Safety Deficiencies Research Articles

Safety in the Home Healthcare Sector

Unsafe household conditions could adversely affect safety and quality in home health care. However, risk identification tools and procedures that can be readily implemented in this setting are lacking. To address this need, we developed and tested a new household safety checklist and accompanying training program. A 50-item, photo-illustrated, multi-hazard checklist was designed as a tool to enable home healthcare paraprofessionals (HHCPs) to conduct visual safety inspections in patients' homes. The checklist focused on hazards presenting the greatest threat to the safety of seniors. A convenience sample of 57 HHCPs was recruited to participate in a 1-hour training program, followed by pilot testing of the checklist in their patients' households. Checklist data from 116 patient homes were summarized using descriptive statistics. Qualitative feedback on the inspection process was provided by HHCPs participating in a focus group. Pretesting and posttesting determined that the training program was effective; participating HHCPs' ability to identify household hazards significantly improved after training (P<0.001). Using the checklist, HHCPs were able to identify unsafe conditions, including fire safety deficiencies, fall hazards, unsanitary conditions, and problems with medication management. Home healthcare paraprofessionals reported that the checklist was easy to use and that inspections were well accepted by patients. Inspections took roughly 20 minutes to conduct. Home healthcare paraprofessionals can be effectively trained to identify commonplace household hazards. Using this checklist as a guide, visual household inspections were easily performed by trained HHCPS. Additional studies are needed to evaluate the reliability of the checklist and to determine if hazard identification leads to interventions that improve performance outcomes.

Combining Statistics and Case Studies to Identify and Understand Deficiencies in Fire Protection

Over the years, much information has been gathered about fires in fire investigation reports and statistics. This information may have been collected nationally by an agency or an insurance company, or locally by the local rescue service. The information thus gathered can be used to learn from these fires and thereby lead to improved fire safety in buildings. This paper describes a method for discovering technical deficiencies in the fire safety of buildings. The method offers a means of analysing several fires systematically with the aim of identifying factors characteristic of a problem in the system studied. In this paper, the method is illustrated through a study of severe fires in school buildings in Sweden. The aim is to discover the underlying factors that cause some fires to grow and become severe. The method is considered a useful tool for discovering the underlying factors to or causes of fires.

Design and Evaluation of Simulation Scenarios for a Program Introducing Patient Safety, Teamwork, Safety Leadership, and Simulation to Healthcare Leaders and Managers

We developed a training program to introduce managers and informal leaders of healthcare organizations to key concepts of teamwork, safety leadership, and simulation to motivate them to act as leaders to improve safety within their sphere of influence. This report describes the simulation scenario and debriefing that are core elements of that program. Twelve teams of clinician and nonclinician managers were selected from a larger set of volunteers to participate in a 1-day, multielement training program. Two simulation exercises were developed: one for teams of nonclinicians and the other for clinicians or mixed groups. The scenarios represented two different clinical situations, each designed to engage participants in discussions of their safety leadership and teamwork issues immediately after the experience. In the scenarios for nonclinicians, participants conducted an anesthetic induction and then managed an ethical situation. The scenario for clinicians simulated a consulting visit to an emergency room that evolved into a problem-solving challenge. Participants in this scenario had a limited time to prepare advice for hospital leadership on how to improve observed safety and cultural deficiencies. Debriefings after both types of scenarios were conducted using principles of "debriefing with good judgment." We assessed the relevance and impact of the program by analyzing participant reactions to the simulation through transcript data and facilitator observations as well as a postcourse questionnaire. The teams generally reported positive perceptions of the relevance and quality of the simulation with varying types and degrees of impact on their leadership and teamwork behaviors. These kinds of clinical simulation exercises can be used to teach healthcare leaders and managers safety leadership and teamwork skills and behaviors.

Psychomotor Skills Acquisition of Novice Learners

Deficiencies in procedural competency compromise patient safety and the quality of care provided. Educators in prelicensure nursing programs are challenged to design effective instruction to develop psychomotor skills abilities among novice learners. Highly contextualized learning and frequent opportunities for performance rehearsal promote knowledge retention and procedural competence. The author discusses data from an evaluation study that explored students' perceptions of the effectiveness of skills instruction and suggests strategies for curricular integration and effective instruction.

Outline for a causal model of traffic conflicts and crashes

Road crashes tend to be infrequent but with nontrivial consequences, leading to a long-running interest in identifying surrogate events, such as traffic conflicts, that can support a timely recognition and correction of safety deficiencies. Although a variety of possible surrogates have been suggested, questions remain regarding how crashes and surrogates are related. Using recent developments in causal analysis we propose a simple model which represents crashes and conflicts as resulting from interactions between initiating conditions and evasive actions, and then use this model to identify relationships between these types of events. Our first set of results expresses the probability of a crash as a mixture of probabilities over different sets of initiating conditions, where the mixing probabilities are governed by the evasive action. Our second set of results considers situations where sampling is restricted to non-crash events, and gives conditions where these truncated probabilities can serve as proxies for crash probabilities. We then illustrate how trajectory-based reconstruction can be used to classify initiating events with respect to severity, and to estimate a proxy for the crash probability from a set of incompletely observed non-crash events.

Prevention and Treatment of Malaria in Pregnancy

Malaria in pregnancy is a substantial public health issue in many tropical countries. However, its prevention and treatment have been hindered because of fears of adverse drug effects in pregnant women recruited to intervention studies. This article details the pharmacological agents and management strategies currently or potentially available for use in pregnant women with or at risk of malaria. There are deficiencies in pharmacokinetic, tolerability, safety and efficacy data for even well-established drugs and combinations. This can have serious implications for the design of rational dose regimens. Approaches such as intermittent preventive treatment are increasingly employed in endemic areas with proven benefits, but the emergence of parasite drug resistance means that new strategies and drug regimens should be continually evaluated.

Highway Work Zone Risk Factors and Their Impact on Crash Severity

Numerous factors may contribute to high-severity crashes in highway work zones. Identifying these factors and then alleviating their impact is a challenging task that traffic engineers and researchers have to confront. In this study, the work zone risk factors that could increase the probability of causing fatalities when severe crashes occur were examined using a comprehensive approach. The researchers first identified the significant risk factors based on a screening process that incorporates both statistical analyses and empirical research findings. They then systematically investigated these factors using logistic regression and frequency analysis techniques. The severe crashes including the fatal crashes between 1998 and 2004 and injury crashes between 2003 and 2004 in Kansas highway work zones were used in the study. The assessed risk factors included variables describing driver characteristics, environmental conditions, crash road conditions, and other crash information. The results of this study will help traffic engineers to understand these risk factors and how the factors could increase the likelihood of having fatalities when a severe crash occurs in a work zone. Consequently, effective safety countermeasures may be designed at the work zone planning and installation stages to prevent safety deficiencies.

Utilization of the Seniors Falls Investigation Methodology to Identify System-Wide Causes of Falls in Community-Dwelling Seniors

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.

A description of oncology nurses’ working conditions in Turkey

Purpose This study was conducted to determine the problems about working conditions, employee rights and working life of oncology nurses in Turkey who administer cytotoxic drugs and to determine whether or not the existing practices are appropriate with national laws, comparing the current practices in private, university and government hospitals. Method The study was designed as an analytic descriptive survey. The research settings took place in nine hospitals of Istanbul, Turkey. The participants were 171 nurses who worked in oncology units and administered cytotoxic drugs. Data were collected using a questionnaire, which was developed by the investigators to determine working conditions of oncology nurses. Findings The oncology nurses overworked, had insufficient time off work, did not receive compensation for overtime work, would not be protected if they were pregnant or breastfeeding, and faced deficiencies in occupational health and safety. Conclusions and recommendations Oncology nurses were exposed to working conditions that were only partly appropriate with national laws and International Labor Organization standards for health care workers were disregarded. Nurses need to be educated during the preparation and administration of chemotherapy drugs and protection against exposure as soon as possible. Chemotherapic drugs need to be prepared in a hood (biological safety cabin), but when unavailable minimal protection measures, including aprons, goggles, masks and latex gloves, need to be worn.

Economic Woes Trickle Down to Elderly, LTC

Economic Woes Trickle Down to Elderly, LTC

No Relief Yet From Medicare Physician Pay Cuts

No Relief Yet From Medicare Physician Pay Cuts

How safe are interview rooms?

Campbell & Fung ( Psychiatric Bulletin , January 2007, 31 , 10-13) highlighted some important deficiencies in safety of patient interview rooms. We conducted a similar audit of 119 interview rooms in southern Hampshire in 2004, which was a repeat of an earlier study by local trainees in 2000. We

Seniors Falls Investigative Methodology (SFIM): A Systems Approach to the Study of Falls in Seniors

An in-depth understanding of human factors and human error is lacking in current research on seniors' falls. Additional knowledge is needed to understand why seniors are falling. The purpose of this article is to describe the adapting of the Integrated Safety Investigation Methodology (ISIM) (used for investigating transportation and industrial accidents) to studying seniors' falls. An adapted version-the Seniors Falls Investigative Methodology (SFIM)-uses a systems approach to take an investigation beyond the immediate cause of an incident and reveal unsafe acts and deeply imbedded unsafe conditions that contribute to adverse outcomes. An example case study is used to describe six phases of the investigative process in detail. The SFIM has the potential to identify safety deficiencies; utilize existing knowledge about falls; establish a standardized reporting system; shift focus from the faller to the system; and guide targeted prevention.

Accessing and understanding the evidence

WHO regularly gathers, evaluates, and cites evidence to support its recommendations. How this is done varies between departments, but highly centralized processes, complex methods and expert consultations are often used. WHO guidelines are distributed to health workers and policy-makers in developing countries, but few of these people have the opportunity to be involved in the process of choosing and weighing the evidence to formulate the guidelines that are ostensibly designed for their use. Such incomplete engagement may impede ownership of WHO recommendations, and thus be an obstacle to full implementation. In 2005 WHO published the Pocketbook of Hospital Care for Children, (1) a comprehensive clinical resource for nurses and doctors in developing countries. The Pocketbook contains recommendations on the management of all common conditions, including serious infections, malnutrition, neonatal and surgical problems, injuries, burns and poisoning. These guidelines are an extension of the Integrated Management of Childhood Illness (IMCI) to the first-referral hospital, providing consistency across all levels of health care systems. The Pocketbook aims to address many of the deficiencies in quality and safety of hospital care for children identified in recent years. (2-4) However, the mere production of high-quality guidelines will not ensure implementation, or be sufficient to improve quality of care. A comprehensive approach to the implementation of the WHO Pocketbook includes training strategies and quality assessment tools. Another key component is a process of documenting, updating and disseminating evidence which engages doctors, medical students and nurses in countries throughout the world, This process and the evidence it is collecting are described at the International Child Health Review Collaboration (ICHRC) web site: www.ichrc.org. ICHRC uses Pubmed, a database which references over 4800 journals, including publications from the Cochrane Collaboration. Pubmed is free online and has validated search filters that provide about 95% sensitivity and specificity when compared with the most comprehensive search strategies, involving multiple (often costly) databases and hand-searching of the literature. (5) Reviews given priority in this project are those addressing issues that are critical to the implementation of the guidelines, such as recommendations which challenge common practices in some countries. A reviewer's toolkit is available on the web site, and support for reviewers is provided by project coordinators. Standardized search strings are developed with the assistance of a librarian. Drafts are written by primary reviewers, further reviewed by an acknowledged expert in the field, and edited before posting on the web site. The ICHRC process is similar to that used by the Cochrane Collaboration, but there are some important differences. ICHRC has a focus that is broader than therapeutic questions (including diagnosis, etiology and implementation); search strategies prioritize randomized trials, but include other research designs when these are more appropriate. …

Health Care Value-Based Purchasing

Two Institute of Medicine studies have focused attention on the glaring deficiencies in health care safety and quality. These studies and others serve as wake-up calls within both the private and government-sponsored United States health care industry. As a result of the "quality chasm" and crippling rise in health care cost, the concept of value-based purchasing (VBP) has gained increasing momentum. The stakeholders affected by the health care value equation include consumers, employers, insurers, and providers. VBP creates quality standards and stakeholder incentives to improve quality of care and become more cost efficient. The greatest challenge is the development of methods and information sources that will allow reliable, accurate, and credible measures of health care quality. VBP presents the ambitious hope of creating transparent measures of quality and cost efficiency that would allow the consumer to make health care purchasing decisions. If this can be achieved, then the competitive forces that increase value in other industries will function in health care.

Assessing safety measures in residential buildings in Saudi Arabia

The incidence rate of fire in residential buildings in Saudi Arabia accounts for 69% of all building fires. A field assessment of current safety issues for residential buildings in Saudi Arabia is used to identify common safety deficiencies. The survey showed that most residents are ignorant many safety aspects in their homes. A safety audit checklist for assessing the effectiveness of safety measures in existing residential buildings is also presented. Based on these findings, a number of strategies for designers, local authorities, building owners and residents is suggested.

Compound Optimization in Early and Late Phase Drug Discovery: Acceptable Pharmacokinetic Properties Utilizing Combined Physicochemical, In Vitro and In Vivo Screens

New chemical entities (NCEs) are abandoned in development primarily because of insufficient efficacy, safety issues and for economic reasons. Since efficacy and safety deficiencies are related in part to pharmacokinetics (PK), uncovering PK defects as early in drug discovery as possible would be highly valuable in reducing NCE failures in preclinical and clinical development. In this review, a strategy is put forth to integrate drug metabolism/pharmacokinetics and toxicology functions into drug discovery. Compound optimization in early- and late-phase drug discovery is covered, emphasizing physicochemical properties, in vitro absorption, metabolism and in vivo animal PK methodologies, primarily from the period 1998 to 1999. The present study also illustrates the idea of sorting oral bioavailability data into high/intermediate/low categories based on combining high/low rank-ordered information from physicochemical properties and in vitro absorption, metabolism and serum binding assays. It is shown that by combining the results from solubility, stability, absorption and metabolism assays, the high/intermediate/low human oral bioavailability for a series of beta- blockers can be approximately predicted. This method has a high sample throughput and should be useful in rank-ordering the predicted oral bioavailability of large collections of compounds at the lead optimization step of drug discovery. These results are useful for selecting compounds for future in vitro/in vivo correlation modeling or in vivo animal testing. This type of approach will improve the decision making process of compound selection in drug discovery.

Practical Safety Tool for Local Low-Volume Rural Roads: The Road Safety Audit Review

Practical tools for improving transportation safety are needed worldwide. It has been estimated that motor vehicle–related crashes account for more than 1 million fatalities each year, and the number of serious injuries far exceeds fatalities. Local and low-volume roads are significantly overrepresented in crash statistics. Globally, the road safety audit (RSA) concept has been recognized as an effective tool in identifying and reducing the crash potential of roadways when used to analyze the safety aspects of project plans and designs before completion. In the local rural road arena, many safety issues are associated with existing roadway networks. Many of these networks have developed over time with little or no planning or design. There is a critical need for a practical tool that focuses on the safety of the existing as-built local road network. The RSA review (RSAR) process has been developed for this purpose, giving specific recognition to the functionality of the road being evaluated for safety issues. Significant numbers of safety improvements are needed, and practical approaches to address these needs are crucial. The RSAR tool has the potential to be particularly beneficial to local governments in systematically addressing safety deficiencies on existing rural road networks. In addition, it is a proactive safety tool that has the potential to protect agencies from tort liability since it establishes a record of the organization’s safety agenda. An RSAR methodology that can be adapted by local agencies is presented. A case study illustrating the application of this process is included. Also highlighted is a local rural training program that has been presented in several states for county applications. The focus is on U.S. county applications, but it is recognized that the process has utility for other agencies and has application in other countries. The necessity for training as a key component in the development of a sustainable safety program is emphasized.

Evaluating safety performance of road projects

In recent years, road safety audits have been adopted in a number of countries to deal with safety deficiencies in road projects as early as possible. In keeping with this trend, Singapore has adopted similar procedures in reviewing its roads. This paper describes a proposed extension of the procedures to include a more quantitative assessment to overcome some of the current problems faced in road safety reviews. The outcome of the quantitative evaluation is a Road Safety Performance Rating (RSPR) of the project with critical components measured in terms of a Road Safety Performance Index (RSPI) and viewed on a Road Safety Performance Chart (RSPC). The advantages of using the RSPR, RSPI and RSPC are given in the paper.

Evaluating safety performance of road projects

In recent years, road safety audits have been adopted in a number of countries to deal with safety deficiencies in road projects as early as possible. In keeping with this trend, Singapore has adopted similar procedures in reviewing its roads. This paper describes a proposed extension of the procedures to include a more quantitative assessment to overcome some of the current problems faced in road safety reviews. The outcome of the quantitative evaluation is a Road Safety Performance Rating (RSPR) of the project with critical components measured in terms of a Road Safety Performance Index (RSPI) and viewed on a Road Safety Performance Chart (RSPC). The advantages of using the RSPR, RSPI and RSPC are given in the paper.