Oops! Another medication error : a literature review of contributing factors and methods to prevent medication errors

The purpose of this bachelor's thesis was to chart scientific research articles to present contributing factors to medication errors done by nurses in a hospital setting, and introduce methods to prevent medication errors. Additionally, international and Finnish research was combined and findings were reflected in relation to the Finnish health care system. Literature review was conducted out of 23 scientific articles. Data was searched systematically from CINAHL, MEDIC and MEDLINE databases, and also manually. Literature was analysed and the findings combined using inductive content analysis. Findings revealed that both organisational and individual factors contributed to medication errors. High workload, communication breakdowns, unsuitable working environment, distractions and interruptions, and similar medication products were identified as organisational factors. Individual factors included nurses' inability to follow protocol, inadequate knowledge of medications and personal qualities of the nurse. Developing and improving the physical environment, error reporting, and medication management protocols were emphasised as methods to prevent medication errors. Investing to the staff's competence and well-being was also identified as a prevention method. The number of Finnish articles was small, and therefore the applicability of the findings to Finland is difficult to assess. However, the findings seem to fit to the Finnish health care system relatively well. Further research is needed to identify those factors that contribute to medication errors in Finland. This is a necessity for the development of methods to prevent medication errors that fit in to the Finnish health care system.

Soins intégrés: comment accompagner un changement de culture [Integrated care: how to support a culture change?].

The primary care center at Lausanne University Hospital trains residents to new models of integrated care. The future GPs discover new forms of collaboration with nurses, pharmacists or social workers. The collaboration model includes seeing patients together or delegating care to other providers, with the aim of improving the efficiency of a patient-centered care approach. The article includes examples of integrated care in consultation for travelers, victims of violence, pharmacist medication adherence counseling, medicosocial team work for alcohol use disorders and nurse practitioners' primary care for asylum seekers.

Urgences vitales au cabinet médical: implications pour la formation et l'equipement du médecin de premier recours [Life-threatening emergencies at the office: implications for medical education and equipment of the primary care physician].

Every medical practitioner is confronted on a daily basis with emergencies. Among these, life-threatening emergencies can have disastrous consequences in term of morbidity and mortality; 22 cardiac arrests and 10 deaths were reported among the 1,650 Swiss practices during a 5 year period. The occurrence of life-threatening emergencies at the office necessitates, according to the type and place of the practice, the skills of the practitioner and the organization of his practice, the implementation of procedures, equipments (for example room equipped with a defibrillator, respiratory nebulizer, splints, emergency drugs) and specific continuous education programs that should be encouraged and made available to the whole medical corporation.

Medical record search engines, using pseudonymised patient identity: an alternative to centralised medical records

Purpose The purpose of our multidisciplinary study was to define a pragmatic and secure alternative to the creation of a national centralised medical record which could gather together the different parts of the medical record of a patient scattered in the different hospitals where he was hospitalised without any risk of breaching confidentiality. Methods We first analyse the reasons for the failure and the dangers of centralisation (i.e. difficulty to define a European patients' identifier, to reach a common standard for the contents of the medical record, for data protection) and then propose an alternative that uses the existing available data on the basis that setting up a safe though imperfect system could be better than continuing a quest for a mythical perfect information system that we have still not found after a search that has lasted two decades. Results We describe the functioning of Medical Record Search Engines (MRSEs), using pseudonymisation of patients' identity. The MRSE will be able to retrieve and to provide upon an MD's request all the available information concerning a patient who has been hospitalised in different hospitals without ever having access to the patient's identity. The drawback of this system is that the medical practitioner then has to read all of the information and to create his own synthesis and eventually to reject extra data. Conclusions Faced with the difficulties and the risks of setting up a centralised medical record system, a system that gathers all of the available information concerning a patient could be of great interest. This low-cost pragmatic alternative which could be developed quickly should be taken into consideration by health authorities.

Forensic science culture

Heretofore the issue of quality in forensic science is approached through a quality management policy whose tenets are ruled by market forces. Despite some obvious advantages of standardization of methods allowing interlaboratory comparisons and implementation of databases, this approach suffers from a serious lack of consideration for forensic science as a science. A critical study of its principles and foundations, which constitutes its culture, enables to consider the matter of scientific quality through a new dimension. A better understanding of what pertains to forensic science ensures a better application and improves elementary actions within the investigative and intelligence processes as well as the judicial process. This leads to focus the attention on the core of the subject matter: the physical remnants of the criminal activity, namely, the traces that produce information in understanding this activity. Adapting practices to the detection and recognition of relevant traces relies on the apprehension of the processes underlying forensic science tenets (Locard, Kirk, relevancy issue) and a structured management of circumstantial information (directindirect information). This is influenced by forensic science education and training. However, the lack of homogeneity with regard to the scientific nature and culture of the discipline within forensic science practitioners and partners represents a real challenge. A sound and critical reconsideration of the forensic science practitioner's roles (investigator, evaluator, intelligence provider) and objectives (prevention, strategies, evidence provider) within the criminal justice system is a means to strengthen the understanding and the application of forensic science. Indeed, the whole philosophy is aimed at ensuring a high degree of excellence, namely, a dedicated scientific quality.

Validation of the Postnatal Perceived Stress Inventory in a French-speaking population of primiparous women

Objective To develop a Postnatal Perceived Stress Inventory (PNPSI) and assess its psychometric properties. Design Cross-sectional quantitative study. Setting One nurse-managed labor and delivery unit in a university hospital in a major metropolitan area. Participants One hundred seventy-nine (179) primiparous French speaking women who gave birth at term. Methods The PNPSI was validated at 6 weeks postpartum. Its predictive validity for depression and anxiety was assessed at the same time. Results The exploratory analysis revealed a 19-item structure divided into six factors. This inventory has good internal consistency (Cronbach's alpha = .815). The predictive validity shows that the PNPSI significantly predicts depression and anxiety at 6 weeks postpartum, and that certain factors are particularly prominent. Conclusion The PNPSI's psychometric properties make it a useful tool for future research to evaluate interventions for perceived stress during the postnatal period. Its predictive power for depression indicates that it is also a promising tool for clinical settings.

Anomalies vasculaires: exemple du syndrome de Klippel-Trenaunay [Vascular anomalies].

Les anomalies vasculaires constituent des affections rares présentes dès la naissance. Elles sont classées selon leur histologie en tumeurs ou malformations vasculaires. La connaissance de ces anomalies par le médecin de famille est importante, permettant ainsi leur diagnostic, qui repose essentiellement sur la clinique. Les caractéristiques anatomiques et hémodynamiques de l'anomalie sont précisées par l'angiologue grâce à l'écho-Doppler. Cet examen permet un suivi de la lésion et le diagnostic d'éventuelles complications. Un bilan radiologique peut compléter cette évaluation avant discussion multidisciplinaire en vue d'un traitement parfois difficile. Dans cet article, un bref aperçu des malformations vasculaires et de leur prise en charge multidisciplinaire est discuté, en particulier dans le cas du syndrome de Klippel-Trenaunay. Vascular anomalies are rare conditions that could be observed at all ages. They are classified, according to their histology, in vascular tumors or vascular malformations. The general practitioner plays a significant role in diagnosis and patient management, diagnosis being suspected on clinical history. In case of vascular anomaly, ultrasound-Doppler assessment is helpful to characterize morphologic and hemodynamic changes of the lesion and permits to monitor the evolution and to detect complications. Further investigations are often necessary prior to multidisciplinary management. In this article, a brief overview of vascular anomalies, their multidisciplinary management and the exemple of Klippel-Trenaunay syndrome are presented.

Emergency department visits for non-life-threatening conditions : evolution over 13 years in a Swiss urban teaching hospital

INTRODUCTION: A large proportion of visits to our Emergency Department (ED) are for non-life-threatening conditions. We investigated whether patients' characteristics and reasons for consultation had changed over 13 years. METHODS: Consecutive adult patients with non-life-threatening conditions at triage were included in the spring of 2000 and in the summer of 2013. In both years patients completed a similar questionnaire, which addressed their reasons for consultation and any previous consultation with a general practitioner (GP). RESULTS: We included 581 patients in 2013 vs 516 in 2000, with a mean age of 44.5 years vs 46.4 years (p=0.128). Of these patients, 54.0% vs 57.0% were male (p=0.329), 55.5% vs 58.7% were Swiss (p=0.282), 76.4% were registered with a GP in both periods, but self-referral increased from 52.0% to 68.8% (p<0.001); 57.7% vs., 58.3% consulted during out-of- hours (p=0.821). Trauma-related visits decreased from 34.2% to 23.7% (p<0.001). Consultations within 12 hours of onset of symptoms dropped from 54.5% to 30.9%, and delays of ≥1 week increased from 14.3% to 26.9% (p<0.001). The primary motive for self-referral remained unawareness of an alternative, followed in 2013 by dissatisfaction with the GP's treatment or appointment. Patients who believed that their health problem would not require hospitalisation increased from 52.8% to 74.2% and those who were actually hospitalised decreased from 24.9% to 13.9% (all p<0.001). CONCLUSION: The number of visits for non-life-threatening consultations continue to increase. Our ED is used by a large proportion of patients as a convenient alternative source of primary care.

Inmigración y formación continuada en el colectivo de enfermería de la región sanitaria de Lleida

El aumento significativo de la inmigración en los últimos años supone un nuevo reto para la enfermería. Objetivos: conocer la situación actual de la formación de enfermería respecto a la inmigración, su interés por formarse y las dificultades y necesidades que tienen en materia de inmigración. Metodología: estudio descriptivo y transversal analizando una muestra representativa de todos los profesionales de enfermería colegiados en la provincia de Lleida. Para la recogida de datos se utilizó un cuestionario y el análisis estadístico se realizó con el programa informático SPSS versión 13.0. Resultados: más del 90% de los profesionales de enfermería de la provincia de Lleida son mujeres menores de 50 años y que mayoritariamente trabajan en atención hospitalaria. No obstante el interés expresado por temas relacionados con la inmigración, sólo el 24% ha realizado algún tipo de formación al respecto. La mayoría también reconoce tener problemas de comunicación con los inmigrantes. Las sugerencias recogidas en el cuestionario se categorizaron en modelos de integración y en formación. Conclusión: la formación de enfermería en inmigración es baja y se debe a su elevado coste y a que no se realiza en horario laboral. En términos generales, los profesionales de enfermería que se dedican a la Atención Primaria de salud, muestran mayor interés por formarse y mayor flexibilidad para modificar los protocolos y cuidados que sus homónimos hospitalarios.

Sensitivity analysis, dominant factors, and robustness of the ECETOC TRA v3, Stoffenmanager 4.5, and ART 1.5 occupational exposure models

Occupational exposure modeling is widely used in the context of the E.U. regulation on the registration, evaluation, authorization, and restriction of chemicals (REACH). First tier tools, such as European Centre for Ecotoxicology and TOxicology of Chemicals (ECETOC) targeted risk assessment (TRA) or Stoffenmanager, are used to screen a wide range of substances. Those of concern are investigated further using second tier tools, e.g., Advanced REACH Tool (ART). Local sensitivity analysis (SA) methods are used here to determine dominant factors for three models commonly used within the REACH framework: ECETOC TRA v3, Stoffenmanager 4.5, and ART 1.5. Based on the results of the SA, the robustness of the models is assessed. For ECETOC, the process category (PROC) is the most important factor. A failure to identify the correct PROC has severe consequences for the exposure estimate. Stoffenmanager is the most balanced model and decision making uncertainties in one modifying factor are less severe in Stoffenmanager. ART requires a careful evaluation of the decisions in the source compartment since it constitutes ∼75% of the total exposure range, which corresponds to an exposure estimate of 20-22 orders of magnitude. Our results indicate that there is a trade off between accuracy and precision of the models. Previous studies suggested that ART may lead to more accurate results in well-documented exposure situations. However, the choice of the adequate model should ultimately be determined by the quality of the available exposure data: if the practitioner is uncertain concerning two or more decisions in the entry parameters, Stoffenmanager may be more robust than ART.

Acute schistosomiasis: a risk underestimated by travelers and a diagnosis frequently missed by general practitioners-a cluster analysis of 42 travelers.

BACKGROUND: In 2011, a patient was admitted to our hospital with acute schistosomiasis after having returned from Madagascar and having bathed at the Lily waterfalls. On the basis of this patient's indication, infection was suspected in 41 other subjects. This study investigated (1) the knowledge of the travelers about the risks of schistosomiasis and their related behavior to evaluate the appropriateness of prevention messages and (2) the diagnostic workup of symptomatic travelers by general practitioners to evaluate medical care of travelers with a history of freshwater exposure in tropical areas. METHODS: A questionnaire was sent to the 42 travelers with potential exposure to schistosomiasis. It focused on pre-travel knowledge of the disease, bathing conditions, clinical presentation, first suspected diagnosis, and treatment. RESULTS: Of the 42 questionnaires, 40 (95%) were returned, among which 37 travelers (92%) reported an exposure to freshwater, and 18 (45%) were aware of the risk of schistosomiasis. Among these latter subjects, 16 (89%) still reported an exposure to freshwater. Serology was positive in 28 (78%) of 36 exposed subjects at least 3 months after exposure. Of the 28 infected travelers, 23 (82%) exhibited symptoms and 16 (70%) consulted their general practitioner before the information about the outbreak had spread, but none of these patients had a serology for schistosomiasis done during the first consultation. CONCLUSIONS: The usual prevention message of avoiding freshwater contact when traveling in tropical regions had no impact on the behavior of these travelers, who still went swimming at the Lily waterfalls. This prevention message should, therefore, be either modified or abandoned. The clinical presentation of acute schistosomiasis is often misleading. General practitioners should at least request an eosinophil count, when confronted with a returning traveler with fever. If eosinophilia is detected, it should prompt the search for a parasitic disease.

Réhabilitation améliorée après chirurgie--L'ere de la prise en charge optimale du patient chirurgical [Enhanced Recovery After Surgery--optimal management of the surgical patient].

Enhanced Recovery After Surgery (ERAS) is a multimodal, standardized and evidence-based perioperative care pathway. With ERAS, postoperative complications are significantly lowered, and, as a secondary effect, length of hospital stay and health cost are reduced. The patient recovers better and faster allowing to reduce in addition the workload of healthcare providers. Despite the hospital discharge occurs sooner, there is no increased charge of the outpatient care. ERAS can be safely applied to any patient by a tailored approach. The general practitioner plays an essential role in ERAS by assuring the continuity of the information and the follow-up of the patient.

Effect Estimation of an Innovative Nursing Intervention to Improve Delirium among Home-Dwelling Older Adults: A Randomized Controlled Pilot Trial.

AIMS: Estimating the effect of a nursing intervention in home-dwelling older adults on the occurrence and course of delirium and concomitant cognitive and functional impairment. METHODS: A randomized clinical pilot trial using a before/after design was conducted with older patients discharged from hospital who had a medical prescription to receive home care. A total of 51 patients were randomized into the experimental group (EG) and 52 patients into the control group (CG). Besides usual home care, nursing interventions were offered by a geriatric nurse specialist to the EG at 48 h, 72 h, 7 days, 14 days, and 21 days after discharge. All patients were monitored for symptoms of delirium using the Confusion Assessment Method. Cognitive and functional statuses were measured with the Mini-Mental State Examination and the Katz and Lawton Index. RESULTS: No statistical differences with regard to symptoms of delirium (p = 0.085), cognitive impairment (p = 0.151), and functional status (p = 0.235) were found between the EG and CG at study entry and at 1 month. After adjustment, statistical differences were found in favor of the EG for symptoms of delirium (p = 0.046), cognitive impairment (p = 0.015), and functional status (p = 0.033). CONCLUSION: Nursing interventions to detect delirium at home are feasible and accepted. The nursing interventions produced a promising effect to improve delirium.

Cross-Border Place Branding : The Case of Geneva Highlighting Multidimensionality of Places and the Potential Role of Politico-Institutional Aspects

Place branding is not a new phenomenon. The emphasis placed on place branding has recently become particularly strong and explicit to both practitioners and scholars, in the current context of a growing mobility of capital and people. On the one hand, there is a need for practitioners to better understand place brands and better implement place branding strategies. In this respect, this domain of study can be currently seen as 'practitioner led', and in this regard many contributions assess specific cases in order to find success factors and best practices for place branding. On the other hand, at a more analytical level, recent studies show the complexity of the concept of place branding and argue that place branding works as a process including various stakeholders, in which culture and identity play a crucial role. In the literature, tourists, companies and residents represent the main target groups of place branding. The issues regarding tourists and companies have been examined since long by place promoters, location branders, economists or other scholars. However, the analysis of residents' role in place branding has been overlooked until recently and represents a new interest for researchers. The present research aims to further develop the concept of place branding, both theoretically and empirically. First of all, the paper presents a theoretical overview of place branding, from general basic questions (definition of place, brand and place brand) to specific current debates of the literature. Subsequently, the empirical part consists in a case study of the Grand Genève (Great Geneva).

Frequent users of the emergency department in a universal health coverage system : a randomized controlled trial of a case-management intervention

BACKGROUND: Frequent emergency department users represent a small number of patients but account for a large number of emergency department visits. They should be a focus because they are often vulnerable patients with many risk factors affecting their quality of life (QoL). Case management interventions have resulted in a significant decrease in emergency department visits, but association with QoL has not been assessed. One aim of our study was to examine to what extent an interdisciplinary case management intervention, compared to standard emergency care, improved frequent emergency department users' QoL. METHODS: Data are part of a randomized, controlled trial designed to improve frequent emergency department users' QoL and use of health-care resources at the Lausanne University Hospital, Switzerland. In total, 250 frequent emergency department users (≥5 attendances during the previous 12 months; ≥ 18 years of age) were interviewed between May 2012 and July 2013. Following an assessment focused on social characteristics; social, mental, and somatic determinants of health; risk behaviors; health care use; and QoL, participants were randomly assigned to the control or the intervention group (n=125 in each group). The final sample included 194 participants (20 deaths, 36 dropouts, n=96 in the intervention group, n=99 in the control group). Participants in the intervention group received a case management intervention by an interdisciplinary, mobile team in addition to standard emergency care. The case management intervention involved four nurses and a physician who provided counseling and assistance concerning social determinants of health, substance-use disorders, and access to the health-care system. The participants' QoL was evaluated by a study nurse using the WHOQOL-BREF five times during the study (at baseline, and at 2, 5.5, 9, and 12 months). Four of the six WHOQOL dimensions of QoL were retained here: physical health, psychological health, social relationship, and environment, with scores ranging from 0 (low QoL) to 100 (high QoL). A linear, mixed-effects model with participants as a random effect was run to analyze the change in QoL over time. The effects of time, participants' group, and the interaction between time and group were tested. These effects were controlled for sociodemographic characteristics and health-related variables (i.e., age, gender, education, citizenship, marital status, type of financial resources, proficiency in French, somatic and mental health problems, and behaviors at risk).