Medication errors during hospital drug rounds.
Objective--To determine the nature and rate of drug administration errors in one National Health Service hospital. Design--Covert observational survey be tween January and April 1993 of drug rounds with intervention to stop drug administration errors reaching the patient. Setting--Two medical, two surgical, and two medicine for the elderly wards in a former district general hospital, now a NHS trust hospital. Subjects--37 Nurses performing routine single nurse drug rounds. Main measures--Drug administration errors recorded by trained observers. Results--Seventy four drug rounds were observed in which 115 errors occurred during 3312 drug administrations. The overall error rate was 3.5% (95% confidence interval 2.9% to 4.1%). Errors owing to omissions, because the drug had not been supplied or located or the prescription had not been seen, accounted for most (68%, 78) of the errors. Wrong doses accounted for 15% (17) errors, four of which were greater than the prescribed dose. The dose was given within two hours of the time indicated by the prescriber in 98.2% of cases. Conclusion--The observed rate of drug administration errors is too high. It might be reduced by a multidisciplinary review of practices in prescribing, supply, and administration of drugs. (+info)
Evaluation of joint medical and nursing notes with preprinted prompts.
OBJECTIVE: To determine the views of doctors and nurses about two recent innovations in the structure of case notes: the use of preprinted prompts and the use of joint medical and nursing notes. DESIGN: Questionnaire survey of all doctors and nurses working on the children's wards. SETTING: Children's wards in a district general hospital. MAIN OUTCOME MEASURES: Whether or not respondents wanted to return to traditional notes; positive and negative aspects of the two innovations. RESULTS: There was an 81% response rate. 45 of 48 respondents (94%) did not want to return to traditional notes. Positive features of joint notes that were identified included: promotes team work (21/48 respondents), improves access to information (14/48), and reduces duplication (14/48). Negative features included uncertainty about identity of writer (8/48) and incompletely filled in sheets (7/48). Positive features of preprinted prompts included: less information omitted (29/48), easier to read and find information (28/48), and quicker to write (21/48). Negative features included: not enough space (19/48) and clerking too mechanical (16/48). CONCLUSION: Advantages of both innovations outweighed their disadvantages to the extent that only three out of 48 respondents wanted to return to writing traditional notes. (+info)
An approach to an index of hospital performance.
Two indexes are described, based on measures of administrative effectiveness and patient care effectiveness. The measures used were selected and ranked by a Delphi panel from a list of 30 measures drawn from the literature. Weights were assigned by the panel to 19 selected measures. The resulting indexes did well in a test on data collected from 32 Texas hospitals. (+info)
Shift work-related problems in 16-h night shift nurses (1): Development of an automated data processing system for questionnaires, heart rate, physical activity and posture.
To assess the shift work-related problems associated with a 16-h night shift in a two-shift system, we took the following important factors into consideration; the interaction between circadian rhythms and the longer night shift, the type of morningness and eveningness experienced, the subjective sleep feeling, the subjects' daily behavior, the effectiveness of taking a nap during the long night shift, and finally the effectiveness of using several different kinds of measuring devices. Included among the measuring devices used were a standard questionnaire, repetitive self-assessment of subjective symptoms and daily behavior at short intervals, and a continuous recording of such objective indices as physical activity and heart rate. A potential problem lies in the fact that field studies that use such measures tend to produce a mass of data, and are thus faced with the accompanying technical problem of analyzing such a large amount of data (time, effort and cost). To solve the data analysis problem, we developed an automated data processing system. Through the use of an image scanner with a paper feeder, standard paper, an optical character recognition function and common application software, we were able to analyze a mass of data continuously and automatically within a short time. Our system should prove useful for field studies that produce a large amount of data collected with several different kinds of measuring devices. (+info)
Shift work-related problems in 16-h night shift nurses (2): Effects on subjective symptoms, physical activity, heart rate, and sleep.
We compared the shift work-related problems between 16-h night shift and 8-h evening/night shifts among nurses in a university hospital with respect to subjective symptoms, physical activity, heart rate (HR), and sleep. The nurses of one group (n = 20) worked a 16-h night shift under a rotating two-shift system, while those of the other group (n = 20) worked an 8-h evening or night shift under a rotating three-shift system. The 16-h night shift was staffed by three or four nurses who alternately took a 2-h nap during the shift, and had at least one day off after each shift. Subjective symptoms and daily behavior were measured every 30 min by the nurses before, during, after each shift as well as during days off using a time-budget method. Also, physical activity, heart rate (HR), and posture were recorded during shifts. The results showed similar or lower levels of sleepiness, difficulty in concentration, fatigue, physical activity, and HR during the 16-h shift compared to the 8-h shifts. No differences in subjective symptoms between the two shift schedules were observed before or after the shifts or during days off. The main sleep was longer after the shifts and during days off in the 16-h shift group than in the 8-h shift group. Our results suggest that the work-related problems in 16-h night shift nurses may not be excessively greater than those in 8-h evening/night shift nurses, as long as appropriate countermeasures are taken during and after the extended shift. (+info)
Audit on the degree of application of universal precautions in a haemodialysis unit.
BACKGROUND: The purpose of the study was to investigate the degree of compliance with standard precautions (hand washing and wearing of gloves) by health workers in one haemodialysis unit. METHODS: During 4 months, two observers monitored the activities of the health care staff in the dialysis unit. Thirty five randomly distributed observation periods of 60 min duration covered one haemodialysis session. The observers evaluated (i) the total number of potential opportunities to implement standard precautions and (ii) the number of occasions when these were actually put into practice. RESULTS: A total of 364 opportunities to wear gloves and to wash hands thereafter and 273 opportunities to wash hands before a patient-oriented activity were observed. The proportion of occasions when gloves were actually used was 18.7%. Hand washing after a patient-oriented activity was performed only on 32.4% of occasions. Finally, only on 3% of such occasions was hand washing before the activity. CONCLUSIONS: The degree of compliance with standard precautions by health care personnel is unsatisfactory and this favours nosocomial transmission in haemodialysis units. (+info)
Injury surveillance in a children's hospital--overcoming obstacles to data collection.
OBJECTIVE: To understand the problems involved in collection of injury surveillance (Glasgow Children Hospital Injury Reporting and Prevention Programme, CHIRPP) forms. METHODS: Glasgow CHIRPP forms were issued by the clerical staff to all eligible child carers for details of the injury or ingestions by the child, and the retrieval rate of forms was monitored. Reasons for the poor collection of forms were identified and rectified. RESULTS: The collection rate of Glasgow CHIRPP forms was poor when the system was introduced in 1993. It improved when the forms were issued by nursing staff, and considerable improvement was noted when the triage nurse was made responsible. CONCLUSIONS: When a named individual was made responsible there was an improvement in the retrieval of Glasgow CHIRPP forms. A few other simpler problems relating to the retrieval of forms were identified and rectified. (+info)
Work stress and menstrual patterns among American and Italian nurses.
OBJECTIVES: This study assessed whether job stress alters menstrual patterns among nurses working in 2 different settings: a tertiary care hospital in New York (99 nurses) and a university hospital in Rome (25 nurses). METHODS: Data on menstrual patterns were collected by a daily diary in which the nurses recorded their basal body temperature (BBT) and their menstrual bleeding status for a 3-month period. The BBT curves were used to classify cycles as biphasic or monophasic, and as adequate or inadequate with respect to the luteal phase. Job stress was evaluated by both objective (environmental and work characteristics) and subjective (perceived stress) criteria. RESULTS: The American nurses, especially those assigned to high stress units, had an increased risk for long and monophasic cycles [relative risk (RR) 4.3, 95% confidence interval (95% CI) 1.1-16.2 and RR 5.5, 95% CI 1.2-25.5, respectively]. Among those who perceived their stress at work to be high or reported strenuous work activity, the risk for longer cycles was also raised (RR 2.3, 95% CI 0.6-8.0 and RR 1.6, 95% CI 0.7-4.2, respectively). Luteal phase inadequacy followed the same pattern. Similar trends were observed in the Italian data. In addition, the rotating shiftwork pattern prevalent in the Italian group was possibly associated with higher rates of short cycles and inadequate luteal phases when compared with those of nurses working fixed shifts either day or night. CONCLUSIONS: Menstrual function may be affected by stressful work conditions. (+info)