of studies have been conducted recently about the impacts of cooperative adaptive cruise control (CACC) system on traffic efficiency, there are few researches analyzing the safety effects of this advanced driving-assistant system. Thus, the primary objective of this study is to evaluate the impacts of the CACC system on reducing rear-end collision risks on freeways. The CACC model is firstly developed, which is based on the Intelligent Driver Model (IDM). Then, two surrogated safety measures, derived from the time-to-collision (TTC), denoting time exposed time-to-collision (TET) and time integrated time-to-collision (TIT), are introduced for quantifying the collision risks. And the safety effects are analyzed both theoretically and experimentally, by the linear stability analysis and simulations. The theoretical and simulation results conformably indicate that the CACC system brings dramatic benefits for reducing rear-end collision risks (TET and TIT are reduced more than 90%, respectively), when the desired time headway and time delay are set properly. The sensitivity analysis indicates there are few differences among different values of the threshold of TTC and the length of a CACC platoon. The results also show that the safety improvements weaken with the decrease of the penetration rates of CACC on the market and the increase of time delay between platoons. We also evaluate the traffic efficiency of the CACC system with different desired time headway. Copyright © 2016 Elsevier Ltd. All rights reserved.

Energy Storage Technology Development for Space Exploration

NASA Technical Reports Server (NTRS)

Mercer, Carolyn R.; Jankovsky, Amy L.; Reid, Concha M.; Miller, Thomas B.; Hoberecht, Mark A.

2011-01-01

The National Aeronautics and Space Administration is developing battery and fuel cell technology to meet the expected energy storage needs of human exploration systems. Improving battery performance and safety for human missions enhances a number of exploration systems, including un-tethered extravehicular activity suits and transportation systems including landers and rovers. Similarly, improved fuel cell and electrolyzer systems can reduce mass and increase the reliability of electrical power, oxygen, and water generation for crewed vehicles, depots and outposts. To achieve this, NASA is developing non-flow-through proton-exchange-membrane fuel cell stacks, and electrolyzers coupled with low permeability membranes for high pressure operation. The primary advantage of this technology set is the reduction of ancillary parts in the balance-of-plant fewer pumps, separators and related components should result in fewer failure modes and hence a higher probability of achieving very reliable operation, and reduced parasitic power losses enable smaller reactant tanks and therefore systems with lower mass and volume. Key accomplishments over the past year include the fabrication and testing of several robust, small-scale non-flow-through fuel cell stacks that have demonstrated proof-of-concept. NASA is also developing advanced lithium-ion battery cells, targeting cell-level safety and very high specific energy and energy density. Key accomplishments include the development of silicon composite anodes, lithiatedmixed- metal-oxide cathodes, low-flammability electrolytes, and cell-incorporated safety devices that promise to substantially improve battery performance while providing a high level of safety.

Radio frequency identification-enabled capabilities in a healthcare context: An exploratory study.

PubMed

Hornyak, Rob; Lewis, Mark; Sankaranarayan, Balaji

2016-09-01

Increasingly, the adoption and use of radio frequency identification systems in hospital settings is gaining prominence. However, despite the transformative impact that radio frequency identification has in healthcare settings, few studies have examined how and why this change may occur. The purpose of this study is to systematically understand how radio frequency identification can transform work practices in an operational process that directly impacts cost and operational efficiency and indirectly contributes to impacting patient safety and quality of care. We leverage an interdisciplinary framework to explore the contextual characteristics that shape the assimilation of radio frequency identification in healthcare settings. By linking the use of radio frequency identification with specific contextual dimensions in healthcare settings, we provide a data-driven account of how and why radio frequency identification can be useful in inventory management in this setting. In doing so, we also contribute to recent work by information systems scholars who argue for a reconfiguration of conventional assumptions regarding the role of technology in contemporary organizations. © The Author(s) 2015.

An irreplaceable safety culture.

PubMed

Render, Marta L; Hirschhorn, Larry

2005-01-01

Intensive care unit (ICU) clinicians are sources of errors and of resilience. When they learn how to juggle many competing goals, remain vigilant, and tell safety stories--all in the context of changing technologies and demand--they can create safe settings of care. Other strategies (eg, using computerized tools and implementing safety procedures) are important, but alone they are not sufficient. An ICU needs a safety culture that is rooted in a committed leadership, the acknowledgment that error is inevitable, a reporting system, and continuous learning. The all too common norm, "no harm no foul," is an obstacle. ICU leaders can use a campaign strategy to spread the safety practices that sustain a safety culture. They should attend to the political, marketing, and military aspects of such campaigns and recognize that people's time and attention are limited and built projects from existing ongoing pilots. Pilots can compete for people's attention; it has pull when it exemplifies a moral idea, simplifies work, and gives the health care professional more control and feedback. Under these conditions, the campaign will release individuals' passions and add energy and insight to the campaign itself.

Scheduling Real-Time Mixed-Criticality Jobs

NASA Astrophysics Data System (ADS)

Baruah, Sanjoy K.; Bonifaci, Vincenzo; D'Angelo, Gianlorenzo; Li, Haohan; Marchetti-Spaccamela, Alberto; Megow, Nicole; Stougie, Leen

Many safety-critical embedded systems are subject to certification requirements; some systems may be required to meet multiple sets of certification requirements, from different certification authorities. Certification requirements in such "mixed-criticality" systems give rise to interesting scheduling problems, that cannot be satisfactorily addressed using techniques from conventional scheduling theory. In this paper, we study a formal model for representing such mixed-criticality workloads. We demonstrate first the intractability of determining whether a system specified in this model can be scheduled to meet all its certification requirements, even for systems subject to two sets of certification requirements. Then we quantify, via the metric of processor speedup factor, the effectiveness of two techniques, reservation-based scheduling and priority-based scheduling, that are widely used in scheduling such mixed-criticality systems, showing that the latter of the two is superior to the former. We also show that the speedup factors are tight for these two techniques.

A cadaver study of mastoidectomy using an image-guided human-robot collaborative control system.

PubMed

Yoo, Myung Hoon; Lee, Hwan Seo; Yang, Chan Joo; Lee, Seung Hwan; Lim, Hoon; Lee, Seongpung; Yi, Byung-Ju; Chung, Jong Woo

2017-10-01

Surgical precision would be better achieved with the development of an anatomical monitoring and controlling robot system than by traditional surgery techniques alone. We evaluated the feasibility of robot-assisted mastoidectomy in terms of duration, precision, and safety. Human cadaveric study. We developed a multi-degree-of-freedom robot system for a surgical drill with a balancing arm. The drill system is manipulated by the surgeon, the motion of the drill burr is monitored by the image-guided system, and the brake is controlled by the robotic system. The system also includes an alarm as well as the brake to help avoid unexpected damage to vital structures. Experimental mastoidectomy was performed in 11 temporal bones of six cadavers. Parameters including duration and safety were assessed, as well as intraoperative damage, which was judged via pre- and post-operative computed tomography. The duration of mastoidectomy in our study was comparable with that required for chronic otitis media patients. Although minor damage, such as dura exposure without tearing, was noted, no critical damage to the facial nerve or other important structures was observed. When the brake system was set to 1 mm from the facial nerve, the postoperative average bone thicknesses of the facial nerve was 1.39, 1.41, 1.22, 1.41, and 1.55 mm in the lateral, posterior pyramidal and anterior, lateral, and posterior mastoid portions, respectively. Mastoidectomy can be successfully performed using our robot-assisted system while maintaining a pre-set limit of 1 mm in most cases. This system may thus be useful for more inexperienced surgeons. NA.

In Situ Analysis of Gas Generation in Lithium-Ion Batteries with Different Carbonate-Based Electrolytes.

PubMed

Teng, Xin; Zhan, Chun; Bai, Ying; Ma, Lu; Liu, Qi; Wu, Chuan; Wu, Feng; Yang, Yusheng; Lu, Jun; Amine, Khalil

2015-10-21

Gas generation in lithium-ion batteries is one of the critical issues limiting their safety performance and lifetime. In this work, a set of 900 mAh pouch cells were applied to systematically compare the composition of gases generated from a serial of carbonate-based composite electrolytes, using a self-designed gas analyzing system. Among electrolytes used in this work, the composite γ-butyrolactone/ethyl methyl carbonate (GBL/EMC) exhibited remarkably less gassing because of the electrochemical stability of the GBL, which makes it a promising electrolyte for battery with advanced safety and lifetime.

En route care patient safety: thoughts from the field.

PubMed

McNeill, Margaret M; Pierce, Penny; Dukes, Susan; Bridges, Elizabeth J

2014-08-01

The purpose of this study was to describe the patient safety culture of en route care in the United States Air Force aeromedical evacuation system. Almost 100,000 patients have been transported since 2001. Safety concerns in this unique environment are complex because of the extraordinary demands of multitasking, time urgency, long duty hours, complex handoffs, and multiple stressors of flight. An internet-based survey explored the perceptions and experiences of safety issues among nursing personnel involved throughout the continuum of aeromedical evacuation care. A convenience sample of 236 nurses and medical technicians from settings representing the continuum was studied. Descriptive and nonparametric statistics were used to analyze the quantitative data, and thematic analysis was applied to the qualitative data. Results indicate that over 90% of respondents agree or strongly agree safety is a priority in their unit and that their unit is responsive to patient safety initiatives. Many respondents described safety incidents or near misses, and these have been categorized as personnel physical capability limitations, environmental threats, medication and equipment issues, and care process problems. Results suggest the care of patients during transport is influenced by the safety culture, human factors, training, experience, and communication. Suggestions to address safety issues emerged from the survey data. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Defining Safety in the Nursing Home Setting: Implications for Future Research.

PubMed

Simmons, Sandra F; Schnelle, John F; Sathe, Nila A; Slagle, Jason M; Stevenson, David G; Carlo, Maria E; McPheeters, Melissa L

2016-06-01

Currently, the Agency for Healthcare Research and Quality (AHRQ) Common Format for nursing homes (NHs) accommodates voluntary reporting for 4 adverse events: falls with injury, pressure ulcers, medication errors, and infections. In 2015, AHRQ funded a technical brief to describe the state of the science related to safety in the NH setting to inform a research agenda. Thirty-six recent systematic reviews evaluated NH safety-related interventions to address these 4 adverse events and reported mostly mixed evidence about effective approaches to ameliorate them. Furthermore, these 4 events are likely inadequate to capture safety issues that are unique to the NH setting and encompass other domains related to residents' quality of care and quality of life. Future research needs include expanding our definition of safety in the NH setting, which differs considerably from that of hospitals, to include contributing factors to adverse events as well as more resident-centered care measures. Second, future research should reflect more rigorous implementation science to include objective measures of care processes related to adverse events, intervention fidelity, and staffing resources for intervention implementation to inform broader uptake of efficacious interventions. Weaknesses in implementation contribute to the current inconclusive and mixed evidence base as well as remaining questions about what outcomes are even achievable in the NH setting, given the complexity of most resident populations. Also related to implementation, future research should determine the effects of specific staffing models on care processes related to safety outcomes. Last, future efforts should explore the potential for safety issues in other care settings for older adults, most notably dementia care within assisted living. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.

Impact of a computerized physician order entry system on nurse-physician collaboration in the medication process.

PubMed

Pirnejad, Habibollah; Niazkhani, Zahra; van der Sijs, Heleen; Berg, Marc; Bal, Roland

2008-11-01

Due to their efficiency and safety potential, computerized physician order entry (CPOE) systems are gaining considerable attention in in-patient settings. However, recent studies have shown that these systems may undermine the efficiency and safety of the medication process by impeding nurse-physician collaboration. To evaluate the effects of a CPOE system on the mechanisms whereby nurses and physicians maintain their collaboration in the medication process. SETTING AND METHODOLOGY: Six internal medicine wards at the Erasmus Medical Centre were included in this study. A questionnaire was used to record nurses' attitudes towards the effectiveness of the former paper-based system. A similar questionnaire was used to evaluate nurses' attitudes with respect to a CPOE system that replaced the paper-based system. The data were complemented and triangulated through interviews with physicians and nurses. Response rates for the analyzed questions in the pre- and post-implementation questionnaires were 54.3% (76/140) and 52.14% (73/140). The CPOE system had a mixed impact on medication work: while it improved the main non-supportive features of the paper-based system, it lacked its main supportive features. The interviews revealed more detailed supportive and non-supportive features of the two systems. A comparison of supportive features of the paper-based system with non-supportive features of the CPOE system showed that synchronisation and feedback mechanisms in nurse-physician collaborations have been impaired after the CPOE system was introduced. This study contributes to an understanding of the affected mechanisms in nurse-physician collaboration using a CPOE system. It provides recommendations for repairing the impaired mechanisms and for redesigning the CPOE system and thus for better supporting these structures.

A multi-disciplinary approach to medication safety and the implication for nursing education and practice.

PubMed

Adhikari, Radha; Tocher, Jennifer; Smith, Pam; Corcoran, Janet; MacArthur, Juliet

2014-02-01

Medication management is a complex multi-stage and multi-disciplinary process, involving doctors, pharmacists, nurses and patients. Errors can occur at any stage from prescribing, dispensing and administering, to recording and reporting. There are a number of safety mechanisms built into the medication management system and it is recognised that nurses are the final stage of defence. However, medication error still remains a major challenge to patient safety globally. This paper aims to illustrate two main aspects of medication safety practices that have been elicited from an action research study in a Scottish Health Board and three local Higher Education Institutions: firstly current medication safety practices in two clinical settings; and secondly pre and post-registration nursing education and teaching on medication safety. This paper is based on Phase One and Two of an Action Research project. An ethnography-style observational method, influenced by an Appreciative Inquiry (AI) approach was adapted to study the everyday medication management systems and practices of two hospital wards. This was supplemented by seven in-depth interviews with nursing staff, numerous informal discussions with healthcare professionals, two focus-groups, one peer-interview and two in-depth individual interviews with final year nursing students from three Higher Education Institutions in Scotland. This paper highlights the current positive practical efforts in medication safety practices in the chosen clinical areas. Nursing staff do employ the traditional 'five right' principles - right patient, right medication, right dose, right route and right time - for safe administration. Nursing students are taught these principles in their pre-registration nursing education. However, there are some other challenges remaining: these include the establishment of a complete medication history (reconciliation) when patients come to hospital, the provision of an in-depth training in pharmacological knowledge to junior nursing staff and pre-registration nursing students. This paper argues that the 'five rights' principle during medication administration is not enough for holistic medication safety and explains two reasons why there is a need for strengthened multi-disciplinary team-work to achieve greater patient safety. To accomplish this, nurses need to have sufficient knowledge of pharmacology and medication safety issues. These findings have important educational implications and point to the requirement for the incorporation of medication management and pharmacology in to the teaching curriculum for nursing students. There is also a call for continuing professional development opportunities for nurses working in clinical settings. © 2014.

Ontology-Based Architecture for Intelligent Transportation Systems Using a Traffic Sensor Network.

PubMed

Fernandez, Susel; Hadfi, Rafik; Ito, Takayuki; Marsa-Maestre, Ivan; Velasco, Juan R

2016-08-15

Intelligent transportation systems are a set of technological solutions used to improve the performance and safety of road transportation. A crucial element for the success of these systems is the exchange of information, not only between vehicles, but also among other components in the road infrastructure through different applications. One of the most important information sources in this kind of systems is sensors. Sensors can be within vehicles or as part of the infrastructure, such as bridges, roads or traffic signs. Sensors can provide information related to weather conditions and traffic situation, which is useful to improve the driving process. To facilitate the exchange of information between the different applications that use sensor data, a common framework of knowledge is needed to allow interoperability. In this paper an ontology-driven architecture to improve the driving environment through a traffic sensor network is proposed. The system performs different tasks automatically to increase driver safety and comfort using the information provided by the sensors.

Towards a global IT system for personalized medicine: the Medicine Safety Code initiative.

PubMed

Samwald, Matthias; Minarro-Giménez, José Antonio; Blagec, Kathrin; Adlassnig, Klaus-Peter

2014-01-01

The availability of pharmacogenomic data of individual patients can significantly improve physicians' prescribing behavior, lead to a reduced incidence of adverse drug events and an improvement of effectiveness of treatment. The Medicine Safety Code (MSC) initiative is an effort to improve the ability of clinicians and patients to share pharmacogenomic data and to use it at the point of care. The MSC is a standardized two-dimensional barcode that captures individual pharmacogenomic data. The system is backed by a web service that allows the decoding and interpretation of anonymous MSCs without requiring the installation of dedicated software. The system is based on a curated, ontology-based knowledge base representing pharmacogenomic definitions and clinical guidelines. The MSC system performed well in preliminary tests. To evaluate the system in realistic health care settings and to translate it into practical applications, the future participation of stakeholders in clinical institutions, researchers, pharmaceutical companies, genetic testing providers, health IT companies and health insurance organizations will be essential.

Towards a global IT system for personalized medicine: the Medicine Safety Code initiative.

PubMed

Samwald, Matthias; Minarro-Giménez, José Antonio; Blagec, Kathrin; Adlassnig, Klaus-Peter

2014-01-01

The availability of pharmacogenomic data of individual patients can significantly improve physicians' prescribing behavior, lead to a reduced incidence of adverse drug events and an improvement of effectiveness of treatment. The Medicine Safety Code (MSC) initiative is an effort to improve the ability of clinicians and patients to share pharmacogenomic data and to use it at the point of care. The MSC is a standardized two-dimensional barcode that captures individual pharmacogenomic data. The system is backed by a web service that allows the decoding and interpretation of anonymous MSCs without requiring the installation of dedicated software. The system is based on a curated, ontology-based knowledge base representing pharmacogenomic definitions and clinical guidelines. The MSC system performed well in preliminary tests. To evaluate the system in realistic health care settings and to translate it into practical applications, the future participation of stakeholders in clinical institutions, medical researchers, pharmaceutical companies, genetic testing providers, health IT companies and health insurance organizations will be essential.

Ontology-Based Architecture for Intelligent Transportation Systems Using a Traffic Sensor Network

PubMed Central

Fernandez, Susel; Hadfi, Rafik; Ito, Takayuki; Marsa-Maestre, Ivan; Velasco, Juan R.

2016-01-01

Intelligent transportation systems are a set of technological solutions used to improve the performance and safety of road transportation. A crucial element for the success of these systems is the exchange of information, not only between vehicles, but also among other components in the road infrastructure through different applications. One of the most important information sources in this kind of systems is sensors. Sensors can be within vehicles or as part of the infrastructure, such as bridges, roads or traffic signs. Sensors can provide information related to weather conditions and traffic situation, which is useful to improve the driving process. To facilitate the exchange of information between the different applications that use sensor data, a common framework of knowledge is needed to allow interoperability. In this paper an ontology-driven architecture to improve the driving environment through a traffic sensor network is proposed. The system performs different tasks automatically to increase driver safety and comfort using the information provided by the sensors. PMID:27537878

Towards an International Classification for Patient Safety: a Delphi survey

PubMed Central

Thomson, Richard; Lewalle, Pierre; Sherman, Heather; Hibbert, Peter; Runciman, William; Castro, Gerard

2009-01-01

Objective Interpretation and comparison of patient safety information have been compromised by the lack of a common understanding of the concepts involved. The World Alliance set out to develop an International Classification for Patient Safety (ICPS) to address this, and to test the relevance and acceptability of the draft ICPS and progressively refine it prior to field testing. Design Two-stage Delphi survey. Quantitative and qualitative analyses informed the review of the ICPS. Setting International web-based survey of expert opinion. Participants Experts in the fields of patient safety, health policy, reporting systems, safety and quality control, classification theory and development, health informatics, consumer advocacy, law and medicine; 253 responded to the first round survey, 30% of whom responded to the second round. Results In the first round, 14% felt that the conceptual framework was missing at least one class, although it was apparent that most respondents were actually referring to concepts they felt should be included within the classes rather than the classes themselves. There was a need for clarification of several components of the classification, particularly its purpose, structure and depth. After revision and feedback, round 2 results were more positive, but further significant changes were made to the conceptual framework and to the major classes in response to concerns about terminology and relationships between classes. Conclusions The Delphi approach proved invaluable, as both a consensus-building exercise and consultation process, in engaging stakeholders to support completion of the final draft version of the ICPS. Further refinement will occur. PMID:19147596

Prospective cohort study of a new vacuum delivery device to assist with complicated labour in low-resource settings.

PubMed

Khan, Mishal; Hashmani, Farah Naz; Ahmed, Sajjad; Ahmed, Owais; Asim, Shabnam S; Wajahat, Yasmin; Sobani, Shoaib; Syed, Shershah; Qazi, Fahad

2015-02-01

Currently available vacuum devices used to assist women undergoing complicated labour are unsuitable for use in low-resource settings. The objective of this study was to evaluate the safety and feasibility of a new low-cost vacuum device, named Koohi Goth Vacuum Delivery System (KGVDS), designed for use in low-resource settings. A hospital-based, multicentre, prospective cohort study with no control group was conducted in Karachi, Pakistan. After training, KGVDS devices were made available for use by labour room staff at their discretion when instrumental delivery was indicated. Women to whom KGVDS was applied were followed from the start of labour until discharge. Feasibility was assessed in terms of successful expulsion of the foetal head following application of KGVDS and ease of use ratings. Safety was assessed by observing maternal and newborn post-delivery outcomes prior to discharge. Koohi Goth Vacuum Delivery System was applied to 137 women requiring instrumental delivery, of whom 111 (81%; 95% CI = 74-88%) successfully expelled the foetal head assisted by KGVDS and 103 (75%) stated that they would agree to use KGVDS again. There were no serious maternal or neonatal injuries or infections related to KGVDS use. The mean score for 'ease of use' given by doctors and midwives using the device was 8 of 10. Koohi Goth Vacuum Delivery System was feasible and safe to use for assisting complicated deliveries in low-resource hospitals in this initial evaluation. Our results indicate that this new device may have the potential to improve birth outcomes in settings where most mortality occurs and that further evaluations should be conducted. © 2014 John Wiley & Sons Ltd.

Toward a New Gold Standard for Early Safety: Automated Temperature-Controlled hERG Test on the PatchLiner®

PubMed Central

Polonchuk, Liudmila

2012-01-01

The Patchliner® temperature-controlled automated patch clamp system was evaluated for testing drug effects on potassium currents through human ether-à-go-go related gene (hERG) channels expressed in Chinese hamster ovary cells at 35–37°C. IC50 values for a set of reference drugs were compared with those obtained using the conventional voltage clamp technique. The results showed good correlation between the data obtained using automated and conventional electrophysiology. Based on these results, the Patchliner® represents an innovative automated electrophysiology platform for conducting the hERG assay that substantially increases throughput and has the advantage of operating at physiological temperature. It allows fast, accurate, and direct assessment of channel function to identify potential proarrhythmic side effects and sets a new standard in ion channel research for drug safety testing. PMID:22303293

Systems Thinking and Leadership: How Nephrologists Can Transform Dialysis Safety to Prevent Infections.

PubMed

Wong, Leslie P

2018-04-06

Infections are the second leading cause of death for patients with ESKD. Despite multiple efforts, nephrologists have been unable to prevent infections in dialysis facilities. The American Society of Nephrology and the Centers for Disease Control and Prevention have partnered to create Nephrologists Transforming Dialysis Safety to promote nephrologist leadership and engagement in efforts to "Target Zero" preventable dialysis infections. Because traditional approaches to infection control and prevention in dialysis facilities have had limited success, Nephrologists Transforming Dialysis Safety is reconceptualizing the problem in the context of the complexity of health care systems and organizational behavior. By identifying different parts of a problem and attempting to understand how these parts interact and produce a result, systems thinking has effectively tackled difficult problems in dynamic settings. The dialysis facility is composed of different physical and human elements that are interconnected and affect not only behavior but also, the existence of a culture of safety that promotes infection prevention. Because dialysis infections result from a complex system of interactions between caregivers, patients, dialysis organizations, and the environment, attempts to address infections by focusing on one element in isolation often fail. Creating a sense of urgency and commitment to eradicating dialysis infections requires leadership and motivational skills. These skills are not taught in the standard nephrology or medical director curriculum. Effective leadership by medical directors and engagement in infection prevention by nephrologists are required to create a culture of safety. It is imperative that nephrologists commit to leadership training and embrace their potential as change agents to prevent infections in dialysis facilities. This paper explores the systemic factors contributing to the ongoing dialysis infection crisis in the United States and the role of nephrologists in instilling a culture of safety in which infections can be anticipated and prevented. Copyright © 2018 by the American Society of Nephrology.

A Concept Analysis of Systems Thinking.

PubMed

Stalter, Ann M; Phillips, Janet M; Ruggiero, Jeanne S; Scardaville, Debra L; Merriam, Deborah; Dolansky, Mary A; Goldschmidt, Karen A; Wiggs, Carol M; Winegardner, Sherri

2017-10-01

This concept analysis, written by the National Quality and Safety Education for Nurses (QSEN) RN-BSN Task Force, defines systems thinking in relation to healthcare delivery. A review of the literature was conducted using five databases with the keywords "systems thinking" as well as "nursing education," "nursing curriculum," "online," "capstone," "practicum," "RN-BSN/RN to BSN," "healthcare organizations," "hospitals," and "clinical agencies." Only articles that focused on systems thinking in health care were used. The authors identified defining attributes, antecedents, consequences, and empirical referents of systems thinking. Systems thinking was defined as a process applied to individuals, teams, and organizations to impact cause and effect where solutions to complex problems are accomplished through collaborative effort according to personal ability with respect to improving components and the greater whole. Four primary attributes characterized systems thinking: dynamic system, holistic perspective, pattern identification, and transformation. Using the platform provided in this concept analysis, interprofessional practice has the ability to embrace planned efforts to improve critically needed quality and safety initiatives across patients' lifespans and all healthcare settings. © 2016 Wiley Periodicals, Inc.

49 CFR 385.5 - Safety fitness standard.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 5 2010-10-01 2010-10-01 false Safety fitness standard. 385.5 Section 385.5... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION FEDERAL MOTOR CARRIER SAFETY REGULATIONS SAFETY FITNESS PROCEDURES General § 385.5 Safety fitness standard. A motor carrier must meet the safety fitness standard set forth...

49 CFR 385.5 - Safety fitness standard.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 5 2011-10-01 2011-10-01 false Safety fitness standard. 385.5 Section 385.5... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION FEDERAL MOTOR CARRIER SAFETY REGULATIONS SAFETY FITNESS PROCEDURES General § 385.5 Safety fitness standard. A motor carrier must meet the safety fitness standard set forth...

Prediction Study on Anti-Slide Control of Railway Vehicle Based on RBF Neural Networks

NASA Astrophysics Data System (ADS)

Yang, Lijun; Zhang, Jimin

While railway vehicle braking, Anti-slide control system will detect operating status of each wheel-sets e.g. speed difference and deceleration etc. Once the detected value on some wheel-set is over pre-defined threshold, brake effort on such wheel-set will be adjusted automatically to avoid blocking. Such method takes effect on guarantee safety operation of vehicle and avoid wheel-set flatness, however it cannot adapt itself to the rail adhesion variation. While wheel-sets slide, the operating status is chaotic time series with certain law, and can be predicted with the law and experiment data in certain time. The predicted values can be used as the input reference signals of vehicle anti-slide control system, to judge and control the slide status of wheel-sets. In this article, the RBF neural networks is taken to predict wheel-set slide status in multi-step with weight vector adjusted based on online self-adaptive algorithm, and the center & normalizing parameters of active function of the hidden unit of RBF neural networks' hidden layer computed with K-means clustering algorithm. With multi-step prediction simulation, the predicted signal with appropriate precision can be used by anti-slide system to trace actively and adjust wheel-set slide tendency, so as to adapt to wheel-rail adhesion variation and reduce the risk of wheel-set blocking.

Quality management system and accreditation of the in vivo monitoring laboratory at Karslruhe Institute of Technology.

PubMed

Breustedt, B; Mohr, U; Biegard, N; Cordes, G

2011-03-01

The in vivo monitoring laboratory (IVM) at Karlsruhe Institute of Technology (KIT), with one whole body counter and three partial-body counters, is an approved lab for individual monitoring according to German regulation. These approved labs are required to prove their competencies by accreditation to ISO/IEC 17025:2005. In 2007 a quality management system (QMS), which was successfully audited and granted accreditation, was set up at the IVM. The system is based on the ISO 9001 certified QMS of the central safety department of the Research Centre Karlsruhe the IVM belonged to at that time. The system itself was set up to be flexible and could be adapted to the recent organisational changes (e.g. founding of KIT and an institute for radiation research) with only minor effort.

Operations system administration plan for HANDI 2000 business management system

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

Adams, D.E.

The Hanford Data Integration 2000 (HANDI 2000) Project will result in an integrated and comprehensive set of functional applications containing core information necessary to support the Project Hanford Management Contract (PHMC). It is based on the Commercial-Off-The-Shelf (COTS) product solution with commercially proven business processes. This includes systems that support finance, supply, chemical management, human resources and payroll activities on the Hanford Site. The Passport (PP) software is an integrated application for Accounts Payable, Contract Management, Inventory Management, Purchasing, and Material Safety Data Sheets (MSDS). The PeopleSoft (PS) software is an integrated application for General Ledger, Project Costing, Human Resources,more » Payroll, Benefits, and Training. The implementation of this set of products, as the first deliverable of the HANDI 2000 Project, is referred to as Business Management System (BMS) and MSDS.« less

[Comparative study of device labeling regulation in U.S.A. and China].

PubMed

Li, Fei; Wei, Jing; Ma, Yanbin; Li, Zhu

2010-09-01

To provide references for the evolvement of medical devices labeling and manual administration in China, By content analysis, 10 juristic documents relevant to device labeling and manual were collected from FDA website, compared to which, the federal regulation was mainly analyzed. There are five main differences of device labeling regulation between U.S.A. and China: juristic system, administrative scope, administrative target, characteristics and practice, A set of comprehensive juristic system for device labeling has been established by FDA. from which China should draw experience, to administrate the prescription devices and the over-the-counter devices in classification, and set up device labeling guidance, thus guarantee the safety and efficacy of device.

The likelihood of achieving quantified road safety targets: a binary logistic regression model for possible factors.

PubMed

Sze, N N; Wong, S C; Lee, C Y

2014-12-01

In past several decades, many countries have set quantified road safety targets to motivate transport authorities to develop systematic road safety strategies and measures and facilitate the achievement of continuous road safety improvement. Studies have been conducted to evaluate the association between the setting of quantified road safety targets and road fatality reduction, in both the short and long run, by comparing road fatalities before and after the implementation of a quantified road safety target. However, not much work has been done to evaluate whether the quantified road safety targets are actually achieved. In this study, we used a binary logistic regression model to examine the factors - including vehicle ownership, fatality rate, and national income, in addition to level of ambition and duration of target - that contribute to a target's success. We analyzed 55 quantified road safety targets set by 29 countries from 1981 to 2009, and the results indicate that targets that are in progress and with lower level of ambitions had a higher likelihood of eventually being achieved. Moreover, possible interaction effects on the association between level of ambition and the likelihood of success are also revealed. Copyright © 2014 Elsevier Ltd. All rights reserved.

Safety Policy and Procedure Manual (Electronic Version)

DOT National Transportation Integrated Search

1997-08-18

The state Secretary of Transportation has set a goal of zero accidents for the : North Carolina Department of Transportation (NCDOT). To guide the NCDOT towards : that goal, this safety manual sets for philosophy, goals, cardinal rules : (grounds for...

Workers' involvement--a missing component in the implementation of occupational safety and health management systems in enterprises.

PubMed

Podgórski, Daniel

2005-01-01

Effective implementation of occupational safety and health (OSH) legislation based on European Union directives requires promotion of OSH management systems (OSH MS). To this end, voluntary Polish standards (PN-N-18000) have been adopted, setting forth OSH MS specifications and guidelines. However, the number of enterprises implementing OSH MS has increased slowly, falling short of expectations, which call for a new national policy on OSH MS promotion. To develop a national policy in this area, a survey was conducted in 40 enterprises with OSH MS in place. The survey was aimed at identifying motivational factors underlying OSH MS implementation decisions. Specifically, workers' and their representatives' involvement in OSH MS implementation was investigated. The results showed that the level of workers' involvement was relatively low, which may result in a low effectiveness of those systems. The same result also applies to the involvement of workers' representatives and that of trade unions.

Assessing Patient Activation among High-Need, High-Cost Patients in Urban Safety Net Care Settings.

PubMed

Napoles, Tessa M; Burke, Nancy J; Shim, Janet K; Davis, Elizabeth; Moskowitz, David; Yen, Irene H

2017-12-01

We sought to examine the literature using the Patient Activation Measure (PAM) or the Patient Enablement Instrument (PEI) with high-need, high-cost (HNHC) patients receiving care in urban safety net settings. Urban safety net care management programs serve low-income, racially/ethnically diverse patients living with multiple chronic conditions. Although many care management programs track patient progress with the PAM or the PEI, it is not clear whether the PAM or the PEI is an effective and appropriate tool for HNHC patients receiving care in urban safety net settings in the United States. We searched PubMed, EMBASE, Web of Science, and PsycINFO for articles published between 2004 and 2015 that used the PAM and between 1998 and 2015 that used the PEI. The search was limited to English-language articles conducted in the United States and published in peer-reviewed journals. To assess the utility of the PAM and the PEI in urban safety net care settings, we defined a HNHC patient sample as racially/ethnically diverse, low socioeconomic status (SES), and multimorbid. One hundred fourteen articles used the PAM. All articles using the PEI were conducted outside the U.S. and therefore were excluded. Nine PAM studies (8%) included participants similar to those receiving care in urban safety net settings, three of which were longitudinal. Two of the three longitudinal studies reported positive changes following interventions. Our results indicate that research on patient activation is not commonly conducted on racially and ethnically diverse, low SES, and multimorbid patients; therefore, there are few opportunities to assess the appropriateness of the PAM in such populations. Investigators expressed concerns with the potential unreliability and inappropriate nature of the PAM on multimorbid, older, and low-literacy patients. Thus, the PAM may not be able to accurately assess patient progress among HNHC patients receiving care in urban safety net settings. Assessing progress in the urban safety net care setting requires measures that account for the social and structural challenges and competing demands of HNHC patients.

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.

Compliant flooring to prevent fall-related injuries in older adults: A scoping review of biomechanical efficacy, clinical effectiveness, cost-effectiveness, and workplace safety.

PubMed

Lachance, Chantelle C; Jurkowski, Michal P; Dymarz, Ania C; Robinovitch, Stephen N; Feldman, Fabio; Laing, Andrew C; Mackey, Dawn C

2017-01-01

Compliant flooring, broadly defined as flooring systems or floor coverings with some level of shock absorbency, may reduce the incidence and severity of fall-related injuries in older adults; however, a lack of synthesized evidence may be limiting widespread uptake. Informed by the Arksey and O'Malley framework and guided by a Research Advisory Panel of knowledge users, we conducted a scoping review to answer: what is presented about the biomechanical efficacy, clinical effectiveness, cost-effectiveness, and workplace safety associated with compliant flooring systems that aim to prevent fall-related injuries in healthcare settings? We searched academic and grey literature databases. Any record that discussed a compliant flooring system and at least one of biomechanical efficacy, clinical effectiveness, cost-effectiveness, or workplace safety was eligible for inclusion. Two independent reviewers screened and abstracted records, charted data, and summarized results. After screening 3611 titles and abstracts and 166 full-text articles, we included 84 records plus 56 companion (supplementary) reports. Biomechanical efficacy records (n = 50) demonstrate compliant flooring can reduce fall-related impact forces with minimal effects on standing and walking balance. Clinical effectiveness records (n = 20) suggest that compliant flooring may reduce injuries, but may increase risk for falls. Preliminary evidence suggests that compliant flooring may be a cost-effective strategy (n = 12), but may also result in increased physical demands for healthcare workers (n = 17). In summary, compliant flooring is a promising strategy for preventing fall-related injuries from a biomechanical perspective. Additional research is warranted to confirm whether compliant flooring (i) prevents fall-related injuries in real-world settings, (ii) is a cost-effective intervention strategy, and (iii) can be installed without negatively impacting workplace safety. Avenues for future research are provided, which will help to determine whether compliant flooring is recommended in healthcare environments.

Compliant flooring to prevent fall-related injuries in older adults: A scoping review of biomechanical efficacy, clinical effectiveness, cost-effectiveness, and workplace safety

PubMed Central

Jurkowski, Michal P.; Dymarz, Ania C.; Robinovitch, Stephen N.; Feldman, Fabio; Laing, Andrew C.; Mackey, Dawn C.

2017-01-01

Background Compliant flooring, broadly defined as flooring systems or floor coverings with some level of shock absorbency, may reduce the incidence and severity of fall-related injuries in older adults; however, a lack of synthesized evidence may be limiting widespread uptake. Methods Informed by the Arksey and O’Malley framework and guided by a Research Advisory Panel of knowledge users, we conducted a scoping review to answer: what is presented about the biomechanical efficacy, clinical effectiveness, cost-effectiveness, and workplace safety associated with compliant flooring systems that aim to prevent fall-related injuries in healthcare settings? We searched academic and grey literature databases. Any record that discussed a compliant flooring system and at least one of biomechanical efficacy, clinical effectiveness, cost-effectiveness, or workplace safety was eligible for inclusion. Two independent reviewers screened and abstracted records, charted data, and summarized results. Results After screening 3611 titles and abstracts and 166 full-text articles, we included 84 records plus 56 companion (supplementary) reports. Biomechanical efficacy records (n = 50) demonstrate compliant flooring can reduce fall-related impact forces with minimal effects on standing and walking balance. Clinical effectiveness records (n = 20) suggest that compliant flooring may reduce injuries, but may increase risk for falls. Preliminary evidence suggests that compliant flooring may be a cost-effective strategy (n = 12), but may also result in increased physical demands for healthcare workers (n = 17). Conclusions In summary, compliant flooring is a promising strategy for preventing fall-related injuries from a biomechanical perspective. Additional research is warranted to confirm whether compliant flooring (i) prevents fall-related injuries in real-world settings, (ii) is a cost-effective intervention strategy, and (iii) can be installed without negatively impacting workplace safety. Avenues for future research are provided, which will help to determine whether compliant flooring is recommended in healthcare environments. PMID:28166265

Workplace Safety Manual

DOT National Transportation Integrated Search

2002-04-10

N.C. Department of Transportation's workplace safety manual for online viewing. : The government of North Carolina feels that all employees are responsible for safety : on the job. This manual describes and sets out the operation of safety program : ...

Good Practice Recommendations in the Field of Heating, Ventilation, and Air Conditioning for Health Related Research Laboratories.

ERIC Educational Resources Information Center

Laboratory Design Notes, 1966

1966-01-01

A collection of laboratory design notes to set forth minimum criteria required in the design of basic medical research laboratory buildings. Recommendations contained are primarily concerned with features of design which affect quality of performance and future flexibility of facility systems. Subjects of economy and safety are discussed where…

Teaching and Assessment of Mathematical Principles for Software Correctness Using a Reasoning Concept Inventory

ERIC Educational Resources Information Center

Drachova-Strang, Svetlana V.

2013-01-01

As computing becomes ubiquitous, software correctness has a fundamental role in ensuring the safety and security of the systems we build. To design and develop software correctly according to their formal contracts, CS students, the future software practitioners, need to learn a critical set of skills that are necessary and sufficient for…

78 FR 17939 - Announcement of Funding Awards; Capital Fund Safety and Security Grants; Fiscal Year 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-25

... publishing the names, addresses, and amounts of the 18 awards made under the set aside in Appendix A to this... Security Camera Harrison Street, Oakland, CA Surveillance System 94612. including digital video recorders... Cameras, 50 Lincoln Plaza, Wilkes-Barre, Network Video PA 18702. Recorders, and Lighting. Ft. Worth...

T & I--Building Construction, Safety. Kit No. 1. Instructor's Manual [and] Student Learning Activity Guide.

ERIC Educational Resources Information Center

Howard, John

An instructor's manual and student activity guide on building construction safety are provided in this set of prevocational education materials which focuses on the vocational area of trade and industry. (This set of materials is one of ninety-two prevocational education sets arranged around a cluster of seven vocational offerings: agriculture,…

A rough set-based measurement model study on high-speed railway safety operation.

PubMed

Hu, Qizhou; Tan, Minjia; Lu, Huapu; Zhu, Yun

2018-01-01

Aiming to solve the safety problems of high-speed railway operation and management, one new method is urgently needed to construct on the basis of the rough set theory and the uncertainty measurement theory. The method should carefully consider every factor of high-speed railway operation that realizes the measurement indexes of its safety operation. After analyzing the factors that influence high-speed railway safety operation in detail, a rough measurement model is finally constructed to describe the operation process. Based on the above considerations, this paper redistricts the safety influence factors of high-speed railway operation as 16 measurement indexes which include staff index, vehicle index, equipment index and environment. And the paper also provides another reasonable and effective theoretical method to solve the safety problems of multiple attribute measurement in high-speed railway operation. As while as analyzing the operation data of 10 pivotal railway lines in China, this paper respectively uses the rough set-based measurement model and value function model (one model for calculating the safety value) for calculating the operation safety value. The calculation result shows that the curve of safety value with the proposed method has smaller error and greater stability than the value function method's, which verifies the feasibility and effectiveness.

Feasibility and acceptability of interventions to delay gun access in VA mental health settings.

PubMed

Walters, Heather; Kulkarni, Madhur; Forman, Jane; Roeder, Kathryn; Travis, Jamie; Valenstein, Marcia

2012-01-01

The majority of VA patient suicides are completed with firearms. Interventions that delay patients' gun access during high-risk periods may reduce suicide, but may not be acceptable to VA stakeholders or may be challenging to implement. Using qualitative methods, stakeholders' perceptions about gun safety and interventions to delay gun access during high-risk periods were explored. Ten focus groups and four individual interviews were conducted with key stakeholders, including VA mental health patients, mental health clinicians, family members and VA facility leaders (N=60). Transcripts were consensus-coded by two independent coders, and structured summaries were developed and reviewed using a consensus process. All stakeholder groups indicated that VA health system providers had a role in increasing patient safety and emphasized the need for providers to address gun access with their at-risk patients. However, VA mental health patients and clinicians reported limited discussion regarding gun access in VA mental health settings during routine care. Most, although not all, patients and clinicians indicated that routine screening for gun access was acceptable, with several noting that it was more acceptable for mental health patients. Most participants suggested that family and friends be involved in reducing gun access, but expressed concerns about potential family member safety. Participants generally found distribution of trigger locks acceptable, but were skeptical about its effectiveness. Involving Veteran Service Organizations or other individuals in temporarily holding guns during high-risk periods was acceptable to many participants but only with numerous caveats. Patients, clinicians and family members consider the VA health system to have a legitimate role in addressing gun safety. Several measures to delay gun access during high-risk periods for suicide were seen as acceptable and feasible if implemented thoughtfully. Published by Elsevier Inc.

Safety risks associated with physical interactions between patients and caregivers during treatment and care delivery in Home Care settings: A systematic review.

PubMed

Hignett, Sue; Edmunds Otter, Mary; Keen, Christine

2016-07-01

To explore the safety risks associated with physical interactions between patients and caregivers during treatment and care delivery in Home Care settings. Seven-stage framework from the PRISMA statement for research question, eligibility (definition), search, identification of relevant papers from title and abstract, selection and retrieval of papers, appraisal and synthesis. British Nursing Index (BNI), Allied and Complementary Medicine Database (AMED), Applied Social Sciences Index and Abstracts (ASSIA), Cinahl, Cochrane Library, Embase, Ergonomics Abstracts, Health Business Elite, Health Management Information Consortium (HMIC), Medline, PsycInfo, Scopus, Social Care online, Social Science Citation Index. The included references (n=42) were critically appraised using a modified version of Downs and Black checklist and the Mixed Methods Appraisal Tool. The risk factors are reported using the modified model of human factors of health care in the home to represent the roles of both patients and caregivers in the system. The results are grouped as environment (health policy, physical and social), artefacts (equipment and technology), tasks (procedures and work schedules) and care recipient/provider. These include permanent and temporary building design and access, communication and lone working, provision of equipment and consumables, and clinical tasks. The topics with strong evidence from at least 2 papers relate to risks associated with awkward working positions, social environment issues (additional tasks and distractions), abuse and violence, inadequate team (peer) support, problems with workload planning, needle stick injuries and physical workload (moving and handling patients). As home care increases, there is a need to ensure the safety of both patients and caregivers with an understanding of the physical interactions and tasks to manage safety risks and plan safer care delivery systems. Copyright © 2016 Elsevier Ltd. All rights reserved.

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.

Measuring safety culture in the ambulatory setting: the safety attitudes questionnaire--ambulatory version.

PubMed

Modak, Isitri; Sexton, J Bryan; Lux, Thomas R; Helmreich, Robert L; Thomas, Eric J

2007-01-01

Provider attitudes about issues pertinent to patient safety may be related to errors and adverse events. We know of no instruments that measure safety-related attitudes in the outpatient setting. To adapt the safety attitudes questionnaire (SAQ) to the outpatient setting and compare attitudes among different types of providers in the outpatient setting. We modified the SAQ to create a 62-item SAQ-ambulatory version (SAQ-A). Patient care staff in a multispecialty, academic practice rated their agreement with the items using a 5-point Likert scale. Cronbach's alpha was calculated to determine reliability of scale scores. Differences in SAQ-A scores between providers were assessed using ANOVA. Of the 409 staff, 282 (69%) returned surveys. One hundred ninety (46%) surveys were included in the analyses. Cronbach's alpha ranged from 0.68 to 0.86 for the scales: teamwork climate, safety climate, perceptions of management, job satisfaction, working conditions, and stress recognition. Physicians had the least favorable attitudes about perceptions of management while managers had the most favorable attitudes (mean scores: 50.4 +/- 22.5 vs 72.5 +/- 19.6, P < 0.05; percent with positive attitudes 18% vs 70%, respectively). Nurses had the most positive stress recognition scores (mean score 66.0 +/- 24.0). All providers had similar attitudes toward teamwork climate, safety climate, job satisfaction, and working conditions. The SAQ-A is a reliable tool for eliciting provider attitudes about the ambulatory work setting. Attitudes relevant to medical error may differ among provider types and reflect behavior and clinic operations that could be improved.

Evaluation of the organisation and effectiveness of internal audits to govern patient safety in hospitals: a mixed-methods study

PubMed Central

van Gelderen, Saskia C; Zegers, Marieke; Boeijen, Wilma; Westert, Gert P; Robben, Paul B; Wollersheim, Hub C

2017-01-01

Objectives Hospital boards are legally responsible for safe healthcare. They need tools to assist them in their task of governing patient safety. Almost every Dutch hospital performs internal audits, but the effectiveness of these audits for hospital governance has never been evaluated. The aim of this study is to evaluate the organisation of internal audits and their effectiveness for hospitals boards to govern patient safety. Design and setting A mixed-methods study consisting of a questionnaire regarding the organisation of internal audits among all Dutch hospitals (n=89) and interviews with stakeholders regarding the audit process and experienced effectiveness of audits within six hospitals. Results Response rate of the questionnaire was 76% and 43 interviews were held. In every responding hospital, the internal audits followed the plan–do–check–act cycle. Every hospital used interviews, document analysis and site visits as input for the internal audit. Boards stated that effective aspects of internal audits were their multidisciplinary scope, their structured and in-depth approach, the usability to monitor improvement activities and to change hospital policy and the fact that results were used in meetings with staff and boards of supervisors. The qualitative methods (interviews and site visits) used in internal audits enable the identification of soft signals such as unsafe culture or communication and collaboration problems. Reported disadvantages were the low frequency of internal audits and the absence of soft signals in the actual audit reports. Conclusion This study shows that internal audits are regarded as effective for patient safety governance, as they help boards to identify patient safety problems, proactively steer patient safety and inform boards of supervisors on the status of patient safety. The description of the Dutch internal audits makes these audits replicable to other healthcare organisations in different settings, enabling hospital boards to complement their systems to govern patient safety. PMID:28698328

75 FR 5844 - Agency Information Collection Activity Seeking OMB Approval

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-04

..., vol. 74, no. 199, page 53315. This rule set safety and oversight rules for a broad variety of...: An estimated 30,320.6 hours annually. Abstract: This rule set safety and oversight rules for a broad...

The Effects of Safety Discrimination Training and Frequent Safety Observations on Safety-Related Behavior

ERIC Educational Resources Information Center

Taylor, Matthew A.; Alvero, Alicia M.

2012-01-01

The intent of the present study was to assess the effects of discrimination training only and in combination with frequent safety observations on five participants' safety-related behavior in a simulated office setting. The study used a multiple-baseline design across safety-related behaviors. Across all participants and behavior, safety improved…

Design of disturbances control model at automotive company

NASA Astrophysics Data System (ADS)

Marie, I. A.; Sari, D. K.; Astuti, P.; Teorema, M.

2017-12-01

The discussion was conducted at PT. XYZ which produces automotive components and motorcycle products. The company produced X123 type cylinder head which is a motor vehicle forming component. The disturbances in the production system has affected the company performance in achieving the target of Key Performance Indicator (KPI). Currently, the determination of the percentage of safety stock of cylinder head products is not in accordance to the control limits set by the company (60% - 80%), and tends to exceed the control limits that cause increasing the inventory wastage in the company. This study aims to identify the production system disturbances that occurs in the production process of manufacturing components of X123 type cylinder head products and design the control model of disturbance to obtain control action and determine the safety stock policy in accordance with the needs of the company. The design stage has been done based on the Disturbance Control Model which already existing and customized with the company need in controlling the production system disturbances at the company. The design of the disturbances control model consists of sub-model of the risk level of the disturbance, sub-model of action status, sub-model action control of the disturbance, and sub-model of determining the safety stock. The model can assist the automotive company in taking the decision to perform the disturbances control action in production system cylinder head while controlling the percentage of the safety stock.

Effect of ambient pressure variation on closed loop gas system for India based Neutrino Observatory (INO)

NASA Astrophysics Data System (ADS)

Satyanarayana, B.; Majumder, G.; Mondal, N. K.; Kalmani, S. D.; Shinde, R. R.; Joshi, A.

2014-10-01

Pilot unit of a closed loop gas mixing and distribution system for the INO project was designed and is being operated with 1.8meters × 1.9meters RPCs for about two years. A number of studies on controlling the flow and optimisation of the gas mixture through the RPC stack were carried out during this period. The gas system essentially measures and attempts to maintain absolute pressure inside the RPC gas volume. During typical Mumbai monsoon seasons, the barometric pressure changes rather rapidly, due to which the gas system fails to maintain the set differential pressure between the ambience and the RPC gas volume. As the safety bubblers on the RPC gas input lines are set to work on fixed pressure differentials, the ambient pressure changes lead to either venting out and thus wasting gas through safety bubblers or over pressuring the RPCs gas volume and thus degrading its performance. The above problem also leads to gas mixture contamination through minute leaks in gas gap. The problem stated above was solved by including the ambient barometric pressure as an input parameter in the closed loop. Using this, it is now possible to maintain any set differential pressure between the ambience and RPC gas volumes between 0 to 20mm of water column, thus always ensuring a positive pressure inside the RPC gas volume with respect to the ambience. This has resulted in improved performance of the gas system by maintaining the constant gas flow and reducing the gas toping up frequency. In this paper, we will highlight the design features and improvements of the closed loop gas system. We will present some of the performance studies and considerations for scaling up the system to be used with the engineering module and then followed by Iron Calorimeter detector (ICAL), which is designed to deploy about 30,000 RPCs of 1.8meters × 1.9 meters in area.

Sports Injury Surveillance Systems: A Review of Methods and Data Quality.

PubMed

Ekegren, Christina L; Gabbe, Belinda J; Finch, Caroline F

2016-01-01

Data from sports injury surveillance systems are a prerequisite to the development and evaluation of injury prevention strategies. This review aimed to identify ongoing sports injury surveillance systems and determine whether there are gaps in our understanding of injuries in certain sport settings. A secondary aim was to determine which of the included surveillance systems have evaluated the quality of their data, a key factor in determining their usefulness. A systematic search was carried out to identify (1) publications presenting methodological details of sports injury surveillance systems within clubs and organisations; and (2) publications describing quality evaluations and the quality of data from these systems. Data extracted included methodological details of the surveillance systems, methods used to evaluate data quality, and results of these evaluations. Following literature search and review, a total of 15 sports injury surveillance systems were identified. Data relevant to each aim were summarised descriptively. Most systems were found to exist within professional and elite sports. Publications concerning data quality were identified for seven (47%) systems. Validation of system data through comparison with alternate sources has been undertaken for only four systems (27%). This review identified a shortage of ongoing injury surveillance data from amateur and community sport settings and limited information about the quality of data in professional and elite settings. More surveillance systems are needed across a range of sport settings, as are standards for data quality reporting. These efforts will enable better monitoring of sports injury trends and the development of sports safety strategies.

Measuring patient safety culture in maternal and child health institutions in China: a qualitative study.

PubMed

Wang, Yuanyuan; Liu, Weiwei; Shi, Huifeng; Liu, Chaojie; Wang, Yan

2017-07-12

Patient safety culture (PSC) plays a critical role in ensuring safe and quality care. Extensive PSC studies have been undertaken in hospitals. However, little is known about PSC in maternal and child health (MCH) institutions in China, which provide both population-based preventive services as well as individual care for patients. This study aimed to develop a theoretical framework for conceptualising PSC in MCH institutions in China. The study was undertaken in six MCH institutions (three in Hebei and three in Beijing). Participants (n=118) were recruited through stratified purposive sampling: 20 managers/administrators, 59 care providers and 39 patients. In-depth interviews were conducted with the participants. The interview data were coded using both inductive (based on the existing PSC theory developed by the Agency for Healthcare Research and Quality) and deductive (open coding arising from data) approaches. A PSC framework was formulated through axial coding that connected initial codes and selective coding that extracted a small number of themes. The interviewees considered patient safety in relation to six aspects: safety and security in public spaces, safety of medical services, privacy and information security, financial security, psychological safety and gap in services. A 12-dimensional PSC framework was developed, containing 69 items. While the existing PSC theory was confirmed by this study, some new themes emerged from the data. Patients expressed particular concerns about psychological safety and financial security. Defensive medical practices emerged as a PSC dimension that is associated with not only medical safety but also financial security and psychological safety. Patient engagement was also valued by the interviewees, especially the patients, as part of PSC. Although there are some common features in PSC across different healthcare delivery systems, PSC can also be context specific. In MCH settings in China, the meaning of 'patient safety' goes beyond the traditional definition of patients. General well-being, health and disease prevention are important anchor points for defining PSC in such settings. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Advances in measuring culturally competent care: a confirmatory factor analysis of CAHPS-CC in a safety-net population.

PubMed

Stern, Rachel J; Fernandez, Alicia; Jacobs, Elizabeth A; Neilands, Torsten B; Weech-Maldonado, Robert; Quan, Judy; Carle, Adam; Seligman, Hilary K

2012-09-01

Providing culturally competent care shows promise as a mechanism to reduce health care inequalities. Until the recent development of the Consumer Assessment of Healthcare Providers and Systems Cultural Competency Item Set (CAHPS-CC), no measures capturing patient-level experiences with culturally competent care have been suitable for broad-scale administration. We performed confirmatory factor analysis and internal consistency reliability analysis of CAHPS-CC among patients with type 2 diabetes (n=600) receiving primary care in safety-net clinics. CAHPS-CC domains were also correlated with global physician ratings. A 7-factor model demonstrated satisfactory fit (χ²₂₃₁=484.34, P<0.0001) with significant factor loadings at P<0.05. Three domains showed excellent reliability-Doctor Communication-Positive Behaviors (α=0.82), Trust (α=0.77), and Doctor Communication-Health Promotion (α=0.72). Four domains showed inadequate reliability either among Spanish speakers or overall (overall reliabilities listed): Doctor Communication-Negative Behaviors (α=0.54), Equitable Treatment (α=0.69), Doctor Communication-Alternative Medicine (α=0.52), and Shared Decision-Making (α=0.51). CAHPS-CC domains were positively and significantly correlated with global physician rating. Select CAHPS-CC domains are suitable for broad-scale administration among safety-net patients. Those domains may be used to target quality-improvement efforts focused on providing culturally competent care in safety-net settings.

Electrochemical performance evaluations and safety investigations of pentafluoro(phenoxy)cyclotriphosphazene as a flame retardant electrolyte additive for application in lithium ion battery systems using a newly designed apparatus for improved self-extinguishing time measurements

NASA Astrophysics Data System (ADS)

Dagger, Tim; Lürenbaum, Constantin; Schappacher, Falko M.; Winter, Martin

2017-02-01

A modified self-extinguishing time (SET) device which enhances the reproducibility of the results is presented. Pentafluoro(phenoxy)cyclotriphosphazene (FPPN) is investigated as flame retardant electrolyte additive for lithium ion batteries (LIBs) in terms of thermal stability and electrochemical performance. SET measurements and adiabatic reaction calorimetry are applied to determine the flammability and the reactivity of a standard LIB electrolyte containing 5% FPPN. The results reveal that the additive-containing electrolyte is nonflammable for 10 s whereas the commercially available reference electrolyte inflames instantaneously after 1 s of ignition. The onset temperature of the safety enhanced electrolyte is delayed by ≈ 21 °C. Compatibility tests in half cells show that the electrolyte is reductively stable while the cyclic voltammogram indicates oxidative decomposition during the first cycle. Cycling experiments in full cells show improved cycling performance and rate capability, which can be attributed to cathode passivation during the first cycle. Post-mortem analysis of the electrolyte by gas chromatography-mass spectrometry confirms the presence of the additive in high amounts after 501 cycles which ensures enhanced safety of the electrolyte. The investigations present FPPN as stable electrolyte additive that improves the intrinsic safety of the electrolyte and its cycling performance at the same time.

Pretest and refinement of items for alcohol highway safety surveys

DOT National Transportation Integrated Search

1984-05-30

This study summarizes the procedures employed in pre-testing a set of alcohol-highway safety questionnaire items. The procedures included conducting a set of focus groups and a series of telephone interviews on several forms of the questionnaires. Th...

78 FR 37505 - International Standard-Setting Activities

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-21

... Code of Practice for Weed Control to Prevent and Reduce Pyrrolizidine Alkaloid Contamination in Food... DEPARTMENT OF AGRICULTURE Food Safety and Inspection Service [Docket No. FSIS-2013-0002] International Standard-Setting Activities AGENCY: Office of Food Safety, USDA. ACTION: Notice. SUMMARY: This...

Setting culture apart: distinguishing culture from behavior and social structure in safety and injury research.

PubMed

Myers, Douglas J; Nyce, James M; Dekker, Sidney W A

2014-07-01

The concept of culture is now widely used by those who conduct research on safety and work-related injury outcomes. We argue that as the term has been applied by an increasingly diverse set of disciplines, its scope has broadened beyond how it was defined and intended for use by sociologists and anthropologists. As a result, this more inclusive concept has lost some of its precision and analytic power. We suggest that the utility of this "new" understanding of culture could be improved if researchers more clearly delineated the ideological - the socially constructed abstract systems of meaning, norms, beliefs and values (which we refer to as culture) - from concrete behaviors, social relations and other properties of workplaces (e.g., organizational structures) and of society itself. This may help researchers investigate how culture and social structures can affect safety and injury outcomes with increased analytic rigor. In addition, maintaining an analytical distinction between culture and other social factors can help intervention efforts better understand the target of the intervention and therefore may improve chances of both scientific and instrumental success. Copyright © 2013 Elsevier Ltd. All rights reserved.

System cost/performance analysis (study 2.3). Volume 1: Executive summary

NASA Technical Reports Server (NTRS)

Kazangey, T.

1973-01-01

The relationships between performance, safety, cost, and schedule parameters were identified and quantified in support of an overall effort to generate program models and methodology that provide insight into a total space vehicle program. A specific space vehicle system, the attitude control system (ACS), was used, and a modeling methodology was selected that develops a consistent set of quantitative relationships among performance, safety, cost, and schedule, based on the characteristics of the components utilized in candidate mechanisms. These descriptive equations were developed for a three-axis, earth-pointing, mass expulsion ACS. A data base describing typical candidate ACS components was implemented, along with a computer program to perform sample calculations. This approach, implemented on a computer, is capable of determining the effect of a change in functional requirements to the ACS mechanization and the resulting cost and schedule. By a simple extension of this modeling methodology to the other systems in a space vehicle, a complete space vehicle model can be developed. Study results and recommendations are presented.

An Analysis of Adverse Events in the Rehabilitation Department: Using the Veterans Affairs Root Cause Analysis System.

PubMed

Hagley, Gregory W; Mills, Peter D; Shiner, Brian; Hemphill, Robin R

2018-04-01

Root cause analyses (RCA) are often completed in health care settings to determine causes of adverse events (AEs). RCAs result in action plans designed to mitigate future patient harm. National reviews of RCA reports have assessed the safety of numerous health care settings and suggested opportunities for improvement. However, few studies have assessed the safety of receiving care from physical therapists, occupational therapists, or speech and language pathology pathologists. The objective of this study was to determine the types of AEs, root causes, and action plans for risk mitigation that exist within the disciplines of rehabilitation medicine. This study is a retrospective, cross-sectional review. A national search of the Veterans Health Administration RCA database was conducted to identify reports describing AEs associated with physical therapy, occupational therapy, or speech and language pathology services between 2009 and May 2016. Twenty-five reports met the inclusion requirements. The reports were classified by the event type, root cause, action plans, and strength of action plans. Delays in care (32.0%) and falls (28.0%) were the most common type of AE. Three AEs resulted in death. RCA teams identified deficits regarding policy and procedures as the most common root cause. Eighty-eight percent of RCA reports included strong or intermediate action plans to mitigate risk. Strong action plans included standardizing emergency terminology and implementing a dedicated line to call for an emergency response. These data are self-reported and only AEs that are scored as a safety assessment code 3 in the system receive a full RCA, so there are likely AEs that were not captured in this study. In addition, the RCA reports are deidentified and so do not include all patient characteristics. As the Veterans Health Administration system services mostly men, the data might not generalize to non-Veterans Health Administration systems with a different patient mix. Care provided by rehabilitation professionals is generally safe, but AEs do occur. Based on this RCA review, the safety of rehabilitation services can be improved by implementing strong practices to mitigate risk to patients. Checklists should be considered to aid timely decision making when initiating an emergency response.

NASIS data base management system - IBM 360/370 OS MVT implementation. 4: Program design specifications

NASA Technical Reports Server (NTRS)

1973-01-01

The design specifications for the programs and modules within the NASA Aerospace Safety Information System (NASIS) are presented. The purpose of the design specifications is to standardize the preparation of the specifications and to guide the program design. Each major functional module within the system is a separate entity for documentation purposes. The design specifications contain a description of, and specifications for, all detail processing which occurs in the module. Sub-modules, reference tables, and data sets which are common to several modules are documented separately.

NASIS data base management system: IBM 360 TSS implementation. Volume 4: Program design specifications

NASA Technical Reports Server (NTRS)

1973-01-01

The design specifications for the programs and modules within the NASA Aerospace Safety Information System (NASIS) are presented. The purpose of the design specifications is to standardize the preparation of the specifications and to guide the program design. Each major functional module within the system is a separate entity for documentation purposes. The design specifications contain a description of, and specifications for, all detail processing which occurs in the module. Sub-models, reference tables, and data sets which are common to several modules are documented separately.

Feasibility of a Video-Based Advance Care Planning Website to Facilitate Group Visits among Diverse Adults from a Safety-Net Health System.

PubMed

Zapata, Carly; Lum, Hillary D; Wistar, Emily; Horton, Claire; Sudore, Rebecca L

2018-02-20

Primary care providers in safety-net settings often do not have time to discuss advance care planning (ACP). Group visits (GV) may be an efficient means to provide ACP education. To assess the feasibility and impact of a video-based website to facilitate GVs to engage diverse adults in ACP. Feasibility pilot among patients who were ≥55 years of age from two primary care clinics in a Northern California safety-net setting. Participants attended two 90-minute GVs and viewed the five steps of the movie version of the PREPARE website ( www.prepareforyourcare.org ) concerning surrogates, values, and discussing wishes in video format. Two clinician facilitators were available to encourage participation. We assessed pre-to-post ACP knowledge, whether participants designated a surrogate or completed an advance directive (AD), and acceptability of GVs and PREPARE materials. We conducted two GVs with 22 participants. Mean age was 64 years (±7), 55% were women, 73% nonwhite, and 55% had limited literacy. Knowledge improved about surrogate designation (46% correct pre vs. 85% post, p = 0.01) and discussing decisions with others (59% vs. 90%, p = 0.01). Surrogate designation increased (48% vs. 85%, p = 0.01) and there was a trend toward AD completion (9% vs. 24%, p = 0.21). Participants rated the GVs and PREPARE materials a mean of 8 (±3.1) on a 10-point acceptability scale. Using the PREPARE movie to facilitate ACP GVs for diverse adults in safety net, primary care settings is feasible and shows potential for increasing ACP engagement.

The translation of sports injury prevention and safety promotion knowledge: insights from key intermediary organisations.

PubMed

Bekker, Sheree; Paliadelis, Penny; Finch, Caroline F

2017-03-28

A recognised research-to-practice gap exists in the health research field of sports injury prevention and safety promotion. There is a need for improved insight into increasing the relevancy, accessibility and legitimacy of injury prevention and safety promotion research knowledge for sport settings. The role of key organisations as intermediaries in the process of health knowledge translation for sports settings remains under-explored, and this paper aims to determine, and describe, the processes of knowledge translation undertaken by a set of key organisations in developing and distributing injury prevention and safety promotion resources. The National Guidance for Australian Football Partnerships and Safety (NoGAPS) project provided the context for this study. Representatives from five key NoGAPS organisations participated in individual face-to-face interviews about organisational processes of knowledge translation. A qualitative descriptive methodology was used to analyse participants' descriptions of knowledge translation activities undertaken at their respective organisations. Several themes emerged around health knowledge translation processes and considerations, including (1) identifying a need for knowledge translation, (2) developing and disseminating resources, and (3) barriers and enablers to knowledge translation. This study provides insight into the processes that key organisations employ when developing and disseminating injury prevention and safety promotion resources within sport settings. The relevancy, accessibility and legitimacy of health research knowledge is foregrounded, with a view to increasing the influence of research on the development of health-related resources suitable for community sport settings.

Issues Concerning The Development Of A Mobile Platform For Health Care Applications

NASA Astrophysics Data System (ADS)

Korba, Larry W.; Liscano, Ramiro; Green, David; Durie, Nelson

1989-03-01

There are a number of problems that must yet be overcome before robotic technology can be applied in a hospital or a home care setting. The four basic problems are: cost, safety, finding appropriate applications and developing application specific solutions. Advanced robotics technology is now costly because of the complexity associated with autonomous systems. In any application, it is most important that the safety of the individuals using or exposed to the vehicle is ensured. Often in the health care field, innovative and useful new devices require an inordinate amount of time before they are accepted. The technical and ergonomic problems associated with any application must be solved so that cost containment, safety, ease of use, and quality of life are ensured. This paper discusses these issues in relation to our own development of an autonomous vehicle for health care applications. In this advancement, a commercially available platform is being equipped with an on-board, multiprocessor computer system and a variety of sensor systems. In order to develop pertinent solutions to the technical problems, there must be a framework wherein there is a focus upon the practical issues associated with the end application.

30 CFR 75.1 - Scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

... SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES General § 75.1 Scope. This part 75 sets forth safety standards compliance with which is mandatory in each underground coal mine subject to the Federal Mine Safety and Health Act...

30 CFR 75.1 - Scope.

Code of Federal Regulations, 2013 CFR

2013-07-01

... SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES General § 75.1 Scope. This part 75 sets forth safety standards compliance with which is mandatory in each underground coal mine subject to the Federal Mine Safety and Health Act...

30 CFR 75.1 - Scope.

Code of Federal Regulations, 2012 CFR

2012-07-01

... SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES General § 75.1 Scope. This part 75 sets forth safety standards compliance with which is mandatory in each underground coal mine subject to the Federal Mine Safety and Health Act...

30 CFR 75.1 - Scope.

Code of Federal Regulations, 2011 CFR

2011-07-01

... SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES General § 75.1 Scope. This part 75 sets forth safety standards compliance with which is mandatory in each underground coal mine subject to the Federal Mine Safety and Health Act...

30 CFR 75.1 - Scope.

Code of Federal Regulations, 2014 CFR

2014-07-01

... SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES General § 75.1 Scope. This part 75 sets forth safety standards compliance with which is mandatory in each underground coal mine subject to the Federal Mine Safety and Health Act...

A cadaver study of mastoidectomy using an image‐guided human–robot collaborative control system

PubMed Central

Yoo, Myung Hoon; Lee, Hwan Seo; Yang, Chan Joo; Lee, Seung Hwan; Lim, Hoon; Lee, Seongpung

2017-01-01

Objective Surgical precision would be better achieved with the development of an anatomical monitoring and controlling robot system than by traditional surgery techniques alone. We evaluated the feasibility of robot‐assisted mastoidectomy in terms of duration, precision, and safety. Study Design Human cadaveric study. Materials and Methods We developed a multi‐degree‐of‐freedom robot system for a surgical drill with a balancing arm. The drill system is manipulated by the surgeon, the motion of the drill burr is monitored by the image‐guided system, and the brake is controlled by the robotic system. The system also includes an alarm as well as the brake to help avoid unexpected damage to vital structures. Experimental mastoidectomy was performed in 11 temporal bones of six cadavers. Parameters including duration and safety were assessed, as well as intraoperative damage, which was judged via pre‐ and post‐operative computed tomography. Results The duration of mastoidectomy in our study was comparable with that required for chronic otitis media patients. Although minor damage, such as dura exposure without tearing, was noted, no critical damage to the facial nerve or other important structures was observed. When the brake system was set to 1 mm from the facial nerve, the postoperative average bone thicknesses of the facial nerve was 1.39, 1.41, 1.22, 1.41, and 1.55 mm in the lateral, posterior pyramidal and anterior, lateral, and posterior mastoid portions, respectively. Conclusion Mastoidectomy can be successfully performed using our robot‐assisted system while maintaining a pre‐set limit of 1 mm in most cases. This system may thus be useful for more inexperienced surgeons. Level of Evidence NA. PMID:29094065

Undergraduate baccalaureate nursing students' self-reported confidence in learning about patient safety in the classroom and clinical settings: an annual cross-sectional study (2010-2013).

PubMed

Lukewich, Julia; Edge, Dana S; Tranmer, Joan; Raymond, June; Miron, Jennifer; Ginsburg, Liane; VanDenKerkhof, Elizabeth

2015-05-01

Given the increasing incidence of adverse events and medication errors in healthcare settings, a greater emphasis is being placed on the integration of patient safety competencies into health professional education. Nurses play an important role in preventing and minimizing harm in the healthcare setting. Although patient safety concepts are generally incorporated within many undergraduate nursing programs, the level of students' confidence in learning about patient safety remains unclear. Self-reported patient safety competence has been operationalized as confidence in learning about various dimensions of patient safety. The present study explores nursing students' self-reported confidence in learning about patient safety during their undergraduate baccalaureate nursing program. Cross-sectional study with a nested cohort component conducted annually from 2010 to 2013. Participants were recruited from one Canadian university with a four-year baccalaureate of nursing science program. All students enrolled in the program were eligible to participate. The Health Professional Education in Patient Safety Survey was administered annually. The Health Professional Education in Patient Safety Survey captures how the six dimensions of the Canadian Patient Safety Institute Safety Competencies Framework and broader patient safety issues are addressed in health professional education, as well as respondents' self-reported comfort in speaking up about patient safety issues. In general, nursing students were relatively confident in what they were learning about the clinical dimensions of patient safety, but they were less confident about the sociocultural aspects of patient safety. Confidence in what they were learning in the clinical setting about working in teams, managing adverse events and responding to adverse events declined in upper years. The majority of students did not feel comfortable speaking up about patient safety issues. The nested cohort analysis confirmed these findings. In particular, confidence in acquiring basic clinical skills, learning about adverse events, and managing safety risks improved between Year 1 and Year 2, and confidence in managing safety risks declined in upper years. These findings suggest nursing students are confident in what they are learning about clinical aspects of patient safety, however, their confidence in learning about sociocultural aspects declines as they are increasingly exposed to the clinical environment. This suggests a need to address the impact of the practice environment on nursing students' confidence in what they are learning about patient safety. Copyright © 2015 Elsevier Ltd. All rights reserved.

Equivalent Treatment and Survival after Resection of Pancreatic Cancer at Safety-Net Hospitals.

PubMed

Dhar, Vikrom K; Hoehn, Richard S; Kim, Young; Xia, Brent T; Jung, Andrew D; Hanseman, Dennis J; Ahmad, Syed A; Shah, Shimul A

2018-01-01

Due to disparities in access to care, patients with Medicaid or no health insurance are at risk of not receiving appropriate adjuvant treatment following resection of pancreatic cancer. We have previously shown inferior short-term outcomes following surgery at safety-net hospitals. Subsequently, we hypothesized that safety-net hospitals caring for these vulnerable populations utilize less adjuvant chemoradiation, resulting in inferior long-term outcomes. The American College of Surgeons National Cancer Data Base was queried for patients diagnosed with pancreatic adenocarcinoma (n = 32,296) from 1998 to 2010. Hospitals were grouped according to safety-net burden, defined as the proportion of patients with Medicaid or no insurance. The highest quartile, representing safety-net hospitals, was compared to lower-burden hospitals with regard to patient demographics, disease characteristics, surgical management, delivery of multimodal systemic therapy, and survival. Patients at safety-net hospitals were less often white, had lower income, and were less educated. Safety-net hospital patients were just as likely to undergo surgical resection (OR 1.03, p = 0.73), achieving similar rates of negative surgical margins when compared to patients at medium and low burden hospitals (70% vs. 73% vs. 66%). Thirty-day mortality rates were 5.6% for high burden hospitals, 5.2% for medium burden hospitals, and 4.3% for low burden hospitals. No clinically significant differences were noted in the proportion of surgical patients receiving either chemotherapy (48% vs. 52% vs. 52%) or radiation therapy (26% vs. 30% vs. 29%) or the time between diagnosis and start of systemic therapy (58 days vs. 61 days vs. 53 days). Across safety-net burden groups, no difference was noted in stage-specific median survival (all p > 0.05) or receipt of adjuvant as opposed to neoadjuvant systemic therapy (82% vs. 85% vs. 85%). Multivariate analysis adjusting for cancer stage revealed no difference in survival for safety-net hospital patients who had surgery and survived > 30 days (HR 1.02, p = 0.63). For patients surviving the perioperative setting following pancreatic cancer surgery, safety-net hospitals achieve equivalent long-term survival outcomes potentially due to equivalent delivery of multimodal therapy at non-safety-net hospitals. Safety-net hospitals are a crucial resource that provides quality long-term cancer treatment for vulnerable populations.

Production roll out plan for HANDI 2000 business management system

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

Adams, D.E.

The Hanford Data Integration 2000 (HANDI 2000) Project will result in an integrated and comprehensive set of functional applications containing core information necessary to support the Project Hanford Management Contract (PHMC). It is based on the Commercial-Off-The-Shelf (COTS) product solution with commercially proven business processes. The COTS product solution set, of Passport (PP) and PeopleSoft (PS) software, supports finance, supply, human resources, and payroll activities under the current PHMC direction. The PP software is an integrated application for Accounts Payable, Contract Management, Inventory Management, Purchasing and Material Safety Data Sheets (MSDS). The PS software is an integrated application for Projects,more » General Ledger, Human Resources Training, Payroll, and Base Benefits. This set of software constitutes the Business Management System (BMS) and MSDS, a subset of the HANDI 2000 suite of systems. The primary objective of the Production Roll Out Plan is to communicate the methods and schedules for implementation and roll out to end users of BMS.« less

Real-time flight conflict detection and release based on Multi-Agent system

NASA Astrophysics Data System (ADS)

Zhang, Yifan; Zhang, Ming; Yu, Jue

2018-01-01

This paper defines two-aircrafts, multi-aircrafts and fleet conflict mode, sets up space-time conflict reservation on the basis of safety interval and conflict warning time in three-dimension. Detect real-time flight conflicts combined with predicted flight trajectory of other aircrafts in the same airspace, and put forward rescue resolutions for the three modes respectively. When accorded with the flight conflict conditions, determine the conflict situation, and enter the corresponding conflict resolution procedures, so as to avoid the conflict independently, as well as ensure the flight safety of aimed aircraft. Lastly, the correctness of model is verified with numerical simulation comparison.

Addressing Uniqueness and Unison of Reliability and Safety for a Better Integration

NASA Technical Reports Server (NTRS)

Huang, Zhaofeng; Safie, Fayssal

2016-01-01

Over time, it has been observed that Safety and Reliability have not been clearly differentiated, which leads to confusion, inefficiency, and, sometimes, counter-productive practices in executing each of these two disciplines. It is imperative to address this situation to help Reliability and Safety disciplines improve their effectiveness and efficiency. The paper poses an important question to address, "Safety and Reliability - Are they unique or unisonous?" To answer the question, the paper reviewed several most commonly used analyses from each of the disciplines, namely, FMEA, reliability allocation and prediction, reliability design involvement, system safety hazard analysis, Fault Tree Analysis, and Probabilistic Risk Assessment. The paper pointed out uniqueness and unison of Safety and Reliability in their respective roles, requirements, approaches, and tools, and presented some suggestions for enhancing and improving the individual disciplines, as well as promoting the integration of the two. The paper concludes that Safety and Reliability are unique, but compensating each other in many aspects, and need to be integrated. Particularly, the individual roles of Safety and Reliability need to be differentiated, that is, Safety is to ensure and assure the product meets safety requirements, goals, or desires, and Reliability is to ensure and assure maximum achievability of intended design functions. With the integration of Safety and Reliability, personnel can be shared, tools and analyses have to be integrated, and skill sets can be possessed by the same person with the purpose of providing the best value to a product development.

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.

Patient safety in emergency medical services: executive summary and recommendations from the Niagara Summit.

PubMed

Bigham, Blair L; Bull, Ellen; Morrison, Merideth; Burgess, Rob; Maher, Janet; Brooks, Steven C; Morrison, Laurie J

2011-01-01

Emergency medical services (EMS) personnel care for patients in challenging and dynamic environments that may contribute to an increased risk for adverse events. However, little is known about the risks to patient safety in the EMS setting. To address this knowledge gap, we conducted a systematic review of the literature, including nonrandomized, noncontrolled studies, conducted qualitative interviews of key informants, and, with the assistance of a pan-Canadian advisory board, hosted a 1-day summit of 52 experts in the field of EMS patient safety. The intent of the summit was to review available research, discuss the issues affecting prehospital patient safety, and discuss interventions that might improve the safety of the EMS industry. The primary objective was to define the strategic goals for improving patient safety in EMS. Participants represented all geographic regions of Canada and included administrators, educators, physicians, researchers, and patient safety experts. Data were collected through electronic voting and qualitative analysis of the discussions. The group reached consensus on nine recommendations to increase awareness, reduce adverse events, and suggest research and educational directions in EMS patient safety: increasing awareness of patient safety principles, improving adverse event reporting through creating nonpunitive reporting systems, supporting paramedic clinical decision making through improved research and education, policy changes, using flexible algorithms, adopting patient safety strategies from other disciplines, increasing funding for research in patient safety, salary support for paramedic researchers, and access to graduate training in prehospital research.

New Nuclear Emergency Prognosis system in Korea

NASA Astrophysics Data System (ADS)

Lee, Hyun-Ha; Jeong, Seung-Young; Park, Sang-Hyun; Lee, Kwan-Hee

2016-04-01

This paper reviews the status of assessment and prognosis system for nuclear emergency response in Korea, especially atmospheric dispersion model. The Korea Institute of Nuclear Safety (KINS) performs the regulation and radiological emergency preparedness of the nuclear facilities and radiation utilizations. Also, KINS has set up the "Radiological Emergency Technical Advisory Plan" and the associated procedures such as an emergency response manual in consideration of the IAEA Safety Standards GS-R-2, GS-G-2.0, and GS-G-2.1. The Radiological Emergency Technical Advisory Center (RETAC) organized in an emergency situation provides the technical advice on radiological emergency response. The "Atomic Computerized Technical Advisory System for nuclear emergency" (AtomCARE) has been developed to implement assessment and prognosis by RETAC. KINS developed Accident Dose Assessment and Monitoring (ADAMO) system in 2015 to reflect the lessons learned from Fukushima accident. It incorporates (1) the dose assessment on the entire Korean peninsula, Asia region, and global region, (2) multi-units accident assessment (3) applying new methodology of dose rate assessment and the source term estimation with inverse modeling, (4) dose assessment and monitoring with the environmental measurements result. The ADAMO is the renovated version of current FADAS of AtomCARE. The ADAMO increases the accuracy of the radioactive material dispersion with applying the LDAPS(Local Data Assimilation Prediction System, Spatial resolution: 1.5 km) and RDAPS(Regional Data Assimilation Prediction System, Spatial resolution: 12km) of weather prediction data, and performing the data assimilation of automatic weather system (AWS) data from Korea Meteorological Administration (KMA) and data from the weather observation tower at NPP site. The prediction model of the radiological material dispersion is based on the set of the Lagrangian Particle model and Lagrangian Puff model. The dose estimation methodology incorporate the dose assessment methods of IAEA, WHO, and USNRC. The dose assessment result will express on the GIS (GIS (Geographic Information System) to provide to the local- governments and the central government. Acknowledgements This research has been supported by the Nuclear Safety and Security Commission [Reference No.1305020-0315-SB110

A review of national policies and strategies to improve quality of health care and patient safety: a case study from Lebanon and Jordan.

PubMed

El-Jardali, Fadi; Fadlallah, Racha

2017-08-16

Improving quality of care and patient safety practices can strengthen health care delivery systems, improve health sector performance, and accelerate attainment of health-related Sustainability Development Goals. Although quality improvement is now prominent on the health policy agendas of governments in low- and middle-income countries (LMICs), including countries of the Eastern Mediterranean Region (EMR), progress to date has not been optimal. The objective of this study is to comprehensively review existing quality improvement and patient safety policies and strategies in two selected countries of the EMR (Lebanon and Jordan) to determine the extent to which these have been institutionalized within existing health systems. We used a mixed methods approach that combined documentation review, stakeholder surveys and key informant interviews. Existing quality improvement and patient safety initiatives were assessed across five components of an analytical framework for assessing health care quality and patient safety: health systems context; national policies and legislation; organizations and institutions; methods, techniques and tools; and health care infrastructure and resources. Both Lebanon and Jordan have made important progress in terms of increased attention to quality and accreditation in national health plans and strategies, licensing requirements for health care professionals and organizations (albeit to varying extents), and investments in health information systems. A key deficiency in both countries is the absence of an explicit national policy for quality improvement and patient safety across the health system. Instead, there is a spread of several (disjointed) pieces of legal measures and national plans leading to fragmentation and lack of clear articulation of responsibilities across the entire continuum of care. Moreover, both countries lack national sets of standardized and applicable quality indicators for performance measurement and benchmarking. Importantly, incentive systems that link contractual agreement, regulations, accreditation, and performance indicators are underutilized in Lebanon and absent in Jordan. At the healthcare organizational level, there is a need to instill a culture of continuous quality improvement and promote professional training in quality improvement and patient safety. Study findings highlight the importance of aligning policies, organizations, methods, capacities and resources in order to institutionalize quality improvement and patient safety practices in health systems. Gaps and dysfunctions identified can help inform national deliberations and dialogues among key stakeholders in each study country. Findings can also inform future quality improvement efforts in the EMR and beyond, with a particular emphasis on LMICs.

SCALE Code System 6.2.2

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

Rearden, Bradley T.; Jessee, Matthew Anderson

The SCALE Code System is a widely used modeling and simulation suite for nuclear safety analysis and design that is developed, maintained, tested, and managed by the Reactor and Nuclear Systems Division (RNSD) of Oak Ridge National Laboratory (ORNL). SCALE provides a comprehensive, verified and validated, user-friendly tool set for criticality safety, reactor physics, radiation shielding, radioactive source term characterization, and sensitivity and uncertainty analysis. Since 1980, regulators, licensees, and research institutions around the world have used SCALE for safety analysis and design. SCALE provides an integrated framework with dozens of computational modules including 3 deterministic and 3 Monte Carlomore » radiation transport solvers that are selected based on the desired solution strategy. SCALE includes current nuclear data libraries and problem-dependent processing tools for continuous-energy (CE) and multigroup (MG) neutronics and coupled neutron-gamma calculations, as well as activation, depletion, and decay calculations. SCALE includes unique capabilities for automated variance reduction for shielding calculations, as well as sensitivity and uncertainty analysis. SCALE’s graphical user interfaces assist with accurate system modeling, visualization of nuclear data, and convenient access to desired results. SCALE 6.2 represents one of the most comprehensive revisions in the history of SCALE, providing several new capabilities and significant improvements in many existing features.« less

Design and Realization of Ship Fire Simulation Training System Based on Unity3D

NASA Astrophysics Data System (ADS)

Ting, Ye; Feng, Chen; Wenqiang, Wang; Kai, Yang

2018-01-01

Ship fire training is a very important training to ensure the safety of the ship, but limited by the characteristics of the ship itself, it is difficult to carry out fire training on the ship. This paper proposes to introduce a virtual reality technology to build a set of ship fire simulation training system, used to improve the quality of training, reduce training costs. First, the system design ideas are elaborated, and the system architecture diagram is given. Then, the key technologies in the process of system implementation are analyzed. Finally, the system examples are built and tested.

Safety and Security Interface Technology Initiative

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

Dr. Michael A. Lehto; Kevin J. Carroll; Dr. Robert Lowrie

Safety and Security Interface Technology Initiative Mr. Kevin J. Carroll Dr. Robert Lowrie, Dr. Micheal Lehto BWXT Y12 NSC Oak Ridge, TN 37831 865-576-2289/865-241-2772 carrollkj@y12.doe.gov Work Objective. Earlier this year, the Energy Facility Contractors Group (EFCOG) was asked to assist in developing options related to acceleration deployment of new security-related technologies to assist meeting design base threat (DBT) needs while also addressing the requirements of 10 CFR 830. NNSA NA-70, one of the working group participants, designated this effort the Safety and Security Interface Technology Initiative (SSIT). Relationship to Workshop Theme. “Supporting Excellence in Operations Through Safety Analysis,” (workshop theme)more » includes security and safety personnel working together to ensure effective and efficient operations. One of the specific workshop elements listed in the call for papers is “Safeguards/Security Integration with Safety.” This paper speaks directly to this theme. Description of Work. The EFCOG Safety Analysis Working Group (SAWG) and the EFCOG Security Working Group formed a core team to develop an integrated process involving both safety basis and security needs allowing achievement of the DBT objectives while ensuring safety is appropriately considered. This effort garnered significant interest, starting with a two day breakout session of 30 experts at the 2006 Safety Basis Workshop. A core team was formed, and a series of meetings were held to develop that process, including safety and security professionals, both contractor and federal personnel. A pilot exercise held at Idaho National Laboratory (INL) in mid-July 2006 was conducted as a feasibility of concept review. Work Results. The SSIT efforts resulted in a topical report transmitted from EFCOG to DOE/NNSA in August 2006. Elements of the report included: Drivers and Endstate, Control Selections Alternative Analysis Process, Terminology Crosswalk, Safety Basis/Security Documentation Integration, Configuration Control, and development of a shared ‘tool box’ of information/successes. Specific Benefits. The expectation or end state resulting from the topical report and associated implementation plan includes: (1) A recommended process for handling the documentation of the security and safety disciplines, including an appropriate change control process and participation by all stakeholders. (2) A means to package security systems with sufficient information to help expedite the flow of that system through the process. In addition, a means to share successes among sites, to include information and safety basis to the extent such information is transportable. (3) Identification of key security systems and associated essential security elements being installed and an arrangement for the sites installing these systems to host an appropriate team to review a specific system and determine what information is exportable. (4) Identification of the security systems’ essential elements and appropriate controls required for testing of these essential elements in the facility. (5) The ability to help refine and improve an agreed to control set at the manufacture stage.« less

Requirements for the conceptual design of advanced underground coal extraction systems

NASA Technical Reports Server (NTRS)

Gangal, M. D.; Lavin, M. L.

1981-01-01

Conceptual design requirements are presented for underground coal mining systems having substantially improved performance in the areas of production cost and miner safety. Mandatory performance levels are also set for miner health, environmental impact, and coal recovery. In addition to mandatory design goals and constraints, a number of desirable system characteristics are identified which must be assessed in terms of their impact on production cost and their compatibility with other system elements. Although developed for the flat lying, moderately thick seams of Central Appalachia, these requirements are designed to be easily adaptable to other coals.

75 FR 31749 - International Standard-Setting Activities

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-04

... DEPARTMENT OF AGRICULTURE Food Safety and Inspection Service [Docket No. FSIS-2009-0033] International Standard-Setting Activities AGENCY: Office of Food Safety, USDA. ACTION: Notice. SUMMARY: This..., and hand- or courier-delivered items: Send to Docket Clerk, U.S. Department of Agriculture, Food...

Progress of IRSN R&D on ITER Safety Assessment

NASA Astrophysics Data System (ADS)

Van Dorsselaere, J. P.; Perrault, D.; Barrachin, M.; Bentaib, A.; Gensdarmes, F.; Haeck, W.; Pouvreau, S.; Salat, E.; Seropian, C.; Vendel, J.

2012-08-01

The French "Institut de Radioprotection et de Sûreté Nucléaire" (IRSN), in support to the French "Autorité de Sûreté Nucléaire", is analysing the safety of ITER fusion installation on the basis of the ITER operator's safety file. IRSN set up a multi-year R&D program in 2007 to support this safety assessment process. Priority has been given to four technical issues and the main outcomes of the work done in 2010 and 2011 are summarized in this paper: for simulation of accident scenarios in the vacuum vessel, adaptation of the ASTEC system code; for risk of explosion of gas-dust mixtures in the vacuum vessel, adaptation of the TONUS-CFD code for gas distribution, development of DUST code for dust transport, and preparation of IRSN experiments on gas inerting, dust mobilization, and hydrogen-dust mixtures explosion; for evaluation of the efficiency of the detritiation systems, thermo-chemical calculations of tritium speciation during transport in the gas phase and preparation of future experiments to evaluate the most influent factors on detritiation; for material neutron activation, adaptation of the VESTA Monte Carlo depletion code. The first results of these tasks have been used in 2011 for the analysis of the ITER safety file. In the near future, this R&D global programme may be reoriented to account for the feedback of the latter analysis or for new knowledge.

Synthetic biology and occupational risk.

PubMed

Howard, John; Murashov, Vladimir; Schulte, Paul

2017-03-01

Synthetic biology is an emerging interdisciplinary field of biotechnology that involves applying the principles of engineering and chemical design to biological systems. Biosafety professionals have done an excellent job in addressing research laboratory safety as synthetic biology and gene editing have emerged from the larger field of biotechnology. Despite these efforts, risks posed by synthetic biology are of increasing concern as research procedures scale up to industrial processes in the larger bioeconomy. A greater number and variety of workers will be exposed to commercial synthetic biology risks in the future, including risks to a variety of workers from the use of lentiviral vectors as gene transfer devices. There is a need to review and enhance current protection measures in the field of synthetic biology, whether in experimental laboratories where new advances are being researched, in health care settings where treatments using viral vectors as gene delivery systems are increasingly being used, or in the industrial bioeconomy. Enhanced worker protection measures should include increased injury and illness surveillance of the synthetic biology workforce; proactive risk assessment and management of synthetic biology products; research on the relative effectiveness of extrinsic and intrinsic biocontainment methods; specific safety guidance for synthetic biology industrial processes; determination of appropriate medical mitigation measures for lentiviral vector exposure incidents; and greater awareness and involvement in synthetic biology safety by the general occupational safety and health community as well as by government occupational safety and health research and regulatory agencies.

The potential application of behavior-based safety in the trucking industry

DOT National Transportation Integrated Search

2000-04-01

Behavior-based safety (BBS) is a set of methods to improve safety performance in the workplace by engaging workers in the improvement process, identifying critical safety behaviors, performing observations to gather data, providing feedback to encour...

Semantic distance as a critical factor in icon design for in-car infotainment systems.

PubMed

Silvennoinen, Johanna M; Kujala, Tuomo; Jokinen, Jussi P P

2017-11-01

In-car infotainment systems require icons that enable fluent cognitive information processing and safe interaction while driving. An important issue is how to find an optimised set of icons for different functions in terms of semantic distance. In an optimised icon set, every icon needs to be semantically as close as possible to the function it visually represents and semantically as far as possible from the other functions represented concurrently. In three experiments (N = 21 each), semantic distances of 19 icons to four menu functions were studied with preference rankings, verbal protocols, and the primed product comparisons method. The results show that the primed product comparisons method can be efficiently utilised for finding an optimised set of icons for time-critical applications out of a larger set of icons. The findings indicate the benefits of the novel methodological perspective into the icon design for safety-critical contexts in general. Copyright © 2017 Elsevier Ltd. All rights reserved.

Development of a multilevel health and safety climate survey tool within a mining setting.

PubMed

Parker, Anthony W; Tones, Megan J; Ritchie, Gabrielle E

2017-09-01

This study aimed to design, implement and evaluate the reliability and validity of a multifactorial and multilevel health and safety climate survey (HSCS) tool with utility in the Australian mining setting. An 84-item questionnaire was developed and pilot tested on a sample of 302 Australian miners across two open cut sites. A 67-item, 10 factor solution was obtained via exploratory factor analysis (EFA) representing prioritization and attitudes to health and safety across multiple domains and organizational levels. Each factor demonstrated a high level of internal reliability, and a series of ANOVAs determined a high level of consistency in responses across the workforce, and generally irrespective of age, experience or job category. Participants tended to hold favorable views of occupational health and safety (OH&S) climate at the management, supervisor, workgroup and individual level. The survey tool demonstrated reliability and validity for use within an open cut Australian mining setting and supports a multilevel, industry specific approach to OH&S climate. Findings suggested a need for mining companies to maintain high OH&S standards to minimize risks to employee health and safety. Future research is required to determine the ability of this measure to predict OH&S outcomes and its utility within other mine settings. As this tool integrates health and safety, it may have benefits for assessment, monitoring and evaluation in the industry, and improving the understanding of how health and safety climate interact at multiple levels to influence OH&S outcomes. Copyright © 2017 National Safety Council and Elsevier Ltd. All rights reserved.

Identification of an updated set of prescribing-safety indicators for GPs

PubMed Central

Spencer, Rachel; Bell, Brian; Avery, Anthony J; Gookey, Gill; Campbell, Stephen M

2014-01-01

Background Medication error is an important contributor to patient morbidity and mortality and is associated with inadequate patient safety measures. However, prescribing-safety tools specifically designed for use in general practice are lacking. Aim To identify and update a set of prescribing-safety indicators for assessing the safety of prescribing in general practice, and to estimate the risk of harm to patients associated with each indicator. Design and setting RAND/UCLA consensus development of indicators in UK general practice. Method Prescribing indicators were identified from a systematic review and previous consensus exercise. The RAND Appropriateness Method was used to further identify and develop the indicators with an electronic-Delphi method used to rate the risk associated with them. Twelve GPs from all the countries of the UK participated in the RAND exercise, with 11 GPs rating risk using the electronic-Delphi approach. Results Fifty-six prescribing-safety indicators were considered appropriate for inclusion (overall panel median rating of 7–9, with agreement). These indicators cover hazardous prescribing across a range of therapeutic indications, hazardous drug–drug combinations and inadequate laboratory test monitoring. Twenty-three (41%) of these indicators were considered high risk or extreme risk by 80% or more of the participants. Conclusion This study identified a set of 56 indicators that were considered, by a panel of GPs, to be appropriate for assessing the safety of GP prescribing. Twenty-three of these indicators were considered to be associated with high or extreme risk to patients and should be the focus of efforts to improve patient safety. PMID:24686882

Changing patient safety culture in China: a case study of an experimental Chinese hospital from a comparative perspective.

PubMed

Xu, Xiao Ping; Deng, Dong Ning; Gu, Yong Hong; Ng, Chui Shan; Cai, Xiao; Xu, Jun; Zhang, Xin Shi; Ke, Dong Ge; Yu, Qian Hui; Chan, Chi Kuen

2018-01-01

The World Health Organization highlights that patient safety interventions are not lacking but that the local context affects their successful implementation. Increasing attention is being paid to patient safety in Mainland China, yet few studies focus on patient safety in organizations with mixed cultures. This paper evaluates the current patient safety culture in an experimental Chinese hospital with a Hong Kong hospital management culture, and it aims to explore the application of Hong Kong's patient safety strategies in the context of Mainland China. A quantitative survey of 307 hospital staff members was conducted using the Hospital Survey on Patient Safety Culture questionnaire. The findings were compared with a similar study on general Chinese hospitals and were appraised with reference to the Manchester Patient Safety Framework. Lower scores were observed among participants with the following characteristics: males, doctors, those with more work experience, those with higher education, and those from the general practice and otolaryngology departments. However, the case study hospital achieved better scores in management expectations, actions and support for patient safety, incident reporting and communication, and teamwork within units. Its weaknesses were related to non-punitive responses to errors, teamwork across units, and staffing. The case study hospital contributes to a changing patient safety culture in Mainland China, yet its patient safety culture remains mostly bureaucratic. Further efforts could be made to deepen the staff's patient safety culture mind-set, to realize a "bottom-up" approach to cultural change, to build up a comprehensive and integrated incident management system, and to improve team building and staffing for patient safety.

Qualitative Research for Patient Safety Using ICTs: Methodological Considerations in the Technological Age.

PubMed

Yee, Kwang Chien; Wong, Ming Chao; Turner, Paul

2017-01-01

Considerable effort and resources have been dedicated to improving the quality and safety of patient care through health information systems, but there is still significant scope for improvement. One contributing factor to the lack of progress in patient safety improvement especially where technology has been deployed relates to an over-reliance on purely objective, quantitative, positivist research paradigms as the basis for generating and validating evidence of improvement. This paper argues the need for greater recognition and accommodation of evidence of improvement generated through more subjective, qualitative and pragmatic research paradigms to aid patient safety especially where technology is deployed. This paper discusses how acknowledging the role and value of more subjective ontologies and pragmatist epistemologies can support improvement science research. This paper illustrates some challenges and benefits from adopting qualitative research methods in patient safety improvement projects, particularly focusing challenges in the technological era. While adopting methods that can more readily capture, analyse and interpret direct user experiences, attitudes, insights and behaviours in their contextual settings, patient safety can be enhanced 'on the ground' and errors reduced and/or mitigated, challenges of using these methods with the younger "technologically-centred" healthcare professionals and patients needs to recognised.

Design of an automated cart and mount for a hyperspectral imaging system to be used in produce fields

NASA Astrophysics Data System (ADS)

Lefcourt, Alan M.; Kistler, Ross; Gadsden, S. Andrew

2016-05-01

The goal of this project was to construct a cart and a mounting system that would allow a hyperspectral laser-induced fluorescence imaging system (HLIFIS) to be used to detect fecal material in produce fields. Fecal contaminated produce is a recognized food safety risk. Previous research demonstrated the HLIFIS could detect fecal contamination in a laboratory setting. A cart was designed and built, and then tested to demonstrate that the cart was capable of moving at constant speeds or at precise intervals. A mounting system was designed and built to facilitate the critical alignment of the camera's imaging and the laser's illumination fields, and to allow the HLIFIS to be used in both field and laboratory settings without changing alignments. A hardened mount for the Powell lens that is used to produce the appropriate illumination profile was also designed, built, and tested.

Primary care quality and safety systems in the English National Health Service: a case study of a new type of primary care provider.

PubMed

Baker, Richard; Willars, Janet; McNicol, Sarah; Dixon-Woods, Mary; McKee, Lorna

2014-01-01

Although the predominant model of general practice in the UK National Health Service (NHS) remains the small partnership owned and run by general practitioners (GPs), new types of provider are emerging. We sought to characterize the quality and safety systems and processes used in one large, privately owned company providing primary care through a chain of over 50 general practices in England. Senior staff with responsibility for policy on quality and safety were interviewed. We also undertook ethnographic observation in non-clinical areas and interviews with staff in three practices. A small senior executive team set policy and strategy on quality and safety, including a systematic incident reporting and investigation system and processes for disseminating learning with a strong emphasis on customer focus. Standardization of systems was possible because of the large number of practices. Policies appeared generally well implemented at practice level. However, there was some evidence of high staff turnover, particularly of GPs. This caused problems for continuity of care and challenges in inducting new GPs in the company's systems and procedures. A model of primary care delivery based on a corporate chain may be useful in standardizing policies and procedures, facilitating implementation of systems, and relieving clinical staff of administrative duties. However, the model also poses some risks, including those relating to stability. Provider forms that retain the long term, personal commitment of staff to their practices, such as federations or networks, should also be investigated; they may offer the benefits of a corporate chain combined with the greater continuity and stability of the more traditional general practice.

Unmanned aircraft system sense and avoid integrity and continuity

NASA Astrophysics Data System (ADS)

Jamoom, Michael B.

This thesis describes new methods to guarantee safety of sense and avoid (SAA) functions for Unmanned Aircraft Systems (UAS) by evaluating integrity and continuity risks. Previous SAA efforts focused on relative safety metrics, such as risk ratios, comparing the risk of using an SAA system versus not using it. The methods in this thesis evaluate integrity and continuity risks as absolute measures of safety, as is the established practice in commercial aircraft terminal area navigation applications. The main contribution of this thesis is a derivation of a new method, based on a standard intruder relative constant velocity assumption, that uses hazard state estimates and estimate error covariances to establish (1) the integrity risk of the SAA system not detecting imminent loss of '"well clear," which is the time and distance required to maintain safe separation from intruder aircraft, and (2) the probability of false alert, the continuity risk. Another contribution is applying these integrity and continuity risk evaluation methods to set quantifiable and certifiable safety requirements on sensors. A sensitivity analysis uses this methodology to evaluate the impact of sensor errors on integrity and continuity risks. The penultimate contribution is an integrity and continuity risk evaluation where the estimation model is refined to address realistic intruder relative linear accelerations, which goes beyond the current constant velocity standard. The final contribution is an integrity and continuity risk evaluation addressing multiple intruders. This evaluation is a new innovation-based method to determine the risk of mis-associating intruder measurements. A mis-association occurs when the SAA system incorrectly associates a measurement to the wrong intruder, causing large errors in the estimated intruder trajectories. The new methods described in this thesis can help ensure safe encounters between aircraft and enable SAA sensor certification for UAS integration into the National Airspace System.

An Overview of the NASA Aerospace Flight Battery Systems Program

NASA Technical Reports Server (NTRS)

Manzo, Michelle

2003-01-01

Develop an understanding of the safety issues relating to space use and qualification of new Li-Ion technology for manned applications. Enable use of new technology batteries into GFE equipment - laptop computers, camcorders. Establish a data base for an optimized set of cells (and batteries) exhibiting acceptable performance and abuse characteristics for utilization as building blocks for numerous applications.

Utilization of the Seniors Falls Investigation Methodology to Identify System-Wide Causes of Falls in Community-Dwelling Seniors

ERIC Educational Resources Information Center

Zecevic, Aleksandra A.; Salmoni, Alan W.; Lewko, John H.; Vandervoort, Anthoney A.; Speechley, Mark

2009-01-01

Purpose: As a highly heterogeneous group, seniors live in complex environments influenced by multiple physical and social structures that affect their safety. Until now, the major approach to falls research has been person centered. However, in industrial settings, the individuals involved in an accident are seen as the inheritors of system…

A meta-model for computer executable dynamic clinical safety checklists.

PubMed

Nan, Shan; Van Gorp, Pieter; Lu, Xudong; Kaymak, Uzay; Korsten, Hendrikus; Vdovjak, Richard; Duan, Huilong

2017-12-12

Safety checklist is a type of cognitive tool enforcing short term memory of medical workers with the purpose of reducing medical errors caused by overlook and ignorance. To facilitate the daily use of safety checklists, computerized systems embedded in the clinical workflow and adapted to patient-context are increasingly developed. However, the current hard-coded approach of implementing checklists in these systems increase the cognitive efforts of clinical experts and coding efforts for informaticists. This is due to the lack of a formal representation format that is both understandable by clinical experts and executable by computer programs. We developed a dynamic checklist meta-model with a three-step approach. Dynamic checklist modeling requirements were extracted by performing a domain analysis. Then, existing modeling approaches and tools were investigated with the purpose of reusing these languages. Finally, the meta-model was developed by eliciting domain concepts and their hierarchies. The feasibility of using the meta-model was validated by two case studies. The meta-model was mapped to specific modeling languages according to the requirements of hospitals. Using the proposed meta-model, a comprehensive coronary artery bypass graft peri-operative checklist set and a percutaneous coronary intervention peri-operative checklist set have been developed in a Dutch hospital and a Chinese hospital, respectively. The result shows that it is feasible to use the meta-model to facilitate the modeling and execution of dynamic checklists. We proposed a novel meta-model for the dynamic checklist with the purpose of facilitating creating dynamic checklists. The meta-model is a framework of reusing existing modeling languages and tools to model dynamic checklists. The feasibility of using the meta-model is validated by implementing a use case in the system.

Efficacy, Safety, and Feasibility of the Morphine Microdose Method in Community-Based Clinics.

PubMed

Wilkes, Denise M; Orillosa, Susan J; Hustak, Erik C; Williams, Courtney G; Doulatram, Gulshan R; Solanki, Daneshvari R; Garcia, Eduardo A; Huang, Li-Yen M

2017-06-13

The goal of this study was to assess the success of the morphine microdose method in a community pain clinic setting by monitoring follow-up frequency, dose escalation, and monotherapy/polytherapy ratio. The morphine microdose method involves a pretrial reduction or elimination of systemic opioids followed by a period of abstinence. Intrathecal (IT) morphine is then started at doses of less than 0.2 mg per day. Systemic opioid abstinence is then continued after pump implant and IT morphine monotherapy. Retrospective review of medical records. Private and academic pain clinic practices. Chronic noncancer pain patients. We reviewed the charts of 60 patients who had completed a microdose regimen and had an IT pump implanted between June 11, 2008, and October 11, 2014. During IT therapy, dose change over time, pain scores, side effects, max dose, and duration were recorded. The majority of patients (35/60, 58%) were successfully managed solely on morphine microdose monotherapy. These patients did not require additional oral therapy. There was a significant reduction in mean pain scores, from 7.4 ± 0.32 before microdose therapy to 4.8 ± 0.3 after microdose therapy. Microdose therapy achieved analgesia, improved safety, and avoided systemic side effects. The safety of IT therapy was increased by using a lower concentration (2 mg/mL) and lower daily doses (<3 mg/d) of morphine. Furthermore, microdose therapy was feasible, safe, and cost-effective in the outpatient setting. 2017 American Academy of Pain Medicine. This work is written by US Government employees and is in the public domain in the US.

The NUITM-KEMRI P3 Laboratory in Kenya: Establishment, Features, Operation and Maintenance

PubMed Central

Inoue, Shingo; Wandera, Ernest; Miringu, Gabriel; Bundi, Martin; Narita, Chika; Ashur, Salame; Kwallah, Allan; Galata, Amina; Abubakar, Mwajuma; Suka, Sora; Mohamed, Shah; Karama, Mohamed; Horio, Masahiro; Shimada, Masaaki; Ichinose, Yoshio

2013-01-01

A biocontainment facility is a core component in any research setting due to the services it renders towards comprehensive biosafety observance. The NUITM-KEMRI P3 facility was set up in 2007 and has been actively in use since 2010 by researchers from this and other institutions. A number of hazardous agents have been handled in the laboratory among them MDR-TB and yellow fever viruses. The laboratory has the general physical and operational features of a P3 laboratory in addition to a number of unique features, among them the water-air filtration system, the eco-mode operation feature and automation of the pressure system that make the facility more efficient. It is equipped with biosafety and emergency response equipments alongside common laboratory equipments, maintained regularly using daily, monthly and yearly routines. Security and safety is strictly observed within the facility, enhanced by restricted entry, strict documentation and use of safety symbols. Training is also engrained within the operation of the laboratory and is undertaken and evaluated annually. Though the laboratory is in the process of obtaining accreditation, it is fully certified courtesy of the manufactures’ and constructed within specified standards. PMID:23533023

Guidelines of care for the management of psoriasis and psoriatic arthritis Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies

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

Menter, A.; Korman, N.J.; Elmets, C.A.

2009-04-15

Psoriasis is a common, chronic, inflammatory, multi-system disease with predominantly skin and joint manifestations affecting approximately 2% of the Population. In this third of 6 sections of the guidelines of care for psoriasis, we discuss the use of topical medications for the treatment of psoriasis. The majority of patients with psoriasis have limited disease (<5% body surface area involvement) and can be treated with topical agents, which generally provide a high efficacy-to-safety ratio. Topical agents may also be used adjunctively for patients with more extensive psoriasis undergoing therapy with either ultraviolet light, systemic or biologic medications. However, the use ofmore » topical agents as monotherapy in the setting of extensive disease or in the setting of limited, but recalcitrant, disease is not routinely recommended. Treatment should be tailored to meet individual patients' needs. We will discuss the efficacy and safety of as well as offer recommendations for the use of topical corticosteroids, vitamin D analogues, tazarotene, tacrolimus, pimecrolimus, emollients, salicylic acid, anthralin, coal tar, as well as combination therapy.« less

Fully Closed-Loop Multiple Model Probabilistic Predictive Controller Artificial Pancreas Performance in Adolescents and Adults in a Supervised Hotel Setting.

PubMed

Forlenza, Gregory P; Cameron, Faye M; Ly, Trang T; Lam, David; Howsmon, Daniel P; Baysal, Nihat; Kulina, Georgia; Messer, Laurel; Clinton, Paula; Levister, Camilla; Patek, Stephen D; Levy, Carol J; Wadwa, R Paul; Maahs, David M; Bequette, B Wayne; Buckingham, Bruce A

2018-05-01

Initial Food and Drug Administration-approved artificial pancreas (AP) systems will be hybrid closed-loop systems that require prandial meal announcements and will not eliminate the burden of premeal insulin dosing. Multiple model probabilistic predictive control (MMPPC) is a fully closed-loop system that uses probabilistic estimation of meals to allow for automated meal detection. In this study, we describe the safety and performance of the MMPPC system with announced and unannounced meals in a supervised hotel setting. The Android phone-based AP system with remote monitoring was tested for 72 h in six adults and four adolescents across three clinical sites with daily exercise and meal challenges involving both three announced (manual bolus by patient) and six unannounced (no bolus by patient) meals. Safety criteria were predefined. Controller aggressiveness was adapted daily based on prior hypoglycemic events. Mean 24-h continuous glucose monitor (CGM) was 157.4 ± 14.4 mg/dL, with 63.6 ± 9.2% of readings between 70 and 180 mg/dL, 2.9 ± 2.3% of readings <70 mg/dL, and 9.0 ± 3.9% of readings >250 mg/dL. Moderate hyperglycemia was relatively common with 24.6 ± 6.2% of readings between 180 and 250 mg/dL, primarily within 3 h after a meal. Overnight mean CGM was 139.6 ± 27.6 mg/dL, with 77.9 ± 16.4% between 70 and 180 mg/dL, 3.0 ± 4.5% <70 mg/dL, 17.1 ± 14.9% between 180 and 250 mg/dL, and 2.0 ± 4.5%> 250 mg/dL. Postprandial hyperglycemia was more common for unannounced meals compared with announced meals (4-h postmeal CGM 197.8 ± 44.1 vs. 140.6 ± 35.0 mg/dL; P < 0.001). No participants met safety stopping criteria. MMPPC was safe in a supervised setting despite meal and exercise challenges. Further studies are needed in a less supervised environment.

Evaluating the Safety Profile of Non-Active Implantable Medical Devices Compared with Medicines.

PubMed

Pane, Josep; Coloma, Preciosa M; Verhamme, Katia M C; Sturkenboom, Miriam C J M; Rebollo, Irene

2017-01-01

Recent safety issues involving non-active implantable medical devices (NAIMDs) have highlighted the need for better pre-market and post-market evaluation. Some stakeholders have argued that certain features of medicine safety evaluation should also be applied to medical devices. Our objectives were to compare the current processes and methodologies for the assessment of NAIMD safety profiles with those for medicines, identify potential gaps, and make recommendations for the adoption of new methodologies for the ongoing benefit-risk monitoring of these devices throughout their entire life cycle. A literature review served to examine the current tools for the safety evaluation of NAIMDs and those for medicines. We searched MEDLINE using these two categories. We supplemented this search with Google searches using the same key terms used in the MEDLINE search. Using a comparative approach, we summarized the new product design, development cycle (preclinical and clinical phases), and post-market phases for NAIMDs and drugs. We also evaluated and compared the respective processes to integrate and assess safety data during the life cycle of the products, including signal detection, signal management, and subsequent potential regulatory actions. The search identified a gap in NAIMD safety signal generation: no global program exists that collects and analyzes adverse events and product quality issues. Data sources in real-world settings, such as electronic health records, need to be effectively identified and explored as additional sources of safety information, particularly in some areas such as the EU and USA where there are plans to implement the unique device identifier (UDI). The UDI and other initiatives will enable more robust follow-up and assessment of long-term patient outcomes. The safety evaluation system for NAIMDs differs in many ways from those for drugs, but both systems face analogous challenges with respect to monitoring real-world usage. Certain features of the drug safety evaluation process could, if adopted and adapted for NAIMDs, lead to better and more systematic evaluations of the latter.

Effects of auditing patient safety in hospital care: design of a mixed-method evaluation

PubMed Central

2013-01-01

Background Auditing of patient safety aims at early detection of risks of adverse events and is intended to encourage the continuous improvement of patient safety. The auditing should be an independent, objective assurance and consulting system. Auditing helps an organisation accomplish its objectives by bringing a systematic, disciplined approach to evaluating and improving the effectiveness of risk management, control, and governance. Audits are broadly conducted in hospitals, but little is known about their effects on the behaviour of healthcare professionals and patient safety outcomes. This study was initiated to evaluate the effects of patient safety auditing in hospital care and to explore the processes and mechanisms underlying these effects. Methods and design Our study aims to evaluate an audit system to monitor and improve patient safety in a hospital setting. We are using a mixed-method evaluation with a before-and-after study design in eight departments of one university hospital in the period October 2011–July 2014. We measure several outcomes 3 months before the audit and 15 months after the audit. The primary outcomes are adverse events and complications. The secondary outcomes are experiences of patients, the standardised mortality ratio, prolonged hospital stay, patient safety culture, and team climate. We use medical record reviews, questionnaires, hospital administrative data, and observations to assess the outcomes. A process evaluation will be used to find out which components of internal auditing determine the effects. Discussion We report a study protocol of an effect and process evaluation to determine whether auditing improves patient safety in hospital care. Because auditing is a complex intervention targeted on several levels, we are using a combination of methods to collect qualitative and quantitative data about patient safety at the patient, professional, and department levels. This study is relevant for hospitals that want to early detect unsafe care and improve patient safety continuously. Trial registration Netherlands Trial Register (NTR): NTR3343 PMID:23800253

Effects of auditing patient safety in hospital care: design of a mixed-method evaluation.

PubMed

Hanskamp-Sebregts, Mirelle; Zegers, Marieke; Boeijen, Wilma; Westert, Gert P; van Gurp, Petra J; Wollersheim, Hub

2013-06-22

Auditing of patient safety aims at early detection of risks of adverse events and is intended to encourage the continuous improvement of patient safety. The auditing should be an independent, objective assurance and consulting system. Auditing helps an organisation accomplish its objectives by bringing a systematic, disciplined approach to evaluating and improving the effectiveness of risk management, control, and governance. Audits are broadly conducted in hospitals, but little is known about their effects on the behaviour of healthcare professionals and patient safety outcomes. This study was initiated to evaluate the effects of patient safety auditing in hospital care and to explore the processes and mechanisms underlying these effects. Our study aims to evaluate an audit system to monitor and improve patient safety in a hospital setting. We are using a mixed-method evaluation with a before-and-after study design in eight departments of one university hospital in the period October 2011-July 2014. We measure several outcomes 3 months before the audit and 15 months after the audit. The primary outcomes are adverse events and complications. The secondary outcomes are experiences of patients, the standardised mortality ratio, prolonged hospital stay, patient safety culture, and team climate. We use medical record reviews, questionnaires, hospital administrative data, and observations to assess the outcomes. A process evaluation will be used to find out which components of internal auditing determine the effects. We report a study protocol of an effect and process evaluation to determine whether auditing improves patient safety in hospital care. Because auditing is a complex intervention targeted on several levels, we are using a combination of methods to collect qualitative and quantitative data about patient safety at the patient, professional, and department levels. This study is relevant for hospitals that want to early detect unsafe care and improve patient safety continuously. Netherlands Trial Register (NTR): NTR3343.

Examination of the relationship between management and clinician perception of patient safety climate and patient satisfaction.

PubMed

Mazurenko, Olena; Richter, Jason; Kazley, Abby Swanson; Ford, Eric

2017-04-25

The aim of this study was to explore the relationship between managers and clinicians' agreement on deeming the patient safety climate as high or low and the patients' satisfaction with those organizations. We used two secondary data sets: the Hospital Survey on Patient Safety Culture (2012) and the Hospital Consumer Assessment of Healthcare Providers and Systems (2012). We used ordinary least squares regressions to analyze the relationship between the extent of agreement between managers and clinicians' perceptions of safety climate in relationship to patient satisfaction. The dependent variables were four Hospital Consumer Assessment of Healthcare Providers and Systems patient satisfaction scores: communication with nurses, communication with doctors, communication about medicines, and discharge information. The main independent variables were four groups that were formed based on the extent of managers and clinicians' agreement on four patient safety climate domains: communication openness, feedback and communication about errors, teamwork within units, and teamwork across units. After controlling for hospital and market-level characteristics, we found that patient satisfaction was significantly higher if managers and clinicians reported that patient safety climate is high or if only clinicians perceived the climate as high. Specifically, manager and clinician agreement on high levels of communication openness (β = 2.25, p = .01; β = 2.46, p = .05), feedback and communication about errors (β = 3.0, p = .001; β = 2.89, p = .01), and teamwork across units (β = 2.91, p = .001; β = 3.34, p = .01) was positively and significantly associated with patient satisfaction with discharge information and communication about medication. In addition, more favorable perceptions about patient safety climate by clinicians only yielded similar findings. Organizations should measure and examine patient safety climate from multiple perspectives and be aware that individuals may have varying opinions about safety climate. Hospitals should encourage multidisciplinary collaboration given that staff perceptions about patient safety climate may be associated with patient satisfaction.

Offshore safety case approach and formal safety assessment of ships.

PubMed

Wang, J

2002-01-01

Tragic marine and offshore accidents have caused serious consequences including loss of lives, loss of property, and damage of the environment. A proactive, risk-based "goal setting" regime is introduced to the marine and offshore industries to increase the level of safety. To maximize marine and offshore safety, risks need to be modeled and safety-based decisions need to be made in a logical and confident way. Risk modeling and decision-making tools need to be developed and applied in a practical environment. This paper describes both the offshore safety case approach and formal safety assessment of ships in detail with particular reference to the design aspects. The current practices and the latest development in safety assessment in both the marine and offshore industries are described. The relationship between the offshore safety case approach and formal ship safety assessment is described and discussed. Three examples are used to demonstrate both the offshore safety case approach and formal ship safety assessment. The study of risk criteria in marine and offshore safety assessment is carried out. The recommendations on further work required are given. This paper gives safety engineers in the marine and offshore industries an overview of the offshore safety case approach and formal ship safety assessment. The significance of moving toward a risk-based "goal setting" regime is given.

Design criteria for a self-actuated shutdown system to ensure limitation of core damage. [LMFBR

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

Deane, N.A.; Atcheson, D.B.

1981-09-01

Safety-based functional requirements and design criteria for a self-actuated shutdown system (SASS) are derived in accordance with LOA-2 success criteria and reliability goals. The design basis transients have been defined and evaluated for the CDS Phase II design, which is a 2550 MWt mixed oxide heterogeneous core reactor. A partial set of reactor responses for selected transients is provided as a function of SASS characteristics such as reactivity worth, trip points, and insertion times.

The Marine Corps Needs a Targeting, Sensors, and Surveillance Systems Operational Integration and Support Team

DTIC Science & Technology

2010-03-02

triggerman is probably still close ; lately all IEDs in the area have been initiated via command-wire. The squad leader sets a cordon, ensures an IED 9...Operational Surveillance System (G-BOSS) with a Class IIIb laser pointer. This class of laser requires users to receive a laser safety class...2) The Keyhole kit of surveillance equipment. Designed to provide “snipers with an increased capability to visually detect the enemy emplacing IEDs

Patient Safety Competence of Nursing Students in Saudi Arabia: A Self-Reported Survey

PubMed Central

Colet, Paolo C.; Cruz, Jonas P.; Cruz, Charlie P.; Al-otaibi, Jazi; Qubeilat, Hikmet; Alquwez, Nahed

2015-01-01

Objective With the growing recognition of the significance of patient safety (PS) in educational institutions and health organizations, it is essential to understand the perspective of nursing students on their own PS competence. This study analyzed the self-reported PS competence of nursing students at a government university in Saudi Arabia. Methodology A cross-sectional self-reported survey of 191 respondents, using the Health Professional Education in Patient Safety Survey (H-PEPSS) was conducted. The survey tool reflected 6 key socio-cultural dimensions assessing competence in classroom and clinical setting. Results Female nursing students reported higher PS competence in both the classroom and clinical settings along the dimensions ‘working in teams’ and ‘communicating effectively’ while males reported higher competence in both settings as to the ‘managing safety risks’ and ‘understanding human and environmental factors’ dimensions. The respondents’ academic level and self–reported PS competence have weak negative correlation in the classroom while a strong negative correlation between the 2 variables existed in the clinical setting. Self-reported PS competence for the dimensions ‘working in teams’, ‘recognize and respond to remove immediate risks of harm’, and ‘culture of safety’ is significantly higher in classroom than in the clinical setting. Conclusion Generally, the Saudi nursing students reported varying levels of competence in the six dimensions of patient safety. Significant gap between the perceived PS competence was observed between learning settings. Educational and training interventions are suggested for implementation to bridge this gap. PMID:26715921

Performance measures for a dialysis setting.

PubMed

Gu, Xiuzhu; Itoh, Kenji

2018-03-01

This study from Japan extracted performance measures for dialysis unit management and investigated their characteristics from professional views. Two surveys were conducted using self-administered questionnaires, in which dialysis managers/staff were asked to rate the usefulness of 44 performance indicators. A total of 255 managers and 2,097 staff responded. Eight performance measures were elicited from dialysis manager and staff responses: these were safety, operational efficiency, quality of working life, financial effectiveness, employee development, mortality, patient/employee satisfaction and patient-centred health care. These performance measures were almost compatible with those extracted in overall healthcare settings in a previous study. Internal reliability, content and construct validity of the performance measures for the dialysis setting were ensured to some extent. As a general trend, both dialysis managers and staff perceived performance measures as highly useful, especially for safety, mortality, operational efficiency and patient/employee satisfaction, but showed relatively low concerns for patient-centred health care and employee development. However, dialysis managers' usefulness perceptions were significantly higher than staff. Important guidelines for designing a holistic hospital/clinic management system were yielded. Performance measures must be balanced for outcomes and performance shaping factors (PSF); a common set of performance measures could be applied to all the healthcare settings, although performance indicators of each measure should be composed based on the application field and setting; in addition, sound causal relationships between PSF and outcome measures/indicators should be explored for further improvement. © 2017 European Dialysis and Transplant Nurses Association/European Renal Care Association.

[Establishment of model of traditional Chinese medicine injections post-marketing safety monitoring].

PubMed

Guo, Xin-E; Zhao, Yu-Bin; Xie, Yan-Ming; Zhao, Li-Cai; Li, Yan-Feng; Hao, Zhe

2013-09-01

To establish a nurse based post-marketing safety surveillance model for traditional Chinese medicine injections (TCMIs). A TCMIs safety monitoring team and a research hospital team engaged in the research, monitoring processes, and quality control processes were established, in order to achieve comprehensive, timely, accurate and real-time access to research data, to eliminate errors in data collection. A triage system involving a study nurse, as the first point of contact, clinicians and clinical pharmacists was set up in a TCM hospital. Following the specified workflow involving labeling of TCM injections and using improved monitoring forms it was found that there were no missing reports at the ratio of error was zero. A research nurse as the first and main point of contact in post-marketing safety monitoring of TCM as part of a triage model, ensures that research data collected has the characteristics of authenticity, accuracy, timeliness, integrity, and eliminate errors during the process of data collection. Hospital based monitoring is a robust and operable process.

The Evolution of the NASA Commercial Crew Program Mission Assurance Process

NASA Technical Reports Server (NTRS)

Canfield, Amy C.

2016-01-01

In 2010, the National Aeronautics and Space Administration (NASA) established the Commercial Crew Program (CCP) in order to provide human access to the International Space Station and low Earth orbit via the commercial (non-governmental) sector. A particular challenge to NASA has been how to determine that the Commercial Provider's transportation system complies with programmatic safety requirements. The process used in this determination is the Safety Technical Review Board which reviews and approves provider submitted hazard reports. One significant product of the review is a set of hazard control verifications. In past NASA programs, 100% of these safety critical verifications were typically confirmed by NASA. The traditional Safety and Mission Assurance (S&MA) model does not support the nature of the CCP. To that end, NASA S&MA is implementing a Risk Based Assurance process to determine which hazard control verifications require NASA authentication. Additionally, a Shared Assurance Model is also being developed to efficiently use the available resources to execute the verifications.