Occurrence Of Critical Incidents Research Articles

Four-year follow-up of surface contamination by antineoplastic drugs in a compounding unit

ObjectivesThis study aimed to monitor the contamination by antineoplastic drugs on work surfaces in a compounding unit 4 years after its implementation.MethodsThis descriptive study was done in a unit performing...

Discussing the Effect of Students' Crisis Awareness on Emotion During the COVID-19 Pandemic From the Perspective of Trust.

The effects of crises vary among individuals, societies, and nations. Governments' crisis management is quite different from that of non-governmental organizations, especially in terms of “publicity,” since it involves bureaucracy to address people's accountability concerns. The purpose of this study is to investigate the relationship between students' crisis awareness, trust, and emotions in the event of a major public health emergency. A questionnaire survey was conducted for this study. A total of 500 copies of questionnaires were distributed to the college students in Jiangxi. Among those, 437 valid copies were retrieved, with a retrieval rate of 87%. A structural equation model (SEM) was used to conduct the statistical analyses. The research results were summarized as follows: (1) At the stage of epidemic spread, people can easily fall into the negative emotion. (2) The society with a good trust relationship considers schools less responsible for critical incidents and more helpful for crisis communication. (3) Reducing the negative emotions of the public after the occurrence of critical incidents can effectively reduce the damage of critical incidents to the organization. Avoiding a loss of student confidence and increasing anger, protecting the school's reputation, having a good communication effect, and minimizing the impact of the crisis can help the students develop better trust toward the school. When a crisis occurs on campus, this can reduce the possibility of students' showing negative emotions and spreading rumors. It is considered that the findings provide guidance on how to optimize the management of public health crisis situations and improve students' mental health.

COMPARISON OF LEVOBUPIVACAIN AND ROPIVAKAIN IN COMBINED ANESTHESIA IN ONCOGNECOLOGICAL INTERVENTIONS

The aim of the study was to evaluate the nature of the development of the sensory block and the frequency of occurrence of critical incidents during anesthesia, in the immediate postoperative period using levobupivacaine and ropivacaine in patients with an oncogynecological profile. Materials and methods. The study included 48 women who were randomized into two groups of 24 patients each, depending on the anesthetic used: group 1 - ropivacaine, group 2 - levobupivacaine. The latent period of the sensory block, the motor block, the maximum level of development of the sensory block after 15 minutes, critical incidents at the stages of anesthesia, the level of the pain syndrome after extubation and coughing were analyzed in the groups. Results. The sensory response to the cold sample, after the administration of local anesthetics in the groups, differed: in the first group, 300 (241.25, 314.75) s, in the second group 54.5 (45.75, 60.25) s. The maximum level of the sensory block in the groups was different. During the induction and maintenance of anesthesia, the most common critical incident was hypotension. Reduction of systolic blood pressure for the induction of anesthesia in group 1 was detected in 6 (25%) cases, in group 2 in 7 (29%). After extubation, the pain syndrome in the first group was 1.7 (1; 6), in the second group 1.7 (1; 4). With a cough, the assessment of the pain syndrome had the same intensity of pain, both in the first and in the second group 2 (1; 3). Conclusions. Levobupivacaine with epidural anesthesia accelerates the development of the sensory block. The maximum level of the sensory block does not differ with the use of levobupivacaine and ropivacaine. Hypotension in the stages of anesthesia is a frequent critical incident in epidural anesthesia. The severity of the pain syndrome during extubation and in the immediate postoperative period does not depend on the selected anesthetic.

PREDICTION OF CRITICAL INCIDENT DURING EPIDURAL ANESTHESIA IN GYNECOLOGICAL PATIENTS

Objective - to estimate frequency of occurrence of critical incidents during epidural anesthesia in gynecological patients with different sensitivity of peripheral chemoreflex. Material and Methods: prospective observational blind study, 54 gynecological patients, elective surgery. The day before the surgery, the sensitivity of peripheral chemoreflex was determined by the duration of an arbitrary threshold apnea in a test with a delayed respiration. According to the duration of the test, the patients were divided into groups: high (group «1») and medium (group «2») sensitivity of peripheral chemoreflex. During the operation and in the early postoperative period, critical incidents were recorded. Results and Conclusion(s). During epidural anesthesia in gynecological patients from intraoperative critical incidents is revealed hypotension. The frequency of occurrence of hypotension was 32.1% in patients of group «1» and 15.4% in patients of group «2». High sensitivity of peripheral chemoreflex in patients during epidural anesthesia is a predictor of unstable hemodynamics, as well as the risk of postoperative nausea and vomiting.

Simulated settings; powerful arenas for learning patient safety practices and facilitating transference to clinical practice. A mixed method study.

Poor teamwork is an important factor in the occurrence of critical incidents because of a lack of non-technical skills. Team training can be a key to prevent these incidents. The purpose of this study was to explore the experience of nursing and medical students after a simulation-based interprofessional team training (SBITT) course and its impact on professional and patient safety practices, using a concurrent mixed-method design. The participants (n=262) were organized into 44 interprofessional teams. The results showed that two training sequences the same day improved overall team performance. Making mistakes during SBITT appeared to improve the quality of patient care once the students returned to clinical practice as it made the students more vigilant. Furthermore, the video-assisted oral debriefing provided an opportunity to strengthen interprofessional teamwork and share situational awareness. SBITT gave the students an opportunity to practice clinical reasoning skills and to share professional knowledge. The students conveyed the importance of learning to speak up to ensure safe patient practices. Simulated settings seem to be powerful arenas for learning patient safety practices and facilitating transference of this awareness to clinical practice.

Household norms and their role in reducing household electricity consumption

AbstractResearchers have only recently begun to investigate the role of the norms of the household or family group in energy‐efficiency decisions. These researchers have demonstrated that these norms can influence the behaviour and attitudes of children within the household. We contribute to their findings by providing a characterization of the use of household norms in household decisions about electricity efficiency. For our qualitative research, we conducted focus groups with three different household types: (1) share houses/young couples with no children; (2) households with children; and (3) empty nest/elderly households in three regional centres in New South Wales, Australia (total of 76 respondents in nine focus groups). Specifically, we found that household norms were evident in the decision‐making process through rules and expectations about behaviour and the use of sanctions to enforce or shaped that behaviour. We identified several drivers of household norms including a household member taking the role of ‘efficiency champion’ and the occurrence of critical incidents in the household. In addition, we found that household members try to establish household norms to socialize household members with the goal of the intergenerational transmission of desirable behaviours. Based on these observations, we conclude that household members employ norms to regulate and reduce their electricity consumption, and as a mechanism for consumer socialization. As such, our findings are important for marketers and policy makers tasked with regulating household consumption.

Residual anaesthesia drugs – silent threat, visible solutions

We read Bowman et al.'s editorial 1 regarding retention of anaesthetic drugs in intravenous lines with great interest and commend the standards of care proposed. We have taken an interest in this topic ourselves due to a recent incident. A patient in our hospital underwent rapid sequence induction using an indwelling intravenous cannula sited on the ward and after induction, a new cannula was inserted for use during surgery. Several hours later, the original cannula and connector (total dead space 0.7 ml) was flushed before antibiotic administration on a surgical ward. The patient experienced a rapid loss of motor function, leading to respiratory arrest, presumably from accidental administration of retained suxamethonium. After approximately five minutes of bag-valve-mask ventilation, the patient recovered neuromuscular function and reported explicit awareness of events with no physical sequelae. Clinical psychology interviews were conducted and the patient's overriding concern was that measures be taken within our hospital to prevent a recurrence. In our review of this incident we have become aware of the need not only to flush all intravenous cannulae but also to remove any unnecessary cannulae after anaesthesia. This reduces the risk of both administration of retained drugs and cannula-associated infections. Before instigating a safety campaign, we conducted a local survey of practice using visible propofol as a surrogate for an unflushed cannula or connector. This was seen in 32% of cases. In 26% of cases, unnecessary connectors or cannulae remained in place after anaesthesia. Flushing of cannulae was not documented in the anaesthetic record or drug chart of any patient. We have addressed the problem with a local protocol, post-anaesthesia handover documentation and regular repeat audit. A range of safety posters – designed to be intentionally eye-catching – have been placed in areas where anaesthesia is administered or where anaesthetists gather (Fig. 1). These have been found to be particularly effective in maintaining awareness amongst anaesthetists and theatre staff. A subsequent re-survey has demonstrated that only 1.6% of patients had visible propofol in a cannula, no total intravenous anaesthesia connectors were left attached to lines and both written documentation and verbal handover to recovery staff have increased by 36%. Recovery nurses now routinely remove any unused cannulae. As described in Bowman et al.'s article, it is well recognised that the occurrence of critical incidents in general 2, and anaesthesia specifically, is underestimated due to under-reporting and misclassification 3. The danger posed by retained anaesthetic drugs in cannulae has long been recognised as a problem 4. Given this, and the potentially devastating sequelae, it would seem imprudent to view this issue as rare and not take firm action as an anaesthetic community. Analogous to the ‘Stop Before You Block’ campaign regarding wrong-site nerve blockade 5, the development of a highly visible national patient safety initiative to help prevent the accidental administration of anaesthetic drugs would improve patient safety.

The effect of sleep disruption on performance of anaesthetists--a pilot study.

Fatigue has been implicated in the occurrence of critical incidents. Using a driving simulator to assess vigilance, we investigated the effect of sleep disruption on the ability of anaesthetists to maintain vigilance after a night on-call. Following an undisturbed night of sleep, subjects demonstrated a significant improvement in their vigilance scores. Subjects failed to demonstrate this following a disturbed night. The timing of disturbance had a bearing on performance. Subjects' performance was worse if their sleep had been disturbed in the first third of the night. The effect of sleep disruption on vigilance has implications for patient safety during anaesthesia.

Student perceptions about the occurrence of critical incidents in tutorial groups

The study reported here examines student perceptions about the occurrence of critical incidents in tutorial groups across years of medical training. The study investigates the following research questions. (1) Which factors underlie the occurrence of critical incidents in the tutorial group? (2) How do students rate the incidents with respect to whether they occur in the tutorial groups? (3) Are there differences in scores on the factors identified across years of medical training? The subjects consisted of a stratified random sample of 200 students at the Medical School of the University of Maastricht. In general, the results of the confirmatory factor analyses indicate that a six-factor model showed a good fit. The results show that students frequently perceive lack of elaboration, lack of interaction and unequal participation in tutorial groups. For most of the factors (lack of elaboration, difficult personalities, lack of cohesion, and lack of motivation) the average scores differ significantly ( p <0.01) across the years.