Safety Score Research Articles

P-1615. Inappropriate Urine Cultures: The Order Stops Here

Abstract Background Our most frequently missed bundle element from catheter-associated urinary tract infection (CAUTI) case reviews was that the urine culture did not meet evidence-based criteria for testing. Possible harm to the patient from an inappropriate urine culture and subsequent treatment includes unnecessary antibiotics, diagnostic anchoring, Clostridioides difficile infection, and longer length of stay. Risks to the organization include artificially inflated infection rates, associated lower quality and safety scores, and reduced federal reimbursements.Figure 1:Catheter-Associated Urinary Tract Infection (CAUTI) Rate CAUTI rate before (0.61 cases per 1,000 catheter days) and after (0.22 cases per 1,000 catheter days) diagnostic stewardship intervention in March 2022 (p=0.005). Methods In March 2022 an automated report was built in a third-party software system using data from the electronic health record to identify urine cultures ordered in a patient hospitalized for two or more days with an indwelling urinary catheter (IUC), or who had an IUC removed in the previous two days. When a qualifying culture was identified, laboratory personnel held results and contacted the Antimicrobial Stewardship (AMS) Pharmacist. The case was discussed at AMS rounds with an Infectious Disease provider and the decision made whether to release the results. In cases where the culture was not appropriate, the patient’s provider was notified that the result would not be finalized and released. The infection rate pre- and post-intervention was calculated, and statistical analysis conducted with the Student’s T-test. Results In the 11 months prior to implementation of the urine culture review protocol, the average CAUTI rate was 0.61 cases per 1,000 IUC days. In the 23 months since the intervention, the average CAUTI rate was 0.22 cases per 1,000 IUC days, a 63.9% reduction in the infection rate (p=0.005). 19% of orders reviewed were determined to be appropriate. The AMS team reports the volume of culture reviews is manageable. When notified that the culture results would not be released, ordering providers responded favorably to the decision and no objections or adverse patient outcomes have been observed. Conclusion Our non-traditional intervention of enlisting the expertise of the AMS team for a diagnostic stewardship review has been successful in preventing unnecessary treatments to patients and has saved the institution from reportable CAUTI cases that did not meet clinical indication for testing. Disclosures All Authors: No reported disclosures

Influence of Psychological Safety and Safety Climate Perceptions on Nurses’ Infection Prevention and Occupational Safety Practices and Environment

Background/Objectives: The aim of this study was to describe and examine the relationships among elements of infection prevention practices, the care environment, psychological safety, and safety climate in adult medical surgical units in the wake of the COVID-19 pandemic. Methods: Nurses in adult inpatient medical surgical units in the northeast were surveyed electronically. Each self-rated their infection prevention practices and elements of the care environment in their primary work unit. They were also asked to rate a series of questions regarding how psychologically safe they felt on their units as well as the overall patient safety climate. Results: A total of 259 nurses responded (52% response rate) to the survey. Overall psychological safety was rated neutrally among respondents, with a rating of 3.5 (1 being the lowest and 5 being the highest). Respondents reported better ratings of the safety climate on their unit (4.0) but also identified areas for improvement. Eight of twelve infection prevention practices were correlated with higher safety climate scores and ten were correlated with higher psychological safety scores. Nine of ten environmental factors were correlated with higher safety climate and higher psychological safety scores. Conclusions: Both psychological safety and patient safety climate are related to nurse self-ratings of performance of infection prevention practices. Similarly, the care environment nurses work in has important implications for psychological safety and patient safety. It is essential for nursing leadership to act as a steward in these areas to build a higher quality care environment for nurses and patients alike.

Evolution of a patient safety program in an academic medical center

Background The Academic Medical Center earned a 1-Star CMS designation and received an F on the Leapfrog Safety Grade in 2015, which led to leadership setting Clinical Quality Improvement as the #1 Strategic Priority. This paper presents the evolution of a structured patient safety program as a component of this plan to direct and motivate employees to succeed in reducing patient harm. Methods Data-driven quality improvement using simple, timely, actionable data drillable scorecards available to all employees was the cornerstone of the above strategic priority. A comprehensive patient safety program was developed utilizing three phases: Error Prevention Training, Improved Event Reporting, and the Chasing Zero Harm initiative. Results Improvement was achieved in Culture of Safety Survey domains of overall safety, event reporting, nonpunitive response to errors, and hand-off communication. Patient safety indicators and hospital-acquired infections improved on the Medical Center's internal scorecard and public reported data by >60%. These resulted in improvement in Leapfrog Safety Score from an F in 2015 to a B in 2023, and increase from CMS 1-Star to 2-Star rank in 2023. Adverse event reports and review with follow up increased by 45% between 2018 and 2023. A Chasing Zero harm program was initiated following establishment of these steps. Discussion A successful patient safety program, predicated on high reliability, can successfully be built with leadership commitment, development of safety culture, and performance improvement.

Pre‐clinical evaluation of the Hyaguard™ sub‐conjunctival insert in maintaining post‐trabeculectomy intra‐ocular pressure vs MMC and Prednisolone drops

Aims/Purpose: Post‐trabeculectomy rabbit model efficacy and safety evaluation of HyaGuard™; a biodegradable sub‐conjunctival drug eluting platform, designed to replace Mitomycin C (MMC) and post‐operate steroid drops in glaucoma drainage surgeries.Methods: Pre‐clinical evaluation was conducted on normotensive New Zealand White rabbits (8‐12 weeks old, 50/50 male/female). A 4x4 mm trabeculectomy was performed on the left eye of each rabbit. All animals received Ofloxacin 3mg/ml (2 drops) 4 times daily for one week. Control and 1% w/w prednisolone HyaGuard groups did not receive MMC or prednisolone drops, whereas positive control animals were treated with 0.04% MMC for 4 minutes followed by prednisolone acetate 0.5% drops (2 drops) 4 times daily for two weeks. Intraocular pressure (IOP) was measured using TonoVet® pre‐operatively (week ‐1) and on days 3, 7, 14, and 28 post operation. Ophthalmic examinations were performed. Post study, eyes were histologically analyzed using H+E staining.Results: 1% prednisolone HyaGuard inserts demonstrated significantly better welfare and safety scores than standard of care. Histological analysis revealed no fibrotic encapsulation and intact conjunctivas. From an initial average IOP of 11.5 (± 1.0) mm Hg, the Day 28 ΔIOP (% of starting IOP) was ‐35.38 ±19.75% for MMC‐drops (p < 0.01), ‐8.61 ±10.56% for blank HyaGuard (non‐significant), and ‐24.54 ±10.20% for 1% prednisolone HyaGuard (p < 0.05). The 1% prednisolone HyaGuard group maintained a significantly greater reduction in IOP compared to the negative control (p < 0.01) and was statistically equivalent to the positive control.Conclusions: HyaGuard demonstrated improved tolerability and safety following subconjunctival insertion in rabbits. The 1% prednisolone loaded HyaGuard effectively maintained significant decreases in post trabeculectomy IOP, without the need for MMC or repeat drop administration, suggesting its potential as a viable solution to the long running fibrotic failures associated with bleb forming drainage surgeries.

Development and effectiveness of an educational program to foster psychological safety: A randomized controlled trial focusing on care workers in geriatric care facilities

This study aimed to examine the effectiveness of a program for improving interpersonal relationships to foster psychological safety among geriatric care workers. A randomized controlled trial was conducted with 192 care workers in seven geriatric care facilities. Participants were divided into intervention or control groups; intervention groups attended a 60-minute program twice. Participants completed questionnaires addressing psychological safety, work environment, and intention to leave three times in six months. A linear multiple regression analysis was performed for each score at Time 1 or Time 2 as the dependent variable, with the score at baseline as the covariate. The psychological safety score increased (p < .05), and the “exclusive workplace climate” score decreased (p < .10) between the baseline and second survey. However, the significance became nonexistent between the second and third surveys. Although the program effectively fostered psychological safety, further ingenuity should be provided for continued effectiveness.

Prevalence and determinants of intimate partner violence under a corona virus situation: technical efficiency analysis across Indian states and union territories

This study attempted to determine how political engagement, accreditation, and female autonomy controlled intimate partner violence (IPV) in the COVID-19 scenario. The empirical investigation used published statistics on IPV for 27 Indian states and two union territories. The investigation used methods such as principal component analysis, the technical inefficiency effects model, and nonparametric analysis of variance (ANOVA). The results showed that Odisha, West Bengal, Uttarakhand, and Chhattisgarh were the states most efficient in regulating IPV. The Judiciary and Public Safety Score, female autonomy, and political involvement and accreditation, as evaluated based on female Members of Parliament (MPs) and Members of the Legislative Assembly (MLAs), are the most important factors in minimizing state-managed inefficiency. The study concludes with pertinent conclusions, some policy recommendations, and a focus on the trajectory of future research.

The Built Environment, PTSD Symptoms, and Tobacco Use among Permanent Supportive Housing Residents.

50% of permanent supportive housing (PSH) residents in the U.S. smoke cigarettes, and tobacco-related mortality is their number one cause of death. Over 30% of PSH residents have post-traumatic stress disorder (PTSD), and many perceive their built environment (e.g., housing) as inadequate for mental and physical health recovery. It is unknown whether built environment factors moderate the relationship between PTSD and tobacco use among PSH residents. We used baseline data from 400 participants in a smoke-free home intervention in PSH sites in the San Francisco Bay Area between 2022 and 2024. We explored whether perceived housing quality and perceived neighborhood safety moderated the relationship between PTSD symptoms and cigarettes per day (CPD) using linear mixed models. 62.8% of the participants were male, 41.8% were Black, 30.5% screened positive for PTSD, 54.3% rated their housing as average/poor, and the mean neighborhood safety score was 3.4 (SD 0.9). Mean CPD was significantly higher in participants with PTSD compared to those without PTSD among participants who rated their housing as good/excellent (5.1; 95% CI: 2.7, 7.5) or their neighborhood as safer (7.8; 95% CI: 2.8, 12.8). Mean CPD was not significantly different between those with and without PTSD among participants who rated their housing as average/poor or their neighborhood as less safe. Perceived housing quality and neighborhood safety moderated the association between PTSD symptoms and CPD. Findings have implications for developing trauma-informed, multi-level interventions for tobacco use that combine individually directed approaches with those that consider the built environment.

A preparation program for psychological safety of hospitalized adolescents

IntroductionThe study aimed to investigate the impact of an information-based preparation program on the psychological safety of adolescents admitted to pediatric wards, emphasizing the importance of enhancing patient safety.MethodsThis quasi-experimental study was conducted among 98 adolescents admitted to pediatric wards at Namazi Hospital, managed by Shiraz University of Medical Sciences, in 2021. The participants were randomly assigned to either an intervention group or a control group using an electronic randomization table. The intervention group received an information-based preparation program, while the control group followed routine care. Adolescents completed the Psychological Safety Questionnaire after admission and at discharge. Data were analyzed using SPSS (Version 22), with a significance level of 0.05.ResultsThe mean psychological safety scores before the intervention were 136.73 ± 17.30 in the control group and 141.03 ± 16.34 in the intervention group, with no significant difference between the two groups (p = 0.20). After the intervention, the mean scores were 136.65 ± 19.01 in the control group and 145.50 ± 14.05 in the intervention group. A comparison of the mean psychological safety scores showed a significant difference between the two groups after the intervention (p = 0.01).ConclusionsThe findings of this study indicate that the information-based preparation program positively affected the psychological safety of hospitalized adolescents. Therefore, it is recommended that nurses incorporate this method into therapeutic programs for hospitalized adolescents to enhance their psychological safety effectively.

Effects of 60 Degrees of Flexion and Perioperative Use of Tranexamic Acid on Recovery After Knee Replacement

Objective To explore the effect of 60 knee flexion combined with multiple tranexamic acid application on postoperative recovery of knee replacement patients. Methods Knee replacement patients admitted to our hospital from February 2022 to February 2024 were selected as the study subjects, and randomly divided into 2 groups. Postoperative D-dimer, prothrombin time, and partial thrombin time were recorded in the 2 groups, and the differences between the 2 groups were compared. Erythrocyte, hemoglobin, and erythrocyte volume were recorded before, 1 day, and 3 days after surgery, and the affected limb circumference were also assessed. Results On the first and third day after surgery, red blood cells, hemoglobin, and hematocrit levels in the experimental group were higher than those in the control group, and the differences were statistically significant (P &amp;lt; 0.05). The difference in visual analogue score (VAS) and circumference between the two groups on the first day and third day after surgery was compared, and the difference was statistically significant. The difference in VAS score and circumference was lower in the control group (P &amp;lt; 0.05). After surgical treatment, knee joint function recovered, knee joint mobility, and Healthcare Security and Safety (HSS) score improved, and the difference between the experimental groups was statistically significant (P &amp;lt; 0.05). Conclusion Perioperative 60° flexion combined with multiple tranexamic acids can significantly reduce blood loss in patients undergoing knee replacement surgery, increase red blood cells, hemoglobin levels, and red blood cell volume on postoperative days 1 and 3, and reduce postoperative swelling of the affected limb.

Psychological safety in the perioperative environment: a cost-consequence analysis

IntroductionPsychologically unsafe healthcare environments can lead to high levels of staff turnover, and unwanted financial burden. In this study, we investigate the hypothesis that lower levels of psychological safety are...

Impact of artificial intelligence in managing musculoskeletal pathologies in physiatry: a qualitative observational study evaluating the potential use of ChatGPT versus Copilot for patient information and clinical advice on low back pain.

The self-management of low back pain (LBP) through patient information interventions offers significant benefits in terms of cost, reduced work absenteeism, and overall healthcare utilization. Using a large language model (LLM), such as ChatGPT (OpenAI) or Copilot (Microsoft), could potentially enhance these outcomes further. Thus, it is important to evaluate the LLMs ChatGPT and Copilot in providing medical advice for LBP and assessing the impact of clinical context on the quality of responses. This was a qualitative comparative observational study. It was conducted within the Department of Physical Medicine and Rehabilitation, University of Montreal in Montreal, QC, Canada. ChatGPT and Copilot were used to answer 27 common questions related to LBP, with and without a specific clinical context. The responses were evaluated by physiatrists for validity, safety, and usefulness using a 4-point Likert scale (4, most favorable). Both ChatGPT and Copilot demonstrated good performance across all measures. Validity scores were 3.33 for ChatGPT and 3.18 for Copilot, safety scores were 3.19 for ChatGPT and 3.13 for Copilot, and usefulness scores were 3.60 for ChatGPT and 3.57 for Copilot. The inclusion of clinical context did not significantly change the results. LLMs, such as ChatGPT and Copilot, can provide reliable medical advice on LBP, irrespective of the detailed clinical context, supporting their potential to aid in patient self-management.

Safe reinforcement learning-based control using deep deterministic policy gradient algorithm and slime mould algorithm with experimental tower crane system validation

This paper presents a novel optimal control approach resulting from the combination between the safe Reinforcement Learning (RL) framework represented by a Deep Deterministic Policy Gradient (DDPG) algorithm and a Slime Mould Algorithm (SMA) as a representative nature-inspired optimization algorithm. The main drawbacks of the traditional DDPG-based safe RL optimal control approach are the possible instability of the control system caused by randomly generated initial values of the controller parameters and the lack of state safety guarantees in the first iterations of the learning process due to (i) and (ii): (i) the safety constraints are considered only in the DDPG-based training process of the controller, which is usually implemented as a neural network (NN); (ii) the initial values of the weights and the biases of the NN-based controller are initialized with randomly generated values. The proposed approach mitigates these drawbacks by initializing the parameters of the NN-based controller using SMA. The fitness function of the SMA-based initialization process is designed to incorporate state safety constraints into the search process, resulting in an initial NN-based controller with embedded state safety constraints. The proposed approach is compared to the classical one using real-time experimental results and performance indices popular for optimal reference tracking control problems and based on a state safety score.

ChatGPT provides safe responses to post-operative concerns following total joint arthroplasty

Introduction: Postoperative triage is a considerable financial and time burden following total joint arthroplasty (TJA). An ideal post-operative triage method would be equally as safe as triage nurses, but more cost-effective and time-efficient. Therefore, this study aimed to see if ChatGPT could serve as a safe and effective method of postoperative triage in responding to patient concerns following TJA. Methods: A list of ten potential concerns from post-operative arthroplasty patients was compiled ranging from “How much walking can I do?” to “My leg is throbbing and red, and I’m having trouble breathing. What should I do?”. These concerns were presented to trained orthopaedic triage nurses (n=3) and ChatGPT (Version 3.5). The generated responses were rated blindly by three fellowship-trained orthopaedic surgeons specializing in adult reconstruction using Likert scales ranging from 1-5 for safety and completeness (1 being highly unsafe/incomplete; 5 being highly safe/complete). The average scores were calculated for each prompt and are presented as mean±standard deviation. Results: There was no significant difference in average safety scores between ChatGPT responses (4.2±0.5) and those of triage nurses (4.3±0.4) (P=0.68). Similarly, there was no significant difference in completeness scores between ChatGPT responses (3.9±0.8) and those of triage nurses (4.0±0.6) (P=0.67). Furthermore, there were no significant differences in safety or completeness between ChatGPT and triage nurses for any of the individual prompts (all P values &gt;0.05). Conclusions: Postoperative triage is a critical component of perioperative care but represents a substantial time and cost burden. This preliminary study highlights the promising opportunity for future use of AI-enabled chatbots to provide instantaneous, safe, and complete responses to postoperative patient concerns.

Simulation training for invasive cardiovascular procedures: the Heart-SIMS-1 study

Abstract Introduction Interventional cardiology training has a long learning curve and exposes patients and clinicians to undesirable procedural risks. We aim to assess whether mentored simulation-based training with three dimensional (3D) printed models can improve the procedural skills and safety performance of beginners in coronary diagnostic procedures. Methods Twenty-nine final-year medical students from a single centre were lectured in the basic principles of invasive coronary angiography (ICA) for one-hour, and then randomized to conventional training or simulation training. Conventional training (n=15) consisted in watching a 20-minute video demonstrating all ICA steps in a 3D-printed coronary simulator. Simulation training (n=14) offered the same explanations in a hands-on training session with the 3D-printed model, in pairs, for 20 minutes. The co-primary endpoint was efficacy and safety of performing a simulated ICA in the 3D-printed simulator, installed under sterile drapes, in a conventional angiography suite. Efficacy and safety were graded by a blinded investigator using a pre-specified performance checklist, including the identification of procedural "red flags", graded 0-100%. The secondary endpoint was theoretical knowledge, assessed in a 25-question multiple-choice quiz, graded 0-100%. Results All participants completed the training and evaluation phases. Both elements of the co-primary endpoint were superior in the simulation group: efficacy score of 91.5 ± 3.8 vs 64.6 ± 8.3% and safety score 100.0 (100.0-100.0) vs 62.5 (20.8-79.2) %, p&amp;lt;0.001. The median number of "red flags" were 2 (1-4) in conventional and 0 (0-0) in simulation training recipients (p&amp;lt;0.001). Secondary endpoint was higher in simulation training: 85.7 ± 9.0 vs 76.8 ± 12.7% (p=0.039). Conclusion Mentored simulation-based training of medical students in ICA with 3D-printed models resulted in improved performance regarding efficacy, procedural safety, and theoretical knowledge.ResultsSimulation and evaluation setup

Collection and use of patient-reported experience measures: approach to improve health care

Abstract Background Patient experience is one of the fundamental determinants of healthcare quality. There is progress in the collection of PREM in national level for hospitalized patients since 2020 in Latvia. Aim Analyze (2020.-2022.) in-patients Top-box rates about communication, share-decision making, patient safety and Net Promoter Score (NPS). Methods Project starting point was 2019. Agreement with EC, Sant’Anna School, Ministry of Health and Centre for Disease Prevention and Control of Latvia. Since 2020, the collection of PREM has been taking place regularly in hospitals (around 40% from all hospitals) and on average 20% response rate of those who agreed to participate in the survey. PREM questionnaire according to HCAHPS (Consumer Assessment of Healthcare Providers and Systems) standards, including Picker Institute patient experience questions. In line with OECD (Organization for Economic Co-operation and Development) recommendations, patient safety issues are also included. Top-box rates (most positive response) and percentiles (25th - 75th) were calculated. Results Totally 17019 adult (18 years and more) patient responses were analyzed with response rate 20.3% (n = 83983). 74.6% (67.5-78.2) during hospital stay doctors always explain things in a way you could understand and sufficiently involved in the decision-making process of treatment - 75.0% (70.1-81.4). During hospital stay 4.1% (n = 601) experienced patient safety incidents which were patient-reported. The most common groups were wrong patients, medication errors, incl. adverse drug reactions and falls. Hospitals achieved a NPS of 61 for 3 year period (2020.-2022.). Conclusions Collecting information about the patient experience may be the starting point for engaging patients and moving to more patient-centered health care. The results of these in-patient PREM data can be used to identify areas of improvement and make changes to better meet the needs and expectations of their patients. Key messages • It is a good practice for the implementation of new health care quality data - patient experience reported measures at the national level. • Feedback about the patient experience on regular basis provides insight into patient needs, preferences and values, which can help to improve the quality and safety of care.

Comparison of Efficacy And Safety of Isotretinoin Versus Lymecycline Capsule For The Treatment of Acne Vulgaris

Background: Acne vulgaris is a very common condition which can cause significant physical and psychological morbidity. Oral retinoids and tetracyclines have a major role in acne treatment. Isotretinoin (13-cis-retinoic acid) is the only therapy that impacts on all of the major aetiological factors implicated in acne. Another agent is lymecycline, a tetracycline antibiotic have an antibacterial action against P. acnes and also an anti-inflammatory action and used for treatment of acne. Objectives: To determine the efficacy and safety of Isotretinoin capsules versus Lymecycline capsule in treatment of mild to moderate facial acne vulgaris. Materials &amp; method: This open labelled, randomized study was conducted in Department of Dermatology and Venereology, Dr. Sirajul Islam Medical College &amp; Hospital Ltd., Dhaka, from December 2021 to May 2022. Patients of mild to moderate facial acne vulgaris were enrolled for study. Clinical examination and relevant investigation were done meticulously. A total number of 50 patients was selected and randomization was done 1:1 parallel design into two groups (group-A and group-B), each of which included 25 patients. Group A patients received Isotretinoin and group B patients were given Lymecycline. Patients were followed up on 2nd, 4th, 8th and finally on 12th week to see clinical improvement and adverse effects. All information was recorded in data collection sheet. Result: The mean age was found 20.4±5.7 years in group A and 19.9±6.9 years in group B. The mean age difference was not statistically significant (p&gt;0.05) between two groups. Male to female ratio was almost 1:3 in the whole study patients. Mean score for open comedone (0.28±0.22 vs. 2.2±1.13), closed comedone (1.92±0.19 vs. 2.08±0.25), papule (0.82±0.29 vs. 1.27±1.04) and pustule (0.85±0.33 vs. 1.19±0.39) was identical in group-A and B respectively and significantly better reduction of acne score (p=0.001) in the group A than the group B. It was evident that abdominal discomfort (4.0% vs. 32.0% in group A &amp; B), diarrhea (0% vs. 16.0% in group A &amp; B) and photosensitivity (4.0% vs. 16.0% in group A &amp; B) was predominant in group B. The difference was statistically significant (p=0.029). Whereas, erythema and burning was predominant in group A. Mean burning was found 0.15±0.08 in group A and 0.11±0.05 in group B and mean scaling was found 1.27±0.98 in group A and 1.45±0.98 in group B which were statistically non significant (p&gt;0.05) between two groups. At 4th follow up mean total safety score was found 3.05±0.92 in group A and 4.65±1.25 in group B. Conclusion: Isotretinoin was as effective as lymecycline for the treatment of moderately severe acne vulgaris. Both treatments were well tolerated &amp; effective. J Dhaka Med Coll. 2023; 32(1) : 63-70

Comparison of the effects of medication error encouragement training and problem-based scenario on the medication safety competence and knowledge of nursing students: A quasi-experimental study

BackgroundMedication errors among nursing students pose a threat to medication safety. Medication Error Encouragement Training and Problem Based Scenario are two innovative educational methods used in medication education. AimCompare the effects of Medication Error Encouragement Training and Problem Based Scenario on the knowledge and competency of medication safety among nursing students. DesignQuasi -experimental, double-blind, two-group pretest-posttest study. MethodThis study was conducted in 2023. Participants were randomly assigned to two groups: one group received the Medication Error Encouragement Training method, while the other group was taught using the Problem-Based Scenario method. Data collection was performed using the Medication Safety Critical Element Checklist and Medication Safety Knowledge Assessment before and four weeks after the intervention. Data analysis was conducted using SPSS version 16. ResultsThe Pair t-test demonstrated that the change in competency and knowledge scores of medication safety before and after the intervention was significant in both groups (P< 0.05). The results of the Mancova test indicated a significant increase in medication safety competency scores in the Medication Error Encouragement Training group compared with the Problem Based Scenario group after the intervention (P< 0.05), while there was no significant difference in medication safety knowledge scores between the two groups after the intervention (P> 0.05). ConclusionThe Medication Error Encouragement and Problem Based Scenario methods were effective in increasing the knowledge and competency of medication safety among students, but the effectiveness of the Medication Error Encouragement method was more pronounced in achieving safe medication administration.

Evaluation of the Safety and Effectiveness of Ultrasound-guided Internal Jugular Vein Catheterization in Critically Ill Patients

Background:Central venous catheterization is a frequently performed procedure in intensive care units (ICU) for diagnostic and therapeutic purpose. As an invasive procedure it carries some risk and should be performed with few attempts. Traditionally this procedure is performed blindly by considering body surface landmark, but this procedure can be done with the help of ultrasound machine as an alternative of landmark procedure. Objectives: Evaluation of the safety and effectiveness of USG-guided internal jugular vein(IJV) catheterization in critically ill patients. Methods: This prospective observational study was conducted in the ICU of Dhaka Medical College Hospital, from May 2017 to October 2018. Patients scheduled for central venous catheterization via the IJV were included based on selection criteria and randomly allocated into two groups of 50 patients each using card sampling. Group A received ultrasound-guided catheterization, while the landmark technique was used in Group B. Results: The analysis revealed that in the ultrasound group 49 out of 50 (98.0%) patients were successfully catheterized while the landmark method was successful in 45 out of 50 (90.0%) patients. Successful catheterization by first attempt was possible in 29 patients of group A, where as it was 5 in group B. The average number of attempts for successful catheterization in Group A was 1.7 (SD=0.2) and in the landmark group it was 2.8 (SD=0.1). On the average, 4.9 minutes (SD=1.3) were needed for catheterization in ultrasound group. The time was significantly increased in the landmark group 11.4 (SD=5.8). Total number of complication was 2 in Group A and it was 8 in Group B. After considered all the above parameter, by using four points safety and effectiveness rating scale, safety and effectiveness mean score was 10.3 for Group A and 8.2 for Group B. Conclusion: Two-dimensional ultrasound offers improved safety and quality when compared with an anatomical landmark technique for IJV catheterization. Bangladesh Crit Care J September 2024; 12 (2): 96-104

Quality of Treatment Selection for Medicare Beneficiaries With Cancer.

The Medicare part D Low-Income Subsidy (LIS) improves access to oral cancer drugs, but provides no assistance for clinician-administered/part B drugs. This analysis assessed the association between LIS participation and receipt of optimal cancer treatment. We investigated initial systemic therapy using SEER-Medicare data (2015-2017) and National Comprehensive Cancer Network (NCCN) Evidence Blocks (EB) as the standard for treatment recommendations. We included cancer clinical scenarios wherein (1) ≥one treatment was optimal (higher efficacy and safety scores) versus other treatments; (2) identifiable in SEER-Medicare (eg, not defined by clinical data unavailable in registry data or claims); and (3) both EB and ASCO Value Framework agreed regarding optimal treatment. We fit logistic regression models to assess the association between receipt of systemic therapy (v no therapy) and patient and provider characteristics. Contingent on receipt of treatment, we modeled the likelihood of receiving a treatment ranked (by EB scores) within the highest or lowest quartile for that cancer type. Nine thousand two hundred and ninety patients were included across 11 clinical scenarios. Fifty-seven percent (5,336) of patients received any systemic therapy and 43% (3,954) received no systemic therapy. Compared with non-LIS participants, LIS participants were less likely to receive any systemic therapy versus no systemic therapy (odds ratio, 0.64 [95% CI, 0.57 to 0.72]). Contingent on receiving systemic therapy, LIS participants received treatment ranked within the worst quartile 24.8% of the time, compared with 21.9% of non-LIS patients (adjusted prevalence difference, 4.3% [95% CI, 0.5 to 8.2]). LIS participants were less likely to receive systemic therapy at all and were more likely to receive treatments that receive low NCCN EB scores.

A Composite Score Reflecting an Initiative to Reduce Harm, Protect Patients, and Promote Safety.

Since 2011, hospitals in the United States have used the Total Harm Rate as a metric to address and enhance patient safety by mitigating harmful events. However, upon evaluation, it was concluded that this tool had lost its validity and was not widely used as an effective measure to prevent harm to patients. There are no similar comparative data in the literature to which we can compare our results with others. The Quality Management Performance Improvement team began to develop a composite safety score that would be used to reflect the environment of patient safety and promote improvement opportunities.