Frequent Audits Research Articles

Effectiveness of frequent inventory audits in retail stores: an empirical evaluation

PurposeThe purpose of this paper is to focus on the effectiveness of the inventory audit process to manage operational issues related to inventory errors in retail stores. An evaluation framework is proposed based on developing an error profile of store inventory using product attributes and inventory information.Design/methodology/approachA store inventory error profile is developed using data on price, sales, popularity, replenishment cycle, inventory levels and inventory errors. A simulation model of store inventory management system grounded in empirical data is used to evaluate the effectiveness of the inventory audit process in a high SKU-variety retail store. The framework is tested using a large transaction data set comprised of over 200,000 records for 7,400 SKUs.FindingsThe results show that store inventory exhibits different inventory error profile groups that would determine the effectiveness of store inventory audits. The results also identify an interaction effect between store inventory policies and replenishment process that moderates the effectiveness of inventory audits.Research limitations/implicationsThe analysis is based on data collected from a single focal firm and does not cover all the different segments of the retail industry. However, the evaluation framework presented in the paper is fully generalizable to different retail settings offering opportunity for additional studies.Practical implicationsThe findings about the role of different error profile groups and the interaction effect of store audits with inventory and store replenishments would help retailers incorporate a more effective inventory audit process in their stores.Originality/valueThis paper presents a novel approach that uses store inventory profiles to evaluate the effectiveness of inventory audits. Unlike previous papers, it is the first empirical study in this area that is based on inventory error data gathered from multiple audits that identify the interaction effect of inventory policy and replenishments on the inventory audit process.

Monitoring quality of care for peripheral intravenous catheters; feasibility and reliability of the peripheral intravenous catheters mini questionnaire (PIVC-miniQ)

BackgroundPeripheral intravenous catheters (PIVCs) account for a mean of 38% of catheter associated bloodstream infections (CABSI) with Staphylococcus aureus, which are preventable if deficiencies in best practice are addressed. There exists no feasible and reliable quality surveillance tool assessing all important areas related to PIVC quality. Thus, we aimed to develop and test feasibility and reliability for an efficient quality assessment tool of overall PIVC quality.MethodsThe Peripheral Intravenous Catheter- mini Questionnaire, PIVC-miniQ, consists of 16 items calculated as a sum score of problems regarding the insertion site, condition of dressing and equipment, documentation, and indication for use. In addition, it contains background variables like PIVC site, size and insertion environment. Two hospitals tested the PIVC-miniQ for feasibility and inter-rater agreement. Each PIVC was assessed twice, 2–5 min apart by two independent raters. We calculated the intraclass correlation coefficient (ICC) for each hospital and overall. For each of the 16 items, we calculated negative agreement, positive agreement, absolute agreement, and Scott’s pi.ResultsSixty-three raters evaluated 205 PIVCs in 177 patients, each PIVC was assessed twice by independent raters, in total 410 PIVC observations. ICC between raters was 0.678 for hospital A, 0.577 for hospital B, and 0.604 for the pooled data. Mean time for the bedside assessment of each PIVC was 1.40 (SD 0.0007) minutes. The most frequent insertion site symptom was “pain and tenderness” (14.4%), whereas the most prevalent overall problem was lack of documentation of the PIVC (26.8%). Up to 50% of PIVCs were placed near joints (wrist or antecubital fossae) or were inserted under suboptimal conditions, i.e. emergency department or ambulance.ConclusionsOur study highlights the need for PIVC quality surveillance on ward and hospital level and reports the PIVC-miniQ to be a reliable and time efficient tool suitable for frequent point-prevalence audits.

Does Monitoring Influence Financial Accountability? Answers from National Public Secondary Schools in Kenya

The general objective was to assess the effect of monitoring on financial accountability in national public secondary schools in Kenya.103 national public secondary schools in Kenya were used in the study. Agency theory, Fraud triangle theory and accountability theory guided the research. Survey research was used to collect data from a populace of; 103 principals, 103 bursars, 103 BOM chairs. Questionnaires and audited financial statements were used to obtain data. Reliability was tested through Cronbach’s Alpha.The association between monitoring and financial accountability was established through a bivariate simple linear regression model which was fitted to assess the influence of Monitoring on financial accountability. The regression coefficient estimate of Monitoring was (β =0.616, t=5.020, p-value = 0.000). It was recommended that frequent external audits by county auditors be done. The principal and bursar should be allowed to evaluate the work done by the auditors and post to the central website. Keywords ：Monitoring, auditing, BOM oversight DOI : 10.7176/RJFA/10-18-14 Publication date :September 30 th 2019

Quality of asthma care at a university-based primary care clinic in Malaysia

Purpose The quality of asthma care may be affected if asthma management is overlooked, thus needing frequent clinical audits to identify areas for improvement. The purpose of this paper is to evaluate the quality of the process (e.g. documentation of asthma-specific information), the structure (e.g. availability of resources) and the outcome (e.g. proportion of patients prescribed with asthma medications) at a university-based primary care clinic. The associated clinical factors for non-documentation of asthma control at the last visit were also examined. Design/methodology/approach This retrospective study involved auditing medical records and the pharmacy data system of 433 adult patients with asthma to evaluate 18 quality indicators. The standard target for the indicators of process and structure was 80 percent and the standard target for the indicators of outcome was 100 percent. Findings All the indicators failed to reach the standard targets. Documentation of asthma-specific information and availability of resources were deficient. The non-documentation of asthma control was significantly associated with presence of acute complaint(s) unrelated to asthma, presence of other issues and number of the documented parameters for asthma control. Although the prescription rates of inhaled reliever and preventer were substandard, they were reasonably high compared to the targets. Research limitations/implications In this study, evaluation of the quality of care was limited by absence of asthma register, use of paper-based medical records and restricted practice capacity. Besides, the asthma-specific assessments and management were only audited at one particular time. Furthermore, the findings of this study could not be generalised to other settings that used other methods of record keeping such as patient-held cards and electronic medical records. Future studies should sample asthma patients from a register, evaluate more reliable quality indicators (e.g. over-prescription of short-acting β-2 agonist and underuse of inhaled corticosteroid) and assess asthma management over a duration of time. Practical implications This study provides quality information on all aspects of asthma care (process, structure and outcome) which can be a basis for clinical improvement. It is hoped that the study could assist the stakeholders to plan strategies for improvement of the asthma care. A more strategic and reliable system of documentation is needed, such as the use of a simple template or structured form, which should not jeopardise the provision of personalised and comprehensive care. With complete documentation, thorough investigational audits can be continuously performed to determine the quality of asthma care. Social implications This study could provide useful findings to guide healthcare providers in developing a more strategic model of asthma care that can ensure asthma patients to receive a personalised, comprehensive, holistic and continuous care. Through this approach, their physical and psychosocial well-being can be optimised. Originality/value Even though our healthcare has advanced, the quality of asthma care is still suboptimal which requires further improvement. However, it could be considered assuring due to high outcome levels of asthma care despite having limited resources and practice capacity.

An Audit of 138 Patients Admitted with Lump in the Neck in Surgical Department of Services Hospital Lahore, (SIMS)

Introduction: Neck swellings are very common problem in head and neck region. Causes are highly variable, ranging from simple treatable disease to a metastatic incurable carcinoma. The common causes may differ depending upon the different geographical location, gender and age of the patients. Therefore, the knowledge of local causative factors is important to avoid diagnostic delay. Commonly presenting head and neck masses are due to lymph node, thyroid and salivary gland enlargement. In third world countries, infective causes are most common. Malignant neoplasms were the second most common group. Therefore, frequent audit is necessary for prompt diagnosis and further work up.
 Objective: An audit of 138 patients admitted with neck swelling in surgical department of a tertiary care Hospital of Lahore.
 Methodology: This cross-sectional study was carried out at Department of Surgery, (unit-1) Services Institute of Medical Sciences Lahore, (SIMS) during January 2014 to July 2015. All patients who presented with neck swelling during study period were included. Diagnosis made after taking clinical history, examination and relevant laboratory work up.
 Results: Out of 138 patients with lump in the neck, 93 (67.39%) were female and 45 (32.60%) were male. The commonest swelling is tuberculous lymphadenitis that is 34 (24.63%) and 9 (6.52%) were lymphoma and 4 (3%) with reactive hyperplasia. 49 (35.5%) arose from thyroid (40 benign and 9 malignant). Among the benign swellings, 15 were solitary nodular goiter, 12 were Multinodular goiter and 13 were diffuse thyroid goiter, 11 were Thyroglossal cyst. Other causes included sebaceous cyst 12 (8.69%), lipoma 19 (13.67%), thyroglossal cyst 11 (8%) and carcinoma of thyroid 9 (6.52%)
 Conclusion: The most common cause of neck lump is thyroid disease and tuberculous lymphadenitis. Early diagnosis of tuberculosis and goiter is crucial for appropriate management.
 
 Keywords: Head and Neck Swellings, Lymph Nodes, Tuberculous lymphadenitis, Goiter

Effect of Liquidity Management on Performance of Commercial Banks in Kenya

The purpose of the study was to analyze the effect of Liquidity management on performance of commercial banks in Kenya. The study was based on Portfolio theory of Cash Management, Cash Management theory, Transaction Cost theory, Free Cash Flow theory and pecking order theory. The study used mixed research design which involves collecting and analyzing both qualitative and quantitative data. The target population of the study comprised the 6913 employees in management and supervisory cadres in commercial banks in Kenya. Stratified sampling technique was used to identify the sample size in every stratum. Data collection instruments were both structured and unstructured questionnaires. Data collection methods were both primary and secondary. The data was analyzed using Statistical Program for Social Sciences (SPSS) windows version 21.Multiple linear regression analysis was carried out to analyze the determinants of cash flow management on performance of commercial banks in Nairobi City County, Kenya. Pilot test was carried out for validity and reliability of research instruments. Regression analysis was carried out to test the significant levels of one variable to the other in the study. ANOVA was carried out to test the hypotheses of the study. The study is significant to the banking sector and the government of Kenya in formulation of different financial decisions and in policy making. The results of the study indicate that all the independent variable have a significant positive effect on performance of Commercial banks Kenya. The findings revealed that commercial banks in Kenya carry out liquidity management practice and that inflation rates influence interest rates in commercial banks in Kenya. Liquidity management practice was found to be positively related to performance of commercial banks in Kenya. The study recommends that the management of commercial banks in Kenya should be enhanced through frequent audits to be able to curb interest rates especially the unanticipated inflation which adversely affects the functions of money by undermining wealth holders’ confidence in its ability to be used as medium of exchange and store of value. They should also maintain the minimum liquidity requirement as stated by the Central Bank of Kenya as both illiquidity and excess liquidity are financial diseases that can easily erode the profit base of a bank as they affect bank's attempt to attain high profitability-level. They should also put into consideration liquidity levels in pursuit of high profit for it can cause great illiquidity, which reduces the customers' patronage and loyalty. Keywords: Liquidity, Financial Performance DOI : 10.7176/EJBM/11-17-04 Publication date :June 30 th 2019

Determinants of Cash Flow Management Practice on Performance of Commercial Banks in Kenya

The purpose of the study was to analyze the determinants of cash flow management on performance practice of commercial banks in Kenya. Specific objectives of the study were to determine the effect of cash forecasting practice on performance of commercial banks in Kenya, to identify the effect of cash accounting practice on performance of commercial banks in Kenya. The study was based on Portfolio theory of Cash Management, Cash Management theory, Transaction Cost theory, Free Cash Flow theory and pecking order theory. The study used mixed research design which involves collecting and analyzing both qualitative and quantitative data. The target population of the study comprised the 6913 employees in management and supervisory cadres in commercial banks in Kenya. Stratified sampling technique was used to identify the sample size in every stratum. Data collection instruments were both structured and unstructured questionnaires. Data collection methods were both primary and secondary. The data was analyzed using Statistical Program for Social Sciences (SPSS) windows version 21.Multiple linear regression analysis was carried out to analyze the determinants of cash flow management on performance of commercial banks in Nairobi City County, Kenya. Pilot test was carried out for validity and reliability of research instruments. Regression analysis was carried out to test the significant levels of one variable to the other in the study. ANOVA was carried out to test the hypotheses of the study. The study is significant to the banking sector and the government of Kenya in formulation of different financial decisions and in policy making. The results of the study indicate that all the independent variable have a significant positive effect on performance of Commercial banks Kenya. The findings revealed that commercial banks in Kenya carry out cash flow forecasting practice and that inflation rates influence interest rates in commercial banks in Kenya. Cash accounting practice was found to be positively related to performance of commercial banks in Kenya. The study recommends that the management of commercial banks in Kenya should be enhanced through frequent audits to be able to curb interest rates especially the unanticipated inflation which adversely affects the functions of money by undermining wealth holders’ confidence in its ability to be used as medium of exchange and store of value. Keywords: Cash Accounting, Financial Performance DOI : 10.7176/EJBM/11-17-03 Publication date :June 30 th 2019

A Tale of Two Departments: How Collaboration Between Infection Prevention and Sterile Processing Departments Can Improve Patient Safety

BACKGROUND Sterile Processing Departments (SPD) play a critical role in patient safety by proper sterilization of surgical instruments. Infection Preventionists (IPs) are often responsible for overseeing Infection Control (IC) standards for SPD, but frequently lack training in sterile processing that can create challenges. In 2015 we developed a quality improvement project improving IP knowledge of SPD processes and compliance with IC measures. METHODS An audit tool was created utilizing observations, staff responses to IC questions and documentation review. To gain familiarity with SPD processes and improve audits, IPs attended weekly SPD meetings, Skills Fairs, APIC webinars and professional conferences . Audits were developed from nationally recommended practices, done bimonthly by IC personnel and reviewed quarterly with SPD leadership. IPs provided education for staff when gaps were identified. Implementation of SPD audits occurred concurrently with other OR quality improvement projects to facilitate improved instrument reprocessing RESULTS Average overall audit scores increased in the first year from 67% in 2015 to 84% in 2016 (p CONCLUSIONS By attending SPD conferences, staff meetings, and skills fairs, IPs developed an audit tool to improve SPD oversight. Frequent auditing and education improved audit scores and correlated with an improvement in SPD function, as measured by decreased bioburden events. This project demonstrates how collaboration between the IP and SPD departments can lead to improved compliance and patient safety.

Using audit and feedback to increase clinician adherence to clinical practice guidelines in brain injury rehabilitation: A before and after study.

ObjectiveThis study evaluated whether frequent (fortnightly) audit and feedback cycles over a sustained period of time (>12 months) increased clinician adherence to recommended guidelines in acquired brain injury rehabilitation.DesignA before and after study design.SettingA metropolitan inpatient brain injury rehabilitation unit.ParticipantsClinicians; medical, nursing and allied health staff.InterventionsFortnightly cycles of audit and feedback for 14 months. Each fortnight, medical file and observational audits were completed against 114 clinical indicators.Main outcome measureAdherence to guideline indicators before and after intervention, calculated by proportions, Mann-Whitney U and Chi square analysis.ResultsClinical and statistical significant improvements in median clinical indicator adherence were found immediately following the audit and feedback program from 38.8% (95% CI 34.3 to 44.4) to 83.6% (95% CI 81.8 to 88.5). Three months after cessation of the intervention, median adherence had decreased from 82.3% to 76.6% (95% CI 72.7 to 83.3, p<0.01). Findings suggest that there are individual indicators which are more amenable to change using an audit and feedback program.ConclusionA fortnightly audit and feedback program increased clinicians’ adherence to guideline recommendations in an inpatient acquired brain injury rehabilitation setting. We propose future studies build on the evidence-based method used in the present study to determine effectiveness and develop an implementation toolkit for scale-up.

Outsourced dynamic provable data possession with batch update for secure cloud storage

With the advent of data outsourcing, how to efficiently verify the integrity of data stored at an untrusted cloud service provider (CSP) has become a significant problem in cloud storage. Provable data possession (PDP) is a model that allows clients or a trusted auditor to verify whether CSP possesses the outsourced data without downloading it. However, this model requires clients to tolerate non-negligible computation burden incurred by frequent verifications in private schemes, and does not provide any security assurances when client or/and auditor are dishonest. Therefore, it cannot be directly transformed into a secure outsourced auditing scheme, where any one of three participants (i.e., CSP, client and auditor) may be dishonest and any two participants may be colluded with each other. In this paper, we propose an outsourced dynamic provable data possession (ODPDP) scheme, which migrates frequent auditing task to an external auditor to reduce clients’ verification overhead, and simultaneously provides log audit mechanism with lower computation burden for clients to prevent from dishonest auditor. In addition, we propose a batch update algorithm that can perform and verify multiple update operations at once, avoiding repetitive calculations and transmissions. Security analysis proves that our scheme is secure in the enhanced threat model, and experimental results show that our scheme achieves high efficiency in terms of computation time and communication cost compared with existing outsourced auditing schemes.

Prescription Audit, Drug Utilization Pattern and Adverse Drug Reaction Monitoring in Outpatients of Orthopedics Department of Tertiary Care Teaching Hospital: A Pilot Study

Background: The domain of orthopedic illnesses is grossly underrepresented in the current healthcare scenario especially due to overreliance on mortality rather than the morbidity or dysfunction. Continuous introduction of new drugs in the field of pharmacology requires holistic utilization, effectiveness, and side-effects studies. In addition, inappropriate use of drugs poses a risk of adverse drug reactions (ADRs). Our study aims to analyze the prescription pattern in outpatient department of orthopedics at a tertiary care hospital of Delhi. Methodology: The study was carried out in 210 patients who attended the orthopedics outpatient department for a period of 3 months. Patient demographic details, duration of illness, comorbid conditions, drugs prescribed, ADRs, and usage of complementary and alternative medicine were used to analyze the pattern of drug use. Results: In our study, we observed that vitamins and mineral preparations (20%) was the most commonly prescribed class of drugs followed by nonsteroidal antiinflammatory drugs (11.42%). Polypharmacy was seen in most of the prescriptions (60.95%), but 100% of the drugs were from Essential Medicine List of Government of National Capital Territory, Delhi. About 75% of the prescriptions were prescribed by generic names. ADRs were reported in 30 patients and majority of them were mild in nature (96%). Complementary and alternative medicine was used by 13.3% of the study patients. Conclusion: Majority of the drugs were prescribed by generic names and were essential medicines. Trend of polypharmacy was noted. Injudicious use of multivitamins and calcium was seen. Nonsteroidal antiinflammatory drugs were a significant part of therapy. ADRs reported were generally mild in severity and involved gastrointestinal tract. Need of the hour is to conduct frequent prescription audits to inculcate good prescribing practices.

KNOWLEDGE, ATTITUDES AND PRACTICES OF SAFE HANDLING OF CYTOTOXIC DRUGS AMONG ONCOLOGY NURSES IN TANTA UNIVERSITY HOSPITALS

Introduction: Occupational exposure to antineoplastic agents and safe handling of cytotoxic drugs (CDs) had gained a high concern among oncology nursing staff due to their potential health risks. Many organizations such as Occupational Safety and Health Administration (OSHA), Oncology Nursing Society and National Institute for Occupational Safety and Health (NIOSH) have recommended guidelines for safe handling of cytotoxic drugs. Aim of work: To assess the knowledge, attitudes, and practices (KAP) of oncology nursing staff working at Tanta University Hospitals towards the safe handling of CDs. Materials and methods: A cross-sectional study was conducted for 3 months (from February to April, 2018) at the Oncology department in Tanta University Hospitals, Egypt. A pre-designed questionnaire was used to assess nurses` KAP regarding safe handling of CDs. Results: A total of 55 oncology nurses participated in the study. The total KAP scores of nurses towards the safe handling of CDs were satisfactory among 63.6% of the studied group. The mean scores of responses for knowledge, attitudes, and practices were 19.05 ± 4.8 out of 26, 13.09 ± 3.07 out of 16, and 8.87 ± 1.35 out of 12, respectively. More than half of the nurses had previous training in the Oncology department. Defective use of personal protective equipments (PPE) during various steps of CDs handling was noticed. Conclusion: There was inadequate practice of safe handling of CDs and defective implementation of guidelines among the studied oncology nurses, necessitating more frequent in-service training and audit system to monitor and evaluate their performance after training.

Effects of Agency Banking on Bank Performance: A Case of Equity Bank Meru Branch, Kenya

The purpose of this study was to establish the effects of agency banking on bank performance with a focus of Equity Bank Meru Branch, Kenya. The reason for the selection of Equity Bank was because of its large customer base and because of its growth. The study adopted a descriptive research design and the target population was the eighteen agency bank agents. The study used stratified random sampling to select 11 agents that were used in the study. Both quantitative and qualitative data was collected by use of questionnaires with both open and closed ended questions. Data was analyzed and presented using descriptive statistical tools. The study findings indicated that the general cost such as operations and transactions cost were still high even for agency banking, security measures were in place that is physical security though it needed strengthening, transaction security and customer security were not good and needed improvement and the regulations that were in place for agency banking also needed to be improved. The study made the following recommendations: For agent banking operations to be effective, strong internal control systems should be put in place which should be flexible and be evaluated periodically to increase efficiency and effectiveness; there should also be frequent updates of regulations and policies that guide agency banking and procedures that are used in the banking and agency industry in Kenya. Bankers Association in consultation with the Central Bank of Kenya should carry out frequent audit and research in relationship to agency banking to determine any loopholes and challenges in order to advice the banks accordingly. Also banks should work closely with the agents in order to streamline the systems and processes to help achieve efficiency. The results gathered out of the audit and research will help the banks to keep their agents updated.

Effective association between audit committees and the internal audit function and its impact on financial reporting quality: Empirical evidence from Omani listed firms

The role of the audit committee in oversight of the internal control and internal audit function has grown in the last decades as corporate governance mechanisms after the dramatic scandals and failures. This paper examines the impact of the audit committee and the presence of internal audit function on a company's financial reporting quality. Moreover, this study focus on the association between the audit committee and internal audit function and company's financial reporting quality measured as accruals quality and absolute discretionary accruals. It is hypothesized that the financial reporting quality is related to the strength of internal corporate governance mechanisms, including audit committee and internal audit and its association. Different mechanisms are being examined: audit committee size and independence, frequency of meeting, financial literacy, existence of internal audit function and its meeting independently. To test our hypothesis, we employ panel data analysis for 71 nonfinancial firms through 139 observations listed on the Muscat Securities Market during the period of 2013 and 2014. The data used in the analysis were collected from the companies' annual reports published by the Muscat Securities Market. Ordinary least squares is used to regress financial reporting quality linear variables on audit committee and internal audit. The findings suggest that audit committee meetings frequency and the presence of internal audit function positively affect a company's financial reporting quality. Hence, an audit committee that meets more frequently provides effective monitoring of financial reporting and increases the likelihood of discussing and following up any problems and findings in the financial statements and audit reports. Thus, frequent audit committee meetings provide better oversight of the annual accounts. Likewise, the internal audit function is considered an important corporate governance mechanism to safeguard the quality of financial reporting by monitoring organizational risks, assessing internal controls and detecting possible manipulation because the internal auditor evaluates financial procedures. However, results suggest that the relationship between other corporate governance mechanisms and financial reporting quality is not significant.

The External Governance Effect of Government Auditing: Evidence from Firms' Stock Price Crash Risk

As a strong part of government monitoring measures, the role of government auditing and its effectiveness is an important research topic. This paper uses the difference-in-difference model to study the external governance effect of government auditing from a perspective of stock price crash risk based on the setting of audits of CSOEs by the National Audit Office of China (CNAO) from 2009 to 2015. It shows that after the implementation of government auditing, the CSOEs' stock price crash risk reduces significantly, and this finding is robust to a series of robustness tests. Further study indicates government auditing promotes CSOEs' more timely disclosure of bad news, thus reducing their stock price crash risk. In addition, more frequent government auditing leads to stronger role in the alleviation of stock price crash risk and there is the spillover effect of government auditing, namely stock price crash risk of CSOEs that are not audited also reduces after the occurrence of audit events. It is of great theoretical and practical significance to the evaluation and perfection of government monitoring in China.

The effectiveness of sterilization for flexible ureteroscopes: A real-world study

There are no guidelines or quality benchmarks specific to ureteroscope reprocessing, and patient injuries and infections have been linked to ureteroscopes. This prospective study evaluated ureteroscope reprocessing effectiveness. Reprocessing practices at 2 institutions were assessed. Microbial cultures, biochemical tests, and visual inspections were conducted on sterilized ureteroscopes. Researchers examined 16 ureteroscopes after manual cleaning and sterilization using hydrogen peroxide gas. Every ureteroscope had visible irregularities, such as discoloration, residual fluid, foamy white residue, scratches, or debris in channels. Tests detected contamination on 100% of ureteroscopes (microbial growth 13%, adenosine triphosphate 44%, hemoglobin 63%, and protein 100%). Contamination levels exceeded benchmarks for clean gastrointestinal endoscopes for hemoglobin (6%), adenosine triphosphate (6%), and protein (100%). A new, unused ureteroscope had hemoglobin and high protein levels after initial reprocessing, although no contamination was found before reprocessing. Flexible ureteroscope reprocessing methods were insufficient and may have introduced contamination. The clinical implications of residual contamination and viable microbes found on sterilized ureteroscopes are unknown. Additional research is needed to evaluate the prevalence of suboptimal ureteroscope reprocessing, identify sources of contamination, and determine clinical implications of urinary tract exposure to reprocessing chemicals, organic residue, and bioburden. These findings reinforce the need for frequent audits of reprocessing practices and the routine use of cleaning verification tests and visual inspection as recommended in reprocessing guidelines.

Effect of hospital-wide interventions to optimize albumin use in a tertiary hospital.

Albumin has been frequently used as a therapeutic agent based on previous recommendations that are mostly controversial. Considering limited evidence-based indications, common inappropriate albumin use in many hospitals necessitates prompt educational and regulatory interventions. We performed this study to assess the effect of a hospital-wide programme to optimize albumin use in a tertiary referral university-affiliated hospital. This study was conducted in three 45-day phases, separated by two sequential interventions: guideline implementation and albumin order-sheet consideration. We evaluated albumin use and assessed its appropriateness in each phase at baseline, after guideline implementation and after order-sheet consideration. We recorded 100, 93 and 71 albumin orders for 100, 84 and 66 patients during the first, second and third phases, respectively. The adjusted number of albumin orders (used albumin vials) was 94.9 (1481.7 vials), 80.8 (1037.6 vials) and 66 (1219 vials) in the first, second and third phases of the study, respectively. Albumin orders with appropriate indication increased significantly over the three phases of the study (OR=1.5, P=.008). The frequency of inappropriate orders reduced significantly from the first phase to the third phase (58%-27%, P=.007). The pattern and amount of albumin use changed following guideline implementation and order-sheet consideration, and inappropriate albumin use was reduced in our hospital. There was still room for improvement, particularly for indications that were not included in the guideline. Hence, a more comprehensive guideline, frequent audit, feedback and interactive educational approaches might be necessary to achieve results that are of a greater magnitude.

Police Reform Through Data-Driven Management

Over a 2-year span, the New Orleans Police Department (NOPD) transformed from a department struggling to comply with its expansive federal consent decree to one exploring even broader reforms through a data-driven management approach. NOPD believes more than ever in the adage you manage what you measure. NOPD conducts monthly audits of consent decree compliance and distributes the results to hold leadership accountable for implementing reforms. Through frequent audits, NOPD has produced dramatic, swift compliance improvements. Concurrently, NOPD leadership introduced a data-driven management framework that addressed all facets of management: MAX (Management Analytics for Excellence). This article presents the viewpoints of two sides of the consent decree: NOPD and the federal judge overseeing implementation of the consent decree. NOPD and its monitoring partners use MAX’s performance metrics to monitor reform implementation and address areas requiring improvement. This article details how to implement reforms through a data-driven management approach.

Analgesia-based sedation

Analgesia-based sedation

Internal and External Audit Attributes, Audit Committee Characteristics, Ownership Concentration and Earnings Quality: Evidence from Malaysia

The objective of the study is to examine the association between internal and external audit attributes, audit committee characteristics, ownership concentration and discretionary accruals (as a proxy of earnings quality) based on the agency and resource dependence theories. The final sample of the study is 508 firms listed on the Malaysia Main Market from 2009 to 2012. Two measures of discretionary accruals are used, Modified Jones model by Dechow et al. (1995); and extended Modified Jones Model by Yoon et al. (2006). Results of the study suggest that outsourcing internal audit function, investment in internal audit function and external audit fees are related to higher earnings quality. However, large audit committee size, more frequent audit committee meetings, having a senior or former audit partner as audit committee chairman and ownership concentration are associated with lower earnings quality. This study extends the prior related literature by apply extended modified Jones model by Yoon, et al.’s (2006) of discretionary accruals to measure earnings quality in Malaysia Main Market listed companies and introduce new variables, namely audit committee chairman who is a senior or former audit partner in the audit firm. DOI: 10.5901/mjss.2015.v6n3p458