Improve Patient Safety Research Articles

Risk Assessment and Recommended Approaches to Optimize Infection Control and Antibiotic Stewardship to Reduce External Ventricular Drain Infection: A Single-Center Study

Background: An external ventricular drain (EVD) is used to release elevated intracranial pressure by draining cerebrospinal fluid (CSF) from the brain’s ventricles. The establishment of an EVD is one of the most commonly performed neurosurgical procedures to treat intracranial pressure in patients. Nevertheless, infections are very frequent complications. Identifying the risk factors for EVD-related infections is a key to improving patient safety and outcomes. Methods: We conducted a retrospective, single-center study of patients who underwent EVD implantation between January 2022 and March 2024. Patients were classified into infected and non-infected groups based on their clinical symptoms, as well as laboratory and microbiological results. Patient characteristics and possible risk factors for infection were compared between the two groups. Results: In total, 123 patients treated with 156 EVDs were included in this study, with a mean age of 55.8 (range: 25–84) years. EVD-associated infections were observed in 37 patients (30%). We found no significant association between infection risk and patient characteristics, including gender, primary diagnosis, craniotomy, or immunosuppression. There was no significant difference in terms of EVD insertion, i.e., whether the insertion took place in the operating room (OR) with antibiotic prophylaxis or outside the OR with no periprocedural antibiotic treatment. However, within the intensive care unit (ICU), EVD infection was much lower (13%) if EVD insertion took place in a single-bed room compared to multiple-bed room insertions (34%). Furthermore, there were significant differences in terms of the duration of first EVD (both single and multiple catheterizations) (p < 0.0001) and the total catheterization time (p = 0.0001). Additionally, there was a significant association with patient days in the ICU and EVD catheterization. Conclusions: Revisiting infection control measures is necessary, with special attention to the replacement of EVDs in single-bed ICU rooms, to introduce antibiotic prophylaxis in the ICU. Minimizing unnecessary EVD manipulation during catheterization is crucial in order to decrease the risk of EVD infection.

Pharmacovigilance insights into drug-induced cystitis: analysis of FDA data from 2004 to 2024.

Drug-induced cystitis (DIC) significantly impacts patient quality of life and treatment outcomes. This study investigates the incidence and characteristics of DIC using data from the FDA Adverse Event Reporting System (FAERS). We reviewed FAERS reports related to cystitis from Q1 2004 to Q1 2024, compiling a list of potential causative drugs. The top 50 drugs with the highest number of cystitis reports were ranked. Statistical disproportionality analyses, including Proportional Reporting Ratio (PRR) and Reporting Odds Ratio (ROR), were used to detect unusually high reporting frequencies of cystitis associated with specific drugs. From 17,703,515 FAERS reports spanning 2004-2024, 36399 involved cystitis. The majority of implicated drugs were antineoplastics. Busulfan, BCG, and mitomycin had the highest ROR and PRR values. Additionally, drugs such as defibrotide sodium, milrinone, and dyazide, which do not have cystitis listed on their labels, were identified, highlighting the need for increased clinical vigilance and awareness. The findings underscore the importance of ongoing pharmacovigilance in identifying and characterizing DIC. Further clinical studies are warranted to validate these associations and to develop strategies for mitigating the risk of DIC, thereby improving patient safety and treatment outcomes.

Safety of inpatient care in surgical settings: cohort study

ObjectivesTo estimate the frequency, severity, and preventability of adverse events associated with perioperative care, and to describe the setting and professions concerned.DesignMulticenter retrospective cohort study.Setting11 US hospitals.Participants1009 patients from a...

Cyclin-dependent kinase 4/6 inhibitors and cardiotoxic events in breast cancer: A pharmacovigilance study based on the FAERS database.

Recent trials have highlighted the cardiotoxicity of ribociclib, a CDK4/6 inhibitor, particularly its association with QT prolongation. However, studies on the link between CDK4/6 inhibitors and cardiotoxic events show inconsistent results, and the factors influencing these events and related drug interactions remain underexplored. To address these uncertainties, our study utilizes the FDA adverse event reporting system database (Q1 2015 to Q1 2024) to examine the cardiotoxic events of CDK4/6 inhibitors in breast cancer patients. We employed a comprehensive analytical framework, applying disproportionality methods including Bayesian confidence propagation neural network, proportional reporting ratio, and reporting odds ratio. Our findings highlight significant variability in cardiotoxic events among different CDK4/6 inhibitors, with ribociclib (IC: 0.26, 95%CI: 0.18-0.34) exhibiting pronounced cardiotoxicity. Notably, ribociclib was associated with serious cardiotoxic events such as torsade de pointes/QT prolongation (IC: 2.11, 95% CI: 1.90-2.29) and conduction defects (IC: 2.07, 95% CI: 1.87-2.23). For the first time, palbociclib has been identified with positive signals for cardiotoxic events at the preferred terms level, including pulmonary oedema, increased blood pressure, myocardial infarction, and cardiac flutter. Moreover, multivariable logistic regression and Bayesian network analyses reveal that age, geographic location, and the number of concomitant medications significantly influence cardiotoxic events. Our study also highlights significant drug interactions that increase the probability of specific cardiotoxic outcomes, notably with drugs like sertraline, lansoprazole, capecitabine, and torasemide. These findings highlight the need for personalized treatment plans to mitigate cardiotoxic events and improve patient safety.

AHP SO05 - First year experience of running a specialist pre-op clinic for patients undergoing a Whipple procedure that focuses on patient education and improving theatre utilisation

Abstract Background The Whipple’s pre-operative clinic was organised to ensure patients were fully aware of the impact of this operation. Additionally, it was implemented to reduce the risk of preventable theatre cancellations and unfilled operating theatre slots arising given the challenges currently faced in the current NHS climate. The primary aim of the clinic is to improve education to ensure the patients are aware of what the procedure and aftercare entails. A secondary aim is to identify correctable issues in the pre-operative period which could prevent surgery from proceeding safely. Method The clinic ran over 12 months in the tertiary HPB centre at University Hospital Southampton. The clinic has two elements: a 30min video appointment with a specialist nurse for each individual patient to provide comprehensive information regarding the procedure This was followed by a checklist to ensure there was appropriate up-to-date imaging available, as well as a review of the latest blood tests and current medications. Results There were a total of 105 patients reviewed in the clinic. Due to this new service, 21 (20%) essential interventions were made. These included requesting or reviewing new imaging (n=14) correcting anticoagulation plans (n=2) and admitting patients for optimisation prior to surgery (n=2). A total nine all day theatre lists were saved as a direct result of this clinic. Costing of each theatre is estimated at £12,000. Five (5%) patients had their surgeries cancelled in advance and all theatre slots were subsequently re-allocated. Four (4%) patients had interventions which directly prevented an on the day cancellation. Conclusion These results show that there are significant benefits from running a specialised pre-operative Whipple’s clinic. Multiple interventions have led to improving patient safety, optimising theatre utilisation and improving patient experience.

VS 04 - HPB Laparoscopic trans-vesical approach is safe management for cholecystoduodenal fistula

Abstract Background A 71 year old female initially presented cholangitis. Her MRCP showed a distal common bile duct (CBD) stone. An ERCP was then performed which was not successful due to anatomical challenge in the form of a large diaphragmatic hernia. An elective laparoscopic cholecystectomy with IOC was performed. An incidental cholecystoduodenal fistula was found therefore the clinical decision was made to perform a trans-vesical approach to fistulogram. This showed a fistula was present and that it was not complicated further. This case shows that this approach avoided iatrogenic injury by confirming presence of the fistula and aided further surgical planning. Method Standard four-port technique with 10mm, 30-degree laparoscope. Blunt, sharp, energised and hydro-dissection were employed. The duodenum was adherent to the gallbladder body therefore a trans-vesical enterotomy was performed. Fistulogram confirmed presence of a cholecystoduodenal fistula but nil further pathology. The fistula was dissected from the gallbladder and stapled with the GIA endo- tri-staple 45 Purple. Further dissection to gallbladder to ensure clear visualisation of calot’s triangle. Basket trawl of the CBD was performed and repeat cholangiogram was clear. The gallbladder was dissected from gallbladder fossa, all gallstones were removed and 3L of wash was used to irrigate the intra-abdominal cavity. Results The patient was admitted following the procedure and was discharged on day two with PPI. She was reviewed post-operatively at 12 weeks and had no further issues. She remains well and has had no further episodes of cholangitis or hospital admissions in almost four years since the procedure. Conclusion This case shows an unexpected finding of cholecystoduodenal fistula in a planned laparoscopic cholecystectomy with IOC. It is important to note that some gas was seen in the gallbladder on initial imaging therefore indicating a possible cholecystoduodenal fistula. This trans-vesical approach with fistulogram confirmed a simple fistula and no further pathology and aided safe surgical planning. This improved patient outcomes and avoided iatrogenic injury thus providing a safer way to manage cholecystoenteric fistula. This novel approach to cholecystoduodenal fistula repair improves patient safety, length of stay and by aiding intra-operative planning and avoiding iatrogenic injury.

Medical arbitration court: status and perspectives

Abstract. More than forty years ago, medical courts, which are arbitration tribunals (arbitration) for resolving medical malpractice disputes, emerged in the United States, while they remain relatively little known in our country. The problem of the study is the legal nature of medical disputes, the object is medical arbitration as a medico-legal phenomenon, the subject is the effectiveness of arbitration in resolving medical disputes. The issue of arbitrability, i.e. the admissibility of arbitration of a dispute: arbitration clauses are often challenged on the grounds that a patient could not reasonably express his or her will due to a medical condition. Despite conceptual difficulties, medical arbitration has been actively developed in the US since the 1980s. Its proponents emphasise a number of advantages over conventional litigation: speeding up the process, compensating a wider range of patients, reducing attorney fees, and improving patient safety. Opponents see as disadvantages the insufficient professional level of arbitrators, simplification of proceedings and its reduction to compensation payments, lack of connection between the activities of medical courts and improvement of the quality of medical care, transformation into an administrative procedure, "privatisation" of arbitration by large corporations. Some countries (South Korea, Indonesia, Mexico) implement arbitration in their country, but its results are rather modest. In Russia, medical disputes are characterised by increased complexity due to certain legal conditions. Alternative dispute resolution procedures are practically not used, and medical arbitration is expressly prohibited by the Code of Civil Procedure.

Unpacking the Role of Interdisciplinary Collaboration in Surgical Teams: A Critical Analysis of Operational Efficiency and Patient Outcomes

Interdisciplinary collaboration is essential for effective surgical operations, impacting both operational efficiency and patient outcomes. This critical analysis explores the dynamics of teamwork within surgical teams, focusing on how structured collaboration can streamline procedures, enhance resource management, and reduce surgical errors. Drawing from existing literature and recent empirical data, the article examines key factors that contribute to successful interdisciplinary collaboration, including role clarity, communication protocols, and mutual respect among team members. Findings reveal that well-coordinated interdisciplinary efforts lead to improved patient safety, reduced postoperative complications, and increased patient satisfaction. However, barriers such as hierarchical structures and communication breakdowns remain significant challenges. This analysis highlights actionable recommendations for fostering effective collaboration in surgical settings, such as targeted training, standardized communication strategies, and clear role definitions. Ultimately, strengthening teamwork within surgical teams not only optimizes operational efficiency but also enhances patient care quality, underscoring the importance of collaborative practices in modern healthcare.

Pharmacogenetic testing: current state of the issue

Aim. The purpose of this work is to emphasize the importance and practical benefits of pharmacogenetics in medicine, demonstrating how the integration of pharmacogenetics into clinical practice can improve treatment outcomes and enhance the safety of therapies. Pharmacogenetics is a rapidly developing branch of pharmacology that studies how genetic variation affects an individual’s response to drugs. By understanding these genetic differences, healthcare providers can tailor drug therapy to maximize efficacy and minimize adverse drug reactions. The field aims to move away from the traditional one-size-fits-all approach and instead personalize medical treatment based on a person’s genetic makeup. The ability to predict a person’s response to medication based on their genetic profile has profound implications. For example, pharmacogenetic testing can identify patients at risk for life-threatening adverse drug reactions, such as drug-induced liver injury. This proactive approach can prevent adverse events, improving patient safety and the overall quality of care. In addition, pharmacogenetics aids in the development of new drugs by identifying genetic markers associated with drug responses, optimizing the drug development process, and reducing the time and costs associated with bringing new drugs to market. Key advances in pharmacogenetics include the identification of genetic polymorphisms in enzymes, such as cytochrome P450, that affect drug metabolism, thereby influencing both safety and efficacy. Pharmacogenetic testing allows doctors to predict the best drug and dosage for a patient, improving treatment outcomes and reducing the risk of adverse drug events. Despite its potential, the integration of pharmacogenetics into clinical practice faces challenges, including a lack of reliable clinical evidence, inadequate physician education, and the need for a comprehensive health IT infrastructure to support the use of genetic data. Ethical and legal issues, such as patient privacy and the risk of genetic discrimination, also present significant obstacles. However, continued research, the development of genetic testing technologies, and interdisciplinary collaborations are paving the way for more widespread adoption of pharmacogenetics, which promises to significantly improve patient care and healthcare efficiency. Key resources such as PharmGKB, CPIC, and the NIH provide valuable information and guidance for clinicians, researchers, and students, helping bridge the gap between genetics research and clinical application. Conclusions. Pharmacogenetics represents a significant advancement in personalized medicine, offering the potential to tailor drug therapies to individual genetic profiles. Although the field has made substantial progress, challenges remain in the form of insufficient clinical evidence, implementation barriers, and ethical concerns. Continued research and collaboration among stakeholders are essential to fully realize the benefits of pharmacogenetic testing in clinical practice.

A mixed method service evaluation of Electronic Prescribing and Medicines Administration (EPMA) within 10 community hospitals in England

Abstract Introduction Electronic Prescribing and Medicines Administration (EPMA) was implemented in 13 adult inpatient wards across 10 community hospitals within one NHS community trust in England, March 2023, replacing paper drug-charts. EPMA, integrates with patients’ electronic health records, includes prescribing, administration, closed-loop supply, discharge prescribing, electronic-tasking between clinicians and provides a medicines audit trail. Laptops enable remote access. Aim To evaluate EPMA against expected safety, quality and efficiencies benefits, assess clinicians’ acceptance of EPMA and impact on pharmacy practice compared to paper-drug charts. Methods Mixed methods1 evaluation conducted in November and December 2023. This evaluation included assessing twenty-six expected multi-dimensional benefits as being achieved, partially achieved or not achieved post-EPMA implementation based on quantitative and qualitative data. Online anonymous surveys were emailed to all eligible clinicians: prescribers, nurses and pharmacy staff working on 13 inpatient wards, containing closed and open questions, adapted according to clinical group for different aspects of EPMA including questions to assess clinicians’ acceptance of EPMA2. These data were analysed using descriptive statistics in Excel. Pharmacy staff working on the inpatient wards and the dispensary were invited to attend separate virtual focus groups for pharmacists, pharmacy technicians and dispensary staff, respectively. These were recorded and transcribed via Microsoft Teams. Eight pharmacists, six pharmacy technicians and five dispensary staff agreed to participate. A semi-structured interview guide was used covering EPMA’s impact on practice, communication, patient safety, benefits and challenges. Thematic-analysis3 of the focus group interviews were undertaken by IA. Themes were validated with pharmacists and pharmacy technicians, respectively. The NHS Health Research Authority decision tool confirmed this evaluation was not NHS Research therefore did not require NHS ethics review or approval. Sussex Community NHS Foundation Trust approved this service evaluation. Results Of 26 expected multi-dimensional benefits post EPMA, 77% were achieved or partially achieved with 13% not achieved. Thirty-seven inpatient ward clinicians responded to the survey: eight prescribers, fifteen nurses, six pharmacists and eight pharmacy technicians. This showed clinicians underutilised some functionalities, although 100% felt confident using EPMA. Overall, 81% of clinicians stated medication safety had improved with EPMA, 16% felt it was the same and 3% felt it was worse, with 92% not wanting to return to paper drug-charts. Clinicians requested further prescribing developments. Thematic analysis identified four themes for pharmacists: maintaining visibility with prescribers, moving towards targeted interactions with prescribers but reducing opportunistic interactions, being increasingly available due to remotely accessing EPMA and improving patient safety through increased prescription checking; and three themes for pharmacy technicians: expanding role, improving workflow and enhancing communication with clinicians. The dispensary staff focus group emphasised that EPMA adversely impacted dispensary workflow. Discussion/Conclusion EPMA achieved some expected benefits. Clinicians have accepted EPMA, perceiving improved medication safety compared to paper-drug charts. Pharmacists are exploring ways of adapting their practice. Pharmacy technicians are enhancing their roles. Recommendations include EPMA system improvements, additional EPMA training, reviewing dispensary and pharmacists’ workflow. EPMA needs time to embed in practice. Limitations of the evaluation included no focus groups for prescribers and nurses, and limited baseline data pre-EPMA.

Development and application of a non-technical skills coaching intervention framework for surgeons: A pilot quality improvement initiative.

Non-technical skills (NTS) challenges experienced by surgeons may degrade performance, ultimately impacting the safety and quality of care delivered to patients. The objectives of this work were to develop a framework for NTS coaching for surgeons and implement a coaching program utilizing the developed NTS coaching framework. Leveraging adult learning and self-determination theories, a specialty-agnostic NTS coaching framework was developed for individual coaching sessions with robotic surgeons. The framework was used to deliver NTS coaching sessions to robotic surgeons. Surgeon's robotic procedures were recorded, and expert raters assessed their NTS using the Non-Technical Skills for Surgeons tool. Measures of surgeon satisfaction, learning outcomes, and performance improvement were determined. Cohen's d statistic was used to estimate the effect size of the coaching intervention. To pilot the program, ten robotic-assisted surgeries (five pre-coaching and five post-coaching) were observed from five practicing robotic surgeons who were recruited from a large academic healthcare system. Expert raters' assessment of surgeons' NTS revealed several exemplar and non-exemplar behaviors. Surgeons were satisfied with the coaching, rating its quality very highly on all NTS dimensions. On a Likert scale of 1 (strongly disagree) to 5 (strongly agree), surgeons had a stronger agreement that the coaching could improve their situation awareness (4.0±.5) and leadership (4.8±.2) skills compared to their decision making and communication (3.8±.7). From the post-coaching observations, coaching had medium-to-large effect on situation awareness (d = .65) and leadership (d = .41), small effect on communication and teamwork (d = .14), and no effect on decision-making. Overall, the coaching intervention had a medium effect on total NTS (d = .33). We presented a quality improvement initiative to enhance the NTS of surgeons by implementing a coaching program that leverages our developed NTS framework. Recognizing the importance of NTS in surgeries, our initiative shows a commitment to continuous improvement of patient safety and quality of care.

Qualitative study exploring perceptions and experiences of Pharmacy technicians’ professional identity in NHS Scotland

Abstract Introduction Pharmacy technicians worldwide share workplace challenges including: job role; scope of practice; level of pharmacist’ supervision; and education1. In the USA, Canada and many European countries, pharmacy technicians require national or state registration2. In the UK, Pharmacy technicians became registered professionals in 2011, as a means of improving patient safety through compliance with General Pharmaceutical Council (GPhC) standards. There are approximately 2,500 pharmacy technicians and 5,500 pharmacists registered with the GPhC in Scotland3. Given the importance of professional identity, and the lack of research exploring pharmacy technicians’ professional affiliation, we explored the perspectives and experiences of pharmacy technicians’ professionalism across Scotland. Aim To explore pharmacy technicians’ perceptions and experiences of their professional status and professional identity. Methods Following West of Scotland Research and Ethics Service Scientific Officer’s approval, Pharmacy technicians from all fourteen Scottish territorial health boards were invited by email using snowball sampling technique to provide a national representation. A draft semi-structured interview was piloted on four pharmacy technicians. Between May and August 2023, 36 pharmacy technicians were recruited: 23 from acute services; mental health (n=1); rehabilitation hospitals (n=1); primary care (n=8); and community pharmacy (n=3). Twenty two participants were interviewed in person and 14 on line. Interviews lasted between 17-91 minutes, were audio recorded, transcribed verbatim and accuracy checked, then analysed thematically using a framework approach and NVivo software. Three researchers analysed data including initial coding, categorisation, and theme generation. Any disagreements were discussed and addressed within the research team. Results Seven themes emerged from the data describing pharmacy technicians: feeling stuck in the shadow of pharmacists; underrepresented in policy and practice; and marginalised, undervalued and underpaid. There was frustration at the lack of awareness of pharmacy technician roles amongst the wider healthcare team. Primary care pharmacy technicians were thought to have more opportunities than secondary care colleagues. There was a pervasive feeling that pharmacy technicians were increasingly squeezed between pharmacists and support workers and a lack of confidence and feeling unsupported in the delivery of clinical roles. Pharmacy technicians acknowledged that they may not have used their initiative to take new opportunities, but did not feel they had sufficient clinical and educational opportunities. Catalysts to professional development were recognised including pharmacy technician led management and leadership, readiness to undertake traditional pharmacist roles and the potential positive impact of strengthened professional identity. Interviewees described the absence of a structured, funded career framework, and lack of post-registration higher-level professional qualification as inhibiting increased responsibility and scope of practice. Discussion/Conclusion Professional registration does not appear to have strengthened pharmacy technicians’ professional identity. There is a pervasive lack of development opportunities impacting negatively on pharmacy technicians and therefore, service delivery across Scotland. A review of defined roles is required. A lack of previous qualitative evaluation limits comparisons with the perceptions and experiences of pharmacy technicians worldwide. Findings offer a starting point to inform practice and policy. Further research could explore pharmacy technicians’ perceptions of the potential impact of the emerging career framework on developing roles and responsibilities. Keywords: Pharmacy technician, Professional identity

DPYD genotype-guided dose personalisation for fluoropyrimidine-based chemotherapy prescribing in solid organ cancer patients in Australia: GeneScreen 5-FU study protocol

BackgroundFluoropyrimidine (FP) chemotherapies are commonly prescribed for upper and lower gastrointestinal, breast and head and neck malignancies. Over 16,000 people with cancer require FP chemotherapies per annum in Australia. Between 10 and 40% patients experience grade 3–4 (≥ G3) toxicities that require hospital-based management ± intensive care admission. Approximately 1% of patients die secondary to FP toxicities. Prospective screening for DPYD gene variants (encoding the key enzyme for FP catabolism) can identify patients at risk of ≥ G3 toxicity and allow for dose adjustment prior to first FP exposure. Evidence supports this as a cost-effective method of improving patient safety and reducing healthcare burden internationally; however, no Australian data confirms its feasibility on a large scale.MethodThis investigator-led, single-arm study will determine large scale feasibility of prospective DPYD genotyping, confirming patient safety and cost-effectiveness within the Australian health care system. 5000 patients aged 18 years and older with solid organ cancers requiring FP chemotherapy will be consented and genotyped prior to commencing treatment, and early toxicity (within 60 days) post-FP exposure will be determined. Toxicity data for DPYD variant carriers who have dose adjustments will be compared to the wild-type cohort and historical cohorts of carriers who did not undergo genotyping prior to FP exposure, and prospective variant carriers who do not undergo dose-adjustment. Prevalence of the four standard DPYD gene variants will be confirmed in an Australian population. Additionally, health economic analysis, implementation research via semi-structured interviews of patients and clinicians, and feasibility of UGT1A1 genotyping will be conducted.DiscussionThis study will determine the prevalence of DPYD gene variant status in Australia and its impact on FP-induced toxicity among Australians with cancer. Feasibility and cost-effectiveness for Australian health care system will be estimated to support national roll-out of prospective DPYD genotyping prior to FP administration. Additionally, feasibility will be confirmed with the intention of including UGT1A1 in future pharmacogenomic panels to aid chemotherapy prescribing.Trial registrationThis trial was registered with the Australian and New Zealand Cancer Trials Registry on 13th Dec 2023, ACTRN12623001301651.

A questionnaire study evaluating the completion and content of unlicensed medicines risk assessments in NHS Trusts

Abstract Introduction Unlicensed medicine (ULM) use is necessary and prevalent within the NHS. Compared to licensed medicines, there are no centralised assessments of safety, efficacy, and quality. The risks associated with using unlicensed medicines have been well documented: increased risk of adverse events, potentially poorer quality formulation and absence of regulated manufacturing and supply standards1. Therefore, there is a requirement for NHS organisations to risk assess the need and quality of unlicensed medicines to reduce harm2. There are currently minimal published data on whether NHS trusts complete these risk assessments and whether practice is standardised3. This study focuses on understanding how NHS trusts in England conduct Unlicensed Medicine Risk Assessments (ULMRA). Aim To determine whether there is variability in the completion, content, and volume of unlicensed medicines risk assessments for unlicensed medicines procured within NHS trusts. Methods An online and anonymous questionnaire was developed and distributed to procurement pharmacy professionals. The questionnaire assessed four key areas: quantity of ULMRA conducted; completion and content of ULMRA; completion of clinical ULMRA; and risk management and mitigation strategies for ULM. To increase response rates, potential respondents were contacted via regional procurement groups as well as the NHS Chief Pharmacist network. Approval for this study was granted by the NHS Health and Research Authority and the University of Reading Ethics Committee. Results Content validity was ensured by a panel of six secondary care pharmacy professionals, achieving a content validity index (CVI) of greater than 0.8 for each question. Thirty-seven responses were received, representing a 20% response rate. Most respondents (48.6%) were pharmacists, followed by pharmacy technicians (45.9%). The questionnaire revealed that 73% of respondents conducted quality and clinical risk assessments for all ULMs before use, and 94.4% had a ULM policy or procedure. Most respondents procured 1-3 ULMs per month, with some conducting over 12 ULMRA monthly. 97% specified procuring imported products licensed in the country of origin and 'Specials' from UK manufacturers, and 57% indicated they procure imported medicines not licensed in the country of origin. 68% of respondents indicated that quality checks were not completed upon receipt of ULMs. Discussion The study highlighted significant variation and duplication in the ULMRA processes across NHS trusts. Variations were identified in the content of ULMRA, professionals completing risk assessments and the volume of unlicensed medicines procured. While most trusts performed quality and clinical risk assessments, inconsistencies in practices and ULMRA content were evident. Standard methodologies for ULMRA and collaborative data sharing could improve reliability and efficiency, reducing patient risk and resource duplication. A limitation of this study is that the low response rate limits generalisability of data. Conclusion This study identified areas of variation within the NHS around the content and quantity of ULMRA completed, as well as some areas of duplication, particularly in the medicines risk assessed. Future research should explore the reasons for variation identified and evaluate the acceptability of current risks. Addressing these variations could lead to improved patient safety and optimised use of NHS resources.

MPharm students’ views and experiences of the teaching of pharmaceutical calculations and their importance in pharmacy practice

Abstract Introduction Accurately undertaking pharmaceutical calculations is an important professional skill as part of a pharmacist’s role ensuring patient safety1. Effective teaching in this area supports safe, high-quality care from future pharmacists. In the United Kingdom, the need to accurately perform calculations is stipulated in the General Pharmaceutical Council (GPhC) standards for initial education and training of pharmacists2. During a review of teaching in this area, the views and experiences of pharmacy students were sought, in order to inform course design. Aim This project aimed to explore undergraduate MPharm students’ views regarding the importance of pharmaceutical calculations to their future careers, experiences of current calculations teaching, and opinions on improving course design. Methods A questionnaire was developed and distributed to Years 1-4 pharmacy students (n=524) at the School of Pharmacy, Queen’s University Belfast (QUB), in December 2023. The questionnaire consisted of 45 questions, collecting demographic information, as well as students’ views and experiences of pharmaceutical calculations, various teaching methods, and student confidence with calculations. Data was transcribed into Microsoft Excel, followed by analysis using descriptive statistics in IBM SPSS. Ethical approval was received from the QUB Faculty of Medicine, Health & Life Sciences Research Ethics Committee (MHLS23_159). Results A total of 271 students responded to the questionnaire, providing a response rate of 52%. Students felt that being able to perform calculations is important to their future career, with 97% of respondents agreeing or strongly agreeing with this statement. Hospital pharmacy was considered the sector where calculations were most important (96% agree/ strongly agree). Overall, 75% of respondents agreed/ strongly agreed that they were confident in undertaking pharmaceutical calculations. Students felt most competent using provided formula, and with dose and dosage regimen calculations. Conversely, students felt least competent performing displacement value and dilutions questions. With respect to teaching design, students preferred blended-learning to self-directed study or traditional lectures. Eighty-seven percent of respondents reported blended-learning as beneficial/ very beneficial, compared to 57% and 46% for the other approaches. Students reported formative quizzes as the most beneficial activity for learning (92% beneficial/ very beneficial). This was followed by provision of worked examples, with a preference for handwritten solutions. Recommended textbooks and online discussion boards were considered least beneficial. Having dedicated introductory calculations teaching in Year 1, with repeated opportunities for practice and support in subsequent years had the most support for improving teaching, with 87% stating this would be beneficial/ very beneficial. There was also support for the NUMBAS3 e-assessment system for formative examples, along with video or pencasted worked examples, with 80% and 70% of respondents respectively classing these as beneficial/ very beneficial. Discussion / Conclusion QUB MPharm students appreciate the importance of pharmaceutical calculations to their future careers. They prefer a blended-learning approach to teaching, incorporating formative quizzes and worked examples. Dedicated Year 1 teaching, the use of NUMBAS, and pencasting were identified as methods to improve teaching. These findings will aid future course design, with the aim of improving patient safety relating to pharmaceutical calculations.

Root causes behind patient safety incidents in the emergency department and suggestions for improving patient safety - an analysis in a Finnish teaching hospital.

Adverse events occur frequently at emergency departments (ED) because of several risk factors related to varying conditions. It is still unclear, which factors lead to patient safety incident reports. The aim of this study was to explore the root causes behind ED-associated patient safety incidents reported by personnel, and based on the findings, to suggest learning objectives for improving patient safety. The study material included incident reports (n = 340) which concerned the ED of a teaching hospital over one year. We used a mixed method combining quantitative descriptive statistics and qualitative research by inductive content analysis and deductive Ishikawa root cause analysis. Most (76.5%) incidents were reported after patient transfer from the ED. Nurses reported 70% of incidents and physicians 7.4%. Of the reports,40% were related to information flow or management. Incidents were evaluated as no harm (29.4%), mild (46%), moderate (19.7%), and severe (1.2%) harm to the patient. The main consequences for the organization were reputation loss (44.1%) and extra work (38.9%). In the qualitative analysis, nine specific problem groups were found: insufficient introduction, adherence to guidelines and protocols, insufficient human resources, deficient professional skills, medication management deficiencies, incomplete information transfer from the ED, language proficiency, unprofessional behaviour, identification error, and patient-dependent problems. Six organizational themes were identified: medical staff orientation, onboarding and competence requirements; human resources; electronic medical records and information transfer; medication documentation system; interprofessional collaboration; resources for specific patient groups such as geriatric, mental health, and patients with substance abuse disorder. Entirely human factor-related themes could not be defined because their associations with system factors were complex and multifaceted. Individual and organizational learning objectives were addressed, such as adherence to the proper use of instructions and adequate onboarding. System factors caused most of the patient safety incidents reported concerning ED. The introduction and training of ED -processes is elementary, as is multiprofessional collaboration. More research is needed about teamwork skills, patients with special needs and non-critical patients, and the reporting of severe incidents.

Using the ReSPECT emergency care and treatment plan in a community hospital: a quality improvement initiative.

The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is a care plan to guide emergency treatment when the person cannot contribute. ReSPECT is important in supporting adults at risk of decline. To implement, evaluate and embed ReSPECT conversations to improve patient safety out of hours and support involvement of patients and their families. A quality improvement design underpinned by normalisation process theory (NPT) undertaken in a 35-bed community hospital ward between May 2022 and September 2023. Organisational prioritisation, facilitators, and champions supported the plan. Evaluation analysed ReSPECT plans, observations and a follow-up focus group. ReSPECT conversations increased by 43% over 1 year (23 to 32 patients), and in quality (from 15/23 patients with a do not attempt cardiopulmonary resuscitation decision recorded and no ReSPECT plan to 32/35 with an individualised ReSPECT plan). ReSPECT could be implemented in community hospitals with facilitators and champions to deliver and embed change. The implementation plan is informing wider rollout across community hospital wards for adults with frailty and multiple conditions.

The Implications of Handwashing and Skin Hygiene on Infectious Disease Dynamics: The African Scenario

Infectious diseases are largely preventable, yet they continue to pose a significant threat to public health, particularly among vulnerable populations in developing countries. Basic hygiene practices, especially hand and skin hygiene, have been shown to significantly reduce the risk of the cross-transmission of infections, including those caused by multi-drug-resistant organisms. In light of the growing global concern about antimicrobial resistance, there is an urgent need to review and reinforce these practices. This study provides a general overview of the role that hand hygiene practices play in decreasing infectious diseases by conducting a comprehensive review. Multiple online databases, including Google Scholar, Scopus, and Web of Science, were searched using relevant keywords such as “hygiene practices”, “infectious diseases”, “public health”, “Africa”, and “sanitation”. After filtering the search results for relevancy, selected studies were narratively synthesized to present the latest data on hand hygiene and its impact on infectious diseases. Strengthening hand and skin hygiene, along with environmental sanitation and preventive measures, can help reduce the spread of nosocomial infections. By emphasizing the importance of these fundamental hygiene practices, particularly in regions where the burden of infectious diseases is highest, the development of antibiotic-resistant diseases can be prevented, improving patient safety, and enhancing public health outcomes. Adopting comprehensive hygiene policies, including regular handwashing, is crucial for reducing the prevalence of infectious diseases and improving health outcomes in developing countries.

DETERMINATION OF DOSE REFERENCE LEVELS AT BENDAN PEKALONGAN REGIONAL HOSPITAL FOR INTERNAL DOSE AUDIT AS AN EFFORT TO OPTIMIZE RADIATION PROTECTION FOR PATIENTS

Unnecessary exposure is less of a concern because it is considered not to cause injury to patients. Radiation protection optimization is carried out for patients to reduce unnecessary exposure. Following BAPETEN Regulation No. 4 of 2020 Article 46, permit holders are required to implement radiation protection optimization [1]. This study aimed to obtain the local dose reference level (TPD) value through an internal dose audit to optimize patient radiation protection. This optimization is carried out in several steps, including conducting an internal dose audit, determining the local TPD, and evaluating the examination. This study is expected to motivate documentation of radiation parameters to obtain sufficient data for analysis. The method used in this study is a literature study through related references and X-ray radiation output data to calculate the dose in the form of incident air kerma (INAK) and entrance surface air kerma (ESAK). The results showed that the local INAK TPD value was 52% below the national TPD, and the local ESAK TPD value was 57% below the national TPD. The expected local TPD value is a TPD value that is lower than the national TPD value. This indicates that the imaging protocol at RSUD Bendan has been well-optimized. However, there are still several types of examinations where the local TPD value exceeds the national TPD, indicating the need to review further the imaging techniques and protocols used. The influence of body weight and radiological image diagnosis was analyzed as a basis for further optimization. Thus, the determination of this local TPD can be an essential reference in efforts to improve patient safety and optimize radiation protection in health facilities. Keywords: radiation protection optimization of patient, Dose Reference Level (DRL), patient dose.

Coping difficulties after inpatient hospital treatment: validity and reliability of the German version of the post-discharge coping difficulty scale.

Patients transitioning between different care contexts are at increased risk of experiencing adverse events. In particular, being discharged to home after inpatient treatment involves significant risks. However, there is a lack of valid and internationally comparable assessment tools on patients' experiences of difficulties following hospital discharge. Therefore, this study aimed to adapt and validate the German version of the post-discharge coping difficulty scale (PDCDS-G). Patients were recruited at a German university hospital. 815 adult patients participated in a self-report survey following an inpatient stay of at least three days. Factorial validity of the PDCDS-G was evaluated via factor analyses. Further, examination of measurement invariance was performed. To establish criterion validity, associations with patients' self-reported health status and occurrence of patient safety were determined. Further, group differences regarding patient characteristics, hospitalization factors, and survey-related variables were examined. Factorial validity of the PDCDS-G was confirmed by a two-factorial model with good model fit. Both factors showed good to excellent reliability. The two-factor model achieved measurement invariance across all patient characteristics, hospitalization factors, and survey-related variables. Significant relationships with patients' health status and the occurrence of patient safety incidents corroborate criterion validity of the PDCDS-G. Differential associations of the two PDCDS-G factors regarding patient characteristics, hospitalization, and survey-related variables were found. Construct and criterion validity, as well as the reliability of the PDCDS-G, were verified. Further, instrument's measurement invariance was confirmed allowing use of the scale for the interpretation of group differences and comparisons between studies. The PDCDS-G provides a validated and comparable patient-reported outcomes measure for patient experiences after hospital discharge to home. The PDCDS-G can be used for patient surveys in quality or patient safety improvement in care transition processes.