Medical Practice Management Research Articles

Management of COVID-19 Pneumonia: Experience in a Peripheral Tertiary Level Hospital in Bangladesh

Background: Since the detection of the first case of the novel SARS-CoV-2 virus in Wuhan, China, on December 31, 2019, the world stepped into an era of the pandemic as declared by WHO on March 11, 2020. With no prior knowledge regarding this new pandemic, the evidence-based practice of medical management was at stake. Experience sharing from different corners of the world played an essential role in building knowledge to save the world. Methods: The researchers collected data for this retrospective study, from hospital records of the COVID-19 dedicated unit of Sylhet Women’s Medical College, Sylhet, Bangladesh, that was formed temporarily in July 2020, in response to the pandemic situation in the country. This article includes data on 3408 admitted COVID-19 patients with moderate to severe symptoms, managed in the isolation unit including its intensive care unit (ICU) up to November 2021. Results: The mean age of the patients was 57.21±12.58 years and male to female ratio was 1:1.8. Fever (44.4%), cough (38.9), and fatigability (33.3%) were the common symptoms. Diabetes mellitus (67.7%), systemic hypertension (63.7%), asthma (8.65%), chronic obstructive pulmonary disease (21.94%), and, ischemic heart disease (31.2%) were the top co-morbid conditions. Of the study subjects, 68.2% were RT-PCR positive for COVID-19, 67.3% had an abnormal baseline chest X-ray, and 91.1% had a ground glass shadow on a high-resolution CT scan of chest. Average C-reactive protein, D-dimer, and serum ferritin values were 71.68±60.38, 1.16±2.11, and 839±748.57 respectively. Hypoxemia, which was a common problem among them, was managed with oxygen therapy with an appropriate delivery device, with or without supplementation by dexamethasone (78.3%), or methylprednisolone (18.8%). Eighteen (18) patients refused to receive any antiviral therapy, 61 received oral Favipiravir and the rest of them received injectable Remdesevir. Standard care was augmented with Baricitinib in 60 patients. Thirty-six (36) patients in the ICU, with poor response to standard care, were treated with Tocilizumab. Death rates were 9.46% in the non-ICU block, but they were 6-10 times higher in the ICU. Conclusion: Every medical professional learned from the initial two years of the COVID-19 pandemic. Lessons learnt from experience helped building up the knowledge pool necessary for generating effective protocols for COVID-19 pneumonia management.

ПРАКТИЧЕСКАЯ ЭТИКА СФЕРЫ МЕДИЦИНСКИХ ДАННЫХ В ЦИФРОВУЮ ЭПОХУ: ПСИХОЛОГИЧЕСКИЙ АСПЕКТ

The aim of the study is to study the ethical implications of the processing and use of medical data in the digital age, with particular attention to the psychological aspect, as well as understanding the impact of medical data management practices on the psychological well-being of individuals and communities. Medical digital data is an integral part of healthcare and is increasingly becoming a daily routine. The digital age has brought with it many new opportunities, such as accessing medical data in real time, storing it in vast databases and using it to inform decisions. However, these advances raise ethical questions about how data is managed and used by whom. The article explores the need for practical ethics in the processing of medical data, and sets out key principles and considerations. The study aims to provide a comprehensive understanding of the ethical and psychological implications of medical data management practices in the digital age, including the potential advantages and disadvantages of these practices. By examining these issues from a psychological perspective, the study aims to provide valuable insights on how to balance the benefits of using medical data with the need to protect people's rights.

Generalized metabolic flux analysis framework provides mechanism-based predictions of ophthalmic complications in type 2 diabetes patients

Chronic metabolic diseases arise from changes in metabolic fluxes through biomolecular pathways and gene networks accumulated over the lifetime of an individual. While clinical and biochemical profiles present just real-time snapshots of the patients’ health, efficient computation models of the pathological disturbance of biomolecular processes are required to achieve individualized mechanistic insights into disease progression. Here, we describe the Generalized metabolic flux analysis (GMFA) for addressing this gap. Suitably grouping individual metabolites/fluxes into pools simplifies the analysis of the resulting more coarse-grain network. We also map non-metabolic clinical modalities onto the network with additional edges. Instead of using the time coordinate, the system status (metabolite concentrations and fluxes) is quantified as function of a generalized extent variable (a coordinate in the space of generalized metabolites) that represents the system’s coordinate along its evolution path and evaluates the degree of change between any two states on that path. We applied GMFA to analyze Type 2 Diabetes Mellitus (T2DM) patients from two cohorts: EVAS (289 patients from Singapore) and NHANES (517) from the USA. Personalized systems biology models (digital twins) were constructed. We deduced disease dynamics from the individually parameterized metabolic network and predicted the evolution path of the metabolic health state. For each patient, we obtained an individual description of disease dynamics and predict an evolution path of the metabolic health state. Our predictive models achieve an ROC-AUC in the range 0.79–0.95 (sensitivity 80–92%, specificity 62–94%) in identifying phenotypes at the baseline and predicting future development of diabetic retinopathy and cataract progression among T2DM patients within 3 years from the baseline. The GMFA method is a step towards realizing the ultimate goal to develop practical predictive computational models for diagnostics based on systems biology. This tool has potential use in chronic disease management in medical practice.

IMPROVING MEDICATION MANAGEMENT FOR HOME-DWELLING OLDER ADULTS WITH COGNITIVE IMPAIRMENT: END-USER INPUT

Abstract HOPES™ Program is a joint community-university partnership, intended to build capacity for improving medication adherence and reducing medication mistakes, misuse, and abuse for community-dwelling older adults with reduced cognitive functioning (CWCs) in New York State (NYS). The goal of this program is to contribute to the health and safety of older adults, empower them and their caregivers to reduce medication non-adherence consequences and risks, and enable older adults to continue living at home while managing their health conditions. This program applied a collective user-centered approach to connect resources, identify and address barriers, and reach the most vulnerable groups. One aspect of our user-centered approach included a medication management and safety training module video that was adapted from the Medication Use Safety Training for Seniors™ (MUST for Seniors™) and underwent alpha and beta testing. A qualitative analysis was also conducted on input from home-care providers, CWCs, and their designated caregivers about the current practices, challenges, and solutions related to medication management. Our preliminary findings demonstrated a need for research on reducing the steep estimated national costs of medication non-adherence. Thus, a sub-team has developed a methodology to build an economic perspective on the scope and magnitude of interventions to enhance medication management practices for CWCs. A NYS-specific survey was also developed in close collaboration with providers, university partners, and state-level advocacy organizations according to our preliminary findings to document the state and magnitude of medication non-adherence, discern risk factors and determinants of non-adherence, and explore solutions and barriers.

PENGELOLAAN LIMBAH MEDIS RUMAH SAKIT DARURAT WISMA ATLET DALAM PENANGANAN COVID-19 BERDASARKAN HUKUM LINGKUNGAN INTERNASIONAL

Environmental threats due to medical waste management problems have increased due to the Corona Virus Disease 19 (Covid-19) pandemic. Indonesia has experienced an increase in medical waste due to the Covid-19 pandemic, so that medical waste management at the Wisma Atlet Emergency Hospital needs more attention. The problem in this study, namely whether the medical waste management rules at the Wisma Atlet Emergency Hospital (RSDC) in handling COVID-19 are in accordance with the rules of International Environmental Law along with Indonesian Environmental Law and whether the management of COVID-19 medical waste at the Wisma Atlet Emergency Hospital is in accordance with the rules of Indonesian Environmental Law. The type of research used is normative juridical, data processing is done qualitatively, and deductive conclusions are drawn. Based on the analysis conducted, the rules for managing COVID-19 medical waste at Wisma Atlet Emergency Hospital are in accordance with International Environmental Law made by WHO and UNEP and Indonesian Environmental Law made by the Ministry of Environment and the Ministry of Health, including the SOP of Wisma Atlet Emergency Hospital regarding medical waste management. The practice of medical waste management at Wisma Atlet RSDC is also in accordance with Indonesian Environmental Law.

Promoting Medication Management Skills Among Home Health Occupational Therapists: A Quality Improvement Project

Medication management is a national patient safety goal for home care practice. Medication management is an occupation within the scope of occupational therapy. Occupational therapists are able to assess and provide intervention for cognitive, visual, motor, process, environmental and personal factors that impact an individual’s ability to manage their medication independently. This quality improvement project describes a program developed to promote medication management competence in occupational therapists practicing in a large, academic home health agency. The quality improvement project consisted of an online module providing education on the Performance Assessment of Self-Care Skills (PASS) and a 1-hour training session combining didactic education with case-based learning. Pre-post assessment surveys revealed a 25% increase in perceived medication management competence after the intervention. Occupational therapists identified 4 barriers to medication management practice: role ambiguity, documentation challenges, pharmacology knowledge deficit, and reconciliation process barriers.

Use of the behaviour change wheel to improve everyday person-centred conversations on physical activity across healthcare

BackgroundAn implementation gap exists between the evidence supporting physical activity in the prevention and management of long-term medical conditions and clinical practice. Person-centred conversations, i.e. focussing on the values, preferences and aspirations of each individual, are required from healthcare professionals. However, many currently lack the capability, opportunity, and motivation to have these conversations. This study uses the Behaviour Change Wheel (BCW) to inform the development of practical and educational resources to help bridge this gap.MethodsThe BCW provides a theoretical approach to enable the systematic development of behaviour change interventions. Authors followed the described eight-step process, considered results from a scoping review, consulted clinical working groups, tested and developed ideas across clinical pathways, and agreed on solutions to each stage by consensus.ResultsThe behavioural diagnosis identified healthcare professionals’ initiation of person-centred conversations on physical activity at all appropriate opportunities in routine medical care as a suitable primary target for interventions. Six intervention functions and five policy categories met the APEASE criteria. We mapped 17 Behavioural Change Techniques onto BCW intervention functions to define intervention strategies.ConclusionsThis study uses the BCW to outline a coherent approach for intervention development to improve healthcare professionals’ frequency and quality of conversations on physical activity across clinical practice. Time-sensitive and role-specific resources might help healthcare professionals understand the focus of their intervention. Educational resources aimed at healthcare professionals and patients could have mutual benefit, should fit into existing care pathways and support professional development. A trusted information source with single-point access via the internet is likely to improve accessibility. Future evaluation of resources built and coded using this framework is required to establish the effectiveness of this approach and help improve understanding of what works to change conversations around physical activity in clinical practice.

Optimal Medical Management in Chronic Limb-threatening Ischemia Improves Patient Outcomes

Optimal medical management of chronic limb-threatening ischemia (CLTI) includes use of antiplatelets, antihypertensives, statins, and smoking cessation, and remains underutilized. Participation in programs like Vascular Quality Initiative (VQI) offers opportunities to increase compliance. The objective of this study was to evaluate medical management practice patterns and its effect on survival and limb salvage in CLTI patients.

EXPLORING THE PREVALENCE OF MEDICATION ERRORS IN KUWAITI HOSPITALS

Objective: Reducing medication errors in Kuwaiti government hospitals through pharmacovigilance involves the improvement of medication safety culture achieve the desired outcome. The study explored the medication management practices in Kuwaiti hospitals and made recommendations for the improvement of medication safety practices. The aim of the study was to investigate the extent of medication errors in Kuwaiti government hospitals.
 Methods: Medical records and systems audits, healthcare professionals’ observation study, healthcare professionals survey. Data was collected from paper records, electronic records and systems and the observation study. Data was then analysed quantitatively and qualitatively.
 Results: The study revealed important results at all five steps of the medication process. The audit revealed nearly half of the errors identified to have occurred during the prescribing stage.
 Conclusion: The study revealed important results at all five steps of the medication process. The audit revealed nearly half of the errors identified to have occurred during the prescribing stage. The study highlights the need for an IT based, no-blame incident reports to be implemented and utilised in investigating adverse events and medication errors across the multiple sites in the Kuwaiti healthcare setting to guide reduction strategies and further improve standards of medication safety.

Research and Scholarly Methods: Implementation Science Studies.

Traditional research focuses on efficacy or effectiveness of interventions but lacks evaluation of strategies needed for equitable uptake, scalable implementation, and sustainable evidence-based practice transformation. The purpose of this introductory review is to describe key implementation science (IS) concepts as they apply to medication management and pharmacy practice, and to provide guidance on literature review with an IS lens. There are five key ingredients of IS, including: (1) evidence-based intervention; (2) implementation strategies; (3) IS theory, model, or framework; (4) IS outcomes and measures; and (5) stakeholder engagement, which is key to a successful implementation. These key ingredients apply across the three stages of IS research: (1) pre-implementation; (2) implementation; and (3) sustainment. A case example using a combination of IS models, PRISM (Practical, Robust Implementation and Sustainability model) and RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance), is included to describe how an IS study is designed and conducted. This case is a cluster randomized trial comparing two clinical decision support tools to improve guideline-concordant prescribing for patients with heart failure and reduced ejection fraction. The review also includes information on the Standards for Reporting Implementation Studies (StaRI), which is used for literature review and reporting of IS studies,as well as IS-related learning resources.

Awareness Level of Workers in the Management of Medical Waste Generated from Hospitals in Bayelsa State

There is an increase awareness of the public on the dangers associated with the improper disposal of medical waste in this country predominantly waste contaminated with communicable disease agent. Given the general lack of knowledge and effective practice of medical waste documentation about the composition of bio-hazardous waste and the large amount generated, it becomes so difficult to evaluate strategies for waste reduction. The present work presents awareness level of workers in the management of medical waste generated from hospitals in Bayelsa State. The study aimed at assessing the awareness levels and knowledge on the documentation of medical waste among healthcare workers in the various healthcare institutions. The waste generated were weighed kg at source (various unit) for days, week monthly for a period of 3nonths at various unit in the health facilities. Other relevant data were obtained via well-structured questionnaire, and considering the Cochran formula, a sample size of 300 was obtained. Data were further analysed using simple percentage, frequency and charts. Result indicated that there was very poor awareness level of workers in the management of medical waste generated from hospitals in Bayelsa State, and that the level of knowledge on waste documentation as a practice of medical waste management was poor and supercilious in a twenty first century medical waste management process. Thus, it was recommended that the concern government agency should carry out sensitization, awareness, training and retraining of medical workers at the various healthcare institutions on effective medical waste management. Staff of the various hospitals should be properly trained on significance of documentation of waste generated in the various unit on the health facility and there should be provision of all medical waste management infrastructures to cushion the likely impact of these wastes on the on the workers and the general environment.

Audit of Adherence to Prescribing Guidelines of Psychotropic Drugs for People With Intellectual Disability and Behaviours That Challenge -Specialist Support Team -SST-Merseycare NHS Foundation Trust

AimsThere are concerns following the Winterbourne view investigation and from the Learning Disabilities Census that psychotropic medications are being inappropriately given to people with learning disability as a means of managing difficult behaviours. Stopping Overuse of Medication in People with Learning Disability (STOMP) is a key area which has been identified as needing improvement for the Transforming Care Programme which is being supported by the Royal College of Psychiatrists. Members are encouraged include STOMP in their local audits. It is for this reason that the topic has been chosen. The overall aim of this project is to capture the snapshot of prescribing of psychotropic medications for people under SST care. This information has been used for establishing baseline of current practice as they are happening and to develop SST base response to support STOMP agenda.MethodsThe population audited was patients open to the SST LANCS/GM. Patients had to be between 18 and 65 years old, have a diagnosis of a learning disability and be known to have challenging behaviour. Patients were excluded from the audit if they had no challenging behaviour, had been discharged from services. The sample size was 20 (10 from GM and 10 from LANCS). Data were collected using the proforma and then entered into Microsoft excel for analysis.ResultsFour overall standards were audited, each with key lines of enquiry within the standard audited to help determine compliance. Overall compliance for standard one, the indication and rationale should be clearly stated, was 50%. For standard 2, consent to treatment procedure, the third standard, regular monitoring of the treatment response and side effects, and the final standard, review and evaluation of the need for continuation or discontinuation of the psychotropic drug, the compliance was less than 10%. It should be noted that the audit erred on the side of counting in any information that suggested that the theme had been thought about at all: an in depth capturing of any of the themes did not feature in the sample.ConclusionThis audit highlights important issues for improvement within the SST both in relation to better supporting STOMP and good psychotropic medication management practice, and in relation to its documentation. It also serves as a springboard to a number of initiatives that would help to turn that situation around. In the light of concerns, an early re-audit of practice is recommended.

Formulary management guiding principles for automated systems.

Structural and financial changes in US healthcare are the driving forces reshaping care delivery and the technologies that clinicians use in their practice. Structural-level changes in healthcare organizations bringing facilities varying in size, systems, and complexity under the new integrated care delivery networks create unprecedented challenges. This paper develops guiding principles for formulary management in automated systems that facilitate medication management and alignment of medication information technology (IT) solutions in healthcare organizations ranging in size from a single facility to very large enterprise/multifacility networks. This paper describes formulary management best practices for healthcare organizations as they follow crucial medication management processes: formulary item builds, urgent and nonformulary medication requests, and formulary item build testing and maintenance. As medication management practices are embedded in automated technologies that are similar yet nuanced, we pay special attention to practices and change control processes that maximize coordination among systems while preserving medication data integrity and reducing medication errors. For increasingly complex healthcare systems with multiple medication management system demands, formulary drug database builds and maintenance are challenging and time-consuming. Formulary item build, testing, and maintenance processes involve multifunctional teams collaborating to ensure the integrity of data, prevent unexpected system incompatibilities, and improve patient safety by reducing medication errors. Ideally, formulary item build, testing, and maintenance processes produce consistent final drug records in IT systems meeting user needs.

Factors Influencing Medication Errors in the Prehospital Paramedic Environment: A Mixed Method Systematic Review

Introduction: There is limited research available on safe medication management practices in EMS practice, with most evidence-based medication safety guidelines based on research in nursing, operating theatre and pharmacy settings. Prevention of errors requires recognition of contributing factors across the spectrum from the organizational level to procedural elements and patient characteristics. Evidence is inconsistent regarding the incidence of medication errors and multiple sources also state that errors are under-reported, making the true magnitude of the problem difficult to quantify. Definitions of error also vary, with the specific context of medication errors in prehospital practice yet to be established. The objective of this review is to identify the factors influencing the occurrence of medication errors by EMS personnel in the prehospital environment. Methods and Analysis: The review included both qualitative and quantitative research involving interventions or phenomena related to medication safety or medication error by EMS personnel in the prehospital environment. A search of multiple databases was conducted to identify studies meeting these inclusion criteria. All studies selected were assessed for methodological quality, however this was not used as a basis for exclusion. Each stage of study selection, appraisal and data extraction was conducted by two independent reviewers, with a third reviewer deciding any unresolved conflicts. The review follows a convergent integrated approach, conducting a single qualitative synthesis of qualitative and “qualitized” quantitative data. Results: 56 articles were included in the review, with case reports and qualitative studies being the most frequent study types. Qualitative analysis revealed seven major themes: organizational factors (with reporting as a sub-theme), equipment/medications, environmental factors, procedure-related factors, communication, patient-related factors (with pediatrics as a sub-theme) and cognitive factors. Both contributing factors and protective factors were identified. Discussion: The body of evidence regarding medication errors is heterogenous and limited in both quantity and quality. Multiple factors influence medication errors occurrence; knowledge of these is necessary to mitigate the risk of errors. Medication error incidence is difficult to quantify due to inconsistent measure, definitions and contexts of research conducted to date. Further research is required to quantify the prevalence of identified factors in specific practice settings.

Knowledge and Practice of Medical Waste Management in Small, Medium and Large Hospitals in Bayelsa State

The consciousness and practical in-depth knowledge of the nature of medical waste, its public and environmental implications serves as a veritable tool in the effective and efficient management of medical waste in any healthcare institution. Thus, this study considered the knowledge and practice of medical waste in small, medium and large hospital in Bayelsa State, South-south Nigeria. It is aimed at assessing waste management practices with respect to colour coding at the various healthcare institutions within the study area. A descriptive study design was considered and a sample size of 300 obtained using Cochran’s formula. A well-structured questionnaire was used to elicit information from the respondents. Data were analyzed using simple percentage and frequency including graphs and bar chart. Result indicated that the rate of awareness and utilization of colour code for medical waste segregation in the various hospitals was poor except the large hospital (63%). The poor awareness level observed in the Medium and small hospitals in this study could be attributed to paucity of waste management infrastructure in addition to medical waste management deficiency and policy implementation practices. Furthermore, it was discovered that the use of sharp receptacle was high in small hospital (56%) and large hospital (75%) as compared to Medium hospital (43%). Also, knowledge, awareness and practice of medical waste management across the various healthcare institutions revealed that the small hospital (79%), medium hospital 71% and the large hospital 75% are well abreast and thus have good understanding of medical waste management, albeit, proper medical waste management is in a state of limbo at the hospitals at the time of this study. Government at all levels should ensure adequate funding and encourage professional to handle medical waste management whereas staff of the various hospitals should be properly trained on significance of the utilization of colour coding.

Interprofessional care of patients with type 2 diabetes mellitus in primary care: family physicians\u2019 perspectives

BackgroundThere is a lack of understanding of the team processes and factors that influence teamwork and medication management practices in the care of patients with type 2 diabetes mellitus (T2DM). The purpose of the study was to explore physicians’ perspectives of barriers and facilitators to interprofessional care of patients with T2DM within team-based family practice settings.MethodsThis was a qualitative, descriptive study. Participants included physicians affiliated with a primary care network providing care to patients with T2DM in an interprofessional team-based primary care setting in Edmonton, Alberta, Canada. Participants’ contact information was obtained from the publicly available College of Physicians and Surgeons of Alberta and respective primary care network websites. Interview questions addressed physicians’ perspectives on factors or processes that facilitated and hindered the care and medication management of adult patients with T2DM in primary care team-based clinical practice. Interviews were audio-recorded, transcribed, and analyzed using qualitative content analysis and a constant comparative approach.ResultsA total of 15 family physicians participated in individual interviews. Family physicians identified facilitators of interprofessional team-based care and medication management of patients with T2DM in three theme areas—access to team members and programs, knowledgeable and skilled health professionals, and provision of patient education by other health professionals. Two themes emerged as barriers to interprofessional care – lack of provider continuity and the loss of skills from delegation of tasks.ConclusionFamily physicians perceive both benefits and risks to interprofessional team-based care in caring for patients with T2DM. Successful functioning of team-based care in family practice will require overcoming traditional professional roles.

Attitudes of German GP trainees regarding add-on training programs differ if in office or hospital training phase

BackgroundMany residents are exposed to negative attitudes towards primary care during hospital training. Attractive add-on training programs exist, but it is unclear whether these need to be tailored to the location of training (hospital vs. office). We report differences in learner attitudes from a large German add-on training program.MethodsBetween 2017 and 2020, a regional network offered 31 quarterly seminars to primary care residents. The seminars addressed medical content, practice management and mentoring. We elicited participants’ satisfaction, perceived topic relevance, preferences for future seminars, work situation and employer support for participation. A proportionate odds model was used to assess predictors of ratings; results were stratified by training location (hospital vs. office).ResultsMost respondents were female (380/575 = 70.0%), aged between 26 and 40 (80.8%), and had on average 3.54 ± 1.64 years of residency training. The majority (83.8%) was working in an office and full-time (63.0%). Overall evaluations were positive (very satisfactory 72.1%). Comparing residents in the hospital phase vs. the office phase, overall seminar ratings of the perceived impact on the motivation for primary care did not differ (p = 0.73 vs. 0.18, respectively). Hospital-based residents were less likely to rate the topics as relevant (39.4% vs. 55.7%, p = 0.02) and had different preferences for future seminar topics (top 3: palliative care, emergencies and chronic care vs. billing, disease management and practice finances for hospital and office phase, respectively).ConclusionsKeeping primary care residents motivated may require education tailored to training location. Our findings may be of interest to teachers, administrators and policymakers.

Correlation between knowledge and medical waste management practices of puskesmas officers in Medan City

Health care industry has contributed to the increasing amount of medical waste. It is very important for health care providers to have the necessary knowledge to practice medical waste management. The study aims to determine the correlation between knowledge and solid medical waste management practices by city health center (puskesmas) officers in Medan City in 2021. This study was an analytical observational study and was collected using questionnaires to 41 puskesmas officers in Medan City, North Sumatra, Indonesia. The independent variable was knowledge of puskesmas officer in solid medical waste management and the dependent variable was practice of puskesmas officer in solid medical waste management. The result is there are puskesmas officers who have less knowledge and less practice as many as 2 respondents (4,9%), puskesmas officers who have less knowledge and good practice as many as 6 respondents (14,6%), puskesmas officers who have good knowledge and good practice as many as 1 respondent (2,4%), and puskesmas officers who have good knowledge and good practice as many as 32 respondents (78%). The results of the statistical test obtained a p-value of 0.032, so there is correlation between the level of knowledge and solid medical waste management practices at puskesmas in Medan City in 2021. To improve knowledge and practice of medical waste management, it is recommended for puskesmas officers to attend training and implement the standard operating procedures and for the government, it is recommended for carrying out training, providing adequate temporary disposal sites, and supervising medical waste management.

Critical care nurses' perceptions and practices towards clinical alarms.

Muted or controlled alarms resulting from alarm fatigue have become a threat to patient safety and several institutions are aware of this risk. This study aimed to investigate critical care nurses' perceptions of medical device alarms, alarm fatigue, and alarm management practices. This descriptive study investigated 48 nurses working at two intensive care units (ICUs) within a single university hospital, in South Korea. They were asked to complete a self-administered questionnaire about their perception of the ICU medical device alarm, alarm fatigue, and related management practices. The response rate was 100%. Critical care nurses experienced a moderate or higher level of alarm fatigue, scoring 29.1 out of 40. Participants identified the items "Frequent false alarms, which lead to reduced attention or response to alarm when they occur," and "Inadequate staff" as the most important issues for alarm management. The most frequently involved item in alarm management practice was "I only use infusion pumps for drugs that require precise dose." Alarm management practices among the nurses differed significantly according to ICU clinical career and experience of patient safety accidents. This study highlights the need to develop a standardized medical device alarm management protocol that can help identify different alarms correctly and respond to them rapidly and appropriately. It is necessary to reduce alarm fatigue and promote safe and effective alarm management practices among critical care nurses through sufficient education and steady training. Alarm fatigue should also be mitigated by employment of sufficient nursing personnel in ICUs.

An Automatic Data Mapping for Interoperability of OpenEMR Medical Practice Management Software Using the Fast Healthcare Interoperability Resources

An Automatic Data Mapping for Interoperability of OpenEMR Medical Practice Management Software Using the Fast Healthcare Interoperability Resources