Safety Toolkit Research Articles

Prepped and ready: educating caregivers to secure firearms and medications via webinars

BackgroundMeans restriction is an approach to suicide prevention that has been shown to be effective but is underutilized in the United States. For the current study, we sought to determine if a webinar-based education intervention could impact caregiver means restriction knowledge and behaviors.MethodsNine webinars for caregivers were offered by a children’s hospital in conjunction with community groups. Education on raising teenagers was paired with information about suicide prevention, including the importance of securing medications and firearms. Participants completed surveys prior to the presentation, immediately following and two weeks later to measure change in knowledge and storage of medications and firearms. Participants were provided a safety toolkit to secure medications and firearms.ResultsOf the 327 participants who completed the baseline survey, 299 and 257 completed the second and third surveys. By the conclusion of the study, 46.6% of participants reported they had disposed of unneeded medications and 44.1% had locked up medications. Among firearm owners, use of a cable gun lock rose from 13.7% to 25.8%. In addition, 40.2% of firearm owners reported learning more about how their firearms were stored at the final survey. Most participants (88.3%) strongly agreed that the presentation provided value.ConclusionThis study shows that a webinar on safe storage appears to have some impact on behavior changes for caregivers of adolescents. A controlled study could help to clarify if the webinar format or the timing during the Covid-19 pandemic might have played a role in the degree of behavior change reported.

An Overview of the CRoME Lab's MedSMA℞T Families Intervention for Promoting Opioid Medication Safety among Adolescents and Parents.

As the opioid epidemic unrelentingly places profound weight on pharmacists, youth, parents, and the nation at large, innovative interventions are critical to prevent potential misuse and untimely death. Adolescents are especially vulnerable to misuse behaviors due to knowledge, attitudinal, and social influences. To best resonate with adolescents, appropriate tools and technologies must be developed and deployed. Few educational tools are more ubiquitous to adolescents than video games. Video games, specifically serious games, have the potential to connect with adolescents and impart critical knowledge related to opioid safety. Engaging youth, parents, and pharmacists in the design, refinement, and evaluation of a serious game is novel and necessary for building a robust, efficacious game. This commentary describes the conceptualization, inception, development, and evaluation of a novel opioid medication safety intervention, MedSMA℞T Families. This two-part intervention is comprised of an adolescent-tailored serious game entitled MedSMA℞T: Adventures in PharmaCity, and a family-focused tool named the personalized Family Medication Safety Plan. This intervention is the first theory-based, family-focused opioid medication safety toolkit co-designed by an interdisciplinary team of researchers, game developers, behavioral health scientists, pharmacists, student pharmacists, addiction medicine physician, adolescent health physician, parents, and teens. Responses from key stakeholders (pharmacists, parents, and teens) have demonstrated positive attitudes and impressions towards both components of the MedSMA℞T Families intervention. Empirical evidence of efficacy from two separate studies denotes improvement in key concepts related to safe behavior in adolescents. Findings to date support the widespread use, implementation, and dissemination of this efficacious intervention to supporting safe opioid prescription practices in families with adolescents. In this paper, we outline and summarize our process of intervention development and use of longitudinal data to validate each step of our process. Future directions include mobile compatibility, refinement based on key stakeholder feedback, and dissemination in various clinical settings where opioid medications are prescribed and dispensed such as emergency departments, pharmacies, hospitals, and clinics.

Caregiver perspectives on a water safety toolkit for child supervision.

Drowning is one of the leading causes of unintentional deaths among children and adolescents globally. Adult supervision is one method to decrease the risk of drowning among youth. We sought to assess the acceptability of a Water Watcher toolkit among children's caregivers. The toolkit consists of a badge-to designate the adult(s) responsible for supervision during water activities-and a smartphone application. When activated, the application blocks incoming calls, text messages and other applications, for example, mobile games and social media, as well as providing a button to quickly dial 911 and information for guided cardiopulmonary resuscitation. We conducted online and in-person semi-structured interviews of 16 adults residing in Washington State, United States and providing supervision to a child under 18 years of age for at least 20 h per week. Interview guides were developed based on the Health Belief Model and we performed content analysis on interview transcripts using an inductive approach. When asked about Water Watcher tools, respondents generally reacted favourably towards the intervention, citing benefits of formally delegating a responsible party during group activities and elimination of distractions. Primary challenges to using the toolkit were social acceptability, competence with technology, and the independence of older children (i.e., those 13- to 17-years-old). Caregivers recognized the importance of minimizing distractions, and many liked the strategy to formally designate responsibility for child supervision during aquatic recreation. SO WHAT?: Interventions such as the Water Watcher toolkit are generally considered acceptable and expanding access to these resources could reduce the burden of unintentional drownings.

Quality improvement dissemination in pediatric surgery: The APSA quality and safety toolkit

Shared experiential learning is critical in the field of pediatric surgery to support the translation of evidence into practice. Surgeons who develop QI interventions in their own institutions based on the best available evidence create work products that can accelerate similar projects in other institutions, rather than continuously reinventing the wheel. The American Pediatric Surgical Association (APSA) Quality and Safety Committee (QSC) toolkit was created to facilitate knowledge-sharing and thereby hasten the development and implementation of QI. The toolkit is an expanding open-access web-based repository of curated QI projects that includes evidence-based pathways and protocols, stakeholder presentations, parent/patient educational materials, clinical decision support (CDS) tools, and other components of successful QI interventions in addition to contact information for the surgeons who developed and implemented them. This resource catalyzes local QI endeavors by showcasing a range of projects that can be adapted to fit the needs of a given institution, and it also serves as a network to connect interested surgeons with successful implementers. As healthcare shifts towards value-based care models, quality improvement becomes increasingly important, and the APSA QSC toolkit will continue to adapt to the evolving needs of the pediatric surgery community.

The Botanical Safety Consortium: A public-private partnership to enhance the botanical safety toolkit

Botanical dietary supplement use is widespread and growing, therefore, ensuring the safety of botanical products is a public health priority. This commentary describes the mission and objectives of the Botanical Safety Consortium (BSC) - a public-private partnership aimed at enhancing the toolkit for conducting the safety evaluation of botanicals. This partnership is the result of a Memorandum of Understanding between the US FDA, the National Institute of Environmental Health Sciences, and the Health and Environmental Sciences Institute. The BSC serves as a global forum for scientists from government, academia, consumer health groups, industry, and non-profit organizations to work collaboratively on adapting and integrating new approach methodologies (NAMs) into routine botanical safety assessments.The objectives of the BSC are to: 1) engage with a group of global stakeholders to leverage scientific safety approaches; 2) establish appropriate levels of chemical characterization for botanicals as complex mixtures; 3) identify pragmatic, fit-for-purpose NAMs to evaluate botanical safety; 4) evaluate the application of these tools via comparison to the currently available safety information on selected botanicals; 5) and integrate these tools into a framework that can facilitate the evaluation of botanicals. Initially, the BSC is focused on oral exposure from dietary supplements, but this scope could be expanded in future phases of work. This commentary provides an overview of the structure, goals, and strategies of this initiative and insights regarding our first objectives, namely the selection and prioritization of botanicals based on putative toxicological properties.

A comparative assessment of two tools designed to support patient safety culture in UK general practice

BackgroundThe NHS has recognised the importance of a high quality patient safety culture in the delivery of primary health care in the rapidly evolving environment of general practice. Two tools, PC-SafeQuest and MapSaf, were developed with the intention of assessing and improving patient safety culture in this setting. Both have been made widely available through their inclusion in the Royal College of General Practitioners’ Patient Safety Toolkit and our work offerss a timely exploration of the tools to inform practice staff as to how each might be usefully applied and in which circumstances. Here we present a comparative analysis of their content, and describe the perspectives of staff on their design, outputs and the feasibility of their sustained use.MethodsWe have used a content analysis to provide the context for the qualitative study of staff experiences of using the tools at a representative range of practices recruited from across the Midlands (UK). Data was collected through moderated focus groups using an identical topic guide.ResultsA total of nine practices used the PC-SafeQuest tool and four the MapSaf tool. A total of 159 staff completed the PC-SafeQuest tool 52 of whom took part in the subsequent focus group discussions, and 25 staff completed the MapSaf tool all of whom contributed to the focus group discussions. PC-SafeQuest was perceived as quick and easy to use with direct questions pertinent to the work of GP practices providing useful quantitative insight into important areas of safety culture. Though MaPSaF was more logistically challenging, it created a forum for synchronous cross- practice discussions raising awareness of perceptions of safety culture across the practice team.ConclusionsBoth tools were able to promote reflective and reflexive practice either in individual staff members or across the broader practice team and the oversight they granted provided useful direction for senior staff looking to improve patient safety. Because PC SafeQuest can be easily disseminated and independently completed it is logistically suited to larger practice organisations, whereas the MapSaf tool lends itself to smaller practices where assembling staff in a single workshop is more readily achieved.

COVID-19 Vaccine: Updates and Role of Pharmacists

The 2019 novel coronavirus (SARS-COV-2 or 2019-nCoV) and coronavirus disease-2019 (COVID-19) pandemic is a global health crisis. As of December 31, 2020, there are over 83.5 million cases and 1.8 million deaths globally(1) and 2.2 million cases and 25,300 deaths in California.(2) The addition of a vaccine to prevent COVID-19 is an essential addition to the public health and safety toolkit alongside recommendations for physical distancing, hand hygiene, masks and face coverings, testing, tracing, quarantining or isolation, and therapeutics. There are currently two vaccines that have received emergency use authorization (EUA) in the United States to prevent COVID-19: the Pfizer-BioNTech mRNA COVID-19(3) and Moderna mRNA COVID-19 vaccines.(4) In the first 3 weeks since its authorization, the U.S. has distributed over 12.4 million and 2.7 million first doses had been administered.(5)The Pfizer-BioNTech (BNT162b2) vaccine, authorized on December 11, 2020, was reviewed and authorized or recommended by the US Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC)(6), and the Western States Scientific Safety Review Workgroup(7) for the prevention of COVID-19 in individuals 16 years and older. The Phase 3 trial for the BNT162b2 included 43,548 participants from the US, Argentina, Brazil, and South Africa.(8) BNT162b2 was found to be 95% effective in preventing COVID-19 with similar vaccine efficacy observed across subgroups defined by age, sex, race, ethnicity, baseline body-mass index, and the presence of coexisting conditions. The incidence of serious adverse events was low and the safety profile was characterized by local and systemic reactions. Following two reports of anaphylaxis in the United Kingdom, the CDC identified six cases after 272,001 doses were administered in the U.S. and continues to monitor through its surveillance programs.(9) See Table 1 for summary of vaccine characteristics, inducing information on dosing, storage, preparation, and administration.The Moderna (mRNA-1273) vaccine, authorized on December 18, 2020, was reviewed and authorized or recommended by the FDA, CDC(10), and the Western States Scientific Safety Review Workgroup(11) for the prevention of COVID-19 in individuals 18 years and older. The Phase 3 trial for the mRNA-1273 included 30,420 participants from the US.(12) The interim efficacy analysis of BNT162b2 demonstrated vaccine efficacy of 94.5% in preventing symptomatic COVID-19 with similar vaccine efficacy observed across subgroups defined by age, sex, race, ethnicity, and occupational risk factors. The incidence of serious adverse events was low and the safety profile was characterized by local and systemic reactions. See Table 1 for summary of vaccine characteristics, inducing information on dosing, storage, preparation, and administration.See Table 2 for list of clinical resources for both vaccines, including FDA fact sheets, CDC recommendations, and manufacturer resources.Vaccine distribution and allocation is largely being overseen at the federal level with subsequent delegated responsibility to the state, local, and provider level. Both the CDC(13,14,15) and the California Department of Public Health (CDPH)(16) have established guidelines for the phased distribution of COVID-19 vaccine to prioritized groups. The CDC and CDPH have identified populations for Phase 1A, 1B, and 1C while the remaining phases are still to be determined. See Table 3 for the list of phases and tiers of prioritized and sub-prioritized groups.The current phase and tier of allocation may vary on the local level. Generally, most California counties are currently in Phase 1A, tier 1 or 2.Pharmacists are playing a major role in the implementation and distribution of the COVID-19 vaccine. Pharmacists can order and administer the COVID-19 vaccine and intern pharmacists and pharmacy technicians can administer the COVID-19 vaccine.(17,18,19) Pharmacies can receive vaccine allocation through three methods: participation in the Federal Pharmacy Partnership for Long-Term Care (LTC) Program(20,21), participation in Federal Retail Pharmacy Partnership(22,23), or invitation from the local health department (LHD). For more information about provider enrollment through the local jurisdictions, visit the COVIDReadi Platform(24) and contact your LHD.(25)The current status of each program may vary on the local level. Generally, the federal LTC program has been activated and the federal retail and invitations to pharmacies from LHD have not yet been activated in California.The distribution and allocation of the COVID-19 vaccine are still in its initial stages. Ass vaccine supply increases, the remainder of the plans will be activated and pharmacies, pharmacists, pharmacy technicians, and intern pharmacists will play a crucial role in ensuring quick and equitable access to nearly 40 million Californians across all 58 counties.

STARS interventions for violence reduction: Safety, technology, activity, relief, and surroundings.

Caregivers without behavioral health expertise struggle to manage behaviorally challenging patients while providing continuous observation (CO) care. A gap in knowledge exists concerning effective CO interventions to reduce patient violence with limited psychiatric resources. The objectives of this project were to improve safety and engagement among staff providing in-person 1:1 CO for patients and optimize acute care CO utilization. Nurse leaders rounded regularly on CO staff and patients requiring CO and provided the safety, technology, activity, relief, and surroundings interventions tool kit for CO staff, patients, and families. Patient readiness to trial remote video monitoring CO was assessed, and violence prevention and assault reporting education to CO staff was reinforced. A survey of 46 CO staff demonstrated positive responses to perceptions of: (1) improved safety (p < .01); (2) violence reduction (p < .001); (3) increased awareness of the importance of the CO role (p < .001); and (4) improved CO care (p < .001). Nurse leader rounding with an educational tool kit yielded CO staff-endorsed feelings of increased staff safety and engagement.

Development of the prototype concise safe systems checklist tool for general practice

BackgroundIn the course of producing a patient safety toolkit for primary care, we identified the need for a concise safe-systems checklist designed to address areas of patient safety which are under-represented in mandatory requirements and existing tools. This paper describes the development of a prototype checklist designed to be used in busy general practice environments to provide an overview of key patient safety related processes and prompt practice wide-discussion.MethodsAn extensive narrative review and a survey of world-wide general practice organisations were used to identify existing primary care patient safety issues and tools. A RAND panel of international experts rated the results, summarising the findings for importance and relevance. The checklist was created to include areas that are not part of established patient safety tools or mandatory and legal requirements. Four main themes were identified: information flow, practice safety information, prescribing, and use of IT systems from which a 13 item checklist was trialled in 16 practices resulting in a nine item prototype checklist, which was tested in eight practices. Qualitative data on the utility and usability of the prototype was collected through a series of semi-structured interviews.ResultsIn testing the prototype four of nine items on the checklist were achieved by all eight practices. Three items were achieved by seven of eight practices and two items by six of eight practices. Participants welcomed the brevity and ease of use of the prototype, that it might be used within time scales at their discretion and its ability to engage a range of practice staff in relevant discussions on the safety of existing processes. The items relating to prescribing safety were considered particularly useful.ConclusionsAs a result of this work the concise patient safety checklist tool, specifically designed for general practice, has now been made available as part of an online Patient Safety Toolkit hosted by the Royal College of General Practitioners. Senior practice staff such as practice managers and GP partners should find it a useful tool to understand the safety of less explored yet important safety processes within the practice.

Implementing safety toolkit on the Fort Peck Indian Reservation, Montana

Indian Reservations have suffered from high crash rates that lead to fatal and incapacitating injuries for years. Among numerous issues, resource gap, rustic nature of the reservations, cross jurisdictional issues, and scarce crash data, act as obstacles in an effort to reduce the number of these fatal and serious crashes. Numerous organizations have recognized the importance of addressing issues on Indian reservations and improving roadway safety. Wyoming Technology Transfer Center / Local Technical Assistance Program (WYT2/LTAP) center developed a safety toolkit for tribal communities to ascertain high-risk crash locations and determine the low-cost safety improvement countermeasures. This safety toolkit acts as a guideline providing information, field examples, and resources in key topic areas to improve roadway safety through the use of the five-step methodology from Wyoming Rural Road Safety Program. These steps included compiling and crash data analysis, level I field evaluation, combined ranking, level II field evaluation, and benefit-cost analysis. In this study, the safety toolkit was implemented on the Fort Peck Indian Reservation (FPIR), Montana, to provide the tribes with a real-life example. This study reveals that low- cost safety countermeasures have significant impacts in reducing the number of fatal and serious injury crashes on the FPIR. This methodology with slight modification can be applied to other Indian reservations or similar entities to improve roadway safety.

Il rischio biologico. Punture accidentali da taglio e da punta nel settore ospedaliero

Biohazard is one of the main risks to which Healthcare professionals are exposed and the most frequent causeis represented by biohazard accidents due to wounds by needles or blades contaminated with infected biologicalmaterial . The consequence can be the diagnosis of severe chronic disease ( Hepatitis B , Hepatitis C or AIDS/HIV) which is classified as a professional disease with legal outcomes . The evolution of technology has made availablea more updated standard safety toolkit , but its general introduction is slow due to its high price . Recently , thisproblem has been legally solved with specific standard Laws applied in Europe ( “ Direttiva 2010/32/EU ”) and inItaly by the introduction of the “ D.Lgs. 81/2008 e smii Titolo X-bis “ protection of wounds from blades and needlesin Hospitals and in Healthcare professional sector “ which includes specific rules to be respected by the ProfessionalJob Director/Manager , with serious legal outcomes . In particular , the Professional Job Director/Manager mustmake a careful evaluation of the risk/biohazard and define the preventive measures to be implemented in professionalpractice and the related First Aid priority procedures to be , consequently , integrated in a Prevention Scheme aimedat improving Safety condition on workplace for the Healthcare Professionals . Obviuosly , this must imply to forgetor either underestimate other types of risks(biohazard exposures , but it must simply make the “ Quality Procedure“ much easier , so that – starting from the main standard priority events – the main goal is to eliminate , or at leastsomehow , reduce all professional exposure to biohazard and /or biological risk .

Il rischio biologico. Punture accidentali da taglio e da punta nel settore ospedaliero

Biohazard is one of the main risks to which Healthcare professionals are exposed and the most frequent cause is represented by biohazard accidents due to wounds by needles or blades contaminated with infected biological material . The consequence can be the diagnosis of severe chronic disease ( Hepatitis B , Hepatitis C or AIDS/HIV) which is classified as a professional disease with legal outcomes . The evolution of technology has made available a more updated standard safety toolkit , but its general introduction is slow due to its high price . Recently , this problem has been legally solved with specific standard Laws applied in Europe ( “ Direttiva 2010/32/EU ”) and in Italy by the introduction of the “ D.Lgs. 81/2008 e smii Titolo X-bis “ protection of wounds from blades and needles in Hospitals and in Healthcare professional sector “ which includes specific rules to be respected by the Professional Job Director/Manager , with serious legal outcomes . In particular , the Professional Job Director/Manager must make a careful evaluation of the risk/biohazard and define the preventive measures to be implemented in professional practice and the related First Aid priority procedures to be , consequently , integrated in a Prevention Scheme aimed at improving Safety condition on workplace for the Healthcare Professionals . Obviuosly , this must imply to forget or either underestimate other types of risks(biohazard exposures , but it must simply make the “ Quality Procedure “ much easier , so that – starting from the main standard priority events – the main goal is to eliminate , or at least somehow , reduce all professional exposure to biohazard and /or biological risk.

USING ACCESSIBLE TECHNOLOGY TO SUPPORT CAREGIVERS OF PERSONS WITH DEMENTIA

There is widespread enthusiasm about the potential of technology in general to support persons living with dementia and their families and other caregivers. At the same time, recommendations from the 2017 National Research Summit on Care, Services, and Supports for Persons with Dementia and their Caregivers emphasize the need for research to develop, evaluate, and disseminate specific technologies that can achieve meaningful benefits for well-defined subgroups of persons living with dementia and their caregivers, including individuals from diverse populations and individuals who live and receive care in various settings. This symposium focuses on specific home-based technologies to help family caregivers of community-living persons with dementia. Our three speakers will talk about research results for three different technology-related interventions, including: use of home video telehealth visits to help family caregivers provide effective dementia care and provide medical management; use of home video assessments by occupational therapists to help family caregivers increase home safety for community-living persons with dementia; and approaches for making a self-paced Home Safety Toolkit available to family caregivers of community-living veterans with dementia. Each speaker will report both positive outcomes, including family caregiver satisfaction, and barriers encountered in delivering the interventions. Such barriers include difficulties with the technologies as well as caregiver reluctance to change and costs that were not covered by health care insurance or health systems. Our discussant will respond to the presentations and solicit audience questions and discussion.

IMPLEMENTING HOME SAFETY TOOLKIT TO CAREGIVERS OF VETERANS WITH DEMENTIA

The purpose of this project was to study the processes necessary to make a Home Safety Toolkit (HST) for Veterans with dementia accessible to veterans and their caregivers. This Type 3 Implementation–Effectiveness Hybrid Research Design, included diagnostic analyses of the current processes by which Veterans receive home safety items, and identification of modifications necessary in order to provide the HST to Veterans with dementia. Two Veterans Health Administration Networks, one in the Northeast and one in the Mid-Atlantic region, participated. A formative evaluation used semi-structured interviews with key staff informants and caregivers identified facilitators and barriers to successful acquisition and use of home safety items. Qualitative data analysis reveals key barriers of time and cost, selection of best items, and caregiver reluctance to change. There was resounding support from caregivers regarding the potential benefits of self-paced toolkit including education and home safety items to implement for their veteran.

Directed content analysis of Veterans Affairs policy documents: A strategy to guide implementation of a dementia home safety toolkit for Veterans to promote ageing in place.

Older adults' preference to age in place, coupled with an increasing prevalence of dementia, creates an imperative to address home safety risks that occur due to cognitive impairment. Providing caregivers with home safety items and education can facilitate ageing in place for older adults living with dementia. In 2015-2017, we examined barriers and facilitators within 17 policy documents and dementia guidelines of the United States (US) Veterans Health Administration pertinent to implementation of a home safety toolkit (HST) for Veterans living with dementia. The documents were issued from 2000 to 2015. Directed qualitative content analysis of these documents guided by themes from stakeholder interviews revealed two key implementation barriers: a focus on physical rather than cognitive risks when determining medical necessity for home equipment, and a focus on rehabilitation and treatment rather than prevention. Mandates for person-centred care planning, including comprehensive assessment, interdisciplinary collaboration, staff education and a focus on population health in primary care facilitate HST implementation. Content analysis can identify policy-level barriers that slow innovation and facilitators that can increase access to care that support ageing in place.

Quality improvement of prescribing safety: a pilot study in primary care using UK electronic health records.

BackgroundQuality improvement (QI) is a priority for general practice, and GPs are expected to participate in and provide evidence of QI activity. There is growing interest in harnessing the potential of electronic health records (EHR) to improve patient care by supporting practices to find cases that could benefit from a medicines review.AimTo develop scalable and reproducible prescribing safety reports using patient-level EHR data.Design and settingUK general practices that contribute de-identified patient data to the Clinical Practice Research Datalink (CPRD).MethodA scoping phase used stakeholder consultations to identify primary care QI needs and potential indicators. QI reports containing real data were sent to 12 pilot practices that used Vision GP software and had expressed interest. The scale-up phase involved automating production and distribution of reports to all contributing practices that used both Vision and EMIS software systems. Benchmarking reports with patient-level case review lists for two prescribing safety indicators were sent to 457 practices in December 2017 following the initial scale-up (Figure 2).ResultsTwo indicators were selected from the Royal College of General Practitioners Patient Safety Toolkit following stakeholder consultations for the pilot phase involving 12 GP practices. Pilot phase interviews showed that reports were used to review individual patient care, implement wider QI actions in the practice, and for appraisal and revalidation.ConclusionElectronic health record data can be used to provide standardised, reproducible reports that can be delivered at scale with minimal resource requirements. These can be used in a national QI initiative that impacts directly on patient care.

The Royal College of General Practitioners (RCGP) quality improvement initiative using Clinical Practice Research Datalink (CPRD) data: Lessons learned

BackgroundQuality improvement (QI) is a priority for general practice, and GPs are expected to participate and provide evidence of QI activity. Pressures on the primary care workforce require approaches to QI to prioritise efficiency and effectiveness.AimThis project aimed generate and scale up bespoke QI reports for GP practices contributing data to CPRD.MethodCPRD is a UK government research service facilitating public health research using anonymised primary care data. A pilot report was designed with stakeholders and covered two indicators from the RCGP Patient Safety Toolkit. The reports enabled GPs to identify patients needing case review and to benchmark data on practice-level prescribing. Reports for 12 practices, containing real patient data, were sent to GPs and feedback was obtained via interviews. The report was scaled up to 457 practices and a survey sent out to request feedback.ResultsGPs used the reports to review the care of individual patients, and to implement QI actions such as adding flags to patients notes. One participant used the report as evidence for their annual appraisal. Survey response was limited (n = 31.7%) but overwhelmingly positive. Responders highlighted the importance of clinical input when developing indicators and ensuring the tone of the reports is supportive.ConclusionThe collaborative RCGP/CPRD QI reports are unique in their ability to provide benchmarking and case-finding on a national scale. The indicators selected must lead to actionable reports. Clinical input is required to ensure code lists are appropriate and that reports are clinically relevant. CPRD aims to send out two reports annually.

Development of a food safety toolkit for dry common beans (Phaseolus vulgaris L.) in Uganda using a Hazard Analysis and Critical Control Point (HACCP) approach

Common beans ( Phaseolus vulgaris L) may be contaminated with heavy metals and aflatoxins. Cooked beans may also be contaminated with micro-organisms due to poor hygiene and sanitation practices. Hazard Analysis and Critical Control Point (HACCP), which is a globally recognised food safety program, was proposed as a suitable program to minimise/eliminate the risk of contamination. Therefore, the objective of this study was to develop a HACCP plan for dry common beans in Uganda and an accompanying food safety toolkit. The seven principles of HACCP as outlined by Codex Alimentarius were followed to develop a HACCP plan for the dry common beans value chain in Uganda. A decision tree diagram was further used to identify each potential hazard at each processing stage and Critical Control Points (CCPs) along the chain. The identification of the CCPs was further supported by an evaluation of the actual risk and severity of the hazard. For the CCP identified, reliable control mechanism and corrective actions were established to fulfill the requirements set by the critical limits to guarantee the safety of the products. Verification and records systems were proposed to determine the effectiveness and traceability of the HACCP plan. For identified CCPs, a co-creation methodology was used to develop the food safety toolkit. This was carried out in four sessions that included a background of the chain actors’ ambitions to determine the suitability of the toolkit, assessment of CCPs, expert advice on the CCP and an exercise to develop concepts for each CCP. From the analysis, fourteen processing stages starting from land selection to cooking and serving were identified. Out of these, four stages were CCPs. These were land selection and preparation, storage, post-harvest drying, and cooking and serving. Hazards at the CCPs included heavy metals, mycotoxins, and micro-organisms such as S. aureus, E. coli, and Salmonella spp. A combination of good hygiene and sanitation practices and good agricultural practices were recommended as control measures against the hazards. To further equip the value chain actors with mitigation strategies, a food safety toolkit whose usefulness is to give the actors a systematic means to control identified CCPs was developed. In this regard, the toolkit and HACCP plan will complement each other. From the study results, implementation of the toolkit, followed by an assessment of its uptake and impact on livelihoods and food safety risks is recommended. Key words: Common beans, food safety toolkit, prerequisite programs, HACCP plan, hazards, Uganda

Surgical Safety Toolkit based Quality Monitoring of Fistula Surgery in Bangladesh

Aims: To share our experience using a new tool to monitor quality in a surgical care delivery system and document fistula surgery-related mortality and morbidity.&#x0D; Methods: Surgeons, nurses and other clinical care providers were trained to use SST for every client they served at seven facilities. From April 2017 to June 2018, data were captured for 283 clients across these facilities. Anonymous SST data were centrally collected, entered in a spreadsheet and summarized.&#x0D; Results: Among 283 fistula patients, who had repair surgery, 27 morbidities were recorded and there was no mortality. 44% of morbidities were related to intra/post-operative hemorrhage requiring blood transfusion, 30% were repair wound breakdown. The SST documented that all women who had fistula surgery received counseling on follow-up care, the importance of abstinence during the recovery period and on family planning.&#x0D; Conclusions: The SST is derived from global standards for safe surgical care with a focus on fistula-specific metrics. This toolkit can be used for routine documentation of surgical care processes for fistula cases and be adapted for monitoring other types of surgical care.&#x0D; Keywords: fistula surgery, monitoring, surgical safety kit.

Developing a Toolkit to Improve Transportation Safety on Indian Reservations

Indian reservations hold the highest rate of crashes that lead to fatal and incapacitating injuries across the United States. Limited resources, absence of coordination across jurisdictions, and limited crash data make it difficult for tribes to reduce the number of these fatal and serious crashes. A safety toolkit was developed in this work to identify the high-risk crash locations and determine low-cost safety improvement countermeasures. The toolkit serves as a guideline and provides information, field examples, and resources in key topic areas to lead the effort to improve safety via the use of a five-step methodology. These five steps are, namely, compile data and crash data analysis, Level I field evaluation, combined ranking, Level II field evaluation to identify countermeasures, and benefit–cost analysis. The objective of the toolkit is to assist tribes to reduce the number of fatal and serious crashes, and provides flexibility for the tribes to utilize the methodology compatible with the onsite data, preferences of the tribes, and other factors to meet demands. The methodology described was successfully implemented on the Wind River Indian Reservation, Standing Rock Sioux Tribe, Sisseton Wahpeton Oyate Tribe, and the Yankton Sioux Tribe and showed great success in identifying high-crash locations.