Incidence Of Harm Research Articles

Humanizing harm: Using a restorative approach to heal and learn from adverse events.

BackgroundHealthcare is not without risk. Despite two decades of policy focus and improvement efforts, the global incidence of harm remains stubbornly persistent, with estimates suggesting that 10% of hospital patients are affected by adverse events.MethodsWe explore how current investigative responses can compound the harm for all those affected—patients, families, health professionals and organizations—by neglecting to appreciate and respond to the human impacts. We suggest that the risk of compounded harm may be reduced when investigations respond to the need for healing alongside system learning, with the former having been consistently neglected.DiscussionWe argue that incident responses must be conceived within a relational as well as a regulatory framework, and that this—a restorative approach—has the potential to radically shift the focus, conduct and outcomes of investigative processes.ConclusionThe identification of the preconditions and mechanisms that enable the success of restorative approaches in global health systems and legal contexts is required if their demonstrated potential is to be realized on a larger scale. The policy must be co‐created by all those who will be affected by reforms and be guided by restorative principles.Patient or Public ContributionThis viewpoint represents an international collaboration between a clinician academic, safety scientist and harmed patient and family members. The paper incorporates key findings and definitions from New Zealand's restorative response to surgical mesh harm, which was co‐designed with patient advocates, academics and clinicians.

P652 The burden of mental illness, including deliberate self-harm, before and after a diagnosis of IBD, a UK population study

Abstract Background The burden of mental illness among IBD patients is recognised to be greater than among their healthy peers. Due to the bi-directional influence of the gut-brain axis,mental health may be linked to IBD outcomes and vice versa. The aim of this study was to use population level data to describe the incidence of anxiety, depression, insomnia, severe mental illness and deliberate self-harm in patients with IBD. Methods A retrospective cohort study was conducted using The Health improvement Network (THIN) database to estimate the incidence rates of anxiety, depression, insomnia, severe mental illness and deliberate self harm in patients with IBD between 1995 to 2021 and matched controls with no pre-existing mental health illness.The prevalence of pre-existing depression, anxiety and insomnia prior to IBD diagnosis was assessed for IBD patients and matched controls.The association between deliberate self harm and incident mental health diagnoses following IBD diagnosis were estimated using Cox regression analysis. Results We identified 59,613 incident cases of IBD,34,615 (58.1%) had UC and 25,000 (41.9%) had Crohn’s disease. The median age was;41.5 (IQR 29.6–57.5) years,with an equal proportion of males and females with IBD (49.2% vs 50.8%). Patients with a diagnosis of IBD had an increased prevalence of anxiety 10 years (3.0% vs 2.5%,p<0.001) and 2 years prior to diagnosis (6.2% and 5.3%,p<0.001). A similar pattern was seen for insomnia at 10 years (1.0% vs 0.9%, p=0.028) and 2 years (3.4% vs 3.0%, p<0.001) and for depression at 10 years (3.7% vs 4.5%, p<0.001) and 2 years (8.1% vs 9.6%, p<0.001). The incidence of mental illness was higher in IBD patients than controls for; anxiety [6.1 vs 5.3 per 1000 patient years,HR 1.14(1.09–1.20),p<0.001], depression [11.3 vs 7.5 per 1000 patient years,HR 1.34 (1.28–1.39),p<0.001], insomnia [9.6 vs 6.0 per 1000 patient years,HR 1.54(1.5–1.6),p<0.001] and DSH [1.6 vs 1.2 per 1000 patient years,HR 1.20(1.07–1.35),p<0.001]. Associations of deliberate self harm in this patient groups included: IBD (HR 1.20(1.07–1.35),p=0.002),female gender (HR 1.06(1.35–1.60),p<0.001),age quintile <27.4 years (HR 4.48(3.95–5.93),p<0.001) compared to >61.3 years,anxiety (HR 1.57(1.35–1.82),p<0.001),depression (HR 5.97(5.33–6.69),p<0.001),insomnia (HR 2.32(2.02–2.66),p<0.001), and severe mental illness (HR 5.74(4.56–7.22),p<0.001). Conclusion There is an additional burden of mental illness in patients who are later diagnosed with IBD. Following diagnosis,the incidence of depression, anxiety, insomnia and deliberate self harm is higher in individuals with IBD than controls.Patients who develop mental illness in the setting of IBD are at particularly high risk of deliberate self-harm.

Islamophobia: Radical Western Thoughts and it’s Encounter in the Light of Islam

Islamophobia is an imposed term of the West broadly defined as a fear or hatred of Islam and its followers. Prejudice is considered an unjustifiable and harmful incident of discrimination that is related to the rise of Islamophobia. In western opinion, Muslims are warmongers who have extremist approaches towards life, and Islam is a backward religion. This radical mindset has relegated Muslims to an unimportant and powerless position within society and groups, which has triggered anti-Muslim sentiments among non-Muslims. Bullying, surveillance, fear, prejudgments against Muslims have been increased by schools, districts, landlords, and employees on the globe, especially in the western world. Mosque controversies in the United States, anti-veiling legislation in France, the 'minaret' row in Switzerland, the killing of Turkish immigrants in Germany, and hateful statements of Dutch politicians against Muslims are well-known examples of Islamophobia. The paper's primary purpose is to highlight the radical approach and anti-Muslim sentiments of the world in the name of Islamophobia. It will show Muslims are brutally targeted on every forum due to misperceptions regarding Islam and its teachings. Furthermore, the true spirit of Islam and its teachings are highlighted in this paper that Muslims are the ambassadors of peace, and Islam is the only religion of moderation that negates fanaticism and terrorist acts. In contrast, the rebellious acts of a few radical groups do not allow anyone to adopt hateful and intolerant attributes towards the whole nation.

Healthcare workers' experiences of caring for patients diagnosed with intellectual disability co-occurrent with psychiatric disorders.

WHAT IS KNOWN ON THE SUBJECT?: Intellectual disability (ID) involves problems with general mental abilities and affects intellectual functioning and adaptive functioning. People diagnosed with ID present higher levels of functional disability, which means they usually have difficulty or the inability to independently perform basic activities of daily living. Little to no attention has been paid to the issues of the mental health of people diagnosed with ID. Specifically, healthcare workers' experiences of caring for patients with IDPD have been neglected. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The findings increase our understanding and partially address the knowledge gap regarding the situations and circumstances faced by healthcare workers in caring for patients diagnosed with intellectual disability co-occurrent with psychiatric disorders (IDPD). In cases of insufficient staffing, healthcare workers may be forced to ignore the individualized needs of patients so as to facilitate management. Healthcare workers may also feel frustrated by not being able to anticipate or deal with patients' unexpected problem behaviours or accidents. They adapt by adjusting their expectations of their patients. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Healthcare administrators need to understand the difficulties faced by staff in caring for patients diagnosed with IDPD, arrange appropriate in-service education to increase the healthcare workers' knowledge and skills in caring for patients diagnosed with IDPD, and create warm and supportive environments for them. The government department responsible for the management of ID patient care institutions should be able to regularly monitor the overall staffing and quality of care in these institutions. ABSTRACT: Introduction When intellectual disability co-occurs diagnosed with psychiatric disorders (IDPD), the impact of the burden of illness on the affected individuals, their caregivers, their family and friends, and the services that provide for them is particularly high. The issues of the mental health of people diagnosed with ID have received little, if any, attention. One specific area of neglect is healthcare workers' experiences of caring for patients diagnosed with IDPD. Aim The aim of this study was to understand healthcare workers' experiences of caring for patients diagnosed with IDPD. Methods A qualitative descriptive research approach and semi-structured interviews were used in this study. We interviewed 15 participants who had experience in caring for patients diagnosed with a dual diagnosis of IDPD. Findings Four themes were found, as follows: (1) Negative impacts of insufficient staffing on the quality of care, (2) Constantly worrying about harmful incidents, (3) Discovering effective ways to provide individual patient care and (4) Adjusting expectations and attitudes towards patients. Participants' experiences revealed that they perceived the importance and effectiveness of providing individualized care for IDPD patients. However, when staffing is insufficient, they may be forced to ignore the individualized needs of patients so as to facilitate management. They may also feel frustrated by not being able to anticipate or deal with patients' unexpected problem behaviours or accidents. In addition, they adapt by adjusting their expectations of the patients. Discussion The findings from this research help to fill the knowledge gap in our understanding of healthcare workers' experiences of and their perspectives on caring for patients diagnosed with IDPD. Implications for Practice Healthcare administrators need to understand the difficulties faced by staff in caring for patients diagnosed with IDPD, arrange appropriate in-service education to increase the healthcare workers' knowledge and skills in caring for patients diagnosed with IDPD, and create warm and supportive environments for them. The government department overseeing the management of institutions providing ID patient care should be empowered to conduct regular monitoring of the overall staffing and quality of care in such institutions.

Emotional Harm in the Radiology Department: Analysis of an Underrecognized Preventable Error.

Background Emotional harm incidents in health care may result in lost trust and adverse outcomes. However, investigations of emotional harm in radiology departments remain lacking. Purpose To better understand contributors and clinical scenarios in which emotional harm can occur in radiology, to document incidences, and to develop preventative countermeasures. Materials and Methods A large tertiary hospital adverse event reporting system was retrospectively searched for submissions under the category of dignity and respect in radiology between December 2014 and December 2020. Submissions were assigned to one of 14 categories per a previously developed classification system. Root-cause analysis of events was performed with a focus on countermeasures for future prevention. The person experiencing emotional harm (patient or staff) was noted. Results Of all radiology-related submissions, 37 of 3032 (1.2%) identified 43 dignity and respect incidents: failure to be patient centered (n = 23; 54%), disrespectful communication (n = 16; 37%), privacy violation (n = 2; 5%), minimization of patient concerns (n = 1; 2%), and loss of property (n = 1; 2%). Failure to be patient centered (n = 23) was subcategorized into disregard for patient preference (12 of 23; 52%), delay in care (eight of 23; 35%), and ineffective communication (three of 23; 13%). Of the 43 incidents, 32 involved patients (74%) and 11 involved staff (26%). Emotional harm in staff was because of disrespectful communication from other staff (eight of 11; 73%). Seventy-three countermeasures were identified: staff communication training (n = 32; 44%), individual feedback (n = 18; 25%), system innovation (n = 16; 22%), improvement of existing communication processes (n = 3; 4%), process reminders (n = 3; 4%), and unclear (n = 1; 1%). Individual feedback and staff communication training that focused on active listening, asking for the patient's preferences, and closed-loop communication addressed 34 of the 43 incidents (79%). Conclusion Most emotional harm incidents were from disrespectful communication and failure to be patient centered. Providing training focused on active listening, asking for patient's preferences, and closed-loop communication would potentially prevent most of these incidents. © RSNA, 2021 See also the editorial by Bruno in this issue.

From principles to practice: methods to increase the transparency of research ethics in violent contexts

AbstractThere has been a proliferation of research with human participants in violent contexts over the past ten years. Adhering to commonly held ethical principles such as beneficence, justice, and respect for persons is particularly important and challenging in research on violence. This letter argues that practices around research ethics in violent contexts should be reported more transparently in research outputs, and should be seen as a subset of research methods. We offer practical suggestions and empirical evidence from both within and outside of political science around risk assessments, mitigating the risk of distress and negative psychological outcomes, informed consent, and monitoring the incidence of potential harms. An analysis of published research on violence involving human participants from 2008 to 2019 shows that only a small proportion of current publications include any mention of these important dimensions of research ethics.

Priorities for occupational noise in Britain

Regulation of occupational exposure to noise in Britain for 50 years has reduced risk. However, statistics from around the globe (and in Britain alone) suggest that the range in harm is between around zero and more than 1 in 4 workers exposed to high noise. The uncertainty in statistics and the potential high incidence and prevalence of harm justifies investigation. In Britain, we will investigate the current risk of occupational hearing loss and the effectiveness of current noise control measures. We propose to gather data during inspections of industries that are known to have high levels of workplace noise. Finding high incidence of hearing damage will indicate a failure of immediate management of risk and likely result in enforcement action. We propose to review employers' control of noise propagation in the workplace through use and maintenance of noise controls supplied with machines and supplemented with acoustic barriers and noise havens. We propose to review suppliers design and build of noise control into their products and their reported noise emissions for noisiest typical use. We are looking to benefit from the experience of our global counterparts before finalising our plans.

Extension of Intravenous Tubing and Pumps Outside Rooms for Safety and Efficiency.

Extension of Intravenous Tubing and Pumps Outside Rooms for Safety and Efficiency.

Nurses competence in the reporting of medication-related incidents: An intervention study.

ObjectivesLess than 5% of all harmful medicine‐related incidents (MIs) or adverse drug reactions received by the Spanish Pharmacovigilance system are notified by Registered Nurses (RNs). The main objective of this study was to determine the impact of a multifaceted institutional intervention (MII) in patient safety on the reporting competence of medication incidents of hospital RNs.DesignOne‐group pre‐test–posttest design.SettingTertiary, public, teaching hospital in Spain.ParticipantsA total of 139 RNs responded to pre‐ and postintervention questionnaires constituting the paired sample subjected to analysis.InterventionA MII, consisting of educational activities and materials, change in MI reporting form from paper to electronic and appointment of reporting support services, was designed and directed to all hospital RNs and midwifes.Main outcome measuresOverall MIs reporting competence (OC) and its dimensions (attitudes, knowledge and skills) were measured through a synthetic variable (total OC value range: 34–170 points) by means of an electronic questionnaire.ResultsA statistically significant 7.96‐point increase in OC from baseline to the final measurement was obtained (CI: 5.05–10.85). There was an increase of 7.38 points in the skills dimension (CI: 5.06–9.68). After the MII, 73.4% nurses improved their OC and 33.8% reported at least one no‐harm MI postintervention compared to 4.4% pre‐intervention (p < .001). A one‐point increase in OC improved the probability of becoming reporter by 2.9% and a one‐point increase in skills by 6.4%.ConclusionMIs reporting competence among RNs increased after a multifaceted institutional intervention, due to an improvement in the skills dimension. The MII was also effective in raising both, the rate of RNs who become reporters and the number of no‐harm MIs reported.

Frequency of outpatient care adverse events in an occupational mutual insurance company in Spain

BackgroundOccupational mutual insurance companies (OMICs), in collaboration with the Spanish Social Security System, provide healthcare and manage the economic benefits for the workers in Spain. They have ambulatory care centers that attend outpatient trauma pathology, although most of the studies published have focused on surgical and hospital activity.The aim of this study was to detect adverse events (AEs) in outpatient trauma care in the context of an OMIC. MethodsA cohort study designed to identify harmful safety incidents (adverse events, AEs) in 2017 was conducted. A random sample of 313 medical records among patients who were visited more than 3 medical and nursing attendances during their outpatient process. The AEs detected were classified according to category, severity and preventability. ResultsWe identified 48 AEs (15.3% of medical records, 95% CI 11.3–19.3), most of them procedure-related, while 27 (56.2%) were preventable and 46 mild (95.8%). ConclusionsThe AEs identified are double than those found in primary care general consultations in Spain and are close to the lower range of studies on surgical AEs in traumatology and orthopedics. Preventable AEs were within expected limits. Over half of AEs are preventable, within that group, the mild AEs have an increased rate of preventability. These results highlight the relevance of research of patient safety in the outpatient care of trauma and orthopaedic procedures in an OMIC for patient safety and contribute to introduce improvements in outpatient care.

Epidemiology of healthcare harm in New Zealand general practice: a retrospective records review study

ObjectivesTo determine the epidemiology of healthcare harm observable in general practice records.DesignRetrospective cohort records review study.Setting72 general practice clinics were randomly selected from all 988 New Zealand clinics stratified by...

Prevention of Shaken Baby Syndrome Among High-Risk Neonates: Program Implementation and Evaluation

Background: Studies suggest that the implementation of high-quality education and support services for caregivers may reduce the incidence of unplanned harm to infants and young children under high-stress circumstances. Purpose: This pilot study evaluates the usefulness of the Period of PURPLE Crying program in a high-acuity NICU at The University of Chicago Comer Children’s Hospital based on six measurable objectives. Methods: The pilot study utilized a Likert-style pretest-posttest survey design to evaluate how NICU nurses perceived the Period of PURPLE Crying program. Nurses were educated on the program content during an in-service to teach participants how to utilize the Period of PURPLE Crying program materials to support and educate families about Shaken Baby Syndrome (SBS). Results: The intervention effectively increased nursing confidence in delivering the SBS and Abusive Head Trauma (AHT) education and increased accessibility to available resources pertaining to SBS and AHT. Questions pertaining specifically to the Period of PURPLE Crying presented exclusively on the post-test were met with an overwhelmingly positive response, with the majority (n=33, 97%) of respondents agreeing that the intervention was useful in standardizing SBS education, providing meaningful, effective information on this topic area, and delivering SBS and AHT information promptly.

Collective Critical Care Ambulance: an innovative transportation of critical care patients by bus in COVID-19 pandemic response

BackgroundDuring the COVID-19 pandemic, as the number of available Intensive Care beds in France did not meet the needs, it appeared necessary to transfer a large number of patients from the most affected areas to the less ones. Mass transportation resources were deemed necessary. To achieve that goal, the concept of a Collective Critical Care Ambulance (CCCA) was proposed in the form of a long-distance bus re-designed and equipped to accommodate up to six intensive care patients and allow Advanced Life Support (ALS) techniques to be performed while en route.MethodsThe expected benefit of the CCCA, when compared to ALS ambulances accommodating a single patient, was to reduce the resources requirements, in particular by a lower personnel headcount for several patients being transferred to the same destination. A foreseen prospect, comparing to other collective transportation vectors such as airplanes, was the door-to-door capability, minimalizing patients’ handovers for safety concerns and time efficiency.With the project of a short-distance transfer of several Intensive Care Unit (ICU) patients together, the opportunity came to test the CCCA under real-life conditions and evaluate safely its technical feasibility and impact in time and resources saving, before it could be proposed for longer distances.ResultsFour COVID-19 patients were transported over 37 km. All patients were intubated and under controlled ventilation. One of them was under Norepinephrine support. Mean loading time was 1 min 39 s. Transportation time was 29 min. At destination, the mean unloading time was 1 min 15 s. No serious adverse effect, in particular regarding hemodynamic instability or ventilation disorder, has been observed. No harmful incident has occurred.ConclusionsIt was a very instructive test. Collective medical evacuation by bus for critically ill patients under controlled ventilation is suitable and easy to implement. Design, ALS equipment, power autonomy, safety and resources saving, open the way for carrying up to 6 ICU-patients over a long distance. The CCCA could bring a real added-value in an epidemic context and could also be helpful in many other events generating multiple victims such as an armed conflict, a terrorist attack or a natural disaster.

Incident Management in Health Care: A Pan-Canadian Perspective.

Nearly 10% of patients experience a harmful patient safety incident in the hospital setting. Current evidence focuses on incident reporting, whereas little is known about how incidents are managed within organizations. The aim of this study was to explore processes, tools, and resources for incident management in Canadian health care organizations. Qualitative focus groups were conducted with key stakeholders, representing clinicians, managers, executives, governors, patients, and families (n = 45). Qualitative data were thematically analyzed and presented as 3 themes: (1) variations in incident reporting and management; (2) simplification of the incident management process; and (3) need for leadership to support just culture and redefine harm. The study findings support and inform efforts to create a patient safety culture in Canadian and international health care organizations. There is a need to develop a standardized, accessible incident reporting and management system for use across health care sectors to promote continuous learning and improvement about patient safety.

Development of video animations to encourage patient-driven deprescribing: A Team Alice Study

ObjectivePatient-driven deprescribing initiatives aim to increase patient knowledge and strengthen self-advocacy skills. This article describes the development of three animated videos designed to educate older adults about unsafe prescribing and medication harm, based on the actionable lessons from the death, by polypharmacy, of an older adult in our community. MethodsUsing a community based participatory research approach (CBPR), members of three senior centers (n = 53) and the Deprescribing Partnership of Western New York (n = 30) were recruited and participated in two rounds of focus groups to guide the video development. ResultsStakeholder input led to changes in content, wording, and visual presentation. The final versions of the videos emphasize the following messages (1) “New medications and what you should know about the risks”, (2) “What you should do when a doctor tells you never to take a certain medication”, (3) “What you should know about medications when you are in the hospital.” ConclusionThe study highlights the successful process of using CBPR to develop a series of videos designed to provide information on the risks of polypharmacy, and empower older adults to advocate for themselves. Practice implicationsAnimated educational videos are a novel strategy to address medication harm in older adults. This research is a critical first step to increasing patient-led discussions that reduce the incidence of medication harm and inappropriate medication use among older adults.

A Mixed-Methods Analysis of Medication Safety Incidents Reported in Neonatal and Children's Intensive Care.

BackgroundCritically ill neonates and paediatric patients may be at a greater risk of medication-related safety incidents than those in other clinical areas.ObjectiveThis study aimed to examine the nature of, and contributory factors associated with, medication-related safety incidents reported in neonatal and paediatric intensive care units (ICUs).MethodsWe carried out a mixed-methods analysis of anonymised medication safety incidents reported to the National Reporting and Learning System that involved children (aged ≤ 18 years) admitted to ICUs across England and Wales over a 9-year period (2010–2018). Data were analysed descriptively, and free-text descriptions of harmful incidents were examined to explore potential contributory factors associated with incidents.ResultsIn total, 25,567 eligible medication-related incident reports were examined. Incidents commonly occurred during the medicines administration (n = 13,668 [53.5%]) and prescribing stages (n = 7412 [29%]). The most commonly implicated error types were drug omission (n = 4812 [18.8%]) and dosing errors (n = 4475 [17.5%]). Neonates were commonly involved in reported incidents (n = 12,235 [47.9%]). Anti-infectives (n = 6483 [25.4%]) were the medications most commonly associated with incidents and commonly involved neonates. Incidents that were reported to have caused patient harm accounted for 12.2% (n = 3129) and commonly involved neonates (n = 1570/3129 [50.2%]). Common contributing factors to harmful incidents included staff-related factors (68.7%), such as failure to follow protocols or errors in documentation, which were often associated with working conditions, inadequate guidelines, and design of systems and protocols.ConclusionsNeonates were commonly involved in medication-related incidents reported in children’s intensive care settings. Improvements in staffing and workload, design of systems and processes, and the use of anti-infective medications may reduce this risk.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40272-021-00442-6.

Prediction of the mortality rate and framework for remote monitoring of pregnant women based on IoT

To save the risk during the pregnancies in remote areas (where women cannot approach the doctors in the urban areas for proper check-ups), the authors have proposed an IoT based remote monitoring of pregnant ladies where the data is collected at the cloud server. Machine learning techniques will be applied on the trimesters’ attributes to find out the reasons of mortality rate of the babies. The use of these advanced technologies in pregnant women care environment can absolutely eradicate the pregnancy complications and harmful incidents. An initial work towards this study is to assess mortality risk prediction in pregnant ladies using machine-learning algorithms for proper prediction and treatment on time. A dataset of 10,000 pregnant women is analysed in this study. Classification algorithms are used to check the death rate of new born babies based on the mother’s age. The survival ratio is presented by applying the various algorithms. Two class SVM model is presented as the most accurate prediction model which outperformed over boosted decision tree, average perceptron, decision forest, locally deep SVM, Bayes point machine, decision forest and logistic regression. Age of the mother and frequency of the pregnancy without proper gap (i.e. less than 3 years) make impact on the mortality rate of the babies. Among the various algorithms, the AUC value of decision forest is augmented at 91.4% whereas two class SVM shows significantly improved performance to 96.6%. The authors have proposed machine learning-based final model, death rate of infants, frequency of pregnancy and age of the mother were interrelated as notable risk factors for mortality in Indian ladies along with other issues.

Intraoperative injuries from abdominopelvic surgery: an analysis of national medicolegal data.

BackgroundIntraoperative injuries during abdominopelvic surgery can be associated with substantial patient harm. The objective of this study was to describe abdominopelvic intraoperative injuries and their contributing factors among medicolegal cases.MethodsThis study was a descriptive analysis of medicolegal matters reported to a national body, with subgroup analyses by type of surgery. We reviewed medicolegal matters involving a population-based sample of physicians who were subject to a civil legal action or complaint to a regulatory authority that was closed between 2013 and 2017 in Canada.ResultsOur analysis included 181 civil legal cases and 88 complaints to a regulatory authority. Among legal cases, 155 patients (85.6%) (median age 47 yr) underwent elective procedures. The most common injury site was the bowel (53 cases [29.3%]). Injuries frequently occurred during dissection (79 [43.6%]) and ligation (38 [21.0%]), were identified postoperatively (138 [76.2%]) and necessitated further surgery (139 [76.8%]). Many patients experienced severe harm (55 [30.4%]) or died (25 [13.8%]). Peer experts in nongynecologic cases were more likely than those in gynecologic cases to include criticisms of a provider in a harmful incident (79 [71.2%] v. 30 [42.9%], p < 0.01). Peer expert criticisms often related to clinical evaluation, decision-making and misidentification of anatomy. Criticisms of nontechnical skills identified documentation and communication deficiencies.ConclusionThis study confirms the importance of provider and team training to improve clinical evaluation and decision-making, documentation and communication. Effective protocols may help support clinicians in providing safer surgical care.

The value of downstream traceability in food safety management systems: an empirical examination of product recalls

Non-conforming food products that reach consumers create potential for consumer harm and negative financial consequences for recalling firms. Food quality management systems are therefore of critical importance to consumers, policy-makers, and firms. In addition to implementing a Food Safety Management System (FSMS) for regulatory compliance, a firm may invest in a certified FSMS that enables downstream traceability. Downstream traceability is the ability to follow a product through the supply chain from production to point of sale. We use information processing theory (IPT) and supply chain coordination theory (SCCT) to hypothesize that downstream traceability improves integration and coordination, and hence, outcomes, of a product recall. Evaluating the role of downstream traceability systems in enabling firms to manage quality failures and associated outcomes is relevant because managers and policy-makers need to understand incentives for making such investments. We empirically investigate the effect of downstream traceability on the length of time unsafe product is in distribution, number of products recalled, incidence of product harm, and shareholder value using event study and regression methods in a sample of 211 food recalls announced in the United States (U.S.) from 2007–2013. We find downstream traceability enhances food safety by reducing time in distribution and number of products, but is not significant with respect to product harm. Furthermore, this capability mitigates negative shareholder value impacts. These findings suggest that downstream traceability is both fiscally and socially responsible. These results contribute to the extant academic literature and offer new insights to both practitioners and policy-makers.

Evaluation of medication error rates in Saudi Arabia: A protocol for systematic review and meta-analysis.

Introduction:Due to the diversity of reports and on the rates of medications errors (MEs) in Saudi Arabia, we performed the first meta-analysis to determine the rate of medications errors in Saudi Arabia using meta-analysis in the hospital settings.Methods:We conducted a systematic literature search through August 2019 using PubMed, EMBASE, CINAHL, PsycINFO, and Google Scholar to identify all observational studies conducted in hospital settings in Saudi Arabia that reported the rate of MEs. A random-effects models were used to calculate overall MEs, as well as prescribing, dispensing, and administration error rates. The I2 statistics were used to analyze heterogeneity.Results:Sixteen articles were included in this search. The total incidence of MEs in Saudi Arabia hospitals was estimated at 44.4%. Prescribing errors, dispensing errors, and adminstration errors incidents represent 40.2%, 28.2%, and 34.5% out of the total number of reported MEs, respectively. However, between-study heterogeneity was also generally found to be >90% (I-squared statistic).Conclusions:This study demonstrates the MEs common in health facilities. Additional efforts in the field are needed to improve medication management systems in order to prevent patient harm incidents.