Causes of preventable drug-related hospital admissions: a qualitative study

Objective: To explore the causes of preventable drug-related admissions (PDRAs) to hospital. Design: Qualitative case studies using semi-structured interviews and medical record review; data analysed using a framework derived from Reason's model of organisational accidents and cascade analysis. Participants: 62 participants, including 18 patients, 8 informal carers, 17 general practitioners, 12 community pharmacists, 3 practice nurses and 4 other members of healthcare staff, involved in events leading up to the patients' hospital admissions. Setting: Nottingham, UK. Results: PDRAs are associated with problems at multiple stages in the medication use process, including prescribing, dispensing, administration, monitoring and help seeking. The main causes of these problems are communication failures ( between patients and healthcare professionals and different groups of healthcare professionals) and knowledge gaps ( about drugs and patients' medical and medication histories). The causes of PDRAs are similar irrespective of whether the hospital admission is associated with a prescribing, monitoring or patient adherence problem. Conclusions: The causes of PDRAs are multifaceted and complex. Technical solutions to PDRAs will need to take account of this complexity and are unlikely to be sufficient on their own. Interventions targeting the human causes of PDRAs are also necessary - for example, improving methods of communication.

Designing Hospital Bedside Systems for use by Patients with Visual Impairments

This paper describes the development of an interface to a hospital portal system for information, communication and entertainment such that it can be used easily and effectively by all patients regardless of their age, disability, computer experience or native language. Specifically, this paper reports on the work conducted to ensure that the interface design took into account the needs of visually impaired users.

Acidentes perfurocortantes e avaliação do impacto de um dispositivo de segurança para a sua prevenção em um hospital geral terciário do Rio de Janeiro (2001-2011)

Introdução Os trabalhadores da saúde estão expostos a riscos biológicos no exercício da profissão, particularmente os agentes transmitidos por sangue e secreções, através de acidentes perfurocortantes. A maioria dos países implantou normatizações ou leis visando proteger estes profissionais, entre outros através da introdução de dispositivos de segurança. Desde a publicação da NR.32 em novembro 2005, as novas diretrizes vêm sendo implementadas nas unidades de saúde brasileiras, com dificuldades. Objetivos: (1) Principal: Verificar as alterações na incidência e no perfil dos acidentes perfurocortantes após a introdução de dispositivos de segurança (lanceta retrátil e catéteres para punção venosa periférica) no Hospital Federal dos Servidores do Estado a partir de 2009 em relação ao período anterior (2001-2008). (2) Secundários: \2013 Determinar os tipos de acidentes que sofreram redução. - Determinar a(s) categoria(s) profissional (is) beneficiadas pela introdução do(s) dispositivo(s) \2013 Estimar a relação entre os acréscimos de custos devidos à aquisição do(s) dispositivo(s) e a redução teórica das despesas obtida com diminuição dos acidentes. Métodos. Análise retrospectiva de um arquivo contendo os dados dos acidentes biológicos registrados entre janeiro de 2001 e dezembro de 2011 quanto a natureza do acidente, categoria profissional, tempo de profissão, tipo de instrumento, causa e/ou circunstância. Foram comparados os índices ao longo do tempo, particularmente até 2008 e de 2009 a 2011. Estimou-se também, com a ajuda de um modelo teórico, o impacto eventual de uma lanceta retrátil para coleta da glicemia capilar no orçamento da instituição Resultados. A proporção dos acidentes perfurocortantes diminuiu a partir de 2009 em comparação com o período anterior (P<0,001). Evidenciou-se uma relação inversa entre a média do tempo de experiência dos profissionais e o número absoluto dos acidentes perfurocortantes. A equipe de enfermagem teve uma redução significativa nos acidentes perfurocortantes por 100 equivalentes a tempo integral (ETI) de 2007 a 2011 (P<0,001), enquanto os residentes de medicina tiveram o maior índice no mesmo período. Observou-se uma redução dos acidentes perfurocortantes por agulhas de pequeno calibre desde 2009 e os acidentes durante a medida da glicemia capilar caíram bruscamente em 2010 e 2011 à medida que aumentava o número de lancetas retráteis adquiridas pelo hospital (P<0,001). Não se observaram reduções de acidentes envolvendo agulhas maiores ou vasos sanguíneos. Conclusões A adoção de um único dispositivo seguro e fácil de usar, uma lanceta retrátil, reduziu significativamente os acidentes perfurocortantes na equipe de enfermagem com provável vantagem custo-benefício. Ressalta-se a importância do treinamento dos recém-contratados e da educação continuada

Understanding stakeholder requirements on an NHS hospital project: application of semiotics-rooted theories.

Hospitals represent complex and difficult contexts for AEC (architecture, engineering and construction) professionals to engage with due to their functional complexity and diversity of stakeholder interests (i.e. patient, visitor, medical specialist). Hospital designers need to take note of changing NHS policy contexts (e.g. the possible empowerment of general practitioners to shape services), technological advances in medical equipment design and the potential health needs of future generations. It is imperative for hospital designers and architects to align their processes and methodologies (e.g. briefing and requirements capture) to the needs and desires of their clients so that a medical facility design is produced which is truly aligned to the requirements of the hospital stakeholders. Semiotics, the “study” or “discipline” of signs aims to investigate the nature of signs (their inception, representation and meaning), whilst semiotics-rooted theories are concerned with investigating how meaning and understanding is mobilized between persons and between organisations. This paper details a semiotics-rooted research approach for investigating the interactions between hospital designers and stakeholders on a forthcoming NHS hospital project in the UK. A semiotics grounded study will potentially provide a deeper understanding of how meaning and understanding is established between hospital project stakeholders and construction professionals.

Variability of starch-based thickened drinks for patients with dysphagia in the hospital setting

Starch-based thickening agents may be prescribed for patients with dysphagia. Thickened fluids alter variables of the swallow reflex, allowing more time for bolus manipulation without compromising airway closure. This investigation explored the variation in viscosity and physical characteristics of thickened drinks prepared in different media under laboratory conditions and compared the results with those of thickened drinks presented to dysphagic patients in one hospital. The rheological characteristics were tested on a simple plastometer and a Bohlin CVOR rheometer (Malvern Instruments, Worcestershire, UK). Samples prepared to “syrup” consistency both in the laboratory and in the hospitalwere significantly different from each other (P < 0.0001). This was also the case for samples prepared to “custard” consistency. Differences existed not only in viscosity, but drinks prepared in different media produced different rheological matrices. This signifies different viscoelastic behaviors that may effect manipulation in the mouth. From this study, preparation of thickened drinks using starch-based instant thickening powders appears to be a highly variable practice.

Hospital catering systems and their impact on the sensorial profile of foods provided to older patients in the UK

Impaired sensorial perception is very common in older people and low sensorial quality of foods is associated with decreased appetite and dietary intake. Hospital undernutrition in older patients could be linked to sensorial quality of hospital food if the quality were low or inappropriate for older people. The aim of this study was to examine changes in the sensorial quality of different foods that occur as a result of the food journey (i.e. freezing, regeneration, etc.) in the most common hospital catering systems in the UK. A trained sensory panel assessed sensorial descriptors of certain foods with and without the hospital food journey as it occurs in the in-house and cook/freeze systems. The results showed effects of the food journey on a small number of sensorial descriptors related to flavour, appearance and mouthfeel. The majority of these effects were due to temperature changes, which caused accumulation of condensation. A daily variation in sensorial descriptors was also detected and in some cases it was greater than the effect of the food journey. This study has shown that changes occur in the sensory quality of meals due to hospital food journeys, however these changes were small and are not expected to substantially contribute to acceptability or have a major role in hospital malnutrition.

Differential phenotypic and genotypic characteristics of qnrS1-harboring plasmids carried by hospital and community commensal enterobacteria

The qnrS1 gene induces reduced susceptibility to fluoroquinolones in enterobacteria. We investigated the structure, antimicrobial susceptibility phenotype, and antimicrobial resistance gene characteristics of qnrS1 plasmids from hospitalized patients and community controls in southern Vietnam. We found that the antimicrobial susceptibilities, resistance gene characteristics, and plasmid structures of qnrS1 plasmids from the hospital differed from those from the community. Our data imply that the characteristics of the two plasmid groups are indicative of distinct selective pressures in the differing environments.

Possible role of aerosol transmission in a hospital outbreak of influenza.

BACKGROUND: We examined the role of aerosol transmission of influenza in an acute ward setting. METHODS: We investigated a seasonal influenza A outbreak that occurred in our general medical ward (with open bay ward layout) in 2008. Clinical and epidemiological information was collected in real time during the outbreak. Spatiotemporal analysis was performed to estimate the infection risk among patients. Airflow measurements were conducted, and concentrations of hypothetical virus-laden aerosols at different ward locations were estimated using computational fluid dynamics modeling. RESULTS: Nine inpatients were infected with an identical strain of influenza A/H3N2 virus. With reference to the index patient's location, the attack rate was 20.0% and 22.2% in the "same" and "adjacent" bays, respectively, but 0% in the "distant" bay (P = .04). Temporally, the risk of being infected was highest on the day when noninvasive ventilation was used in the index patient; multivariate logistic regression revealed an odds ratio of 14.9 (95% confidence interval, 1.7-131.3; P = .015). A simultaneous, directional indoor airflow blown from the "same" bay toward the "adjacent" bay was found; it was inadvertently created by an unopposed air jet from a separate air purifier placed next to the index patient's bed. Computational fluid dynamics modeling revealed that the dispersal pattern of aerosols originated from the index patient coincided with the bed locations of affected patients. CONCLUSIONS: Our findings suggest a possible role of aerosol transmission of influenza in an acute ward setting. Source and engineering controls, such as avoiding aerosol generation and improving ventilation design, may warrant consideration to prevent nosocomial outbreaks.