Unsafe Manner Research Articles

A qualitative study of negative sociocultural experiences of accessing primary health care services among Africans from refugee backgrounds in Australia: implications for organisational health literacy

BackgroundPrimary health care is the first point of contact for patients from refugee backgrounds in the Australian health system. Sociocultural factors, including beliefs and value systems, are salient determinants of health literacy and access to primary health care services. Although African refugees in Australia have diverse sociocultural backgrounds, little is known about the influence of sociocultural factors on their experiences of accessing primary health care services. Guided by the theoretical framework of access to health care, this study examined from the perspective of African refugees how culturally and religiously conditioned, constructed and bound health beliefs, knowledge and practices influence their experiences of access to, acceptance and use of primary health care services and information in Australia.MethodsThis exploratory, qualitative study involved 19 African refugees from nine countries living in New South Wales, Australia. Semi-structured interviews were conducted and recorded using Zoom software. The interviews were transcribed verbatim and analysed using a bottom-up thematic analytical approach for theme generation.ResultsFour main themes were identified. The themes included: participants' experiences of services as inaccessible and monocultural and providing information in a culturally unsafe and insensitive manner; the impact of the clinical care environment; meeting expectations and needs; and overcoming access challenges and reclaiming power and autonomy through familiar means. The findings generally support four dimensions in the access to health care framework, including approachability, acceptability, availability and accommodation and appropriateness.ConclusionAfrican refugees experience significant social and cultural challenges in accessing primary health care services. These challenges could be due to a lack of literacy on the part of health services and their providers in servicing the needs of African refugees. This is an important finding that needs to be addressed by the Australian health care system and services. Enhancing organisational health literacy through evidence-informed strategies in primary health systems and services can help reduce disparities in health access and outcomes that may be exacerbated by cultural, linguistic and religious differences.

Association of Opioid Disposal Practices with Parental Education and a Home Opioid Disposal Kit Following Pediatric Ambulatory Surgery.

The majority of opioid analgesics prescribed for pain after ambulatory pediatric surgery remain unused. Most parents do not dispose of these leftover opioids or dispose of them in an unsafe manner. We aimed to evaluate the association of optimal opioid disposal with a multidisciplinary quality improvement (QI) initiative that proactively educated parents about the importance of optimal opioid disposal practices and provided a home opioid disposal kit before discharge after pediatric ambulatory surgery. Opioid disposal behaviors were assessed during a brief telephone interview pre- (Phase I) and post-implementation (Phase II) after surgery. For each phase, we aimed to contact the parents of 300 pediatric patients ages 0 to 17 years who were prescribed an opioid after an ambulatory surgery. The QI initiative included enhanced education and a home opioid disposal kit including DisposeRX®, a medication disposal packet that renders medications inert within a polymeric gel when mixed with water. Weighted segmented regression models evaluated the association between the QI initiative and outcomes. We considered the association between the QI initiative and outcome significant if the beta coefficient for the change in intercept between the end of Phase I and the beginning of Phase II was significant. Safe opioid disposal and any opioid disposal were evaluated as secondary outcomes. The analyzed sample contained 161 pediatric patients in Phase I and 190 pediatric patients in Phase II. Phase II (post-QI initiative) cohort compared to Phase I cohort reported higher rates of optimal (58%, n = 111/190 vs 11%, n = 18/161) and safe (66%, n = 125/190 vs 34%, n = 55/161) opioid disposal. Weighted segmented regression analyses demonstrated significant increases in the odds of optimal (odds ratio [OR], 26.5, 95% confidence interval [CI], 4.0-177.0) and safe (OR, 4.4, 95% CI, 1.1-18.4) opioid disposal at the beginning of Phase II compared to the end of Phase I. The trends over time (slopes) within phases were nonsignificant and close to 0. The numbers needed to be exposed to achieve one new disposal event were 2.2 (95% CI, 1.4-3.7]), 3.1 (95% CI, 1.6-7.4), and 4.3 (95% CI, 1.7-13.6) for optimal, safe, and any disposal, respectively. A multidisciplinary approach to educating parents on the importance of safe disposal of leftover opioids paired with dispensing a convenient opioid disposal kit was associated with increased odds of optimal opioid disposal.

Effects of a behavior-based safety observation program: Promoting safe behaviors and safety climate at work.

Behavior-based safety (BBS) programs promote coworkers observing and correcting each other's at-risk behaviors on site; the idea behind BBS programs is to create a cultural shift in a company where it is acceptable for coworkers to stop anyone, at any time, from working in an unsafe manner. The main objective of this study is to examine the impacts of a BBS observation program in the construction industry. The subject, an electrical contracting company, implemented the BBS program in January 2019. This study utilized multiple data sources: the company's incident data, BBS program report data, and surveys, including the Safety Climate Assessment Tool for Small Contractors. A total of 3,891 at-risk behaviors from the BBS reports, including 600 comments, and 141 survey responses were analyzed. The most frequently reported at-risk behavior was the line of fire, and the at-risk behaviors were often observed when workers conducted tasks, such as running or pulling wires, installing devices, and installing lights. The overall perception of safety climate was high, and the respondents reported that the safety climate had improved since the adoption of the BBS program. Overall, implementing the BBS program benefited in cultivating the company's collective safety climate. As a result of the BBS program, the company implemented better communication strategies for their safety meetings on the most frequently reported at-risk behaviors, replacing safety gears with higher quality ones, and redesigning online safety training to better reflect the identified tasks that were associated with more at-risk behaviors.

Role of Farmers’ Training on Improving Pesticide Management and Food Safety in Conventional Cabbage and Eggplant Production

Pesticides pose a serious risk to the environment and public health when used in crop production in an unsafe and indiscriminate manner. Moreover, there is a preconceived notion that conventionally grown crops are not as safe as organic crops due to the presence of pesticide residues. To address this, an intervention that focused on farmers’ training on proper pesticide management was conducted. Two farmer clusters were organized separately, and pesticide usage and practices were monitored and evaluated. The results of the evaluation indicated a significant decline in the usage of pesticides not registered for cabbage and eggplant production. Residue analysis for major insecticide groups (organochlorines, organophosphates, and pyrethroids) of the harvested crops showed that 100% of the eggplant samples (n = 20) and 80% of the cabbage samples (n = 20) had non-detectable pesticide residues (< 0.01 mg/kg). The cabbage samples with detectable residues are found to be compliant with the currently established CODEX and ASEAN maximum residue limits for the indicated pesticides. Overall, this suggests that training and monitoring activities conducted to strengthen the knowledge and adherence to pesticide safety practices resulted in safe conventional vegetable production. It is recommended that farmers’ training and other extension activities be conducted periodically to promote the judicious use of pesticides for food safety.

A modified partitioning algorithm for classification of e-waste

Electronic and electrical industry is the largest and fastest growing manufacturing industry because of tremendous growth in both software applications and upgraded hardware. The past two decades have seen an exceptionally strong growth in the electronic equipment market. Electronic and electrical products become electronic waste (e-waste) when the products or items used lifecycle being ended. Electronic products are made up of many materials like plastics, heavy metals (lead, mercury, gold, platinum, silver, copper, zinc, selenium, cadmium, chromium and many more), dioxin, furans and others which require special end-of-life handling. The estimation of Global e-Sustainability Initiative is that about 320 tons of gold (8% of the total gold supply in the world) and throughout the world, 7,500 tons of silver are being used in the electronics manufacturing industry. Around 30-50 million tons of e-waste is produced every year and the production trend is overwhelming. By the end of the decade, the e-waste recycling market is going to touch $44.3 billion, which is more than four (04) times from its existing size. There are three concerns that arise for the crisis of e-waste. The first is the total volume of units of obsolescent electronic items. The second fact is the global problem as the generation of e-waste in vulnerable amount since everywhere there are people. And the third fact is that, the rate of obsolescence of electronic items i.e. 5 -10% yearly. The developing world has forecasted that by the year 2030 the developed country should discard the use of twice numbers of Personal Computers (PC) than developing countries. Moreover, in developing countries the e-waste is processed either by informal sector or being resold or refurbished and resold recycled in an unsafe manner using unskilled labours. Environmental pollution and occupational health hazards are frequently observed due to informal recycling of e-waste. In developed countries, e-waste is collected to recover some precious metals and safely rid of the toxic metals as they have contained but in developing countries, e-waste is collected mainly to recover a few metals of value and the rest are dumped in nearby areas. In developing countries, the laws for restricting hazardous waste are flexible by which the developed countries export their e-waste to developing countries because of low labour wages and the availability of second-hand market.

Peningkatan Kemampuan Komunikasi pada Pendamping Lapangan Penyakit Menular Seksual di Kota Makassar

One of the groups contributing to sexually transmitted infections (STIs) is homosexuals (gays,waria, and male sex men/GWL) who behave in an unsafe manner and hide their risky status fromtheir sexual partners. GWL is said to be risky if they don't come out about their sexualorientation and many GWLs are not caught or not joined by the community, so their presence isdifficult to detect. This service program aims to improve partners' Health Communication skillsand use of media in promoting Health related to changing GWL behavior through training andpractice. This activity is in the form of training with the participants being field outreachworkers from the Gaya Celebes Foundation, Makassar City. After the training, there was anincrease in the understanding and skills of field facilitators in communicating behavior changeto at-risk groups.

Dechlorination of persistent organic pollutants in petrochemical wastewater sludge through a planetary ball mill using synthesized nanocomposite

ABSTRACT Numerous tons of hazardous wastes containing persistent organic pollutants (POPs) are stored in an unsafe manner in the petrochemical industries. The planetary ball mill causes the formation of mineral Cl compounds during the degradation of polychlorinated compounds in the presence of various reagents. In addition, the planetary ball mill has been applied for the synthesis of diverse organic-inorganic hybrid nanomaterials. In the present study, Fe-metal organic framework was prepared using a planetary ball mill, and then Fe@C nanocomposite with core/shell structure was synthesised by carbonisation. X-ray diffraction (XRD) and field emission scanning electron microscope (FESEM) and transmission electron microscope (TEM) were utilised to study the synthesised materials. The nanocomposite was used as a reagent to degrade persistent organic pollutants in the sludge of a petrochemical wastewater treatment plant by a planetary ball mill. CaO was also used to compare the effect of nanocomposites on system performance. Ion chromatography (IC) analysis was carried out to determine chlorine mineralisation. Furthermore, Fourier transform infrared spectroscopy (FTIR) and Raman spectroscopy were applied to determine chemical bonds. The results illustrated a zero-valent iron nanoparticle in the core protected by carbon shell in a synthesised nanocomposite with a core/shell structure. Hence, nanocomposite was the most efficient additive, with 97% dechlorination efficiency in the first hour while the efficiency of the planetary ball mill in the presence of CaO was only 76% after 12 hours of milling. Furthermore, major changes occurred in the organic phases, carbon and chlorine bonds. Simultaneously, graphite and amorphous carbon were produced in the final products after milling. This indicates that aromatic structures and C-Cl bonds were broken down into inorganic compounds. Thus, this study presented a practical method of producing materials while degrading hazardous pollutants in petrochemical wastewater sludge through a planetary ball mill.

Measures for improving pedestrian crossing facilities based on perceptions of urban commuters: An experience in Kolkata

Pedestrian accidents constitute a significant share of total accident victims in urban India. In spite of several efforts put by local authorities, pedestrians continue to cross the road at unauthorised locations in an unsafe manner. The present paper reports an investigation to determine the rational spacing of crossing facilities at midblock sections and identify the optimal type of crossing facility for the prevailing condition considering the perceptions of urban commuters. The rational spacing is determined by analysing the data collected from urban commuters regarding the additional detouring they are ready to accept in order to avail a facility for safe crossing of road. The optimal type of crossing facility is determined considering the preferences of urban commuters and the cost-benefit analysis associated with different facilities. The effect of socioeconomic and trip characteristics of commuters on the response or preference is also investigated. Although, the study has been demonstrated with reference to a corridor in the Kolkata metro city and the results are case-specific, the approach may be applied elsewhere to identify the lacuna in spacing and type of pedestrian crossing facility and to propose suitable improvement measures.

Behavior of alkali-activated pozzocrete-fly ash paste modified with ceramic tile waste against elevated temperatures and seawater attacks

Huge quantities of ceramic tile waste are disposed annually in an unsafe manner, causing some environmental problems including air and soil contamination. So the re-use of such waste would be the perfect solution to get rid of these problems. This research focused on exploring durable and thermal stable geopolymer-based alkaline activation of pozzocrete-fly ash (PFA) doped with different ratios of ceramic tile waste (CW) compared to their plain mixtures under normal conditions. The PFA waste was modified upon partially replaced with the CW waste at replacement levels of 0%, 5%, 10%, 15% and 20%, by weight. All PFA-CW pastes activated with a mixture of NaOH and Na2SiO3 solutions. The hardened specimens were cured in 100% RH at 40 ± 2 °C for 1, 7, 14 and 28 days. After 28 days, some specimens were exposed to elevated temperatures of 200 °C, 400 °C, 600 °C and 1000 °C with a heating rate of 5 °C/min. Another batch of specimens were subjected to seawater for 1, 3 and 6 months. The mechanical properties as well as microstructure analysis prior and after exposure were monitored. The geopolymer phases were examined by Fourier transform infrared spectroscopy (FT-IR), Thermogravimetric analysis plus its derivative (TGA/DTG) and Scanning electron microscopy (SEM). The findings indicated that the CW waste has a positive effect on the properties of PFA-geopolymer. The inclusion of 10% CW enhanced the properties in terms of compressive strength and microstructure before and after exposure to high-temperature and seawater solution.

Evaluation of the potential environmental risk from the destination of medicines: an epidemiological and toxicological study.

The high consumption of medicines by the population and their storage at home might cause an increase in the number of pharmaceutical substances that may be inappropriately discarded in the sanitary sewage, reaching an environmental aquatic. Thus, the effects of these emerging contaminants need more studies. To identify the profile of most medicines that are discarded by users of community pharmacy and evaluate the toxicity of the most disposed drugs. This was a translational study. A descriptive observational study was carried out for convenience of community pharmacy users using a standardized questionnaire. Subsequently, the lethal concentration 50 (LC50) for medicine that is most frequently discarded was determined. After LC50, the embryos (n = 144) were exposed to sublethal concentrations for most discarded drug at 24, 48, and 72h. Mortality, heartbeat, and embryo deformities were used as parameters of toxicity. Most respondents (96%) had a "home pharmacy." The primary forms of disposal were in the common household waste, kitchen sink, and/or bathroom. The medicines that were most incorrectly discarded by the interviewees were nimesulide (17.1%), dipyrone (10.7%), and paracetamol (5.2%). LC50 of nimesulide was calculated (0.92 μgmL-1). The toxicological test revealed that embryos exposed to nimesulide showed several abnormalities, such as defects in the spinal cord, tail, yolk sac, as well as pericardial edema. Furthermore, the heartbeat decreased by 30% at a concentration of 0.4 μgmL-1 as compared with control group. The yolk sac and pericardial areas increased to >100% in all treatment groups when compared with the control group. Respondents disposed medicines in an inappropriate manner primarily in household waste and in the toilet. Nimesulide was the most discarded drug according to study population. Moreover, teratogenic effects such as spinal cord defects, decreasing heartbeats, and increasing pericardial and yolk sac area in embryos were observed after exposure to nimesulide. These results show that nimesulide may promote risk to aquatic organisms and to human health if it is discarded in an unsafe manner.

Toxic waste dumping in the Global South as a form of environmental racism: Evidence from the Gulf of Guinea

ABSTRACT Toxic waste is chemical compounds that, when ingested or inhaled, can cause physiological impairment and, in extreme cases, death. It is also known for its detrimental effect on the environment when disposed of in an unsafe manner. Yet, countries in the Gulf of Guinea continue to be targeted by Western waste-brokers notwithstanding the existence of laws prohibiting the transboundary disposal of such materials. There is also a rise in the export of electronic waste (e-waste) from developed countries to countries in the region, purportedly as reusable electronics, much of which ends up in landfills. The primitive recycling techniques of this e-waste undermines the health of the local populations and their environment due to inadequate care of the heavy metal and toxin content. Drawing on examples from Côte d’Ivoire, Nigeria and Ghana, this paper argues that toxic waste dumping in the Gulf of Guinea amounts to environmental racism. The article makes recommendations relating to the challenges of toxic waste dumping in the Gulf of Guinea, including the need for countries to implement the provisions of the Basel and Bamako conventions in their entirety, recognise acts of environmental racism as violations of human rights, and for young people to rise to the occasion as ‘agents of change’.

From “business continuity” to “back to business” for orthopaedic surgeons during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented challenges to healthcare systems worldwide. Orthopaedic departments have adopted business continuity models and guidelines for essential and non-essential surgeries to preserve hospital resources as well as protect patients and staff. These guidelines broadly encompass reduction of ambulatory care with a move towards telemedicine, redeployment of orthopaedic surgeons/residents to the frontline battle against COVID-19, continuation of education and research through web-based means, and cancellation of non-essential elective procedures. However, if containment of COVID-19 community spread is achieved, resumption of elective orthopaedic procedures and transition plans to return to normalcy must be considered for orthopaedic departments. The COVID-19 pandemic also presents a moral dilemma to the orthopaedic surgeon considering elective procedures. What is the best treatment for our patients and how does the fear of COVID-19 influence the risk-benefit discussion during a pandemic? Surgeons must deliberate the fine balance between elective surgery for a patient’s wellbeing versus risks to the operating team and utilization of precious hospital resources. Attrition of healthcare workers or Orthopaedic surgeons from restarting elective procedures prematurely or in an unsafe manner may render us ill-equipped to handle the second wave of infections. This highlights the need to develop effective screening protocols or preoperative COVID-19 testing before elective procedures in high-risk, elderly individuals with comorbidities. Alternatively, high-risk individuals should be postponed until the risk of nosocomial COVID-19 infection is minimal. In addition, given the higher mortality and perioperative morbidity of patients with COVID-19 undergoing surgery, the decision to operate must be carefully deliberated. As we ramp-up elective services and get “back to business” as orthopaedic surgeons, we have to be constantly mindful to proceed in a cautious and calibrated fashion, delivering the best care, while maintaining utmost vigilance to prevent the resurgence of COVID-19 during this critical transition period. Cite this article: Bone Joint Open 2020;1-6:222–228.

From "business continuity" to "back to business" for orthopaedic surgeons during the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented challenges to healthcare systems worldwide. Orthopaedic departments have adopted business continuity models and guidelines for essential and non-essential surgeries to preserve hospital resources as well as protect patients and staff. These guidelines broadly encompass reduction of ambulatory care with a move towards telemedicine, redeployment of orthopaedic surgeons/residents to the frontline battle against COVID-19, continuation of education and research through web-based means, and cancellation of non-essential elective procedures. However, if containment of COVID-19 community spread is achieved, resumption of elective orthopaedic procedures and transition plans to return to normalcy must be considered for orthopaedic departments. The COVID-19 pandemic also presents a moral dilemma to the orthopaedic surgeon considering elective procedures. What is the best treatment for our patients and how does the fear of COVID-19 influence the risk-benefit discussion during a pandemic? Surgeons must deliberate the fine balance between elective surgery for a patient’s wellbeing versus risks to the operating team and utilization of precious hospital resources. Attrition of healthcare workers or Orthopaedic surgeons from restarting elective procedures prematurely or in an unsafe manner may render us ill-equipped to handle the second wave of infections. This highlights the need to develop effective screening protocols or preoperative COVID-19 testing before elective procedures in high-risk, elderly individuals with comorbidities. Alternatively, high-risk individuals should be postponed until the risk of nosocomial COVID-19 infection is minimal. In addition, given the higher mortality and perioperative morbidity of patients with COVID-19 undergoing surgery, the decision to operate must be carefully deliberated. As we ramp-up elective services and get “back to business” as orthopaedic surgeons, we have to be constantly mindful to proceed in a cautious and calibrated fashion, delivering the best care, while maintaining utmost vigilance to prevent the resurgence of COVID-19 during this critical transition period.Cite this article: Bone Joint Open 2020;1-6:222–228.

Variability: for better and for worse in safety assurance

Traditionally, in trying to design ―safe‖ systems, variability has been seen as a threat, because it brings with it the possibility of an unwanted outcome. Variability of hardware was thus rigorously controlled by, amongst other things, precise specifications. Variability of human behaviour was thought to be adequately managed by inter alia, regulations and protocols. This philosophy is now referred to as SAFETY I and relied on reliability to guarantee the expected system performance. In the now fashionable philosophy of SAFETY-II, on the other hand, variability is seen as unavoidable; a given in real environments and can even be an asset as, in SAFETY-II, humans are recognised as being able to cope with and often exploit the variability of technology and circumstances, to keep systems working. This reliance on the human capacity for coping, has been seen as adding a necessary element of ―resilience‖ to the system. Thus the SAFETY II concept of resilience engineering could be used as a way to promote safety by exploiting the ingenuity of humans to keep systems within the desired operating envelope. Recently the meaning of resilience has been stretched to include the ability of restoring the operational state after an excursion into the realm of inoperability. The problem is that these approaches (SAFETY I and SAFETY II), could be seen as legitimate alternatives as philosophies in the design of physical and operational systems. This stretched, almost complacent interpretation of ―resilience‖ only serves to exacerbate the problem. The mistake that is often made, is to regard either of the approaches as sufficient in themselves, to guarantee safety in today’s highly complex systems of work and decision making organisations. As Rumsfeld and Taleb have so eloquently reminded us, we can no longer justify designing solely for the known knowns and white swans. Similarly reliance on humans to cope if an unexpected situation may arise, can reduce the emphasis on preventive measures that limit the probability that the system may behave in an unsafe manner. In today’s evermore complex and less transparent systems and work places, however, we obviously need both the SAFETY I belts and the SAFETY II braces (to paraphrase Kletz); as the errors that may be introduced by over-relying on humans correctly assessing situations can be catastrophic: not just for an individual or a company, but sometimes for the wider society. So we need to formalise the human’s resilient SAFETY II abilities (to monitor, respond to, learn from and anticipate the meaning of operational variability), and incorporate them fully into the (SAFETY I) design of the system. Enlightened training and management can then, as a bonus almost, further rely on the human’s extraordinary abilities, as an additional layer of security.The problem is that these approaches (SAFETY I and SAFETY II), could be seen as legitimate alternatives as design philosophies. This stretched, almost complacent interpretation of “resilience” only serves to exacerbate the problem. The mistake that is often made, is to regard either of the approaches as sufficient in themselves, to guarantee safety in today’s highly complex systems of work and decision making organisations. As Rumsfeld [ 1 ]and Taleb [ 2 ] have so eloquently reminded us, we can no longer justify designing solely for the known knowns and white swans. Similarly reliance on humans to cope if an unexpected situation may arise, can reduce the emphasis on preventive measures that limit the probability that the system may behave in an unsafe manner. In today’s evermore complex and less transparent systems and work places, however, we obviously need both the SAFETY I belts and the SAFETY II braces (to paraphrase Kletz [ 3 ]); as the errors that may be introduced by over-relying on humans correctly assessing situations can be catastrophic: not just for an individual or a company, but sometimes for the wider society. So we need to formalise the human’s resilient SAFETY II abilities (to monitor, respond to, learn from and anticipate the meaning of operational variability), and incorporate them fully into the (SAFETY I) design of the system. Enlightened training and management can then, as a bonus almost, further rely on the human’s extraordinary abilities, as an additional layer of security.

The prevalence and effects of on-call stepdown on orthopaedic registrar training: the North West trainees' perspective.

Safe staffing levels are increasingly being threatened by gaps in rotas. When a gap occurs in junior grade on-call rotas the orthopaedic registrar needs to step down and undertake the role of both junior and middle-grade doctor. This increased responsibility could compromise the safety and wellbeing of patients and doctors. This study quantifies the prevalence and effects for trainees of stepdown while on call. An anonymous online and paper survey of trainees was conducted. The primary outcomes were the prevalence of stepdown in trainees' experience, the effects of stepdown on trainees and patients, and the overall impact on training and morale. The response rate was 93% (n = 51). Of the total, 55% of trainees had experienced stepdown, which occurred a minimum of 84 times, statistically more frequently for expected absences rather than unexpected absences (p = 0.002). Of the trainees who stepped down, 64% felt pressure to do so from seniors and 79% from hospital management. Some 50% of trainees felt that step down was managed in an unsafe manner; 40% of trainees stated that stepdown impacted on their own personal safety and 50% of trainees lost a training opportunity. Overall, 57% of trainees considered that stepdown and rota gaps affected their morale negatively. In 85% of cases there were no issues that resulted in patient harm. The survey results suggest that stepdown is common and it does impact negatively upon registrar training, safety and morale. Patient safety overall seems to be well protected.

Adaptive behavior of clinicians in response to an over-constrained patient safety policy on the administration of concentrated potassium chloride solutions

In response to fatal accidents involving concentrated potassium chloride (KCl) solutions, the Japanese hospital accreditation body released a safety policy in 2004 requiring the use of foolproof diluted KCl solutions throughout hospitals. However, the policy caused difficulties in treating seriously ill patients in critical care settings who require concentrated KCl solutions promptly. Resilient health care (RHC) provides a theoretical perspective for understanding how work is achieved in complex healthcare systems. ‘Work-as-imagined’ (WAI), as it should be done, and ‘work-as-done’ (WAD), as it actually takes place, are core concepts for understanding performance adjustment among individuals. This study aimed to investigate WAD regarding the administration of KCl solutions in the environment changed by WAI according to the authoritative policy.In 2017, we sent questionnaires to 346 critical care physicians. Topics included types of KCl products available in their units, administration methods, need for concentrated KCl solutions, hospital policies, and physician opinions. The response rate was 30.3% (105/346). Thirty-five physicians (33.3%) used conventional products out of compliance with the safety policy. Among 95 physicians using foolproof products, 69 (72.6%) obtained concentrated solutions from the products in an unsafe manner. The gap between WAI and WAD necessitated performance adjustments by physicians that introduced a new risk of adverse events despite the use of safer products.The study demonstrated that RHC theory can be used to inform the development and improvement of patient safety policies. Policy makers need to understand WAD when intervening in complex adaptive systems such as health care.

MON-021 Patterns of Sharps Handling and Disposal Among Insulin Using Patients with Diabetes

Background: Nearly 7 million patients with diabetes mellitus (DM) in the U.S. use insulin. Both Insulin therapy and self-monitoring of blood glucose (SMBG) have the potential to generate a large volume of biohazardous waste via use of “sharps” (needles and lancets). Unless safely disposed of these sharps could present a public health risk, placing unaware individuals at risk of needle sticks. However, there is a paucity of data on whether patients safely handle and dispose of used insulin needles and lancets. Objective: Assess patterns of sharps use and disposal among a clinic and hospital based population of DM patients on insulin therapy. Method: A survey was administered to a convenience sample of adult insulin treated DM patients recruited from an outpatient endocrinology clinic and an inpatient hospital setting. Patients were asked about patterns of sharps use (frequency of daily SMBG and insulin injections), how often sharps were used prior to disposal, sharp disposal technique, and education received regarding safe sharp disposal. Results: The survey was completed by 142 patients (94 outpatients and 48 inpatients). Mean age was 56 years, self-reported DM duration 20 years, hemoglobin A1c was 8.4%, and BMI 30.2 kg/m2; 57% were men and 75% were white. No differences in characteristics (p>0.1) were seen between outpatient and inpatient respondents. The average number of insulin injections was 3/day, and frequency of SMBG was 3.5/day. A minority (22%) used an insulin needle 2 or more times, and 32% threw the needles directly into the garbage as opposed to a sealable or red sharps container. Most (56%) respondents used a lancet 2 or more times, sometimes changing the lancet once only every few months. Around a third (35%) threw used lancets directly into the garbage; one patient flushed them down the toilet. No differences were seen between outpatients and inpatients (p> 0.3) in patterns of needle use, lancet use, or disposal method. The majority (63%) of respondents indicated they had never received instruction on safe disposal of sharps. Conclusion: In this population of both outpatients and inpatients, repeated use of the same insulin needle and lancet was noted. Moreover, nearly a third of respondents disposed of their sharps in an unsafe manner. If similar data are confirmed in broader studies, this could translate into a large number of insulin using patients improperly disposing of their sharps waste—a potentially important public health hazard. With the rising prevalence of DM and need for insulin, further study is needed to determine sharps disposal practices of these patients. Improved education is needed on both a population and patient level regarding proper handling of these biohazardous materials.

Challenges Facing Home-Based Caregivers in the Management of Health Care Risk Waste.

The quadruple burden of diseases, early discharge from hospital and hospital at home have resulted in home-based care services becoming a requirement in South Africa. These home-based care services generate a significant amount of health care risk waste that is mismanaged. More attention is given to the health care risk waste generated in hospitals and clinics than to health care risk waste generated by home-based caregivers. Therefore, this study investigates the health care risk waste management practices by home-based caregivers. The study adopted a mixed research approach, qualitative and quantitative methods, using a literature review, interviews, and questionnaires as means of data collection. Results show that there are different types of health care risk waste generated as a result of different activities performed by home-based caregivers, but that the waste was found to be managed in an unsafe manner. The majority of households receiving home-based care did not have basic sanitation facilities such as toilets, running water and waste removal services, aggravating the issue of health care risk waste mismanagement. The study recommends a new policy framework that will lead to safe management practices of generated health care risk waste to be adopted by home-based caregivers.

Knowledge, Attitude and Practice towards Induced Abortion and Associated Factors among Female students in Yebu Secondary School, Jimma zone, South West Ethiopia

Induced abortion is considered to be the intentional termination of pregnancy before the fetus can live independently which might be in unsafe manner. Unsafe abortion is one of the three leading causes of maternal mortality globally. In Africa, unsafe abortion accounts for more than a quarter of causes for maternal deaths. Ethiopia is one of the east African countries with highest incidence of unsafe abortion.

Production pressures among anaesthesiologists in Singapore.

Production pressure is the pressure on personnel to prioritise production ahead of safety. We assessed the prevalence of production pressures among anaesthesiologists in Singapore. A random online survey was conducted among local anaesthesiologists. Questions were asked about attitudes to production pressures in the work environment, occurrence of situations involving unsafe actions, and rating of the intensity of external and internal sources of pressure. Demographically, our respondents were largely similar to all anaesthesiologists in Singapore and were fairly distributed across various tertiary hospitals. Nearly half (44.5%) had witnessed production pressures, with a colleague pressured to conduct anaesthesia in an unsafe manner. Such events included pressure from surgeons to proceed for elective surgery in patients without adequate optimisation, pressure to employ anaesthetic techniques that surgeons wanted, having to source for operating rooms to finish the surgeon's list, and being misled regarding surgical time. Over half (52.3%) made errors in clinical judgement due to excess workload. A heavy elective list workload was significantly associated with proceeding with patients despite lack of appropriate support, making changes to practices to avoid delaying the start of surgery and sourcing for operating rooms to finish the surgeon's list (p < 0.05), and being pressured to proceed with patients that the anaesthesiologist would otherwise have cancelled (p < 0.01). The need to avoid delaying the start of surgery and reduce turnover time between patients were the top-ranked internal and external pressures, respectively. Production pressure is prevalent among anaesthesiologists in Singapore and is correlated with a heavy workload.