Mass-Casualty Training Exercise Using High-Fidelity Computerized Simulators and Involving Time and Resource Limitation

2021 ◽  
Vol 36 (3) ◽  
pp. 313-320
Author(s):  
Phillip A. Jacobson ◽  
Paul N. Severin ◽  
Dino P. Rumoro ◽  
Shital Shah
Keyword(s):  
Health Care ◽  
Resource Limitation ◽  
Mass Casualty ◽  
Health Care Personnel ◽  
High Fidelity ◽  
Medical Team ◽  
Training Exercise ◽  
The Mean ◽  
Medical Teams

AbstractPurpose:Training emergency department (ED) personnel in the care of victims of mass-casualty incidents (MCIs) is a highly challenging task requiring unique and innovative approaches. The purpose of this study was to retrospectively explore the value of high-fidelity simulators in an exercise that incorporates time and resource limitation as an optimal method of training health care personnel in mass-casualty care.Methods:Mass-casualty injury patterns from an explosive blast event were simulated for 12 victims using high-fidelity computerized simulators (HFCS). Programmed outcomes, based on the nature of injuries and conduct of participants, ranged from successful resuscitation and survival to death. The training exercise was conducted five times with different teams of health care personnel (n = 42). The exercise involved limited time and resources such as blood, ventilators, and imaging capability. Medical team performance was observed and recorded. Following the exercise, participants completed a survey regarding their training satisfaction, quality of the exercise, and their prior experiences with MCI simulations. The Likert scale responses from the survey were evaluated using mean with 95% confidence interval, as well as median and inter-quartile range. For the categorical responses, the frequency, proportions, and associated 95% confidence interval were calculated.Results:The mean rating on the quality of experiences related trainee survey questions (n = 42) was between 4.1 and 4.6 on a scale of 5.0. The mean ratings on a scale of 10.0 for quality, usefulness, and pertinence of the program were 9.2, 9.5, and 9.5, respectfully. One hundred percent of respondents believed that this type of exercise should be required for MCI training and would recommend this exercise to colleagues. The five medical team (n = 5) performances resulted in the number of deaths ranging from two (including the expectant victims) to six. Eighty percent of medical teams attempted to resuscitate the “expectant” infant and exhausted the O- blood supply. Sixty percent of medical teams depleted the supply of ventilators. Forty percent of medical teams treated “delayed” victims too early.Conclusion:A training exercise using HFCS for mass casualties and employing limited time and resources is described. This exercise is a preferred method of training among participating health care personnel.

scholarly journals N26 Experiences of patients with inflammatory bowel disease (IBD) regarding faecal incontinence and the guidance received

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S669-S669
Author(s):  
T T I Toivonen ◽  
K Helin ◽  
R Nikkola
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Inflammatory Bowel Disease ◽  
Faecal Incontinence ◽  
Bowel Disease ◽  
Bowel Function ◽  
Health Care Personnel ◽  
Wexner Score ◽  
Inflammatory Bowel

Abstract Background Patients with inflammatory bowel disease (IBD) suffer more often than the rest of the population from faecal incontinence, which decreases their quality of life. The purpose of this study was to describe the experiences of Finnish IBD patients regarding faecal incontinence and the guidance they need and have received for faecal incontinence. Methods The data were collected by executing focused interviews of eleven IBD patients, who at the time of the interview were in remission. The interviewees participated in the study via the Finnish patient association Crohn ja Colitis ry. The data were analysed using an inductive content analysis. Results Seven participants were men and four were women. They had had IBD for an average of 2 to 40 years. Five interviewees had Crohn’s disease and six had ulcerative colitis. The extent of the faecal incontinence and its impact on quality of life were assessed by Jorge–Wexner score, which examines the frequency of solid and loose stools and intestinal gas, use of diapers or protective pads, and the patients’ perception of the impact on the quality of life. Zero points stands for complete continence and 20 points for complete incontinence. The average Wexner score among participants was 9.8 (Figure 1). The participants felt that faecal incontinence was constantly disturbing their life. They especially wished for support and information regarding diet. Fear of faecal incontinence made participants skip planned activities and isolate themselves at home. Participants tried to anticipate bowel movements and find out toilet locations in advance in order to venture out of their homes. Participants had discussed faecal incontinence with an IBD nurse and a doctor, but none had met a continence nurse. Furthermore, none of the participants had been told about potential faecal incontinence or ways to manage it. Some participants felt that diet had improved their bowel function, although health care personnel had said in their guidance that diet has no effect on faecal incontinence. Participants also felt that they would have needed information regarding the risk of faecal incontinence and wished that they had been heard regarding problems caused by faecal incontinence. Conclusion IBD patients need guidance from health care personnel and information regarding faecal incontinence to balance their bowel function. Health care personnel taking care of IBD patients in Finland needs more training on faecal incontinence, and in addition, more guidance and criteria on when to direct a patient to a continence nurse is needed.

Balancing Rights and Duties in ‘Life and Death’ Decision Making Involving Children: a role for nurses?

2001 ◽  
Vol 8 (5) ◽  
pp. 397-408 ◽  
Author(s):  
Martin Woods
Keyword(s):  
Health Care ◽  
Decision Making ◽  
New Zealand ◽  
Health Care Personnel ◽  
Medical Team ◽  
Life And Death ◽  
Ethical Decisions ◽  
Moral Ideals ◽  
Seriously Ill

In recent years, increasing pressures have been brought to bear upon nurses and others more closely to inform, involve and support the rights of parents or guardians when crucial ‘life and death’ ethical decisions are made on behalf of their seriously ill child. Such decisions can be very painful for all involved, and may easily become deadlocked when there is an apparent clash of moral ideals or values between the medical team and the parents or guardians. This article examines a growing number of such cases in New Zealand and analyses the moral parameters, processes, outcomes and ethical responses that must be considered when life and death ethical decisions involving children are made. The article concludes with a recommendation that nurses should be recognized as perhaps the most suitable of all health care personnel when careful mediation is needed to produce an acceptable moral outcome in difficult ethical situations.

Effects of Treatment and Alternative Care on Length of Stay on a General Hospital Psychiatric Unit — Results of an Audit

1993 ◽  
Vol 38 (1) ◽  
pp. 39-45 ◽  
Author(s):  
François M. Mai ◽  
Jean-Yves Gosselin ◽  
Lily Varan ◽  
Luc Bourgon ◽  
Joaquin Ruiz Navarro
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Length Of Stay ◽  
Psychiatric Inpatient ◽  
Medical Audit ◽  
Prolonged Stay ◽  
System A ◽  
Psychiatric Inpatient Unit ◽  
The Mean

Quality controls are becoming an important part of our health care system. A medical audit is one way of evaluating quality of care, and this paper describes the results of an audit conducted to investigate the reasons for a prolonged stay on a psychiatric inpatient unit. The results showed a decrease in the mean length of stay over a five year period, although the figure remained substantially above provincial norms. A review of the hospital charts of a random sample of one in six patients whose hospital stay exceeded 30 days was carried out. It revealed that in 50.0% of cases the reasons were “medically acceptable,” in 10.3% the reasons were “medically unacceptable” and in 39.7% the reasons were “social and administrative” and beyond the control of the treating psychiatrist. The implication of these results are discussed.

scholarly journals Medication Safety Practices: A Patient's Perspective

2016 ◽  
Vol 8 (4) ◽  
pp. 271-281
Author(s):  
Sunita Ghike ◽  
Krutika Bhalerao ◽  
Anuja V Bhalerao
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Quality Of Health Care ◽  
Medication Safety ◽  
Medication Administration ◽  
Obstetrics And Gynecology ◽  
Sample Population ◽  
Safety Practices ◽  
The Mean

ABSTRACT Introduction Medication administration constitutes a key element of acute care delivery, while errors in the process threaten patient safety. A foundational cornerstone upon which health care providers endeavor to base all care is the medical oath, “Never do harm to anyone” (Hippocrates). Medication use in hospitals is a complex process and depends on successful interaction among health care personnel functioning at different areas, and errors may occur at any stage of prescribing, documenting, dispensing, preparation, or administration. The purpose of this research is to explore the safety practices employed by nurses during medication administration, specifically from the patients’ perspectives. The fundamental objectives are to explore patients’ perceptions, attitudes, and beliefs about the safety practices utilized by nurses when administering medications and to identify opportunities for increasing patient safety. Materials and methods This study was undertaken employing a quantitative survey instrument as the methodology. For collecting data, a pretested, structured questionnaire was given to the sample population after fulfilling the inclusion/exclusion criteria, and consent to enroll in study was taken. This method is convenient and affords the opportunity to generalize responses from the sample population to the population as a whole. Results The mean age of the respondents from Obstetrics and Gynecology was 29.08 ± 6.53. The mean age of the respondents from medicine was 33.4 ± 9.6. The mean age of the respondents from surgery was 33.68 ± 12.2; 23% respondents belonged to medicine unit, 21.5% respondents belonged to surgery unit, and 55.5% respondents belonged to Obstetrics and Gynecology unit. Of the total respondents, 62.75% were females. Moreover, 76 respondents in medicine, 72 respondents in surgery, and 172 respondents in Obstetrics and Gynecology stayed in the hospital for > 7 days. Respondents < 30 years of age responded negatively to three out of six questions compared to respondents > 30 years of age. This is statistically significant (p = 0.008, 0.0001, and 0.008) showing that age does not alter the perception of the quality of health care. The perception of medicine respondents was negative to four out of six questions as compared to surgery respondents. This is statistically significant (p = 0.008, 0.0001, and 0.008), thus unit alters the perception of the quality of health care. The medicine respondents rated care lower as compared to surgical respondents. The patients’ perception varies with gender, and it has been found to be significant in five out of six cases where p value is < 0.05. Females rated the quality of care better and shared the responsibility for health care. The patients’ perception varies with length of stay (LOS): 47.25% respondents feel that the nursing care of the hospital is very safe; 63% respondents feel that their care is a responsibility shared by both doctors as well as themselves more so by the female respondents from surgical units and who stayed longer. Conclusion According to patients’ perceptions reported in this study, there were a number of inconsistencies noted in the seven rights of medication administration delivered by nurses, specifically patient identification, hand washing, allergy assessment, and patient teaching. The perception of medication safety practices do change with the unit they are in, gender, and LOS. The results identify key safety issues from a patients’ perspective to focus change strategies that will improve patient care. How to cite this article Bhalerao K, Ghike S, Bhalerao AV. Medication Safety Practices: A Patient's Perspective. J South Asian Feder Obst Gynae 2016;8(4):271-281.

scholarly journals EVALUASI PERESEPAN OBAT PASIEN RAWAT JALAN PUSKESMAS SUNGAI TABUK 1 KALIMANTAN SELATAN TERHADAP FORMULAIRUM KABUPATEN

2020 ◽  
Vol 3 (2) ◽  
pp. 377-386
Author(s):  
Okta Muthia Sari ◽  
◽  
Rollah Muhammad Arasy Hasan ◽  
Pretty Wulan Sari ◽  
Henni Selvina ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Of Service ◽  
Primary Health Care ◽  
Prescription Drugs ◽  
Health Workers ◽  
Descriptive Study ◽  
Primary Health ◽  
The Mean

Drug formularies are a guide for health workers in choosing drugs rationally. One of the benefits of formularies is controlling quality and optimizing services for patients. The conformity of prescription drugs to formularies is important to improve the quality of service. The purpose of this study was to assess the conformity of prescription drugs at Sungai Tabuk 1 Primary Health Care against the Banjar District Formulary for the period 2019. This retrospective descriptive study was conducted in January to February 2020 at the outpatient of Sungai Tabuk 1 Primary Health, South Kalimantan. Prescribing drugs at the outpatient of the 16 therapy classes, there are 13 therapy classes 100% according to the Banjar Regency Formulary for the period 2019. Meanwhile, 3 classes of less than 100% conformity therapy include anti-infection, topical medicines for the skin, and vitamins and minerals. The mean percentage of prescription drugs at the outpatient of Sungai Tabuk 1 in accordance with the Banjar Regency Formulary was 99.15.

scholarly journals Evaluation of pharmaceutical assistance in public primary care in Brasília, Brazil

2005 ◽  
Vol 39 (2) ◽  
pp. 223-230 ◽  
Author(s):  
Janeth de Oliveira Silva Naves ◽  
Lynn Dee Silver
Keyword(s):  
Health Care ◽  
High Efficiency ◽  
Cross Sectional Study ◽  
Poor Quality ◽  
Cross Sectional ◽  
Essential Drugs ◽  
Essential Drug List ◽  
Drug Policies ◽  
The Mean

OBJECTIVE: Pharmaceutical assistance is essential in health care and a right of citizens according to Brazilian law and drug policies. The study purpose was to evaluate aspects of pharmaceutical assistance in public primary health care. METHODS: A cross-sectional study using WHO drug indicators was carried out in Brasília in 2001. From a random sample of 15 out of 62 centers thirty exiting patients per center were interviewed. RESULTS: Only 18.7% of the patients fully understood the prescription, 56.3% could read it, 61.2% of the prescribed drugs were actually dispensed, and mean duration of pharmaceutical dispensing was 53.2 seconds. Each visit lasted on average 9.4 minutes. Of prescribed and non-dispensed drugs, 85.3% and 60.6% were on the local essential drug list (EDL) respectively. On average 83.2% of 40 essential drugs were in stock, and only two centers had a pharmacist in charge of the pharmacy. The mean number of drugs per prescription was 2.3, 85.3% of prescribed drugs were on the EDL, 73.2% were prescribed using the generic denomination, 26.4% included antibiotics and 7.5% were injectables. The most prescribed groups were: cardiovascular drugs (26.8%), anti-infective drugs (13.1%), analgesics (8.9%), anti-asthmatic drugs (5.8%), anti-diabetic drugs (5.3%), psychoactive drugs (3.7%), and combination drugs (2.7%). CONCLUSIONS: Essential drugs were only moderately available almost 30 years after the first Brazilian EDL was formulated. While physician use of essential drugs and generic names was fairly high, efficiency was impaired by the poor quality of pharmaceutical care, resulting in very low patient understanding and insufficient guarantee of supply, particularly for chronic diseases.

When and Why Health Care Personnel Respond to a Disaster: The State of the Science

2014 ◽  
Vol 29 (3) ◽  
pp. 270-274 ◽  
Author(s):  
Susan B. Connor
Keyword(s):  
Health Care ◽  
Emergency Response ◽  
Health Care Services ◽  
Mass Casualty ◽  
The State ◽  
Health Care Personnel ◽  
Current Evidence ◽  
Evidence Based ◽  
Publication Type ◽  
State Of The Science

AbstractObjectiveEmergency response relies on the assumption that essential health care services will continue to operate and be available to provide quality patient care during and after a patient surge. The observed successes and failures of health care systems during recent mass-casualty events and the concern that these assumptions are not evidence based prompted this review.MethodThe aims of this systematic review were to explore the factors associated with the intention of health care personnel (HCP) to respond to uncommon events, such as a natural disaster or pandemic, determine the state of the science, and bolster evidence-based measures that have been shown to facilitate staff response.ResultsAuthors of the 70 studies (five mixed-methods, 49 quantitative, 16 qualitative) that met inclusion criteria reported a variety of variables that influenced the intent of HCP to respond. Current evidence suggests that four primary factors emerged as either facilitating or hindering the willingness of HCP to respond to an event: (1) the nature of the event; (2) competing obligations; (3) the work environment and climate; and (4) the relationship between knowledge and perceptions of efficacy.ConclusionsFindings of this study could influence and strengthen policy making by emergency response planners, staffing coordinators, health educators, and health system administrators.ConnorSB. When and why health care personnel respond to a disaster: the state of the science. Prehosp Disaster Med. 2014;29(3):1-5.

scholarly journals P26 Pharmacy discharge service to facilitate early discharges and to improve the quality of electronic discharge letters (EDL’s)

2020 ◽  
Vol 105 (9) ◽  
pp. e19.2-e20
Author(s):  
Sonal Ladani ◽  
Mohammed AbouDaya ◽  
William Thornhill ◽  
Nanna Christiansen
Keyword(s):  
Electronic Patient Record ◽  
Electronic System ◽  
Discharge Process ◽  
Medical Team ◽  
Related Information ◽  
Written Information ◽  
Complex Patients ◽  
Medical Teams ◽  
Discharge Prescription

AimThe current discharge process on the paediatric wards involves transcribing medications from one electronic system to another, this has led to errors and compromises patient safety. Discharges are also sometimes delayed due to patients waiting for their medications. The newly implemented discharge service involves pharmacists working closely with the medical team to identify patients for discharge as early as possible and to accurately transcribe medications onto the electronic patient record (EPR).MethodThe pharmacist would attend the consultant-led morning handover or would liaise with the nurse in charge on the ward to establish discharges and transfers for that day or over the weekend if on a Friday. The most urgent discharges and any complex patients were prioritised. The EPR system would be used to generate the EDL’s, transcribe the medicines for discharge and add any other relevant written information. Any medication related issues would be clarified with the medical team. The prescription would be handed over to the medical team to be reviewed and signed. This would then be dispensed and checked by the pharmacy team. The patient/parent or carer would be counselled on their medications. Data was collected from November 2018 – March 2019, this included time informed about discharge, time EDL started, time EDL printed and time EDL completed. Other data collected included if any additional written information was provided to the GP and if any amendments were required after the doctor had reviewed the prescription. The data was inputted into an Excel spreadsheet and was compared against August – October 2018.Results152 discharge prescriptions were included in the service. The data was compared to the data from August – October 2018 which showed more than double of the prescriptions were completed in the morning between 9am-12noon (compared to 12noon-5.30pm) since the service started. Less prescription needed amendments at the point of screening and more prescriptions included additional medication related information. The quality of the prescriptions had improved and completing prescriptions earlier meant timely discharges, improved bed utilisation and improved patient quality. Positive feedback was given by patients, doctors and nurses as well as the rest of the ward teams.ConclusionCommunication has improved between the hospital and community care, as well as patient satisfaction and bed availability. A future development would be to introduce prescribing pharmacists within medical teams to streamline the discharge prescription process further, freeing up medical time and increasing the focus on medicines optimisation for all patients.

scholarly journals Quality of Services in Health Care Exploring New Opportunity as Medical Tourism in India

2019 ◽  
Vol 8 (3S2) ◽  
pp. 106-111
Keyword(s):  
Health Care ◽  
Medical Tourism ◽  
Study Data ◽  
Quality Of Services ◽  
Medical Procedure ◽  
Test Analysis ◽  
The People ◽  
The Mean ◽  
The Impact

Medical tourism is being a hot cake for the people of India. An emerging destination for tourism, and support getting from government is fortified the impact of services in this sector. This study is exploring the impacts of quality and cost based services in health care which is helping the health care sector to attract more customers across the world. Now a day India has been developed as a great destination for eco-tourism, medical tourism where uses of technology enabled services in medical procedure make it more safe and reliable. In this study data was normally distributed so researchers compare the mean and used t-test analysis. Resultants are exploratory in nature

Sign in / Sign up

Export Citation Format

Share Document