scholarly journals Implementation and Effectiveness of a Bar Code–Based Transfusion Management System for Transfusion Safety in a Tertiary Hospital: Retrospective Quality Improvement Study

10.2196/14192 ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. e14192 ◽  
Author(s):  
Shin-Shang Chou ◽  
Ying-Ju Chen ◽  
Yu-Te Shen ◽  
Hsiu-Fang Yen ◽  
Shu-Chen Kuo
Keyword(s):  
Quality Improvement ◽  
Blood Transfusion ◽  
Large Scale ◽  
Tertiary Hospital ◽  
Patient Identification ◽  
Transfusion Therapy ◽  
Process Maps ◽  
Bar Code ◽  
Before And After ◽  
Product Verification

Background Large-scale and long-term studies are not sufficient to determine the efficiency that IT solutions can bring to transfusion safety. Objective This quality-improvement report describes our continuous efforts to implement and upgrade a bar code–based transfusion management (BCTM) system since 2011 and examines its effectiveness and sustainability in reducing blood transfusion errors, in a 3000-bed tertiary hospital, where more than 60,000 prescriptions of blood transfusion are covered by 2500 nurses each year. Methods The BCTM system uses barcodes for patient identification, onsite labeling, and blood product verification, through wireless connection to the hospital information systems. Plan-Do-Study-Act (PDSA) cycles were used to improve the process. Process maps before and after implementation of the BCTM system in 2011 were drawn to highlight the changes. The numbers of incorrect labeling or wrong blood in tube incidents that occurred quarterly were plotted on a run chart to monitor the quality changes of each intervention introduced. The annual occurrences of error events from 2011 to 2017 were compared with the mean occurrence of 2008-2010 to determine whether implementation of the BCTM system could effectively reduce the number of errors in 2016 and whether this reduction could persist in 2017. Results The error rate decreased from 0.03% in 2008-2010 to 0.002% in 2016 (P<.001) and 0.001% in 2017 (P<.001) after implementation of the BTCM system. Only one incorrect labeling incident was noted among the 68,324 samples for blood typing, and no incorrect transfusions occurred among 67,423 transfusion orders in 2017. Conclusions This report demonstrates that continuous efforts to upgrade the existing process is critical to reduce errors in transfusion therapy, with support from information technology.

scholarly journals Direct-Push Blood Transfusion Practice in the Neonatal Unit of a Tertiary Hospital in South-South, Nigeria

2021 ◽  
pp. 91-96
Author(s):  
E. U. Bassey ◽  
S. B. Adesina
Keyword(s):  
Blood Transfusion ◽  
Cell Volume ◽  
Packed Cell Volume ◽  
Tertiary Hospital ◽  
Transfusion Practice ◽  
Hospital Data ◽  
Direct Push ◽  
Before And After ◽  
Aseptic Conditions ◽  
Blood Bag

Introduction: Transfusion of blood is a life-saving intervention in the care of ill neonates. Donated blood is a scarce national resource and must be used in the most efficient way. Exchange blood transfusion using the blood bag is the commonest mode of blood delivery employed. Other modalities of safe and sustainable blood delivery should also be explored, especially where paucity of funds predominates. This study aims to assess the usefulness of the direct push method where applicable, as an alternative to blood bag delivery in neonatal units of resource poor settings. Methods: A two year retrospective study of newborns admitted in the neonatal wards of the University of Uyo Teaching Hospital. Data obtained were the age, gender, indication for admission, packed cell volume (PCV) before and after transfusion. Blood transfusion was done in aliquots over 24 hours under aseptic conditions, via a peripheral vein. The push and pull method was employed, with no anticoagulant in the syringe. Post-transfusion PCV was done at least 24 hours after the procedure. Results: Of the one thousand and seventy-seven (1077) admitted neonates, two hundred and thirty-nine (22.2%), received blood products. Of these, twenty-one (8.8%), received a direct whole blood transfusion. Age (days) of the neonates transfused ranged from 1 to 26 days, with a mean of 10.4 ± 8.13. The Packed Cell Volume (PCV) pre-transfusion ranged between 20% - 44%, with a mean of 30.05 ± 6.39 while post-transfusion PCV ranged between 31% to 51%, with a mean of 38.17 ± 5.52(Fig. 1). The commonest indication for transfusion was prematurity, 9(42.8%) and neonatal sepsis 5 (23.8%). Conclusion: The direct transfusion of blood occasionally used, seems a relatively safe practice to correct mild/moderate anaemia. It also provides sufficient blood, with the advantage of usage when the umbilical cord access is no longer feasible and where cost of blood would otherwise, hinder quick intervention. This practice may need further evaluation by other centers.

The Effect of Active Site-inhibited Factor VIIa on Tissue Factor-initiated Coagulation Using Platelets before and after Aspirin Administration

1997 ◽  
Vol 78 (04) ◽  
pp. 1202-1208 ◽  
Author(s):  
Marianne Kjalke ◽  
Julie A Oliver ◽  
Dougald M Monroe ◽  
Maureane Hoffman ◽  
Mirella Ezban ◽  
...  
Keyword(s):  
Tissue Factor ◽  
Active Site ◽  
Large Scale ◽  
Thrombin Generation ◽  
Factor Viia ◽  
Dependent Manner ◽  
Antithrombotic Agent ◽  
Before And After ◽  
Ic50 Values

SummaryActive site-inactivated factor VIIa has potential as an antithrombotic agent. The effects of D-Phe-L-Phe-L-Arg-chloromethyl ketone-treated factor VIla (FFR-FVIIa) were evaluated in a cell-based system mimicking in vivo initiation of coagulation. FFR-FVIIa inhibited platelet activation (as measured by expression of P-selectin) and subsequent large-scale thrombin generation in a dose-dependent manner with IC50 values of 1.4 ± 0.8 nM (n = 8) and 0.9 ± 0.7 nM (n = 7), respectively. Kd for factor VIIa binding to monocytes ki for FFR-FVIIa competing with factor VIIa were similar (11.4 ± 0.8 pM and 10.6 ± 1.1 pM, respectively), showing that FFR-FVIIa binds to tissue factor in the tenase complex with the same affinity as factor VIIa. Using platelets from volunteers before and after ingestion of aspirin (1.3 g), there were no significant differences in the IC50 values of FFR-FVIIa [after aspirin ingestion, the IC50 values were 1.7 ± 0.9 nM (n = 8) for P-selectin expression, p = 0.37, and 1.4 ± 1.3 nM (n = 7) for thrombin generation, p = 0.38]. This shows that aspirin treatment of platelets does not influence the inhibition of tissue factor-initiated coagulation by FFR-FVIIa, probably because thrombin activation of platelets is not entirely dependent upon expression of thromboxane A2.

scholarly journals Algorithmic prediction of failure modes in healthcare

2020 ◽  
Author(s):  
Ayala Kobo-Greenhut ◽  
Ortal Sharlin ◽  
Yael Adler ◽  
Nitza Peer ◽  
Vered H Eisenberg ◽  
...  
Keyword(s):  
Adverse Events ◽  
Failure Modes ◽  
Medical Center ◽  
Hazard Analysis ◽  
Working Hours ◽  
Hazard Identification ◽  
Patient Identification ◽  
Complete Identification ◽  
Before And After ◽  
Fmea Method

Abstract Background Preventing medical errors is crucial, especially during crises like the COVID-19 pandemic. Failure Modes and Effects Analysis (FMEA) is the most widely used prospective hazard analysis in healthcare. FMEA relies on brainstorming by multi-disciplinary teams to identify hazards. This approach has two major weaknesses: significant time and human resource investments, and lack of complete and error-free results. Objectives To introduce the algorithmic prediction of failure modes in healthcare (APFMH) and to examine whether APFMH is leaner in resource allocation in comparison to the traditional FMEA and whether it ensures the complete identification of hazards. Methods The patient identification during imaging process at the emergency department of Sheba Medical Center was analyzed by FMEA and APFMH, independently and separately. We compared between the hazards predicted by APFMH method and the hazards predicted by FMEA method; the total participants’ working hours invested in each process and the adverse events, categorized as ‘patient identification’, before and after the recommendations resulted from the above processes were implemented. Results APFMH is more effective in identifying hazards (P &lt; 0.0001) and is leaner in resources than the traditional FMEA: the former used 21 h whereas the latter required 63 h. Following the implementation of the recommendations, the adverse events decreased by 44% annually (P = 0.0026). Most adverse events were preventable, had all recommendations been fully implemented. Conclusion In light of our initial and limited-size study, APFMH is more effective in identifying hazards (P &lt; 0.0001) and is leaner in resources than the traditional FMEA. APFMH is suggested as an alternative to FMEA since it is leaner in time and human resources, ensures more complete hazard identification and is especially valuable during crisis time, when new protocols are often adopted, such as in the current days of the COVID-19 pandemic.

scholarly journals THU0642-HPR EVOLUTION OF THE PERCEPTIONS OF RA PATIENTS AFTER EDUCATION PATIENT SESSION TEACHING METHOTREXATE SELF-INJECTION A PROSPECTIVE PILOT STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 566.1-566
Author(s):  
S. Afilal ◽  
H. Rkain ◽  
B. Berchane ◽  
J. Moulay Berkchi ◽  
S. Fellous ◽  
...  
Keyword(s):  
Pilot Study ◽  
Patient Education ◽  
Median Duration ◽  
Large Scale ◽  
Education Session ◽  
Prospective Pilot Study ◽  
Mean Delay ◽  
Lack Of Information ◽  
Level Of Satisfaction ◽  
Before And After

Background:Methotrexate is a gold standard for treatment of RA. In our context, RA patients prefer to be injected by paramedics rather than self-injecting. This can be explained by patients’ bad perceptions of self-injection or lack of information. Appropriate self-injection education can therefore be an important element in overcoming these obstacles and improving disease self-management.Objectives:Compare the RA patients’ perceptions on methotrexate self-injection before and after a patient education session.Methods:Prospective pilot study that included 27 consecutive patients (81.5% female, mean age 44.4 years, illiteracy rate 40.7%) with RA (median duration of progression of 4 years, mean delay in referral for specialist of 6 months, median duration of methotrexate use of 1 year). The patients benefited from an individual patient education session to learn how to self-inject with methotrexate subcutaneously. The patient education session was supervised by a nurse and a rheumatologist with a control a week later. Perceptions of the reluctance to self-inject and the difficulties encountered by patients were assessed before the patient education session, after the 1st and 2nd self-injection of methotrexate using a 10 mm visual analog scale. Patients also reported their level of satisfaction (10 mm VAS) after the 1st and 2nd self-injection.Results:The mean duration of patient education session is 13 min.Table I compares the evolution of the degrees of reluctance to self-injection, the difficulties encountered, and the satisfaction experienced by the patients.Table 1.Evolution of RA patients’ perceptions on the methotrexate self-injection. (N = 27)BeforeAfter the 1stself-injectionAfter the 2end self-injectionpVAS reluctance (0-10mm)6,5 ± 3,62,2 ± 2,91,0 ± 2,3<0,0001VAS difficulty (0-10mm)7,5 ± 2,62,5 ± 2,71,0 ± 1,9<0,0001VAS satisfaction (0-10mm)-8,9 ± 1,89,5 ± 1,50,002Conclusion:This study suggests the effectiveness of a methotrexate self-injection patient education session in RA patients. It also highlights the value of patient education in rheumatologic care. A large-scale study is necessary to better interpret and complete these preliminary results from this pilot study.Disclosure of Interests:None declared

scholarly journals Patients and relatives as auditors of safe practices in oncology and hematology day hospitals

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Isabel Rodrigo Rincón ◽  
Isabel Irigoyen Aristorena ◽  
Belén Tirapu León ◽  
Nicolás Zaballos Barcala ◽  
Maite Sarobe Carricas ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Tertiary Hospital ◽  
Patient Identification ◽  
Healthcare Organizations ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Younger Age ◽  
Day Hospitals ◽  
Cross Sectional Design ◽  
Safe Practices

Abstract Background When there is a gap in professionals’ adherence to safe practices during cancer treatment, the consequences can be serious. Identifying these gaps in order to enable improvements in patient safety can be a challenge. This study aimed to assess if cancer patients and their relatives can be given the skills to audit reliably four safe practices, and to explore whether they are willing to play this new role. Methods We recruited 136 participants in 2018, from the oncology and haematology day hospital of a tertiary hospital in Spain. Patient identification, hand hygiene, blood or chemotherapy identification, and side effects related to transfusion and chemotherapy, were the safe practices selected for evaluation. The study comprised two parts: an interventional educational program and a cross-sectional design to collect data and assess to what degree participants are able and willing to be auditors depending on their characteristics using multivariate logistic regression models. A participant’s auditing skill were assessed pre and post the educational intervention. Results The model was seeking predictors of being a good auditor. 63 participants (46.3%) were classified as good auditors after the training. To have younger age, higher educational level and to have had an experience of an adverse event were associated with a higher probability of being a good auditor. Additionally, 106 (77.9%) participants said that they would like to audit anonymously the professionals’ compliance of at least three of four safe practices. The willingness to audit safe practices differed depending on the safe practice but these differences did not reach statistical significance. Conclusions The data gathered by patients and relatives acting as auditors can provide healthcare organizations with valuable information about safety and quality of care that is not accessible otherwise. This new role provides an innovative way to engage patients and their families’ in healthcare safety where other methods have not had success. The paper sets out the methods that healthcare organizations need to undertake to enrol and train patients and relatives in an auditor role.

scholarly journals Dynamic variations in salinity and potassium grade of a potassium-rich brine deposit in Lop Nor basin, China

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lichun Ma ◽  
Kai Wang ◽  
Yu Zhang ◽  
Qingfeng Tang ◽  
Hui Yan
Keyword(s):  
Large Scale ◽  
Sustainable Use ◽  
Potassium Sulfate ◽  
Middle Pleistocene ◽  
Underground Brine ◽  
Average Decrease ◽  
Rational Development ◽  
Mining History ◽  
Before And After ◽  
Lop Nor

AbstractThe Quaternary Lop Nor playa is the largest production base of potassium sulfate in the world. It has a mining history of more than 10 years, and its share in the Chinese potassium sulfate market is about 50% to-date. In this basin, the high-salinity potassium-rich brines are mainly contained in Middle Pleistocene–Holocene glauberite strata. Based on the monitoring of the underground brine table and geochemical analysis, this study reveals variations in the underground brine table and potassium-bearing grade before and after large-scale mining in the Lop Nor potash deposit. The results showed that the underground brine table and potassium sulfate grade decreased by varying degrees over sub-mineral areas after large-scale mining. The underground brine table declined by 8.5 m, on average, in the Luobei depression, by 6.4 m in the Tenglong platform and by 1.9 m in the Xinqing platform. However, the potassium-bearing grade showed the different trend. The Tenglong platform had the largest decline with average decreases in layers W1, W2 and W3 of 18.2%, 13.0% and 24.8%, respectively. In the Xinqing platform, the average decrease in layersW2 and W3 were 17.4% and 16.0% respectively. The Luobei depression decreases were relatively small (W1, W2 and W3 decreased 4.3%, 4.2% and 3.1%, respectively). This research provides a theoretical basis for the rational development and sustainable use of the potassium-rich brines in the Lop Nor basin.

scholarly journals Species and characteristics of volatile organic compounds emitted from an auto-repair painting workshop

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
M. Y. Song ◽  
H. Chun
Keyword(s):  
Volatile Organic Compounds ◽  
Organic Compounds ◽  
Large Scale ◽  
Butyl Acetate ◽  
Small Scale ◽  
Indoor Environments ◽  
Voc Emissions ◽  
Volatile Organic ◽  
Before And After ◽  
Adsorption Systems

AbstractVolatile organic compounds (VOCs) are secondary pollutant precursors having adverse impacts on the environment and human health. Although VOC emissions, their sources, and impacts have been investigated, the focus has been on large-scale industrial sources or indoor environments; studies on relatively small-scale enterprises (e.g., auto-repair workshops) are lacking. Here, we performed field VOC measurements for an auto-repair painting facility in Korea and analyzed the characteristics of VOCs emitted from the main painting workshop (top coat). The total VOC concentration was 5069–8058 ppb, and 24–35 species were detected. The VOCs were mainly identified as butyl acetate, toluene, ethylbenzene, and xylene compounds. VOC characteristics differed depending on the paint type. Butyl acetate had the highest concentration in both water- and oil-based paints; however, its concentration and proportion were higher in the former (3256 ppb, 65.5%) than in the latter (2449 ppb, 31.1%). Comparing VOC concentration before and after passing through adsorption systems, concentrations of most VOCs were lower at the outlets than the inlets of the adsorption systems, but were found to be high at the outlets in some workshops. These results provide a theoretical basis for developing effective VOC control systems and managing VOC emissions from auto-repair painting workshops.

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