Implementation Of System Research Articles

Quality Management in Spanish Community Pharmacy: Implementation of ISO 9001.

Spanish community pharmacy has been incorporating some methods and approaches in the evaluation and improvement of quality, with the ISO 9001 standard being the most used reference. The experience of a community pharmacy in Spain is presented. The pharmacy implemented a management system based on the ISO 9001 standard in 2020, using the Deming cycle with the aim of enhancing the quality of pharmaceutical care. The results obtained in the processes over the following 2 years are also presented. The ISO 9001 standard was reviewed to ensure compliance. The Quality Management System control documentation was updated and included the following documents: quality manual, process map, operational processes and procedures, quality indicators and incident records. The pharmacy has planned and implemented a process of monitoring, measurement, analysis of results and continuous improvement for operational, strategic and support processes during the time period of the study. The main operational processes were associated with a set of indicators which permitted to know the results obtained, analyse deviations and implement improvements. The planning and development of the project encompassed approximately 1 year and involved several key stages: (1) diagnosis and assessment of quality situation, (2) analysis of processes, (3) preparation of documentation, (4) implementation of the Quality Management System, (5) internal audit, (6) monitoring of activities and continuous improvement, (7) follow-up audit by the certifying body, (8) obtaining the ISO 9001:2015 quality certificate. The planned schedule was adhered and the documents were successfully drafted. In total, eight operational processes, nine support processes and six strategic processes were reviewed and included in the Quality Management System. Twenty indicators were established to monitor and analyse the performance of these processes. During audits, deviations in the system or nonconformances were identified and analysed. In the first year of system implementation, five nonconformances were identified, decreasing to two in the subsequent two periods. In 2020, three improvement actions were implemented with the objective of: (1) implementing a medication reconciliation service, (2) developing a medication dose adjustment service for polymedicated patients, and (3) implementing a service to measure and improve inhalation technique in patients using inhalers. The implementation of a methodology based on the ISO 9001 standard has facilitated: (1) Integrating process management as a regular working methodology, (2) A focus on the continuous improvement of services, (3) Achieving recognition of the staff efforts and involvement.

Why an Integrated Approach to Tick-Borne Pathogens (Bacterial, Viral, and Parasitic) Is Important in the Diagnosis of Clinical Cases.

Tick-borne diseases have emerged as a major global public health problem in recent decades. The increasing incidence and geographical dissemination of these diseases requires the implementation of robust surveillance systems to monitor their prevalence, distribution, and public health impact. It is therefore not unexpected that tick-borne pathogens coexist in the same vectors, but the interactions of these agents between vectors and vertebrate hosts, including humans, remain poorly understood. The impact of infection in humans extends to the diagnostic challenges that arise when the same symptomatology can be associated with any tick-borne pathogen, and therapeutic recommendations only focus on the major or best-known tick-borne diseases, ignoring other lesser-known or less prevalent infections. Both surveillance systems and the holistic diagnosis of tick-borne pathogens are necessary tools to address the emergence of vector-borne diseases. In this study, we will focus on the main tick-borne viral, bacterial, and parasitic diseases in Spain to reflect the need to establish syndromic diagnostics in samples from patients with a history of tick bites and symptomatology compatible with them. On the other hand, and highlighting this need, innovations in molecular techniques, syndromic surveillance, and surveillance programs for ticks and tick-borne pathogens with public health implications are expected to be developed.

Development of a Smart Lock System using QR Code Technology

A smart lock system refers to a modern security solution that enables users to remotely control access to their homes or businesses using a smart device such as smartphone, tablet, or computer. This paper presents the development of a smart lock system using Quick Response (QR) code technology to address the problem of insecurity, inconvenience, and inflexibility in access control. The proposed system eliminates the need for physical keys or complex authentication and verification methods. The system integrates an ESP8266 microcontroller, barcode scanner, 16x2 liquid-crystal display (LCD), solenoid lock, relay, and a 12V power supply. The system allows authorised users to generate unique QR codes representing their access credentials through a user-friendly interface. These QR codes are scanned by the system, which processes the codes, verifies access permissions via a central server and provides real-time feedback through the LCD. Upon successful verification, the system triggers a relay to control the solenoid lock, to grant or deny access. The implementation and testing of the smart lock system demonstrated successful operation. The performance indices include authentication speed, system reliability, accuracy and response time, which were evaluated and found to be satisfactory. The obtained results showed that the proposed system outperformed traditional methods such as keys, and fingerprint authentication, with an access speed of 2.00 seconds, which is significantly faster than the alternatives. Comparative analysis with existing access control techniques demonstrated the developed system's enhanced security features and user-friendly operation, making it applicable for residential, commercial, and industrial use. Additionally, the system's scalability and adaptability allow it to be customised for various environments, offering a versatile solution to diverse security challenges. This work contributes to the field of security technology by providing an efficient and scalable smart lock system with novel algorithms, which enhances the convenience, robustness of access control and seamless user experience.

A BALANCED MONITORING SYSTEM AS AN ELEMENT OF ENTERPRISE MANAGEMENT SYSTEM

The article is dedicated to the study of a balanced monitoring system as an element of the enterprise management system. The purpose of the research is to analyze, systematize, and summarize the existing theoretical and methodological aspects of the implementation of a balanced monitoring system and to develop conceptual foundations for monitoring within the enterprise management system. The study examines in detail the role of monitoring as an essential tool in the enterprise management system, particularly in the agricultural sector. It has been determined that monitoring ensures comprehensive control and analysis of various aspects of activity, providing managers with timely and accurate information for making effective managerial decisions. The research demonstrates that promptly identifying deviations and risks allows enterprises to quickly respond to changes, adjust their actions, and minimize potential losses, which is especially important in a dynamic market environment. It is substantiated that monitoring allows enterprises to evaluate the effectiveness of their activities from different perspectives: financial, production, human resources, and environmental, contributing to the identification of strengths and weaknesses in operations and helping to determine priority areas for development. Arguments are provided regarding the importance of monitoring in strategic planning, as it provides the necessary information for forming long-term plans, considering current and projected changes in market conditions. It has been revealed that a balanced monitoring system, which takes into account not only financial but also non-financial indicators, helps to avoid a one-sided approach to enterprise management, facilitating more informed decision-making. The study on the effectiveness of using a balanced monitoring system demonstrated its positive impact on improving the competitiveness of enterprises, particularly through the optimization of resource use, improvement of product quality, and cost reduction. It is noted that monitoring plays a key role in ensuring environmental standards and social responsibility of agricultural enterprises, which is an important factor for maintaining market reputation and complying with international norms. The application of modern automated monitoring systems enables enterprises to quickly adapt to changes in the external environment, respond to demand fluctuations, and make necessary adjustments to their activities.

Administrative and legal framework for the introduction of the electronic notarial system in Ukraine

The article is dedicated to the study of the administrative and legal foundations for the implementation of the electronic notarial system in Ukraine. The author examines the process of transitioning from the traditional paper-based notarial system to a digital one, highlighting the benefits of increased efficiency, document security, and accessibility. The study focuses on the phased approach adopted by the government to implement the e-notary system, outlining key stages such as the creation of electronic registries, the development of a digital archive for notarial acts, and the introduction of a system for online notarial services. These developments represent a significant modernization of Ukraine’s notarial services. The author emphasizes the need for substantial legal reforms to support the full-scale digitalization of notarial services. It is highlighted that the Ukrainian Law on Notariate currently lacks explicit provisions for the use of digital technologies, which necessitates amendments to accommodate electronic notarial acts, remote notarization, and the integration of digital signatures. Additionally, the article discusses the challenge of aligning the e-notary system with European standards, especially regarding the cross-border recognition of electronic documents. The alignment of Ukrainian notarial laws with international frameworks is crucial for ensuring the system’s compatibility with global legal standards. The article identifies several key advantages of the e-notary system, including the automation of processes, which significantly reduces the time and administrative burden involved in notarial acts. Enhanced security measures, such as digital signatures and QR codes, provide protection against forgery and unauthorized alterations of notarial documents. Furthermore, the integration of the e-notary system with state databases facilitates efficient information exchange, thereby improving the accuracy and reliability of notarial services. These factors contribute to a more transparent and effective notarial system that can better meet the needs of modern society. Of particular note is the author’s focus on the importance of cybersecurity and data protection in ensuring the long-term success of the e-notary system. The article underscores the need for robust security measures to protect sensitive legal information from cyber threats, which are increasingly becoming a concern in the digital age. The author concludes by outlining prospects for further research, particularly in the areas of legal reform, public trust in digital notarial services, and the technological infrastructure needed to ensure the resilience and security of the electronic notarial system.

Semi-Aerobic Landfill System as Alternative Solution for Indonesian Landfill

Indonesia has been encountering pressing problems in managing municipal solid waste (MSW). According to data from the Ministry of Environment and Forestry (KLHK), up to 35.46% of landfills were run as open-dumping landfills until May 2022 because proper sanitary landfill concepts were not fully implemented and the condition of landfills in Indonesia is on the point of being overcapacity. With the development of landfill technology, the Ministry of Public Works is currently starting to develop other alternative landfill systems. From the general findings of this study, it can be concluded that the semi-aerobic landfill system is an available method to be used as an alternative solution for Indonesian landfills. This is based on the results of the SWOT matrix, which shows strategic factors derived from internal and external factors originating from previous studies and issues regarding landfills in Indonesia. The analysis of these factors shows that the semi-aerobic landfill system produces better performance by reducing the potential for environmental pollution of water and air and greenhouse gas emissions. The implementation of a semi-aerobic landfill system is a viable method to be used in developing countries.

Impact of Family Mutual Aid System for Personal Medical Insurance Accounts on Paediatric Patients' Outpatient Utilisation Patterns and Costs: a difference-in-differences analysis.

This study explores the effect of the transformation of paediatric healthcare through the implementation of the Family Mutual Aid System (FMAS) for personal medical insurance accounts, among paediatric patients at a children's hospital (Hospital A in Shanghai, China). We conducted a cohort study in the endocrinology department of Hospital A from August 2021 to July 2023 to assess the impact of the FMAS enrolment on patients' annual outpatient visits, annual outpatient expenditures, and the allocation of these costs among the Basic Medical Insurance Pooling Fund and patients' out-of-pocket (OOP) expenses, with a further subdivision into online and offline consultations. Analysis employed a weighted Difference-in-Differences approach within a fixed-effects model following Propensity Score Matching. The study encompassed 10,975 paediatric patients, divided into those enrolled in the FMAS (observation group) and those not (control group). Enrolment in FMAS was associated with a statistically significant increase in annual outpatient visits by an average of 1.107, predominantly attributed to an uptick in offline consultations. Additionally, there was a substantial 38.9% rise in annual outpatient costs. Detailed analysis revealed a 52.5% increase in costs covered by the medical insurance pooling fund, while patients' OOP expenses decreased by an average of 69.2%. These findings highlight the beneficial effects of FMAS enrolment on healthcare service utilization and risk-sharing mechanisms of medical insurance.

Research on the effect of multiple credit ratings from the perspective of financial regulatory systems in Chinese bond market.

This paper, starting from the effects of financial regulatory policies, considers the interaction between Chengxin_Moody and Lianhe_Fitch with the dual rating system and the multi-rating system, constructs a new ordered Logit model, and attempts to explore the impact of the Notice, the dual rating system and the multiple rating system on the probability of Chinese corporate bond defaults, rating upgrades, rating downgrades, and the magnitude of credit rating migrations. This study compares the effectiveness of different rating regulatory systems. Using nine thousand two hundred and sixty-two data of Chinese corporate bonds as the research samples. Empirical analysis and robustness test reveal the following findings: (1) The issuance of the Notice has a significant positive effect on the implementation of both the dual rating system and the multiple rating system, with a greater impact on the implementation of the multiple rating system; (2) The issuance of the Notice, along with the dual rating system and the multiple rating system, can all reduce the probability of corporate bond defaults, with the multiple rating system showing the best preventive effect against corporate bond defaults; (3) The dual rating system is more effective in promoting rating agencies to adjust rating behaviors, accurately correcting corporate bond ratings and effectively alleviating the issue of rating inflation. Competition among rating agencies intensifies rating shopping; (4) Under the dual rating system, rating agencies are more likely to expand the magnitude of credit rating upgrades and downgrades, enhancing the differentiation between high-quality corporate bonds and junk corporate bonds; (5) The selection of rating information from Chengxin_Moody and Lianhe_Fitch can appropriately adjust the degree of flexibility or tightening in response to rating regulatory systems. Chengxin_Moody demonstrates a more sensitive reaction compared to Lianhe_Fitch regarding the rating regulatory systems. This study provides valuable references for the formulation and evaluation of the effectiveness of Chinese corporate bond rating regulatory policies.

Research on Financial Regulation and Sustainable Development of Real Estate Markets

The sustainable development of real estate is related to the interests of all parties, and it is of great significance to strengthen the macro-control and supervision of the real estate market to promote the sustainable development of the property market. This paper, taking Hangzhou as an example, points out that changes have occurred in Hangzhou's current macro-control policy system and the latest regulatory policies through literature review and case analysis. These changes are based on land supply, developer credit management, presale fund supervision, and financing credit support for enterprises, etc. These policies have played a positive role in the current sustainable development and transaction of Hangzhou's real estate. However, in the long run, there are still shortcomings in the top-level design of regulatory policies, policy implementation, and regulatory systems. This paper believes that in order to promote the sustainable and healthy development of Hangzhou's real estate market, improvements need to be made in policy optimization, regulatory models, and regulatory systems, so as to better play the unique role and value of policy regulation and better serve the overall economic situation. The research of this paper will also play a positive reference role for the real estate regulatory policies of other cities.

Enhancing Healthcare with Personalized Recommendations: A Machine Learning Approach to Symptom-Driven Diagnosis

This paper introduces the Personalized Medical Recommendation System, a machine learning-based platform that supports users in symptom analysis and personalized healthcare management. Users input symptoms through a simple interface, and machine learning models predict potential diseases. The system offers tailored recommendations, including suggested medications, prescription details, and exercise routines. Built on a Flask web application, it provides accessible healthcare support with a strong focus on data privacy and security. Continuous improvement through user data refines predictive accuracy, advancing personalized medicine. This study outlines the system's design, implementation, and performance, underscoring its potential to enhance health outcomes. Key Words: personalized healthcare, machine learning, disease prediction, medical recommendation system, symptom analysis, data privacy.

Influence of Information Security Awareness on Information System Implementation in Manufacturing Industry in China

Information security is one primary function of any information management system, ensuring protection of sensitive information like financial data, customers’ credentials and intellectual property from unauthorized and illegal access. The present study, while emphasizing on an effective implementation of information system, aimed to examine the impact of information security awareness (ISA) on self-efficacy to comply (SEC), attitude towards compliance (ATC) and intention to comply (IC) and the role of these constructs on information system implementation in the manufacturing industry in China. The study also examined the mediation role of SEC, ATC and IC among ISA and information system implementation. Data was gathered through surveys responded by a sample of 357 employees of the manufacturing industry in China. To check the data reliability and association among variables, smart-PLS was used, which indicated that ISA had a positive impact on SEC, ATC and IC and these constructs, in turn, positively impacted information system implementation. The results also exposed that SEC, ATC and IC significantly mediate among ISA and information system implementation in the manufacturing industry in China.

Online Voting System Using Blockchain: A Secure and Transparent Approach

Blockchain technology has emerged as a viable solution for secure and transparent digital voting systems. Traditional voting systems, particularly online voting mechanisms, are often vulnerable to security risks such as hacking, tampering, and vote manipulation. Furthermore, maintaining voter anonymity and ensuring data integrity are significant challenges. Blockchain, with its distributed and immutable ledger, offers potential solutions by providing a secure and decentralized approach to recording votes. This paper explores the architecture, implementation, and advantages of a blockchain-based online voting system that leverages the security features of blockchain technology to improve the voting process. By utilizing cryptographic principles and decentralized data storage, the system enhances transparency, reduces fraud risks, and ensures that votes remain immutable. The proposed system includes mechanisms for voter registration, vote casting, and result verification, all of which are secured by smart contracts. Experimental results demonstrate that blockchain can maintain voter anonymity, resist tampering, and provide an auditable voting trail. Additionally, the study discusses challenges in scalability, latency, and regulatory compliance, offering insights into potential improvements and future work. Overall, the research indicates that blockchain based voting has the potential to transform electoral processes, providing a trusted digital voting alternative that aligns with democratic principles. Key Words: Blockchain Technology, Digital Voting, Online Voting Systems, Data Integrity, Transparency, Security, Cryptography, Smart Contracts, Voter Anonymity, Tamper-Resistance, Immutable Ledger, Scalability, Decentralization.

Ensuring AI Algorithm Fairness in Healthcare Decision-Making

This paper provides a comprehensive analysis of artificial intelligence (AI) implementation in Ghana's healthcare system, synthesizing findings from recent Ghanaian studies. It examines legal and regulatory frameworks, ethical considerations, bias and fairness, transparency and accountability, interdisciplinary approaches, patient rights and data protection, healthcare access and equity, and implementation and oversight. The analysis reveals both significant opportunities for AI to improve healthcare delivery in Ghana and substantial challenges in ensuring its ethical, equitable, and effective implementation. Key findings highlight the need for AI-specific healthcare regulations, investment in local capacity building, culturally sensitive AI design, robust fairness and accountability mechanisms, and ongoing stakeholder engagement. This paper contributes to the discourse on AI in healthcare in developing countries, offering insights into the unique challenges faced by lower-middle-income countries. It aims to inform evidence-based policymaking and enrich academic understanding of AI implementation in diverse cultural and economic contexts.

Enhancing Urban Traffic Flow Through Fuzzy Logic-Based Signal Light Control Optimization

Urban traffic congestion is an urgent problem, which is aggravated by the fixed-time urban traffic signal control system. In order to solve this problem, optimization based on fuzzy logic provides flexibility to adapt to real-time traffic conditions. This study discusses the application of fuzzy logic in traffic control and puts forward the optimization scheme of urban traffic light system, including the design of fuzzy controller, the formulation of fuzzy rules, and the system implementation. The results show that compared with the traditional method, the traffic flow and efficiency have been improved, which shows that it has great potential in the real world. By considering the dynamic characteristics of traffic conditions, this method can realize a more flexible and effective control strategy. It is possible to significantly improve the quality of urban transportation system by implementing this method in real scenes.

Multi-cylinder leveling control systems based on dual-valve parallel and adaptive eccentric torque suppression

In the composite material hydraulic press, the mismatched velocities between the movable beam and the multiple leveling cylinders produce disturbing superfluous forces, and the eccentric torque causes the movable beam to tilt when pressed. They severely damage the leveling displacement accuracy and limit the implementation of muti-cylinder system in higher precision field. A dual-loop leveling control strategy is proposed, comprising a dual-valve parallel pressure inner loop and an adaptive control displacement outer loop. Firstly, a dual-valve parallel scheme is proposed in the pressure inner loop, where a compensation valve is added in parallel with the original single-valve. A variable compensation valve spool algorithm is designed, considering both velocity and displacement to mitigate the effects of superfluous forces and achieve precise and smooth leveling. Secondly, a control strategy for the adaptive displacement outer loop is designed to estimate and compensate for eccentric torque. An innovative torque decoupling algorithm is formulated to overcome the challenge of indeterminate coupling relations between inner and outer loops caused by the adaptive incorporation of dual-loop control. Then, eccentric load compensation torque is decoupled to the multiple leveling cylinders and derives the desired pressure for the inner loop. The inner loop suppresses the disturbance of eccentric torque to enhance robust leveling precision. Finally, the effectiveness of the proposed strategy was validated through experimentation on the constructed hydraulic press leveling system test bench. The control strategy presented in this paper provides a reference for achieving smooth and precise control in multi-cylinder systems.

Business Process Clustering in Small and Medium Manufacturing Industries Based on Enterprise Resource Planning Concepts: A Systematic Literature Review

Abstract Business process management has become increasingly important in the manufacturing sector, playing a vital role in fostering productivity and facilitating organizational adaptability to technological advancements. Although each company’s business process models vary in uniqueness and complexity, certain similarities can be identified from these differences. This study employs a systematic literature review to aggregate and summarize findings on business process models, modeling languages, clustering techniques, and foundational clustering principles. Results demonstrate the dearth of research on the grouping of business process models in the manufacturing industry. Several studies have focused on sectors such as services, trading, and insurance. Research specifically addressing clustering in the manufacturing sector is limited. Existing clustering efforts in manufacturing revolve around groupings related to product defects, industrial locations, business ecosystems, and similar factors. Analysis of the methods, scope, and criteria used in grouping business process models in the manufacturing industry indicates that most approaches rely on structural or graphic similarities. Follow-up research is lacking once these business process clusters are identified. This study proposes a novel approach to grouping, integrating business process modeling with the implementation of a management information system. Business process management relies on integrating departments within the company through an enterprise resource planning (ERP) system. The next step involves proposing a conceptual framework to categorize business processes and assess the comparability of models in the manufacturing sector. Future research directions are also delineated.

Design and implementation of a smoke alarm system using YOLOv8

Abstract. This paper present a smoke alarm system built using Yolov8, a state-of-the-art object detection model. The system is designed to detect smoke in real-time environments and alert users in the event of a fire or smoke detection. The use of Yolov8 in this system offers several advantages over other object detection models, making it a suitable choice for building an effective smoke alarm system. One of the critical advantages of Yolov8 is its high accuracy in detecting objects with a small size, such as smoke. This is achieved through its efficient and robust architecture, which allows it to process images quickly and accurately. In comparison to other object detection models, Yolov8 demonstrates superior performance in terms of speed and accuracy. Furthermore, Yolov8s ability to detect objects with high precision and low false positives is crucial for a smoke alarm system. This is because smoke detection needs high accuracy to prevent false alarms and promptly detect real threats. The smoke alarm system built using Yolov8 can be implemented in various environments, including homes, offices, and public buildings. It can provide early warnings for fires and smoke, enabling timely evacuation and reducing potential injuries or damages. The implementation of this system can greatly contribute to improving safety in various environments by providing early warnings of fires and smoke.

Corporate Technology for the Implementation of an Automated System: Functional, Technological and Methodological Aspects

The purpose of the study is to form a methodological justification for the pedagogical model of the individual trajectory of professional development of bachelors and masters for the implementation of the stages of creating an automated system based on the principles of continuity and experimental verification of its application in the educational process of the university in accordance with the requirements of IT departments, vendors and employers. It is shown that there is a gap between the socio-economic order for the training of IT specialists with high professional competence in the field of information systems and the insufficient level of targeted formation of their readiness to implement the stages of creating automated systems. In addition, the lack of methods and practical recommendations for the implementation of such systems in the context of maximum preservation of corporate standards and taking into account the requirements of Russian legislation, as well as specialists competent in these matters, determined the feasibility of conducting the study in two aspects - functional-technological and pedagogical.Methods and materials. The key methods are structural-functional and process modeling, interactive methods of organizing the educational process (project method, etc.). The research materials include a functional model for developing a corporate technology for implementing an automated system in the form of a function tree.Results. The results present a model of causes and factors determining the success of the projects for the implementation of the automatization systems. The role of the factor “qualification of the performing team” and the possibilities of the educational environment of the university to influence this factor are considered. The pedagogical aspect of the research problem is determined by the methodological justification for conducting students’ project work within a number of disciplines for training bachelors and masters in the field of “Applied Informatics”. The description of the structure and requirements for students’ projects gives an idea of the level of formed competencies, their consistency with the work functions of specialists in the field of information systems.Conclusion. At this stage of work on the research problem, its dual nature was determined. On the one hand, modern IT projects require their own technologies and management methodologies, which should change from project to project, so it is important to have practical recommendations for the development of corporate technology for the implementation of an automated system. On the other hand, one of the success factors of the project for the implementation of an automated system is the “Project Implementation Team”, its level of qualification. This factor is successfully determined and influenced by educational institutions responsible for training specialists in this field. In this direction, the project method plays a key role. It ensures the development of communication skills, the ability to independently pose a problem and develop a way to solve it together. Methodological aspects and practical results, generalizing the pedagogical model for training bachelors in the field of creating automated systems presented in the paper, as well as the development of corporate technology for the implementation of information systems, were reflected in three electronic multimedia educational publications: “Portfolio of Software Engineering Projects”, “Theory and Practice of IS Implementation”, “Theory and Practice of IS Maintenance”.

Human Factors Engineering (HFE) Considerations for Mounting Internal Interfaces in Heavy Vehicles

Trucking fleets often need to install additional displays and consoles in vehicles to interface with the driver. These devices may be used for fleet management, assistance with logistics, or connecting to business applications. However, if these devices are installed without consideration of the drivers, the users may become distracted or frustrated with the system. Therefore, a human factors engineering (HFE) approach to the installation of additional console(s) reduces the likelihood of rework, distractions, and driver inconvenience. Model-based systems engineering (MBSE) approach utilizing best practices for HFE design is presented in this paper. The results of the effort are captured with a prototype assembly bracket used in the production version of the heavy vehicle. The plan-do-study-act (PDSA) model-based human factors systems engineering methodology demonstrates efficiencies in the design and implementation of the display system. This method proved effective as new mounts were fitted in a preproduction electric vehicle before they were released in production.

An audit to review compliance to cisplatin hydration guidelines within the royal Marsden NHS hospital

Abstract Introduction Cisplatin is a cytotoxic agent that forms the backbone of many cancer regimens.1 Cisplatin exhibits good anti-tumour activity however it can accumulate in the renal proximal tubules, leading to nephrotoxicity. It is therefore essential that adequate hydration with diuretics and fluids alongside is administered prior, during and after cisplatin infusion to promote renal perfusion.2 The local policy for intravenous hydration for cisplatin-based regimens states that adult patients are to be weighed prior to treatment and weighed again after treatment to ensure they have not developed fluid retention.3 This audit was necessary following the implementation of the new electronic prescribing system, where nurses no longer got prompted to weigh patients in the same way they did before. Aim To assess the level of compliance with current locally approved guidelines for cisplatin hydration administration since the launch of the new electronic prescribing system (EPIC). Methods Ethics approval was not required for this audit as retrospective use of anonymous data. Compiled records of 262 patients who were prescribed cisplatin-containing regimens from 17th March 2023 until 31st November 2023 were used to identify patients for inclusion in the audit. Data collection was performed retrospectively using a data collection form and a pilot study was carried out on 20 patients. A sample size of 144 patients was obtained using the Raosoft sample size calculator to achieve a 95% confidence interval with a 5% margin of error accepted.3 All data were collected by the auditor. Patients’ hospital numbers were then individually searched on EPIC to identify if weights were recorded pre- and post-administration of cisplatin. Treatment plans and medical notes on EPR were checked to identify if escalation was appropriately followed where patients gained >2 kg and, in this case to see if furosemide 20mg tablet was given. In addition, laboratory test results and structured notes were reviewed to ascertain if an increase in serum creatinine occurred and if patients were admitted to hospital as a consequence. Data was directly input into Microsoft excel for data analysis. Results The majority of cisplatin administration episodes (72%) did have the patient’s weight recorded before and after treatment. Of the remaining 28% where the weight was missing or incomplete, 4 episodes resulted in a documented AKI and 3 of these episodes were severe enough to warrant hospital admission. Discussion and conclusion The results demonstrate a lack of documentation of patient’s weights across RMH. Only 72% of patients who were administered IV cisplatin at RMH between 17th March 2023 and 31st November 2023 were recorded. This falls below the local guidance, which recommends all patients (100%) should be weighed pre- and post- cisplatin administration. Documentation is critical to ensure a clear audit trail and to enable identification pf patients who may be at higher risk of developing fluid retention. This therefore needs improvement. A limitation of the audit is the increased potential for human error due to the way data was collected. The requirement to search through all structured notes and observations flowsheet was time consuming and intensive, increasing the likelihood documentation may have been missed.