Using Proactive Risk Assessment (HFMEA) to Improve Patient Safety and Quality Associated with Intraocular Lens Selection and Implantation in Cataract Surgery

2019 ◽  
Vol 45 (10) ◽  
pp. 680-685 ◽  
Author(s):  
Joseph M. DeRosier ◽  
Beth K. Hansemann ◽  
Michael W. Smith-Wheelock ◽  
James P. Bagian
Keyword(s):  
Risk Assessment ◽  
Patient Safety ◽  
Cataract Surgery ◽  
Intraocular Lens ◽  
Improve Patient Safety ◽  
Improve Patient

Human-Factor-Based Risk Management in the Healthcare to Improve Patient Safety

2016 ◽  
Vol 7 (3) ◽  
pp. 16-28 ◽  
Author(s):  
Barbara Streimelweger ◽  
Katarzyna Wac ◽  
Wolfgang Seiringer
Keyword(s):  
Risk Assessment ◽  
Patient Safety ◽  
Human Factors ◽  
Human Factor ◽  
Improve Patient Safety ◽  
Assessment Method ◽  
Healthcare Sector ◽  
Risk Assessment Method ◽  
Quality Aspects ◽  
Improve Patient

‘Patient Safety' tries to increase safety and transparency within healthcare systems for both patients and professionals. Within the healthcare sector, workflows become more and more complex, while time and money become scarce. As a consequence, the risk awareness, fault management and quality aspects become more important. One of the most well established risk assessment method is Failure Mode and Effect Analysis (FMEA) – a reliability analysis and risk assessment tool widely used in various industries. The traditional FMEA is using a Risk Priority Number (RPN) ranking system to evaluate and identify the risk level of failures, and to prioritize actions. However, there are several shortcomings in obtaining a quality estimate of the failure ratings with FMEA, especially when human factors play an important role. Thus, a new risk assessment method called HFdFMEA (Human Factor dependent FMEA) based on the dependency of used parameters and the observation of human factors, is proposed to address the drawbacks. The opportunity to improve patient safety is discussed as result of HFdFMEA.

Human-Factor-Based Risk Management in the Healthcare to Improve Patient Safety

2020 ◽  
pp. 453-468
Author(s):  
Barbara Streimelweger ◽  
Katarzyna Wac ◽  
Wolfgang Seiringer
Keyword(s):  
Risk Assessment ◽  
Patient Safety ◽  
Human Factors ◽  
Human Factor ◽  
Improve Patient Safety ◽  
Assessment Method ◽  
Risk Level ◽  
Effect Analysis ◽  
Risk Assessment Method ◽  
Improve Patient

‘Patient Safety' tries to increase safety and transparency within healthcare systems for both patients and professionals. Within the healthcare sector, workflows become more and more complex, while time and money become scarce. As a consequence, the risk awareness, fault management and quality aspects become more important. One of the most well established risk assessment method is Failure Mode and Effect Analysis (FMEA) – a reliability analysis and risk assessment tool widely used in various industries. The traditional FMEA is using a Risk Priority Number (RPN) ranking system to evaluate and identify the risk level of failures, and to prioritize actions. However, there are several shortcomings in obtaining a quality estimate of the failure ratings with FMEA, especially when human factors play an important role. Thus, a new risk assessment method called HFdFMEA (Human Factor dependent FMEA) based on the dependency of used parameters and the observation of human factors, is proposed to address the drawbacks. The opportunity to improve patient safety is discussed as result of HFdFMEA.

scholarly journals Writing’s on the wall: improving the WHO Surgical Safety Checklist

2021 ◽  
Vol 10 (1) ◽  
pp. e001086
Author(s):  
Claire Cushley ◽  
Tom Knight ◽  
Helen Murray ◽  
Lawrence Kidd
Keyword(s):  
Patient Safety ◽  
Online Survey ◽  
Improve Patient Safety ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Time Out ◽  
Mandatory Requirement ◽  
Who Checklist ◽  
Improve Patient ◽  
Theatre Team

Background and problemThe WHO Surgical Safety Checklist has been shown to improve patient safety as well as improving teamwork and communication in theatres. In 2009, it was made a mandatory requirement for all NHS hospitals in England and Wales. The WHO checklist is intended to be adapted to suit local settings and was modified for use in Gloucestershire Hospitals NHS Foundation Trust. In 2018, it was decided to review the use of the adapted WHO checklist and determine whether improvements in compliance and engagement could be achieved.AimThe aim was to achieve 90% compliance and engagement with the WHO Surgical Safety Checklist by April 2019.MethodsIn April 2018, a prospective observational audit and online survey took place. The results showed compliance for the ‘Sign In’ section of the checklist was 55% and for the ‘Time Out’ section was 91%. Engagement by the entire theatre team was measured at 58%. It was proposed to move from a paper checklist to a wall-mounted checklist, to review and refine the items in the checklist and to change the timing of ‘Time Out’ to ensure it was done immediately prior to knife-to-skin.ResultsFollowing its introduction in September 2018, the new wall-mounted checklist was reaudited. Compliance improved to 91% for ‘Sign In’ and to 94% for ‘Time Out’. Engagement by the entire theatre team was achieved 100% of the time. Feedback was collected, adjustments made and the new checklist was rolled out in stages across all theatres. A reaudit in December 2018 showed compliance improved further, to 99% with ‘Sign In’ and to 100% with ‘Time Out’. Engagement was maintained at 100%.ConclusionsThe aim of the project was met and exceeded. Since April 2019, the new checklist is being used across all theatres in the Trust.

scholarly journals Understanding safety in healthcare: the system evolution, erosion and enhancement model

2013 ◽  
Vol 2 (3) ◽  
pp. 25 ◽  
Author(s):  
Jane Carthey
Keyword(s):  
Patient Safety ◽  
Complex Systems ◽  
Human Error ◽  
Improve Patient Safety ◽  
New Model ◽  
System Evolution ◽  
Accident Causation ◽  
System Migration ◽  
Improve Patient

The paper summarises previous theories of accident causation, human error, foresight, resilience and system migration. Five lessons from these theories are used as the foundation for a new model which describes how patient safety emerges in complex systems like healthcare: the System Evolution Erosion and Enhancement model. It is concluded that to improve patient safety, healthcare organisations need to understand how system evolution both enhances and erodes patient safety.

Atmung – Standardisierte Checkliste macht Intubation von Neugeborenen sicherer

2017 ◽  
Vol 22 (03) ◽  
pp. 124-125
Author(s):  
Maria Weiß
Keyword(s):  
Intensive Care Unit ◽  
Patient Safety ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Improve Patient Safety ◽  
Improve Patient

Hatch LD. et al. Intervention To Improve Patient Safety During Intubation in the Neonatal Intensive Care Unit. Pediatrics 2016; 138: e20160069 Kinder auf der Neugeborenen-Intensivstation sind besonders durch Komplikationen während des Krankenhausaufenthaltes gefährdet. Dies gilt auch für die Intubation, die relativ häufig mit unerwünschten Ereignissen einhergeht. US-amerikanische Neonatologen haben jetzt untersucht, durch welche Maßnahmen sich die Komplikationsrate bei Intubationen in ihrem Perinatal- Zentrum senken lässt.

Sign in / Sign up

Export Citation Format

Share Document