Safe Working Cycle: Is It a Panacea to Combat Construction Site Safety Accidents in Hong Kong?

In Hong Kong, the accident statistics of the construction industry is still comparatively higher than other industries. However, accident rates within the industry have significantly decreased, starting from the implementation of diverse safety initiatives, including the Safe Working Cycle (SWC). In this study, a post-positivist philosophical stance was adopted, and a questionnaire survey was launched to gather empirical data on the application of SWC in construction projects, the effectiveness of the safety initiative, and the benefits thereof. The data gathered from 197 construction participants were analysed using descriptive statistics, mean score, Mann–Whitney U-Test, Kendall’s concordance analysis, Chi-square value, Spearman rank-order correlation test and exploratory factor analysis. The findings revealed significant adoption of SWC in the Hong Kong construction industry. Furthermore, daily, weekly, and monthly inspections and supervisions and safety committee meetings are effective items of this safety initiative. The benefits of adopting SWC can be grouped into the safety of frontline workers and increase in the organisation’s safety commitment and reputation. This study has created an excellent theoretical platform for future research work on the usefulness of the SWC in the construction industry at large.

EFORT recommendations for off-label use, mix & match and mismatch in hip and knee arthroplasty

Off-label use is frequently practiced in primary and revision arthroplasty, as there may be indications for the application of implants for purposes outside the one the manufacturers intended. Under certain circumstances, patients may benefit from selective application of mix & match. This can refer to primary hip arthroplasty (if evidence suggests that the combination of devices from different manufacturers has superior results) and revision hip or knee arthroplasty (when the exchange of one component only is necessary and the invasiveness of surgery can be reduced). Within the EFORT ‘Implant and Patient Safety Initiative’, evidence- and consensus-based recommendations have been developed for the safe application of off-label use and mix & match in primary as well as revision hip and knee arthroplasty. Prior to the application of a medical device for hip or knee arthroplasty off-label and within a mix & match situation, surgeons should balance the risks and benefits to the patient, obtain informed consent, and document the decision process appropriately. Nevertheless, it is crucial for surgeons to only combine implants that are compatible. Mismatch of components, where their sizes or connections do not fit, may have catastrophic effects and is a surgical mistake. Surgeons must be fully aware of the features of the components that they use in off-label indications or during mix & match applications, must be appropriately trained and must audit their results. Considering the frequent practice of off-label and mix & match as well as the potential medico-legal issues, further research is necessary to obtain more data about the appropriate indications and outcomes for those procedures. Cite this article: EFORT Open Rev 2021;6:982-1005. DOI: 10.1302/2058-5241.6.210080

Standardizing Crash Carts Using Collaborative Design Methods And Usability Testing

Crash carts are mobile containers of medications and supplies used to resuscitate patients in emergencies within health care facilities. Contents and organization of carts often differ across hospitals and even departments within the same hospital. To support our team members in emergencies across our multi-hospital system, we created a system safety initiative to standardize and optimally organize adult crash carts. Our team established a three-phase user-centered research and design approach. First, we facilitated a collaborative design workshop with front line stakeholders to develop an initial cart organization. Second, 59 clinicians across 8 departments interacted with a cart mock-up and provided feedback. Finally, 18 clinicians participated in usability testing of the updated cart in 3 separate full simulations of realistic patient emergencies including an airway emergency (anaphylaxis), cardiac arrest (ventricular fibrillation), and sepsis using manikins. Observations and feedback from all three research phases contributed to a final medical supply list and crash cart design for our hospital system. This work also provides guidance for using co-design methods and usability testing within hospital environments.

Impact of the VA opioid safety initiative on pain management for cancer patients.

102 Background: Limited research exists on how risk reduction policies in response to the opioid epidemic have impacted pain management among cancer patients. This study investigated the impact of the Veteran’s Health Administration (VHA) Opioid Safety Initiative (OSI) on opioid prescribing patterns and opioid-related toxicity among patients undergoing definitive cancer treatment. Methods: This retrospective cohort study included 42,064 opioid-naïve patients receiving definitive local therapy for prostate, lung, breast, and colorectal cancer at the VHA from 2011-2016. Interrupted time series analysis with segmented regression was used to evaluate the impact of the OSI, which launched October 2013. The primary outcome was the incidence of new opioid prescriptions with diagnosis or treatment. Secondary outcomes included rates of high daily dose opioid (≥ 100 morphine milligram equivalent) and concomitant benzodiazepine prescriptions. Additional long-term outcomes included persistent opioid use, opioid abuse diagnoses, pain-related ED visits, and opioid-related admissions. Results: Prior to OSI implementation, the incidence of opioid prescriptions among new cancer patients increased from 26.7% (95% CI 25.0 – 28.4) in the first quarter (Q1) of 2011 to 50.6% (95% CI 48.3 – 53.0) in Q3 2013. There was a monthly increase in opioid prescription rate pre-OSI followed by a monthly decrease post-OSI (Table). High-dose opioid prescriptions were rare, and the monthly rate was stable before and after the OSI. Monthly incidence of concomitant benzodiazepine prescriptions was stable pre-OSI and decreased post-OSI. Persistent opioid use increased pre-OSI and decreased post-OSI. Pain-related ED visits had an incidence of 0.8% (95% CI 0.4 – 1.0) in Q1 2011, 0.3% (95% CI 0.1 – 0.6) in Q3 2013, and 1.8% (95% CI 0.9 – 2.7) in Q4 2016, with an increasing monthly rate after the OSI. At three years, the cumulative incidence of opioid abuse was 1.2% for both the pre- and post-OSI groups but opioid-related admissions were greater in the pre-OSI cohort than the post-OSI cohort (0.9% vs. 0.5%, p < 0.001). Conclusions: The OSI was associated with a decrease in new, persistent, and certain high-risk opioid prescribing as well as an increase in pain-related ED visits. Further research on patient-centered outcomes is required to optimize opioid prescribing policies for patients with cancer.[Table: see text]