Standard Operating Procedures Research Articles

Reduction of production delay cost in underground coal mines: An FMEA-based method study approach

Coal is the backbone of the Indian economy, essential for electricity, steel, cement, and other vital items. Although India aims to be carbon emission-free by 2070, it must rely on coal for a few more decades. In the fiscal year 2021–22, India produced 96 percent of its coal from open-cast (OC) mines, whereas 70 percent of India's total coal reserve is in deep undergrounds. Despite underground (UG) coal mining being eco-friendly and yielding richer coal, its production cost is nearly four times higher than OC mining. Therefore, further research on UG mines is necessary to address these challenges. This study analyzed an underground coal mine production system in India and identified production delays as a major cost driver. Causes of delays were categorized by their association with machine, material, and man. An innovative technique, the Machine Criticality Score (MCS), has been developed to quantify production delay costs and guide management in mitigating them. Additional methods like failure mode and effects analysis (FMEA), standard operating procedure (SOP), inventory management tools, and method study were also used in this study to reduce production delay costs.

Subclinical hypothyroidism and plasma levels of commonly prescribed anti-seizure medications

Background: Epilepsy remains the most common neurological problem worldwide. Most commonly prescribed antiseizure medications (ASMs) like phenytoin, sodium valproate, and carbamazepine show high inter-individual variability in bioavailability due to genetic and epigenetic factors resulting in either therapeutic failure or toxicity. In our study, we aim to determine the association between subclinical hypothyroidism and the plasma levels of these commonly prescribed ASMs, leading to either therapeutic failure or adverse drug reactions. Methods: We collected demographic data, details about the antiepileptic medication, and plasma levels of ASMs (phenytoin, carbamazepine, and sodium valproate) from patients on antiseizure medications who came for routine therapeutic drug monitoring (TDM). High-performance liquid chromatography (HPLC) estimated plasma levels of the antiseizure medications as per the TDM laboratory standard operating procedure (SOP) and thyroid function test (TSH) by a standard enzyme-linked immune-sorbent assay (ELISA) kit. Results: Of the 158 patients who had TDM, 75.31% were taking sodium valproate, 15.18% were on phenytoin, and 9.49% were on carbamazepine monotherapy. In our study, we found that 12 patients (7.59%) had TSH levels between 4 to 10 mIU/l, indicating subclinical hypothyroidism (SCH). The plasma drug levels of all 12 patients who had SCH were found to be below the therapeutic range. Conclusions: This study has established a significant association between ASMs, particularly sodium valproate, and thyroid dysfunction, specifically SCH, in patients with epilepsy. Our findings suggest that prolonged ASM therapy can lead to thyroid disturbances, warranting careful monitoring of thyroid function in these patients.

PELATIHAN PEMIKIRAN BERBASIS RISIKO MENGGUNAKAN TEKNOLOGI KOMPUTER UNTUK MENINGKATKAN AKUNTABILITAS KANTOR DISTRIK NAVIGASI PALEMBANG

With its strategic role, the Palembang Navigation District Office has made substantial efforts to improve the quality of its services, particularly by conducting initiatives to develop Standard Operating Procedures for the many types of services it offers. One of the main activities in this series of activities is providing training entitled Risk-Based Thinking - Identifying Risk Aspects in Processes that can support Accounting and Management Information Systems. The author explains to the participants using three methods: the Lecture Method, the Question-and-Answer Method, and the Case Study Discussion Method, all of which are conducted face-to-face and divided into five sessions, beginning with the opening session, material presentation session, illustration session, question and answer session, and closing session. It is hoped that by participating in this training activity, participants will gain a better understanding of the concept and application of risk-based thinking, as well as skills in using various types of tools, techniques and computer technology commonly used in risk management, which will be integrated into the process of developing the new service procedures. According to the results of the post-activity interview, the Head of the Palembang Navigation Office was satisfied with the training results and his team's absorption of the content.

The Chilean COVID-19 Genomics Network Biorepository: A Resource for Multi-Omics Studies of COVID-19 and Long COVID in a Latin American Population

Although a lack of diversity in genetic studies is an acknowledged obstacle for personalized medicine and precision public health, Latin American populations remain particularly understudied despite their heterogeneity and mixed ancestry. This gap extends to COVID-19 despite its variability in susceptibility and clinical course, where ethnic background appears to influence disease severity, with non-Europeans facing higher hospitalization rates. In addition, access to high-quality samples and data is a critical issue for personalized and precision medicine, and it has become clear that the solution lies in biobanks. The creation of the Chilean COVID-19 Biorepository reported here addresses these gaps, representing the first nationwide multicentric Chilean initiative. It operates under rigorous biobanking standards and serves as one of South America’s largest COVID cohorts. A centralized harmonization strategy was chosen and included unified standard operating procedures, a sampling coding system, and biobanking staff training. Adults with confirmed SARS-CoV-2 infection provided broad informed consent. Samples were collected to preserve blood, plasma, buffy coat, and DNA. Quality controls included adherence to the standard preanalytical code, incident reporting, and DNA concentration and absorbance ratio 260/280 assessments. Detailed sociodemographic, health, medication, and preexisting condition data were gathered. In five months, 2262 participants were enrolled, pseudonymized, and sorted by disease severity. The average Amerindian ancestry considering all participant was 44.0% [SD 15.5%], and this value increased to 61.2% [SD 19.5%] among those who self-identified as Native South Americans. Notably, 279 participants self-identified with one of 12 ethnic groups. High compliance (>90%) in all assessed quality controls was achieved. Looking ahead, our team founded the COVID-19 Genomics Network (C19-GenoNet) focused on identifying genetic factors influencing SARS-CoV-2 outcomes. In conclusion, this bottom-up collaborative effort aims to promote the integration of Latin American populations into global genetic research and welcomes collaborations supporting this endeavor. Interested parties are invited to explore collaboration opportunities through our catalog, accessible online.

PENGARUH KOMPETENSI TERHADAP KINERJA PERAWAT BANGSAL RAWAT INAP DI RSUD dr. SOEHADI PRIJONEGORO SRAGEN

Introduction: Human resources are the most important determining factor in achieving the strategic goals of an organization, especially in the healthcare industry. Based on the results of a preliminary study, inpatient ward nurses have education ranging from third diploma to bachelor's degree to postgraduate degree, and inpatient indicators meet the ten standards set by the Indonesian Ministry of Health. The competence of nurses in terms of knowledge and skills in nursing is very important to know how good the performance of nurses is in achieving good health goals in accordance with the duties and authority, code of ethics and applicable standard operating procedures. Objectives: The purpose of this study was to determine the effect of competence on the performance of inpatient ward nurses at RSUD Dr. Soehadi Prijonegoro Sragen Methods: This study used a quantitative paradigm with a cross-sectional design to test the hypothesis. The study population consisted of all nurses (N = 158) in 11 inpatient wards. The study sample consisted of 121 nurses selected using proportional random sampling technique. The predictor variable was competence and the criterion variable was nursing performance. The analysis used univariate and bivariate analysis (simple linear regression analysis). Results: Based on univariate analysis, competence and performance are in the "good" category, with the percentage of competence of 95.87% and nurse performance of 92.56%. Based on bivariate analysis, the significance value is 0.000 <0.05 and t count is 8.796> t table 1.980. The results of the study indicate that competence has a positive influence on the performance of nursing staff. Conclusions: The conclusion is that competence has a positive effect on the performance of the inpatient ward hospital Dr. Soehadi Prijonegoro Sragen Regional Hospital.

Efforts to Prevent Recurrence of Stroke in Stroke Patients

Stroke is a major health problem for modern society today. A person who has had a stroke has a greater tendency to have a recurrence of stroke. This study aims to analyze efforts to prevent the occurrence of recurrent stroke in stroke patients at the Neurological Poly of Muhammdiyah Gresik Hospital. This type of research is correlational analysis, which is looking for a relationship between two variables, with a cross sectional approach between independent and dependent variables. The population in this study is all stroke patients at the Neurological Poly. The sample was taken by purposive sampling technique obtained by 48 respondents. The test results showed that the significance of the overall count results was less than 0.05 which meant that there was a significant relationship between prevention efforts, namely blood pressure control, bloodsugar control, obesity, medication adherence, family support and stress to the occurrence of recurrent strokes. Based on the results of the study, it is hoped that health workers can make efforts to prevent recurrent stroke as an important step in handling stroke patients and provide education about it to patients and their families. The hospital should make standard operational procedures or other forms of policies regarding efforts to prevent recurrent strokes. Keywords : Efforts to Prevent Recurrent Stroke, Recurrent Stroke Incidence

Integrated design and procurement strategy to achieve efficient performance in design and build government project

Design and procurement integration strategies in construction projects play an important role and have an impact on the overall project cycle. Integrated design and procurement will increase productivity and reduce waste. This research aims to provide a guide to good design and procurement integration strategies in Design and Build (DB) projects in government projects. This research uses qualitative and quantitative methods in the form of a schematic literature review followed by a Focus Group Discussion (FGD) with the Delphi method to formulate integrated design and procurement that improve project performance. In-depth interviews were conducted with 90 respondents to explore the implementation of the design and procurement strategy on the project used as a case study. The results of this research are recommendations for an integrated design and procurement strategy which can be used as a Standard Operating Procedure (SOP) in DB projects on government projects so that it can provide added value from the start of the project being designed through tenders. This research can be utilized by project stakeholders, academics and anyone who will develop project performance through the integrated design and procurement in the long term.

Harmonizing neuropathic pain research: outcomes of the London consensus meeting on peripheral tissue studies.

Neuropathic pain remains difficult to treat, with drug development hampered by an incomplete understanding of the pathogenesis of the condition, as well as a lack of biomarkers. The problem is compounded by the scarcity of relevant human peripheral tissues, including skin, nerves, and dorsal root ganglia. Efforts to obtain such samples are accelerating, increasing the need for standardisation across laboratories. In this white paper, we report on a consensus meeting attended by neuropathic pain experts, designed to accelerate protocol alignment and harmonization of studies involving relevant peripheral tissues. The meeting was held in London in March 2024 and attended by 28 networking partners, including industry and patient representatives. We achieved consensus on minimal recommended phenotyping, harmonised wet laboratory protocols, statistical design, reporting, and data sharing. Here, we also share a variety of relevant standard operating procedures as supplementary protocols. We envision that our recommendations will help unify human tissue research in the field and accelerate our understanding of how abnormal interactions between sensory neurons and their local peripheral environment contribute towards neuropathic pain.

PENERAPAN GOOD AGRICULTURE PRACTICES (GAP) PADA USAHATANI BUAH NAGA MERAH DI KECAMATAN PESANGGARAN KABUPATEN BANYUWANGI

This research develops and applies the implementation of Good Agriculture Practices to red dragon fruit farming, influencing factors, and recommendations for providing extension materials to increase its implementation. Implementing Good Agricultural Practices must be by Control Points, Standard Operating Procedures, Plant Pest Control, filling out workbooks, and re-registration, which are obligations that farmers must carry out after obtaining a Good Agricultural Practices certificate. In this study, as many as 62 red dragon fruit farmers certified as Good Agriculture Practices were selected as a whole or total sampling. The Likert scale is used to analyze the level of implementation of Good Agriculture Practices. Logistic Regression Analysis is used to see the factors that influence the level of implementation of Good Agriculture Practices. Efforts to increase the implementation of Good Agricultural Practices through rankings. The research results show that (1) the implementation of Good Agriculture Practices in red dragon fruit farming is sufficient; (2) factors that influence the implementation of Good Agriculture Practices are the variables of farming experience, perception of production quantity, and perception of selling price. (3) recommendations for increasing the implementation of Good Agriculture Practices in red dragon fruit farming in Pesanggaran District can be done by providing material on priority efforts starting from Mandatory Control Points, Very Green Control Points, filling out workbooks, implementing Plant Pest Control, re-registering, Points Control Recommendations, and implementation of Standard Operating Procedures.

Development of ventilator-associated pneumonia (VAP) prevention model in the hospital based on Six Sigma and VAP Bundle

Background & Objective: Ventilator-Associated Pneumonia (VAP) is the leading cause of death in Healthcare-Associated Infections (HCAI), with 30-day mortality of 59% of patients with ventilator devices. The aim of this research was to develop a VAP prevention model in the intensive care unit (ICU) based on Six Sigma and VAP Bundle, involving individual, organizational and work characteristics factors. Methodology: This research was carried out in the ICU, Poltekkes Kemenkes Malang, Malang, Indonesia, using a cross-sectional design. The research subjects were nurses, selected using a simple random sampling technique. All variables were measured through filling out questionnaires. Next, the measurement data was analyzed using Partial Least Square (PLS), based on Six Sigma and VAP Bundle. Results: Based on Six Sigma and VAP Bundle, the results of the analysis of the effects of the three factors on the implementation of VAP prevention were: 1) for individual factors, path coefficient = 0.189 and P = 0.000, so it was interpreted that this factor had a significant effect on the implementation of VAP prevention; 2) for organizational factors, path coefficient = 0.496 and P = 0.003, so it was interpreted that this factor also had a significant effect; 3) for the work characteristics factors, path coefficient = 0.289 and P = 0.000, so this factor also had a significant effect on the implementation of VAP prevention. Conclusion: Based on the research results, a VAP prevention model based on Six Sigma and VAP bundle was successfully built in the ICU, which involved organizational factors, work characteristics and individual factors. Abbreviations: HCAI - Healthcare-Associated Infections; HAP - Hospital-acquired pneumonia; PLS - Partial Least Square; SOP - standard operating procedure; VAP - ventilator-associated pneumonia; Keywords: Ventilator-Associated Pneumonia, VAP, Prevention; Six Sigma, VAP Bundle; Intensive Care Unit; organizational factors; work characteristics; individual factors Citation: Yuswanto TJA, Ernawati N, SolikhahFK, Nugroho HSW. Development of a prevention model for ventilator-associated pneumonia based on Six Sigma and VAP bundle. Anaesth. pain intensive care 2024;28(5):876−882; DOI: 10.35975/apic.v28i5.2574 Received: July 14, 2024; Reviewed: July 28, 2024; Accepted: July 28, 2024

Empowering Women's Business Groups through Microfinance in Village Enterprises

Background: Effective management of microfinance institutions is essential for rural economic development. Specific Background: This study examines BUMDesa Bersama “Gempol Sejahtera,” focusing on its application of microfinance principles in financial management. Knowledge Gap: There is limited research on how structured bureaucracies affect the success of microfinance programs in community organizations. Aims: The research evaluates the impact of organizational structure on microfinance initiatives and resource management. Results: Findings show that a clear bureaucratic structure enhances efficiency and role clarity, facilitating successful program implementation. Clear Standard Operating Procedures (SOPs) and task fragmentation are critical for optimal execution. Novelty: This study offers new insights into the link between organizational structure and microfinance effectiveness in community enterprises, enriching the literature on rural empowerment. Implications: The results underscore the importance of strong organizational frameworks to improve resource management and program responsiveness, thereby promoting economic empowerment, especially among women. Highlights : Organizational Efficiency: A clear bureaucratic structure enhances operational effectiveness and role clarity. Critical Procedures: Implementing Standard Operating Procedures (SOPs) is essential for program success. Economic Empowerment: Strong frameworks promote responsiveness and resource management, benefiting community initiatives. Keywords: microfinance, organizational structure, community empowerment, financial management, bureaucratic efficiency

Implementation of the Plavon Program in Population Administration Services

Background: The increasing reliance on technology in public service delivery has led local governments to adopt e-government systems. Specific Background: This study explores the implementation of the PLAVON e-government program in a rural context, addressing the operationalization of such systems in local governance. Knowledge Gap: Existing research highlights e-government frameworks, yet the challenges and successes of community-level implementation remain underexplored. Aims: This research aims to analyze PLAVON's implementation, focusing on standard operating procedures (SOPs) and community engagement. Results: Findings reveal that structured SOPs enhance efficiency and transparency in public services, enabling self-service for citizens. Novelty: This study offers insights into the challenges and strategies of rural e-government implementation. Implications: Results underscore the importance of tailored bureaucratic practices and community involvement, providing valuable lessons for similar programs in rural areas. Highlights : Efficiency: Structured SOPs enhance the efficiency of public service delivery. Transparency: Clear procedures foster transparency in administrative processes. Community Involvement: Active participation of local citizens is crucial for successful implementation. Keywords: E-Government, PLAVON, SOP, Community Engagement, Rural Implementation

Pharmaceutical and physicochemical analysis of Mandura Bhasma

Introduction: Mandura (Slag of Iron) is a metallic oxide-cum-silicate of iron with the general formula Fe2SiO4 and is also known as Slag. In the classical text, different types of methods are explained in different classical books for the preparation of Mandura bhasma based on its utility. Objective: To prepare and analyse Mandura bhasma by employing various Bhasma pariksha mentioned in Ayurvedic science and Modern parameters along with analysis as per tools available today. Materials and methods: To standardise the standard operating procedure (SOP), Mandura Bhasma according to the method mentioned in classical Alchemy (Rasatarangini and Rasamrita). Mandura, detoxification process was followed by heating it in charcoal and dipping it in cow urine and the incineration process by levigating with juice of Aloe vera and heating system generated by cow dung cakes. Result: Bhasma became brownish, very fine, very soft and smooth and passed all classical characteristics of Ayurvedic parameters like Rekhapurnatva, Varitaratva, Sukshmatva, Shlakshnatva etc.,. All physic-chemical parameters are within the standard and presence of phytochemicals like steroids, alkaloids and tannin. X-ray diffraction analysis results revealed the crystalline size and FTIR revealed the presence of functional groups. Conclusion: The therapeutic efficacy of the Bhasma is believed to manifest only when it has successfully undergone the Bhasma Pariksha, a rigorous traditional assessment ensuring its quality and potency. This would undoubtedly aid in ensuring safety, efficacy, and batch-to-batch consistency.

Fall Risk Management by Nurses in the Inpatient Wards of Aceh Government Regional General Hospital, Indonesia

A patient fall is an incident that commonly occurs with or without injury. Not only does it potentially cause injury, but these incidents can also prolong the length of stay and increase the treatment cost. Nurses play an essential role in assessing and preventing the risk of falls in patients through appropriate education and preventive measures by Standard Operating Procedures (SOP). Effective implementation of SOPs can reduce the frequency and impact of fall incidents and improve the safety and quality of patient care. This case study aimed to expound on fall risk management in the Aceh Government Regional General Hospital wards. A quantitative case study type with a cross-sectional study was designed. The sample consisted of 28 nurses, and the data collection tool used an observation sheet to examine the implementation of fall risk management following the hospital SOP. Data analysis used descriptive statistical tests; the data was then presented as a frequency distribution table. The results show that 67.9% of nurses implemented fall risk management, and 32.1% did not implement it. It was essential to increase nurses’ compliance with the SOP for managing fall risk by monitoring and evaluating periodically and in stages by the first-line manager in the Aceh Government Regional General Hospital wards. It is also recommended that nurses routinely assess the risk of falling in patients, educate patients and their families about it, and participate in ongoing training to improve patient safety in hospitals to achieve better quality healthcare.

Digital Official Letter Management Using E-Buddy Sidoarjo Application

Background: The rise of digital technology has revolutionized local governance by enhancing efficiency and transparency. Specific Background: In this context, the E-Buddy application facilitates the digital management of official correspondence, yet its effectiveness has not been thoroughly examined. Knowledge Gap: Current literature lacks a detailed analysis of the communication dynamics and bureaucratic structures affecting the success of such digital systems. Aims: This study investigates the implementation of the E-Buddy application, emphasizing communication, resource allocation, executor disposition, and bureaucratic structure. Results: Findings reveal that the application's effectiveness is undermined by limited feature utilization and insufficient adherence to standard operating procedures (SOPs), resulting in miscommunication and inefficiencies. Novelty: The research underscores the importance of effective communication and structured SOPs in optimizing digital systems in governance. Implications: The study recommends enhancing training and establishing clear SOPs to improve implementation outcomes and contribute to more effective governance. Highlights : Effective communication is crucial for successful implementation. Insufficient adherence to SOPs hampers operational efficiency. Training and support enhance user engagement and application effectiveness. Keywords: Digital Governance, E-Buddy Application, Implementation, Communication, Bureaucratic Structure

Implementation of BLT DD: Insights from Village Cash Assistance Program

Background: Direct Cash Assistance from village funds (BLT DD) is vital for supporting rural communities, particularly during economic challenges. Specific background: Since 2020, Desa Gelam has allocated funds for BLT DD, making it a relevant case for examining program implementation. Knowledge gap: Limited research exists on the detailed execution and impact of BLT DD at the village level. Aims: This study analyzes the implementation of BLT DD in Desa Gelam, focusing on the roles of village officials and the importance of standard operating procedures (SOPs) for transparency. Results: Findings reveal that clear SOPs enhance the effective distribution of aid, with significant contributions from the village head and welfare officer, aligning with Edward III’s theory of communication, resources, disposition, and bureaucratic structure. Novelty: This research offers insights into how structured procedures improve social aid program execution, emphasizing village leadership. Implications: The study highlights the necessity of clear guidelines and strong leadership to ensure successful social assistance programs like BLT DD, serving as a model for enhancing aid distribution efficiency in other villages. Highlights : Role of SOPs: Clear standard operating procedures enhance transparency and efficiency in aid distribution. Leadership Impact: Village head and welfare officer are crucial for the successful implementation of BLT DD. Theoretical Alignment: Findings support Edward III’s theory on effective communication and resource management in social programs. Keywords: Direct Cash Assistance, BLT DD, Desa Gelam, standard operating procedures, village leadership

Integrated Service Pos Program Outcomes for Elderly in Kebonsari Village

Background: The elderly population has unique health needs requiring specialized services. Specific Background: This study investigates the implementation of the Posyandu Lansia Wijaya Kusuma program, focusing on operational procedures and challenges in a rural context. Knowledge Gap: There is a lack of understanding regarding specific obstacles faced in implementing such health programs in similar communities. Aims: This research aims to evaluate program operations and identify hindering factors. Results: Data from interviews and participatory observations indicate a structured Standard Operating Procedure (SOP) for the Posyandu Lansia, facilitating essential health services. While the program follows a clear framework, operational barriers impact service delivery. Novelty: This study highlights the importance of adhering to SOPs to enhance healthcare outcomes for the elderly, offering insights distinct from previous research emphasizing SOP improvements. Implications: Findings emphasize the need to optimize health services for the elderly, informing policy decisions to improve healthcare systems in rural areas and advocating for ongoing evaluation of health programs to address evolving elderly needs. Highlights : Structured SOP: The program follows a clear Standard Operating Procedure for service delivery. Operational Barriers: Identified challenges impact the effectiveness of health services for the elderly. Policy Implications: Findings inform improvements in rural healthcare systems and program evaluation. Keywords: elderly care, health services, Posyandu Lansia, implementation, rural health

Village Consultative Body's Contributions to Development in Balongdowo Village

Background: Village consultative bodies (BPD) play a vital role in promoting good governance at the local level. Specific Background: This study examines the implementation of BPD's roles in a specific village context, focusing on their effectiveness in enhancing transparency and participation. Knowledge Gap: Existing literature lacks exploration of the practical applications of BPD roles and their impact on governance across different regions. Aims: This research analyzes how BPD executes its responsibilities, emphasizing its regulatory functions. Results: Findings show that BPD effectively implements its regulatory roles, contributing to improved village governance through adherence to standard operating procedures (SOPs) and strong budgetary support from the local government. Novelty: This study highlights the collaboration between BPD and local government, providing a replicable model of good governance. Implications: The research emphasizes the need to strengthen BPD-local government relationships to enhance community welfare and suggests improving SOPs to achieve collective governance goals, contributing to the discourse on local governance effectiveness. Highlights : Effective Collaboration: Highlights the successful partnership between BPD and local government. Regulatory Functions: Emphasizes BPD's role in enhancing governance through established procedures. Community Impact: Illustrates the positive effects of BPD's actions on local welfare and development. Keywords: BPD, local governance, regulatory roles, community welfare, transparency

An Operations Chain Model for Automatic Assessment of Operation Procedure for Equipment Operators

Automatic assessment of the operation ability of operators based on computers is an essential approach for improving the effectiveness of equipment operation training and enhancing equipment safety. Present methods primarily focus on the operation results but pay less attention to the operation procedure. One reason is that there is a lack of a model that has the ability to describe all probable paths to accomplish the same task. Therefore, an operations chain model is put forward for the first time to describe the standard operation procedure and relationships among operations based on the decomposition of operational tasks and the relationships among the various operations required to fulfill the task. A specific operation task corresponds to an operations chain, which will form one or multiple standard operation sequences that will allow trainees to complete the same task through different paths. The Needleman–Wunsch sequence alignment algorithm is introduced to match the trainees’ operation sequence with all standard sequences. The maximum alignment result is the score of the trainees’ operations. An example shows that the operations chain model can accurately describe the complex structure of the standard operating procedures. The Needleman–Wunsch sequence alignment algorithm can objectively evaluate the trainee’s operation capabilities. The combination of the operations chain model and sequence alignment algorithm can form a complete operation procedure assessment method that is friendlier to trainees and has more objective evaluation results. The method will help to improve the effectiveness of the competency assessment of equipment operators.

Decreasing adverse events from concurrent Vinca-alkaloid and azole antifungals in a pediatric oncology population: Patient safety improvement process.

297 Background: Azole-antifungals like posaconazole and voriconazole have a documented significant risk of adverse drug events (ADE) when concomitantly administered with vinca-alkaloid chemotherapy (vincristine, vinblastine, vinorelbine) due to inhibition of vinca clearance. Potential ADE’s include paralytic ileus, severe, potentially permanent neuropathies, cranial nerve dysfunction, seizures, etc. Aim: Assess a standardized process to hold azole-antifungal around vinca-alkaloid drug administration to decrease the risk of adverse events associated with this drug-drug interaction in pediatric oncology patients. Intervention: Azole-antifungals (fluconazole*, voriconazole, posaconazole, itraconazole) will be held the day before, day of, and day after the vinca-alkaloid administration (with flexibility given provider discretion*) in the outpatient and inpatient setting at a single site. Methods: Development of a Standard Operating Procedure (SOP), informational technology (IT) processes such as Best Practice Advisory (BPA), nursing orders, Vinca Time-Out order and standard nursing note template for telephone encounter to remind patient/parents. Retrospective data was assessed in three 6-12 month phases, Pre-SOP (Phase 0), Post- SOP and Pre-IT support (Phase 1), and Full implementation (Phase 2). Study Outcomes: 1.Hold the azole-antifungal in 100% of encounters where vinca-alkaloid is due. 2. Decrease number of adverse events by 10%. 3. Maintain adequate fungal prophylaxis (or treatment) with a 0% incidence of breakthrough fungal infections. Results: Average number of concomitant azole/vinca administrations for each Phase was 39. A 97% improvement was seen in the number of vinca administrations dose reduced or held from 28 (Phase 0) to 1 (Phase 2). A 66% improvement in SOP compliance was observed (19 % in Phase 0, and 85% in Phase 2). Significant adverse effects were decreased by 33-50% between Phase 0, and Phase 1 and 2, respectively. Three patients in Phase 2 experienced fungal infection breakthrough; all had documented compliance issues prior to the study period. Conclusions: Implementation of the SOP and IT processes helped achieve a process to hold azole antifungals and led to significant decrease in the need to dose reduce or hold vinca-alkaloids thereby allowing less chemotherapy interruption/dose adjustments. Further modification of the SOP may be developed to exclude those patients on anti-fungal therapy for an active fungal infection.