Present Pharmacology curriculum doesn’t give a higher priority to the study of safety of medicines. Ensuring higher priority would lead to enhanced awareness of the balance between the benefits and harms of medicines. An integrated approach to therapeutic decision making to be encouraged. Excessive and irrational drug use, contributes to adverse reactions [2-3]. The misuse of medicines is largely caused by the poor qualityand inaccessibility of drug information available to practioners. Pharmacovigilance is a clinical discipline in its own right that contributes to an ethos of safetyand serves as an indicator of the standards of clinical care practised within a country.
This exploratory-descriptive quantitative study aimed to evaluate the protocol for identifying newborns admitted to the Neonatal Intensive and Semi-intensive Therapy Unit of a private hospital. The case series was made up of 540 observation opportunities, selected by simple random probability sampling. The data was collected between May and August 2010 according to a form and analyzed by descriptive statistic. The protocol’s general performance had a conformity index of 82.2%. There were three stages to the protocol: identification components, the identification wristbands’ condition and the number of identification wristbands. The highest percentage of conformity (93%) was attributed to the second stage and the lowest (89.3%) to the third, presenting a statistically significant difference of p= 0.046. In the group of ‘special’ neonates, 88.5% conformity was achieved. These results will make it possible to restructure the protocol for identifying newborns and to establish careand managerial goals so as to improve the quality of careand the patients’ safety.
Software SAS 9.3 (Statistical Analysis System, SAS Insti- tute Inc., Cary, NC, USA) was used for data analysis. Descrip- tive statistics was used to describe the profile of nursing professionals, hospital characteristics, quality of careand intention to leave the job and the profession. Regarding the variables work environment andsafety attitudes, mean and standard deviation values were presented. Means lower than 2.5 for NWI-R domains indicated environments favorable to the professional practice, while scores above 75 for SAQ domains indicated the presence of positive characteristics for patient safety. Regarding care indicators, line charts were constructed to indicate the evolution of indicators during a five-year period (2009- 2013), consider- ing the month of July/2011 as the landmark of the pre and post accreditation process.
adequate system of management of material resources that allow them to monitor rising prices, in addiion to preserve the quality of acquired products and promote safety for users. Thus, the increase in reusable and dis- posable aprons consumpion associated to the concern of hospital managers to reduce costs, ensure quality of careandsafety for professionals jusify the relevance of this study as an opportunity to analyze the direct costs spent with use of these products.
Several reviews commented that one advantage of telerehabil- itation following stroke is that patients can access rehabilitation even if they live in a remote area. However, it was not clear from the presentation of the studies in the rehabilitation reviews whether the control groups were receiving standard outpatient rehabilitation or no rehabilitation [28,73,74]. There have been trials involving upper and lower limb rehabilitation, carer support and problem solving skills using video-conferencing and the Internet. In one review, there were four randomised controlled trials and four case series. It was not clear what the comparison groups were in the trials . Another review included small studies of rehabilitation for a very diverse group of patients including: community elderly who had had falls or poor mobility, post total-knee replacement, post admission to geriatrics, knee pain, stroke, assessment for home care, multiple sclerosis, traumatic brain injury patients, post myocardial infarction, post cardiac surgery, spinal cord injury patients, speech and voice disorders, gait disorders, prosthetics, high care residents in residential care, and chronic pain. Outcomes were reported to be similar to those with face-to-face rehabilitation, with similar drop-out rates. There was some suggestion of decline in outcomes with longer term follow-up, but findings were inconsistent . It was also reported that patients were more accepting of videocon- ferencing than staff .
Abstract This paper aims at proposing validat- ed principles to underpin clinical management as a means to transform healthcare for integrat- ed healthcare systems. The starting point was the conception of clinical management based on structuring elements that do not separate man- agement, careand education. The authors’ pro- posal was submitted to specialists so that a con- sensus could be reached. At the end of the process, the following principles of clinical management were presented: (1) Focus on health needs and comprehensive care, (2) Qualityandsafety in healthcare, (3) Articulation and legitimation of different health practices and types of knowledge to face health problems, (4) Power sharing and co-accountability among managers, health profes- sionals and citizens in healthcare production; (5) Education of people and organizations; (6) Focus on outcomes that add value to health and life; (7) Transparency and accountability regarding col- lective interests. It is concluded that the principles of clinical management express connections that shed new light on management, healthcare, and education in integrated healthcare systems, re- quiring critical awareness in relation to the simul- taneity of “permanence” and change in practices. Key words Clinical management, Delivery of healthcare, Health systems, Health management Roberto de Queiroz Padilha 1
Segundo o Patient SafetyandQuality of Care working group (2014), os sistemas de relato de incidentes diferem ligeiramente na Europa: na Dinamarca, o banco de dados de segurança do doente foi criado em 2004 pelo Conselho Nacional de Saúde, que em 2011 se tornou na Agência Nacional para os Direitos e queixas dos doentes e é um órgão independente que pertence ao Ministério da saúde; na Suécia de acordo com a Lei de Segurança do Doente de 2010, todos os profissionais de saúde são obrigados a notificar à Inspeção de Saúde e Assistência Social e de acordo com a Lei do Patient Injury (criada em 1996), os doentes que experimentaram algum dano durante a prestação de cuidados de saúde, podem pedir uma indemnização à seguradora realizando um relato ao Comité regional de aconselhamento dos doentes; o Relatório Nacional do Reino Unido foi criado ao abrigo da Agência Nacional de Segurança do doente (National Patient Safety Agency ou NPSA) em 2003 e tem como objetivo facilitar a recolha e análise dos relatórios de segurança dos doentes a nível nacional entre os sistemas nacionais de saúde (National Health Service) na Inglaterra e no País de Gales. Apesar de já se ter percorrido um longo caminho no desenvolvimento de sistemas de relato de incidentes, vários obstáculos contribuem para a não utilização destes sistemas.
and interventions in the public health sector. The limited evidence suggests that engaged staff provide safer patient care (16). High level of employee engagement is related to patient- centred care, patient safety culture and the quality of care provided (17). Prins and colleagues (18) found that Dutch resident doctors who were more engaged were significantly less likely to make mistakes. Dawson’s review, funded by Kings Fund to review engagement within the National Health Service (NHS), showed that engagement has many significant associations with patient satisfaction, mortality, infection rates, Annual Health Check scores, as well as staff absenteeism and turnover (19). Staff reporting more positive experiences within an NHS trust lead to better outcomes for that trust. MacLeod and Clarke performed a review of engagement for the UK government and revealed that two companies who are performing strongly, O2 and Sainsbury’s, believed that their recent growth was built on transforming their approach to their workforce using sophisticated engagement models (20). The Boorman Review of the NHS staff mental health found a strong link between stress and poor trust performance (21). The importance of employee engagement was highlighted after the Francis Report, the largest public enquiry in the UK. The Robert Francis report states that the failure in clinical governance at Mid Staffordshire NHS Foundation Trust was caused by ‘a lack of clinical engagement, whatever, then gets turned out by the Department of Health, whatever initiatives are started at the top, unless the clinical soil is fertile, the seeds will inevitably fall to stony ground at the trust level’ (22). The employer and employee are connected at the rational level, at the emotional level and at motivational level (23). This results in optimal positive output from the engaged employee (7). Research shows that nine out of every ten workers in the world want to take on challenges and are ready to put discretionary effort into their jobs (24). Unfortunately, only two employees in ten do so (25). This discrepancy called as “the engagement gap” may seem standard but it does not have to be. Positive employee engagement is vital for the NHS as it is the largest public sector organisation and employer in the UK. There are five steps described by Harrison et al. (26) to develop positive work engagement culture. The first step is to evaluate the tools and existing employee engagement followed by connecting employee to the values of organisation, to improve the engagement using communication and branding. Finally, to communicate on every platform to get into the minds of employees (26). Gallup questionnaire and the Utrecht Work Engagement Scale (UWES) are the most commonly used tools to measure employee engagement. The present study is aimed to understand the current level of employee engagement at one of the largest teaching hospital in the UK.
Introduction: Surveillance of nosocomial infections (NIs) is an essential part of quality patient care; however, there are few reports of National Healthcare Safety Network (NHSN) surveillance in neonatal intensive care units (NICUs) and none in developing countries. The purpose of this study was to report the incidence of NIs, causative organisms, and antimicrobial susceptibility patterns in a large cohort of neonates admitted to the NICU during a 16-year period. Methods: The patients were followed 5 times per week from birth to discharge or death, and epidemiological surveillance was conducted according to the NHSN. Results: From January 1997 to December 2012, 4,615 neonates, representing 62,412 patient-days, were admitted to the NICU. The device- associated infection rates were as follows: 17.3 primary bloodstream infections per 1,000 central line-days and 3.2 pneumonia infections per 1,000 ventilator-days. A total of 1,182 microorganisms were isolated from sterile body site cultures in 902 neonates. Coagulase-negative staphylococci (CoNS) (34.3%) and Staphylococcus aureus (15.6%) were the most common etiologic agents isolated from cultures. The incidences of oxacillin-resistant CoNS and Staphylococcus aureus were 86.4% and 28.3%, respectively. Conclusions: The most important NI remains bloodstream infection with staphylococci as the predominant pathogens, observed at much higher rates than those reported in the literature. Multiresistant microorganisms, especially oxacillin-resistant staphylococci and gram-negative bacilli resistant to cephalosporin were frequently found. Furthermore, by promoting strict hygiene measures and meticulous care of the infected infants, the process itself of evaluating the causative organisms was valuable.
Objective: to identify the scientific evidence on Patient Safety (PS) in intravenous therapy in the Intensive Care Unit (ICU). Method: integrative review conducted in the Theses Database Higher Education Personnel Improvement Coordination (CAPES) and the WHO Collaborating Centre for Quality of Careand Patient Safety (PROQUALIS) portal. Results: there were 21 productions, seven studies cited to intravenous therapy. The studies, categorized into levels of evidence 1, 2 and 7, include structural, materials and professional performance of the steps of prescription, dispensing, preparation and administration of medications aspects. The productions have low levels of evidence, and therefore do not exhibit strong degree of recommendation. Conclusion: it is believed that the establishment and maintenance of PS in intravenous therapy in ICU greater investment is needed in research with higher levels of evidence and professional preparation to act as the recommended practices. Descriptors: Patient safety, Intensive care, Administration intravenous.
Healthcare institutions are organizing and learning about their quality of care, such as the Australian healthcare system, that has undertaken discussions on healthcare performance with the Australian Council for SafetyandQuality in Health Care. There is no similar specific approach about communication andquality indicators, but improvements along this line have aimed to improve the process of care (7) .
The objecive of this study was to analyze the indiscriminate use of medical technologies could cause damage. The methodology involved a literature review of the use of technologies that can precociously detect diseases, generaing premature diagnoses, unnecessary acions and burden health systems. Resuling in guidelines that seek the raional use of medical technologies to ensure access to those who really will beneit and protect those who do not need to be exposed to risk. The objecive of Clinical Engineering is to help and even inter- vene in the health sector aiming for wellbeing, safety, cost reducion andquality in health services. Health care costs have been increasing drasically and are a global concern. Financial resources are inite compared to the numerous technological resources. Ethical and bioethical issues that should support the policies and pracices of health professionals were considered in the end.
Given the above, the question is: What is the impact of pro- moting self-care in nursing workload? A similar study was not found in the literature, showing the relevance of this research, an unprecedented approach. It is hoped that this publication will contribute to the adequacy of the nursing workload, con- sidering its inluence on quality of service, including patient safety, covering not only patients, families and caregivers, but the staf as a whole.
The WHO Safe Surgery Saves Lives program aims to increase the qualityandsafety standards in health care; contemplate the prevention of sentinel events, surgical site infections, safe anesthesia, safe surgical teams, and indicators of sur- gical care. It was decided that the instrument would serve a core set of safety standards that could be applied glob- ally and in different scenarios. In this set, it was obvious the multidisciplinary character, including all who work and contribute to the excellence of patient care.
blood available, and they are also more likely to receive whole blood when they are transfused. Paradoxically, countries in the Americas with a lower GNP per capita have proportionally more blood banks that actually collect blood than do countries with a higher GNP per capita. This shows that the efficiency of blood services in the Americas is higher in countries with more economic resources per capita. As shown in Table 2, the average number of blood units collected per blood bank in a year is 20 557 for the countries with a GNP per capita above US$ 10 000, and only 854 for those countries with a GNP per capita of less that US$ 1 000. To improve the utilization of resources in the Region of the Americas, efforts must be made to reduce the number of centers that collect and process blood. In addition to overcoming the scar- city of blood for transfusion in the Americas, its safety needs to be im- proved. The shortage of voluntary blood donors increases the risk of trans- fusion-transmitted infections, as shown by the higher prevalence rates of infec- tious markers in countries where the proportion of VNRA donors is lower. In the five countries where remuner- ated donors were reported, the annual donation rates were 3.00, 5.00. 5.30. 9.70, and 15.30 units of blood per 1 000 inhabitants. These rates show that pur- chasing blood does not necessarily lead to sufficiency for a country. On the con- trary, countries with paid donors tend to have prevalences of infectious mark- ers that are far above the prevalence levels found in countries with a high proportion of voluntary donors (Table 4). With more voluntary donors, fewer blood units are discarded and the blood-supply system is more efficient. This is particularly critical as the five countries that reported remunerated blood collection all fall in the lower GNP groupings in our study. Interven- tions to promote voluntary blood do- nation will result in increased blood availability andsafety as well as in a more-efficient use of limited resources. Screening all blood units must be pursued as an attainable major and immediate goal for the Region of the TABLE 4. Types of donors (%) and prevalence (%) of markers for human immunodeficiency
When knowledge is updated, improvements in patient care are evident, as shown in the results of a quasi-experimental study with 35 critical-care nurses from a hospital in Northern Palestine. These nurses presented deficits in knowledge and prac- tices regarding eye care, and improved their care considerably after educational intervention and the use of protocols. This intervention resulted in a decrease in the percentage of eye health complica- tions in the unit, which led to the recommendation of creating an updated protocol for the eye care assessment through continuing education with the intention of providing sufficient knowledge and safe care practices. 31
professionals of information about a patient, accompanying either a transfer of control over, or of responsibility for, the patient”) captures the essential elements of communication during the transitions of care for patients. his means that a handover can occur when patients are changing teams (or control, for example, when they come into the intensive care unit [ICU] from the operating room) or when shifts are changing (responsibility is changing, for example, when the night team takes over for patients in the ICU).
where they could write down any comments, concerns, and observations about medication safety in relation to each photograph. Participants were informed that they should feel free to note anything that seemed relevant to them, whether it applied to the storage, organization, hygiene or other aspects of medication preparation and administration at their unit. While each participant reviewed the photographs and completed the DPST, there was no communication between participants and/or with the researchers. On completing a review of all 10 images, participants had the option to provide written answers to two questions: “If I could do anything in order to improve any of these areas in relation to the medication safety, I would like to….” and “In case you have other concerns about the medication safety that were not represented on these photographs, please describe them”.
This article is protected by copyright. All rights reserved. 16 fatty acids and lactose . In this field, proteomics provided many advances in the detection of subclinical mastitis in serum and milk of infected cows. Recently, Turk and colleagues  and Alonso-Fauste and colleagues  discovered both in serum and milk from mastitis cows, several good candidates as putative biomarkers for subclinical mastitis. In both studies, the technique applied was 2D electrophoresis and shotgun MS analysis. Among subclinical biomarkers of infection, several proteins such as serotransferrin, fibrinogen b-chain, and antimicrobial polypeptide (cathelicidin) have been identified . Also the study of MFGM provided important knowledge in this field. Bovine MFGM analysis revealed the differential protein expression related to Staphylococcus aureus infection . It has been estimated that S. aureus is responsible for about 185 000 food-related illnesses in the United States each year . S. aureus toxin is responsible for several gastrointestinal disorders such as nausea, vomiting, and diarrhea within 12 hours from ingestion of few milligrams of toxin. Callahan and colleagues developed a method that uses mass spectrometry to identify a protein toxin (staphylococcal enterotoxin B), in food matrix . The method is very sensitive and is based on the detection of tryptic fragments through tandem mass spectrometry (MS/MS). Authors state that staphylococcal enterotoxin B can be found in concentration up to 5 parts-per-billion in water-soluble food matrices. Another important advance in the absolute quantification of S.aureus toxins used a combination of immunocapture and Protein Standard Absolute Quantification (PSAQ) methods and is believed to play a key role in the counteraction of outbreaks .
they are often intangible. Sixty Italian companies belonging to the fishing sector were inquired and it is concluded that the implementation and maintenance costs were, usually, lower than expected, but so were the benefits. The authors also concluded that the precision of a trace- ability system is often more preponderant than its scope. Reduced benefits and the evaluation of traceability systems made from the point of view of the consumers has been making the adoption of this systems somewhat slow. It is stated that a traceability solution that is too com- prehensive is unable consider the specificities of each company and that a more specific solution is required. For the purpose of this study, it is considered that such specification would serve as an obstacle to information sharing between different entities, but that may be more efficient on an internal level. Additionally, Dabbene et al.  indicated the main causes of recalls to be incorrect labeling, faults during production, incorrect packing and lack of identification of conditions that compromise safety. This situation leads to loss of consumer trust and costs with withdrawals and destruction of affected products. Most companies are unable to correctly estimate the amount of product that needs to be removed nor have efficient methods to assure an effective recall. Traceability systems can help companies to execute better recalls and so, a good performance indicator is the capacity to reduce capital loss associated to recalls. Another performance indicator is the existence of a systemic information loss. Traceability by itself does not increase the value of a product but helps other systems to identify desirable characteristics, communicate them and their value. Using an automatic traceability system can increase the precision of collected data and the capacity to identify a unit. There has been an emergence of industrial standards for traceability that ease information exchange. Traceability is